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Jo IH, Paik CN, Lee JM, Song DS, Kim YJ. Effect of Trimebutine and Rifaximin on Breath Hydrogen and Methane by Glucose Breath Test in Patients With Functional Bloating: A Randomized Double-blind Clinical Trial. J Neurogastroenterol Motil 2024; 30:220-228. [PMID: 38576371 PMCID: PMC10999843 DOI: 10.5056/jnm23029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/22/2023] [Accepted: 09/12/2023] [Indexed: 04/06/2024] Open
Abstract
Background/Aims Drugs that stabilize intestinal motility may improve the efficacy of nonabsorbable antibiotics, such as rifaximin, against small intestinal bacterial overgrowth (SIBO). We compared the efficacy of rifaximin alone with that of its combination with trimebutine maleate against SIBO. Methods We performed a randomized double-blind placebo-controlled trial (https://cris.nih.go.kr, no. KCT0004836) that included patients with functional bloating, no constipation, and SIBO using the hydrogen (H2)-methane (CH4) glucose breath test (GBT). Patients were randomized into 2 groups in a 1:1 ratio, namely rifaximin (1200 mg/day) + trimebutine maleate (600 mg/day) group and rifaximin + placebo group, for 2 weeks. Patients completed a symptom questionnaire and underwent a GBT at baseline and at 1 month after treatment withdrawal. The primary outcome was SIBO eradication. The secondary outcomes included changes in the concentrations of exhaled gases, symptoms, and presence of adverse events. Results The complete eradication rate of SIBO was 35.9% (14/39) in the rifaximin group, and 34.1% (14/41) in the combined group with no significant differences. In both groups, no significant differences were observed in GBT profiles before and after the treatment, respectively. However total breath H2 and CH4 concentration were conspicuously decreased in the combined group after treatment. The combined group exhibited substantial relief of bloating. The adverse events were similar in the 2 groups. Conclusion While the combination therapy was not superior over rifaximin alone for SIBO eradication, it improves the symptom of bloating with numerically reducing the concentration of breath H2/CH4.
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Affiliation(s)
- Ik Hyun Jo
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Gyeonggi-do, Korea
| | - Chang-Nyol Paik
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Gyeonggi-do, Korea
| | - Ji Min Lee
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Gyeonggi-do, Korea
| | - Do Seon Song
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Gyeonggi-do, Korea
| | - Yeon-Ji Kim
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Korea
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Ng JJJ, Loo WM, Siah KTH. Associations between irritable bowel syndrome and non-alcoholic fatty liver disease: A systematic review. World J Hepatol 2023; 15:925-938. [PMID: 37547029 PMCID: PMC10401413 DOI: 10.4254/wjh.v15.i7.925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/12/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is associated with obesity and metabolic syndrome. IBS and non-alcoholic fatty liver disease (NAFLD) are highly prevalent entities worldwide and may share similar mechanisms including gut dysbiosis, impaired intestinal mucosal barrier and immune system activation.
AIM To systematically review their association according to the Preferred Reporting Items for Systemic Review and Meta-analyses guidelines.
METHODS PubMed, EMBASE and Cochrane Database of Systematic Reviews were searched for relevant papers. Manual searches were also performed.
RESULTS Six studies were included. Both IBS and NAFLD subjects had significantly more metabolic risk factors like hypertension, obesity, dyslipidaemia and diabetes. Our review showed that 23.2% to 29.4% of NAFLD patients had IBS. IBS was significantly higher in NAFLD patients compared with patients without NAFLD (23.2% vs 12.5%, P < 0.01). A higher proportion of IBS patients had NAFLD (65.8% to 74.0%). IBS patients were three times more likely to have NAFLD compared with non-IBS patients (P < 0.001). Two studies showed a significant correlation between the severity of IBS and NAFLD. The proportion of NAFLD subjects with IBS increased with NAFLD severity.
CONCLUSION Further prospective studies are warranted to evaluate the relationship and shared pathways between IBS and NAFLD, potentially leading to the development of future therapeutics.
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Affiliation(s)
- Jareth Jun Jie Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Wai Mun Loo
- AliveoMedical, Mount Alvernia and Mount Elizabeth Hospitals, Singapore 574623, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore 119228, Singapore
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
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Chuah KH, Hian WX, Lim SZ, Beh KH, Mahadeva S. Impact of Small Intestinal Bacterial Overgrowth on Symptoms and Quality of Life in Irritable Bowel Syndrome. J Dig Dis 2023. [PMID: 37200005 DOI: 10.1111/1751-2980.13189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/09/2023] [Accepted: 05/14/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Small intestinal bacterial overgrowth (SIBO) is recognised to have an association with irritable bowel syndrome (IBS), but the impact of SIBO on symptoms and health-related quality of life (HRQOL) in IBS patients is still unknown. METHODS A cross-sectional study of consecutive adult patients who underwent glucose hydrogen breath test was conducted. Factors associated with SIBO were evaluated. Symptom and HRQOL of IBS patients with and without SIBO were compared. The independent factors associated with severe IBS (i.e. IBS symptom severity score: IBS-SSS > 300) were explored. RESULTS A total of 160 patients were included (median age 40 years, males 31.3%). IBS was present among 53.8% of subjects, with 33.8% having diarrhea-predominant IBS (IBS-D). SIBO was diagnosed in 22.5% of the study population. Patients with SIBO were more commonly diagnosed with IBS-D than those without SIBO (SIBO: 50.0% vs non-SIBO: 29.0%, p = 0.019). Amongst IBS patients, severe IBS was associated with SIBO (36.4% vs 15.6%, p = 0.043). The presence of SIBO was associated with poorer HRQOL (EQ-5D utility score: 0.73 (0.69-0.78) vs 0.80 (0.73-1.00), p = 0.024]. The presence of SIBO (44.4% vs 20.6%, p = 0.043), anxiety (77.8% vs 39.7%, p = 0.004) and depression (50.0% vs 19.1%, p = 0.011) were associated with severe IBS at univariate analysis. However, SIBO was the only independent factor associated with severe IBS at multivariate analysis [OR: 3.83 (95% CI: 1.02-14.34), p = 0.046]. CONCLUSIONS There was a significant association between IBS-D and SIBO. The co-existence of SIBO had a significant negative impact on IBS patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Kee Huat Chuah
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wen Xuan Hian
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sze Zee Lim
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Keng Hau Beh
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjiv Mahadeva
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Soheilipour M, Tabesh E, Najmi S, Raisi M, Adibi P. Evaluation and comparison of therapeutic effects of probiotics and colloidal bismuth subcitrate on abdominal bloating. Caspian J Intern Med 2023; 14:518-525. [PMID: 37520877 PMCID: PMC10379796 DOI: 10.22088/cjim.14.3.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/23/2022] [Accepted: 01/07/2023] [Indexed: 08/01/2023]
Abstract
Background Functional abdominal bloating is one of the functional gastrointestinal disorders (FGIDs). Here, we aimed to investigate and compare the effects of probiotics and colloidal bismuth subcitrate on abdominal bloating. Methods This was a double-blinded randomized clinical trial performed on 125 patients with functional abdominal bloating in Isfahan in 2020-2021. At the beginning of the study, information on the frequency of abdominal bloating, its severity, the occurrence of early satiety, frequency of borborygmus, frequency of belching, and the frequency of defecation per week was collected. Patients were divided into 3 groups receiving familact probiotic pills that contained 7 bacterial strains, colloidal bismuth subcitrate tablets, and placebo pills for 4 weeks. Afterwards, the frequency and severity of abdominal bloating and other symptoms were compared. Results After 2 weeks, patients in the probiotic group had a significantly lower frequency of abdominal bloating compared to other groups (P= 0.006). After 4 and 8 weeks, patients in the probiotic group and bismuth group had a lower frequency of bloating )3.18±3.02, 4.11±3.34) compared to placebo (5.10±3.54) (P= 0.001 and P= 0.037, respectively). During the study, patients in the probiotic group had a significantly lower bloating severity (41.90% had no symptom) compared to bismuth and placebo groups (12.50 ,12.00% had no symptom) (p< 0.05). The frequency of borborygmus was significantly lower in the probiotic group after 2 and 4 weeks during the study compared to other groups (1.62±0.2 Vs 2.69±0.3, 2.45±0.3 ) (P= 0.010 and P= 0.013, respectively). Conclusion According to our data, consumption of probiotics improves the frequency and severity of abdominal bloating and reduces borborygmus. Colloidal bismuth subcitrate also has significant effects.
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Affiliation(s)
- Maryam Soheilipour
- Isfahan Gastroenterology and Hepatology Research Center (IGHRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Tabesh
- Isfahan Gastroenterology and Hepatology Research Center (IGHRC), Isfahan University of Medical Sciences, Isfahan, Iran
| | - Soheila Najmi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mostafa Raisi
- Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Isfahan Gastroenterology and Hepatology Research Center (IGHRC), Isfahan University of Medical Sciences, Isfahan, Iran
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Anderle K, Wolzt M, Moser G, Keip B, Peter J, Meisslitzer C, Gouya G, Freissmuth M, Tschegg C. Safety and efficacy of purified clinoptilolite-tuff treatment in patients with irritable bowel syndrome with diarrhea: Randomized controlled trial. World J Gastroenterol 2022; 28:6573-6588. [PMID: 36569277 PMCID: PMC9782844 DOI: 10.3748/wjg.v28.i46.6573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/09/2022] [Accepted: 11/16/2022] [Indexed: 12/08/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder with poor response to treatment. IBS with predominant diarrhea (IBS-D) is accompanied by abdominal pain as well as high stool frequency and urgency. Purified clinoptilolite-tuff (PCT), which is approved by the Food and Drug Administration for use as a dietary supplement with the brand name G-PUR®, has previously shown therapeutic potential in other indications based on its physical adsorption capacity.
AIM To assess whether symptoms of IBS-D can be ameliorated by oral treatment with PCT.
METHODS In this randomized, placebo-controlled, double-blind pilot study, 30 patients with IBS-D diagnosis based on Rome IV criteria were enrolled. Following a 4-wk run-in phase, 14 patients were randomized to receive a 12-wk treatment with G-PUR® (2 g three times daily), and 16 patients received placebo. The relief from IBS-D symptoms as measured by the proportion of responders according to the Subject’s Global Assessment (SGA) of Relief was assessed as the primary outcome. For the secondary outcomes, validated IBS-D associated symptom questionnaires, exploratory biomarkers and microbiome data were collected.
RESULTS The proportions of SGA of Relief responders after 12 wk were comparable in both groups, namely 21% in the G-PUR® group and 25% in the placebo group. After 4 wk of treatment, 36% of patients in the G-PUR® group vs 0% in the placebo group reported complete or considerable relief. An improvement in daily abdominal pain was noted in 94% vs 83% (P = 0.0353), and the median number of days with diarrhea per week decreased by 2.4 d vs 0.3 d in the G-PUR® and placebo groups, respectively. Positive trends were observed for 50% of responders in the Bristol Stool Form Scale. Positive trends were also noted for combined abdominal pain and stool consistency response and the Perceived Stress Questionnaire score. Only 64% in the G-PUR® group compared to 86% in the placebo group required rescue medication intake during the study. Stool microbiome studies showed a minor increase in diversity in the G-PUR® group but not in the placebo group. No PCT-related serious adverse events were reported.
CONCLUSION In this randomized, double-blind, placebo-controlled study, the PCT product, G-PUR®, demonstrated safety and clinical benefit towards some symptoms of IBS-D, representing a promising novel treatment option for these patients.
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Affiliation(s)
- Karolina Anderle
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna 1090, Austria
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna 1090, Austria
| | - Gabriele Moser
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna 1090, Austria
| | - Bettina Keip
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna 1090, Austria
| | - Johannes Peter
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna 1090, Austria
| | - Claudia Meisslitzer
- Glock Health, Science and Research GmbH, Deutsch-Wagram 2232, Lower Austria, Austria
| | | | - Michael Freissmuth
- Institute of Pharmacology and the Gaston H. Glock Research Laboratories for Exploratory Drug Development, Center of Physiology and Pharmacology, Medical University of Vienna, Vienna 1090, Austria
| | - Cornelius Tschegg
- Glock Health, Science and Research GmbH, Deutsch-Wagram 2232, Lower Austria, Austria
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Michael R, Bettina V, Eckehard L. Functional gastrointestinal disorders in children: Effectivity, safety, and tolerability of the herbal preparation STW-5 (Iberogast®) in general practice. Complement Ther Med 2022; 71:102873. [PMID: 35998755 DOI: 10.1016/j.ctim.2022.102873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 06/03/2022] [Accepted: 08/19/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Functional gastrointestinal disorders (FGIDs) of the upper and lower digestive system in children and adolescents present with heterogeneous gastrointestinal symptoms and are a common reason for specialist consultations. The herbal medicinal preparation STW-5 has already shown efficacy and safety in clinical studies with more than 7000 adult participants suffering from functional dyspepsia (FD) or irritable bowel syndrome (IBS). Here, we evaluate with a prospective observational study the effectivity and safety of STW-5 in children with FGID under real-life conditions and interpret these data versus the background of controlled clinical studies in a predominantly adult population. METHODS This prospective observational study included 980 children (age 3-14 years) with FGID. For inclusion, Rome III criteria were recommended to apply. The inclusion of the patients for treatment with STW-5 followed routine clinical practice. Patients were treated for approximately 1 week. The presence and severity of symptoms was documented at the study start and at the end of treatment period utilizing the adapted gastrointestinal symptom score (GIS). Other target parameters included global effectivity and tolerability assessments as well as adverse events. RESULTS The average patient age was 7.6 ± 2.9 years. Most of the patients were treated for IBS (n = 418; 43 %) or FD (n = 259; 26 %), with a mean baseline GIS of 16.1 ± 8.9. During the treatment period, the GIS decreased 76 % to 3.8 ± 4.2. The decrease in symptoms was similar for different age groups, gender, and indications. Patients with a shorter duration of complaints had a lower GIS at study end (p < 0.0001. The global treatment effect was assessed as good or very good by 87-89 % of patients/parents and physicians. Physicians rated the global tolerability as good or very good for 95 % of the patients. Seven patients (0.7 %) reported adverse events. CONCLUSIONS The treatment effect of STW-5 in this study was in its range comparable to according data from controlled clinical trials with predominantly adult participants.Thus, supporting robustness of these data generated in an uncontrolled observational setting. The results of this observational study indicate that STW-5 may be an effective and well tolerated treatment option also for children with FGIDs.
