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Yao X, Yang Y, Zhang S, Shi Y, Zhang Q, Wang Y. The impact of overlapping functional dyspepsia, belching disorders and functional heartburn on anxiety, depression and quality of life of Chinese patients with irritable bowel syndrome. BMC Gastroenterol 2020; 20:209. [PMID: 32631285 PMCID: PMC7336672 DOI: 10.1186/s12876-020-01357-1;] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/23/2020] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Functional dyspepsia (FD), belching disorders (BD) and functional heartburn (FH) are the three most common upper functional gastrointestinal disorders (FGID) in IBS patients. FD is known to exert deleterious effects on health-related quality of life (HRQoL) and the psychological status of IBS patients; however, the impact of overlapping BD and FH on anxiety, depression and HRQoL of IBS patients remains unknown. This cross-sectional study was conducted to investigate the impact of overlapping FD, BD and FH on anxiety, depression and HRQoL in patients with IBS. METHODS This study enrolled 319 consecutive outpatients with IBS from 2 tertiary hospitals in Beijing and Shijiazhuang of China. IBS, FD, BD and FH were diagnosed using the Rome III Criteria. Hospital Anxiety and Depression Scale and a 36-item Short-Form Health Survey (SF-36) were used to assess the psychological distress and HRQoL of patients respectively. RESULTS Among the 319 patients with IBS, the IBS subtypes were diarrhoea (67%), constipation (16%), unsubtyped (12%) and mixed (5%). These IBS patients were further classified into IBS + FD, IBS + BD/FH (BD and/or FH), IBS + FD + BD/FH, or IBS only according to the patients' overlapping upper GI symptoms. IBS+FD patients reported higher levels of anxiety than IBS+BD/FH and elevated depression scores than IBS only patients (P< 0.05). The latter observation remained consistent after confounder-adjustment. The IBS + FD and IBS + FD + BD/FH groups exhibited statistically significant impairment in most of SF-36 scales, while the IBS + BD/FH group only showed lower HRQoL results in general health, when compared to the IBS only group. Multiple linear regression analysis demonstrated IBS + FD + BD/FH was linked to worse mental, physical and global HRQoL. Furthermore, IBS + FD was a strong predictor of poorer physical and global HRQoL compared to IBS only. CONCLUSIONS Among the diarrhoea-prevalent IBS patients, those with concomitant FD experienced more psychological distress and demonstrated poorer physical HRQoL. Overlapping FD + BD/FH is a significant predictor of worse mental and physical HRQoL for IBS patients. The impact of concomitant BD and FH on the psychological status and HRQoL of IBS patients was limited. These findings implied that the overlapping upper FGIDs in IBS might be treated distinctively when developing comprehensive management strategies for IBS treatment.
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Affiliation(s)
- Xin Yao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, No. 95 Yongan Road, Beijing, 100050 China
- Department of Gastroenterology, Bethune International Peace Hospital, No. 398 Zhongshanxi Road, Shijiazhuang, 050082 China
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853 China
| | - Yunsheng Yang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853 China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, No. 95 Yongan Road, Beijing, 100050 China
| | - Yu Shi
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050 China
| | - Qian Zhang
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050 China
| | - Yongjun Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Disease, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, No. 95 Yongan Road, Beijing, 100050 China
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The impact of overlapping functional dyspepsia, belching disorders and functional heartburn on anxiety, depression and quality of life of Chinese patients with irritable bowel syndrome. BMC Gastroenterol 2020; 20:209. [PMID: 32631285 PMCID: PMC7336672 DOI: 10.1186/s12876-020-01357-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background Functional dyspepsia (FD), belching disorders (BD) and functional heartburn (FH) are the three most common upper functional gastrointestinal disorders (FGID) in IBS patients. FD is known to exert deleterious effects on health-related quality of life (HRQoL) and the psychological status of IBS patients; however, the impact of overlapping BD and FH on anxiety, depression and HRQoL of IBS patients remains unknown. This cross-sectional study was conducted to investigate the impact of overlapping FD, BD and FH on anxiety, depression and HRQoL in patients with IBS. Methods This study enrolled 319 consecutive outpatients with IBS from 2 tertiary hospitals in Beijing and Shijiazhuang of China. IBS, FD, BD and FH were diagnosed using the Rome III Criteria. Hospital Anxiety and Depression Scale and a 36-item Short-Form Health Survey (SF-36) were used to assess the psychological distress and HRQoL of patients respectively. Results Among the 319 patients with IBS, the IBS subtypes were diarrhoea (67%), constipation (16%), unsubtyped (12%) and mixed (5%). These IBS patients were further classified into IBS + FD, IBS + BD/FH (BD and/or FH), IBS + FD + BD/FH, or IBS only according to the patients’ overlapping upper GI symptoms. IBS+FD patients reported higher levels of anxiety than IBS+BD/FH and elevated depression scores than IBS only patients (P< 0.05). The latter observation remained consistent after confounder-adjustment. The IBS + FD and IBS + FD + BD/FH groups exhibited statistically significant impairment in most of SF-36 scales, while the IBS + BD/FH group only showed lower HRQoL results in general health, when compared to the IBS only group. Multiple linear regression analysis demonstrated IBS + FD + BD/FH was linked to worse mental, physical and global HRQoL. Furthermore, IBS + FD was a strong predictor of poorer physical and global HRQoL compared to IBS only. Conclusions Among the diarrhoea-prevalent IBS patients, those with concomitant FD experienced more psychological distress and demonstrated poorer physical HRQoL. Overlapping FD + BD/FH is a significant predictor of worse mental and physical HRQoL for IBS patients. The impact of concomitant BD and FH on the psychological status and HRQoL of IBS patients was limited. These findings implied that the overlapping upper FGIDs in IBS might be treated distinctively when developing comprehensive management strategies for IBS treatment.
