Satisfactory Relief Research Articles

Clinical evaluation of Nasya Karma in cervical spondylosis: Case series

Introduction: Cervical spondylosis is one of the most common degenerative, neurological conditions of the cervical spine by which a major part of population is affected. In today's mobile era, for higher achievements and ambitions, man is moving faster to Mars life and is more prone to degenerative disorders. Apart from age, other risk factors for cervical spondylosis include occupations that may cause more stress on neck, certain neck injuries, incorrect posture while sitting or walking, smoking, sedentary lifestyle and genetic factors. Modern therapies such as analgesics, muscle relaxants, steroids, physiotherapies, and even operative procedures are not fulfilling the patients' goal of healthy life. Materials and Methods: In Ayurveda, Degenerative disorders come under the broad umbrella of Vata Vyadhi and Nasya (Nasal Medication) is specifically indicated in Urdhvajatrugata Vikaras. Keeping this view and the increasing incidence of the disease in modern society, a study was conducted on five clinically diagnosed cases of cervical spondylosis, selected from Outpatient / Inpatient departments of Panchakarma Department. The patients were treated with Anu taila Nasya for first 3 days followed by Avartita Kshirabala Taila Nasya for the next 4 days. Results: Satisfactory relief was seen in symptoms with improved quality of life after treatment and follow up. Conclusion: Nasya Karma can be considered as an effective management of cervical spondylosis

Management of Low Back Pain - Call for an Integrated Interventional Approach

Introduction: Using advanced imaging, neurophysiologic and precision diagnostic techniques spinal pain can be diagnosed in only 50 to 80% of the patients. 20 to 50% remain incorrectly diagnosed. Furthermore axial and periaxial pattern of pain from ligaments, muscles, intervertebral discs and facet joints overlap significantly. Therefore patients continue to suffer because of diagnostic dilemma and also pose a therapeutic challenge. Rarely does low back pain involve only a single pain generator, therefore it is unlikely that a single treatment, such as surgery will result in the best outcome for the majority of the causes of low back pain.Materials and method: All cases of Low back Pain reporting to tertiary care service hospital from 2012 to 2016 were evaluated. Cases which responded to conservative management were excluded.Observation: A total of 374 cases were offered pain intervention procedure. Of these 45 (12%) required a second interventional procedure as the pain relief was poor. All cases were followed up for 6 months and pain relief was recorded as Good, satisfactory or poor as told by the patient. We found that 78% reported good relief, 18% reported satisfactory relief while 4% reported poor relief from pain.Conclusion: Scientific evaluation of interventional pain treatments is difficult due to lack of any objective test for pain. Also we cannot have true controls. A single interventional procedure may not suffice in all cases. The Surgeon needs to adopt other modalities to provide pain relief to the ailing patient.

Gastric pH and Therapeutic Responses to Exsomeprazole in Patients With Functional Dyspepsia: Potential Clinical Implications

BackgroundTherapy for functional dyspepsia remains a challenge. This study aimed to evaluate esomeprazole (E) versus placebo (P) regarding (1) the effectiveness in providing relief of abdominal pain or discomfort during 16 weeks of therapy in patients with functional dyspepsia having moderate or severe symptoms; (2) the effects on gastric acid suppression and (3) the relationship between symptom relief and gastric pH. MethodsEnrolled patients were randomized to E (n = 38) or P (n = 35) in a double-blind, placebo-controlled trial. Outcomes were measured at four 4-week intervals. Drug dose titrated at each visit, based on relief of abdominal symptoms. The 24-hour gastric pH was monitored at baseline, 4 and 8 weeks. ResultsAfter 4 weeks, 71% of E patients (40mg) reported satisfactory symptom relief versus 34% of P patients (P < 0.001). When the dose for nonresponders (NR) was titrated to 40mg twice daily, the E relief rate increased to 82% versus 56% in P group (P < 0.05). During the next 4 weeks, with dose decreased by half in responders, E response rate declined to 69% versus 48% in P group (P < 0.10). When the dose was increased for NR during the last 4 weeks, E rate increased to 83% versus 57% in P group (P < 0.05). At 4 and 8 weeks for E responders and NR, patients׳ pH >4 value increased significantly compared to baseline. Conclusions(1) Though E 40mg once daily is superior to P, some patients benefit from 40mg twice daily; (2) E, 40mg once daily, profoundly inhibits gastric acid secretion; (3) intragastric pH monitoring before and after therapy may help address the relationship between symptomatic relief and gastric acid secretion and (4) some patients respond to monitored titrated placebo therapy.

