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Aydemir Y, Aydemir O, Dinleyici M, Saglik AC, Cam D, Kaya TB, Canpolat FE. Screening for functional gastrointestinal disorders in preterm infants up to 12 months of corrected age: a prospective cohort study. Eur J Pediatr 2024; 183:2091-2099. [PMID: 38347262 PMCID: PMC11035472 DOI: 10.1007/s00431-024-05451-4] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 04/23/2024]
Abstract
Functional gastrointestinal disorders (FGIDs) are characterized by a variety of symptoms that are frequently age-dependent, chronic, or recurrent and are not explained by structural or biochemical abnormalities. There are studies in the literature reporting different results regarding the relationship between prematurity and FGIDs. The main objective of this study was to compare the frequency of FGIDs between preterm and term infants. The secondary objective was to evaluate whether there was any association between neonatal characteristics and development of FGIDs. A multicenter prospective cohort study that included preterm infants born before 37 weeks of gestation and healthy term infants was carried out. At 1, 2, 4, 6, 9, and 12 months of age, infants were assessed for the presence of FGIDs using the Rome IV criteria. In preterm infants, an additional follow-up visit was made at 12 months corrected age. 134 preterm and 104 term infants were enrolled in the study. Infantile colic, rumination syndrome, functional constipation, and infant dyschezia were more common in preterm infants. Incidence of other FGIDs (infant regurgitation, functional diarrhea and cyclic vomiting syndrome) were similar among preterm and term infants. Preterm infants who are exclusively breastfeed in the first 6 months of life have a lower incidence of infantile colic (18.8% vs 52.1%, p = 0.025). In terms of chronological age, FGIDs symptoms started later in preterm infants; this difference was statistically significant for infantile colic and regurgitation (median age 2 months vs 1 month, p < 0.001). Conclusions: Preterm infants have a higher prevalence of FGIDs compared with term controls. Therefore, especially if they have gastrointestinal complaints, they should be screened for FGIDs. Possibly due to maturational differences, the time of occurrence of FGIDs may differ in preterm infants. Infantile colic incidence decreases with exclusive breastfeeding. What is Known: • The functional gastrointestinal disorders are a very common in infancy. • Data on preterm infants with FGIDs are currently very limited. What is New: • Preterm infants have a higher incidence of infantile colic, rumination syndrome, functional constipation and infant dyschezia when compared to term infants. • Preterm infants who are exclusively breastfed during the first 6 months of life experience a lower incidence of infantile colic.
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Affiliation(s)
- Yusuf Aydemir
- Faculty of Medicine Department of Pediatrics, Division of Gastroenterology and Hepatology, Eskisehir Osmangazi University, Meselik, 26040, Eskisehir, Turkey.
| | - Ozge Aydemir
- Faculty of Medicine Department of Pediatrics, Division of Neonatology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Meltem Dinleyici
- Faculty of Medicine Department of Pediatrics, Division of Social Pediatrics, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Adviye Cakil Saglik
- Faculty of Medicine Department of Pediatrics, Division of Neonatology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Demet Cam
- Neonatal Intensive Care Unit, Dr. Zekai Tahir Burak Womens Health Research and Education Hospital, Ankara, Turkey
| | - Tugba Barsan Kaya
- Faculty of Medicine Department of Pediatrics, Division of Neonatology, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Fuat Emre Canpolat
- Department of Pediatrics, Division of Neonatology, University of Health Science Ankara Bilkent City Hospital, Ankara, Turkey
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Hamilton MJ. Mast Cell Activation Syndrome and Gut Dysfunction: Diagnosis and Management. Curr Gastroenterol Rep 2024; 26:107-114. [PMID: 38353900 DOI: 10.1007/s11894-024-00924-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE OF REVIEW Mast cell activation syndrome (MCAS) is a clinical disorder that may explain irritable bowel syndrome (IBS) type symptoms as well as other allergic symptoms experienced by an individual. The diagnosis and treatment of MCAS with specific focus on gastrointestinal (GI) manifestations is reviewed. RECENT FINDINGS Although biomarkers for MCAS remain elusive, testing for baseline serum tryptase will distinguish the type of mast cell disorder and urine tests for mast cell mediator metabolites may support the diagnosis. Endoscopy and Colonoscopy with biopsies is not used to diagnose MCAS but is important to rule out other conditions that may cause symptoms. There is increased awareness of the association between MCAS and autonomic dysfunction, small fiber neuropathy, and connective tissue disorders which all impact GI symptoms. MCAS is a disorder often of unknown etiology (idiopathic) and characterized by intermittent allergy type symptoms that affect multiple organ systems after exposure to a trigger. GI symptoms including abdominal cramping and loose stool are prominent and mimic those of IBS. Diagnostic testing is performed to assess for elevations in mast cell mediators during symptoms and to rule out other conditions. A comprehensive treatment plan includes medications that target mast cells, treatments for associated conditions including autonomic dysfunction, and management of comorbid psychiatric illness and nutritional deficits.
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Affiliation(s)
- Matthew J Hamilton
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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3
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Schmidt ML, McCrady E, Lee A, Bowerbank T, Miller MR, Watson M, Dhandapani A, Woolfson JP, Zizzo AN, Bax K, Crowley E. Home-based fecal calprotectin utilization in a general pediatric gastroenterology clinic. J Pediatr Gastroenterol Nutr 2024; 78:790-799. [PMID: 38318970 DOI: 10.1002/jpn3.12150] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 12/20/2023] [Accepted: 01/14/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Remote investigation and monitoring have gained importance in ambulatory practice. A home-based fecal calprotectin (FC) test has been developed where the sample is processed and analyzed at home through a smartphone application. We aimed to assess the use of standard ELISA (sFC) versus home-based (hFC) FC testing in a general pediatric gastroenterology clinic. METHODS Ambulatory pediatric patients with hFC or sFC performed between August 2019 and November 2020 were included. Data regarding demographics, clinical characteristics, medication use, investigations, and final diagnosis, categorized as inflammatory bowel disease (IBD), functional gastrointestinal (GI) disorders, organic non-IBD (ONI) GI disorders, non-GI disorders, and undetermined after 6 months of investigation, were recorded. RESULTS A total of 453 FC tests from 453 unique patients were included. Of those, 249 (55%) were hFC. FC levels (median) were higher in children with IBD compared to non-IBD diagnosis (sFC 795 vs. 57 μg/g, hFC 595 vs. 47 μg/g, p < 0.001), and in ONI compared to functional GI disorders (sFC 85 vs. 54 μg/g, p = 0.003, hFC 57 vs. 40 μg/g, p < 0.001). No significant difference was observed between different ONI GI disorders or subtypes of functional disorders. Age did not significantly influence levels. CONCLUSIONS Overall, hFC and sFC provide similar results in the general pediatric GI ambulatory setting. FC is a sensitive but not disease-specific marker to identify patients with IBD. Values appear to be higher in ONI GI disorders over functional disorders, although cut-off values have yet to be determined.
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Affiliation(s)
- Melanie L Schmidt
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Emma McCrady
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Angus Lee
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Michael R Miller
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Melanie Watson
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
| | - Ashok Dhandapani
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Jessica P Woolfson
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Andréanne N Zizzo
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Kevin Bax
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
| | - Eileen Crowley
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Pediatrics, Division of Pediatric Gastroenterology & Hepatology, Children's Hospital of Western Ontario, London Health Sciences Center, London, Ontario, Canada
- Children's Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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Palsson OS, Tack J, Drossman DA, Le Nevé B, Quinquis L, Hassouna R, Ruddy J, Morris CB, Sperber AD, Bangdiwala SI, Simrén M. Worldwide population prevalence and impact of sub-diagnostic gastrointestinal symptoms. Aliment Pharmacol Ther 2024; 59:852-864. [PMID: 38311841 DOI: 10.1111/apt.17894] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/07/2023] [Accepted: 01/22/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND The Rome Foundation Global Epidemiology Study (RFGES) found that 40.3% of adults in 26 internet-surveyed countries met Rome IV criteria for disorders of gut-brain interaction (DGBI). However, additional people not meeting DGBI criteria may also be burdened by frequent gastrointestinal symptoms. AIMS To explore the prevalence and demographic distribution of sub-diagnostic gastrointestinal symptoms, and the hypothesised associated effects on quality of life (QoL), life functioning and healthcare needs. METHODS We analysed data from the RFGES survey, which included the Rome IV diagnostic questionnaire and QoL, psychological, work productivity and healthcare questions. RESULTS Of the 50,033 people without a history of organic gastrointestinal disorders, 25.3% classified in the sub-diagnostic group (no DGBI but one or more frequent gastrointestinal symptoms), 41.4% had DGBI and 33.4% had no frequent gastrointestinal symptoms (non-GI group). Sub-diagnostic prevalence in different world regions ranged from 22.2% (North America) to 30.5% (Middle East), was slightly higher among males than females and decreased with age. The sub-diagnostic group was intermediate between the non-GI and DGBI groups, and significantly different from both of them on QoL, anxiety, depression, somatisation, healthcare utilisation and life and work impairment. CONCLUSIONS One in four adults without organic gastrointestinal disorders or DGBI report frequent gastrointestinal symptoms. This sub-diagnostic group has reduced QoL, greater psychological and non-GI bodily symptoms, impaired work productivity and life activities and greater healthcare use compared to non-GI individuals. This suggests that many in this sub-diagnostic group might benefit from healthcare services or symptom self-management advice.
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Affiliation(s)
- Olafur S Palsson
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Douglas A Drossman
- University of North Carolina at Chapel Hill and CEO of the Rome Foundation, Raleigh, North Carolina, USA
| | | | | | - Rim Hassouna
- Danone Nutricia Research, Gif-sur-Yvette, France
| | | | | | - Ami D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Magnus Simrén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Chogle A, El-Chammas K, Santucci N, Grimm M, Dorfman L, Graham K, Kelly DR, Dranove JE, Rosen R, Nurko S, Croffie J, Balakrishnan K, Chiou EH, Zhang L, Simpson P, Karrento K. A multicenter registry study on percutaneous electrical nerve field stimulation for pediatric disorders of gut-brain interaction. J Pediatr Gastroenterol Nutr 2024; 78:817-826. [PMID: 38451058 DOI: 10.1002/jpn3.12174] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/02/2024] [Accepted: 02/03/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Percutaneous electrical nerve field stimulation (PENFS) has demonstrated promise in single-center trials for pediatric abdominal pain-related disorders of gut-brain interaction (DGBI). Our aim was to explore efficacy of PENFS as standard therapy for DGBI in a registry involving multiple pediatric gastroenterology referral centers. METHODS This was a multicenter, prospective open-label registry of children (8-18 years) undergoing PENFS for DGBI at seven tertiary care gastroenterology clinics. DGBI subtypes were classified by Rome IV criteria. Parents and patients completed Abdominal Pain Index (API), Nausea Severity Scale (NSS), and Functional Disability Inventory (FDI) questionnaires before, during therapy and at follow-up visits up to 1 year later. RESULTS A total of 292 subjects were included. Majority (74%) were female with median (interquartile range [IQR]) age 16.3 (14.0, 17.7) years. Most (68%) met criteria for functional dyspepsia and 61% had failed ≥4 pharmacologic therapies. API, NSS, and FDI scores showed significant declines within 3 weeks of therapy, persisting long-term in a subset. Baseline (n = 288) median (IQR) child-reported API scores decreased from 2.68 (1.84, 3.58) to 1.99 (1.13, 3.27) at 3 weeks (p < 0.001) and 1.81 (0.85, 3.20) at 3 months (n = 75; p < 0.001). NSS scores similarly improved from baseline, persisting at three (n = 74; p < 0.001) and 6 months later (n = 55; p < 0.001). FDI scores displayed similar reductions at 3 months (n = 76; p = 0.01) but not beyond. Parent-reported scores were consistent with child reports. CONCLUSIONS This large, comprehensive, multicenter registry highlights efficacy of PENFS for gastrointestinal symptoms and functionality for pediatric DGBI.
