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Background: Chronic constipation (CC) is one of the most common disorders of gut–brain interaction (DGBI). The management of CC requires specific skills due to its complex and multifactorial pathophysiology and its multistep treatment. The aims of this study were to evaluate the availability and the use of diagnostic tools for CC in Italy and the therapeutic management of CC by Italian gastroenterologists (GEs). Methods: A survey was conducted during the 28th meeting of the Italian Federation of Digestive Disease Societies (FISMAD; Rome, Italy, 11–14 May 2022). The survey explored the presence of a clinic dedicated to DGBIs, the availability and the use of specific diagnostic tools, the routine use of digital rectal examination (DRE), and the therapeutic approach to CC by Italian GEs. Results: The survey was taken by 236 GEs. The most significant results were that 42% of respondents had a clinic dedicated to DGBI in their institute; DRE was regularly performed by 56.8% of GEs when evaluating a CC patient; young GEs (≤40 years) performed DRE less frequently than older ones (p < 0.001); anorectal manometry was available to 44.3% of GEs; balloon expulsion test (BET) was available to 19.1% of GEs; GEs with a clinic dedicated to DGBI had more frequent access to anorectal physiology testing (p < 0.001); diet and lifestyle advice were the most frequently prescribed treatments; and fiber and macrogol were the second and third most prescribed treatments, respectively. Conclusions: The survey provides an interesting picture of CC management by Italian GEs. The results are in line with previous data collected about 10 years ago among Italian GEs ("CHRO.CO.DI.T.E study"); DRE is still rarely performed by Italian GEs (particularly by young GEs). The availability of anorectal physiology testing is still limited, and BET, which could be easily performed in everyday clinical settings, is rarely performed. Lifestyle suggestions, macrogol and fiber are the preferred treatment, as recommended by all guidelines. These results will be useful to identify as yet unmet educational needs and critical issues to improve CC management. [ABSTRACT FROM AUTHOR]

Objective: To compare polyethylene glycol 4000 versus lactulose in chronic constipation during pregnancy. Methods: Women at 28–32 weeks' gestation attending antenatal clinic for routine care were screened using the Rome IV chronic constipation criterion. Eligible women were approached and consented. Participants were randomized to oral polyethylene glycol (10 g/day) or lactulose (10 g/day) for 4 weeks. A bowel movement diary was kept and outcomes using the Patient Assessment of Constipation Symptoms questionnaire (PAC‐SYM), Patient Assessment of Constipation Quality of Life questionnaire (PAC‐QoL) and Bristol Stool Form Scale (BSFS), which were evaluated at the start and end of the four‐week period. Relative risks (RR) were determined for the coprimary outcomes of complete spontaneous bowel movement (CSBM) and PAC‐SYM mean score improvement (decrease in score of >1 from the baseline). Results: A total of 4323 women underwent screening, of which 780 fulfilled the Rome IV criterion, and 360 consented to participate (180 randomized to PEG and lactulose, respectively). Data from 247 women who completed the study were analyzed. CSBM was achieved in 107/124 (86.3%) versus 102/123 (82.9%) (RR 1.04, 95% CI: 0.93–1.16, P = 0.464) for PEG and lactulose trial arms, respectively. PAC‐SYM mean score improvement was 62/118 (52.5%) in the PEG arm versus 44/118 (37.3%) in the lactulose arm (RR 1.40, 95% CI: 1.05–1.88). Of secondary outcomes, a significant difference was found in favor of PEG, with respect to PAC‐SYM abdominal symptoms subscale, normal stool versus loose stool consistency and side effects of vomiting and diarrhea. After controlling for parity, baseline PAC‐SYM, PAC‐QoL scores, characteristics different at baseline, only diarrhea and loose stools remained significant. Conclusion: Both PEG 4000 and lactulose are effective laxatives in pregnancy with similar performance after adjusted analysis. Diarrhea and loose stools are less frequently reported with PEG. Synopsis: Polyethylene glycol 4000 and lactulose are similarly effective as laxatives for constipation in pregnancy; diarrhea and loose stools are less frequent encountered with polyethylene glycol. [ABSTRACT FROM AUTHOR]