Fermentable Carbohydrate Restriction (Low FODMAP Diet) in Clinical Practice Improves Functional Gastrointestinal Symptoms in Patients with Inflammatory Bowel Disease.

A significant proportion of patients with inflammatory bowel disease (IBD) experience functional-like gastrointestinal symptoms (FGS) even during remission. Research suggests that dietary restriction of fermentable carbohydrates (low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet) can improve FGS, albeit in irritable bowel syndrome. The aim of this study was to investigate the effectiveness of the low FODMAP diet delivered in routine clinical practice in patients with IBD and coexisting FGS. Gastrointestinal symptom scores were compared in consecutive patients with IBD referred for low FODMAP dietary education for symptom management (n = 88). Symptoms were assessed using the Gastrointestinal Symptoms Rating Scale, and stool output was assessed using the Bristol Stool Form Scale at both baseline and follow-up (minimum of 6 weeks). There was a significant and large increase in the numbers of patients reporting satisfactory relief of symptoms between baseline (14/88, 16%) and low FODMAP diet (69/88, 78%; P < 0.001). Following dietary intervention, there was also a significant decrease in severity for most symptoms and a reduction in composite symptom score (baseline mean: 1.2, SD: 0.5 versus low FODMAP diet mean: 0.7, SD: 0.5; P < 0.001). Improvements in stool consistency and frequency were observed, including an increase in "normal" stool form (P = 0.002) and "normal" stool frequency (P < 0.001). The low FODMAP diet delivered in routine clinical practice seems effective in improving satisfaction with, and severity of, FGS in IBD. Randomized controlled trials are warranted to definitively establish effectiveness.

Frontal Sinus Barotrauma.

A 58-year-old woman visited our hospital’s emergency department because of a severe and increasing pain over the right occipital region, irradiating over the right frontal area. The pain started during the descent of a jet airplane on a holiday trip. There were no visual or hearing deficits, head trauma, or epistaxis, and she experienced no difficulty clearing her ears during the flight. Only a minor respiratory tract infection was noted two weeks before this episode, and she had no history of sinus problems. The pain was nothing like previous migraine headaches she had experienced. A noncontrast CT scan was performed which showed no apparent abnormal findings, except for a soft tissue density in the right frontal sinus, initially interpreted as an inflammatory mucosal swelling. Because of the atypical and persistent headache, MRI imaging was performed to exclude underlying pathology. No intracranial mass, hemosiderin deposits, or arteriovenous malformation were observed. A polypoid mass was noted in the right frontal sinus, hyperintense on T1and T2-weighted images, without enhancement after contrast administration (Figures A and B). Considering the clinical history and MRI appearance, the diagnosis of submucosal hematoma secondary to barotrauma was made. Conservative treatment with oral decongestants and analgesics resulted in satisfactory symptom relief.

The neurokinin-2 receptor antagonist ibodutant improves overall symptoms, abdominal pain and stool pattern in female patients in a phase II study of diarrhoea-predominant IBS

BackgroundTachykinins have been implicated in the pathophysiology of IBS with diarrhoea (IBS-D). Our aim was to study the efficacy and safety of ibodutant, a selective neurokinin-2 (NK2) receptor antagonist, in...

World Gastroenterology Organisation Global Guidelines: GERD Global Perspective on Gastroesophageal Reflux Disease.