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Affiliation(s)
- Radke Michael
- Hospital for Paediatrics and Adolescents' Medicine, Hospital for Paediatrics and Youth Medicine, Klinikum Westbrandenburg GmbH, Potsdam, Germany Klinikum Ernst von Bergmann gemeinnützige GmbH, Potsdam, Germany
| | | | - Lehmann Eckehard
- Joint Practice for General Medicine Dr. med. Eckehard Lehmann und Dipl.-Med. Ilona Lehmann, Michendorf, Germany
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Schaper SJ, Stengel A. Emotional stress responsivity of patients with IBS - a systematic review. J Psychosom Res 2022; 153:110694. [PMID: 34942583 DOI: 10.1016/j.jpsychores.2021.110694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Irritable bowel syndrome (IBS) is a highly prevalent disorder of the gut-brain interaction characterized by abdominal discomfort and pain associated with altered bowel habits in the absence of structural abnormalities. Chronic psychological stress is considered a risk factor for the development of IBS. The multifactorial pathogenesis involves complex interactions between biological, psychological and social factors, yet the underlying mechanisms have not been fully understood. METHODS We systematically reviewed the literature from the databases MEDLINE, Embase and PsycINFO to assess stress responsivity of patients with IBS in comparison to healthy individuals, specifically focusing acute psychological stressors. RESULTS A total of 37 case-control studies were included in the narrative synthesis. Findings comprised subjective changes in emotion (k = 18) and of gastrointestinal symptoms (k = 8) as well as objective parameters of gastrointestinal motility (k = 10), autonomic nervous system (k = 23), hypothalamic-pituitary-adrenal axis (k = 11), functional brain activity (k = 7) and immune system (k = 3). Mental stress was found to increase IBS-specific symptomatology and alter gastrointestinal motility. Some patients with IBS showed stress-induced emotional hyperresponsivity and different patterns of neural activation. Autonomic and endocrine stress responses depend on the type of stressor and showed no clear evidence of differential reactivity, partly due to confounding factors. Data on acute immunological changes remains sparse and requires further investigation. CONCLUSIONS Current evidence suggests altered stress reactivity in patients with IBS however, it remains unclear whether it can be attributed to the syndrome itself or the high prevalence of psychiatric comorbidities.
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Murray HB, Zhang F, Call CC, Keshishian A, Hunt RA, Juarascio AS, Thomas JJ. Comprehensive Cognitive-Behavioral Interventions Augment Diaphragmatic Breathing for Rumination Syndrome: A Proof-of-Concept Trial. Dig Dis Sci 2021; 66:3461-3469. [PMID: 33175346 PMCID: PMC8855660 DOI: 10.1007/s10620-020-06685-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Rumination syndrome (RS) is often treated in medical settings with 1-2 sessions of diaphragmatic breathing to target reflexive abdominal wall contraction in response to conditioned cues (e.g., food). However, many patients remain symptomatic and require additional behavioral interventions. AIMS In an attempt to augment diaphragmatic breathing with additional interventions, we tested the proof-of-concept of a comprehensive Cognitive-Behavioral Therapy (CBT) for RS. METHODS In an uncontrolled trial, adults with RS completed a 5-8 session CBT protocol, delivered by one of two psychology behavioral health providers. CBT included two main phases: awareness training and diaphragmatic breathing (Phase 1) and modularized interventions chosen by the therapist and patient to target secondary maintenance mechanisms (Phase 2). At pre-treatment, post-treatment, and 3-month follow-up, participants completed a semi-structured interview on RS symptoms with an independent evaluator. RESULTS Of 10 eligible individuals (ages 20-67 years, 50% female) offered treatment, all 10 initiated treatment and eight completed it. All participants endorsed high treatment credibility at Session 1. Permutation-based repeated measures ANOVA showed participants achieved large reductions in regurgitations across treatment [F(1,7) = 17.7, p = .007, η p2 = .69]. Although participants reduced regurgitations with diaphragmatic breathing during Phase 1, addition of other CBT strategies in Phase 2 produced further large reductions [F(1,7) = 6.3, p = .04, η p2 = .47]. Of eight treatment completers, treatment gains were maintained at 3-month follow-up for n = 6. CONCLUSIONS Findings provide evidence of feasibility, acceptability, and proof-of-concept for a comprehensive CBT for RS that includes interventions in addition to diaphragmatic breathing to target secondary maintenance mechanisms. Randomized controlled trials are needed.
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Affiliation(s)
- Helen Burton Murray
- Department of Psychology, Drexel University, Philadelphia, PA, USA,The WELL Center, Drexel University, Philadelphia, PA, USA,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Fengqing Zhang
- Department of Psychology, Drexel University, Philadelphia, PA, USA,The WELL Center, Drexel University, Philadelphia, PA, USA
| | - Christine C. Call
- Department of Psychology, Drexel University, Philadelphia, PA, USA,The WELL Center, Drexel University, Philadelphia, PA, USA
| | - Ani Keshishian
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Rowan A. Hunt
- Department of Psychology, Drexel University, Philadelphia, PA, USA,The WELL Center, Drexel University, Philadelphia, PA, USA
| | - Adrienne S. Juarascio
- Department of Psychology, Drexel University, Philadelphia, PA, USA,The WELL Center, Drexel University, Philadelphia, PA, USA
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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Chen G, Olver JS, Kanaan RA. Functional somatic syndromes and joint hypermobility: A systematic review and meta-analysis. J Psychosom Res 2021; 148:110556. [PMID: 34237584 DOI: 10.1016/j.jpsychores.2021.110556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There have been multiple reports of increased joint hypermobility (JH) in functional somatic syndromes (FSS). We sought to evaluate the evidence for an association. METHODS A systematic search of the databases Medline and PsycINFO was conducted to identify all controlled studies from inception to February 2020 measuring the association of an FSS and JH. Records were identified and screened, and full-text articles assessed for eligibility by two independent authors. Meta-analysis was performed using random-effects modelling with the DerSimonian and Laird method. RESULTS We found 220 studies initially, which yielded 11 studies for inclusion in the qualitative review and 10 in the quantitative analysis - 5 studies on fibromyalgia, 3 on chronic fatigue syndrome and 3 on functional gastrointestinal disorder. Nine of the 11 studies found increased rates of JH in FSS compared to controls, though most studies were fair to poor in quality. Meta-analysis showed a weighted summary effect odds ratio of 3.27 (95% CI: 1.83, 5.84; p < 0.001) of JH in FSS, suggesting greater odds of FSS in individuals with JH than in those without. CONCLUSIONS There is some evidence for an association between FSS and JH, but this is limited by the generally poor quality of studies and the narrow range of FSS studied. Better research is needed to confirm these findings as well as evaluate causation using prospective cohort studies.
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Affiliation(s)
- Grant Chen
- University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC 3084, Australia.
| | - James S Olver
- University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC 3084, Australia; Fellow of the Royal Australian and New Zealand College of Psychiatrists, Australia
| | - Richard A Kanaan
- University of Melbourne, Department of Psychiatry, Austin Health, Heidelberg, VIC 3084, Australia; Fellow of the Royal Australian and New Zealand College of Psychiatrists, Australia; The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC 3084, Australia; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Weston Education Centre, Denmark Hill, London SE5 9RJ, UK
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10
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Beser OF, Cullu Cokugras F, Dogan G, Akgun O, Elevli M, Yilmazbas P, Ocal M, Bayrak NA, Sezer Yamanel RG, Bozaykut A, Celtik C, Polat E, Gerenli N, Bozlak S, Ayyildiz Civan H, Ozkul Saglam N, Hatipoglu SS, Özgürhan G, Sunnetci Silistre E, Solmaz B, Kutluk G, Genc HS, Onal H, Usta AM, Urganci N, Sahin A, Cam S, Yildirim S, Yildirim A, Vandenplas Y. The frequency of and factors affecting functional gastrointestinal disorders in infants that presented to tertiary care hospitals. Eur J Pediatr 2021; 180:2443-52. [PMID: 33811535 DOI: 10.1007/s00431-021-04059-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/21/2021] [Accepted: 03/29/2021] [Indexed: 12/17/2022]
Abstract
This study aimed to determine the prevalence of infantile functional gastrointestinal disorders (FGIDs) based on Rome IV diagnostic criteria, and to determine the associated patient demographic and nutritional characteristics. A total of 2383 infants aged 1-12 months which were evaluated by 28 general pediatricians and pediatric gastroenterologists on the same day at nine tertiary care hospitals around Istanbul, Turkey, between November 2017 and March 2018, were included in the study. Patients included consulted the pediatric outpatient clinics because of any complaints, but not for vaccines and/or routine well child follow-ups as this is not part of the activities in the tertiary care hospitals. The patients were diagnosed with FGIDs based on Rome IV diagnostic criteria. The patients were divided into a FGID group and non-FGID group, and anthropometric measurements, physical examination findings, nutritional status, risk factors, and symptoms related to FGIDs were evaluated using questionnaires. Among the 2383 infants included, 837 (35.1%) had ≥1 FGIDs, of which 260 (31%) had already presented to hospital with symptoms of FGIDs and 577 (69%) presented to hospital with other symptoms, but were diagnosed with FGIDs by a pediatrician. Infant colic (19.2%), infant regurgitation (13.4%), and infant dyschezia (9.8%) were the most common FGIDs. One FGID was present in 76%, and ≥2 FGIDs were diagnosed in 24%. The frequency of early supplementary feeding was higher in the infants in the FGID group aged ≤6 months than in the non-FGID group (P = 0.039).Conclusion: FGIDs occur quite common in infants. Since early diversification was associated with the presence of FGIDs, nutritional guidance and intervention should be part of the first-line treatment. Only 31% of the infants diagnosed with a FGID were presented because of symptoms indicating a FGID. What is Known: • The functional gastrointestinal disorders (FGIDs) are a very common disorder and affect almost half of all infants. • In infants, the frequency of FGIDs increases with mistakes made in feeding. When FGIDs are diagnosed in infants, nutritional support should be the first-line treatment. What is New: • This study shows that only a third of children presented to hospital because of the symptoms of FGIDs, but pediatricians were able to make the diagnosis in suspected infants after appropriate evaluation. • The early starting of complementary feeding (<6 months) is a risk factor for the development of FGIDs.
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Peralta-Palmezano JJ, Guerrero-Lozano R. The water load test in school children and adolescents with functional gastrointestinal disorders. Indian J Gastroenterol 2021; 40:162-8. [PMID: 32940846 DOI: 10.1007/s12664-020-01073-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS We hypothesize that patients with functional gastrointestinal disorders (FGID) drink less water volume than healthy subjects during water load test. We evaluated and compared the water load test in students with and without FGID using the Rome III questionnaire. METHODS We performed the water load test in 142 students from two schools in Colombia. Students were diagnosed using the Spanish version of the Rome III questionnaire. Students drank water ad libitum for 3 min or until pain, satiety, or vomiting occurred. We correlated anthropometric variables with water volumes drunk. We recorded symptoms like pain and nausea, before and after the water load test. RESULTS We evaluated 142 students, with a mean age of 12.1 ± 0.2 years and 59.9% girls. Mean water volume drunk was 459 ± 22 mL. There was no significant difference between water volume drunk by students with and without FGID (466 ± 36 vs. 453 ± 27 mL, p = 0.108). We found a significant correlation between water volume drunk and gender, age, weight, height, and body mass index. CONCLUSIONS Students with and without FGID ingest similar volumes of water. Test adverse effects are minimal, and the test is safe to perform and well tolerated.
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Chahuan J, Rey P, Monrroy H. Rumination syndrome. A review article. Rev Gastroenterol Mex (Engl Ed) 2021; 86:163-171. [PMID: 33602544 DOI: 10.1016/j.rgmx.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 02/07/2023]
Abstract
Rumination syndrome is a functional gastrointestinal disorder characterized by effortless postprandial regurgitation of ingested food into the mouth. An unperceived postprandial contraction of the abdominal wall could be a key mechanism. In those patients, retrograde flow of the ingested gastric content into the mouth is produced due to a simultaneous combination of elevated intra-abdominal pressure and negative intrathoracic pressure. The estimated prevalence is around 2% in the general adult population. The main clinical characteristics include: a) early postprandial regurgitation, b) the effortlessly regurgitated material is similar to the ingested food, c) the regurgitated material is spit out or swallowed again. The clinical diagnosis of rumination syndrome relies on the clinical criteria. High resolution esophageal manometry, ideally including impedance monitoring, can be an important adjunct for making the clinical diagnosis. Its management is based on instruction as to the nature of the pathology, education in postprandial diaphragmatic breathing, and the assessment of possible psychiatric comorbidity. Baclofen use is reserved for second-line treatment in patients with refractory symptoms.
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Affiliation(s)
- J Chahuan
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - P Rey
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Laboratorio de Fisiología Digestiva, Red de Salud UC-Christus, Santiago, Chile
| | - H Monrroy
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Laboratorio de Fisiología Digestiva, Red de Salud UC-Christus, Santiago, Chile.