Introduction and objectives: No studies have analysed the effectiveness of treatment for constipation in critically ill children. The aim of this study was to assess the implementation, efficacy and safety of a treatment protocol using polyethylene glycol 3350 with electrolytes (PEG 3350 + E) for constipation in critically ill children. Methods: We conducted a single-centre prospective study in children admitted to the paediatric intensive care unit for a minimum of 72 h and who developed constipation. Children with previous gastrointestinal disorders or diseases were excluded. The patients were treated with rectal enemas or with the oral PEG 3350 + E protocol at the discretion of the treating physician. We compared clinical and demographic variables as well as adverse events (diarrhoea, abdominal distension and electrolyte imbalances). Results: The sample included 56 patients with a mean age of 48.2 ± 11.9 months, of who 55.4% were male. Forty-four patients (78.6%) were treated with PEG 3350 + E and 12 (21.4%) with rectal enemas. The proportion of patients that responded well to treatment was greater in the PEG 3350 + E group (79.5%) compared to the enema group (58.3%), but the difference was not statistically significant (P = .151). There were no significant differences between the groups in any of the adverse effects. Treatment with PEG 3350 + E was more effective in children aged less than 2 years (100%) compared to older children (100% vs 65.4%; P

Abstract Background and Aim Colonoscopies are an important diagnostic technique in the detection of colorectal cancer and colonic disease. Adequate examination is dependent on the degree of mucosal visibility, with poor cleansing impeding the detection of neoplasms. These patients require shorter colonoscopy surveillance intervals, longer hospital stays, and increased healthcare costs—rendering a screening colonoscopy cost‐ineffective. In Australia and the Gold Coast Hospital and Health Service (GCHHS), macrogol and 3 L of polyethylene glycol are the preferred regimen given its safety profile and efficacy. Yet, little is known locally about the use of the new low‐volume bowel preparation NER1006 (Plenvu) given its recent registration with the Therapeutic Goods of Australia (TGA). The primary outcome assessed the bowel cleansing efficacy of NER1006 compared with 7 days of macrogol and 3 L of polyethylene glycol using the Boston Bowel Preparation Scale (BBPS), while also assessing the influence of notable patient characteristics such as age, gender, body mass index (BMI), and the patients Charlson comorbidity index (CCI). Secondary outcomes assessed the polyp detection rate and procedural factors including cecal intubation, scope withdrawal time, and rebooking rates. Methods Data from all patients who underwent an outpatient colonoscopy procedure at GCHHS between 1 July 2020 and 30 September 2020 were analyzed. Patients were aged 50–74 years of age and were referred for a screening colonoscopy due to a positive fecal occult blood test (FOBT) result from the National Bowel Cancer Screening Program. Results Of the 238 patients who met the inclusion criteria, 108 patients received NER1006 and 130 patients received macrogol and 3 L polyethylene glycol. NER1006 achieved superior overall (P

The BNT162b2 COVID-19 vaccine is composed of lipid-nanoparticles (LNP) containing the mRNA that encodes for SARS-CoV-2 spike glycoprotein. Bronchospasm has been reported as an early reaction after COVID-19 mRNA vaccines in asthmatic patients. The aim of this study was to investigate the acute impact of BNT162b2 in a human ex vivo model of severe eosinophilic asthma. Passively sensitized human isolated bronchi were challenged with the platelet-activating factor to reproduce ex vivo the hyperresponsiveness of airways of patients suffering from severe eosinophilic asthma. BNT162b2 was tested on the contractile sensitivity to histamine and parasympathetic activation via electrical field stimulation (EFS); some experiments were performed after mRNA denaturation. BNT162b2 increased the resting tone (+11.82 ± 2.27%) and response to histamine in partially contracted tissue (+42.97 ± 9.64%) vs. the control (p < 0.001); it also shifted the concentration-response curve to histamine leftward (0.76 ± 0.09 logarithm) and enhanced the response to EFS (+28.46 ± 4.40%) vs. the control. Denaturation did not significantly modify (p > 0.05) the effect of BNT162b2. BNT162b2 increases the contractile sensitivity to histamine and parasympathetic activation in hyperresponsive airways, a detrimental effect not related to the active component but to some excipient. A possible candidate for the bronchospasm elicited by BNT162b2 could be the polyethylene glycol/macrogol used to produce LNP. [ABSTRACT FROM AUTHOR]

