Increased serum BDNF and ProBDNF levels in children with irritable bowel syndrome

OBJECTIVE

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders among the pediatric population. Recently, neurotrophins have been suggested to be etiological factors or causes of symptoms of IBS. In the present study, the aim was to research the serum brain-derived neurotrophic factor (BDNF) and proBDNF levels in children with IBS.

METHODS

The study group was selected from pediatric gastroenterology outpatient clinic and control group was recruited from healthy children outpatient clinic. Based on the inclusion and exclusion criteria, 29 children with IBS and 55 healthy children were included in the study. The data were obtained from all participants, and if needed, from their parents. All participants were assessed in terms of anthropometric measurements. The serum (BDNF) and proBDNF levels were compared between the groups.

RESULTS

The proBDNF levels in IBS patients were higher compared with the control group in covariance analysis (IBS patients group mean 492.4, SD 534.1; control group mean 332.8, SD 406.7) (p = 0.02; Cohen's d = 0.45). The serum BDNF levels of IBS patients were also higher compared with the control group (IBS patients group mean 3.1, SD 4.3; control group mean 1.7, SD 2.7) (p = 0.02; Cohen's d = 0.51).

CONCLUSIONS

The present study is the first to demonstrate that there is a higher level of serum BDNF in children with IBS. Moreover, it is the first to demonstrate an increased level of proBDNF in IBS. Additional research is needed to confirm the preliminary results.

Irritable bowel syndrome: modern concepts and management options

Irritable bowel syndrome is the most common functional gastrointestinal disorder, manifesting as abdominal pain/discomfort and altered bowel function. Despite affecting as many as 20% of adults, a lack of understanding of etiopathogenesis and evaluation strategies results in diagnostic uncertainty, and in turn frustration of both the physician and the patient. This review summarizes the current literature on the diagnosis and management of irritable bowel syndrome, with attention to evidence-based approaches. A 4-step treatment strategy that has been used successfully in our tertiary referral practice is presented and should lead to successful therapeutic outcomes in the majority of patients with irritable bowel syndrome.

An experience with the Patient-Reported Outcomes Measurement Information System: pros and cons and unanswered questions

The goal of the Patient-Reported Outcomes Measurement Information System (PROMIS) is to create efficient, reliable, and valid assessments of adult and child health. The nursing science literature in which PROMIS measures are used is rapidly expanding. Investigators have been encouraged to consider the integration of PROMIS measures into both descriptive studies and clinical trials. Doing this has created opportunities and challenges for investigators. This article highlights three projects to show the perspectives of nurse scientists who incorporated PROMIS measures into their research. The first project describes advantages of PROMIS to allow for comparisons of a study population with a national sample and to compliment legacy measures. The second project examines issues in the translation of tools for region-specific Hispanic populations. The third project provides a perspective on the use of PROMIS measures to capture cancer-related fatigue and to develop new components of a sexual function scale. As indicated by these three examples, nurse scientists can contribute an important role in moving the PROMIS initiative forward. Results from these types of projects also move symptom science forward within a more interdisciplinary approach to common measures of interest.

Cyst formation and faecal-oral transmission of Dientamoeba fragilis--the missing link in the life cycle of an emerging pathogen

Dientamoeba fragilis is a protozoan parasite emerging as a cause of diarrhoea and "irritable-bowel-like" gastrointestinal disease in humans with a propensity for establishing long-term, chronic infections in humans. Although Dientamoeba was discovered over a century ago its life cycle and mode of transmission is not known. No cyst stage has been described and no animal models are presently available for the study of this parasite. Here we describe the establishment of an animal model using laboratory rodents, the fulfilling of Koch's postulates, and the discovery of a new cyst stage in the life cycle of D. fragilis. Our demonstration of long-term parasite carriage by rodents and prolonged shedding of cysts, together with elevated levels of calprotectin in the stool, confirms the capacity of this organism to cause disease and indicates dientamoebiasis should be considered in the differential diagnosis of gastrointestinal diseases such as Inflammatory Bowel Syndrome (IBS). Finally, we suggest that the cyst stage described here is the vehicle that mediates faecal-oral transmission of D. fragilis between hosts.

[Childhood sexual abuse: how important is the diagnosis to understand and manage sexual, anorectal and lower urinary tract symptoms]

OBJECTIVE

To understand and manage the sequels of childhood sexual abuse on sexual, anorectal and lower urinary tract functions.

MATERIAL AND METHODS

Review of articles published in the Medline database, selected according to their scientific relevance and published guidelines on this subject together with our own experience.

RESULTS

A history of sexual abuse is frequently found when assessing dysfunction or symptoms of the lower urinary tract. In this context, urinary stress incontinence is rarely involved but it can be linked by epidemiological factors. Dysuria with urgency is the most frequent expressed symptom. When associated with anorectal disorders and pelvic pain or a sexual disorder in particular dyspareunia, a sexual abuse should be evoked and specific questions asked to the patient. Although these symptoms are frequently encountered in 12 to 33% of women, and 8 to 16% of men, few practitioners, whatever their speciality ask about them as routine. It is important that the physician diagnose the existence of sexual abuse, in particular when the symptoms mentioned by the patient are not conclusive, in spite of thorough urological assessment. Patients finding the initial examination difficult and painful and the failure of the initial treatment should lead to questions concerning abuse, if neglected by the initial medical inquiry.

CONCLUSIONS

Clinicians involved in perineal functional pathology are able to acquire standardized modalities of inquiry about child sexual abuse for a better time management and efficacy in the therapeutic approach. The interest of a multidisciplinary diagnostic and therapeutic approach is primordial, associating psychological therapy and if necessary perineal re-education. This can avoid unnecessary tests and out-patient visits. Directing patients towards a multidisciplinary approach is highly advisable.

Post-Infectious Irritable Bowel Syndrome, an Inflammation-Immunological Model with Relevance for Other IBS and Functional Dyspepsia

This review presents studies that support an inflammation-immunological model for the pathogenesis of post-infectious irritable bowel syndrome (IBS), and highlights recent studies that support a similar disease model in non-post-infectious IBS, in particular, diarrhoea-predominant IBS, as well as in post-infectious functional dyspepsia. These recent studies are highlighted to demonstrate that one line of research in functional gastrointestinal disorders has moved away from the old psychosomatic concepts. It is hoped that this will encourage future students of this field to explore the role of immunological events.