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Trivić I, Niseteo T, Jadrešin O, Hojsak I. Use of probiotics in the treatment of functional abdominal pain in children-systematic review and meta-analysis. Eur J Pediatr 2021; 180:339-51. [PMID: 32940743 DOI: 10.1007/s00431-020-03809-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/08/2020] [Accepted: 09/11/2020] [Indexed: 02/08/2023]
Abstract
Functional abdominal pain is a very frequent functional gastrointestinal disorder but still without adequate treatment options. Therefore, the main aim of this systematic review and meta-analysis was to evaluate strain-specific probiotic effects on functional abdominal pain in children. This was a systematic review and meta-analysis of randomized controlled trials published in a period up to 1st of April 2020 that analyzed probiotic interventions for pediatric functional abdominal pain. We included 9 randomized controlled trials (a total of 702 children, 506 with functional abdominal pain; 4 to 18 years); 8 studies were available for meta-analysis (a total of 641 children). Lactobacillus rhamnosus GG and Lactobacillus reuteri DSM 17938 were the only two probiotic strains investigated. Significant reduction in pain intensity (6 trials, n = 380, mean difference - 1.24, 95% CI - 2.35 to - 0.13) and increase in number of days without pain (2 trials, n = 101, mean difference 26.42, 95% CI 22.67 to 30.17) were found in children taking L. reuteri DSM 17938. For all other outcomes, there were no significant differences between probiotic and placebo.Conclusion: Based on the available evidence, no firm conclusions can be given; however, L. reuteri was proven to decrease the pain intensity in children with functional abdominal pain. Further trials regarding long-term outcomes, possibly involving longer interventions, are needed. What is Known: • Previously published systematic reviews have suggested that probiotics may have an effect on the pain in children with functional gastrointestinal disorders, but limited data exist on strain-specific effects. What is New: • This systematic review provides evidence on the probiotic use on the strain-specific level. • This systematic review showed that the use of Lactobacillus reuteri DSM 17938 modestly reduces the pain intensity in children with functional abdominal pain.
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Krouwel M, Farley A, Greenfield S, Ismail T, Jolly K. Systematic review, meta-analysis with subgroup analysis of hypnotherapy for irritable bowel syndrome, effect of intervention characteristics. Complement Ther Med 2021; 57:102672. [PMID: 33508441 DOI: 10.1016/j.ctim.2021.102672] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/17/2020] [Accepted: 01/20/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypnotherapy has been shown to be effective at relieving global gastrointestinal symptoms (GGS) in irritable bowel syndrome (IBS). This study examines the impact of hypnotherapy delivery and participant characteristics on IBS outcomes. METHODS This systematic review searched CINAHL, Cochrane Library, Conference Citation Index, Embase, PubMed, PsycARTICLES, PsychINFO, Science Citation index-expanded, Social Science Citation Index. Titles and abstracts, then full-text articles were screened against inclusion criteria: trials with a concurrent comparator of hypnotherapy in adults with IBS diagnosed using Manning or ROME criteria, which provided symptom data. Included studies were extracted and assessed for bias using Cochrane Collaboration 2011 guidance. Random-effects meta-analysis was conducted with sub-group analysis to assess the impact of delivery characteristics on outcomes. RESULTS Twelve trials were included, 7 in the meta-analyses. Hypnotherapy reduced the risk of GGS, but this was not statistically significant, (standardised mean difference (SMD) 0.24, [-0.06, 0.54], I2 66 %). Higher frequency of sessions (≥1/week) reduced GGS (SMD 0.45 [0.23,0.67] I2 0 %), as did higher volumes of intervention (≥8 sessions with ≥6 h of contact) (SMD 0.51 [0.27,0.76] I2 0 %) and group interventions (SMD 0.45 [0.03, 0.88] I2 62 %). Only volume of intervention produced a significant effect between the subgroups. CONCLUSION This review suggests that high volume hypnotherapy is more beneficial than low and should be adopted for GDH. Both high frequency and group interventions are effective in reducing GGS in IBS. However, the sample size is small and more studies are needed to confirm this.
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Affiliation(s)
- Matthew Krouwel
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom.
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Tariq Ismail
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
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Panza R, Baldassarre ME, Di Mauro A, Cervinara A, Capozza M, Laforgia N. Infantile Functional Gastrointestinal Disorders and Maternal Psychological Status: A Narrative Review. Curr Pediatr Rev 2021; 17:111-119. [PMID: 33557737 DOI: 10.2174/1573396317666210208155106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders are often extremely distressing for the infant and parents, leading to infant discomfort and crying, parental anxiety, repeated healthcare consultations, and escalating healthcare costs. AIM In this narrative review, we analyzed the relationship between maternal psychological status during pregnancy and postpartum and the main infantile functional gastrointestinal disorders. MATERIALS AND METHODS The narrative review was conducted searching scientific databases for articles reporting on infantile functional gastrointestinal disorders in association with maternal depressive or anxiety disorders. RESULTS Seven studies were suitable. DISCUSSION Maternal psychological disorders may be correlated to infantile functional gastrointestinal disorders. Whether it is the excessive crying that favors the onset of maternal psychological disorders or, in contrast, an altered attachment style due to the maternal status that facilitates the onset of functional gastrointestinal disorders in the infant is still an open question. Recent findings revealed that both anxious and depressed mothers are more likely to have an adverse gut microbiome. CONCLUSION A healthy interaction of the mother-baby dyad is advantageous in ensuring the mental and physical development of the offspring. Gynecologists, general practitioners and pediatricians should be alert for early identification of mothers at risk with the aim to initiate timely targeted interventions. Further research on the role of microbiota and the possible therapeutic approaches with probiotics is required.
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Affiliation(s)
- Raffaella Panza
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari 70124, Italy
| | - Maria Elisabetta Baldassarre
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari 70124, Italy
| | - Antonio Di Mauro
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari 70124, Italy
| | - Alessandra Cervinara
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari 70124, Italy
| | - Manuela Capozza
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari 70124, Italy
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology, Section of Neonatology and Neonatal Intensive Care Unit, "Aldo Moro" University of Bari, Bari 70124, Italy
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Lee SY, Ryu HS, Choi SC, Jang SH. Psychological Factors Influence the Overlap Syndrome in Functional Gastrointestinal Disorder and Quality of Life among Psychiatric Patients in South Korea. Psychiatry Investig 2020; 17:262-267. [PMID: 32151127 PMCID: PMC7113182 DOI: 10.30773/pi.2019.0278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the predictor variables that could influence overlap syndrome in functional gastrointestinal disorders (FGID) among psychiatric patients. METHODS Data collected from 170 outpatients visiting the psychiatric clinic at a university hospital. FGIDs were screened according to the Rome III questionnaire-Korean version. Demographic factors were investigated, and psychosocial factors were evaluated using the Hospital Anxiety Depression Scale, Patient Health Questionnaire-15, Childhood Trauma Questionnaire-Korean and the Short form health survey. Chi-squared test, Student's t-test, one-way ANOVA, and Pearson's correlation test were used as statistical analysis methods. RESULTS There were no differences in the epidemiologic data between the two groups divided according to the FGID status. In those with FGID overlap syndrome, FD-NERD was most common (n=29), followed by IBS-NERD (n=20). Patients with overlap syndrome had the highest depressive, anxiety, and somatic symptoms. The overlap syndrome group had the lowest physical component summary and mental component summary. FGID symptom severity was significantly correlated with PCS and MCS in the overlap syndrome group. CONCLUSION Psychological factors are associated with the overlap syndrome of FGID. Acknowledging this common comorbidity may facilitate the recognition and treatment of patients with FGID.
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Affiliation(s)
- Sang-Yeol Lee
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Han-Seung Ryu
- Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Suck-Chei Choi
- Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Seung-Ho Jang
- Department of Psychiatry, School of Medicine, Wonkwang University, Iksan, Republic of Korea
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Kikuchi S, Oe Y, Sasaki Y, Ishii H, Ito Y, Horikoshi M, Sozu T, Seno H, Furukawa TA. Group cognitive behavioural therapy (GCBT) versus treatment as usual (TAU) in the treatment of irritable bowel syndrome (IBS): a study protocol for a randomized controlled trial. BMC Gastroenterol 2020; 20:29. [PMID: 32019509 PMCID: PMC7001234 DOI: 10.1186/s12876-020-1157-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/31/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common disease that affects the quality of life (QOL) and social functioning of sufferers. Visceral anxiety is currently considered a key factor in the onset and exacerbation of IBS, and cognitive-behavioural therapy (CBT) targeting visceral anxiety is thought to be effective. However, access to CBT is limited due to the lack of trained therapists, the substantial time required for therapy and the associated costs. Group CBT (GCBT) may solve some of these problems. We have therefore planned this trial to examine the efficacy of GCBT for IBS. METHODS The trial is a two-armed, parallel group, open label, stratified block randomized superiority trial. The study group will consist of 112 participants (aged 18-75 years) with IBS (Rome-III or IV criteria). Participants will be randomly allocated 1:1 to (i) the intervention group: ten-week GCBT plus treatment as usual (TAU) or (ii) the control group: waiting list (WL) plus TAU. The co-primary outcomes are the change in IBS severity or disease-specific quality of life from baseline to week 13 which is 1 month after the end of treatment. The efficacy of GCBT for IBS will be examined through mixed-effects repeated-measures analysis. DISCUSSION GCBT, if found effective, can address the issues of the shortage of therapists as well as the time required and the costs associated with individual CBT. Clinically, the findings will help make effective CBT programmes accessible to a large number of distressed IBS patients at lower costs. Theoretically, the results will clarify the relationship between IBS and psychological stress and will help elucidate the underlying mechanisms of IBS. TRIAL REGISTRATION UMIN, CTR-UMIN000031710. Registered on March 13, 2018.
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Affiliation(s)
- Shino Kikuchi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
| | - Yuki Oe
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawa Higashi, Kodaira, Tokyo Japan
| | - Yohei Sasaki
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawa Higashi, Kodaira, Tokyo Japan
| | - Hirono Ishii
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawa Higashi, Kodaira, Tokyo Japan
| | - Yuri Ito
- Department of Computer Science, Tokyo University of Science, 6-3-1 Shinjyuku, Katuragi-ku, Tokyo, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, 4-1-1 Ogawa Higashi, Kodaira, Tokyo Japan
| | - Takashi Sozu
- Kyoto University Hospital 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan
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Saeed F, Salehi M, Alavi K, Ajdarkosh H, Kashaninasab F, Nasr Esfahani F. Defense Mechanisms in Patients with Irritable Bowel Syndrome and Their Relationship with Symptom Severity and Quality of Life. Middle East J Dig Dis 2019; 11:158-165. [PMID: 31687115 PMCID: PMC6819962 DOI: 10.15171/mejdd.2019.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/01/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Despite the fact that there is theoretical evidence about the association between unconscious defense mechanisms and irritable bowel syndrome (IBS), experimental evidence in this regard is limited. The aim of the present study was to compare the defense mechanisms used by the patients with IBS and a control group, and to investigate the relationship between these mechanisms with the severity of the disease and patients' quality of life. METHODS Fourty-five patients with IBS (mean age of 37.1 years; 14 males) and 45 controls (mean age of 38.0 years; 13 males) were evaluated. IBS diagnosis was determined based on Rome III criteria and the predominant pattern of the disease was determined based on the patient's history (13 diarrheapredominant, 16 constipation-predominant, and 16 alternating IBS). Defense Style Questionnaire-40, IBS Severity Scale, and IBS-Quality of Life questionnaire were used. RESULTS The mean scores of projection, acting-out, somatization, autistic fantasy, passive-aggression, and reaction formation in the IBS group were significantly higher than the control group and the mean scores of humor and anticipation mechanisms were higher in the control group. There was no significant correlation between the score of defense mechanisms and the severity of IBS and the patients' quality of life. CONCLUSION The severity of immature defenses in the IBS group was significantly higher, whereas the severity of mature defenses was higher in the control group. These defenses were not correlated with the severity of IBS. Considering the limited sample size, these relationships need to be more investigated.
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Affiliation(s)
- Fahimeh Saeed
- Psychiatrist, Mental Health Research Center, Psychiatric Department, Iran University of Medical Sciences, Assisstant Professor of Psychiatry, Psychiatric Department, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mansour Salehi
- Associate Professor of Psychiatry, Mental Health Research Center, Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran
| | - Kaveh Alavi
- Assistant Professor of Psychiatry, Mental Health Research Center, Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Ajdarkosh
- Associate Professor of Gastroenterology, Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Kashaninasab
- Assistant Professor of Psychiatry, Rasoul Akram Hospital, Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran
| | - Farnaz Nasr Esfahani
- Psychiatrist, Mental Health Research Center, Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran
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Burns G, Pryor J, Holtmann G, Walker MM, Talley NJ, Keely S. Immune Activation in Functional Gastrointestinal Disorders. Gastroenterol Hepatol (N Y) 2019; 15:539-548. [PMID: 31802978 PMCID: PMC6883739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There is growing appreciation that functional gastrointestinal disorders (FGIDs) such as functional dyspepsia and irritable bowel syndrome are heterogeneous conditions linked by subtle inflammation within the gastrointestinal (GI) tract. The literature suggests that while the symptoms of these diseases may manifest with similar clinical presentations, there are significant differences in triggers and disease severity among patients classified into the same subtype. It is hypothesized that the subtle inflammation observed in these patients is related to an imbalance in GI homeostasis. Disruption of the delicate homeostatic balance within the GI tract can result from any number or combination of factors, including dysbiosis, loss of barrier integrity, genetic predisposition, or immune responses to dietary or luminal antigens. This article discusses the interplay between the immune system, microbiota, and luminal environment in FGIDs. In addition, the article proposes emerging immune pathways, including those involving T-helper type 17 response and innate lymphoid cells, as potential regulators of the subtle inflammation characteristic of FGIDs that warrant investigation in future studies.