Background and Aim: Colonoscopies are an important diagnostic technique in the detection of colorectal cancer and colonic disease. Adequate examination is dependent on the degree of mucosal visibility, with poor cleansing impeding the detection of neoplasms. These patients require shorter colonoscopy surveillance intervals, longer hospital stays, and increased healthcare costs—rendering a screening colonoscopy cost‐ineffective. In Australia and the Gold Coast Hospital and Health Service (GCHHS), macrogol and 3 L of polyethylene glycol are the preferred regimen given its safety profile and efficacy. Yet, little is known locally about the use of the new low‐volume bowel preparation NER1006 (Plenvu) given its recent registration with the Therapeutic Goods of Australia (TGA). The primary outcome assessed the bowel cleansing efficacy of NER1006 compared with 7 days of macrogol and 3 L of polyethylene glycol using the Boston Bowel Preparation Scale (BBPS), while also assessing the influence of notable patient characteristics such as age, gender, body mass index (BMI), and the patients Charlson comorbidity index (CCI). Secondary outcomes assessed the polyp detection rate and procedural factors including cecal intubation, scope withdrawal time, and rebooking rates. Methods: Data from all patients who underwent an outpatient colonoscopy procedure at GCHHS between 1 July 2020 and 30 September 2020 were analyzed. Patients were aged 50–74 years of age and were referred for a screening colonoscopy due to a positive fecal occult blood test (FOBT) result from the National Bowel Cancer Screening Program. Results: Of the 238 patients who met the inclusion criteria, 108 patients received NER1006 and 130 patients received macrogol and 3 L polyethylene glycol. NER1006 achieved superior overall (P < 0.001) and right‐sided colon cleansing (P = 0.016). There was an even distribution of males and females (P = 0.118), the mean age of both cohorts was <65 years of age. The macrogol and 3 L polyethylene glycol group had a statistically higher BMI (P < 0.001) and CCI (P < 0.001). Cecal intubation success was achieved in both cohorts (≥95%) and scope withdrawal time was ≥6 min, polyp detection was non‐superior (P = 0.824), but superior in NER1006 when BBPS ≥6 (P = 0.002). Rebooking rates were significantly lower in the NER1006 group (P = 0.013). Conclusion: This study demonstrated that NER1006 was superior in terms of overall and right‐sided bowel cleansing as a primary endpoint. Patient factors demonstrated to be independent predictors of inadequate bowel preparation. Future studies should aim to explore the safety and tolerability of NER1006 while also assessing the bowel cleansing effectiveness in patients with a high BMI and comorbidity index. [ABSTRACT FROM AUTHOR]

Rectal administration is a suitable route of administration for drugs that are either very irritating to the intestine (e.g., indomethacin) or are more effective when the first-pass effect in the liver is circumvented. Microemulsions are a tool for the improvement of penetration of sparingly soluble drugs. They are mainly used in topical and transdermal drug delivery. However, they find application also in other routes of administration, mainly due to their ability to solubilize sparingly soluble drugs. The selection of a suppository base depends on the physical properties of the drug. The study focused on evaluating the effect of the microemulsion as the solubilizer of sparingly soluble indomethacin in hydrophilic and lipophilic suppository bases compared with Polysorbate 80 as the excipient contained in the microemulsion. The reference suppositories were prepared by the traditional moulding technique from Adeps solidus or Macrogol suppository base without the previous drug solubilization. The microemulsion-based suppositories were prepared after the initial solubilization of the drug in the microemulsion or Polysorbate 80, followed by the addition of suppository base to maintain the same drug/solubilizer ratio. The suppositories were tested for softening time, hardness, and uniformity of mass. The dissolution test was performed using the dialysis tubing method in the basket apparatus. The amount of indomethacin released into the dissolution medium was determined spectrophotometrically at 320 nm. The results indicate that solubilization of indomethacin in the microemulsion had a positive effect on in vitro drug release but not as significant as in the case of Polysorbate 80 used alone. The enhancement ratio for Polysorbate 80 in Adeps suppositories was 2.9, for the microemulsion in Adeps suppositories was 1.1, and for Polysorbate 80 in Macrogol suppositories was 7.4 after 3 hours. The test of uniformity of mass had shown that all suppositories (reference, solubilizer-containing) are within the permitted limits. The softening time was reduced by adding the solubilizer to each type of suppository base.

Introduction: Constipation has a prevalence of 14-30% in Spain, its cause is multifactorial and negatively affects people’s well-being and quality of life. Treatments for functional constipation include osmotic laxatives such as Macrogol 4000. The degree of satisfaction with laxatives is proportional to the perceived effectiveness and improvement in quality of life. Method: a survey was conducted in Spanish pharmacies among 100 consumers who purchased Macrogol 4000 as a medical device, in order to treat the symptoms of constipation. Changes in quality of life and subjective perception of effectiveness were measured after 4, 8 and 14 days of treatment using CATI methodology, based on telephone surveys. Results: After 14 days of consumption, a significant reduction (p<0.05) in physical and psychosocial discomfort was observed. Responses on the effectiveness perception questionnaires improved after day 8. The number of responses expressing agreement with subjective perceptions of relief from constipation (81%-97%), of well-being (90%- 96%) and of improved physical sensations (77%-97%) increased. At the end of the study, 95% of participants were satisfied or very satisfied with the chosen treatment. Conclusions: The use of Macrogol 4000 for 14 days improves physical and psychosocial discomfort at the same time as there is an increase in the perception of its effectiveness in individuals with functional constipation. [ABSTRACT FROM AUTHOR]

