There is no consensus concerning small bowel preparation before capsule endoscopy (CE). This study evaluated the effects of 4 regimens on small bowel cleansing and diagnostic yield. Patients were randomly divided into 4 groups. Group A consumed a clear liquid diet after lunch on the day before CE, followed by overnight fasting. Group B took 250 mL 20% mannitol and 1 L 0.9% saline orally at 05:00 hours on the day of the procedure. In group C, the same regimen was taken at 20:00 hours on the day before and at 05:00 hours on the day of CE. In group D, in addition to the group C regimen, 20 mL oral simethicone was taken 30 minutes before CE. Two hundred patients were prospectively enrolled, and 7 were excluded from the final analysis because of incomplete small bowel transit. No significant difference was noted among the 4 groups for small bowel transit time. Bowel preparation in group D was significantly better than for the other regimens for overall cleansing of the proximal small bowel, and showed improved overall cleansing of the distal small bowel when compared with 10-hours overnight fasting. Pathological lesions of the proximal and distal small bowel were, respectively, achieved in 82 and 74 patients, mostly distributed in group D. Small bowel preparation that involves split-dose oral mannitol plus single-dose simethicone for CE can improve mucosal visualization and subsequent diagnostic yield when compared with 10-hours overnight fasting.

To determine whether methicillin-susceptible S. aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) are present in commercial pig farms and food products from supermarkets in China, we characterized S. aureus isolates from 250 samples associated with swine and animal-related food products in Shandong Province. The isolates were characterized by susceptibility testing, toxin gene detection, pulse-field gel electrophoresis (PFGE), multilocus sequence typing, and spa typing. MRSA were identified and typed by the staphylococcal cassette chromosome mec (SCCmec). The prevalence of S. aureus among all samples was 19.6% (49/250). MRSA and MSSA accounted for 16.7% (20/120) and 8.3% (10/120), respectively, of swine feces samples. Only MSSA was detected from swine carcass, pork, chicken, and raw milk, accounting for 15% (6/40), 10% (3/30), 20% (6/30), and 13.3% (4/30), respectively. The predominant MRSA clone was ST9-t899 SCCmecIVb/PFGE A (70.0%, 14/20). Among the MSSA isolates, ST9-t899/PFGE A was the most prevalent (27.6%), followed by ST15-t084 (17.2%), ST97-t2756 (10.3%), ST1-t127 (6.9%), and ST398-t899 (3.5%). Some lineages were found that are commonly detected in humans (e.g., ST1, ST5, ST7, ST59, ST88) or are human-specific (e.g., ST15). The toxin genes sec, seh, and enterotoxin gene cluster (egc) were significantly more prevalent among isolates of lineage ST9 (p<0.001) compared to other lineages, and the ST9 isolates were more resistant to erythromycin, clindamycin, ciprofloxacin, chloramphenicol, and gentamicin. The same lineage was identified from different sample types, indicating circulation of the related strains within the area of study. In conclusion, swine and food products of animal origin carried S. aureus, and the predominant ST9 clone possesses a multidrug-resistance profile and a high prevalence of sec, seh, and egc enterotoxin genes.

Clinical Research on the Relation Between Body Mass Index, Motilin and Slow Transit Constipation

The approach to small bowel preparation before capsule endoscopy (CE) is still suboptimal. One hundred eighty patients were randomly allocated to 3 groups. Patients in Group A took 250 mL 20% mannitol and 1 L 0.9% saline orally at 05:00 hours on the day of the procedure. In Group B the same preparation was taken at 20:00 on the day before, and at 05:00 on the day of CE; in addition, 20 mL oral simethicone was taken 30 minutes before CE. Group C was treated identically to Group B, except that the patients fasted for 3 days and took 3 g senna orally 3 times daily before CE. The length of bowel containing green luminal contents was assessed by ImageJ software and bowel cleanliness was evaluated by computed assessment of the cleansing score. Cleansing of the whole small bowel and the distal small bowel were significantly different between the 3 groups (χ2 = 22.470, P = .000; χ2 = 17.029, P = .000, respectively). There were also significant differences between the 3 groups in the length of small bowel and specifically the length of the distal small bowel containing green luminal contents (χ2 = 12.390, P = .000, χ2 = 15.141, P = .000, respectively), but not with regard to the proximal small bowel (χ2 = 0.678, P = .509). Three days fasting and oral senna, combined with 20% mannitol and simethicone, before CE, can reduce the effects of bile on the small bowel and improve small bowel cleansing, especially in the distal small intestine.

Background/Aim: The purpose of this study was to evaluate the clinical significance of visualized area percentage assessment of cleansing score (AAC) and computed assessment of cleansing score (CAC) of these two small bowel cleanliness scores systems for capsule endoscopy (CE). Materials and Methods: The reliability and consistency of the AAC and CAC scores were evaluated by comparing the scores by two examiners (one expert, one without any training in CE). Reliability was determined using the intraclass correlation coefficient (ICC) and consistency was determined using the kappa statistic. Results: The inter-observer agreement was excellent for both the AAC and CAC scores. For AAC, the ICC was 0.791 (95% confidence interval: 0.677-0.868), and for CAC the ICC was 1.000. Using 1.5 as the cutoff, there was no significant difference between AAC and CAC results by the expert examiner (kappa = 0.756, P = 0.000) or the non-expert examiner (kappa = 0.831, P = 0.000). Evaluation of small bowel cleanliness using AAC took 15-30 min, and evaluation using CAC took about 2-3 min. The overall adequacy assessment (OAA) using the AAC was not significantly different between the two examiners (χ² = 0.586, P = 0.444). There were also no significant differences between the OAA using the AAC and the OAA using the CAC by the expert examiner (χ² = 1.730, P = 0.188) or the non-expert examiner (χ² = 1.124, P = 0.289). Conclusion: Both of these scores for assessment of small bowel cleanliness can be useful in clinical practice, but the CAC is simpler to use.