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Affiliation(s)
- Ashish Chogle
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Orange County, Orange, California, USA
| | - Khalil El-Chammas
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Neha Santucci
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Monica Grimm
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lev Dorfman
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kahleb Graham
- Department of Pediatrics, Division of Pediatric Gastroenterology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Daniel R Kelly
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Jason E Dranove
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Atrium Health Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Rachel Rosen
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Joseph Croffie
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology & Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Keshawadhana Balakrishnan
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Eric H Chiou
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Liyun Zhang
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pippa Simpson
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katja Karrento
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition & Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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McDonald CM, Reid EK, Pohl JF, Yuzyuk TK, Padula LM, Vavrina K, Altman K. Cystic fibrosis and fat malabsorption: Pathophysiology of the cystic fibrosis gastrointestinal tract and the impact of highly effective CFTR modulator therapy. Nutr Clin Pract 2024; 39 Suppl 1:S57-S77. [PMID: 38429959 DOI: 10.1002/ncp.11122] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 03/03/2024] Open
Abstract
Cystic fibrosis (CF) is a progressive, genetic, multi-organ disease affecting the respiratory, digestive, endocrine, and reproductive systems. CF can affect any aspect of the gastrointestinal (GI) tract, including the esophagus, stomach, small intestine, colon, pancreas, liver, and gall bladder. GI pathophysiology associated with CF results from CF membrane conductance regulator (CFTR) dysfunction. The majority of people with CF (pwCF) experience exocrine pancreatic insufficiency resulting in malabsorption of nutrients and malnutrition. Additionally, other factors can cause or worsen fat malabsorption, including the potential for short gut syndrome with a history of meconium ileus, hepatobiliary diseases, and disrupted intraluminal factors, such as inadequate bile salts, abnormal pH, intestinal microbiome changes, and small intestinal bacterial overgrowth. Signs and symptoms associated with fat malabsorption, such as abdominal pain, bloating, malodorous flatus, gastroesophageal reflux, nausea, anorexia, steatorrhea, constipation, and distal intestinal obstruction syndrome, are seen in pwCF despite the use of pancreatic enzyme replacement therapy. Given the association of poor nutrition status with lung function decline and increased mortality, aggressive nutrition support is essential in CF care to optimize growth in children and to achieve and maintain a healthy body mass index in adults. The introduction of highly effective CFTR modulator therapy and other advances in CF care have profoundly changed the course of CF management. However, GI symptoms in some pwCF may persist. The use of current knowledge of the pathophysiology of the CF GI tract as well as appropriate, individualized management of GI symptoms continue to be integral components of care for pwCF.
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Affiliation(s)
| | - Elizabeth K Reid
- Cystic Fibrosis Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John F Pohl
- Pediatric Gastroenterology, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Tatiana K Yuzyuk
- Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- ARUP Institute for Clinical & Experimental Pathology, Salt Lake City, Utah, USA
| | - Laura M Padula
- Pediatric Specialty, University Health, San Antonio, Texas, USA
| | - Kay Vavrina
- Pediatric Specialty, University Health, San Antonio, Texas, USA
| | - Kimberly Altman
- Gunnar Esiason Adult Cystic Fibrosis and Lung Center, Columbia University Medical Center, New York, New York, USA
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7
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Olden KW. Editorial: Gastrointestinal symptoms-A world of differences. Aliment Pharmacol Ther 2024; 59:904. [PMID: 38462680 DOI: 10.1111/apt.17905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
LINKED CONTENTThis article is linked to Palsson et al paper. To view this article, visit https://doi.org/10.1111/apt.17894
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Affiliation(s)
- Kevin W Olden
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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8
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Murakami K, Arai J, Ihara S, Tsuchida Y, Shoda H, Tsuboi M, Kurokawa K, Shiomi C, Suzuki N, Hayakawa Y, Fujio K, Fujishiro M. Upper gastrointestinal involvement of Behçet's disease in Japan: endoscopic findings and clinical features. J Gastroenterol Hepatol 2024; 39:708-715. [PMID: 38185774 DOI: 10.1111/jgh.16479] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
AIM Behçet's disease (BD) can involve any gastrointestinal (GI) tract site. We analyzed the characteristics, risk factors, and treatment responses to upper GI (UGI) involvement in patients with BD. METHODS This retrospective cohort study analyzed UGI findings in 101 patients with BD who underwent endoscopy between April 2005 and December 2022 at the University of Tokyo Hospital. The patients were divided into two groups based on the presence or absence of UGI findings. Patient backgrounds, clinical symptoms, colonoscopy (CS) findings, and blood test findings were compared between the groups. RESULTS In total, 18.8% (19/101) of the patients had UGI lesions. The prevalence rates in the esophagus, stomach, and duodenum were 6.9%, 6.9%, and 8.9%, respectively. Of these 19 patients, BD treatment were intensified in 10 (52.6%) patients after esophagogastroduodenoscopy (EGD), and all showed improvement in symptoms or endoscopic findings. In the multivariate analysis, symptoms (OR: 37.1, P < 0.001), CRP > 1 mg/dL (OR: 11.0, P = 0.01), and CS findings (OR: 5.16, P = 0.04) were independent predictors of UGI involvement in BD patients. The prediction model for UGI involvement using these three factors was highly accurate, with an AUC of 0.899 on the ROC curve. In the subgroup analysis of intestinal BD, symptoms (OR: 12.8, P = 0.01) and ESR > 20 mm/h (OR: 11.5, P = 0.007) were independent predictors. CONCLUSIONS EGD should be conducted in BD patients with high CRP, GI symptoms, and lower GI involvement, which leads to better management of BD in terms of improving symptoms and endoscopic findings.
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Affiliation(s)
- Keita Murakami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Junya Arai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
- Department of Gastroenterology, The Institute of Medical Science, Asahi Life Foundation, Tokyo, Japan
| | - Sozaburo Ihara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yumi Tsuchida
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hirofumi Shoda
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mayo Tsuboi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ken Kurokawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Chihiro Shiomi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nobumi Suzuki
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoku Hayakawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keishi Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
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9
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Tack J, Carbone F, Chang L, Lacy BE. Patient-Reported Outcomes in Disorders of Gut-Brain Interaction. Gastroenterology 2024; 166:572-587.e1. [PMID: 38309628 DOI: 10.1053/j.gastro.2023.11.307] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 11/06/2023] [Accepted: 11/11/2023] [Indexed: 02/05/2024]
Abstract
Disorders of gut-brain interaction are characterized by chronic gastrointestinal symptoms in the absence of abnormal endoscopic or radiologic findings or objective biomarkers that can be identified during routine clinical evaluation. The assessment of the symptom pattern and severity, therefore, is the key modality to evaluate the presence, impact, and evolution of these conditions, for both clinical and regulatory purposes. Patient-reported outcomes are structured symptom assessment questionnaires designed to evaluate symptom patterns, quantify severity of symptoms, and evaluate response to treatment at follow-up. This review provides an overview of currently available patient-reported outcomes for evaluating the main disorders of gut-brain interaction, specifically, functional dyspepsia; irritable bowel syndrome; and chronic constipation. It summarizes their content, level of validation for clinical practice and for research, and the regulatory approach to these conditions. Expected future developments and need for further research on patient-reported outcomes for these and other disorders of gut-brain interaction are highlighted.
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Affiliation(s)
- Jan Tack
- Translational Research in Gastrointestinal Disorders, University of Leuven, Leuven, Belgium; Department of Gastroenterology, Leuven University Hospitals, Leuven, Belgium.
| | - Florencia Carbone
- Department of Gastroenterology, Leuven University Hospitals, Leuven, Belgium
| | - Lin Chang
- G. Oppenheimer Center for Neurobiology of Stress at University of California, Los Angeles, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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Wei C, Wang M, Li J, Su J, Huang J, Tong S, Yang D. Light chain deposition disease presenting with gastrointestinal disorder as primary manifestation: report of two cases and literature review. J Int Med Res 2024; 52:3000605241233972. [PMID: 38488658 PMCID: PMC10943736 DOI: 10.1177/03000605241233972] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/29/2024] [Indexed: 03/18/2024] Open
Abstract
Light chain deposition disease (LCDD) is an under-recognized condition characterized by deposition of abnormal monoclonal light chains in tissues, leading to organ dysfunction. LCDD involving the gastrointestinal tract is very uncommon, and its diagnosis is challenging. We herein report two cases of LCDD that manifested as inflammatory bowel disease-like symptoms and protein-losing gastroenteropathy. Both patients were women in their early 60s. Tissue biopsies from the gastrointestinal mucosa demonstrated extracellular deposits, which were negative by Congo red staining but positive for κ-light chain by immunohistochemistry. The recent literature on LCDD was reviewed. When patients unexpectedly show extracellular deposits in gastrointestinal biopsy specimens, evaluation of immunoglobulin chains is recommended for diagnosis of LCDD after systemic amyloidosis has been excluded.
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Affiliation(s)
- Chenxiang Wei
- Division of Gastroenterology and Hepatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Min Wang
- Division of Gastroenterology and Hepatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Jiamin Li
- Department of Pathology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Jiajun Su
- Department of Pathology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Jing Huang
- Department of Hematology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Sunwing Tong
- Department of Pathology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
| | - Dongye Yang
- Division of Gastroenterology and Hepatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, P.R. China
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11
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Todd J, Saboori S, Zeidan J, Ahrens W, Jacobs C, Moshiree B. Sevelamer-Induced Gastrointestinal Disease in 12 Patients with End-Stage Renal Disease: A Case Series. Clin Transl Gastroenterol 2024; 15:e00679. [PMID: 38251689 PMCID: PMC10962893 DOI: 10.14309/ctg.0000000000000679] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Isolated case reports and case series have linked the use of sevelamer to severe gastrointestinal (GI) inflammation and perforation among patients with end-stage renal disease. METHODS In this study, we identified 12 cases of biopsy-proven sevelamer-induced gastrointestinal disease from a large urban community hospital over the course of 5 years. We described baseline characteristics, sites and types of injury, histological findings, timing and dosing of sevelamer initiation compared with symptom onset, and in a smaller subset, endoscopic resolution post drug cessation. We also reviewed preexisting conditions to identify trends in populations at risk. RESULTS Several of the patients reviewed had preexisting conditions of decreased motility and/or impaired mucosal integrity. The presentation of disease was broad and included both upper-GI and lower-GI pathologies and in varying severity. DISCUSSION There is a broad phenotypic range of sevelamer-induced gastrointestinal disease. As this becomes a more frequently recognized pathology, clinicians should be aware of how it may present and which populations may be more susceptible.
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Affiliation(s)
- James Todd
- Department of Internal Medicine, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, USA
| | - Shadab Saboori
- Department of Gastroenterology and Hepatology, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, USA
| | - Joseph Zeidan
- Department of Gastroenterology and Hepatology, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, USA
| | - William Ahrens
- Department of Pathology, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, USA
| | - Carl Jacobs
- Department of Pathology, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, USA
| | - Baha Moshiree
- Department of Gastroenterology and Hepatology, Carolinas Medical Center at Atrium Health, Charlotte, North Carolina, USA
- Wake Forest School of Medicine-Carolinas Campus, Charlotte, North Carolina, USA
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12
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Thompson JP, Rittenberry JC, Lawton AW, Kirchner KR. Wernicke's Encephalopathy From Gastrointestinal Disease After Remote Roux-en-Y. J Neuroophthalmol 2024; 44:e147-e148. [PMID: 36729906 DOI: 10.1097/wno.0000000000001776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- John P Thompson
- Louisiana State University at New Orleans (JPT, JCR, KRK), New Orleans, Louisiana; and Ochsner Medical Center Ophthalmology (AL), New Orleans, Louisiana
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13
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Nabar S, Fernandez J, Prakash V, Safder S. Gastrointestinal manifestations seen in pediatric patients diagnosed with small fiber neuropathy. J Pediatr Gastroenterol Nutr 2024; 78:583-591. [PMID: 38504414 DOI: 10.1002/jpn3.12099] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/22/2023] [Accepted: 09/23/2023] [Indexed: 03/21/2024]
Abstract
OBJECTIVES Small fiber neuropathy (SFN) affects the fibers involved in cutaneous and visceral pain and temperature sensation and are a crucial part of the autonomic nervous system. Autonomic dysfunction secondary to SFN and autoimmune receptor antibodies is being increasingly recognized, and gastrointestinal (GI) manifestations include constipation, early satiety, nausea, vomiting, and diarrhea. Enteric nervous system involvement may be a possible explanation of abnormal GI motility patterns seen in these patients. METHODS Children suspected to have SFN based on symptoms underwent skin biopsy at the Child Neurology clinic at Arnold Palmer Hospital for Children, which was processed at Therapath™ Neuropathology. SFN was diagnosed using epidermal nerve fiber density values that were below 5th percentile from the left distal leg (calf) as reported per Therapath™ laboratory. RESULTS Twenty-six patients were diagnosed with SFN. Retrospective chart review was performed, including demographic data, clinical characteristics, and evaluation. A majority of patients were white adolescent females. Autonomic dysfunction, including orthostasis and temperature dysregulation were seen in 61.5% of patients (p = 0.124). Somatosensory symptoms, including pain or numbness were seen in 85% of patients (p < 0.001). GI symptoms were present in 85% of patients (p < 0.001) with constipation being the most common symptom seen in 50% of patients. This correlated with the motility testing results. CONCLUSIONS Pediatric patients with SFN commonly have GI symptoms, which may be the main presenting symptom. It is important to recognize and look for symptoms of small fiber neuropathy in children with refractory GI symptoms that may explain multisystemic complaints often seen in these patients.
