1.Efficacy of Amitriptyline in Irritable Bowel Syndrome:A Systematic Review and Meta-analysis
Minahil IQBAL ; Sara HIRA ; Humza SAEED ; Sufyan SHAHID ; Suha T BUTT ; Kamran RASHID ; Mohammad AHMAD ; Hammad HUSSAIN ; Anzalna MUGHAL ; Gabriel P A COSTA ; Fernanda GUSHKEN ; Neil NERO ; Shreya SENGUPTA ; Akhil ANAND
Journal of Neurogastroenterology and Motility 2025;31(1):28-37
Background/Aims:
Amitriptyline is prescribed off-label for irritable bowel syndrome (IBS). We conducted a meta-analysis to assess its efficacy.
Methods:
A systematic literature review was conducted until November 10, 2023, using MEDLINE, Embase, Cochrane Library, and Web of Science to study the efficacy of amitriptyline in patients with IBS. We included all randomized controlled trials that compared amitriptyline to placebo. Revised Cochrane risk-of-bias tool was used to assess the quality of studies. Meta-analyses were performed using a bivariate random-effects model. Statistical analyses were performed using R Software 4.2.3 and heterogeneity was assessed with I 2 statistics.
Results:
Seven trials were included with 796 patients (61% female). Amitriptyline was associated with better treatment response (OR, 5.30; 95% CI, 2.47 to 11.39; P < 0.001), reduced Irritable Bowel Syndrome Symptom Severity Scores (MD, –50.72; 95% CI, –94.23 to –7.20; P = 0.020) and improved diarrhea (OR, 10.55; 95% CI, 2.90 to 38.41; P < 0.001). No significant difference between the 2 groups regarding the adverse effects was observed. Three trials showed an overall low risk of bias, 2 trials showed an overall high risk of bias due to randomization and missing data, and 2 trials had some concerns regarding missing data.
Conclusions
Amitriptyline was found to be well-tolerated and effective in treating IBS compared to placebo. These findings support the use of amitriptyline for the management of IBS, particularly among patients with the IBS diarrhea subtype. Future research should focus on the dose-dependent effects of amitriptyline in IBS to better guide clinicians in personalized titration regimens.
2.Gastro-retentive drug delivery systems: Modern insights on approaches and applications
Rozinaparvin Iqbal PATEL ; Chainesh SHAH ; Nidhi CHAUHAN ; Umesh UPADHYAY
International Journal of Gastrointestinal Intervention 2025;14(2):43-50
The pharmaceutical research sector is highly interested in oral gastro-retentive dose formulations. The significance of gastro-retentive drug delivery systems (GRDDS) has grown as these systems enhance patient compliance and improve the therapeutic indices of medications. Various technical advancements in the design and production of gastro-retentive dosage forms can overcome physiological limitations, such as short gastric retention time and fluctuations in stomach emptying. Medications with shorter half-lives, instability or poor solubility at alkaline pH, or inadequate absorption in the lower gastrointestinal tract can greatly benefit from GRDDS. To achieve the desired retention period and release pattern, these systems can be developed using a range of innovative methods, including magnetic, bioadhesive, expandable, and floating systems. The use of GRDDS for oral drug administration has significantly increased in recent years, with innovative design strategies—such as the widely used floating drug delivery system—playing a major role. GRDDS offer several advantages, including the ability to provide drugs with a narrow absorption window, improved pharmacological effects, reduced dosing frequency, enhanced bioavailability, and prolonged drug residence in the stomach for local effects such as the treatment of peptic ulcer disease. This study provides a brief introduction to gastro-retentive drug delivery, covering its necessity, advantages, disadvantages, influencing factors, approaches, and applications.
3.The effect of tumor resection on intestinal microbiota dysbiosis in patients with right-sided colon cancer
Aldhimas Marthsyal PRATIKNA ; M. Iqbal RIVAI ; Rini SUSWITA ; Andani Eka PUTRA ; Irwan Abdul RACHMAN ; Avit SUCHITRA
Annals of Coloproctology 2025;41(1):47-56
Purpose:
This study aimed to determine the effect of tumor resection on dysbiosis of the intestinal microbiota in patients with right-sided colon cancer.
Methods:
This study utilized a longitudinal design to explore the outcomes of patients diagnosed with right-sided colon cancer who underwent surgical resection at Dr. M. Djamil General Hospital from July to December 2023. We excluded patients with a documented history of comorbidities, specifically those affecting the digestive system. To compare the microbiota (genus and phylum) between patients with right-sided colon cancer and the control group, we conducted bivariate analyses using the independent t-test or Mann-Whitney test. Furthermore, we employed the dependent t-test or Wilcoxon test to assess changes in the dysbiosis of the microbiota (genus and phylum) before and after resection. A P-value of <0.05 was considered statistically significant.
