BackgroundCritical limb ischaemia (CLI) is a severe manifestation of peripheral arterial disease, characterised by chronic ischaemic rest pain, ulcers or gangrene. Management of ischaemic pain is challenging in patients with no options for revascularisation and optimal pharmacological therapies have not been established.ObjectivesTo identify and evaluate the effectiveness of pharmacological therapies to treat ischaemic pain secondary to non-reconstructable CLI.MethodsThis systematic review was reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Comprehensive searches of three electronic databases, a PubMed-related articles link search, grey literature search and hand-searches of the bibliographies of relevant papers and textbooks were performed. Studies recruiting adult patients with CLI of any aetiology were eligible for inclusion. Surgical and revascularisation procedures, and all invasive interventions were excluded.ResultsOf 792 studies, six met full inclusion criteria. These studies researched the use of intravenous lidocaine, intravenous ketamine, oral gabapentin and the combination of transdermal buprenorphine and epidural morphine/ropivacaine infusion. All studies showed an improvement in severity of ischaemic pain in CLI but with varying side effect profiles and quality. The extracted studies showed substantial heterogeneity and therefore a meta-analysis was not performed.ConclusionThe pharmacological management of pain secondary to non-reconstructable CLI is a challenging review topic. No recommendations of pharmacological agents can be made following this review but a number of novel approaches to manage pain in this cohort have shown positive results and require further investigation.

From this review, we identified a significant gap in research into the palliation of rectal tenesmus. A multimodal approach may be necessary due to the complexity of the pathophysiology of tenesmus. Future research should focus on randomised controlled trials of drug therapies whose potential effectiveness is suggested by case series.

Background/AimsMany patients with functional gastrointestinal disorders (FGIDs) rank sensations of bloating and distension among their most debilitating symptoms. Previous studies that have examined intestinal gas volume (IGV) in patients with FGIDs have employed a variety of invasive and imaging techniques. These studies are limited by small numbers and have shown conflicting results. The aim of our study was to estimate, using CT of the abdomen and pelvis (CTAP), IGV in patients attending FGID clinic and to compare IGV in patients with and without FGID.MethodsAll CTAP (n = 312) performed on patients (n = 207) attending a specialized FGID clinic over 10-year period were included in this study. Patients were classified into one of 3 groups according to the established clinical grading system, as organic gastrointestinal disorder (OGID, ie, patients with an organic non-functional disorder, n = 84), FGID (n = 36) or organic and functional gastrointestinal disorder (OFGID, ie, patients with an organic and a functional disorder, n = 87). Two independent readers blinded to the diagnostic group calculated IGV using threshold based 3D region growing with OsiriX.ResultsMedian IGVs for the FGID, OGID, and OFGID groups were 197.6, 220.6 and 155.0 mL, respectively. Stepwise linear regression revealed age at study, gender, and calculated body mass index to predict the log IGV with an r2 of 0.116, and P < 0.001. There was a significant positive correlation between age and IGV in OGID (Spearman's = 0.253, P = 0.02) but this correlation was non-significant in the other groups.ConclusionsAlthough bloating is a classic symptom in FGID patients, IGV may not be increased compared with OGID and OFGID patients.

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arm (iv) Trial procedures -determine the appropriate primary outcome, adherence/compliance rates Implications We aim to determine whether this approach is feasible and warrants further investigation in a larger randomised Phase II trial leading to a confirmatory multi-centre randomised Phase III trial to include a cost-effectiveness appraisal.