The article presents the experience of using sodium phosphate in patients, who were treated at the Clinic of Hospital Surgery of the Samara State Medical University Clinics in 2019.Purpose of the study: evaluate the quality of patient preparation for colonoscopy with sodium phosphate in surgical hospital environment. Material and methods. A total of 50 patients who were admitted for emergency indications to the Clinic of Hospital Surgery in 2019 were enrolled in the study. All patients were divided into two groups.The study included patients aged 24 to 69 years. The median age was 55.1 years in the treatment group and 56.2 years in the control group (p = 0.06). Men predominated in both groups: 16 (64%) in group 1 and 18 (72%) in group 2 (p = 0.08). The average time for submitting complaints about intestinal bleeding before seeking medical aid was 1.0 ± 0.70 days in the treatment group and 1.0 ± 0.35 days in the control group (p = 0.92). Group 1 included 25 patients, who were preparing for colonoscopy with sodium phosphate, Group 2 included 25 patients who were preparing for the examination with Macrogol.Results: the preparation quality was evaluated using the Boston Bowel Preparation Scale. Initially, the treatment and control groups did not have any statistically significant differences in all studied parameters. The colonoscopy identified the following nosologies. In Group 1, 9 patients had a diverticular disease of the colon; 4 – colon cancer; 12 patients continued treatment of grade 2–3 chronic internal hemorrhoids. In Group 2, the patients were distributed as follows: 10 patients were diagnosed with diverticular disease of the colon; 4 – colon cancer; 1 – an adenomatous polyp of the transverse colon and 10 patients had grade 2–3 chronic internal hemorrhoids. In addition, all patients filled out the questionnaire, which showed that the use of sodium phosphate is more convenient for the patient not only in terms of the dosage, but also due to relatively pleasant organoleptic properties. After examination of the colon, 45 patients received conservative treatment, five were operated following the colonoscopy and preoperative preparation.Conclusion: we believe that the quality of preparation of patients with intestinal bleeding with sodium sulphate and Macrogol does not differ, however, sodium sulfate is preferable because of its more pleasant organoleptic properties and the smaller volume of solution used.

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Polyethylene glycol (PEG), also known as macrogol, is an excipient in numerous medications, health care products, cosmetics, and foods. It acts as an inert bulking, or stabilizing, agent. Despite its ubiquity, including in 2 of the newly launched vaccines against SARS‐CoV‐2, awareness of PEG allergy remains low. We present 6 cases of acute hypersensitivity to PEG. Accurate diagnoses in these cases posed a challenge, and although the triggering agents differed, PEG was demonstrated as the common culprit. All cases were female, with a mean age of 36.4 years. Four patients were originally suspected to have nonsteroid anti‐inflammatory drug allergy, and 2 had a history of chronic spontaneous urticaria and angioedema. Biphasic allergic reactions featured prominently in this case series. Diagnosis relies on a high index of suspicion leading to a focused clinical history, supported by skin tests with PEG solutions to demonstrate sensitization. This case series highlights important clinical features of this rare, potentially serious, and increasingly recognized excipient allergy. [ABSTRACT FROM AUTHOR]

Background and Aim The addition of a laxative prior to a standard bowel preparation (BP) has shown variable results in efficacy, safety, and tolerability of the BP. This study compared the efficacy and tolerability of a macrogol‐augmented BP (M‐BP) with standard BP for routine colonoscopy in unselected patients. Methods Adults undergoing outpatient colonoscopy were randomized to either M‐BP (one sachet of macrogol‐based osmotic laxative (MBOL) twice daily for eight doses prior to standard preparation) or BP (split‐dose of polyethylene glycol and sodium picosulfate). Bowel cleansing was assessed using the Ottawa BP scale. Risk factors for poor BP, patient satisfaction, and tolerance were recorded. Results This randomized trial was stopped due to futility after 14 months; at that point, 92 subjects were randomized to the study arm and 102 to the control arm. M‐BP had a success rate of 71.7% (95% CI: 58.5–82.7%), while the BP had a success rate of 67.7% (95% CI: 54.9–78.8%), with a Pearson χ2 test P‐value of 0.639, which exceeded the cut‐off for futility (0.313). In subgroup analyses, there were statistically significant decreases in the rates of successful BP in patients taking regular opioids and regular laxatives. Both preparations were well tolerated, with no difference between groups (BP – 5.3% and M‐BP – 6.6% P = 0.66). Conclusion The addition of MBOL prior to a standard BP in unselected subjects does not significantly improve bowel cleanliness at routine colonoscopy. The role of this laxative in patients at high risk of poor preparation warrants further investigation.