Results:
This study included a total of 21 patients diagnosed with right-sided colon cancer. In the control group, Bacteroidetes constituted the highest proportion of intestinal microbiota, accounting for 56.34%. Prior to tumor resection, the intestinal microbiota of patients exhibited Proteobacteria as the predominant phylum, representing 52.97%. Following tumor resection, Bacteroidetes remained the most prevalent, comprising 50.9% of the intestinal microbiota. Significant variations in the levels of Proteobacteria, Verrucomicrobia, and Cyanobacteria/Chloroplast were observed in the intestinal microbiota of patients with right-sided colorectal cancer before and after tumor excision (all P=0.001).
Conclusion
The microbiome of patients with right-sided colorectal cancer differed significantly from that of the control group. However, following tumor resection, the microbiome composition of these patients became more similar to that observed in the control group.
4.The effect of tumor resection on intestinal microbiota dysbiosis in patients with right-sided colon cancer
Aldhimas Marthsyal PRATIKNA ; M. Iqbal RIVAI ; Rini SUSWITA ; Andani Eka PUTRA ; Irwan Abdul RACHMAN ; Avit SUCHITRA
Annals of Coloproctology 2025;41(1):47-56
Purpose:
This study aimed to determine the effect of tumor resection on dysbiosis of the intestinal microbiota in patients with right-sided colon cancer.
Methods:
This study utilized a longitudinal design to explore the outcomes of patients diagnosed with right-sided colon cancer who underwent surgical resection at Dr. M. Djamil General Hospital from July to December 2023. We excluded patients with a documented history of comorbidities, specifically those affecting the digestive system. To compare the microbiota (genus and phylum) between patients with right-sided colon cancer and the control group, we conducted bivariate analyses using the independent t-test or Mann-Whitney test. Furthermore, we employed the dependent t-test or Wilcoxon test to assess changes in the dysbiosis of the microbiota (genus and phylum) before and after resection. A P-value of <0.05 was considered statistically significant.
Results:
This study included a total of 21 patients diagnosed with right-sided colon cancer. In the control group, Bacteroidetes constituted the highest proportion of intestinal microbiota, accounting for 56.34%. Prior to tumor resection, the intestinal microbiota of patients exhibited Proteobacteria as the predominant phylum, representing 52.97%. Following tumor resection, Bacteroidetes remained the most prevalent, comprising 50.9% of the intestinal microbiota. Significant variations in the levels of Proteobacteria, Verrucomicrobia, and Cyanobacteria/Chloroplast were observed in the intestinal microbiota of patients with right-sided colorectal cancer before and after tumor excision (all P=0.001).
Conclusion
The microbiome of patients with right-sided colorectal cancer differed significantly from that of the control group. However, following tumor resection, the microbiome composition of these patients became more similar to that observed in the control group.
5.The effect of tumor resection on intestinal microbiota dysbiosis in patients with right-sided colon cancer
Aldhimas Marthsyal PRATIKNA ; M. Iqbal RIVAI ; Rini SUSWITA ; Andani Eka PUTRA ; Irwan Abdul RACHMAN ; Avit SUCHITRA
Annals of Coloproctology 2025;41(1):47-56
Purpose:
This study aimed to determine the effect of tumor resection on dysbiosis of the intestinal microbiota in patients with right-sided colon cancer.
Methods:
This study utilized a longitudinal design to explore the outcomes of patients diagnosed with right-sided colon cancer who underwent surgical resection at Dr. M. Djamil General Hospital from July to December 2023. We excluded patients with a documented history of comorbidities, specifically those affecting the digestive system. To compare the microbiota (genus and phylum) between patients with right-sided colon cancer and the control group, we conducted bivariate analyses using the independent t-test or Mann-Whitney test. Furthermore, we employed the dependent t-test or Wilcoxon test to assess changes in the dysbiosis of the microbiota (genus and phylum) before and after resection. A P-value of <0.05 was considered statistically significant.
Results:
This study included a total of 21 patients diagnosed with right-sided colon cancer. In the control group, Bacteroidetes constituted the highest proportion of intestinal microbiota, accounting for 56.34%. Prior to tumor resection, the intestinal microbiota of patients exhibited Proteobacteria as the predominant phylum, representing 52.97%. Following tumor resection, Bacteroidetes remained the most prevalent, comprising 50.9% of the intestinal microbiota. Significant variations in the levels of Proteobacteria, Verrucomicrobia, and Cyanobacteria/Chloroplast were observed in the intestinal microbiota of patients with right-sided colorectal cancer before and after tumor excision (all P=0.001).