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Wu Q, Chen T, El-Nezami H, Savidge TC. Food ingredients in human health: Ecological and metabolic perspectives implicating gut microbiota function. Trends Food Sci Technol 2020. [DOI: 10.1016/j.tifs.2020.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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54
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Andreev DN, Dicheva DT. A breach in the intestinal permeability as a factor of etiopathogenesis of functional gastrointestinal diseases. MEDITSINSKIY SOVET = MEDICAL COUNCIL 2020:87-95. [DOI: 10.21518/2079-701x-2020-5-87-95] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- D. N. Andreev
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - D. T. Dicheva
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
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Kotani S, Fukuba N, Kawashima K, Mishima Y, Sonoyama H, Okimoto E, Tada Y, Oka A, Tamagawa Y, Oshima N, Mishiro T, Tobita H, Shibagaki K, Moriyama I, Ishimura N, Kushiyama Y, Fujishiro H, Ishihara S. Prevalence of functional dyspepsia-like symptoms in ulcerative colitis patients in clinical remission and overlap with irritable bowel syndrome-like symptoms. Scand J Gastroenterol 2020; 55:560-564. [PMID: 32412797 DOI: 10.1080/00365521.2020.1761998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: Quiescent ulcerative colitis (UC) patients often have irritable bowel syndrome (IBS)-like symptoms and we recently showed that the prevalence of IBS-like symptoms in UC patients in clinical remission was significantly higher as compared to healthy control subjects. However, the prevalence of functional dyspepsia (FD)-like symptoms in quiescent UC patients remains unknown. The purpose of this study was to evaluate the prevalence of FD-like symptoms and the overlap with IBS-like symptoms in such patients.Materials and Methods: We reanalyzed the records of UC patients in remission using the subject cohort from our previous study. Clinical remission was defined as a clinical activity index (CAI) value ≤4 for at least 6 months. Diagnoses of FD- and IBS-like symptoms were evaluated by questionnaire according to the Rome III criteria.Results: One hundred seventy-two UC patients in clinical remission and 330 healthy control subjects were analyzed. Of the 172 patients, 9 (5.2%) met the criteria of FD, which was comparable with the controls (22/330, 6.7%). The prevalence rate of FD-like symptoms in UC patients with IBS-like symptoms (7/46, 15.2%) was lower as compared to that of the control subjects (6/16, 37.5%). On the other hand, a high percentage of the UC patients with FD-like symptoms also had IBS-like symptoms (7/9, 77.8%).Conclusions: Although the prevalence of FD-like symptoms in quiescent UC patients with IBS-like symptoms was low, UC patients with FD-like symptoms frequently had IBS-like symptoms.