The authors performed a systematic review to summarize data on the approaches and methods of bowels preparation for radiography, radiology and ultrasound studies. The review included 15 articles on computed tomography (CT) and 30 articles on magnetic resonance imaging (MRI). Due to the limited evidence, researches on X-ray and ultrasound (US) studies are not included in the review; the authors just summarized the main provisions for these modalities. The bowels preparation must be completed before making the CT colonography (diet, bowel cleansing within max. 24 hours, marking the residual content). For purification, solutions of low-volume polyethylene glycol (PEG) 2 L with ascorbate complex and electrolytes, bisacodyl and other medications were used. The choice of a specific drug regimen of bowels cleansing should be based on a personalized approach to patient, balance, consideration of studies purpose and reasons. The bowels preparation must be completed before making the MRI (two ways: complete cleansing (most often with low-volume polyethylene glycol 2 L solutions with ascorbate complex and electrolytes or diet, followed by contrasting the residual content). There is no reliable information on the benefits of each particular approach. The insufficient evidence is due to the lack of comparative studies. When performing the MRI of men's small pelvic, doctors use antispasmodics, for women they prefer diet, mechanical cleansing, suppositories with bisacodyl or magnesia, followed by rehydration on the day of studies. There is currently no reliable data on the need in bowels preparation before making the following studies: CT of abdominal cavity and small pelvis (except for the large intestine), excretory urography, metro(hystero)salpingography, ultrasound of the large intestine. PEG solutions with electrolytes have relative advantages in preparing bowels for radiation studies (possibility of using in cases when the prescription of other laxatives is contraindicated).

Background. Considering the wide prevalence of functional constipation (FC) at a young age, we set ourselves the task of comparing the effectiveness of osmotic laxative macrogol 4000 (Forlax) in the treatment of FC in adolescents and young adults in the Ukrainian population. Materials and methods. We have examined 35 young adults aged 19 to 25 years (average age 24.10 ± 0.33 years) and 28 children in late adolescence aged 15 to 19 years (average age 15.90 ± 0.21 years). In the group of young adults, female patients slightly dominated (20/15), and among adolescents, both sexes were equally represented (14/14). It was an open-label, multi-center study. Patients with FC were monitored at the Kyiv gastrocenter and Kramatorsk Children’s Territorial Medical Association. The diagnosis of FC in the adult and adolescent groups was made based on the well-known Rome IV criteria. The frequency of bowel movements during the week was evaluated, as well as the shape of the stool according to the Bristol stool scale. The general state of health and severity of abdominal distention were evaluated on a 10-centimeter Visual analogue scale. Macrogol Forlax was administered as 10 g of powder dissolved in a glass of water once a day in the morning. With insufficient effect after 7 days of treatment, the dose was doubled. The duration of the drug use was 14 days. Results. After two weeks of treatment, the following results were obtained. The frequency of bowel movements was 4.36 ± 0.21 (p < 0.001) once a week, the shape of the stool according to the Bristol stool scale was 3.48 ± 0.22 (p

Vaccination against coronavirus is essential to minimize the impact of the COVID-19 pandemic. Rare cases of anaphylaxis associated with the mRNA COVID-19 vaccines are being described, and the mechanisms involved in these reactions are poorly understood. A potential culprit agent of these vaccine-induced anaphylaxis events is polyethylene glycol, which has been reported as a cause of anaphylaxis. However, a cause-effect association has not been demonstrated, and the cases of anaphylaxis to mRNA COVID-19 vaccines should be further investigated. In this scenario, the recommendations are inaccurate and can lead to misinterpretation. At the moment, a more accurate recommendation would be the contraindication of mRNA COVID-19 vaccines in patients with immediate hypersensitivity reaction to polyethylene glycol or polysorbate. Patients with history of anaphylaxis to other or unknown causes should be referred to an allergist-immunologist for further orientation.