Conclusion
The microbiome of patients with right-sided colorectal cancer differed significantly from that of the control group. However, following tumor resection, the microbiome composition of these patients became more similar to that observed in the control group.
6.Gastro-retentive drug delivery systems: Modern insights on approaches and applications
Rozinaparvin Iqbal PATEL ; Chainesh SHAH ; Nidhi CHAUHAN ; Umesh UPADHYAY
International Journal of Gastrointestinal Intervention 2025;14(2):43-50
The pharmaceutical research sector is highly interested in oral gastro-retentive dose formulations. The significance of gastro-retentive drug delivery systems (GRDDS) has grown as these systems enhance patient compliance and improve the therapeutic indices of medications. Various technical advancements in the design and production of gastro-retentive dosage forms can overcome physiological limitations, such as short gastric retention time and fluctuations in stomach emptying. Medications with shorter half-lives, instability or poor solubility at alkaline pH, or inadequate absorption in the lower gastrointestinal tract can greatly benefit from GRDDS. To achieve the desired retention period and release pattern, these systems can be developed using a range of innovative methods, including magnetic, bioadhesive, expandable, and floating systems. The use of GRDDS for oral drug administration has significantly increased in recent years, with innovative design strategies—such as the widely used floating drug delivery system—playing a major role. GRDDS offer several advantages, including the ability to provide drugs with a narrow absorption window, improved pharmacological effects, reduced dosing frequency, enhanced bioavailability, and prolonged drug residence in the stomach for local effects such as the treatment of peptic ulcer disease. This study provides a brief introduction to gastro-retentive drug delivery, covering its necessity, advantages, disadvantages, influencing factors, approaches, and applications.
7.Efficacy of Amitriptyline in Irritable Bowel Syndrome:A Systematic Review and Meta-analysis
Minahil IQBAL ; Sara HIRA ; Humza SAEED ; Sufyan SHAHID ; Suha T BUTT ; Kamran RASHID ; Mohammad AHMAD ; Hammad HUSSAIN ; Anzalna MUGHAL ; Gabriel P A COSTA ; Fernanda GUSHKEN ; Neil NERO ; Shreya SENGUPTA ; Akhil ANAND
Journal of Neurogastroenterology and Motility 2025;31(1):28-37
Background/Aims:
Amitriptyline is prescribed off-label for irritable bowel syndrome (IBS). We conducted a meta-analysis to assess its efficacy.
Methods:
A systematic literature review was conducted until November 10, 2023, using MEDLINE, Embase, Cochrane Library, and Web of Science to study the efficacy of amitriptyline in patients with IBS. We included all randomized controlled trials that compared amitriptyline to placebo. Revised Cochrane risk-of-bias tool was used to assess the quality of studies. Meta-analyses were performed using a bivariate random-effects model. Statistical analyses were performed using R Software 4.2.3 and heterogeneity was assessed with I 2 statistics.
Results:
Seven trials were included with 796 patients (61% female). Amitriptyline was associated with better treatment response (OR, 5.30; 95% CI, 2.47 to 11.39; P < 0.001), reduced Irritable Bowel Syndrome Symptom Severity Scores (MD, –50.72; 95% CI, –94.23 to –7.20; P = 0.020) and improved diarrhea (OR, 10.55; 95% CI, 2.90 to 38.41; P < 0.001). No significant difference between the 2 groups regarding the adverse effects was observed. Three trials showed an overall low risk of bias, 2 trials showed an overall high risk of bias due to randomization and missing data, and 2 trials had some concerns regarding missing data.
Conclusions
Amitriptyline was found to be well-tolerated and effective in treating IBS compared to placebo. These findings support the use of amitriptyline for the management of IBS, particularly among patients with the IBS diarrhea subtype. Future research should focus on the dose-dependent effects of amitriptyline in IBS to better guide clinicians in personalized titration regimens.
8.The effect of tumor resection on intestinal microbiota dysbiosis in patients with right-sided colon cancer
Aldhimas Marthsyal PRATIKNA ; M. Iqbal RIVAI ; Rini SUSWITA ; Andani Eka PUTRA ; Irwan Abdul RACHMAN ; Avit SUCHITRA
Annals of Coloproctology 2025;41(1):47-56
Purpose:
This study aimed to determine the effect of tumor resection on dysbiosis of the intestinal microbiota in patients with right-sided colon cancer.