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Affiliation(s)
- Grace Burns
- Ms Burns is a PhD graduate student, Ms Pryor is an undergraduate research student
- Dr Walker is a professor of anatomical pathology
- Dr Talley is a laureate professor
- Dr Keely is an associate professor in the Priority Research Centre for Digestive Health and Neurogastroenterology in the Faculty of Health and Medicine at the University of Newcastle in Callaghan, New South Wales, Australia, as well as in the Hunter Medical Research Institute in New Lambton Heights, New South Wales, Australia
- Dr Holtmann is director of gastroenterology and hepatology at the Princess Alexandra Hospital in Brisbane, Queensland, Australia and a professor in the Faculty of Medicine at the University of Queensland in Woolloongabba, Queensland, Australia
| | - Jennifer Pryor
- Ms Burns is a PhD graduate student, Ms Pryor is an undergraduate research student
- Dr Walker is a professor of anatomical pathology
- Dr Talley is a laureate professor
- Dr Keely is an associate professor in the Priority Research Centre for Digestive Health and Neurogastroenterology in the Faculty of Health and Medicine at the University of Newcastle in Callaghan, New South Wales, Australia, as well as in the Hunter Medical Research Institute in New Lambton Heights, New South Wales, Australia
- Dr Holtmann is director of gastroenterology and hepatology at the Princess Alexandra Hospital in Brisbane, Queensland, Australia and a professor in the Faculty of Medicine at the University of Queensland in Woolloongabba, Queensland, Australia
| | - Gerald Holtmann
- Ms Burns is a PhD graduate student, Ms Pryor is an undergraduate research student
- Dr Walker is a professor of anatomical pathology
- Dr Talley is a laureate professor
- Dr Keely is an associate professor in the Priority Research Centre for Digestive Health and Neurogastroenterology in the Faculty of Health and Medicine at the University of Newcastle in Callaghan, New South Wales, Australia, as well as in the Hunter Medical Research Institute in New Lambton Heights, New South Wales, Australia
- Dr Holtmann is director of gastroenterology and hepatology at the Princess Alexandra Hospital in Brisbane, Queensland, Australia and a professor in the Faculty of Medicine at the University of Queensland in Woolloongabba, Queensland, Australia
| | - Marjorie M Walker
- Ms Burns is a PhD graduate student, Ms Pryor is an undergraduate research student
- Dr Walker is a professor of anatomical pathology
- Dr Talley is a laureate professor
- Dr Keely is an associate professor in the Priority Research Centre for Digestive Health and Neurogastroenterology in the Faculty of Health and Medicine at the University of Newcastle in Callaghan, New South Wales, Australia, as well as in the Hunter Medical Research Institute in New Lambton Heights, New South Wales, Australia
- Dr Holtmann is director of gastroenterology and hepatology at the Princess Alexandra Hospital in Brisbane, Queensland, Australia and a professor in the Faculty of Medicine at the University of Queensland in Woolloongabba, Queensland, Australia
| | - Nicholas J Talley
- Ms Burns is a PhD graduate student, Ms Pryor is an undergraduate research student
- Dr Walker is a professor of anatomical pathology
- Dr Talley is a laureate professor
- Dr Keely is an associate professor in the Priority Research Centre for Digestive Health and Neurogastroenterology in the Faculty of Health and Medicine at the University of Newcastle in Callaghan, New South Wales, Australia, as well as in the Hunter Medical Research Institute in New Lambton Heights, New South Wales, Australia
- Dr Holtmann is director of gastroenterology and hepatology at the Princess Alexandra Hospital in Brisbane, Queensland, Australia and a professor in the Faculty of Medicine at the University of Queensland in Woolloongabba, Queensland, Australia
| | - Simon Keely
- Ms Burns is a PhD graduate student, Ms Pryor is an undergraduate research student
- Dr Walker is a professor of anatomical pathology
- Dr Talley is a laureate professor
- Dr Keely is an associate professor in the Priority Research Centre for Digestive Health and Neurogastroenterology in the Faculty of Health and Medicine at the University of Newcastle in Callaghan, New South Wales, Australia, as well as in the Hunter Medical Research Institute in New Lambton Heights, New South Wales, Australia
- Dr Holtmann is director of gastroenterology and hepatology at the Princess Alexandra Hospital in Brisbane, Queensland, Australia and a professor in the Faculty of Medicine at the University of Queensland in Woolloongabba, Queensland, Australia
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Oswari H, Alatas FS, Hegar B, Cheng W, Pramadyani A, Benninga MA, Rajindrajith S. Functional abdominal pain disorders in adolescents in Indonesia and their association with family related stress. BMC Pediatr 2019; 19:342. [PMID: 31554509 PMCID: PMC6761710 DOI: 10.1186/s12887-019-1682-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 08/21/2019] [Indexed: 12/17/2022] Open
Abstract
Background Functional abdominal pain disorders (FAPD) have been widely reported as a major group of gastrointestinal disorders across the world. This study describes the prevalence, related factors, symptomatology and its relationship to emotional stress in Indonesian adolescents. Methods This is a cross-sectional study. Adolescents aged 10 to 17 years from nine randomly selected state schools from five districts of Jakarta, Indonesia, were invited to participate. A translated and validated Rome-III self-administered-questionnaire was used to collect data on gastrointestinal symptoms. Data on sociodemographic characteristics, intestinal as well as extra-intestinal symptoms, and exposure to stressful life events were also collected using a separate validated questionnaire. Results A total of 1813 questionnaires were included in the analysis [males 739 (40.8%) mean age of 13.54 years + 0.89]. Of them, 209 children (11.5%) fulfilled Rome III criteria of FAPD. Functional abdominal pain (FAP) was reported as the most prevalent subtype (5.8%), followed by functional dyspepsia (3.3%), irritable bowel syndrome (2%) and abdominal migraine (0.4%). The prevalence was higher in girls (p < 0.05) and those exposed to family-related stressful life events (p < 0.05). They include divorce or separation of parents (adjusted OR 2.55, 95% CI 1.75–3.7, p = < 0.001), death of a close family member (adjusted OR 2.24, 95% CI 1.39–3.59, P = 0.001), and father’s alcoholism (adjusted OR 1.94, 95% CI 1.22–3.1, P = 0.005). Conclusions FAPD are common paediatric entities among Indonesian adolescents with a prevalence of 11.5%. FAPD were noted to be higher in girls and adolescents exposed to family-related stressful life events.
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Affiliation(s)
- Hanifah Oswari
- Department of Child Health, Gastrohepatology division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta, 10430, Indonesia.
| | - Fatima Safira Alatas
- Department of Child Health, Gastrohepatology division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta, 10430, Indonesia
| | - Badriul Hegar
- Department of Child Health, Gastrohepatology division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta, 10430, Indonesia
| | - William Cheng
- Department of Child Health, Gastrohepatology division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta, 10430, Indonesia
| | - Arnesya Pramadyani
- Department of Child Health, Gastrohepatology division, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta, 10430, Indonesia
| | - Marc Alexander Benninga
- Department of Paediatric Gastroenterology and Nutrition, Emma Children's, Hospital, Academic Medical Centre, Amsterdam, The Netherlands
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Chitnavis MV, Baray M, Northup PG, Tuskey AG, Behm BW. Opioid use and misuse in ulcerative colitis. World J Gastrointest Pharmacol Ther 2019; 10:22-28. [PMID: 30697446 PMCID: PMC6347648 DOI: 10.4292/wjgpt.v10.i1.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/24/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with ulcerative colitis (UC) may be exposed to opioids over their disease duration. The use of such medications carries significant risk, including intestinal dysmotility and potential for addiction. However, the rates of narcotic use and misuse in patients with UC have not been studied extensively. Functional gastrointestinal disorders (FGID) are prevalent in patients with UC, and have been shown to increase the risk of narcotic use and misuse in patients with Crohn’s disease. We hypothesized that patients with UC and a concurrent diagnosis of FGID would have increased rates of both opioid use and misuse in our patient cohort.
AIM To evaluate the prevalence of chronic opioid use and misuse in UC.
METHODS A retrospective chart review of UC patients seen at the University of Virginia Digestive Health Center was performed on all patients evaluated between 2006 and 2011. Patient demographics, medical, surgical, and medication histories were obtained from the electronic medical record. Concomitant diagnosis of FGID was also noted at the time. The electronic prescription monitoring program was accessed to obtain prescription opioid filling histories. Prescription opioid misuse was defined as opioid prescriptions filled from four or more prescribers and four or more different pharmacies in a 12-mo period.
RESULTS A total of 497 patients with UC were included. Patients with UC and FGID were more likely to be female, but no other demographic variables were associated with FGID. Of the UC patients who had FGID, a greater proportion were found to be using opioids chronically (36% with FGID vs 9% without FGID, P < 0.0001) and were misusing prescription opioids (12.8% vs 1.3%, P < 0.001). Multivariate logistic regression demonstrated a significant association with FGID and chronic opioid use (OR = 4.50; 95%CI: 1.91-10.59) and opioid misuse (OR = 5.19; 95%CI 1.04-25.76). Tobacco use (OR 2.53; 95%CI: 1.06-6.08) and anxiety (OR 3.17; 95%CI: 1.08-9.26) were other variables associated with an increased risk of chronic narcotic use.
CONCLUSION FGID was associated with a 4.5-fold increase in chronic opioid use and a 5-fold increased risk of opioid misuse in this patient cohort with UC.
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Affiliation(s)
- Maithili V Chitnavis
- Division of Gastroenterology and Hepatology, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, United States
| | - Merwise Baray
- University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Patrick G Northup
- Division of Gastroenterology and Hepatology, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Anne G Tuskey
- Division of Gastroenterology and Hepatology, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
| | - Brian W Behm
- Division of Gastroenterology and Hepatology, University of Virginia School of Medicine, Charlottesville, VA 22908, United States
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Riddle MS, Connor P, Porter CK. Montezuma’s revenge - the sequel: The one-hundred year anniversary of the first description of “post-infectious” irritable bowel syndrome. World J Gastroenterol 2018; 24:5076-5080. [PMID: 30568385 PMCID: PMC6288650 DOI: 10.3748/wjg.v24.i45.5076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/28/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
One-hundred years have passed since the original description of the commonly described phenomenon of persistent abdominal symptoms being triggered by an acute enteric infection. This first account was generated out of astute observations by Sir Arthur Hurst in World War I. Additional descriptions followed from military and non-military practitioners adding the evidence which has transitioned this recognized condition from association to causation. While mechanistic understanding is an area of active pursuit, this historical accounting of a centuries progress highlights important advances and contributions of military medicine and scientists to advances benefiting global populations.
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Affiliation(s)
- Mark S Riddle
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD 20814, United States
| | - Patrick Connor
- Military Enteric Disease Group, Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham Research Park, Birmingham B15 2SQ, United Kingdom
| | - Chad K Porter
- Department of Enteric Diseases, Naval Medical Research Center, Silver Spring, MD 20910, United States
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Nam Y, Kwon SC, Lee YJ, Jang EC, Ahn SH. Relationship between job stress and functional dyspepsia in display manufacturing sector workers: a cross-sectional study. Ann Occup Environ Med 2018; 30:62. [PMID: 30364417 PMCID: PMC6194695 DOI: 10.1186/s40557-018-0274-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/01/2018] [Indexed: 12/15/2022] Open
Abstract
Background Job stress has been reported as a risk factor of psychological changes, which have been shown to be related to gastrointestinal diseases and symptoms such as functional dyspepsia. However, few studies have assessed the relationship between job stress and functional dyspepsia. Therefore, we investigated the relationship between job stress and functional dyspepsia in South Korea. Methods This study was conducted between May 23 and July 6, 2016 and included 901 workers in the display manufacturing sector. Subjects completed self-reported questionnaires, regarding Korean Occupational Stress Scale (KOSS), functional dyspepsia, Insomnia Severity Index-K, and health-related behaviors and job characteristics. Subjects were divided into functional dyspepsia-positive and -negative groups based on the Rome III criteria. The KOSS high-risk group was defined as subjects with KOSS score above the 75 percentile of KOSS reference value. Multiple logistic regression analysis was performed to investigate the association between job stress and functional dyspepsia. Results In women, the risk of functional dyspepsia was significantly higher in the high-risk groups of the following KOSS subcategories in unadjusted model: job demand (OR 3.282, 95% CI 1.181–9.126), and occupational climate (OR 2.665, 95% CI 1.041–6.823). Even in adjusted model, the risk was significantly higher in the high-risk groups of the following KOSS subcategories: job demand (OR 3.123, 95% CI 1.036–9.416) and occupational climate (OR 3.304, 95% CI 1.198–9.115). In men, the risk of functional dyspepsia was not significant in all KOSS subcategories. Conclusions This study showed that job demand and occupational climates were associated with functional dyspepsia in female display manufacturing sector workers. Therefore, both clinical and mental health approaches should be used in the management of functional dyspepsia in women.