PROBIOTICS—THE CONCEPTHistory and DefinitionsA century ago, Elie Metchnikoff (a Russian scientist, Nobel laureate, and professor at the Pasteur Institute in Paris) postulated that lactic acid bacteria (LAB) offered health benefits capable of promoting longevity. He suggested that “intestinal autoint

Bowenwork for Migraine Relief: a Case Report

Migraine is a complex neurological disorder characterized by episodic, neurogenic, cerebrovascular inflammation and hypersensitization of brain tissues and the central nervous system, causing severe pain and debility. Research literature points mostly to pharmaceutical prophylactic and symptomatic treatments, nonpharmaceutical, complementary and alternative medicine (CAM) approaches, acupuncture, massage and bodywork studies, and none has been published on Bowenwork for migraine intervention. This prospective case report describes one migraineur's response to Bowenwork (a soft-tissue bodywork technique) with cessation of migraine, neck pain, and analgesic consumption, and improved well-being and activity function. The client received 14 Bowenwork sessions over a four-month period using the self-reporting Measure Yourself Medical Outcome Profile version 2 (MYMOP2) to evaluate clinically meaningful changes. Baseline MYMOP2 data were recorded prior to the first and subsequent Bowenwork sessions to track changes in migraine and neck pain occurrences, other symptoms, medication use, functional ability and sense of well-being. Specific Bowenwork procedures were applied in each session to address various symptoms. The client did not receive other migraine treatment during this study. A 66-year-old Caucasian female with a history of debilitating migraine since childhood, and severe neck pain and jaw injuries resulting from two motor vehicle accidents (MVAs) sustained as an adult. She had previously sought medical, pharmaceutical and CAM treatments for migraine, neck pain, and right-sided thoracic outlet syndrome (TOS) symptoms, with no satisfactory relief. The client progressively reported decreased migraine and neck pain until acquiring a respiratory infection with prolonged coughing spells causing symptoms to recur (session 11). Prior to session 12, she experienced an allergic reaction to ingesting an unknown food allergen, requiring three days of prednisone and Benadryl treatment, exacerbating neck pain, but not migraine. At session 14, her MYMOP2 data showed no migraine, neck pain or medication use, improved activity function, and sense of well-being. Symptoms in her right arm and thumb persisted to a lesser extent. Bowenwork progressively offered migraine and neck pain relief for one chronic migraineur, with multiple somatic symptoms. Extenuating factors (jaw tension, TOS, respiratory infection, and allergic reaction) added complexity in monitoring progress and selecting appropriate Bowenwork procedures. Further research on Bowenwork's efficacy for migraine treatment on larger populations is needed.

Intracranial arachnoid cyst: an institutional experience

Abstract Aim: In this study, symptoms at presentation, indication for surgery, surgical treatment modalities, postoperative results and complications were studied. Material and methods: We retrospectively compiled the details of patients with IAC from admission and operative records admitted through our OPD during the period between January 1995 and January 2015. Only those patients were admitted whose symptoms attributes to the cyst and asymptomatic patients were followed on OPD basis. This is a single institutional study. Results: This study includes 56 patients of IAC who were operated. Posterior fossa cysts (62.5%) were found more commonly symptomatic. Headache (32%) was the most common symptom in a patient with IAC. Out of all, 24 patients presented with headache and underwent surgery subsequently; 20 showed satisfactory relief after surgery while four showed partial relief. Size of cyst was significantly reduced after surgery in 52 patients after 12 weeks but four patients, who underwent cystoperitoneal shunt, required re-operation as patients showed no decrease in size of cyst due to shunt malfunction. Head circumference was reduced following intervention in infant patients. Three patients who presented with visual field defects with IAC in sellar region showed improvement after endoscopic fenestration of cyst. One of the patient with cerebellopontine angle arachnoid was died immediately after marsupialization due to unexplained bleeding. Conclusions: IAC is not an uncommon finding on imaging but only few are symptomatic. Patients with Intracranial arachnoid cyst should be treated only if the patient’s symptoms are attributable to the cyst.