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Affiliation(s)
- Shruti Nabar
- Center for Digestive Health and Nutrition, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida, USA
| | - Jenelle Fernandez
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Vikram Prakash
- Orlando Health Arnold Palmer Hospital for Children Neurology, Orlando, Florida, USA
| | - Shaista Safder
- Center for Digestive Health and Nutrition, Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida, USA
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14
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Massa B, Vervaeke S, Van Hoecke F. Semi-quantitative assessment of gastrointestinal viruses in stool samples with Seegene Allplex gastrointestinal panel assays: a solution to the interpretation problem of multiple pathogen detection? Eur J Clin Microbiol Infect Dis 2024; 43:435-443. [PMID: 38147237 DOI: 10.1007/s10096-023-04739-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE The aim of the study was to determine and evaluate the clinical usefulness of pathogen specific semi-quantitative cut-offs in stool samples with multiple pathogen detections. METHODS The PCR (Seegene Allplex Gastrointestinal Virus Assay) data from 4527 positive samples received over 16 months were retrospectively analyzed to investigate the distribution of the Ct values of each individual viral pathogen. By using interquartile ranges for each viral pathogen, pathogen specific semi-quantitative cut-offs were determined. RESULTS After a thorough analysis of the Ct values, a well-founded decision to exclude all results with a Ct value higher than 35 was made. This approach made it possible to generate a more nuanced report and to facilitate clinical interpretation in case of mixed infections by linking a lower Ct value of a pathogen to a greater likelihood of being a relevant causative pathogen. Moreover, not reporting viral pathogens with a Ct value higher than 35 led to a significant reduction (p < 0.0001) of reported mixed infections compared to oversimplified qualitative or qualitative reporting. CONCLUSION By omitting very high Ct values and reporting semi-quantitatively, value was added to the syndromic reports, leading to an easier to read lab report, especially in mixed infections.
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Affiliation(s)
- Bo Massa
- Department of Laboratory Medicine, AZ Delta, Roeselare, Belgium.
| | - Steven Vervaeke
- Department of Laboratory Medicine, AZ Delta, Roeselare, Belgium
| | - Frederik Van Hoecke
- Department of Laboratory Medicine, AZ Delta, Roeselare, Belgium
- Department of Laboratory Medicine, Sint-Andries Hospital, Tielt, Belgium
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15
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Pasricha TS, Guerrero-Lopez IL, Kuo B. Management of Gastrointestinal Symptoms in Parkinson's Disease: A Comprehensive Review of Clinical Presentation, Workup, and Treatment. J Clin Gastroenterol 2024; 58:211-220. [PMID: 38260966 PMCID: PMC10855995 DOI: 10.1097/mcg.0000000000001961] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024]
Abstract
Gastrointestinal symptoms in Parkinson's disease (PD) are among the most prevalent and debilitating of complications and present unique diagnostic and management challenges. Patients with PD commonly experience dysphagia, nausea, bloating, and constipation related to pathologic involvement of the enteric nervous system. In turn, gastrointestinal complications may impact motor fluctuations and the efficacy of levodopa therapy. This review will explore the common gastrointestinal manifestations of PD with an emphasis on clinical presentation, workup, and treatment strategies.
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Affiliation(s)
- Trisha S. Pasricha
- Division of Gastroenterology, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
| | | | - Braden Kuo
- Division of Gastroenterology, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
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16
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Kim HJ, Lim YJ. Endoscopic findings and predictors of gastrointestinal lesions in children with iron deficiency anemia. Pediatr Hematol Oncol 2024; 41:114-120. [PMID: 37773488 DOI: 10.1080/08880018.2023.2261986] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/03/2022] [Indexed: 10/01/2023]
Abstract
Iron deficiency anemia (IDA) can be caused by occult gastrointestinal (GI) blood loss; however, the endoscopic findings in children with anemia are unclear. The study aimed to determine the frequency and factors related to lesions in children with IDA undergoing endoscopy. We retrospectively analyzed the clinical and endoscopic findings of children with a laboratory-based diagnosis of IDA. Of 58 patients, 36 (62.1%) had upper GI tract lesions, with erosive gastritis being the most common lesion. Further, 26 patients underwent concomitant colonoscopy, and 12 (46.2%) had lower GI tract lesions. Overall, 44 (75.9%) patients had lesions in either the upper or lower GI tract. Helicobacter pylori infection was detected in 13 patients (22.4%). Patients with lesions found by endoscopy had significantly lower hemoglobin level (8.9 vs. 10.0 g/dL, p = 0.047) and mean corpuscular volume (75.5 vs. 80.9 fL, p = 0.038). The proportion of patients with previous treatment for IDA was also higher in those with lesions on endoscopy. In multivariate analysis, age of ≥10 years (odds ratio [OR], 6.00; 95% confidence Interval [CI], 0.56-10.75) and positive fecal occult blood test (FOBT) findings (OR, 2.25; 95% CI, 0.14-4.52) were factors related to GI lesions. The presence of GI symptoms was not associated with GI lesions. A high proportion of GI lesions were found by endoscopy in children with IDA in this study. Endoscopy should be considered in children with IDA even without GI symptoms, especially in older children, and those with positive FOBT results.
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Affiliation(s)
- Hyun Jin Kim
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yeon Jung Lim
- Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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17
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Ashktorab H, Challa SR, Singh G, Nanduri S, Ibrahim M, Martirosyan Z, Whitsell P, Chirumamilla LG, Shayegh N, Watson K, Smith T, Ogwo V, Kolawole O, Littleton M, Morrison N, Nair V, Byer D, Dawodu DO, Lexima P, Rashid M, Deverapalli M, Atluri SM, Nezamloo A, Nasrin F, Kim RJA, Sherif Z, Oskrochi G, Carethers JM, Brim H. Gastrointestinal Manifestations and Their Association with Neurologic and Sleep Problems in Long COVID-19 Minority Patients: A Prospective Follow-Up Study. Dig Dis Sci 2024; 69:562-569. [PMID: 38135813 DOI: 10.1007/s10620-023-08176-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/29/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Long-COVID is a condition post SARS-CoV-2 infection with persistent or recurring symptoms affecting multiple organs, and may involve viral persistence, changes to the microbiome, coagulopathies, and alterations to neuro-immune interactions. These factors can disrupt the Gut-Brain Axis, which is a complex system involving bidirectional communication between the central nervous system and the gastrointestinal (GI) system. As a result of these disruptions, individuals with long-COVID may develop post-infectious functional GI disorders, which can cause a range of symptoms affecting the digestive system. AIM To understand frequency of GI manifestations of Long-COVID and to determine association with sleep or neurological symptoms in a predominantly minority population. METHODS We included patients with positive SARS-CoV-2 PCR (n = 747) who were hospitalized from Feb. 2020 to May 2021 at Howard University Hospital and followed between 6 and 12 months from discharge. GI, sleep, and neurological symptoms (via the Montreal Cognitive Assessment (MoCA) scoring system) were assessed using a standardized questionnaire. Linear regression analysis, χ2 and Fisher's exact test were utilized to determine the statistical significance of correlations of GI/Neuro/COVID. RESULTS The mean age of patients was 58, with 51.6% females and a predominant African American ethnicity (73.6%, n = 550). A total of 108 patients died during their initial hospital stay, with the remaining 639 patients followed-up. Three hundred fifty (350) patients responded to the questionnaire (57 patients died during the follow-up period). Overall, 39 (13.3%) patients reported GI-related symptoms, out of which 19 (6.4%) had persistent symptoms and 20 (6.8%) developed new onset GI symptoms. Nausea and vomiting were the most common 24/39 (61.5%), followed by abdominal pain 7/39 (18%), diarrhea 5/39 (12.8%), and others 3/39 (7.6%). Patients who presented with vomiting during acute SARS-CoV-2 infection were more likely to have Long-COVID GI manifestations (P = 0.023). Use of ACE inhibitors, abnormal lymphocyte count and elevated ferritin are other variables that showed significant associations with Long-COVID GI manifestations (P = 0.03, 0.006 and 0.03, respectively). During follow-up, a total of 28 (9.5%) patients reported difficulty with sleep and 79 (27%) patients had abnormal MoCA assessment. With further analysis, there was a trend between presentation of GI symptoms on admission with abnormal MoCA assessment, and an association between abnormal LFTs and history of liver disease during hospitalization with subsequent sleep problems. Baseline characteristics, clinical comorbidities, other laboratory values, hospital length of stay, mechanical ventilation, medications during hospitalization, re-admission and Flu or COVID-19 vaccination have not shown any association with Long-COVID GI symptoms in our cohort. CONCLUSION Dyspeptic symptoms were common GI manifestations in the acute and post COVID periods. GI symptoms, abnormal LFTs and a history of liver disease during the acute infectious phase associates with abnormal MoCA and sleep problems during follow-up. Further large population studies are needed to determine if COVID-19 leads to a GI symptoms-associated Long-COVID phenotypes and other symptoms through the Gut-Brain-Axis.
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Affiliation(s)
- Hassan Ashktorab
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA.
- Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA.
| | | | - Gagan Singh
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Sumant Nanduri
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Malika Ibrahim
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Zara Martirosyan
- Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA
| | - Peter Whitsell
- Howard University College of Medicine, 2041 Georgia Avenue, N.W., Washington, DC, 20060, USA
| | - Lakshmi G Chirumamilla
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Nader Shayegh
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Kyra Watson
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Tori Smith
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Valarie Ogwo
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
- Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC, USA
- College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait
- Division of Gastroenterology & Hepatology, Department of Medicine and Moores Cancer Center, UC San Diego, San Diego, USA
- Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, DC, USA
- Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, DC, USA
| | - Oluwapelumi Kolawole
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Megan Littleton
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Nicole Morrison
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Vaisakh Nair
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Danae Byer
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Dideolu O Dawodu
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Patrice Lexima
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Mudasir Rashid
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Mrinalini Deverapalli
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Swetha Mynedi Atluri
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Ali Nezamloo
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Farjana Nasrin
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Rachel Ji-Aeh Kim
- GI Division, Department of Medicine, Cancer Center, Howard University Hospital, Washington, DC, USA
| | - Zaki Sherif
- Department of Biochemistry & Molecular Biology, Howard University College of Medicine, Washington, DC, USA
| | - Gholamreza Oskrochi
- College of Engineering and Technology, American University of the Middle East, Egaila, Kuwait
| | - John M Carethers
- Division of Gastroenterology & Hepatology, Department of Medicine and Moores Cancer Center, UC San Diego, San Diego, USA
| | - H Brim
- Department of Pathology and Cancer Center, Howard University College of Medicine, Washington, DC, USA
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18
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Arfi S, Sharma P, Das K, Bhaskar Y, Goel I, Singh H, Das R. Low abundance of healthy bacteria in the gastric microbiota can be a potential biomarker for gastrointestinal diseases: A pilot study. Indian J Med Res 2024; 159:254-258. [PMID: 38484125 DOI: 10.4103/ijmr.ijmr_864_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Indexed: 04/06/2024] Open
Affiliation(s)
- Safiya Arfi
- Centre for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida 201 301, India
| | - Prateek Sharma
- Centre for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida 201 301, India
| | - Kunal Das
- Department of Gastroenterology, Yashoda Super Specialty Hospital, Ghaziabad 201 001, India
- Department of Gastroenterology, Max Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
| | - Yogendra Bhaskar
- Division of Biomedical Informatics, Indian Council of Medical Research, New Delhi 110 029, India
| | - Isha Goel
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110 029, India
| | - Harpreet Singh
- Division of Biomedical Informatics, Indian Council of Medical Research, New Delhi 110 029, India
| | - Rajashree Das
- Centre for Medical Biotechnology, Amity Institute of Biotechnology, Amity University, Noida 201 301, India
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19
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Quist JR, Rud CL, Brantlov S, Ward LC, Dahl Baunwall SM, Hvas CL. Bioelectrical impedance analysis as a clinical marker of health status in adult patients with benign gastrointestinal disease: A systematic review. Clin Nutr ESPEN 2024; 59:387-397. [PMID: 38220401 DOI: 10.1016/j.clnesp.2023.12.145] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Body composition reflects nutritional status, disease status and progression, and treatment responses. Mounting evidence supports the use of bioelectrical impedance analysis (BIA) as a non-invasive tool to assess body composition. Patients with benign gastrointestinal (GI) disease experience disease-related alterations in their body composition, and bioimpedance outcomes in patients with benign GI diseases have not previously been summarized. We aimed to evaluate BIA as a clinical body composition marker for benign GI diseases and describe its association with physical health status. METHODS We systematically searched PubMed, Scopus, Web of Science, Embase, and CINAHL from inception to October 2023 (PROSPERO registration: CRD42021265866). Of 971 screened studies, 26 studies were included in the final analysis, comprising a total of 2398 adult patients with benign GI disease. The main outcome was raw impedance data. RESULTS The most frequently reported BIA outcome was phase angle (PhA) (reported in 18 of 26 studies), followed by fat-free-mass (FFM) (reported in 13 of 26 studies). The consensus view of the included studies illustrates that BIA can be a useful tool for evaluating body composition in patients with benign GI diseases, and low PhA and FFM were associated with increased nutritional risk, abnormal physical characteristics, and increased mortality risk. CONCLUSION To fully utilize BIA as a clinical marker of health in patients with benign GI disease, standardized protocols specific to this population are needed and prospective studies testing cut-offs and ranges, accuracy, and other raw BIA parameters for classifying disease status.
