BACKGROUND The presence of small air bubbles and foam are an impediment to a successful colonoscopy. They impair an endoscopist’s view and diminish the diagnostic accuracy of the study. This has been particularly noted to be of concern with the switch to lower volume polyethylene glycol (PEG) and bisacodyl combination preparation. AIM To evaluate the effect of oral simethicone addition to bowel preparation on intraluminal bubbles reduction during colonoscopy. METHODS Described is a prospective, randomized, multi-center, double-blinded, placebo-controlled study to evaluate the use of premixed simethicone formulation with split-regimen, low-volume PEG-bisacodyl combination bowel preparation for 168 outpatients undergoing screening, surveillance, and diagnostic colonoscopies. Primary outcome includes evaluation of bubbles during colonoscopy graded using the Intraluminal Bubbles Scale. Secondary outcomes include evaluation of the Boston Bowel Preparation Scale (BBPS), total number of polyps, polyp size differentiation, polyp laterality, adenoma detection, mass detection, cecal insertion time, withdrawal time, and patient-reported adverse events. RESULTS Higher Intraluminal Bubbles grades III and IV (less than 75% of the mucosa cleared of bubbles/foam requiring intervention with simethicone infused wash) were detected in the placebo group [Simethicone n = 4/84 vs Placebo n = 20/84 ( P = 0.007)]. BBPS total score was 7.42 [standard deviation (SD) = ± 1.51] in the simethicone group and 7.28 (SD = ± 1.44) in the placebo group ( P = 0.542) from a total of 9. Significantly higher number of adenomas were detected in the simethicone group ( P = 0.001). CONCLUSION The addition of simethicone to bowel preparation is well advised for its anti-foaming properties. The results of this study suggest that addition of oral simethicone can improve bowel wall visibility.

BackgroundStrategies to reduce toxicity of Methotrexate (MTX) have been receiving increasing attention. One strategy backed by good evidence is folic acid supplementation. However, its optimum dose is not known. Although guidelines suggest 5-10mg per week; this is based on weak evidence.1 Indeed, only one clinical trial has compared different doses; but was done 20 yrs ago using low MTX doses.2 Also, effect of folic acid on efficacy of MTX unclear.ObjectivesTo compare the effect of folic acid at dosages of 10 or 30 mg per week on MTX toxicity and efficacy in patients with rheumatoid arthritis.MethodsPatients included in this double blind randomized controlled trial were started on MTX at 10mg/week which was escalated every two weeks by 2.5 mg till 25 mg per week till 24 weeks. This escalation was based on ongoing disease activity and absence of toxicity evaluated every 8 weeks. They were randomized in a ratio of 1:1 to receive either folic acid 10 mg or 30 mg per week. Patients in the first group recieved two tablets of 5mg folic acid (and four tablets of placebo) and in the second group recieved six tablets of 5 mg folic acid for each week of the study. Patients took one tablet daily except on the day they took MTX. Co-primary endpoints were incidence of toxicity and change in disease activity at 24 weeks. Toxicity included undesirable symptoms (by questionnaire) and laboratory abnormalities including cytopenias (thrombocytopenia or leucopenia) and transaminitis (twice upper limit of normal). Secondary outcomes were change in level of RBC (and serum) folic acid levels at 24 weeks (from baseline) and change in the functional status of patients. Trial # NCT01583959ResultsThis study included 100 RA patients (F:M=86:14) with mean age 44.3 (±10.9) yrs, disease duration 4.8 (±4.7) yrs, RF+ in 73 and anti-CCP+ in 84. Among these, 51 received folic acid 10 mg per week (FA10) and 49 received 30 mg per week (FA30). By 24 weeks, there were 6 patient withdrawals in either group. Mean methotrexate dose at 24 weeks was 22.8±4.4 and 21.4±4.6mg in FA10 and FA30 respectively (p=0.1). There was no singificant difference in occurrence of undesirable symptoms between groups, although they were numerically higher in the 30 mg folic acid group (Figure 1). There was also no difference in frequency of transaminitis (42.6, 45.7%, p=0.7) or cytopenias (4.3, 4.3%, p=0.9). At 24 weeks, DAS28(3) declined in both groups by a similar extent (-1.1±1.0, -1.3±1.0, p=0.2) and EULAR good or moderate response occurred in 56.9 and 67.4% in FA10 and FA30 (p=0.3). Serum folic acid levels increased in both groups. At 24 weeks serum folic acid levels were higher in the 30mg group (20.4±17.1, 45.1±39.7ng/ml, p<0.001). HAQ declined significantly and similarly in both groups (-0.3±0.5, -0.4±0.4, p=0.27)ConclusionsOur results suggest that supplementation of 5-10 mg folic acid is sufficient when using MTX in RA even at currently used dosages. However, apart from there being no additional benefit of a higher dose of folic acid; it also did not lead to reductio...

