Medical Bulletin 29/January/2024

Here are the top medical news of the day:

Ebastine provides subjective relief among patients with non-constipated IBS

Ebastine may provide subjective relief among patients with non-constipated IBS suggests a new study published in the Gut.

They evaluated the histamine 1 receptor antagonist ebastine as a potential treatment for patients with non-constipated irritable bowel syndrome (IBS) in a randomised, placebo-controlled phase 2 study. Non-constipated patients with IBS fulfilling the Rome III criteria were randomly assigned to 20 mg ebastine or placebo for 12 weeks. Subjects scored global relief of symptoms (GRS) and abdominal pain intensity (API). A subject was considered a weekly responder for global relief of symptoms if total or obvious relief was reported and a responder for abdominal pain intensity if the weekly average pain score was reduced by at least 30% vs baseline.

The primary endpoints were the proportion of subjects who were weekly responders for at least 6 out of the 12 treatment weeks for both global relief of symptoms and abdominal pain intensity 'GRS+API', composite endpoint) and for global relief of symptoms and abdominal pain intensity separately. Results: 202 participants (32±11 years, 68% female) were randomly allocated to receive ebastine (n=101) or placebo (n=101).

Treatment with ebastine resulted in significantly more responders (12%, 12/92) for global relief of symptoms+abdominal pain intensity compared with placebo (4%, 4/87, p=0.047) while the proportion of responders for global relief of symptoms and abdominal pain intensity separately was higher for ebastine compared with placebo, although not statistically significant (placebo vs ebastine, global relief of symptoms: 7% (6/87) vs 15%.

The study shows that ebastine is superior to placebo and should be further evaluated as a novel treatment for patients with non-constipated IBS.

Reference: Decraecker L, De Looze D, Hirsch DP, De Schepper H, Arts J, Caenepeel P, Bredenoord AJ, Kolkman J, Bellens K, Van Beek K, Pia F, Peetermans W, Vanuytsel T, Denadai-Souza A, Belmans A, Boeckxstaens G. Treatment of non-constipated irritable bowel syndrome with the histamine 1 receptor antagonist ebastine: a randomised, double-blind, placebo-controlled trial. Gut. 2024 Jan 8:gutjnl-2023-331634. doi: 10.1136/gutjnl-2023-331634. Epub ahead of print. PMID: 38191268.

Excessive gestational weight gain to cause higher risk of mortality in women

A recent study published in The Lancet revealed that excessive weight gain during pregnancy was associated with a 9% to 12% increase in all-cause mortality risk in women with BMI in the normal and overweight range respectively.

Weight gain is a common phenomenon during pregnancy, but excessive gain may be a sign of adverse health issues for mothers.

According to a study of pregnant women with low-risk pregnancy complications in Singapore, approximately 60% of them either gained too little or too much weight during pregnancy. Exceeding the recommended weight gain was associated with a higher risk of caesarean section (C-section) deliveries and the birth of larger babies – rendering this an increasingly alarming issue to be studied.

The impact of such weight gain is usually associated with greater postpartum weight retention, and pregnancy complications such as gestational diabetes, and pregnancy-induced hypertension, as well as a higher chance of requiring a C-section. However, its long-term implications have hitherto remained unknown.

Professor Cuilin Zhang from the Department of Gynaecology and Obstetrics at the Yong Loo Lin School of Medicine, National University of Singapore (NUS Medicine), and Director of the Global Center for Asian Women’s Health (GloW) at NUS Medicine and colleagues from the University of Pennsylvania and the US National Institutes of Health have investigated the association between weight gain during pregnancy, and mortality rate, with a follow-up period of over 50 years.

Excessive weight gain for women with a pre-pregnancy BMI in the underweight and normal range led to an 84% and 20% increased risk of mortality from cardiovascular disease respectively. At the same time, women with a BMI in the overweight range held a 77% increased risk of mortality from diabetes.

Considering current knowledge and the phenomenon of weight gain during pregnancy, the lack of studies and information on this renders the novel findings critical. The findings from this large well-characterised study, with more than 50 years of follow-up data, provide important evidence on the significance of women’s health for reproduction and their overall long-term health, wellbeing, and longevity.

“Promoting women’s health and achieving healthy longevity should start early in women’s lives. In particular, women’s health at their reproductive age and during pregnancy, are critical time windows that have long-term health impacts over their lifespan, as well as intergenerational impact on the offspring and the family,” said Prof Zhang, the principal investigator and last author of the study.

Reference: Stefanie N Hinkle, Prof Sunni L Mumford, Prof Katherine L Grantz, Prof Pauline Mendola, Gestational weight change in a diverse pregnancy cohort and mortality over 50 years: a prospective observational cohort study