Background: Polyethylene glycols (PEGs) are widely used as excipients in drugs, cosmetics and household products. Immediate‐type allergy to PEGs including anaphylaxis is rare. The recent introduction of the mRNA‐based COVID‐19 vaccines has led to an increased focus on PEG as a possible culprit of allergic reactions to the vaccines. A low awareness of the allergenic potential of PEG among consumers, manufacturers and doctors leads to under‐diagnosis and under‐reporting of allergy to PEGs, putting patients at risk of repeated severe reactions. Objectives: To investigate clinical manifestations, time to diagnosis and impact of a PEG allergy diagnosis on the daily life of patients diagnosed with allergy to PEG from 2010 to 2019. Method: Ten patients diagnosed with allergy to PEG were included. Detailed clinical history was obtained, and allergy investigations had been performed at the time of diagnosis. All patients were contacted and asked to retrospectively complete a questionnaire about causes and impact on daily life of an allergy to PEG, scored on a likert scale (0–10) before and after diagnosis. Results: Eight patients had experienced at least one anaphylactic reaction requiring adrenaline treatment. Anaphylaxis was primarily caused by antibiotic/analgesic tablets, depot‐steroids, antacids and laxatives. Seven patients reported repeated reactions before diagnosis (median 3, range 2–6). Median time from first reaction to diagnosis was 20 months (range 2–120). None of the patients experienced severe allergic reactions after the diagnosis. Median likert score of the impact on daily life before diagnosis was 7 compared with 4 after diagnosis. Conclusion and clinical relevance: The clinical manifestations of PEG allergy are often dramatic. Improved awareness about the clinical presentation and common culprits, clear product labelling and a standardized nomenclature is needed to ensure the timely diagnosis of PEG allergy to prevent repeated anaphylactic reactions with severe impact on patients' lives. [ABSTRACT FROM AUTHOR]

This article represents the data on using of macrogol in preparation for rontgenological and endoscopic examination of large intestine.

Background and Aim: The addition of a laxative prior to a standard bowel preparation (BP) has shown variable results in efficacy, safety, and tolerability of the BP. This study compared the efficacy and tolerability of a macrogol‐augmented BP (M‐BP) with standard BP for routine colonoscopy in unselected patients. Methods: Adults undergoing outpatient colonoscopy were randomized to either M‐BP (one sachet of macrogol‐based osmotic laxative (MBOL) twice daily for eight doses prior to standard preparation) or BP (split‐dose of polyethylene glycol and sodium picosulfate). Bowel cleansing was assessed using the Ottawa BP scale. Risk factors for poor BP, patient satisfaction, and tolerance were recorded. Results: This randomized trial was stopped due to futility after 14 months; at that point, 92 subjects were randomized to the study arm and 102 to the control arm. M‐BP had a success rate of 71.7% (95% CI: 58.5–82.7%), while the BP had a success rate of 67.7% (95% CI: 54.9–78.8%), with a Pearson χ2 test P‐value of 0.639, which exceeded the cut‐off for futility (0.313). In subgroup analyses, there were statistically significant decreases in the rates of successful BP in patients taking regular opioids and regular laxatives. Both preparations were well tolerated, with no difference between groups (BP – 5.3% and M‐BP – 6.6% P = 0.66). Conclusion: The addition of MBOL prior to a standard BP in unselected subjects does not significantly improve bowel cleanliness at routine colonoscopy. The role of this laxative in patients at high risk of poor preparation warrants further investigation. [ABSTRACT FROM AUTHOR]

The synthesis, characterization, spectroscopic data, solubility and aggregation behaviors depend on the solvents of metalled (Co, Cu, Ni, Zn) and metal free pegylated phthalocyanines (Pcs) were reported. Precursor phthalonitrile compound (4) for phthalocyanine formation was synthesized by nucleophilic substitution reaction between tetraethylene glycol substituted phthalonitrile (2) and tetraethylene glycol monotosylate (3). Related phthalocyanines (4-H , 4-Co , 4-Cu , 4-Ni , and 4-Zn) were characterized by FT-IR, 1H NMR, 13C NMR, and UV–Vis spectroscopies and elemental analysis. Thermal stabilities of the phthalocyanines were determined in the range between room temperature and 1000 °C. Pegylated phthalocyanines showed high solubility in water and common organic solvents including methanol, ethanol, acetone, pyridine, 1,4-dioxane, dimethylformamide, dimethylsulfoxide, dichloromethane, and chloroform. Aggregation states of all phthalocyanines were investigated in the aforementioned solvents using UV–Vis spectroscopy method. All phthalocyanines were especially found highly aggregated in their aqueous solutions. Image 1 • Tetrasubstituted metalled and metal free phthalocyanines including PEG 400 were synthesized. • The phthalocyanines were characterized by FTIR, 1H NMR, 13C NMR, UV–Vis spectroscopies and elemental analysis technique. • Aggregation statuses of the phthalocyanines were determined depending on the solvents. • Thermal decomposition ranges of these compounds were determined. [ABSTRACT FROM AUTHOR]

Copyright of Gastroenterologia (2308-2097) is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article presents a case study of anaphylaxis in a six year old girl caused by polyethylene glycol (PEG) in a diazepam suppository. It is reported that the girl, with a history of febrile seizures, received the suppository prophylactically and developed pruritus, rash, and respiratory symptoms. It highlights the challenge of diagnosing PEG allergy, which is present in various products, and the importance of lifestyle guidance after diagnosis.