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Affiliation(s)
| | - Charlotte Lock Rud
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Denmark
| | - Steven Brantlov
- Department of Procurement & Clinical Engineering, Central Denmark Region, Denmark
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
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20
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Patel D, Jose F, Baker J, Moshiree B. Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract in Cystic Fibrosis. Curr Gastroenterol Rep 2024; 26:9-19. [PMID: 38057499 DOI: 10.1007/s11894-023-00906-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW To discuss all the various motility disorders impacting people with Cystic Fibrosis (PwCF) and provide diagnostic and management approaches from a group of pediatric and adult CF and motility experts and physiologists with experience in the management of this disease. RECENT FINDINGS Gastrointestinal (GI) symptoms coexist with pulmonary symptoms in PwCF regardless of age and sex. The GI manifestations include gastroesophageal reflux disease, esophageal dysmotility gastroparesis, small bowel dysmotility, small intestinal bacterial overgrowth syndrome, distal idiopathic obstruction syndrome, constipation, and pelvic floor disorders. They are quite debilitating, limiting the patients' quality of life and affecting their nutrition and ability to socialize. This genetic disorder affects many organ systems and is chronic, potentially impacting fertility and future family planning, requiring a multidisciplinary approach. Our review discusses the treatments of motility disorders in CF, their prevalence and pathophysiology. We have provided a framework for clinicians who care for these patients that can help to guide their clinical management.
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Affiliation(s)
- Dhiren Patel
- Department of Pediatrics, Pediatric Gastroenterology, Hepatology and Nutrition, SSM Cardinal Glennon Children's Medical Center, Saint Louis University, St Louis, MO, USA
| | - Folashade Jose
- Pediatric Gastroenterology, Hepatology, and Nutrition, Clinical Associate Professor, Levine Childrens Hospital, Carolina Pediatric Gastroenterology, Charlotte, NC, USA
| | | | - Baha Moshiree
- Division of Gastroenterology, Atrium Health Wake Forest Medical University, Charlotte, NC, USA.
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21
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Morrill V, Benke K, Brinton J, Soke GN, Schieve LA, Fields V, Farzadegan H, Holingue C, Newschaffer CJ, Reynolds AM, Daniele Fallin M, Ladd-Acosta C. Genetic liability for gastrointestinal inflammation disorders and association with gastrointestinal symptoms in children with and without autism. Am J Med Genet B Neuropsychiatr Genet 2024; 195:e32952. [PMID: 37455590 PMCID: PMC10792104 DOI: 10.1002/ajmg.b.32952] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
Children with autism spectrum disorder (ASD) have a greater prevalence of gastrointestinal (GI) symptoms than children without ASD. We tested whether polygenic scores for each of three GI disorders (ulcerative colitis, inflammatory bowel disease, and Crohn's disease) were related to GI symptoms in children with and without ASD. Using genotyping data (564 ASD cases and 715 controls) and external genome-wide association study summary statistics, we computed GI polygenic scores for ulcerative colitis (UC-PGS), inflammatory bowel disease (IDB-PGS), and Crohn's disease (CD-PGS). Multivariable logistic regression models, adjusted for genetic ancestry, were used to estimate associations between each GI-PGS and (1) ASD case-control status, and (2) specific GI symptoms in neurotypical children and separately in ASD children. In children without ASD, polygenic scores for ulcerative colitis were significantly associated with experiencing any GI symptom (adjusted odds ratio (aOR) = 1.36, 95% confidence interval (CI) = 1.03-1.81, p = 0.03) and diarrhea specifically (aOR = 5.35, 95% CI = 1.77-26.20, p = 0.01). Among children without ASD, IBD-PGS, and Crohn's PGS were significantly associated with diarrhea (aOR = 3.55, 95% CI = 1.25-12.34, p = 0.02) and loose stools alternating with constipation (aOR = 2.57, 95% CI = 1.13-6.55, p = 0.03), respectively. However, the three PGS were not associated with GI symptoms in the ASD case group. Furthermore, polygenic scores for ulcerative colitis significantly interacted with ASD status on presentation of any GI symptom within a European ancestry subset (aOR = 0.42, 95% CI = 0.19-0.88, p = 0.02). Genetic risk factors for some GI symptoms differ between children with and without ASD. Furthermore, our finding that increased genetic risks for GI inflammatory disorders are associated with GI symptoms in children without ASD informs future work on the early detection of GI disorders.
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Affiliation(s)
- Valerie Morrill
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kelly Benke
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John Brinton
- Department of Pediatrics, School of Medicine, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Gnakub N. Soke
- Centers for Disease Control and Prevention, Division of Scientific Education and Professional Development, Epidemic Intelligence Service, Atlanta, Georgia, USA
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura A. Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Victoria Fields
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Homayoon Farzadegan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Calliope Holingue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Craig J. Newschaffer
- AJ Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania, USA
- College of Health and Human Development, Pennsylvania State University, Pennsylvania, USA
| | - Ann M. Reynolds
- Department of Pediatrics, School of Medicine, University of Colorado and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - M. Daniele Fallin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Christine Ladd-Acosta
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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22
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Manuelyan Z, Butt E, Parupudi S. Gastrointestinal Behçet's disease: Manifestations, diagnosis, and management. Dis Mon 2024; 70:101674. [PMID: 38185603 DOI: 10.1016/j.disamonth.2023.101674] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Behçet's disease (BD) is a rare, inflammatory vascular disorder with recurrent oral and genital aphthous ulcers, along with ocular and cutaneous manifestations. Gastrointestinal (GI) BD may involve any portion of the GI tract. However, it is commonly described in the terminal ileum, followed by the ileocecal region. Diagnosis is challenging given lack of pathognomonic tests; therefore, it is based on clinical criteria. Management of intestinal BD includes different classes of medications including corticosteroids, 5-aminosalicylic acid, immunomodulators, and anti-tumor necrosis factor alpha monoclonal antibody agents. In this review, we aim to focus on intestinal BD and provide details of clinical manifestations, diagnosis and therapeutic options of intestinal BD from gastroenterology viewpoint.
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Affiliation(s)
- Zara Manuelyan
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, The University of Texas Medical Branch at Galveston, Galveston, TX 77550, USA
| | - Edward Butt
- Department of Internal Medicine, The University of Texas Medical Branch at Galveston, 301 University Blvd, Galveston, TX 77550, USA.
| | - Sreeram Parupudi
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, The University of Texas Medical Branch at Galveston, Galveston, TX 77550, USA
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23
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Ing NH, Steiner JM. The Use of Diets in the Diagnosis and Treatment of Common Gastrointestinal Diseases in Dogs and Cats. Adv Exp Med Biol 2024; 1446:39-53. [PMID: 38625524 DOI: 10.1007/978-3-031-54192-6_3] [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] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The nutritional health of dogs and cats is important to pet owners around the world. Nutrition is inextricably linked to the health of the gastrointestinal system and vice versa. Gastrointestinal signs, such as vomiting, diarrhea, anorexia, or weight loss, are one of the most common reasons that dog and cat owners make non-routine appointments with veterinarians. Those patients are evaluated systematically to identify and/or rule out the causes of the symptoms. Some causes of chronic diarrhea are within the gastrointestinal tract while others are secondary to pathogenic factors outside the digestive system. Some useful biomarkers of chronic intestinal disease (enteropathy) exist in serum and feces. After determination that the clinical signs are due to primary gastrointestinal disease and that there is no parasitism, specific diets are used for at least two weeks. There are several types of diets for pets with chronic enteropathies. There are limited ingredient diets and hydrolyzed protein diets with reduced levels of allergens. There are also highly digestible and fiber-enhanced diets. Some diets contain probiotics and/or prebiotics. If symptoms do not improve and the patient is stable, a diet from a different class may be tried. For chronic enteropathies, the prognosis is generally good for symptom resolution or at least improvement. However, if interventions with novel diets do not ameliorate the symptoms of chronic enteropathy, then antibiotic, anti-inflammatory, or immunosuppressant therapy or further, more invasive diagnostics such as taking an intestinal biopsy, may be indicated. Pancreatitis is a common gastrointestinal disease in dogs and cats and patients may present with mild to severe disease. Many patients with mild to moderate disease can be successfully treated with early supportive care, including feeding a low-fat diet. A novel pharmaceutical, fuzapladib (Panoquell-CA1) looks very promising for treating more severe forms of acute pancreatitis in dogs. Maintenance on a low-fat diet may prevent pancreatitis in at-risk dogs. Future advances in medicine will allow pet owners and veterinarians to use dietary management to maximize the health of their dogs and cats.
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Affiliation(s)
- Nancy H Ing
- Department of Animal Science, Texas A&M University, College Station, TX, 77843, USA.
| | - Joerg M Steiner
- Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, 77843, USA
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24
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Sundas A, Sampath H, Lamtha SC, Soohinda G, Dutta S. Psychosocial quality-of-life correlates in functional gastrointestinal disorders. Rev Gastroenterol Mex (Engl Ed) 2024; 89:11-18. [PMID: 35810093 DOI: 10.1016/j.rgmxen.2022.04.005] [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] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/22/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND AIM Functional gastrointestinal disorders (FGIDs) are complex illnesses characterized by gastrointestinal symptoms, with no underlying organic pathology. They are common, chronic, recurrent, and disabling disorders that significantly impair quality of life (QoL). The aim of the present cross-sectional analytical study was to assess QoL and its correlates in adult patients with FGIDs. MATERIALS AND METHODS A cross-sectional, observational, hospital-based study was conducted at the gastroenterology outpatient department of a tertiary care teaching hospital. The ROME IV diagnostic criteria were used to identify the FGIDs. Anxiety, depression, coping strategies, social support, and QoL were assessed by the hospital anxiety and depression scale, the coping strategies inventory, the multidimensional scale of perceived social support, and the functional digestive disorders quality-of-life questionnaire, respectively. RESULTS Of the 52 consecutive patients diagnosed with FGIDs, functional dyspepsia (51.92%) and irritable bowel syndrome (40.38%) were the most common. There were no significant associations between sociodemographic variables (age, sex, marital status, socioeconomic status, educational level, employment, occupation, dietary pattern) and QoL scores (all p values >0.05). Duration and social support were not significantly associated with QoL (all p values >0.05). In contrast, psychological variables, such as disengagement coping (r=-0.344, p=0.012), depression (r=-0.600, p=0.000), and anxiety (r=-0.590, p=0.000), were significantly correlated with QoL. CONCLUSIONS Despite advances in neurogastroenterology, patients continue to be disabled by FGIDs. Psychological factors, especially depression, significantly contribute to poor QoL in those patients and should be addressed in a holistic, multidisciplinary way. The biopsychosocial framework, as it applies to FGIDs, should lead to the inclusion of psychosocial assessments in the clinical management and research of those disorders.
