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Fulltext How to perform and assess colonic manometry and barostat study in chronic constipation

Lee YY, Erdogan A, Rao SS

J Neurogastroenterol Motil, 2014 Oct 30;20(4):547-52.
PMID: 25230902 DOI: 10.5056/jnm14056

Management of chronic constipation with refractory symptoms can be challenging. Although new drugs and behavioral treat-ments have improved outcome, when they fail, there is little guidance on what to do next. At this juncture, typically most doc-tors may refer for surgical intervention although total colectomy is associated with morbidity including complications such as recurrent bacterial overgrowth. Recently, colonic manometry with sensory/tone/compliance assessment with a barostat study has been shown to be useful. Technical challenges aside, adequate preparation, and appropriate equipment and knowledge of co-lonic physiology are keys for a successful procedure. The test itself appears to be safe with little complications. Currently, colon-ic manometry is usually performed with a 6-8 solid state or water-perfused sensor probe, although high-resolution fiber-optic colonic manometry with better spatiotemporal resolutions may become available in the near future. For a test that has evolved over 3 decades, normal physiology and abnormal findings for common phenotypes of chronic constipation, especially slow transit constipation, have been well characterized only recently largely through the advent of prolonged 24-hour ambulatory colonic manometry studies. Even though the test has been largely restricted to specialized laboratories at the moment, emerg-ing new technologies and indications may facilitate its wider use in the near future.(J Neurogastroenterol Motil 2014;20:547-552).
Fulltext How to assess regional and whole gut transit time with wireless motility capsule

Lee YY, Erdogan A, Rao SS

J Neurogastroenterol Motil, 2014 Apr 30;20(2):265-70.
PMID: 24840380 DOI: 10.5056/jnm.2014.20.2.265

Assessment of transit through the gastrointestinal tract provides useful information regarding gut physiology and patho-physiology. Although several methods are available, each has distinct advantages and limitations. Recently, an ingestible wire-less motility capsule (WMC), similar to capsule video endoscopy, has become available that offers a less-invasive, standardized, radiation-free and office-based test. The capsule has 3 sensors for measurement of pH, pressure and temperature, and collec-tively the information provided by these sensors is used to measure gastric emptying time, small bowel transit time, colonic transit time and whole gut transit time. Current approved indications for the test include the evaluation of gastric emptying in gastroparesis, colonic transit in constipation and evaluation of generalised dysmotility. Rare capsule retention and malfunc-tion are known limitations and some patients may experience difficulty with swallowing the capsule. The use of WMC has been validated for the assessment of gastrointestinal transit. The normal range for transit time includes the following: gastric empty-ing (2-5 hours), small bowel transit (2-6 hours), colonic transit (10-59 hours) and whole gut transit (10-73 hours). Besides avoiding the use of multiple endoscopic, radiologic and functional gastrointestinal tests, WMC can provide new diagnoses, leads to a change in management decision and help to direct further focused work-ups in patients with suspected disordered motility. In conclusion, WMC represents a significant advance in the assessment of segmental and whole gut transit and mo-tility, and could prove to be an indispensable diagnostic tool for gastrointestinal physicians worldwide.
Are we ready for combination therapy in moderate-to-severe ulcerative colitis?

Lee YY, Gangireddy V, Khurana S, Rao SS

Gastroenterology, 2014 Aug;147(2):544.
PMID: 24976027 DOI: 10.1053/j.gastro.2014.03.053
Dietary fiber and risk of inflammatory bowel disease: fact or hype?

Lee YY, Yu S, Khurana S, Rao SS

Gastroenterology, 2014 Apr;146(4):1133-4.
PMID: 24576735 DOI: 10.1053/j.gastro.2013.12.043
Possible underestimation of SIBO in IBS patients: is lack of Glucose Breath Test standardization responsible?

Erdogan A, Rao SS, Gulley D, Jacobs C, Lee YY, Badger C

Neurogastroenterol Motil, 2015 Aug;27(8):1192-3.
PMID: 26220649 DOI: 10.1111/nmo.12603
Fulltext Randomised clinical trial: mixed soluble/insoluble fibre vs. psyllium for chronic constipation

Erdogan A, Rao SS, Thiruvaiyaru D, Lee YY, Coss Adame E, Valestin J, et al.

Aliment Pharmacol Ther, 2016 07;44(1):35-44.
PMID: 27125883 DOI: 10.1111/apt.13647

BACKGROUND: Fibre supplements are useful, but whether a plum-derived mixed fibre that contains both soluble and insoluble fibre improves constipation is unknown.
AIM: To investigate the efficacy and tolerability of mixed soluble/insoluble fibre vs. psyllium in a randomized double-blind controlled trial.
METHODS: Constipated patients (Rome III) received mixed fibre or psyllium, 5 g b.d., for 4 weeks. Daily symptoms and stool habit were assessed using stool diary. Subjects with ≥1 complete spontaneous bowel movement/week above baseline for ≥2/4 weeks were considered responders. Secondary outcome measures included stool consistency, bowel satisfaction, straining, gas, bloating, taste, dissolvability and quality of life (QoL).
RESULTS: Seventy-two subjects (mixed fibre = 40; psyllium = 32) were enrolled and two from psyllium group withdrew. The mean complete spontaneous bowel movement/week increased with both mixed fibre (P < 0.0001) and psyllium (P = 0.0002) without group difference. There were 30 (75%) responders with mixed fibre and 24 (75%) with psyllium (P = 0.9). Stool consistency increased (P = 0.04), straining (P = 0.006) and bloating scores decreased (P = 0.02) without group differences. Significantly more patients reported improvement in flatulence (53% vs. 25%, P = 0.01) and felt that mixed fibre dissolved better (P = 0.02) compared to psyllium. QoL improved (P = 0.0125) with both treatments without group differences.
CONCLUSIONS: Mixed fibre and psyllium were equally efficacious in improving constipation and QoL. Mixed fibre was more effective in relieving flatulence, bloating and dissolved better. Mixed fibre is effective and well tolerated.
Fulltext ROTA: A system for automated scheduling of nursing duties in a tertiary teaching hospital in south India

D'Souza B, Rao SS, Muthana CG, Bhageerathy R, Apuri N, Chandrasekaran V, et al.

Health Informatics J, 2021 4 10;27(2):14604582211001426.
PMID: 33832325 DOI: 10.1177/14604582211001426

The nursing schedule generation is an important activity that takes a considerable amount of time for managers to prepare and amend. It involves the optimal allocation of nurses to shifts, factoring various constraints like shift timings, holidays, leaves, and emergencies. This paper provides the design and development details for an automated nurse scheduling system called "ROTA," implemented for a 2032 bed multi-specialty tertiary teaching hospital, having 1800 staff nurses and 98 wards. The system generates daily, weekly, monthly schedules, nurse face sheets, duty allocation charts, swapping schedules, and training details for nurses. The system improved managerial control and saved a considerable amount of time for nurses to prepare the schedule. A survey conducted to gauge the system's satisfaction level showed that 91% of nurses were satisfied with ROTA. Overall, the system saved 78% of nurse scheduling time, resulting in a 3% cost reduction for the hospital.
Editorial: mixed soluble fibre in chronic constipation - something new? Authors' reply

Erdogan A, Rao SS, Thiruvaiyaru D, Lee YY, Coss Adame E, Valestin J, et al.

Aliment Pharmacol Ther, 2016 08;44(3):303.
PMID: 27375096 DOI: 10.1111/apt.13688