Tegaserod for IBS in Women
A large, international trial has shown that tegaserod is significantly more effective than placebo for irritable bowel syndrome with constipation.
Jan Tack, M.D., of the Centre for Gastroenterological Research, University of Leuven (Belgium), and coauthors worked with physicians from 20 countries to randomize 2,660 female patients; 2,135 received tegaserod (6 mg twice daily) and 525 took a placebo for the initial treatment phase of 1 month.
After a treatment-free interval, the researchers rerandomized 983 patients (488 tegaserod, 495 placebo) who qualified for repeated treatment because they responded to the first treatment and then they had recurrence of IBS symptoms (Gut 2005;54:1707–13).
The patients treated with tegaserod had better work productivity and quality of life than did placebo patients during both the initial therapy and the repeated treatment. The drug, marketed as Zelnorm by Novartis, was initially approved in 2002 for IBS with constipation in women. Due to subsequent concerns about overuse, the label advises physicians and patients to “periodically assess the need for continued therapy.”
Nicotine Enemas in Ulcerative Colitis
Nicotine enemas are no more effective than placebo enemas for patients with active ulcerative colitis, according to a randomized, double-blind study.
In the study by John R. Ingram, M.D., of the department of gastroenterology at Cardiff (Wales) and Vale National Health Services Trust, and his colleagues, 104 patients were given enemas containing 6 mg nicotine or placebo daily for 6 weeks. Patients who had been receiving oral therapy for ulcerative colitis continued on their medications. The nicotine enemas were well tolerated and 14 of 52 patients who received them achieved remission of their ulcerative colitis, as did 14 of the 43 patients who received placebo enemas—a nonsignificant difference (Clin. Gastroenterol. Hepatol. 2005;3:1107–14).
A previous study at the University Hospital of Wales in Cardiff had concluded that nicotine enemas might be more effective than transdermal delivery (Aliment. Pharmacol. Ther. 1997;11:859–63).
A Century of Family G's Genetics
Molecular diagnostic testing has transformed the care offered to families with a mutation for Lynch syndrome, according to an historical cohort study of the 929 known descendants of a German immigrant to America, known as “family G.”
In their prospective analysis of living descendants within family G, Julie A. Douglas, Ph.D., of the University of Michigan, Ann Arbor, and her colleagues tested frequencies and types of cancers, ages at diagnosis, and the presence of the T to G transversion of certain cancer-gene mutations in 40 members of the family (JAMA 2005;294:2195–202).
The family's unusually high incidence of colorectal, stomach, and endometrial cancers has come to be known as Lynch syndrome. The original documentation of family G was in 1913 by Aldred S. Warthin, M.D., based on observations he started in 1895. The most recent update prior to the current study was in 1971 by Henry T. Lynch, M.D., for whom the syndrome subsequently was named.
Molecular diagnostic testing has shown that 5 of the 40 tested members of family G carry the T to G mutation. Among the living relatives of those 5, a total of 15 are at increased risk of developing one or more colorectal or Lynch syndrome-associated cancers, and another 97 can now be excluded as mutation carriers.
Wireless Esophageal pH Monitoring
A catheter-free wireless capsule shows promise as a reliable device for monitoring esophageal pH in the diagnosis of gastroesophageal reflux disease, researchers said based on a prospective study.
S. Bruley des Varannes, M.D., of Hôpital Hôtel Dieu, Nantes, France, and colleagues compared the new Bravo pH monitoring system (Medtronic) with a conventional pH measurement system (CPHMS) by simultaneously recording data with both devices for 24 hours in 36 patients, then continuing for another 24 hours with Bravo only (Gut 2005;54:1682–6).
The Bravo system uses a radiotelemetric capsule that attaches to the esophageal wall and transmits pH data to a small receiver on the patient's belt. The CPHMS with an antimony catheter remains free in the esophageal lumen. Although the Bravo device recorded less acid exposure than did the CPHMS on the first day, the researchers discounted this due to mitigating circumstances such as the capsule's lower sample rate (6 seconds vs. 4 seconds for CPHMS) and presence of the pH catheter on the first day.
R.H. Holloway, M.D., said in an editorial that because patients can undergo recordings with less disruption of their daily activities with the capsule, its use “will provide more meaningful data for evaluation of patients and, hopefully, more discriminative diagnosis”(Gut 2005;54:1672–81).