Reiki Therapy for Symptom Management in Children Receiving Palliative Care: A Pilot Study.

Pain may be reported in one-half to three-fourths of children with cancer and other terminal conditions and anxiety in about one-third of them. Pharmacologic methods do not always give satisfactory symptom relief. Complementary therapies such as Reiki may help children manage symptoms. This pre-post mixed-methods single group pilot study examined feasibility, acceptability, and the outcomes of pain, anxiety, and relaxation using Reiki therapy with children receiving palliative care. A convenience sample of children ages 7 to 16 and their parents were recruited from a palliative care service. Two 24-minute Reiki sessions were completed at the children's home. Paired t tests or Wilcoxon signed-rank tests were calculated to compare change from pre to post for outcome variables. Significance was set at P < .10. Cohen d effect sizes were calculated. The final sample included 8 verbal and 8 nonverbal children, 16 mothers, and 1 nurse. All mean scores for outcome variables decreased from pre- to posttreatment for both sessions. Significant decreases for pain for treatment 1 in nonverbal children ( P = .063) and for respiratory rate for treatment 2 in verbal children ( P = .009). Cohen d effect sizes were medium to large for most outcome measures. Decreased mean scores for outcome measures indicate that Reiki therapy did decrease pain, anxiety, heart, and respiratory rates, but small sample size deterred statistical significance. This preliminary work suggests that complementary methods of treatment such as Reiki may be beneficial to support traditional methods to manage pain and anxiety in children receiving palliative care.

Imipramine for Treatment of Esophageal Hypersensitivity and Functional Heartburn: A Randomized Placebo-Controlled Trial.

Tricyclic antidepressants could be effective in the treatment of symptoms related to hypersensitive esophagus through their pain-modulating effect. We therefore assessed the benefit of imipramine in patients with esophageal hypersensitivity and functional heartburn. Patients with normal endoscopy findings and typical reflux symptoms despite standard-dose proton-pump inhibitor therapy underwent 24-h pH-impedance monitoring. Patients with established esophageal hypersensitivity or functional heartburn were randomly assigned to receive 8 weeks of either once-daily imipramine 25 mg (n=43) or placebo (n=40). The primary end point was satisfactory relief of reflux symptoms, defined as a >50% reduction in the gastroesophageal reflux disease score. The secondary end point was improvement in quality-of-life (QoL) as assessed by the 36-Item Short Form Health Survey score. Patients receiving imipramine did not achieve a higher rate of satisfactory relief of reflux symptoms than did patients receiving placebo (intention-to-treat (ITT) analysis: 37.2 vs. 37.5%, respectively; odds ratio (OR), 0.99; 95% confidence interval (CI), 0.41-2.41; per-protocol (PP) analysis: 45.5 vs. 41.2%, respectively; OR, 1.19; 95% CI, 0.45-3.13). Subgroup analysis to assess the efficacy of imipramine for either esophageal hypersensitivity or functional heartburn yielded similar results. Treatment with imipramine provided significant improvement of QoL by PP analysis (72±17 and 61±19, respectively; P=0.048), but ITT analysis did not reveal any differences between imipramine and placebo (68±19 and 61±19, respectively; P=0.26). Adverse events were similar in both groups; however, constipation was more common with imipramine than placebo (51.2 vs. 22.5%, respectively; P=0.01). Although low-dose imipramine shows potential QoL benefits, it does not relieve symptoms more effectively than does placebo in patients with either esophageal hypersensitivity or functional heartburn.