Introduction and Objectives: No studies have analysed the effectiveness of treatment for constipation in critically ill children. The aim of this study was to assess the implementation, efficacy and safety of a treatment protocol using polyethylene glycol 3350 with electrolytes (PEG 3350 + E) for constipation in critically ill children., Methods: We conducted a single-centre prospective study in children admitted to the paediatric intensive care unit for a minimum of 72 h and who developed constipation. Children with previous gastrointestinal disorders or diseases were excluded. The patients were treated with rectal enemas or with the oral PEG 3350 + E protocol at the discretion of the treating physician. We compared clinical and demographic variables as well as adverse events (diarrhoea, abdominal distension and electrolyte imbalances)., Results: The sample included 56 patients with a mean age of 48.2 ± 11.9 months, of who 55.4% were male. Forty-four patients (78.6%) were treated with PEG 3350 + E and 12 (21.4%) with rectal enemas. The proportion of patients that responded well to treatment was greater in the PEG 3350 + E group (79.5%) compared to the enema group (58.3%), but the difference was not statistically significant (P = .151). There were no significant differences between the groups in any of the adverse effects. Treatment with PEG 3350 + E was more effective in children aged less than 2 years (100%) compared to older children (100% vs 65.4%; P < .01), with no significant differences in the development of adverse events., Conclusions: The PEG 3350 + E treatment protocol for constipation in critically ill children was effective and associated with few adverse events, even in children aged less than 2 years., (Copyright © 2023 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Background and Aim: Polyethylene glycol (PEG) is the gold standard for fecal disimpaction in constipation. A regimen of PEG combined with the stimulant laxative sodium picosulphate (SPS) produced fecal disimpaction in chronically constipated children in the community, but it is unknown if it is effective for more severe constipation. To determine the stool output and effect of a combined PEG and SPS regimen on fecaloma in children with severe constipation and impaction. Methods: Children with symptoms for a duration of ≥2 years, a palpable fecaloma, and enlarged rectum on X‐ray (rectal: pelvic ratio > 0.6) were recruited from a tertiary hospital. Daily diaries recorded laxative dose, stool frequency, volume, and consistency (Bristol stool scale, BSS). Abdominal X‐rays were taken on day 1 and day 8, and stool loading was assessed using the Leech score. Laxative doses were based on the child's age. The dose of PEG with electrolytes taken was 2–8 sachets (14.7 g/sachet) on days 1–2, reducing to 2–6 sachets on day 3. The SPS dose was 15–20 drops on days 2–3. Results: Eighty‐nine children (4–18 years) produced a large volume of soft stool (median/inter‐quartile‐range: 2.2/1.6–3.1 L) over 7 days. Stool volume on X‐rays decreased significantly in the colon (P < 0.001). Fecalomas resolved in 40 of 89 children, while 49 needed a second high dose. Rectal:pelvic ratios did not change. Conclusions: A combined high dose of PEG and SPS on days 1 and 2 was effective in removing the fecaloma in half of the children. Administering high doses for a longer period should be tested to provide outpatient disimpaction for severe fecalomas. Rectums remained flaccid after emptying. [ABSTRACT FROM AUTHOR]