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Affiliation(s)
- Younghyeon Nam
- 1Department of Occupational & Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
| | - Soon-Chan Kwon
- 1Department of Occupational & Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
| | - Yong-Jin Lee
- 1Department of Occupational & Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea.,2Environmental Health Center for Asbestos, Soonchunhyang University Cheonan Hospital, 67, Suncheonhyang 3-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
| | - Eun-Chul Jang
- 1Department of Occupational & Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
| | - Seung-Hwan Ahn
- 1Department of Occupational & Environmental Medicine, Soonchunhyang University Cheonan Hospital, 31, Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 31151 Republic of Korea
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Lee EH, Yang HR, Lee HS. Quantitative Analysis of Distribution of the Gastrointestinal Tract Eosinophils in Childhood Functional Abdominal Pain Disorders. J Neurogastroenterol Motil 2018; 24:614-627. [PMID: 30180307 PMCID: PMC6175563 DOI: 10.5056/jnm18050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/13/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Although functional abdominal pain disorders (FAPDs) are common in children, the accurate pathogenesis of FAPDs is not known yet. Micro-inflammation, particularly tissue eosinophilia of gastrointestinal (GI) tract, has been suggested as the pathophysiology observed in several GI disorders. We aimed to evaluate eosinophilic infiltration throughout the entire GI tract in children with FAPDs, compared to those with inflammatory bowel diseases (IBD) and to normal reference values. Methods We included 56 children with FAPDs, 52 children with Crohn's disease, and 23 children with ulcerative colitis. All subjects underwent esophagogastroduodenoscopic and colonoscopic examination with biopsies. Tissue eosinophil counts were assessed in 10 regions throughout the GI tract. Results Eosinophil counts of the gastric antrum, duodenum, terminal ileum, cecum, and ascending colon were significantly higher in children with FAPDs compared to normal reference values. Eosinophil counts of the stomach and the entire colon were observed to be significantly higher in children with IBD than in those with FAPDs. Even after selecting macroscopically uninvolved GI segments on endoscopy in children with IBD, eosinophil counts of the gastric body, cecum, descending colon, sigmoid colon, and the rectum were also significantly higher in children with IBD than those with FAPDs. Conclusions Significantly high eosinophil counts of the stomach and colon were observed in the order of IBD, followed by FAPDs, and normal controls, regardless of endoscopically detected macroscopic IBD lesions in children. This suggests some contribution of GI tract eosinophils in the intrinsic pathogenesis of FAPDs in children.
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Affiliation(s)
- Eun Hye Lee
- Department of Pediatrics, Nowon Eulji Medical Center, Seoul, Korea.,Department of Pediatrics, Eulji University College of Medicine, Daejeon, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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Bulut Çakmak B, Özkula G, Işıklı S, Özkan Göncüoğlu İ, Öcal S, Altınöz AE, Taşkıntuna N. Anxiety, depression, and anger in functional gastrointestinal disorders: A Cross-sectional observational study. Psychiatry Res 2018; 268:368-372. [PMID: 30103181 DOI: 10.1016/j.psychres.2018.06.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/14/2018] [Accepted: 06/17/2018] [Indexed: 11/15/2022]
Abstract
Previous studies have identified a link between anger and somatization. However, little is known about the associations between anger and the development and progression of Functional Gastrointestinal Disorders (FGID). The study aim was to determine the associations between FGID and anger, anxiety, and depression. Participants in this cross-sectional observational study were 109 consecutive patients aged 18-64 years with FGID at Gastroenterology Clinic of Başkent University Hospital. A control group comprised of 96 individuals with no chronic gastrointestinal disorders recruited via snowball sampling. Sociodemographic and clinical information were obtained and participants completed the Hospital Anxiety and Depression Scale and the State-Trait Anger Expression Inventory-2. FGID participants scored higher than controls on depression, anxiety, state anger, and anger expression-in. When the FGID group was divided into upper and lower gastrointestinal symptom groups, the lower symptom group showed higher anger expression-out scores than the upper symptom group. Anger may contribute to the etiology and development of FGID. This is the first study to demonstrate a significant psychological difference between individuals with lower and upper FGID. Interdisciplinary collaboration with gastroenterologists and psychiatrists could strengthen FGID evaluation and may improve treatment compliance.
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Affiliation(s)
- Berna Bulut Çakmak
- Department of Psychiatry, Ordu Teaching and Research Hospital, Ordu, Turkey.
| | - Güler Özkula
- Department of Psychology, University of Kyrenia, Kyrenia, Turkish Republic of Northern Cyprus
| | - Sedat Işıklı
- Department of Psychology, Hacettepe University, Ankara, Turkey
| | | | - Serkan Öcal
- Department of Gastroenterology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Ali Ercan Altınöz
- Department of Psychiatry, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Nilgün Taşkıntuna
- Department of Psychiatry, Faculty of Medicine, Başkent University, Ankara, Turkey
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Shava U, Yachha SK, Srivastava A, Poddar U, Sen Sarma M. Assessment of stool frequency and colonic transit time in Indian children with functional constipation and healthy controls. Indian J Gastroenterol 2018; 37:410-5. [PMID: 30328091 DOI: 10.1007/s12664-018-0902-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/22/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Indian adults have higher stool frequency and shorter colonic transit time compared to the Western population. Colonic transit time has not been studied well in Indian children. We aimed to compare colonic transit time in normal and constipated children. METHODS In this prospective study, stool characteristics and colonic transit time by radio-opaque markers were studied in healthy children (group A, n = 39) and functional constipation patients (group B, n = 61). Twenty radio-opaque markers were ingested per orally at 0, 12, and 24 h followed by a single abdominal X-ray at 36 h. Total and segmental colonic transit times were calculated using the standard formula. RESULTS Stool frequency per week and consistency were significantly different between group A (9 [2.5-17] years) vs. group B (4.5 [2-14] years), 7 (7-14) vs.1 (1-2), and Bristol type 4 (3-5) vs. type 2 (1-3). Total colonic transit time of groups A and B was 16.2 (0.6-36) vs. 22.8 (1.8-35.4) hours; p = 0.003. Ninety-fifth percentile (upper limit of normal) cutoff derived from group A was 31.8 h. Ninety-two percent of group B had colonic transit < 95th percentile of normal healthy children. Despite 8% with colonic transit > 95th percentile, all group B patients responded well to standard therapy with laxatives. CONCLUSION Indian children have significantly higher stool frequency and shorter colonic transit time, which are different compared to the reported figures from the West. Most of the Indian children with functional constipation had normal colonic transit time.
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Ghoshal UC, Srivastava D, Misra A. A randomized double-blind placebo-controlled trial showing rifaximin to improve constipation by reducing methane production and accelerating colon transit: A pilot study. Indian J Gastroenterol 2018; 37:416-23. [PMID: 30406392 DOI: 10.1007/s12664-018-0901-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 09/20/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Gut microbe-derived methane may slow colon transit causing chronic constipation (CC). Effect of rifaximin on breath methane and slow-transit CC was evaluated. METHOD Bristol stool form, frequency, colon transit time (CTT), and breath methane were evaluated in 23 patients with CC (10 patients with constipation-predominant irritable bowel syndrome [IBS-C], 13 functional constipation, Rome III) and m-ethane production compared with 68 non-constipating IBS. Methane-producing CC (basal ≥ 10 PPM and/or post-lactulose rise by > 10 PPM) was randomized (double-blind) to rifaximin (400-mg thrice/day, 2-weeks) or placebo. Stool forms, frequency, breath methane, and CTT were recorded afterward. RESULTS CC patients tended to be methane producer more often (13/23 [56.5%] vs. 25/68 [36.5%], p = 0.07) and had greater area under curve (AUC) for methane (2415 [435-23,580] vs. 1335 [0-6562.5], p = 0.02) than non-constipating IBS. Methane producers (8/13 [61.5%]) and 5/10 (50%) non-producers had abnormal CTT (marker retention: 36-h, 53 [0-60] vs. 19 [8-56], p = 0.06; 60-h, 16 [0-57] vs. 13 [3-56], p = 0.877). Six and 7/13 methane producers were randomized to rifaximin and placebo, respectively. Rifaximin reduced AUC for methane more (6697.5 [1777.5-23,580] vs. 2617.5 [562.5-19,867.5], p = 0.005) than placebo (3945 [2415-12,952.5] vs. 3720 [502.5-9210], p = 0.118) at 1 month. CTT normalized in 4/6 (66.7%) on rifaximin (36-h retention, 54 [44-57] vs. 36 [23-60], p = 0.05; 60-h, 45 [3-57] vs. 14 [11-51], p = 0.09) but none on placebo (p = 0.02) (36-h, 31 [0-60] vs. 25 [0-45], p = 0.078; 60-h, 6 [0-54] vs. 12 [0-28], p = 0.2). Weekly stool frequency (3 [1-9] and 7 [1-14], p = 0.05) and forms improved with rifaximin than placebo. CONCLUSION Rifaximin improves CC by altering methane production and colon transit. TRIAL REGISTRATION Clinical Trial Registry, India: REF/2012/01/003216 ᅟ ᅟ.
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Abstract
BACKGROUND Cyclic vomiting syndrome (CVS) is characterized by repeated, stereotypical vomiting episodes. It is possibly associated with mitochondrial DNA (mtDNA) variants. We examined the phenotype, disease burden, treatment and performed mtDNA analysis in pediatric CVS. METHODS This retrospective study included 42 children with CVS in a tertiary care center. Information regarding medical history, clinical features, laboratory tests, and treatment were collected. mtDNA sequencing was performed among 13 patients. RESULTS Mean age of onset among patients was 4.0±3.4 years, and mean age at diagnosis was 6.7±4.2 years. CVS episodes in onset and features were stereotypic. Recognizable prodromes were reported in 54.8% patients. Neuroimaging showed previously unknown intracranial abnormalities. Gastrointestinal infection was found in four patients. Mean duration of hospitalization was 7.0±2.4 days, and mean hospitalization cost was 10,891 RMB. Sequencing showed that 4/13 patients had C16519T mtDNA polymorphism, and 2/13 patients had G3010A mtDNA polymorphism. CONCLUSIONS Cyclic vomiting syndrome is a disabling disorder, which causes huge disease burdens to the patients and their families. Early clinical suspicion and prompt diagnosis are crucial. mtDNA polymorphisms were found in some patients, but they were not significantly associated with pediatric CVS.
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Affiliation(s)
- Ziqing Ye
- Department of Gastroenterology, Children’s Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102 China
| | - Aijuan Xue
- Department of Gastroenterology, Children’s Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102 China
| | - Ying Huang
- Department of Gastroenterology, Children’s Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102 China
| | - Qiye Wu
- Department of Gastroenterology, Children’s Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102 China
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Devanarayana NM, Rajindrajith S. Irritable bowel syndrome in children: Current knowledge, challenges and opportunities. World J Gastroenterol 2018; 24:2211-2235. [PMID: 29881232 PMCID: PMC5989237 DOI: 10.3748/wjg.v24.i21.2211] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/26/2018] [Accepted: 05/11/2018] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common and troublesome disorder in children with an increasing prevalence noted during the past two decades. It has a significant effect on the lives of affected children and their families and poses a significant burden on healthcare systems. Standard symptom-based criteria for diagnosis of pediatric IBS have changed several times during the past two decades and there are some differences in interpreting symptoms between different cultures. This has posed a problem when using them to diagnose IBS in clinical practice. A number of potential patho-physiological mechanisms have been described, but so far the exact underlying etiology of IBS is unclear. A few potential therapeutic modalities have been tested in children and only a small number of them have shown some benefit. In addition, most of the described patho-physiological mechanisms and treatment options are based on adult studies. These have surfaced as challenges when dealing with pediatric IBS and they need to be overcome for effective management of children with IBS. Recently suggested top-down and bottom-up models help integrating reported patho-physiological mechanisms and will provide an opportunity for better understanding of the diseases process. Treatment trials targeting single treatment modalities are unlikely to have clinically meaningful therapeutic effects on IBS with multiple integrating patho-physiologies. Trials focusing on multiple combined pharmacological and non-pharmacological therapies are likely to yield more benefit. In addition to treatment, in the future, attention should be paid for possible prevention strategies for IBS.
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Affiliation(s)
| | - Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama 11010, Sri Lanka
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30
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Kim SY, Choung RS, Lee SK, Choe JW, Jung SW, Hyun JJ, Koo JS, Lee SW, Shin C. Self-reported Sleep Impairment in Functional Dyspepsia and Irritable Bowel Syndrome. J Neurogastroenterol Motil 2018; 24:280-288. [PMID: 29605983 PMCID: PMC5885727 DOI: 10.5056/jnm17098;] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/18/2017] [Accepted: 12/12/2017] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND/AIMS Sleep impairment is a common complaint among patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD). This study aimed to evaluate the prevalence of sleep impairment in FD or IBS patients, and to determine whether IBS-FD overlap induced more sleep disturbance than FD or IBS alone. METHODS A population-based cohort in South Korea including 2251 subjects was asked about gastrointestinal symptoms including IBS and dyspepsia-related symptoms. In addition, sleep disturbance was measured using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale questionnaires. One-way ANOVA and logistic regression were used to assess differences among the 4 groups (healthy subjects, IBS alone, FD alone, and IBS-FD overlap). RESULTS Of 2251 subjects who were surveyed by questionnaire, 2031 responded (92.5% response rate) and were analyzed. The prevalence of IBS, FD, and IBS-FD overlap was 8.0% (95% confidence interval [CI], 6.8-9.2%), 4.8% (95% CI, 3.9-5.8%), and 1.8% (95% CI, 1.2-2.4%), respectively. FD alone, but not IBS alone, was significantly associated with a poorer sleep quality index (OR, 2.68; 95% CI, 1.43-5.01) and more daytime sleepiness (OR, 2.21; 95% CI, 1.14-4.30), compared to healthy subjects. IBS-FD overlap had the greatest likelihood of a poorer sleep quality index (OR, 3.88; 95% CI, 1.83-8.19), daytime sleepiness (OR, 2.47; 95% CI, 1.01-5.67), and insomnia (OR, 2.84; 95% CI, 1.39-5.82), compared to healthy subjects. CONCLUSION A correlation between functional gastrointestinal disorders and sleep disturbance was demonstrated, which was significantly pronounced in the context of IBS-FD overlap.