Comparison of nerve combing and percutaneous radiofrequency thermocoagulation in the treatment for idiopathic trigeminal neuralgia

IntroductionIdiopathic trigeminal neuralgia (ITN) is a common pain disease in elderly people. Many methods have been used to alleviate the pain of patients, but few studies in the literature have compared the effect of nerve combing and percutaneous radiofrequency thermocoagulation. ObjectiveThe purpose of this study was to describe and evaluate the clinical outcome of idiopathic trigeminal neuralgia after nerve combing (NC) and compare them with those obtained using percutaneous radiofrequency thermocoagulation (RF). MethodsThe study included 105 idiopathic trigeminal neuralgia patients with similar symptom, age and underlying disease, which were divided into two groups. One group was treated by nerve combing (50 patients), the other by RF (55 cases). All patients were considered medical failures prior to the surgeries. A questionnaire was used to assess the long-term outcomes: pain relief, recurrence, complication and need for additional treatment. ResultsThe median duration of follow-up in both groups was 90 months. Satisfactory relief was noted in 41 patients (82%), 5 patients (10%) initially experienced pain relief, then recurred, and four patients (8%) were designated poor among the group NC. In the group RF, satisfactory relief was noted in 42 patients (76.4%). There were eight “pain free with recurrence patients (14.5%) and 5 poor cases (9.1%). No statistically significant differences existed in the outcomes between both groups (p>0.05). Postoperative morbidity included dysesthesia, diplopia, partial facial nerve palsy, hearing loss, tinnitus, cerebrospinal fluid leak, meningitis and mortality. ConclusionNerve combing and RF are both satisfactory treatment strategies for patients with ITN. Because of the higher risk of sensory morbidity and surgical risk as open surgery, RF is preferred as the recommended procedure for patients with ITN.

MRI in Coccydynia

Patients who are diagnosed clinically as Coccygodynia often do not get satisfactory relief. The clinical diagnosis is based on various hypotheses that have been proposed to explain the pain of coccydynia - including coccygeal spicules, pain from the pericoccygeal soft tissues, pelvic floor muscle spasm, referred pain from lumbar pathology, arachnoiditis of the lower sacral nerve roots, local posttraumatic lesions, somatization, etc. The diagnosis is difficult and the pathophysiology is poorly understood. Till recently, use of dynamic X-rays and MRI imaging was not considered to diagnose this condition. The author would like to report three patients who presented to the pain clinic with refractory coccygeal pain and underwent dynamic coccyx X-rays and MRI as part of their evaluation. All these patients had positive findings on MRI. These patients were treated satisfactorily as a result of the added diagnostic value of MRI.

Dentine hypersensitivity: Real or imagined

Purpose To analyze and evaluate the patency of the endovascular intervention for venous hypertension in upper-extremity hemodialysis access. Patients and methods A prospective cohort study of consecutive patients with chronic renal failure having symptomatic central venous stenotic lesions with hemodialysis access referred for endovascular treatment was conducted from May 2015 to May 2016. Procedure consisted of percutaneous angioplasty with or without stenting. Results A total of 50 patients (30 females and 20 males, with mean age of 47.7 years and range of 22–72 years) were included, and all had successful arteriovenous fistula (AVF) creation (native in 76% of patients and synthetic in 24% of patients). Overall, 64% of the patients had left-sided AVF, and the remaining 36% had right-sided AVF. Patency rates of 34 patients collectively were 100, 97, and 70% at 3, 6, and 12 months, respectively. One-year patency rate of cases with single-lesion group was 91.6%, and those with multiple lesions was 8.3%, with statistically significant difference between the two groups. However, the term patency rate for patients with short lesions ( Conclusion Percutaneous central venous angioplasty could provide satisfactory symptomatic relief in patients who presented with central venous stenosis together with upper-extremity edema. Endovascular procedure offers a minimally invasive, first option of management for a difficult problem in a patient population with significant comorbidities and infrequent complications. However, the durability of percutaneous transluminal angioplasty is limited, and in most patients, adjunctive interventions were required to extend the symptom-free period.