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Affiliation(s)
- A Sundas
- Instituto Central de Psiquiatría, Ranchi, India
| | - H Sampath
- Departamento de Psiquiatría, Hospital Central de Referencias, Instituto de Ciencias Médicas de Sikkim Manipal, Universidad de Sikkim Manipal, Gangtok, Sikkim, India.
| | - S C Lamtha
- Departamento de Gastroenterología, Nuevo Hospital de Gobierno STNM, Gangtok, Sikkim, India
| | - G Soohinda
- Departamento de Psiquiatría, Hospital Central de Referencias, Instituto de Ciencias Médicas de Sikkim Manipal, Universidad de Sikkim Manipal, Gangtok, Sikkim, India
| | - S Dutta
- Departamento de Psiquiatría, Hospital Central de Referencias, Instituto de Ciencias Médicas de Sikkim Manipal, Universidad de Sikkim Manipal, Gangtok, Sikkim, India
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25
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Billing J, Berentsen B, Lundervold A, Hillestad EMR, Lied GA, Hausken T, Lundervold AJ. Cognitive function in patients with irritable bowel syndrome: impairment is common and only weakly correlated with depression/anxiety and severity of gastrointestinal symptoms. Scand J Gastroenterol 2024; 59:25-33. [PMID: 37727887 DOI: 10.1080/00365521.2023.2256916] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To investigate cognitive function in patients with irritable bowel syndrome (IBS) and its relation to anxiety/depression and severity of gastrointestinal (GI) symptoms. METHODS Patients with IBS (n = 65) and healthy controls (HCs, n = 37) performed the ten subtests of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Age-normed index scores of five cognitive domains (Immediate memory, Visuospatial function, Language function, Attention, Recall) and a total (Fullscale) score were derived from the performance. Emotional function was assessed using the Hospital Anxiety and Depression Scale (HADS), and the IBS Symptom Scoring System (IBS-SSS) was used to define the severity of GI symptoms. RESULTS Patients with IBS reported significantly higher scores than the HC group on symptom measures of anxiety and depression, and significantly lower scores on the Immediate memory, Recall, and Fullscale RBANS indexes. Approximately 30% of the IBS patients obtained index scores at least one standard deviation below the population mean, and more than 50% scored above the screening threshold for an anxiety disorder. The severity of GI symptoms was significantly correlated with the severity level of anxiety symptoms (p=.006), but neither the severity level of emotional nor GI symptoms was significantly correlated with the RBANS index scores in the IBS group. CONCLUSION Cognitive and emotional function were more severely affected in patients with IBS than in HCs. The weak correlation between the two functional areas suggests that both should be assessed as part of a clinical examination of patients with IBS.
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Affiliation(s)
- Julie Billing
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Birgitte Berentsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- National Center for Functional Gastrointestinal Disorders, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Arvid Lundervold
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Mohn Medical and Visualization Center, Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Eline M R Hillestad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- National Center for Functional Gastrointestinal Disorders, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Gülen A Lied
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- National Center for Functional Gastrointestinal Disorders, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Trygve Hausken
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- National Center for Functional Gastrointestinal Disorders, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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26
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Aydın ÖG, Baykara HB, Akın K, Kahveci S, Şeker G, Güler Y, Öztürk Y. Evaluation of functional gastrointestinal disorders in children aged 4-10 years with autism spectrum disorder. Turk J Pediatr 2024; 66:57-64. [PMID: 38523379 DOI: 10.24953/turkjped.2023.558] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Gastrointestinal system disorders are known to be prevalent among children with autism spectrum disorder (ASD). Some ASD-associated comorbidities are abdominal pain, constipation, diarrhea, gastroesophageal reflux, sleep disturbances, epilepsy, and psychiatric problems. Nonetheless, there is still limited information about the presence of functional GI disorders (FGIDs) among children with ASD, especially in Türkiye. Using the Rome criteria, we aimed to investigate FGIDs in children with ASD. METHODS The sample of the study consisted of 68 children aged 4-10 years, diagnosed with ASD according to the DSM-5 diagnostic criteria and had scores greater than 30 on the Childhood Autism Rating Scale (CARS-2) and an age-sex matched control group (n=78). The Rome III criteria were used to evaluate FGIDs. RESULTS The frequency of FGIDs in the ASD group was higher (76.5%) compared to the control group (p < 0.001). Compared to the control group, abdominal migraine frequency increased 10 times (p=0.012), functional constipation 7 times (p < 0.001), and fecal incontinence 6 times (p < 0.001) in the ASD group. Stool retention was not present in most children in the ASD group who were found to have fecal incontinence. CONCLUSION In this study, the most common FGIDs in the ASD group were abdominal migraine, functional constipation, and non-retentive fecal incontinence. The finding that most children with ASD who had fecal incontinence did not show stool retention implicated social, psychological, and behavioral factors as the causes of incontinence. Raising awareness of healthcare professionals about the frequency of FGIDs in children with ASD will improve many areas in the daily lives of these children.
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Affiliation(s)
- Özlem Gülpınar Aydın
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, School of Medicine, Dokuz Eylul University, İzmir
| | - Hüseyin Burak Baykara
- Department of Child and Adolescent Psychiatry School of Medicine, Dokuz Eylul University, İzmir
| | - Kardelen Akın
- Department of Pediatrics School of Medicine, Dokuz Eylul University, İzmir, Türkiye
| | - Sinem Kahveci
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, School of Medicine, Dokuz Eylul University, İzmir
| | - Gül Şeker
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, School of Medicine, Dokuz Eylul University, İzmir
| | - Yunus Güler
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, School of Medicine, Dokuz Eylul University, İzmir
| | - Yeşim Öztürk
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, School of Medicine, Dokuz Eylul University, İzmir
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27
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Tardo AM, Del Baldo F, Leal RO, Galiazzo G, Pietra M, Gaspardo A, Fracassi F. Prevalence of eunatremic, eukalemic hypoadrenocorticism in dogs with signs of chronic gastrointestinal disease and risk of misdiagnosis after previous glucocorticoid administration. J Vet Intern Med 2024; 38:93-101. [PMID: 38053513 PMCID: PMC10800188 DOI: 10.1111/jvim.16921] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 10/17/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Dogs with eunatremic, eukalemic hypoadrenocorticism (EEH) typically show signs of chronic gastrointestinal disease (CGD). Previous glucocorticoid administration (PGA) can give false-positive results on the ACTH stimulation test (ACTHst). HYPOTHESIS/OBJECTIVES To determine the prevalence of EEH in dogs with signs of CGD, and to identify clinical and clinicopathological features for EEH and PGA. ANIMALS One hundred twelve dogs with CGD (101 non-PGA and 11 PGA), 20 dogs with EEH. METHODS Multicenter prospective cohort study. Basal serum cortisol (BSC) concentration was measured in dogs with signs of CGD. When BSC was <2 μg/dL and in PGA dogs, ACTHst plus measurement of endogenous ACTH (eACTH) were performed. Records of dogs with EEH from 2009 to 2021 were reviewed. RESULTS The BSC concentration was <2 μg/dL in 48/101 (47.5%) non-PGA and in 9/11 (82%) PGA dogs. EEH was diagnosed in 1/112 dog (prevalence 0.9%; 95% CI, 0.1%-4.8%); the ACTHst provided false-positive results in 2/11 PGA dogs. PGA dogs showed lower C-reactive protein-to-haptoglobin ratio (median 0.01, range 0.003-0.08; P = .01), and higher haptoglobin (140, 26-285 mg/dL; P = .002) than non-PGA dogs (0.04, 0.007-1.5; 38.5, 1-246 mg/dL, respectively). eACTH was higher (P = .03) in EEH (396, 5->1250 pg/mL) than in non-PGA dogs (13.5, 7.3-46.6 pg/mL). Cortisol-to-ACTH ratio was lower (P < .0001 and P = .01, respectively) in EEH (0.002, 0.0002-0.2) than in non-PGA (0.1, 0.02-0.2) and PGA dogs (0.1, 0.02-0.2). CONCLUSIONS AND CLINICAL IMPORTANCE The prevalence of EEH in dogs with signs of CGD was lower than previously reported. The clinical and clinicopathological features herein identified could increase the index of suspicion for EEH or PGA in dogs with an unclear history of glucocorticoid administration.
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Affiliation(s)
- Antonio Maria Tardo
- Department of Veterinary Medical SciencesUniversity of Bologna, Ozzano dell'EmiliaBolognaItaly
| | - Francesca Del Baldo
- Department of Veterinary Medical SciencesUniversity of Bologna, Ozzano dell'EmiliaBolognaItaly
| | - Rodolfo Oliveira Leal
- CIISA – Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary MedicineUniversity of LisbonLisbonPortugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS)LisbonPortugal
| | - Giorgia Galiazzo
- Department of Veterinary Medical SciencesUniversity of Bologna, Ozzano dell'EmiliaBolognaItaly
| | - Marco Pietra
- Department of Veterinary Medical SciencesUniversity of Bologna, Ozzano dell'EmiliaBolognaItaly
| | - Alba Gaspardo
- Department of Veterinary Medical SciencesUniversity of Bologna, Ozzano dell'EmiliaBolognaItaly
| | - Federico Fracassi
- Department of Veterinary Medical SciencesUniversity of Bologna, Ozzano dell'EmiliaBolognaItaly
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28
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Zais IE, Sirotti A, Iesari S, Campioli E, Costantino A, Delbue S, Collini A, Guarneri A, Ambrogi F, Cacciola R, Ferraresso M, Favi E. Human cytomegalovirus-related gastrointestinal disease after kidney transplantation: A systematic review. Clin Transplant 2024; 38:e15218. [PMID: 38063324 DOI: 10.1111/ctr.15218] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Human-cytomegalovirus (hCMV) infection involving the gastrointestinal tract represents a leading cause of morbidity and mortality among kidney transplant (KT) recipients (KTRs). Signs and symptoms of the disease are extremely variable. Prompt anti-viral therapy administration and immunosuppression modification are key factors for optimizing management. However, complex work-up strategies are generally required to confirm the preliminary diagnosis. Unfortunately, solid evidence and guidelines on this specific topic are not available. We consequently aimed to summarize current knowledge on post-KT hCMV-related gastrointestinal disease (hCMV-GID). METHODS We conducted a systematic review (PROSPERO ID: CRD42023399363) about hCMV-GID in KTRs. RESULTS Our systematic review includes 52 case-reports and ten case-series, published between 1985 and 2022, collectively reporting 311 cases. The most frequently reported signs and symptoms of hCMV-GID were abdominal pain, diarrhea, epigastric pain, vomiting, fever, and GI bleeding. Esophagogastroduodenoscopy and colonoscopy were the primary diagnostic techniques. In most cases, the preliminary diagnosis was confirmed by histology. Information on anti-viral prophylaxis were extremely limited as much as data on induction or maintenance immunosuppression. Treatment included ganciclovir and/or valganciclovir administration. Immunosuppression modification mainly consisted of mycophenolate mofetil or calcineurin inhibitor minimization and withdrawal. In total, 21 deaths were recorded. Renal allograft-related outcomes were described for 26 patients only. Specifically, reported events were acute kidney injury (n = 17), transplant failure (n = 5), allograft rejection (n = 4), and irreversible allograft dysfunction (n = 3). CONCLUSIONS The development of local and national registries is strongly recommended to improve our understanding of hCMV-GID. Future clinical guidelines should consider the implementation of dedicated diagnostic and treatment strategies.
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Affiliation(s)
| | - Alessandro Sirotti
- General Surgery and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Samuele Iesari
- General Surgery and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Campioli
- General Surgery and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Costantino
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Serena Delbue
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Andrea Collini
- Renal Transplant Unit, Siena University Hospital, Siena, Italy
| | - Andrea Guarneri
- Department of Clinical Sciences and Community Health (DISCCO), Università degli Studi di Milano, Milan, Italy
| | - Federico Ambrogi
- Department of Clinical Sciences and Community Health (DISCCO), Università degli Studi di Milano, Milan, Italy
| | - Roberto Cacciola
- Dipartimento di Scienze Chirurgiche, Università di Roma Tor Vergata, Rome, Italy
| | - Mariano Ferraresso
- General Surgery and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health (DISCCO), Università degli Studi di Milano, Milan, Italy
| | - Evaldo Favi
- General Surgery and Kidney Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health (DISCCO), Università degli Studi di Milano, Milan, Italy
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29
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Krauß LU, Schmid S, Mester P, Utpatel K, Kunst C, Müller M, Pavel V. Clinical, Endoscopic, and Histopathologic Observations in Gastrointestinal Amyloidosis. J Gastrointestin Liver Dis 2023; 32:497-506. [PMID: 38147621 DOI: 10.15403/jgld-5107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/23/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND AND AIMS Amyloidosis is a group of systemic disorders caused by extracellular deposition of misfolded serum proteins. Gastrointestinal (GI) involvement is associated with a higher risk of GI bleeding, especially if mucosal lesions are present. Our study aims to evaluate the frequency of GI manifestations in patients with amyloidosis, to clinically characterize these patients and to describe the endoscopic and histopathologic findings in GI amyloidosis. METHODS A retrospective, single-center study of all patients admitted with amyloidosis and GI manifestations was conducted at a German University Hospital between July 2003 and June 2023. Clinical, endoscopic, and histopathological data was retrieved from medical records. RESULTS Between July 2003 and June 2023, 63 patients with different types of amyloidosis were included into the study. Twenty-three (36,5%) were diagnosed with GI involvement of amyloidosis (60.9% male, median age 62 ± 18.28 years). The distribution of the types of amyloidosis were amyloid light chain (AL) at 52.5%, transthyretin (ATTR) at 21.7%, amyloid A (AA) at 13.0%, and unknown at 18%. Initial GI symptoms were present in 78.3% of the patients and included mainly diarrhea (34.8%), and abdominal pain (30.4%) Affected GI organs were primarily the colon (60,8%) and the stomach (39.1%). Endoscopic findings were ulcerations (47.8%), mucosal inflammation (43.5%), polyps (26.1%), erosions (13.0%), vascular malformation, polypoid protrusion, submucosal hematoma, erythema, metaplasia, and diverticulum. Histopathological findings included vascular wall thickening, (peri-)vascular and interstitial amyloid deposition. Gastrointestinal bleeding occurred in 39.1% of the patients. The mortality rate 5 years after diagnosis was 47.8%. CONCLUSIONS Gastrointestinal amyloidosis can present with multiple symptoms and endoscopic findings, rendering diagnosis a challenge. Of clinical relevance, GI bleeding was a frequent event in our patient cohort. Therefore, clinicians must be aware of GI bleeding as a manifestation of amyloidosis and definite diagnosis should be achieved based on biopsy results.