Methods:
This study utilized a longitudinal design to explore the outcomes of patients diagnosed with right-sided colon cancer who underwent surgical resection at Dr. M. Djamil General Hospital from July to December 2023. We excluded patients with a documented history of comorbidities, specifically those affecting the digestive system. To compare the microbiota (genus and phylum) between patients with right-sided colon cancer and the control group, we conducted bivariate analyses using the independent t-test or Mann-Whitney test. Furthermore, we employed the dependent t-test or Wilcoxon test to assess changes in the dysbiosis of the microbiota (genus and phylum) before and after resection. A P-value of <0.05 was considered statistically significant.
Results:
This study included a total of 21 patients diagnosed with right-sided colon cancer. In the control group, Bacteroidetes constituted the highest proportion of intestinal microbiota, accounting for 56.34%. Prior to tumor resection, the intestinal microbiota of patients exhibited Proteobacteria as the predominant phylum, representing 52.97%. Following tumor resection, Bacteroidetes remained the most prevalent, comprising 50.9% of the intestinal microbiota. Significant variations in the levels of Proteobacteria, Verrucomicrobia, and Cyanobacteria/Chloroplast were observed in the intestinal microbiota of patients with right-sided colorectal cancer before and after tumor excision (all P=0.001).
Conclusion
The microbiome of patients with right-sided colorectal cancer differed significantly from that of the control group. However, following tumor resection, the microbiome composition of these patients became more similar to that observed in the control group.
9.The effect of tumor resection on intestinal microbiota dysbiosis in patients with right-sided colon cancer
Aldhimas Marthsyal PRATIKNA ; M. Iqbal RIVAI ; Rini SUSWITA ; Andani Eka PUTRA ; Irwan Abdul RACHMAN ; Avit SUCHITRA
Annals of Coloproctology 2025;41(1):47-56
Purpose:
This study aimed to determine the effect of tumor resection on dysbiosis of the intestinal microbiota in patients with right-sided colon cancer.
Methods:
This study utilized a longitudinal design to explore the outcomes of patients diagnosed with right-sided colon cancer who underwent surgical resection at Dr. M. Djamil General Hospital from July to December 2023. We excluded patients with a documented history of comorbidities, specifically those affecting the digestive system. To compare the microbiota (genus and phylum) between patients with right-sided colon cancer and the control group, we conducted bivariate analyses using the independent t-test or Mann-Whitney test. Furthermore, we employed the dependent t-test or Wilcoxon test to assess changes in the dysbiosis of the microbiota (genus and phylum) before and after resection. A P-value of <0.05 was considered statistically significant.
Results:
This study included a total of 21 patients diagnosed with right-sided colon cancer. In the control group, Bacteroidetes constituted the highest proportion of intestinal microbiota, accounting for 56.34%. Prior to tumor resection, the intestinal microbiota of patients exhibited Proteobacteria as the predominant phylum, representing 52.97%. Following tumor resection, Bacteroidetes remained the most prevalent, comprising 50.9% of the intestinal microbiota. Significant variations in the levels of Proteobacteria, Verrucomicrobia, and Cyanobacteria/Chloroplast were observed in the intestinal microbiota of patients with right-sided colorectal cancer before and after tumor excision (all P=0.001).
Conclusion
The microbiome of patients with right-sided colorectal cancer differed significantly from that of the control group. However, following tumor resection, the microbiome composition of these patients became more similar to that observed in the control group.
10.Gastro-retentive drug delivery systems: Modern insights on approaches and applications
Rozinaparvin Iqbal PATEL ; Chainesh SHAH ; Nidhi CHAUHAN ; Umesh UPADHYAY
International Journal of Gastrointestinal Intervention 2025;14(2):43-50
The pharmaceutical research sector is highly interested in oral gastro-retentive dose formulations. The significance of gastro-retentive drug delivery systems (GRDDS) has grown as these systems enhance patient compliance and improve the therapeutic indices of medications. Various technical advancements in the design and production of gastro-retentive dosage forms can overcome physiological limitations, such as short gastric retention time and fluctuations in stomach emptying. Medications with shorter half-lives, instability or poor solubility at alkaline pH, or inadequate absorption in the lower gastrointestinal tract can greatly benefit from GRDDS. To achieve the desired retention period and release pattern, these systems can be developed using a range of innovative methods, including magnetic, bioadhesive, expandable, and floating systems. The use of GRDDS for oral drug administration has significantly increased in recent years, with innovative design strategies—such as the widely used floating drug delivery system—playing a major role. GRDDS offer several advantages, including the ability to provide drugs with a narrow absorption window, improved pharmacological effects, reduced dosing frequency, enhanced bioavailability, and prolonged drug residence in the stomach for local effects such as the treatment of peptic ulcer disease. This study provides a brief introduction to gastro-retentive drug delivery, covering its necessity, advantages, disadvantages, influencing factors, approaches, and applications.

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