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Affiliation(s)
- Seung Young Kim
- Division of Gastoenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan,
Korea
| | - Rok Seon Choung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota,
USA
| | - Seung Ku Lee
- Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan,
Korea
| | - Jung Wan Choe
- Division of Gastoenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan,
Korea
| | - Sung Woo Jung
- Division of Gastoenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan,
Korea
| | - Jong Jin Hyun
- Division of Gastoenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan,
Korea
| | - Ja Seol Koo
- Division of Gastoenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan,
Korea
| | - Sang Woo Lee
- Division of Gastoenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan,
Korea
| | - Chol Shin
- Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan,
Korea
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Kim SY, Choung RS, Lee SK, Choe JW, Jung SW, Hyun JJ, Koo JS, Lee SW, Shin C. Self-reported Sleep Impairment in Functional Dyspepsia and Irritable Bowel Syndrome. J Neurogastroenterol Motil 2018; 24:280-288. [PMID: 29605983 PMCID: PMC5885727 DOI: 10.5056/jnm17098] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/18/2017] [Accepted: 12/12/2017] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Sleep impairment is a common complaint among patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD). This study aimed to evaluate the prevalence of sleep impairment in FD or IBS patients, and to determine whether IBS-FD overlap induced more sleep disturbance than FD or IBS alone. Methods A population-based cohort in South Korea including 2251 subjects was asked about gastrointestinal symptoms including IBS and dyspepsia-related symptoms. In addition, sleep disturbance was measured using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale questionnaires. One-way ANOVA and logistic regression were used to assess differences among the 4 groups (healthy subjects, IBS alone, FD alone, and IBS-FD overlap). Results Of 2251 subjects who were surveyed by questionnaire, 2031 responded (92.5% response rate) and were analyzed. The prevalence of IBS, FD, and IBS-FD overlap was 8.0% (95% confidence interval [CI], 6.8–9.2%), 4.8% (95% CI, 3.9–5.8%), and 1.8% (95% CI, 1.2–2.4%), respectively. FD alone, but not IBS alone, was significantly associated with a poorer sleep quality index (OR, 2.68; 95% CI, 1.43–5.01) and more daytime sleepiness (OR, 2.21; 95% CI, 1.14–4.30), compared to healthy subjects. IBS-FD overlap had the greatest likelihood of a poorer sleep quality index (OR, 3.88; 95% CI, 1.83–8.19), daytime sleepiness (OR, 2.47; 95% CI, 1.01–5.67), and insomnia (OR, 2.84; 95% CI, 1.39–5.82), compared to healthy subjects. Conclusion A correlation between functional gastrointestinal disorders and sleep disturbance was demonstrated, which was significantly pronounced in the context of IBS-FD overlap.
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Affiliation(s)
- Seung Young Kim
- Division of Gastoenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Rok Seon Choung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Seung Ku Lee
- Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan, Korea
| | - Jung Wan Choe
- Division of Gastoenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sung Woo Jung
- Division of Gastoenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jong Jin Hyun
- Division of Gastoenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Ja Seol Koo
- Division of Gastoenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sang Woo Lee
- Division of Gastoenterology and Hepatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Chol Shin
- Institute of Human Genomic Study, Korea University Ansan Hospital, Ansan, Korea
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Ranasinghe N, Devanarayana NM, Rajindrajith S, Perera MS, Nishanthinie S, Warnakulasuriya T, de Zoysa PT. Functional gastrointestinal diseases and psychological maladjustment, personality traits and quality of life. BMC Gastroenterol 2018; 18:33. [PMID: 29486708 PMCID: PMC5830068 DOI: 10.1186/s12876-018-0760-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 02/22/2018] [Indexed: 12/12/2022] Open
Abstract
Background Chronic abdominal pain is a common worldwide problem and known to be associated with psychological problems. This study evaluated the association between abdominal pain-predominant functional gastrointestinal disorders (AP-FGIDs), psychological maladjustment and personality traits in adolescents. Methods Adolescents aged 13–18 years were recruited from 5 randomly selected schools in Ampara district of Sri Lanka. AP-FGIDs were diagnosed using Rome III criteria. Translated and validated Rome III questionnaire (Child report form), personality questionnaire (PAQ) and PedsQL (Pediatric Quality of Life) inventory were used in data collection. Written consent was obtained from a parent and assent was obtained from every child recruited. The questionnaire was distributed in an examination setting to ensure confidentiality and privacy. Research assistants were present during data collection to assist on any necessary clarifications. Results A total of 1697 subjects were recruited [males 779 (45.9%), mean age 15.1 years, SD 1.6 years]. AP-FGIDs were present in 202 (11.9%). Those with AP-FGIDs had significantly higher mean scores for all personality traits (hostility and aggression, negative self-esteem, emotional unresponsiveness, emotional instability and negative world view), except dependency. Affected children had lower scores for all 4 domains of HRQoL (physical, emotional, social and school functioning), compared to controls (p < 0.05). When the cut off value for Sri Lankan children (89) was used, 66.3% with AP-FGIDs and 48.2% controls had PAQ scores within that of psychological maladjustment (p < 0.001). When the international normative value of 105 was used, these percentages were 27.2% and 14.2% respectively (p < 0.0001). The scores obtained for PAQ negatively correlated with scores obtained for HRQoL (r = − 0.52, p < 0.0001). One hundred and seventeen adolescents with AP-FGIDs (57.9%) had sought healthcare for their symptoms. Healthcare consulters had higher PAQ and lower HRQoL scores (p < 0.05). Conclusions Adolescents with AP-FGIDs have more psychological maladjustment and abnormal personality traits than healthy controls. Affected adolescents with higher psychological maladjustments have lower HRQoL. Greater psychological maladjustment and lower HRQoL are associated with healthcare seeking behaviour in adolescents with AP-FGIDs.
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Affiliation(s)
| | - Niranga Manjuri Devanarayana
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka.
| | - Shaman Rajindrajith
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka
| | - Madusanka S Perera
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka
| | - Samudu Nishanthinie
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka
| | - Tania Warnakulasuriya
- Department of Physiology, Faculty of Medicine, University of Kelaniya, Thalagolla Road, Ragama, 11010, Sri Lanka
| | - Piyanjali Thamesha de Zoysa
- Department of Psychological Medicine, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo, 000800, Sri Lanka
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Indrio F, Miqdady M, Al Aql F, Haddad J, Karima B, Khatami K, Mouane N, Rahmani A, Alsaad S, Salah M, Samy G, Tafuri S. Knowledge, attitudes, and practices of pediatricians on infantile colic in the Middle East and North Africa region. BMC Pediatr 2017; 17:187. [PMID: 29058577 PMCID: PMC5651634 DOI: 10.1186/s12887-017-0939-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/12/2017] [Indexed: 12/27/2022] Open
Abstract
Background Regional evidence-based guidelines for the prophylaxis and management of infantile colic are not available for the Middle East and North Africa (MENA) region. The Allied Against Infantile Functional GI Disorders (ACT) Working Group was created in January, 2015 to determine the knowledge gaps and the current management practices of infantile colic by physicians in the MENA region. The ACT group determined the need for a survey to address these questions. The objectives of the survey were to highlight current clinical practices on the management of infantile colic and to raise awareness on colic severity in the MENA region. Methods The ACT working group developed the survey which included respondent characteristics and closed questions on practice in colic prevention. The survey was subject to validation and ethics committee approval in all countries. Results A total of 1628 physicians (mostly pediatricians (75.4%), neonatologists (2.4%) and general practitioners (19.8%)) responded to the survey. The 5 most represented countries were KSA (27.9%), Kuwait (22.1%), Morocco (13.8%), Lebanon (10.6%), and Iraq (7.4%). Most of the respondents (77.8%) practiced in governmental settings. A majority of respondents (91.7%) reported that colic is diagnosed predominantly by clinical examination. Above 63%, of pediatricians surveyed, believed that the colic prevalence rate was >40%, which is greater than the 20% rate reported in worldwide surveys. Yet, most of the responding physicians (73%) prefer to simply reassure parents rather than prescribe a therapeutic agent. Most physicians were either neutral (58%) or did not endorse (18.4%) colic prophylaxis. Of those who prescribed formulae for non-breastfed children, a majority (64.3%) chose “Comfort” formulae over hydrolyzed or lactose-free formulae or formulae with probiotics. Conclusions The results of this survey suggest that a substantial proportion of responding physicians from the selected MENA countries do not advocate for prophylaxis of colic. The findings of this survey suggest that more educational efforts are required to increase awareness of the strong body of evidence supporting the efficacy of probiotics in the prevention and management of infantile colic. Electronic supplementary material The online version of this article (10.1186/s12887-017-0939-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Flavia Indrio
- Department of Pediatric University of Bari Ospedale Pediatrico Giovanni XXIII Hospital, Via Amendola 270, 70126, Bari, Italy.
| | - Mohamad Miqdady
- Hepatology & Nutrition Division, Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Fahd Al Aql
- King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Joseph Haddad
- Department of Pediatrics, Saint George University Hospital, Balamand University, Beirut, Lebanon
| | - Berkouk Karima
- Department of Pediatrics, Bab El Oued Hospital, Algiers, Algeria
| | - Katayoun Khatami
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nehza Mouane
- Gastroenterology Nutrition Department, Children Hospital Ibn Sina, University Mohammed V Faculty of Medicine, Rabat, Morocco
| | | | | | | | - Gamal Samy
- Department of Child Health and Nutrition, Institute of Postgraduate Childhood Studies, Ain Shams University, Cairo, Egypt
| | - Silvio Tafuri
- Department of Pediatric University of Bari Ospedale Pediatrico Giovanni XXIII Hospital, Via Amendola 270, 70126, Bari, Italy
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Vandenplas Y, Analitis A, Tziouvara C, Kountzoglou A, Drakou A, Tsouvalas M, Mavroudi A, Xinias I. Safety of a New Synbiotic Starter Formula. Pediatr Gastroenterol Hepatol Nutr 2017; 20:167-177. [PMID: 29026733 PMCID: PMC5636933 DOI: 10.5223/pghn.2017.20.3.167] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/06/2017] [Accepted: 04/24/2017] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Breastfeeding is the best way to feed all infants, but not all infants can be (exclusively) breastfed. Cow's milk based infant formula is the second choice infant feeding. METHODS The safety of a new synbiotic infant formula, supplemented with Bifidobacterium lactis and fructo-oligosaccharides, with lactose and a whey/casein 60/40 protein ratio was tested in 280 infants during 3 months. RESULTS The median age of the infants at inclusion was 0.89 months. Weight evolution was in accordance with the World Health Organization growth charts for exclusive breastfed infants. The evolution of all anthropometric parameters (weight-for-length z score and body mass index-for-age z score) was within the normal range. The incidence of functional constipation (3.2%), daily regurgitation (10.9%), infantile crying and colic (10.5%) were all significantly lower than the reported median prevalence for a similar age according to literature (median value of 7.8% for functional constipation, 26.7% for regurgitation, 17.7% for infantile colic). CONCLUSION The new synbiotic infant starter formula was safe, resulted in normal growth and was well tolerated. Functional gastro-intestinal manifestations (functional constipation, regurgitation and colic) were significantly lower than reported in literature. Synbiotics (Bifidobacterium lactis and fructo-oligosaccharides) in cow's milk based infant formula bring the second choice infant feeding, formula, closer to the golden standard, exclusive breastfeeding.
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Affiliation(s)
- Yvan Vandenplas
- Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Antonis Analitis
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chara Tziouvara
- 3rd Pediatric Department, Hippocration Hospital, Thessaloniki, Greece
| | | | - Anastasia Drakou
- 3rd Pediatric Department, Hippocration Hospital, Thessaloniki, Greece
| | - Manos Tsouvalas
- 3rd Pediatric Department, Hippocration Hospital, Thessaloniki, Greece
| | - Antigoni Mavroudi
- 3rd Pediatric Department, Hippocration Hospital, Thessaloniki, Greece
| | - Ioannis Xinias
- 3rd Pediatric Department, Hippocration Hospital, Thessaloniki, Greece
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Ghoshal UC. Pros and Cons While Looking Through an Asian Window on the Rome IV Criteria for Irritable Bowel Syndrome: Pros. J Neurogastroenterol Motil 2017; 23:334-340. [PMID: 28672432 PMCID: PMC5503282 DOI: 10.5056/jnm17020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/04/2017] [Accepted: 06/07/2017] [Indexed: 01/06/2023] Open
Abstract
A decade after Rome III, in 2016, Rome IV criteria were published. There are major differences between Rome IV and the earlier iteration, some of which are in line with Asian viewpoints. The clinical applicability of the Rome IV criteria of irritable bowel syndrome (IBS) in Asian perspective is reviewed here. Instead of considering functional gastrointestinal disorders (FGIDs) to be largely psychogenic, Rome IV suggested the importance of the gut over brain (“disorders of gut-brain interaction” not “brain-gut interaction”). The word “functional” is underplayed. Multi-dimensional clinical profile attempts to recognize micro-organic nature, like slow colon transit and fecal evacuation disorders in constipation and dietary intolerance including that of lactose and fructose, bile acid malabsorption, non-celiac wheat sensitivity, small intestinal bacterial overgrowth, and gastrointestinal infection in diarrhea. Overlap between different FGIDs has been recognized as Rome IV suggests these to be a spectrum rather than discrete disorders. Bloating, common in Asia, received attention, though less. Sub-typing of IBS may be more clinician-friendly now as the patient-reported stool form may be used than a diary. However, a few issues, peculiar to Asia, need consideration; Rome IV, like Rome III, suggests that Bristol type I–II stool to denote constipation though Asian experts include type III as well. Work-up for physiological factors should be given greater importance. Language issue is important. Bloating, common in IBS, should be listed in the criteria. Threshold values for symptoms in Rome IV criteria are based on Western data. Post-infectious malabsorption (tropical sprue) should be excluded to diagnose post-infectious IBS, particularly in Asia.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Ohtsu T, Takagi A, Uemura N, Inoue K, Sekino H, Kawashima A, Uchida M, Koga Y. The Ameliorating Effect of Lactobacillus gasseri OLL2716 on Functional Dyspepsia in Helicobacter pylori-Uninfected Individuals: A Randomized Controlled Study. Digestion 2017; 96:92-102. [PMID: 28768250 PMCID: PMC5637312 DOI: 10.1159/000479000] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/26/2017] [Accepted: 06/26/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Probiotics appear to improve Helicobacter pylori-associated dyspepsia via an inhibitory effect on H. pylori; however, uncertainty exists regarding their effects in H. pylori-uninfected individuals. We evaluated the efficacy of Lactobacillus gasseri OLL2716 (L. gasseri OLL2716) on H. pylori-uninfected individuals with functional dyspepsia (FD). METHODS A double-blind, parallel-group, placebo-controlled, randomized, controlled trial was performed. Participants were randomly assigned to ingest L. gasseri OLL2716-containing yogurt (L. gasseri OLL2716 group) or L. gasseri OLL2716-free yogurt (placebo group) for 12 weeks. Participants completed questionnaires that dealt with a global assessment as well as symptom severity. The per-protocol (PP) population was evaluated for efficacy in accordance with a plan prepared beforehand. RESULTS Randomization was performed on 116 individuals; the PP population consisted of 106 individuals (mean age 42.8 ± 9.0). The impressions regarding the overall effect on gastric symptoms were more positive in the L. gasseri OLL2716 group compared to that in the placebo group (statistical trend; p = 0.073). The elimination rate for major FD symptoms was 17.3 and 35.3% in the placebo and L. gasseri OLL2716 groups respectively (p = 0.048). CONCLUSION L. gasseri OLL2716 has beneficial effects on FD without H. pylori involvement.