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Affiliation(s)
- Satoshi Kotani
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Nobuhiko Fukuba
- Department of Internal Medicine, Izumo City General Medical Center, Izumo, Japan
| | - Kousaku Kawashima
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan.,Inflammatory Bowel Disease Center, Shimane University Hospital, Izumo, Japan
| | - Yoshiyuki Mishima
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Hiroki Sonoyama
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Eiko Okimoto
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Yasumasa Tada
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Akihiko Oka
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Yuji Tamagawa
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Naoki Oshima
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Tsuyoshi Mishiro
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Hiroshi Tobita
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Kotaro Shibagaki
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Ichiro Moriyama
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan
| | | | - Hirofumi Fujishiro
- Division of Gastroenterology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University School of Medicine, Izumo, Japan.,Inflammatory Bowel Disease Center, Shimane University Hospital, Izumo, Japan
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Lee JY, Kim N, Choi YJ, Park JH, Ashktorab H, Smoot DT, Lee DH. Expression of Tight Junction Proteins According to Functional Dyspepsia Subtype and Sex. J Neurogastroenterol Motil 2020; 26:248-258. [PMID: 32235032 PMCID: PMC7176499 DOI: 10.5056/jnm19208] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 12/11/2022] Open
Abstract
Background/Aims To determine whether the expression of tight junction proteins (TJPs) differs depending on the subtype of functional dyspepsia (FD) and sex. Methods Control (n = 95) and FD (n = 165) groups based on Rome III criteria were prospectively enrolled. Gastric mucosal mRNA expression levels of various TJPs (claudins [CLDN] 1, 2, and 4; zonula occludens-1; occludin [OCLN]) were assessed by reverse transcription polymerase chain reaction. Western blot was performed to determine the levels of various TJPs. Helicobacter pylori infection status was evaluated by histology, rapid urease test, and culture. Questionnaires were analyzed. Results In all groups irrespective of H. pylori, FD group showed significantly higher CLDN2 mRNA levels than control group (P = 0.048). The level of CLDN4 mRNA expression was significantly lower in female FD group than in male FD group (P = 0.018). In H. pylori uninfected subjects, the level of CLDN1 mRNA expression in female FD group was significantly lower than that of male FD group (P = 0.014). The level of CLDN2 mRNA expression was significantly higher in the male postprandial distress syndrome (P = 0.001) and male epigastric pain syndrome (P = 0.023) groups than in the male control group. In Western blot analysis, the expression of OCLN was significantly elevated 48 hour after the culture with H. pylori strain 43504. Conclusions H. pylori can affect a variety of TJPs, particularly claudin-4 and occludin. Claudin-2 is thought to be involved in FD irrespective of H. pylori status, especially in the pathophysiology of male FD.
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Affiliation(s)
- Ju Yup Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi-do, Korea.,Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Jin Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi-do, Korea
| | - Ji Hyun Park
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hassan Ashktorab
- Department of Medicine and Cancer Center, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Duane T Smoot
- Department of Medicine, Meharry Medical Center, Nashville, Tennessee, USA
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoungnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Efficacy Comparison of Different Acupuncture Treatments for Functional Dyspepsia: A Systematic Review with Network Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:3872919. [PMID: 32256643 PMCID: PMC7106911 DOI: 10.1155/2020/3872919] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/23/2020] [Accepted: 02/07/2020] [Indexed: 12/13/2022]
Abstract
Background Acupuncture has been found to be an effective treatment for functional dyspepsia (FD). Currently, several types of acupuncture have been developed but it is not clear which type is suitable for FD. Currently, doctors often rely on experience to decide which form of acupuncture to apply. Herein, we employed network meta-analysis (NMA) to compare the effectiveness of various methods of acupuncture in the treatment of functional dyspepsia. Methods We searched for randomized controlled trials (RCTs) of acupuncture treatments for functional dyspepsia in seven databases; PubMed, the Cochrane Library, Embase, Wanfang database, China National Knowledge Infrastructure (CNKI) database, Chinese Science and Technique Journals (CQVIP), and Chinese Biomedical Database (CBM) from the date of database inception to October 10, 2019. Cochrane risk of bias tool was used to analyze the risk of bias of the included RCTs. Pairwise meta-analyses were performed with RevMan 5.3 and the network meta-analysis of the included RCTs was performed using the frequentist framework. Results A total of 35 studies involving 3301 patients and 10 interventions were eligible for this study. NMA results showed that five types of acupuncture (manual acupuncture, acupoint application, moxibustion, acupoint catgut embedding, and warm acupuncture alone) all were superior to prokinetics (itopride, mosapride, and domperidone) and sham acupuncture in terms of improving the symptoms of functional dyspepsia. Specifically, manual acupuncture and electroacupuncture were more effective in improving the MOS 36 Item Short-Form Health Survey (SF-36) compared to itopride and sham acupuncture, and electroacupuncture was the best among the three acupuncture therapies (acupuncture, electroacupuncture, and acupoint catgut embedding). Moxibustion and manual acupuncture were more effective in improving Nepean Dyspepsia Life Quality Index (NDLQI) compared to itopride, domperidone, and sham acupuncture; moxibustion ranks first among the three acupuncture therapies (acupuncture, electroacupuncture, moxibustion). Conclusions These results showed that manual acupuncture alone was the most effective therapy for FD. It should, therefore, be considered as an alternative treatment for FD patients who are unresponsive to prokinetics or intolerant to the adverse effects of prokinetics. We recommend further multiple centers and high-quality RCT studies to confirm the present findings.
