We examined the effects of chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA) on fasting motility patterns and transit in ileocolonic loops of 5 dogs. Animals were prepared with isolated loops (40 cm ileum and 5 cm colon) which maintained neuromuscular continuity with the intact bowel through a bridge of tunica muscularis. Myoelectrical activity was recorded from multiple serosal, monopolar electrodes and muscle contractions recorded from serosal strain gauges; fluid transit was assessed by continuous perfusion (1.4 ml min^-1) of solutions containing polyethylene glycol 4000 marker, with or without bile acids. Saline perfusion did not disturb the fasting cycle of motility and mean cycle length in unperfused (106 ± 7 min) loop was the same as during perfusion of saline (108 ± 9 min). Bile acids abolished interdigestive cycles in 11 of 12 experiments, fasting patterns returned 64–106 min after bile acid perfusion was stopped. The fasting pattern continued to cycle normally in the proximal small bowel during bile acid perfusion. CDCA (15 mM) stimulated the occurrence of propulsive contractions of long duration. Bile acids shortened transit time through the loops and altered the pattern of flow towards a more continuous, steady stream. These effects of bile acids on ileal motility, like those described previously in the colon, could play a role in bile acid diarrhea.

Introduction: There is concern that glucagon-like peptide-1 (GLP1) receptor agonists may be associated with acute pancreatitis. The data from the ABCD nationwide liraglutide audit (November 2009-June 2013; 6010 patients) provide an opportunity to assess the extent of the problem in routine clinical practice in the UK. Methods: At every patient visit, audit-contributors were invited to submit, via an electronic form, clinical data collected as part of routine clinical practice, including data on possible side effects of treatment. Cases of 'possible pancreatitis' were identified and we contacted the centres concerned to obtain full details. Results: To date, the audit has monitored 3720 years of exposure to liraglutide. There were four cases of possible pancreatitis documented from the 6010 patients on liraglutide: three patients had likely causes of pancreatitis identified and one patient had no aetiological cause. This sole case represents an incidence of 0.027/100 patient-years of exposure to liraglutide. Conclusion: In cases of acute pancreatitis of a patient on liraglutide, if another cause can be found (usually gall stones associated with obesity), the drug is not be necessarily culpable. People with Type 2 diabetes are at greater risk of acute pancreatitis (hazard ratio between 1.5 and 2.8). Thus, the possibility of liraglutide-associated pancreatitis in 'real-world' clinical practice (0.027/100 patient years) represents a very small risk.

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Introduction Fragmented care overwhelmingly affects populations with multimorbid chronic conditions, like systemic lupus erythematosus (SLE). However, strategies to mitigate care fragmentation typically focus on singular disease frameworks with insufficient evidence regarding approaches for individuals with two or more concurrent chronic conditions (multimorbidity). This review explores the literature to identify the (C)ontextual influences, underlying (M)echanisms, and associated (O)utcomes of fragmented care prevention in SLE and other multimorbid conditions. Methods A realist review was applied to systematically examine literature, including the search of >1300 published articles focused on SLE and multimorbidity, continuity of care, and approaches to mitigate fragmented care. The analysis was guided by care continuity elements and organized by fragmented care concepts explicated by the MacColl Institute for Healthcare Innovations Care Coordination Model and further grouped for context–mechanism–outcome (CMO) configurations. Results Fourteen articles met inclusion/exclusion criteria and were included in the sample to illustrate the relationship between C-M-O for approaches focused on fragmented care prevention. Favorable outcomes in mechanisms that produced positive responses to resources relevant to fragmented care prevention included 1) opportunities for exposure and negotiation within professional teams, 2) structured health education, role clarity, and access to adherence services for patients, and 3) awareness of workflow waste and use of clinical algorithms. Discussion Review findings suggest using a multidimensional approach to mitigate fragmented care in SLE and other multimorbid conditions. Multidimensional approaches should focus on shared decision-making, social support, social–cultural–economic factors, patient engagement, and technological infrastructure to support the complex care needs of the multimorbid patient.

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