Patient Satisfaction With IBS Symptom Relief Using a Novel Peppermint Oil Delivery System in a Randomized Clinical Trial and by the General Patient Population

Introduction: A recent 4-week, placebo controlled, randomized clinical trial (RCT) with a novel peppermint oil (PO) targeted delivery system demonstrated significant relief of IBS symptoms compared to placebo1. In addition to individual symptom improvement, patient satisfaction is an important clinical trial endpoint, Post-marketing patient satisfaction and dosing frequency is also important to assess. 1IBSREST Trial Outcome Presented at DDW 2015, May 16-19 in Washington, DC. Methods: The IBSREST RCT included an end-of-study questionnaire to evaluate the overall satisfaction with the relief of IBS symptoms for subjects in the active arm. A separate survey study (IBSACT) was conducted with patients who were using the same active PO preparation in the general patient population to assess satisfaction and dosing frequency. The frequency of dosing in the clinical trial was fixed at 2 capsules TID, while the general patient population was allowed flexible dosing. Results: 35 subjects randomized to PO in the RCT and 285 patients in the general population completed the surveys. The questions and responses for the questionnaire in the RCT and IBSACT are shown in Table 1. Dosage frequency in the general population was much lower (60.8% used only 1 to 2 capsules per day) compared to 6 capsules per day in the RCT. There was a very high satisfaction rate (>80%) with the novel PO delivery system in both surveys. The response for all questions from patients in each trial was remarkably similar despite the lower capsule intake by patients in the general population.Table 1Conclusion: The novel PO delivery system showed a high rate of patient satisfaction in an RCT and the general patient population. Patients recruited for IBSREST had moderate to severe IBS symptoms. Their overall satisfaction rate of greater than 80% for all questions is encouraging since patients with severe IBS are historically not satisfied even with improvement of individual IBS symptoms2. In the general IBS patient population the overall satisfaction was also high (85%), even with much lower usage of capsules. 2Whitehead, WE et al. Reports of “Satisfactory Relief” by IBS Patients Receiving Usual Medical Care Are Confounded by Baseline Symptom Severity and Do Not Accurately Reflect Symptom Improvement. Am J Gastroenterol 2006; 101:1057-1065.

Bilateral Portal Percutaneous Endoscopic Debridement and Lavage for Lumbar Pyogenic Spondylitis.

Common management approaches for spinal infections include conservative administration of antibiotics and aggressive surgical debridement. Minimally invasive endoscopic treatment has been reported and is gaining widespread attention because of its simplicity and effectiveness. This study retrospectively evaluated the clinical outcomes of bilateral portal percutaneous endoscopic debridement and lavage with dilute povidone-iodine solution in the treatment of patients with lumbar pyogenic spondylitis. From January 2007 to December 2011, a total of 22 patients diagnosed with single-level lumbar pyogenic spondylitis underwent bilateral portal percutaneous endoscopic debridement and lavage with dilute povidone-iodine solution at the authors' institution. Clinical outcomes were assessed by careful physical examination, visual analog scale pain score, modified MacNab criteria functional score, regular serologic testing, and imaging studies to determine whether percutaneous endoscopic debridement and lavage treatment was successful or if surgical intervention was required. Causative bacteria were identified in 19 (86.4%) of 22 biopsy specimens. Eighteen patients had satisfactory relief of back pain and uneventful recovery after this treatment. The success rate was 81.8% (18 of 22). Both visual analog scale and modified MacNab criteria scores improved significantly in successfully treated patients. No major surgical complications were noted, except for 3 patients who had residual or subsequent paresthesia in the affected lumbar segment. Percutaneous endoscopic debridement and lavage is a minimally invasive procedure that can yield a higher bacterial diagnosis, relieve back pain, and help to eradicate lumbar pyogenic spondylitis. It is an effective alternative treatment for patients with spinal infection before extensive open surgery.