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Affiliation(s)
- Lea U Krauß
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious diseases, University Hospital Regensburg, Regensburg, Germany. .
| | - Stephan Schmid
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious diseases, University Hospital Regensburg, Regensburg, Germany. .
| | - Patricia Mester
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious diseases, University Hospital Regensburg, Regensburg, Germany.
| | - Kirsten Utpatel
- Institute of Pathology, University of Regensburg, Regensburg, Germany.
| | - Claudia Kunst
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious diseases, University Hospital Regensburg, Regensburg, Germany.
| | - Martina Müller
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious diseases, University Hospital Regensburg, Regensburg, Germany.
| | - Vlad Pavel
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology, and Infectious diseases, University Hospital Regensburg, Regensburg, Germany.
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Maasakkers CM, Hageman JHJ, Balcazar Muñoz O, Gómez Tamayo T, Blanco Montero A, Garza Lara LG, Flores-López R, Contreras Fernández M, Morán Ramos S, Lambers TT. A cross-sectional study on stool- and gastrointestinal-related outcomes of Mexican infants consuming different formulae. BMC Pediatr 2023; 23:634. [PMID: 38102583 PMCID: PMC10722798 DOI: 10.1186/s12887-023-04426-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Immaturities present at birth, such as in the gut microbiome and digestive, nervous, and immune system, resolve with time. Nevertheless, this may result in mild digestive symptoms early in life, particularly in formula-fed infants. Formula composition and processing may impact this discomfort. This study therefore aimed to assess stool characteristics and gastrointestinal symptoms of healthy infants fed different formulae. METHODS A multicenter, cross-sectional, observational trial was performed in Mexico between November 2019 and January 2022, where exclusively formula-fed infants (n = 342, aged 1-4 months) were studied in four groups based on their existing formula use. Feeding was continued per practice following label instructions. For 7 days, parents/caregivers were requested to record fecal characteristics, using the Amsterdam Infant Stool Scale, and rate gastrointestinal symptoms. Stool samples were collected to determine pH, dry matter content, and fecal calprotectin levels. RESULTS Most infants had a soft/formed stool consistency, although odds for hard stools were different between groups. Gastrointestinal symptom scores revealed significant differences for burping and diarrhea, while other symptoms did not differ between groups. No significant differences between groups were found for stool frequency, dry matter content, and fecal pH. Although calprotectin was within the expected healthy ranges, significant differences among groups were seen. Furthermore, calprotectin significantly correlated with the severity of the gastrointestinal symptoms burping, flatulence, abdominal distension, and diarrhea. CONCLUSIONS Differences in stool characteristics and specific differences in gastrointestinal symptoms were observed between different formula brand users. This may potentially be explained by the different composition and processing of the formulae, although there are multiple factors that influence the assessed outcomes. TRIAL REGISTRATION The study was registered in the Netherlands Trial Registry (NL7805), linked to https://trialsearch.who.int/ , on 11/06/2019.
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Affiliation(s)
| | | | | | | | | | | | - Regina Flores-López
- Unidad de Genómica de Poblaciones, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
| | | | - Sofía Morán Ramos
- Unidad de Genómica de Poblaciones, Instituto Nacional de Medicina Genómica, Mexico City, Mexico
- Departamento de Alimentos y Biotecnología, Facultad de Química, UNAM, Mexico City, Mexico
| | - Tim T Lambers
- FrieslandCampina, Amersfoort, The Netherlands.
- , P.O. Box 238, Wageningen, 6700 AE, The Netherlands.
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31
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Bar N, Karaa A, Kiser K, Kuo B, Zar-Kessler C. Gastrointestinal Sensory Neuropathy and Dysmotility in Fabry Disease: Presentations and Effect on Patient's Quality of Life. Clin Transl Gastroenterol 2023; 14:e00633. [PMID: 37578052 PMCID: PMC10749702 DOI: 10.14309/ctg.0000000000000633] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/04/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Fabry disease is a rare multisystemic lysosomal disease resulting in variable manifestations of the gastrointestinal (GI), neurologic, cardiac, and renal systems. Whether GI manifestations are a result of gut dysmotility is undetermined. We aimed to explore GI manifestations in depth and their effect on patients with Fabry disease and to characterize gut motility. METHODS We recruited adult patients with Fabry disease reporting GI manifestations. All patients answered a battery of questionnaires covering symptom severity, GI-specific quality of life, and effects of work/productivity and underwent a wireless motility capsule test to measure pan-gut motility. RESULTS In 48 patients with Fabry disease, abnormal bowel habits and abdominal pain were the most common symptoms. Bloating, nausea, vomiting, and reflux were also prevalent. Neurologic manifestations were found in 95.8% of patients, along with their GI manifestations. Dysmotility was found in less than 35% of wireless motility capsule tests. Colon transit time was associated with constipation severity and Bristol Stool Scale. Several GI symptoms were associated with reduced quality of life, anxiety, and work/productivity, but not Fabry severity score. DISCUSSION This is the largest study of GI manifestations in patients with Fabry disease that characterizes gut motility. We found little association between GI manifestations and motility indices, suggesting that visceral hypersensitivity may be a major driver of symptoms. GI symptoms affect different aspects of patients' lives, yet are not always well-discussed or optimally managed in Fabry disease. Disease severity scores when used for therapeutic decision making do not often include GI symptoms or their impact.
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Affiliation(s)
- Nir Bar
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Neurogastroenterology and Motility Service, Department of Gastroenterology and Hepatology, Tel Aviv Medical Center, Tel Aviv university school of medicine, Tel Aviv, Israel
| | - Amel Karaa
- Department of Genetics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Katheryn Kiser
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Braden Kuo
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claire Zar-Kessler
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Karakas HD, Kuloglu Z, Aydin F, Ozdemir S, Avar-Aydin PO, Tuna Kirsaclioglu C, Cakar N, Ozcakar ZB. Evaluation of Gastrointestinal System Complaints and Comorbidities in Pediatric Familial Mediterranean Fever Patients. J Clin Rheumatol 2023; 29:375-380. [PMID: 37723615 DOI: 10.1097/rhu.0000000000002027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
OBJECTIVE Familial Mediterranean fever (FMF) is the most prevalent hereditary autoinflammatory disease among children. Abdominal pain and various gastrointestinal system (GIS) manifestations may arise directly from FMF or concomitantly with FMF. This study aimed to evaluate GIS complaints and findings other than classic peritonitis attacks in patients with FMF and to interpret concomitant GIS and hepatic disorders in these patients. METHODS The medical and genetic findings of patients with FMF who attended our clinic between December 2011 and December 2021 were reviewed. Gastrointestinal system symptoms, liver function tests, abdominal images, and endoscopic and histopathological data were extracted from medical records. RESULTS A total of 576 pediatric patients (female, 52.3%) diagnosed with FMF were included. Among them, almost one-fifth displayed GIS complaints, such as abdominal pain, defecation problems, and dyspepsia, distinct from typical FMF attacks. High serum aminotransferase levels were detected in 18.4% of the patients, with viral infections being the most common cause of moderate/severe hypertransaminasemia. In addition, during follow-up, 26.9% of them were referred to the pediatric gastroenterology department. At least 1 gastroenterological and hepatobiliary disorder was detected in 17.5% of the patients because of organic and functional GIS disorders or hepatobiliary disorders, such as gastroesophageal reflux disease, esophagitis, functional dyspepsia, and inflammatory bowel diseases. CONCLUSION Various GIS and hepatic disorders can be encountered in children with FMF. The spectrum of these complaints and pathologies can range from frequently observed health problems to more severe diseases.
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Affiliation(s)
| | - Zarife Kuloglu
- Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatma Aydin
- From the Departments of Pediatric Rheumatology
| | - Serpil Ozdemir
- Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
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33
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Arbizu RA, Trauernicht S, Pinillos S, Nurko S, Rodriguez L. The Clinical Utility of Antroduodenal Manometry in the Evaluation of Children with Upper Gastrointestinal Symptoms. J Pediatr Gastroenterol Nutr 2023; 77:734-740. [PMID: 37756372 DOI: 10.1097/mpg.0000000000003956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
OBJECTIVES Antroduodenal manometry (ADM) measures antral and small bowel motility and is clinically used to evaluate upper gastrointestinal (UGI) symptoms. We aimed to evaluate its utility in guiding treatment, predicting response, and association with clinical findings. METHODS Retrospective review of 200 children undergoing ADM. ADM interpretation and parameters were compared to outcomes (response to first therapy after ADM and overall response), predominant symptom (group A, abdominal distention and/or vomiting and group B, abdominal pain and/or nausea), etiology (idiopathic or with known comorbidity), and ADM indication [suspected chronic intestinal pseudo-obstruction (CIPO) or unexplained UGI symptoms]. RESULTS We found an association between a normal intestinal phase III of the migrating motor complex (MMC) and idiopathic etiology, group B symptoms and unexplained UGI symptoms. No variable was associated with initial successful response. However, normal small bowel phase III of the MMC and idiopathic etiology were associated with overall successful response to treatment (including feeding tolerance and weaning of parenteral nutrition). No antral ADM parameter was associated with outcomes or other comparisons. The time to overall successful treatment response was significantly shorter in patients with a normal ADM and presence of a normal phase III of the MMC. CONCLUSIONS The presence of the phase III of the MMC was the single ADM parameter predictive of overall treatment response, also associated to group B symptoms and idiopathic etiology. Our findings suggest that small bowel ADM parameters are more useful to predict outcomes and ADM should be performed primarily in patients presenting with abdominal distention and/or vomiting and those being evaluated for CIPO.
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Affiliation(s)
- Ricardo A Arbizu
- From the Center for Motility and Gastrointestinal Functional Disorders, Division of Gastroenterology & Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
- the Neurogastroenterology and Motility Center, Section of Gastroenterology & Hepatology, Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT
| | - Sean Trauernicht
- From the Center for Motility and Gastrointestinal Functional Disorders, Division of Gastroenterology & Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
- the Division of Pediatric Gastroenterology, Hospital Infantil de Mexico, Mexico City, Mexico
| | - Sergio Pinillos
- From the Center for Motility and Gastrointestinal Functional Disorders, Division of Gastroenterology & Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
- the Division of Pediatric Gastroenterology, Quironsalud Hospital, Barcelona, Spain
| | - Samuel Nurko
- From the Center for Motility and Gastrointestinal Functional Disorders, Division of Gastroenterology & Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Leonel Rodriguez
- From the Center for Motility and Gastrointestinal Functional Disorders, Division of Gastroenterology & Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
- the Neurogastroenterology and Motility Center, Section of Gastroenterology & Hepatology, Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT
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Lamps LW. Infectious Disease Pathology of the Gastrointestinal Tract: Diagnosing the Challenging Cases. Surg Pathol Clin 2023; 16:779-804. [PMID: 37863566 DOI: 10.1016/j.path.2023.05.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Infectious diseases of the GI tract mimic a variety of other GI diseases, including chronic idiopathic inflammatory bowel disease and ischemia. It can be challenging to identify pathogens in tissue sections as well, as many trainees are not exposed to infectious disease pathology other than in the context of microbiology. Our ability to diagnose infections in formalin fixed, paraffin embedded material has grown exponentially with the advent of new histochemical and immunohistochemical stains, as well as more options for molecular testing. Correlating these diagnostic techniques with morphology has led to increasing understanding of the histologic patterns that are associated with specific pathogens.
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Affiliation(s)
- Laura W Lamps
- Department of Pathology, University of Michigan, NCRC Building 35, 2800 Plymouth Road, Ann Arbor, MI 48109, USA.