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PURPOSE: Psychiatric disorders and abnormal personality traits are commonly identified in patients complaining of fatigue, most of whom can be diagnosed to have depressive (D), anxiety (A), somatoform (S) or eating (E) disorders. This study was designed to determine the relationship between the prevalence of severe fatigue and the presence of personality pathology in individuals with these psychiatric disorders. METHODS: We analyzed 1197 referrals to an academic psychosomatic medicine outpatient unit. All patients underwent highly structured standardized psychometric and clinical assessments which allowed the categorical classification into D, A, S, and E groups. Within each group, the self-scored severity of fatigue experienced during the week preceding the evaluation was compared for patients with and without personality disorders (P). RESULTS: The one-week prevalence of severe fatigue was 38% in D (N ϭ 324) and 45% in D ϩ P (N ϭ 139), p ϭ NS; 29% in A (N ϭ 216) and 29% in A ϩ P (N ϭ 79), p ϭ NS; 33% in E (N ϭ 99) and 32% in E ϩ P (N ϭ 53), p ϭ NS; and 20% in S (N ϭ 209) and 34% in S ϩ P (N ϭ 78), p Ͻ .01. The difference in fatigue severity was ϩ 5% for D ϩ P vs D (p ϭ NS), ϩ 1% for A ϩ P vs A (p ϭ NS), Ϫ 2% for E ϩ P vs E (p ϭ NS) and 32% for S ϩ P vs S (p Ͻ .01). The greater severity of fatigue had a significant contribution to the difference in the 14-item index of somatic distress only for S vs S ϩ P (p ϭ .03) CONCLUSION: Severe fatigue may be a marker of personality pathology in patients with unexplained somatic complaints who do not suffer from depressive, anxiety or eating disorders. SOMATIC DISTRESS OF THE MENTALLY ILL AND ITS RELATIONSHIP TO PERSONALITY DISORDERS.N Schmitz, N Hartkamp, W Tress, M Franz, P Manu, Department of Psychosomatics and Psychoterapy, Heinrich-Heine-University, Duesseldorf, Germany; Department of Medicine and Department of Psychiatry, Long Island Jewish Medical Center, Glen Oaks, NY PURPOSE: Personality disorders are often invoked by clinicians as a contributing factor to the severity of physical complaints of psychiatric patiens, but the scientific support for this asociation is scant. This study was designed to determine the relationship between somatic distress and the presence of personality pathology in individuals with well-defined psychiatric disorders. METHODS: We analyzed 1437 consective referrals to an academic psychosomatic outpatient unit. Standardized psychometric and clinical evaluations were used to diagnose personality (P), depressive (D), anxiety (A), and somatoform (S) disorders. The assessment of somatic distress was based on the self-rating of the severity of 14 somatic experiences (SE) during the week preceding the evaluation. RESULTS: Compared with D (N ϭ 324), A (N ϭ 216) and S (N ϭ 209), patients with P (N ϭ 392) indicated the lowest severity of somatic distress (p ϭ .001). Patients with the comorbid associations D ϩ P (N ϭ 139) and A ϩ P (N ϭ 79) had experienced milder somatic distress than those with D or A alone (p ϭ .007). In contrast, patients with S...