PTU-178 The clinical effectiveness of a low fodmap dietary approach in clients with functional gut disorder

Introduction To assess the clinical effectiveness of a Low FODMAP diet in clients referred with functional gut disorder. Method Funding was sought to set up a Low FODMAP pilot clinic, 3.5 h per week for six months. A local protocol and care pathway was developed by the author. Potential clients were referred by the Consultant Gastroenterologist. An audit template developed and completed. Results 19 Clients where recruited to the pilot phase. There was an overall 88% adherence to the three appointment care pathway. There was reduced use of antispasmodics, anti-diarrhoeals and laxatives from appointment one to appointment three. 56.3% of clients had the symptoms >10 years, with 100% having the symptoms more than 1 year. Thus it is very important to build a good rapport and relationship with the client from the start. The author does feel that the carepathway designed, of 3 appointments with 1 h long sessions, is essential in building this relationship. As IBS is known to be a relapsing condition it is important that all education is given accurately to prevent the client from re-entering the healthcare system at a later date. 64% of clients reported following the diet >75% of the time. 67% of clients reported having overall satisfactory relief of gut symptoms at appointment two, with 71% reporting overall satisfactory relief of gut symptoms at appointment three. The individual patient satisfaction questionnaire results at the 3rdappointment exhibited: 85% improved in bloating, 78% improved in abdominal/discomfort, 77% flatulence/wind improvement, 69% diarrhoea improvement, 46% improvement in constipation, 46% improvement in nausea and 62% improvement in energy. Only 13% of clients were re-referred back to the Consultant Gastroenterologist. Conclusion Overall, 88% of clients completed the carepathway within the designated time. Only 13% were re-referred back to the Consultant Gastroenterologist for further investigation/treatment options. 71% of clients who completed the carepathway reported overall satisfactory relief of gut symptoms. Disclosure of interest None Declared. References Staudacher HM, Whelan K, Irving PM, Lomer MCE. Comparison of symptom response following advice for a diet low in fermentable carbohydrates (FODMAPs) versus standard dietary advice in patients with Irritable Bowel Syndrome. J Hum Nutr Diet 2011;24:487–495 Barrett JS, Gearry RB, Muir JG, Irving P, Rose R, Haines M, Shepherd SJ, Gibson PR. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther. 2010;31:874–882 Maxion-Bergemann, et al. Costs of irritable bowel syndrome in the UK aned US. Pharmacoeconomics 2006;24(1):21–37

PTU-299 Delivering cost effective management for irritable bowel syndrome (ibs) across somerset

<h3>Introduction</h3> Despite 2008 NICE guidance on managing IBS in primary care, referrals to gastroenterology persist with baseline audit finding 14% of new outpatient slots in two DGHs were used by patients aged 16–45 years with no red flag symptoms where the GP felt diagnosis at referral was IBS. Given evidence for lifestyle and diet modification, we set out to help GPs avoid referral as outpatient review and investigation cost over £160,000 annually for these patients. Using potential savings, we funded direct GP access to faecal calprotectin (FC) testing and specialist IBS dietetic-led clinics in four centres across Somerset. <h3>Method</h3> We designed new care pathways for 16–45 year olds with no red flag symptoms with county-wide GP education using Rome III criteria to make a positive diagnosis of IBS and avoid missing red flags. Instead of referring to secondary care, GPs were asked to check FC, with Coeliac screen, FBC, CRP and TFT. If FC &lt;50 mg/g with normal blood tests, GPs and community-based dietitians were encouraged to manage symptoms using first-line diet and lifestyle advice, referring to the specialist IBS dietetic clinic if needed. If FC &gt;50 µg/g, secondary care referral was appropriate to consider investigation, especially if FC &gt;150 µg/g. A management algorithm provided symptom-based drug therapies. To aid implementation, the Somerset Pathway Navigator provided a single gateway to GP referrals. <h3>Results</h3> Outpatient data: Repeating our initial audit at 1 year showed referrals to secondary care for management and investigation fall from 14% to 9% of new appointments. Faecal calprotectin: 94 patients met this protocol; 64 patients had FC &lt;50 µg/g, 19 had FC 51–150 µg/g and 11 had FC &gt;150 µg/g. Even when FC &lt;50 µg/g, 13 patients were still referred for secondary care review and investigation with no GI pathology found. Only 1/12 patients referred with FC 51–150 mg/g had Crohn’s; others had normal endoscopy/radiology. This contrasts with FC &gt;150 mg/g with 10 referred and 5 having Crohn’s or Ulcerative colitis. Specialist Dietetic outcomes: Over 12 months, 83 patients completed 8-week treatment courses including low FODMAP advice with statistically significant reductions in severity scores of all symptoms. After treatment, 65% reported satisfactory relief of IBS and 74% reported improved quality of life. <h3>Conclusion</h3> Providing GP education, developing new diagnosis and management pathways, introducing FC testing for GPs and effective dietetic treatments have encouraged self-management, provided cost-effective symptom resolution and reduced unnecessary secondary care referrals for likely IBS. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Irritable bowel syndrome in adults (2008) CG61 NICE