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Affiliation(s)
- Toshihiro Ohtsu
- Food Science Research Laboratories, Meiji Co. Ltd., Odawara, Japan
| | - Atsushi Takagi
- Department of Internal Medicine, Isehara, Isehara, Japan
| | - Naomi Uemura
- Department of Gastroenterology, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Japan
| | | | | | | | - Masayuki Uchida
- Food Science Research Laboratories, Meiji Co. Ltd., Odawara, Japan
| | - Yasuhiro Koga
- Division of Infectious Disease, Tokai University School of Medicine, Isehara, Japan
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Abstract
Abdominal pain is a common complaint that leads to pediatric patients seeking emergency care. The emergency care provider has the arduous task of determining which child likely has a benign cause and not missing the devastating condition that needs emergent attention. This article reviews common benign causes of abdominal pain as well as some of the cannot-miss emergent causes.
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Affiliation(s)
- Jeremiah Smith
- Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, MEB Floor 3, Charlotte, NC 28203, USA.
| | - Sean M Fox
- Emergency Medicine Residency Program, Department of Emergency Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, MEB Floor 3, Charlotte, NC 28203, USA
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Abstract
There is growing evidence for the role of several natural products as either useful agents or adjuncts in the management of functional GI disorders (FGIDs). In this review, we examine the medical evidence for three such compounds: chili, a culinary spice; curcumin, another spice and active derivative of a root bark; and prebiotics, which are nondigestible food products. Chili may affect the pathogenesis of abdominal pain especially in functional dyspepsia and cause other symptoms. It may have a therapeutic role in FGIDs through desensitization of transient receptor potential vanilloid-1 receptor. Curcumin, the active ingredient of turmeric rhizome, has been shown in several preclinical studies and uncontrolled clinical trials as having effects on gut inflammation, gut permeability and the brain-gut axis, especially in FGIDs. Prebiotics, the non-digestible food ingredients in dietary fiber, may serve as nutrients and selectively stimulate the growth and/or activity of certain colonic bacteria. The net effect of this change on colonic microbiota may lead to the production of acidic metabolites and other compounds that help to reduce the production of toxins and suppress the growth of harmful or disease-causing enteric pathogens. Although some clinical benefit in IBS has been shown, high dose intake of prebiotics may cause more bloating from bacterial fermentation.
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Laird KT, Tanner-Smith EE, Russell AC, Hollon SD, Walker LS. Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and meta-analysis. Clin Psychol Rev. 2017;51:142-152. [PMID: 27870997 DOI: 10.1016/j.cpr.2016.11.001] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 09/18/2016] [Accepted: 11/04/2016] [Indexed: 12/15/2022]
Abstract
Previous meta-analyses have shown that psychotherapy improves gastrointestinal symptoms in adults with irritable bowel syndrome (IBS); however, the impact on functioning in daily activities is unknown. Meta-analysis was used to estimate the effect of psychotherapy on mental health and daily functioning in adults with IBS. An extensive literature search located 28 eligible randomized controlled trials (RCTs) providing outcome data for mental health and 18 RCTs providing data for daily functioning. Compared to a mixed group of control conditions, psychotherapy produced significantly greater improvements to mental health (d-=0.41) and daily functioning (d-=0.43). Cognitive behavior therapy (CBT) was evaluated in the largest number of trials (21 trials), followed by hypnosis (4 trials), psychodynamic (3 trials), and relaxation (2 trials). The psychotherapeutic modalities were comparable with respect to their effect on mental health. CBT produced the greatest improvements to daily functioning, and this effect was significantly larger than that produced by relaxation therapy. These results have important clinical implications for treatment of adults with IBS.
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Karling P, Maripuu M, Wikgren M, Adolfsson R, Norrback KF. Association between gastrointestinal symptoms and affectivity in patients with bipolar disorder. World J Gastroenterol 2016; 22:8540-8548. [PMID: 27784966 PMCID: PMC5064035 DOI: 10.3748/wjg.v22.i38.8540] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/24/2016] [Accepted: 09/12/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal (GI) symptoms in patients with bipolar disorder.
METHODS A total of 136 patients with bipolar disorder (mean age 49.9 years; 61% women) and 136 controls from the general population (mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome (GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale (HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.
RESULTS In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls (GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for “constipation” and “reflux”. Factors associated to GI symptoms in the patient group were female sex (adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score (adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores (29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls (25% vs 17%, P = 0.108).
CONCLUSION Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.
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Lee EH, Yang HR, Lee HS. Analysis of Gastric and Duodenal Eosinophils in Children with Abdominal Pain Related Functional Gastrointestinal Disorders According to Rome III Criteria. J Neurogastroenterol Motil 2016; 22:459-69. [PMID: 27053514 PMCID: PMC4930301 DOI: 10.5056/jnm15174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 01/27/2016] [Accepted: 03/05/2016] [Indexed: 12/14/2022] Open
Abstract
Background/Aims Abdominal pain-related functional gastrointestinal disorder (AP-FGID) is common in children and adults. However, the mechanism of AP-FGID is not clearly known. Recently, micro-inflammation, especially eosinophilia in the gastrointestinal tract, was suggested in the pathophysiology of AP-FGID in adults. The aim of this study was to evaluate the association of gastric and duodenal eosinophilia with pediatric AP-FGID. Methods In total, 105 pediatric patients with AP-FGID were recruited and classified into 4 subgroups based on the Rome III criteria. Eosinophil counts in the gastric and duodenal tissues of children with AP-FGID were compared to those from normal pathology references or those of children with Helicobacter pylori infection. Tissue eosinophil counts were also compared among the 4 subtypes of AP-FGID. Results Eosinophil counts in the gastric antrum and body were significantly higher in children with AP-FGID than normal reference values. Duodenal eosinophil counts were higher in children with AP-FGID, but not significantly when compared with normal reference values. There were no significant differences in eosinophil counts of the stomach or duodenum among the 4 subtypes of AP-FGID. Eosinophils counts in the gastric antrum and body were significantly higher in children with H. pylori infection than in those with AP-FGID. Duodenal eosinophilia was prominent in cases of H. pylori infection, but not statistically significant when compared with AP-FGID. Conclusions Our study revealed that gastric eosinophilia is associated with AP-FGID in children, regardless of the subtype of functional abdominal pain. This suggests some contribution of gastrointestinal eosinophils in the development of pediatric AP-FGID.
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Affiliation(s)
- Eun Hye Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
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Lozoya Angulo ME, de Las Heras Gómez I, Martinez Villanueva M, Noguera Velasco JA, Avilés Plaza F. Faecal calprotectin, an useful marker in discriminating between inflammatory bowel disease and functional gastrointestinal disorders. Gastroenterol Hepatol 2016; 40:125-131. [PMID: 27260632 DOI: 10.1016/j.gastrohep.2016.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/11/2016] [Accepted: 04/21/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Diagnostic discrimination between inflammatory bowel disease (IBD) and functional gastrointestinal disorders is complex, as they cause similar signs and symptoms. Faecal calprotectin (FC) is a useful marker in this context, and can be used to select patients who will most benefit from colonoscopy. The aim of this study was to evaluate the utility of FC in discriminating between organic disease and functional disorders. MATERIAL AND METHODS The study included 264 patients presenting with gastrointestinal complaints consistent with an organic pathology. FC levels were determined and diagnostic accuracy was assessed using the area under the curve obtained from the final diagnosis. RESULTS Calprotectin levels in organic bowel disease patients were significantly higher (median 254μg/g; 95% confidence interval [CI], interquartile range 105-588.5) than in functional disease patients (95μg/g; 95% CI, 47.25-243.92) (P<.0001). Similarly, in patients with IBD, the values obtained were higher (270.85μg/g; 95% CI, 96.85-674.00) than in those with irritable bowel syndrome (79.70μg/g; 95% CI, 36.50-117.25) (P<.0001). For a cut-off of 150μg/g, FC had an area under the ROC curve to discriminate between organic and functional disease of 0.718, and 0.872 to discriminate between irritable bowel syndrome and IBD. CONCLUSION Our study supports the importance of FC as a marker in the evaluation of patients with IBD. The best diagnostic accuracy is obtained at a cut-off value of 150μg/g.
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Affiliation(s)
- Maria Elena Lozoya Angulo
- Servicio de Análisis Clínicos, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España.
| | | | | | | | - Francisco Avilés Plaza
- Servicio de Análisis Clínicos, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
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Palsson OS, Whitehead WE, van Tilburg MAL, Chang L, Chey W, Crowell MD, Keefer L, Lembo AJ, Parkman HP, Rao SS, Sperber A, Spiegel B, Tack J, Vanner S, Walker LS, Whorwell P, Yang Y. Rome IV Diagnostic Questionnaires and Tables for Investigators and Clinicians. Gastroenterology 2016; 150:S0016-5085(16)00180-3. [PMID: 27144634 DOI: 10.1053/j.gastro.2016.02.014] [Citation(s) in RCA: 355] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 12/19/2022]
Abstract
The Rome IV Diagnostic Questionnaires were developed to screen for functional gastrointestinal disorders (FGIDs), serve as inclusion criteria in clinical trials, and support epidemiological surveys. Separate questionnaires were developed for adults, children/adolescents, and infants/toddlers. For the adult questionnaire, we first surveyed 1,162 adults without gastrointestinal disorders, and recommended the 90th percentile symptom frequency as the threshold for defining what is abnormal. Diagnostic questions were formulated and verified with clinical experts using a recursive process. The diagnostic sensitivity of the questionnaire was tested in 843 patients from 9 gastroenterology clinics, with a focus on clinical diagnoses of irritable bowel syndrome (IBS), functional constipation (FC), and functional dyspepsia (FD). Sensitivity was 62.7% for IBS, 54.7% for FD, and 32.2% for FC. Specificity, assessed in a population sample of 5,931 adults, was 97.1% for IBS, 93.3% for FD, and 93.6% for FC. Excess overlap among IBS, FC, and FD was a major contributor to reduced diagnostic sensitivity, and when overlap of IBS with FC was permitted, sensitivity for FC diagnosis increased to 73.2%. All questions were understandable to at least 90% of individuals, and Rome IV diagnoses were reproducible in ¾ of patients after one month. Validation of the pediatric questionnaires is ongoing.
