AIM:To compare the effect of oral erythromycin vs no preparation with prokinetics on the transit time and the image quality of capsule endoscopy (CE) in evaluating small bowel (SB) pathology. METHODS:We conducted a retrospective, blinded (to the type of preparation) review of 100 CE studies, 50 with no preparation with prokinetics from one medical center (Group A) and 50 from another center with administration of a single dose of 200 mg oral erythromycin 1 h prior to CE (Group B).Gastric, SB and total transit times were calculated, the presence of bile in the duodenum was scored, as was cleanliness within the proximal, middle and distal intestine. RESULTS:The erythromycin group had a slightly shorter gastric transit time (21 min vs 28 min, with no statistical significance).SB transit time was similar for both groups (all P > 0.05).Total transit time was almost identical in both groups.The rate of incomplete examination was 16% for Group A and 10% for Group B (P = 0.37).Bile and cleanliness scores in different parts of the intestine were similar for the two groups (P > 0.05). CONCLUSION:Preparation for capsule endoscopy with erythromycin does not affect SB or total transit time.It tends to reduce gastric transit time, but it does not increase the cecum-reaching rate.Erythromycin does not adversely affect image quality.We consider the routine use of oral erythromycin preparation as being unjustified, although it might be considered in patients with known prolonged gastric emptying time.
A recently discovered homologue of the angiotensin-converting enzyme, ACE2, insensitive to ACE inhibitors, was found in rodents and humans. ACE2 is expressed mainly in the vasculature, heart and kidney. ACE2 removes a single amino acid of the carboxy terminal of peptides. In the renin-angiotensin-aldosterone system (RAAS), it is responsible for the conversion of angiotensin I (Ang I) and angiotensin II (Ang II) to Ang 1-9 and Ang 1-7, respectively. While ACE forms Ang II, a potent vasoconstrictor, ACE2 degrades this peptide to form Ang 1-7 which has an opposite action. Therefore, ACE2 counteracts ACE in the balance of vasopressor/vasodilator as well as heart and kidney function. The importance of ACE2 in physiological and pathophysiological conditions is unclear and is currently being studied.
End-stage renal disease (ESRD) is a major cause of morbidity and mortality worldwide. Survival of ESRD patients depends on renal replacement therapies, such as kidney transplantation and dialysis. Due to the shortage of potential kidney donors and patients' comorbidities, dialysis is the major therapeutic option offered to such patients. In this review, recent advances in hemodialysis and hemodiafiltration, and their potential impact on improving patient survival will be discussed.