Pharmacological interventions for painful diabetic neuropathy: Comparative analysis using network meta-analysis.

Diabetic peripheral neuropathy is a common complication of diabetes mellitus that disturbs the quality of life of affected persons. Although diabetic neuropathy includes many types of different pathogeneses and clinical manifestations, the most common type is chronic sensorimotor distal symmetrical polyneuropathy. Among a variety of symptoms as a result of this type of neuropathy, neuropathic pain must be one of the most devastating problems. When painful symptoms are predominant, it is often called ‘painful diabetic neuropathy’ (PDN). It is well known that functionality and quality of life have been deeply disturbed in patients with PDN. Therefore, the therapeutic strategy should be directed toward satisfactory relief of pain symptoms. The first therapeutic step for PDN should be glycemic control. However, patients occasionally require analgesics, even despite glycemic normalization. In addition, the best approach for pain control must be ‘the sooner, the better’ approach. Thus, development of beneficial analgesics are essential. At the present time, several classes of analgesics are available for treating PDN.

Su1377 Efficacy of Oral Ibodutant in IBS-D Female Patients Measured by Abdominal Pain Severity - An Iris 2 Post-Hoc Analysis

Introduction Ibodutant, a selective and potent antagonist of neurokinin 2 receptors under clinical development for Irritable Bowel Syndrome with Diarrhea (IBS-D). A phase II (IRIS 2) study tested the efficacy of 8-week oral treatment with 3 doses of ibotudant in a total 559 IBS-D patients defined by Rome III criteria. Based on the combined response of satisfactory relief of IBS symptoms and abdominal pain/discomfort according to the 75% rule, i.e. positive response in at least 6 out of 8 treatment weeks (primary end-point), a statistically and clinically relevant efficacy was demonstrated in the female subgroup (n=333) at the 10 mg dose with 46.84% of responders vs 24.36% in placebo (p=0.0034). Aim To evaluate the benefit of ibodutant in the female population exposed to the efficacious oral daily dose of 10 mg participating to the IRIS 2 study when considering the mean abdominal pain severity score at baseline. Methods The analysis of primary efficacy end-point was repeated classifying female patients according to the mean abdominal pain score at baseline, as recorded on the daily diary during the 2 week no-treatment run-in phase, with pain rating on a 0-4 scale (0= no pain; 4= very severe). Two severity categories were considered, with mean score > 2 defining patients with severe/very severe pain. Results At baseline, n= 228 female patients (40.79% of total patients) reported severe/very severe mean abdominal pain score. In this population, ibodutant 10 mg confirmed the high clinically and statistically significant superiority to placebo in terms of reaching satisfactory relief of overall IBS symptoms and abdominal pain/discomfort, with a response rate of 47.06% versus 21.05% (p=0.0044). The same magnitude of responders (46.43%) was shown in patients reporting mild /moderate abdominal pain score at baseline, however responders to placebo was consistently higher (33.3%), and the difference did not reach statistical significance. Conclusion When the severity criteria of IBS-D patients are established according to the abdominal pain at baseline, ibodutant confirmed a significant benefit at 10 mg once daily dose in the severe/very severe female population. The analysis also showed patients with lower pain intensity are characterized by a significantly higher placebo response.