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35
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Rigg L, Kesavan A, Patel P. Methemoglobinemia and Chronic Gastrointestinal Symptoms in a Neonate: Diagnostic Considerations. Clin Pediatr (Phila) 2023; 62:1580-1582. [PMID: 36927131 DOI: 10.1177/00099228231161326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Lauren Rigg
- Division of Allergy and Immunology, RUSH University Medical Center, Chicago, IL, USA
| | - Anil Kesavan
- Section of Pediatric Gastroenterology, RUSH University Children's Hospital, Chicago, IL, USA
| | - Payal Patel
- Division of Allergy and Immunology, RUSH University Medical Center, Chicago, IL, USA
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Yin J, Chen JD. Noninvasive electrical neuromodulation for gastrointestinal motility disorders. Expert Rev Gastroenterol Hepatol 2023; 17:1221-1232. [PMID: 38018087 PMCID: PMC10842705 DOI: 10.1080/17474124.2023.2288156] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Gastrointestinal motility disorders are highly prevalent without satisfactory treatment. noninvasive electrical neuromodulation is an emerging therapy for treating various gastrointestinal motility disorders. AREAS COVERED In this review, several emerging noninvasive neuromodulation methods are introduced, including transcutaneous auricular vagal nerve stimulation, percutaneous auricular vagal nerve stimulation, transcutaneous cervical vagal nerve stimulation, transcutaneous electrical acustimulation, transabdominal interference stimulation, tibial nerve stimulation, and translumbosacral neuromodulation therapy. Their clinical applications in the most common gastrointestinal motility are discussed, including gastroesophageal reflux disease, functional dyspepsia, gastroparesis, functional constipation, irritable bowel syndrome, and fecal incontinence. PubMed database was searched from 1995 to June 2023 for relevant articles in English. EXPERT OPINION Noninvasive neuromodulation is effective and safe in improving both gastrointestinal symptoms and dysmotility; it can be used when pharmacotherapy is ineffective. Future directions include refining the methodology, improving device development and understanding mechanisms of action.
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Affiliation(s)
- Jieyun Yin
- Transtimulation Research Inc, Oklahoma City, OK, USA
| | - Jiande Dz Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, Ann Arbor MI, USA
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Powell EA, Hata DJ, Starolis MW. Viral pathogen detection using multiplex gastrointestinal molecular panels: The pros and cons of viral target inclusion. J Clin Virol 2023; 169:105612. [PMID: 37866093 DOI: 10.1016/j.jcv.2023.105612] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/31/2023] [Accepted: 10/14/2023] [Indexed: 10/24/2023]
Abstract
Diagnosis of gastrointestinal infections has been revolutionized by the development of in vitro diagnostic (IVD) multiplex molecular panels for the detection of viral nucleic acids. In addition to a high degree of accuracy, these panels are commercially available and relatively simple to perform in the clinical laboratory. However, use of these panels must be carefully considered owing to the laboratory costs of the test, limited reimbursement, and potential for overuse. In this review from the Pan American Society for Clinical Virology, we focus on the viral components of GI multiplex panels (GIPs), presenting a brief overview of pathogens included on most panels and a discussion of advantages and challenges of the inclusion of viral targets on GIPs that should be considered before implementation in the clinical laboratory.
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Affiliation(s)
- Eleanor A Powell
- Department of Pathology and Laboratory Medicine, University of Cincinnati College of Medicine, 234 Goodman St., Cincinnati, OH 45219, United States.
| | - D Jane Hata
- Department of Laboratory Medicine and Pathology, Mayo Clinic Florida, 4500 San Pablo Rd., Jacksonville, FL 32266, United States
| | - Meghan W Starolis
- Quest Diagnostics, 14225 Newbrook Dr., Chantilly, VA 20155, United States
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38
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Lifschitz C, Walker S, Tookman A. Awareness of Tissue Disorders and Functional Gastrointestinal Diseases. J Pediatr Gastroenterol Nutr 2023; 77:e115. [PMID: 37771009 DOI: 10.1097/mpg.0000000000003947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
| | - Steven Walker
- St. Gilesmedical (London & Berlin) & University of Applied Sciences, Bremen, Germany
| | - Adrian Tookman
- Former Medical Director Marie Curie Hospice, Hampstead, London, United Kingdom
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Mendelson S, Anbukkarasu P, Cassisi JE, Zaman W. Gastrointestinal functioning and menstrual cycle phase in emerging young adult women: a cross-sectional study. BMC Gastroenterol 2023; 23:406. [PMID: 37990300 PMCID: PMC10664285 DOI: 10.1186/s12876-023-03036-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Women experience more severe gastrointestinal (GI) symptoms compared to men. The onset of puberty and the menstrual cycle may influence these differences. Additionally, health anxiety is an important construct that has been shown to play a role in increased symptomatology across many medical conditions. Using standardized clinical measures often employed to assess disorders of gut-brain interaction (DGBI) we aimed to identify differences of GI functioning across menstrual cycle phases and to evaluate the role of health anxiety in this relationship. METHODS Six hundred three participants completed a survey including functional GI assessment scales (PROMIS-GI®), an abdominal pain scale and map, and a health anxiety measure. They were grouped by menstrual cycle phases (Menses, Follicular, Early-Luteal, and Premenstrual) based on self-reported start date of most recent period. Multivariate analyses of covariance were conducted to identify differences between menstrual cycle phase and scores on the symptom scales. Heath anxiety was included as a covariate in all analyses. RESULTS No significant differences were found between menstrual cycle group and PROMIS-GI scores. Higher GI-symptom and pain levels were found as health anxiety increased. Pain in the hypogastric region of the abdomen was significantly higher during the Menses phase when compared to Early-Luteal and Premenstrual phases. A subset of participants with DGBI diagnoses demonstrated significantly higher GI-symptom severity on several PROMIS-GI scales when compared to matched controls who did not have those diagnoses. In addition, participants with DGBI diagnoses reported significantly greater pain across multiple abdominal regions than their non-diagnosed counterparts. CONCLUSIONS GI symptom levels as measured by the PROMIS-GI scales in otherwise healthy women were not dependent on menstrual cycle phase. Yet, the PROMIS-GI scales were sensitive to symptom differences in women with DGBI diagnoses. Overall, this study demonstrated that the PROMIS-GI measures are unlikely to be affected by gynecological functioning in healthy young women. We argue that the abdominal pain map is an essential addition to classification and diagnosis.
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Affiliation(s)
- Sivanne Mendelson
- Department of Psychology, University of Central Florida, Orlando, FL, 32816, USA
| | - Preethashree Anbukkarasu
- College of Medicine, University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Jeffrey E Cassisi
- Department of Psychology, University of Central Florida, Orlando, FL, 32816, USA.
| | - Widaad Zaman
- Department of Psychology, University of Central Florida, Orlando, FL, 32816, USA
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40
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Zlatnik K, Milliken A, Weaver M, Sideridis G, Harris H, Harstad E. Gastrointestinal and Sleep Issues in Toddlers With Autism Versus Other Neurodevelopmental Disorders. Clin Pediatr (Phila) 2023; 62:1335-1341. [PMID: 36919794 DOI: 10.1177/00099228231156774] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Neurodevelopmental disorders (NDDs) are frequently associated with gastrointestinal symptoms (GIS) and sleep issues, but there are insufficient data on the occurrence of these symptoms in young children with autism spectrum disorder (ASD) compared with other NDDs. We abstracted data on 500 children aged 18 to 36 months with ASD and 146 children aged 18 to 47 months with non-ASD NDDs to compare the frequency of these symptoms. In the overall sample, there was a high rate of GIS (46.0%) and sleep difficulties (22.6%). In age-adjusted analyses, children with non-ASD NDDs were more likely to have GIS (61.0% vs 41.6%; adjusted odds ratio [OR] = 2.35; 95% confidence interval = 1.56-3.56) and sleep difficulties (34.9% vs 19.0%; adjusted OR = 2.08; 95% confidence interval = 1.33-3.26) compared with those with ASD. These findings demonstrate the need to assess these symptoms in all young children with developmental concerns to provide appropriate guidance to their families.
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Frieling T, Gjini B, Melchior I, Euler P, Kreysel C, Kalde S, Krummen B, Kiesslich R, Hemmerlein B. Endoscopic laser endomicroscopy and "leaky gut" in patients with functional gastrointestinal symptoms and food intolerance. Z Gastroenterol 2023; 61:1465-1471. [PMID: 36417920 DOI: 10.1055/a-1959-3200] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intestinal epithelial barrier dysfunction ("leaky gut syndrome", LGS) is thought to play a major role in the pathogenesis of disorders of the gut brain axis. Endoscopic confocal laser endomicroscopy (eCLE) is an objective measure to test duodenal permeability. We applied this technique in patients with functional gastrointestinal symptoms and food intolerance to characterize the proportion of patients with LGS. MATERIAL AND METHODS In an observational study, we evaluated 85 patients with functional gastrointestinal symptoms and food intolerance. Gastrointestinal symptoms were classified according to Rom IV into functional abdominal pain (FAP), irritable bowel syndrome (IBS), irritable bowel syndrome diarrhea dominant (IBS-D), irritable bowel syndrome constipation dominant (IBS-C), irritable bowel syndrome with mixed stool (IBS-M), functional abdominal bloating (FAB), functional diarrhea (FD) and unclassified (NC). During eCLE, spontaneous transfer of intravenously applied fluorescein into duodenal lumen (LGS) and following duodenal food challenge (DFC) were analyzed. Blood analysis comprised parameters of mast cell function, histology of duodenal mucosal biopsies analysis of mucosal inflammation, intraepithelial lymphocytes (IELs) as well as number, distribution and morphology of mast cells. RESULTS 24 patients (9 IBS, 9 FAP, 3 FAB, 1 FD, 2 NC), showed LGS, 50 patients (14 IBS-D, 4 IBS-C, 3 IBS-M, 23 FAP, 3 FAB, 3 NC) had no LGS but responded to DFC and 11 patients (6 NC, 3 FAP, 1 FAB, 1 FD) had no LGS and no response to DFC. The proportion of subgroups with/or without spontaneous leakage of fluorescein (+LGS/-LGS) were IBS-LGS/IBS+LGS 67%/33%, FAP-LGS/FAP+LGS 72%/28%,FAB-LGS/FAB+LGS 50%/50%, NC-LGS/NC+LGS 60%/40%. Subgroup analysis revealed no significant differences for all parameters tested. CONCLUSION As a proof of concept, the results of our study indicate that eCLE is a clinical useful tool to evaluate patients with disorders of the gut brain axis and those suspicious of LGS. However, the clinical significance of LGS remains unclear. The study should be an incentive to perform a randomized study including healthy controls.
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Affiliation(s)
- Thomas Frieling
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Besmir Gjini
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Ilka Melchior
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Philipp Euler
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | | | - Sigrid Kalde
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Britta Krummen
- Medizinische Klinik II, HELIOS Klinikum Krefeld, Krefeld, Germany
| | - Ralf Kiesslich
- Helios Dr. Horst Schmidt Kliniken Wiesbaden GmbH, Wiesbaden, Germany
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Dovgan K, Gynegrowski K, Ferguson BJ. Bidirectional relationship between internalizing symptoms and gastrointestinal problems in youth with Autism Spectrum Disorder. J Autism Dev Disord 2023; 53:4488-4494. [PMID: 35441914 DOI: 10.1007/s10803-022-05539-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/25/2022]
Abstract
Many youth with autism spectrum disorder (ASD) experience co-occurring conditions, such as gastrointestinal (GI) problems and internalizing symptoms. However, the relationship among these co-occurring problems is not well-understood. We analyzed parent reports of GI problems and internalizing symptoms of 621 youth with ASD using path models in a structural equation modeling framework. The best-fitting model was a bidirectional model wherein internalizing symptoms, including withdrawn and anxious behavior, were correlated with GI problems, including constipation, diarrhea, nausea, and stomach pain. This study provides a better understanding of the relationship among co-occurring conditions in youth with ASD and should encourage clinicians to consider treatment of underlying internalizing symptoms or GI problems when providing services for individuals with ASD.
