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- Drossman, D. A., et al.
(författare)
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Neuromodulators for Functional Gastrointestinal Disorders (Disorders of Gut−Brain Interaction): A Rome Foundation Working Team Report
- 2018
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Ingår i: Gastroenterology. - : Elsevier BV. - 0016-5085 .- 1528-0012. ; 154:4
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Tidskriftsartikel (refereegranskat)abstract
- Background & Aims: Central neuromodulators (antidepressants, antipsychotics, and other central nervous system−targeted medications) are increasingly used for treatment of functional gastrointestinal disorders (FGIDs), now recognized as disorders of gut−brain interaction. However, the available evidence and guidance for the use of central neuromodulators in these conditions is scanty and incomplete. In this Rome Foundation Working Team report, a multidisciplinary team summarized available research evidence and clinical experience to provide guidance and treatment recommendations. Methods: The working team summarized the literature on the pharmacology of central neuromodulators and their effects on gastrointestinal sensorimotor function and conducted an evidence-based review on their use for treating FGID syndromes. Because of the paucity of data for FGIDs, we included data for non-gastrointestinal painful disorders and specific symptoms of pain, nausea, and vomiting. This information was combined into a final document comprising a synthesis of available evidence and recommendations for clinical use guided by the research and clinical experience of the experts on the committee. Results: The evidence-based review on neuromodulators in FGID, restricted by the limited available controlled trials, was integrated with open-label studies and case series, along with the experience of experts to create recommendations using a consensus (Delphi) approach. Due to the diversity of conditions and complexity of treatment options, specific recommendations were generated for different FGIDs. However, some general recommendations include: (1) low to modest dosages of tricyclic antidepressants provide the most convincing evidence of benefit for treating chronic gastrointestinal pain and painful FGIDs and serotonin noradrenergic reuptake inhibitors can also be recommended, though further studies are needed; (2) augmentation, that is, adding a second treatment (adding quetiapine, aripiprazole, buspirone α2δ ligand agents) is recommended when a single medication is unsuccessful or produces side effects at higher dosages; (3) treatment should be continued for 6−12 months to potentially prevent relapse; and (4) implementation of successful treatment requires effective communication skills to improve patient acceptance and adherence, and to optimize the patient−provider relationship. Conclusions: Based on systematic and selectively focused review and the consensus of a multidisciplinary panel, we have provided summary information and guidelines for the use of central neuromodulators in the treatment of chronic gastrointestinal symptoms and FGIDs. Further studies are needed to confirm and refine these recommendations.
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- Droste, E. S., et al.
(författare)
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The influence of tides on the marine carbonate chemistry of a coastal polynya in the south-eastern Weddell Sea
- 2022
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Ingår i: Ocean Science. - : Copernicus GmbH. - 1812-0784 .- 1812-0792. ; 18:5, s. 1293-1320
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Tidskriftsartikel (refereegranskat)abstract
- Tides significantly affect polar coastlines by modulating ice shelf melt and modifying shelf water properties through transport and mixing. However, the effect of tides on the marine carbonate chemistry in such regions, especially around Antarctica, remains largely unexplored. We address this topic with two case studies in a coastal polynya in the south-eastern Weddell Sea, neighbouring the Ekstrom Ice Shelf. The case studies were conducted in January 2015 (PS89) and January 2019 (PS117), capturing semi-diurnal oscillations in the water column. These are pronounced in both physical and biogeochemical variables for PS89. During rising tide, advection of sea ice meltwater from the north-east created a fresher, warmer, and more deeply mixed water column with lower dissolved inorganic carbon (DIC) and total alkalinity (TA) content. During ebbing tide, water from underneath the ice shelf decreased the polynya's temperature, increased the DIC and TA content, and created a more stratified water column. The variability during the PS117 case study was much smaller, as it had less sea ice meltwater input during rising tide and was better mixed with sub-ice shelf water. The contrasts in the variability between the two case studies could be wind and sea ice driven, and they underline the complexity and highly dynamic nature of the system. The variability in the polynya induced by the tides results in an air-sea CO2 flux that can range between a strong sink (-24 mmol m(-2) d(-1)) and a small source (3 mmol m(-2) d(-1)) on a semi-diurnal timescale. If the variability induced by tides is not taken into account, there is a potential risk of overestimating the polynya's CO2 uptake by 67 % or underestimating it by 73 %, compared to the average flux determined over several days. Depending on the timing of limited sampling, the polynya may appear to be a source or a sink of CO2. Given the disproportionate influence of polynyas on heat and carbon exchange in polar oceans, we recommend future studies around the Antarctic and Arctic coastlines to consider the timing of tidal currents in their sampling strategies and analyses. This will help constrain variability in oceanographic measurements and avoid potential biases in our understanding of these highly complex systems.
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- Droste, Heiko, 1963-
(författare)
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Adler Salvius, Johan
- 2008
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Ingår i: Hamburgische Biografie. - Göttingen : Wallstein Verlag. - 9783835302297 ; , s. 14-15
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Bokkapitel (refereegranskat)
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