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Affiliation(s)
- Olafur S Palsson
- Bioinformatics Building Room 4111, Campus Box 7080, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080
| | - William E Whitehead
- Bioinformatics Building Room 4112, Campus Box 7080, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Miranda A L van Tilburg
- Bioinformatics Building Room 4008 Campus Box 7080 University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7080
| | - Lin Chang
- Center for Neurobiology of Stress, David Geffen School of Medicine, UCLA Los Angeles,California
| | - William Chey
- Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Laurie Keefer
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Henry P Parkman
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Satish Sc Rao
- Director, Digestive Health Center, Medical College of GeorgiaGeorgia Regents University, Augusta, Georgia
| | - Ami Sperber
- Kibbutz Farod, House 86, D.N. Bikat Bet Hakerem, 2010000, Israel
| | | | - Jan Tack
- K. U. Leuven, Center for GI Research, Herestraat 49, Leuven 3000, Belgium
| | - Stephen Vanner
- Division of Gastroenterology, Kingston General Hospital, Ontario, Canada
| | - Lynn S Walker
- Department of Pediatrics, Adolescent Division, Vanderbilt University Medical Center, 2146 Belcourt Ave, Nashville TN 37212
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Shukla R, Ghoshal U, Dhole TN, Ghoshal UC. Fecal Microbiota in Patients with Irritable Bowel Syndrome Compared with Healthy Controls Using Real-Time Polymerase Chain Reaction: An Evidence of Dysbiosis. Dig Dis Sci 2015; 60:2953-62. [PMID: 25784074 DOI: 10.1007/s10620-015-3607-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/21/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dysbiosis may play a role in irritable bowel syndrome (IBS), hitherto an enigmatic disorder. We evaluated selected fecal microbes in IBS patients and healthy controls (HC). METHODS Fecal 16S rRNA copy number of selected bacteria was studied using qPCR in 47 patients with IBS (Rome III) and 30 HC. RESULTS Of 47 patients, 20 had constipation (IBS-C), 20 diarrhea (IBS-D), and seven unclassified IBS (IBS-U). Relative difference in 16S rRNA copy number of Bifidobacterium (P = 0.042) was lower, while those of Ruminococcus productus-Clostridium coccoides (P = 0.016), Veillonella (P = 0.008), Bacteroides thetaiotamicron (P < 0.001), Pseudomonas aeruginosa (P < 0.001), and Gram-negative bacteria (GNB, P = 0.001) were higher among IBS patients than HC. Number of Lactobacillus (P = 0.002) was lower, while that of Bacteroides thetaiotamicron (P < 0.001) and segmented filamentous bacteria (SFB, P < 0.001) was higher among IBS-D than IBS-C. Numbers of Bacteroides thetaiotamicron (P < 0.001), P. aeruginosa (P < 0.001), and GNB (P < 0.01) were higher among IBS-C and IBS-D than HC. Quantity of SFB was higher among IBS-D (P = 0.011) and lower among IBS-C (P = 0.002) than HC. Number of Veillonella species was higher among IBS-C than HC (P = 0.002). P. aeruginosa was frequently detected among IBS than HC (46/47 [97.9 %] vs. 10/30 [33.3 %], P < 0.001). Abdominal distension (n = 34/47) was associated with higher number of Bacteroides thetaiotamicron, Clostridium coccoides, P. aeruginosa, SFB, and GNB; bloating (n = 22/47) was associated with Clostridium coccoides and GNB. Microbial flora was different among IBS than HC on principal component analysis. CONCLUSION Fecal microbiota was different among IBS than HC, and different sub-types were associated with different microbiota. P. aeruginosa was more frequent and higher in number among IBS patients.
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Jang KM, Choe BH, Choe JY, Hong SJ, Park HJ, Chu MA, Cho SM, Kim JM. Changing Prevalence of Helicobacter pylori Infections in Korean Children with Recurrent Abdominal Pain. Pediatr Gastroenterol Hepatol Nutr 2015; 18:10-6. [PMID: 25866728 PMCID: PMC4391995 DOI: 10.5223/pghn.2015.18.1.10] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 10/13/2014] [Accepted: 10/21/2014] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the changing prevalence rate of Helicobacter pylori infection in children, of different age groups, with recurrent abdominal pain over a 10-year period. METHODS Children with recurrent abdominal pain who visited the pediatric outpatient clinic at university hospital were screened for H. pylori. Children were divided into 3 age categories of 4-5, 6-11, and 12-16 years. To study the changes in the annual prevalence rates of H. pylori infection, the study period was divided into 3 time periods: 2004-2007, 2008-2010, and 2011-2014. Urea breath test was performed for all children aged 4-16 years, with a cut-off value of 4.0‰ for children aged ≥6 years and 7‰ for children aged <6 years. RESULTS A total of 2,530 children (1,191 boys) with a mean age of 10.0±3.0 years (range, 4.0-16.9 years) were included in the study. The total prevalence of H. pylori infection was 7.4% (187/2,530). The prevalence rate of H. pylori infection in children with recurrent abdominal pain was 8.0% (70/873) in 2004-2007, 7.7% (51/666) in 2008-2010, and 6.7% (66/991) in the 2011-2014. Nevertheless, a significant difference was observed in the prevalence rate between children <12 years old and ≥12 years of age (p=0.018). CONCLUSION The prevalence of H. pylori infection in Korean children with recurrent abdominal pain was 7.4%, showing no significant decrease in the last 11 years; however, the prevalence rate in children <12 years old was significantly lower than that in those ≥12 years old.
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Affiliation(s)
- Kyung Mi Jang
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Byung-Ho Choe
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Young Choe
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Suk Jin Hong
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyo Jung Park
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Mi Ae Chu
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Man Cho
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jung Mi Kim
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
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Chao GQ, Zhang S. Effectiveness of acupuncture to treat irritable bowel syndrome: A meta-analysis. World J Gastroenterol 2014; 20:1871-1877. [PMID: 24587665 PMCID: PMC3930986 DOI: 10.3748/wjg.v20.i7.1871] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 11/25/2013] [Accepted: 12/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of acupuncture for treatment of irritable bowel syndrome (IBS) through meta-analysis of randomized controlled trials.
METHODS: We searched MEDLIINE, PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials from 1966 to February 2013 for double-blind, placebo-controlled trials investigating the efficacy of acupuncture in the management of IBS. Studies were screened for inclusion based on randomization, controls, and measurable outcomes reported. We used the modified Jadad score for assessing the quality of the articles. STATA 11.0 and Revman 5.0 were used for meta-analysis. Publication bias was assessed by Begg’s and Egger’s tests.
RESULTS: Six randomized, placebo-controlled clinical trials met the criteria and were included in the meta-analysis. The modified Jadad score of the articles was > 3, and five articles were of high quality. We analyzed the heterogeneity and found that these studies did not cause heterogeneity in our meta-analysis. Begg’s test showed P = 0.707 and Egger’s test showed P = 0.334. There was no publication bias in our meta-analysis (Begg’s test, P = 0.707; Egger’s test, P = 0.334). From the forest plot, the diamond was on the right side of the vertical line and did not intersect with the line. The pooled relative risk for clinical improvement with acupuncture was 1.75 (95%CI: 1.24-2.46, P = 0.001). Using the two different systems of STATA 11.0 and Revman 5.0, we confirmed the significant efficacy of acupuncture for treating IBS.
CONCLUSION: Acupuncture exhibits clinically and statistically significant control of IBS symptoms.
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Rosen JM, Adams PN, Saps M. Umbilical hernia repair increases the rate of functional gastrointestinal disorders in children. J Pediatr 2013; 163:1065-8. [PMID: 23759426 DOI: 10.1016/j.jpeds.2013.04.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 02/28/2013] [Accepted: 04/22/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To hypothesize that hernia repair would not change the incidence of functional gastrointestinal disorders (FGIDs) due to the benign and limited nature of the procedure. STUDY DESIGN This cohort study assessed a randomized selection of children aged 4-18 years who underwent hernia repair more than 4 years prior at Ann and Robert H. Lurie Children's Hospital of Chicago. Controls were siblings who had not undergone surgery previously. Parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version by telephone for subjects and controls. The primary outcome was the presence of FGIDs. RESULTS Fifty children with hernia repair and 43 sibling controls were identified. At the time of survey, subjects with hernia repair were average age 12.9 years (range 5-18 years, 60% male) and controls were average age 12.2 years (range 4-18 years, 49% male). Average age at surgical repair was 5.2 years (median 5.2 years, range 0.2-10.4 years) and average time since surgical repair was 7.8 years (range 4.8-13.7 years). FGIDs were diagnosed in 10/50 (20%) cases of hernia repair and 2/43 (5%) controls (P = .033, Fisher 2-tailed test). CONCLUSIONS Umbilical hernia repair increases the likelihood of FGIDs in childhood. Additional studies are needed to identify aspects of surgery that may be associated with development of FGIDs.
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Affiliation(s)
- John M Rosen
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Yacob D, Di Lorenzo C, Bridge JA, Rosenstein PF, Onorato M, Bravender T, Campo JV. Prevalence of pain-predominant functional gastrointestinal disorders and somatic symptoms in patients with anxiety or depressive disorders. J Pediatr 2013; 163:767-70. [PMID: 23522860 DOI: 10.1016/j.jpeds.2013.02.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 01/09/2013] [Accepted: 02/14/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine whether children with symptoms of internalizing psychiatric disorders have a greater prevalence of pain-predominant functional gastrointestinal disorders (FGIDs) and migraine-like headaches. STUDY DESIGN Children and adolescents aged 6-18 years were recruited from a behavioral health center (n = 31) and a primary care center (n = 36). Subjects completed Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-based symptom inventory questionnaires to screen for internalizing psychiatric disorders, the Questionnaire on Pediatric Gastrointestinal Symptoms, and a somatic distress assessment interview. RESULTS Thirty-three subjects (19 of 31 from the behavioral health center and 14 of 36 from the primary care center) screened positive for symptoms of anxiety or depressive disorders. The remainder screened negative and served as controls. Pain-predominant FGIDs were more common in the group with symptoms of anxiety or depression compared with controls (prevalence, 51.5% vs 8.8%; P = .0002). Migraine headaches occurred in 57.6% of the subjects with internalizing psychiatric disorders vs 23.5% of the control group (P = .006). The prevalence of functional constipation did not differ significantly between the 2 groups. The data remained essentially unchanged when analyzed within each center of recruitment. CONCLUSION Youths with anxiety or depressive symptoms are more likely to suffer from pain-predominant FGIDs and migraine-like headaches, but not from functional constipation. The lack of an association between functional constipation and internalizing psychiatric symptoms suggests that FGIDs associated with pain may bear a specific relationship to emotional disorders.
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Affiliation(s)
- Desale Yacob
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital and The Ohio State University, Columbus, OH 75390-9063, USA.
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Perez ME, Coley B, Crandall W, Di Lorenzo C, Bravender T. Effect of nutritional rehabilitation on gastric motility and somatization in adolescents with anorexia. J Pediatr 2013; 163:867-72.e1. [PMID: 23587435 PMCID: PMC3923459 DOI: 10.1016/j.jpeds.2013.03.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 01/28/2013] [Accepted: 03/07/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine gastric function, as well as the presence of somatic complaints, anxiety symptoms, and functional gastrointestinal disorders (FGIDs), in adolescents with anorexia nervosa (AN) before and after nutritional rehabilitation. STUDY DESIGN Sixteen females with AN and 22 healthy controls with similar demographic profiles were included. Gastric emptying (measured as residual gastric volume) and gastric accommodation (measured as postprandial antral diameter) were assessed with abdominal ultrasonography. Participants completed the Children's Somatization Inventory (CSI), the Screen for Child Anxiety-Related Emotional Disorders, and the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III version. All testing was repeated 3-4 months later. RESULTS Body mass index in the AN group improved over time (P = .012). Fasting gastric parameters were similar in the 2 groups. Maximum postprandial antral diameter was significantly greater in controls compared with the AN group (P = .008). Only adolescents with AN demonstrated a significant increase in maximum postprandial diameter at repeat testing (P = .009). There was no difference in residual gastric volume between the 2 groups. Initial CSI scores were higher in adolescents with AN (P < .0001), including higher scores for nausea and abdominal pain. CSI scores were significantly lower in adolescents with AN (P = .035). Initial scores on the Screen for Child Anxiety-Related Emotional Disorders were significantly higher in adolescents with AN (P = .0005), but did not change over time. Adolescents with AN met significantly more criteria for FGIDs (P = .003). CONCLUSION Adolescents with AN have impaired gastric accommodation that improves after nutritional rehabilitation, have significantly more somatic complaints, and meet more criteria for anxiety disorders and FGIDs. After nutritional rehabilitation, somatization improves and FGIDs become less common, but symptoms of anxiety persist.
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Affiliation(s)
- Maria E Perez
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH, USA.
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Panigrahi MK, Kar SK, Singh SP, Ghoshal UC. Defecation frequency and stool form in a coastal eastern Indian population. J Neurogastroenterol Motil 2013; 19:374-80. [PMID: 23875105 PMCID: PMC3714416 DOI: 10.5056/jnm.2013.19.3.374] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 06/01/2013] [Accepted: 06/01/2013] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Data on normal stool form and frequency, which are important for defining constipation, are scanty; hence, we studied these in an eastern Indian population. Methods One thousand and two hundred apparently healthy asymptomatic subjects were evaluated for predominant stool form (Bristol chart with descriptor) and frequency. Data on demographic and life-style (diet and physical activity) were collected. Results Of 1,200 subjects (age 42 ± 14.5 years, 711, 59% male), most passed predominantly Bristol type IV stool (699 [58.2%]; other forms were: type I (23 [1.9%]), type II (38 [3.2%]), type III (99 [8.2%]), type V (73 [6%]), type VI (177 [14.7%]), type VII (7 [0.6%]) and an irregular combination (84 [7%]). Weekly stool frequency was 12.1 ± 4.7 (median 14, range 2-42). Less than 3 stools/week was noted in 32/1,200 (2.6%). Female subjects (n = 489) passed stools less frequently than males (n = 711) (11.1 ± 5.6/week vs. 12.8 ± 3.8/week, P < 0.001) and tended to pass harder forms (type I: 17, type II: 20, type III: 39 vs. 6, 18 and 60, respectively, P = 0.061). Vegetarians (n = 252) and physically active (n = 379) subjects tended to pass stool more frequently than occasional (n = 553) and regular non-vegetarian (n = 395) (11.8 ± 4.5 and 12.8 ± 4.7 vs. 11.3 ± 4.7; P < 0.05) and sedentary (n = 464) and intermediately active (n = 357) subjects (13.4 ± 4.0 and 12.3 ± 4.5 vs. 10.9 ± 5.1, P = 0.080) in different age groups, respectively. Older age was associated with less frequent stool, particularly among female population. Female gender and age > 35 years were significant on multivariate analysis. Conclusions Median stool frequency in the studied population was 14/week (range 2-42) and predominant form was Bristol type IV. Older age was associated with lesser stool frequency, particularly among female subjects.
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