Objectives: To assess the tolerance and potential nutritional consequences of long-term repeated doses of PEG 4000 (10 to 30 g/day) in elderly patients with chronic constipation as compared to lactulose (10-30 g/ day). Design: Single blind, randomised, multicentre, parallel group comparative study. Setting: Community-dwelling patients and nursing homes residents aged 70 years and older with a history of chronic constipation. Treatment intervention: PEG 4000 (10-30 g/day) or lactulose (10-30 g/day) for six months. Assessments: Clinical nutritional status (Mini Nutritional Assessment), blood and stool samples were taken at baseline and after three and six months for assay of nutritional and absorption parameters. A patient diary documented digestive symptoms and adverse events were recorded. Information on efficacy (stool frequency and consistency) was collected as a secondary outcome measure. Results: Of the 316 patients screened, 245 eligible patients constituted the ITT population (PEG 4000: N = 118; lactulose group: N = 127). The proportion of patients receiving PEG 4000 with abnormal levels of electrolytes, nutritional markers or vitamins did not significantly change in the six months after initiating laxative treatment and do not differ between the two groups. After a D-xylose challenge test, the proportion of patients with abnormally low xylosaemia (suggesting malabsorption) varied from 24.6% at baseline to 35.8% after six months in the PEG 4000 group and from 29.1% to 42.4% in the lactulose group, with no significant between-group or within-group differences. The proportion of patients with poor nutritional status (MNA score <17) varied from 8.5% at baseline to 9.8% after 6 months in the PEG 4000 group and from 3.9% to 5.0% in the lactulose group. No changes in stool fat or total or soluble stool nitrogen were observed in the minority of patients for whom stool analysis was performed. A significantly higher stool frequency p <0.05) and improved stool consistency p <0.05) was observed in the PEG 4000 group compared to the lactulose group at each monthly evaluation period. Conclusions: After six months of treatment with PEG 4000, no clinically relevant changes in biochemical and nutritional parameters and no unanticipated treatment-related adverse events were detected, demonstrating the good clinical tolerance of PEG 4000 in this population of elderly constipated patients. This tolerance was associated with a better clinical efficacy of PEG 4000 compared to lactulose. [ABSTRACT FROM AUTHOR]

Background: Whole-bowel irrigation (WBI) is a strategy of gastrointestinal decontamination, recommended by several European and American learned societies, which may be used in the management of the poisoned patients., Objectives: The objectives of this study were to describe the feasibility and tolerability of this technique and to compare the clinical outcome of a group of poisoned patients treated with WBI versus that of an untreated group., Methods: This was a retrospective and observational study of data recorded by the Angers Poison Control Centre (PCC) between 2012 and 2018. All cases for which the PCC advised WBI were included. The association between outcomes (clinical deterioration after WBI advised by a PCC, length of hospitalisation), WBI treatment, and relevant associated risk factors was determined using univariate and multivariate logistic regression., Results: A total of 257 patients were included. One hundred forty-one patients were treated with WBI with clearly successful induction of diarrhoea in 47 cases (31%). WBI was not initiated in 89 patients. WBI was initiated but unsuccessful (no diarrhoea) in nine cases. The median age is 46 years (interquartile range: 32-55 years), with a sex ratio (M/F) of 1.3. A total of 27 of 150 patients (18%) who underwent WBI had adverse effects possibly linked to WBI, mainly vomiting (n=23). The patients with clinical deterioration (n=49) were irrigated significantly less often (95% confidence interval: 0.13-0.52; p<0.001). After adjustment for sex, age, time to implementation of WBI, type of substance ingested, and admission to intensive care, patients who were treated with WBI were less likely to deteriorate clinically than patients who were not treated with WBI (p<0.001)., Conclusion: Despite a low rate of completion of this procedure, WBI appeared to provide clinical benefits in patients treated in comparison of an untreated group and is associated with an acceptably low risk of direct complications., (Copyright © 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Polyethylene glycol is commonly used to manage constipation and is available with or without electrolytes. The addition of electrolytes dates back to its initial development as lavage solutions in preparation for gastrointestinal interventions. The clinical utility of the addition of electrolytes to polyethylene glycol for the management of constipation is not established. The objective of this systematic review and network meta-analysis (NMA) was to assess the relative effectiveness of polyethylene glycol with (PEG + E) or without electrolytes (PEG) in the management of functional constipation in adults.Methods: A systematic review was conducted to identify randomised controlled clinical trials that assessed the use of polyethylene glycol in functional constipation. The primary outcome was the mean number of bowel movements per week.Results: Nineteen studies were included in the NMA (PEG N = 9, PEG + E N = 8, PEG versus PEG + E N = 2; involving 2247 patients). PEG and PEG + E are both effective, increasing the number of bowel movements per week by 1.8 (95 % Crl 1.0, 2.8) and 1.9 (95 % Crl 0.9, 3.0) respectively versus placebo and by 1.8 (95 % Crl 0.0, 3.5) and 1.9 (95 % Crl 0.2, 3.6) respectively versus lactulose. There was no efficacy difference between PEG + E and PEG (0.1, 95 % Crl -1.1, 1.2) and there were no differences in safety or tolerability.Conclusions: Polyethylene glycol with and without electrolytes are effective and safe treatments for constipation in adults. The addition of electrolytes to polyethylene glycol does not appear to offer any clinical benefits over polyethylene glycol alone in the management of constipation. [ABSTRACT FROM AUTHOR]