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Affiliation(s)
- Kristen Dovgan
- Marist College, Department of Psychology, Poughkeepsie, NY, United States.
| | - Kyra Gynegrowski
- Marist College, Department of Psychology, Poughkeepsie, NY, United States
| | - Bradley J Ferguson
- Department of Health Psychology, University of Missouri, Columbia, MO, United States
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri, Columbia, MO, United States
- Department of Radiology, University of Missouri, Columbia, MO, United States
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Kiyak U, Urganci N, Usta M. Assesment of functional gastrointestinal diseases in obese children. Eur J Pediatr 2023; 182:4949-4955. [PMID: 37606702 DOI: 10.1007/s00431-023-05165-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
Functional gastrointestinal disorders (FGID) are disorders of gut-brain interactions characterized by chronic recurrent gastrointestinal symptoms and are reported to be more common in obese individuals. The aim of the study was to evaluate FGID in obese children. A total of 405 children (6-18 years) were enrolled in this cross sectional study. The children were divided into two groups according to body mass index (BMI) as < 85th percentile and > 95th percentile. Diagnosis of FGID was based on ROME VI criteria. Demographic and clinical characteristics of the patients were evaluated. FGID and subgroups were determined. The mean age of the children was 12.73 ± 3.17 years; 52% (n = 211) of them was female and 47.9% (n = 194) was male. A total of 50.6% patients had BMI > 95th percentile, and 55.1% of those patients had FGID. The subgroups of FGID, functional abdominal pain disorders and functional defecation disorders were significantly more common in obese children than non-obese group (P < 0.01). Additionally, constipation-predominant irritable bowel syndrome (IBS), diarrhea-predominant IBS, functional diarrhea, and abdominal distention were significantly more common in obese children than non-obese children (P < 0.01). CONCLUSION FGID in obese children was found to be increased significantly. Assessment of functional gastrointestinal symptoms in obese children will prevent unnecessary examinations. WHAT IS KNOWN • Functional gastrointestinal disorders are reported to be more common in obese individuals. WHAT IS NEW • Functional abdominal pain disorders and functional defecation disorders were significantly more common in obese children than non-obese group. • Constipation-predominant irritable bowel syndrome (IBS), diarrhea-predominant IBS, functional diarrhea, and abdominal distention were significantly more common in obese children than non-obese children.
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Affiliation(s)
- Umit Kiyak
- SBU Sisli Hamidiye Etfal Training and Research Hospital, Pediatrics, MD, Istanbul, Turkey
| | - Nafiye Urganci
- Division of Pediatric Gastroenterology, SBU Sisli Hamidiye Etfal Training and Research Hospital, Kazim Karabekir Pasa, Bahcekoy No: 62 Sariyer, Istanbul, Turkey.
| | - Merve Usta
- Division of Pediatric Gastroenterology, SBU Sisli Hamidiye Etfal Training and Research Hospital, Kazim Karabekir Pasa, Bahcekoy No: 62 Sariyer, Istanbul, Turkey
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Jang B, Chung MG, Lee DS. Association between gut microbial change and acute gastrointestinal toxicity in patients with prostate cancer receiving definitive radiation therapy. Cancer Med 2023; 12:20727-20735. [PMID: 37921267 PMCID: PMC10709749 DOI: 10.1002/cam4.6636] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND This prospective study investigated the association between gut microbial changes and acute gastrointestinal toxicities in prostate cancer patients receiving definitive radiation therapy (RT). METHODS Seventy-nine fecal samples were analyzed. Stool samples were collected at the following timepoints: pre-RT (prRT), 2 weeks after the start of RT (RT-2w), 5 weeks after the start of RT (RT-5w), 1 month after completion of RT (poRT-1 m), and 3 months after completion of RT (poRT-3 m). We computed the microbial community polarization index (MCPI) as an indicator of RT-induced dysbiosis. RESULTS Patients experiencing toxicity had lower alpha diversity, especially at RT-2w (p = 0.037) and RT-5w (p = 0.003). Compared to patients without toxicity, the MCPI in those experiencing toxicities was significantly elevated (p = 0.019). In terms of predicted metabolic pathways, we found linearly decreasing pathways, including carbon fixation pathways in prokaryotes (p = 0.035) and the bacterial secretion system (p = 0.005), in patients who experienced toxicities. CONCLUSIONS We showed RT-induced dysbiosis among patients who experienced toxicities. Reduced diversity and elevated RT-related MCPI could be helpfully used for developing individualized RT approaches.
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Affiliation(s)
- Bum‐Sup Jang
- Department of Radiation OncologyCollege of MedicineSeoul National UniversitySeoulKorea
| | - Moon Gyu Chung
- Microbiome centerKorea Research Institute of Bio‐medical ScienceDaejeonKorea
| | - Dong Soo Lee
- Department of Radiation Oncology, College of MedicineThe Catholic University of KoreaSeoulKorea
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Safaee M, Malekzadeh M, Motamedi N, Sayadishahraki M, Eizadi-Mood N. Gastrointestinal Manifestations of Lead Poisoning: A Brief Report. Iran J Med Sci 2023; 48:600-605. [PMID: 38094284 PMCID: PMC10715114 DOI: 10.30476/ijms.2023.95824.2749] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/26/2022] [Accepted: 12/17/2022] [Indexed: 12/18/2023]
Abstract
Gastrointestinal (GI) manifestations of lead poisoning include abdominal pain, constipation, and diarrhea. Depending on the severity of a symptom, surgical consultation is required. The present study aimed to make a comparison between the mean blood lead levels of patients hospitalized for lead toxicity and the various Gl symptoms. A retrospective cross-sectional study was performed in 2020 at Khorshid Hospital, the main regional referral center for poisoned patients (Isfahan, Iran). A total of 82 patients aged ≥18 years who were hospitalized for lead poisoning during 2017-2018 were included in the study. Patients' information was extracted from hospital medical records, including demographic information, clinical manifestations, blood lead levels, and treatment outcome. The mean age of the patients was 48.18±11.9 years, 91.5% were men, and 62.2% suffered from multiple GI symptoms, with abdominal pain being predominant (31.7%). Blood lead levels in patients with multiple GI symptoms were higher than those with only one symptom (P=0.01). Surgical consultation was required in 14.6% of the patients. Multiple GI symptoms were the main predictive factor for blood lead levels above 70 mg/dL (P=0.03, Odds ratio=3.06, 95% CI=1.09-8.61). Given the prevalence of abdominal pain and its association with elevated blood lead levels, differential diagnosis of abdominal pain should include lead toxicity.
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Affiliation(s)
- Masumeh Safaee
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdi Malekzadeh
- Department of Clinical Toxicology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Motamedi
- Department of Preventive and Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Sayadishahraki
- Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nastaran Eizadi-Mood
- Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Toppeta A, Dell'Era A, Molteni P, Ardizzone S. Severe chronic diarrhoea caused by hereditary transthyretin amyloidosis. BMJ Case Rep 2023; 16:e256673. [PMID: 37844979 PMCID: PMC10583022 DOI: 10.1136/bcr-2023-256673] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/18/2023] Open
Abstract
Amyloidosis includes a heterogeneous group of diseases caused by the extracellular deposition of insoluble fibrillar proteins, leading to multiple organ dysfunction and a poor life expectancy. In the early stages of amyloidosis, gastrointestinal (GI) symptoms are uncommon. We describe a rare case of hereditary transthyretin amyloidosis (ATTRv) with involvement of the heart, nervous system and GI tract. A man in his 60s was hospitalised due to chronic diarrhoea, orthostatic hypotension, malabsorption and weight loss. An organic origin for the diarrhoea was suspected, but the most common causes were ruled out. The review of GI biopsies and an abdominal fat aspirate confirmed the diagnosis of amyloidosis. The diagnosis of ATTRv amyloidosis with GI presentation is challenging, especially in the early stages, and misdiagnosis is common. The recent approval of therapies emphasises the importance of early diagnosis to prevent irreversible organ damage.
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Affiliation(s)
- Angelica Toppeta
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
| | - Alessandra Dell'Era
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Milano, Italy
- Gastroenterology and Endoscopy Unit, ASST Fatebenefratelli-Sacco, Milano, Lombardia, Italy
| | - Paola Molteni
- Gastroenterology and Endoscopy Unit, ASST Fatebenefratelli-Sacco, Milano, Lombardia, Italy
| | - Sandro Ardizzone
- Gastroenterology and Endoscopy Unit, ASST Fatebenefratelli-Sacco, Milano, Lombardia, Italy
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31st United European Gastroenterology Week 2023. United European Gastroenterol J 2023; 11 Suppl 8:1-1542. [PMID: 37839044 DOI: 10.1002/ueg2.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
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Herrán M, Adler BL, Perin J, Morales W, Pimentel M, McMahan ZH. Antivinculin Antibodies in Systemic Sclerosis: Associations With Slow Gastric Transit and Extraintestinal Clinical Phenotype. Arthritis Care Res (Hoboken) 2023; 75:2166-2173. [PMID: 36951252 PMCID: PMC10517080 DOI: 10.1002/acr.25118] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/19/2022] [Accepted: 03/21/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The gastrointestinal (GI) tract is commonly affected in systemic sclerosis (SSc). A positive association between antivinculin antibody levels and GI symptom severity is reported in SSc. We sought to examine whether antivinculin antibodies associate with measures of GI dysmotility and extraintestinal clinical phenotype in SSc. METHODS A total of 88 well-characterized patients with SSc and GI disease were assayed for antivinculin antibodies by enzyme-linked immunosorbent assay. Whole-gut scintigraphy, GI symptom scores, and clinical features of SSc were compared between patients with and without antibodies. RESULTS Twenty of 88 (23%) patients had antivinculin antibodies, which were more prevalent in patients with slow gastric transit (35% versus 22%). In the univariate analyses, patients who were positive for antivinculin antibodies were more likely to have limited cutaneous disease (odds ratio [OR] 9.60 [95% confidence interval (95% CI) 1.19, 77.23]) and thyroid disease (OR 4.09 [95% CI 1.27, 13.21]). Such patients were also less likely to have lung involvement based on a Medsger Severity Score of ≥2 (OR 0.25 [95% CI 0.07, 0.92]). Higher levels of antivinculin autoantibodies were associated with less gastric emptying (β coefficient -3.41 [95% CI -6.72, -0.09]). The association between antivinculin antibodies and each of these clinical features remained significant in the multivariable model. In particular, the presence of antivinculin antibodies (β coefficient -6.20 [95% CI -12.33, -0.063]) and higher levels of antivinculin antibodies (β coefficient -3.64 [95% CI -7.05, -0.23]) were each significantly associated with slower gastric transit. CONCLUSION Antivinculin antibodies associate with slower gastric transit in SSc and may provide insight into GI complications of SSc.
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Affiliation(s)
| | | | - Jamie Perin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Mark Pimentel
- Cedars-Sinai Medical Center, Los Angeles, California
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VanWormer JJ, Bendixsen CG, Shukla SK. Dairy Farm Work and Protection from Gastrointestinal Illness. J Agromedicine 2023; 28:640-646. [PMID: 37128886 PMCID: PMC10664175 DOI: 10.1080/1059924x.2023.2209091] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Gastrointestinal (GI) disorders are a major public health burden in the United States. Due to close contact with animals, farmers may be a high risk subgroup for acute GI infections, though some studies suggest farm work is actually protective against GI illness. The purpose of this study was to examine associations between dairy farm work and GI symptoms over 3 years. A prospective, matched cohort study was used that included 70 adult dairy farm workers and 74 matched (age, gender, ZIP code) non-farm participants from central Wisconsin. The outcome was mean GI symptom scores for abdominal pain, diarrhea, constipation, dyspepsia, nausea, and reflux, per the 23-item Gastrointestinal Symptoms Severity Index (GISSI). After adjustment for potential confounding variables, linear regression results indicated dairy farm workers had significantly lower GISSI scores for abdominal pain (mean±SE = 4.3 ± 1.1 dairy vs. 7.6 ± 1.1 non-farm, p = .047), diarrhea (3.2 ± 1.0 dairy vs. 7.0 ± 1.0 non-farm, p = .010), constipation (2.0 ± 0.8 dairy vs. 6.6 ± 0.8 non-farm, p < .001), and dyspepsia (2.0 ± 0.6 dairy vs. 3.9 ± 0.5 non-farm, p = .026). Working on a dairy farm was associated with significantly less frequent and severe GI illness symptoms in adults. Future research should identify underlying causal pathways, including possible farm animal exposures, that influence beneficial gut microbiota that could inform therapeutic remedies to help prevent clinical GI disorders.
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Affiliation(s)
- Jeffrey J. VanWormer
- Center for Clinical Epidemiology & Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Casper G. Bendixsen
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Sanjay K. Shukla
- Center for Precision Medicine Research, Marshfield Clinic Research Institute, Marshfield, WI, USA
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Kizilarslanoglu MC, Kollu K. Comment on: Association between gastrointestinal dysfunction score and disease severity and prognosis in critically ill patients. Clin Nutr 2023; 42:2081. [PMID: 37301686 DOI: 10.1016/j.clnu.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Muhammet Cemal Kizilarslanoglu
- University of Health Sciences Türkiye, Konya City Hospital, Department of Internal Medicine, Division of Geriatrics, Konya, Turkiye.
| | - Korhan Kollu
- University of Health Sciences Türkiye, Konya City Hospital, Department of Internal Medicine, Division of Intensive Care Medicine, Konya, Turkiye
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