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Tan N, Gwee KA, Tack J, Zhang M, Li Y, Chen M, Xiao Y. Herbal medicine in the treatment of functional gastrointestinal disorders: A systematic review with meta-analysis. J Gastroenterol Hepatol 2020; 35:544-556. [PMID: 31674057 DOI: 10.1111/jgh.14905] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/08/2019] [Accepted: 10/11/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The efficacy of herbal medicines (HMs) for functional gastrointestinal disorders (FGIDs) including irritable bowel syndrome (IBS), functional dyspepsia (FD) and functional constipation (FC) is controversial. A systematic review with meta-analysis was conducted to determine their effectiveness for FGIDs. METHODS We searched the following electronic databases till July 2019 with English language restriction: The Cochrane Library, EMBASE and PUBMED. Randomized double-blind controlled trials of HMs compared with placebo or conventional pharmacological drugs for adult FGIDs patients were included. RESULTS In total, 49 trials involving 7396 participants with FGIDs were included. The risk of bias was low in 9, unclear in 36, and high in 4 trials. More than 33 different herbal formulae were tested. HMs demonstrated statistically significant benefits for symptom improvement compared with placebo in 46 trials (RR = 1.67, 95% CI 1.48-1.88). When compared with conventional pharmacological therapy in 5 trials, HMs were found to be non-inferior (RR = 1.10, 95% CI 1.03-1.18). The number of trials with regards to FD, IBS and FC were 19, 23 and 7 respectively. Subgroup analysis found that HMs were better than placebo in alleviating symptoms for FD (RR = 1.50, 95% CI 1.32-1.69), IBS (RR = 1.62, 95% CI 1.32-1.97) and FC (RR = 3.83, 95% CI 2.26-6.50). HMs tended to have more patients with adverse events than placebo, but similar to conventional pharmacological drugs. CONCLUSIONS Our findings provide a positive signal for HMs as a potentially well-tolerated and effective treatment for FGIDs, deserving further examination in high-quality trials.
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Affiliation(s)
- Niandi Tan
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kok Ann Gwee
- Department of Medicine, National University of Singapore and Gleneagles Hospital, Singapore
| | - Jan Tack
- Department of Chronic Diseases, Metabolism and Ageing, University of Leuven, Belgium
| | - Mengyu Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuwen Li
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yinglian Xiao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Alfaro Cruz L, Minard C, Guffey D, Chumpitazi BP, Shulman RJ. Does a Minority of Children With Functional Gastrointestinal Disorders Receive Formal Diet Advice? JPEN J Parenter Enteral Nutr 2020; 44:1525-1529. [PMID: 32017170 DOI: 10.1002/jpen.1771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/01/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Diet therapies may be recommended for pediatric functional gastrointestinal disorders (FGIDs). However, little is known about the frequency with which diet therapy is recommended in FGIDs. Our aims were to determine and contrast the frequency and types of diet recommendations provided to children with FGIDs by pediatric gastroenterologists (PGIs) versus primary care pediatricians (PCPs). METHODS A retrospective chart review was performed using data from a large, metropolitan children's academic healthcare system to identify subjects meeting Rome IV criteria for functional abdominal pain, functional dyspepsia, irritable-bowel syndrome (IBS), and/or abdominal migraine over a period of 23 months. RESULTS Of 1929 patient charts reviewed, 268 were included for further analyses. Of these, 186 patients (69%) were seen by a PGI and 82 (31%) by a PCP. The most common diagnosis was IBS (49% for PGIs and 71% for PCPs). Diet recommendations were provided to 115 (43%) patients (PGI group: 86 [75%] vs PCP group: 29 [25%]; P < .1). The most frequent recommendations were high fiber (PGI: 15%; PCP: 14%) and low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) diet (PGI: 12%; PCP: 4%). Of those provided with diet recommendations, only 20% (n = 23) received an educational consult by a dietitian. Provision of diet recommendations was not affected by years in practice. CONCLUSION Despite increasing awareness of the role of diet in the treatment of childhood FGIDs, a minority of patients receive diet recommendations in tertiary care or primary care settings. When diet recommendations were given, there was great variability in the guidance provided.
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Affiliation(s)
- Ligia Alfaro Cruz
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, East Tennessee State University, Johnson City, Tennessee, USA
| | - Charles Minard
- Dan L, Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Danielle Guffey
- Dan L, Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Bruno P Chumpitazi
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Robert J Shulman
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.,USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Berens S, Engel F, Gauss A, Tesarz J, Herzog W, Niesler B, Stroe-Kunold E, Schaefert R. Patients with Multiple Functional Gastrointestinal Disorders (FGIDs) Show Increased Illness Severity: A Cross-Sectional Study in a Tertiary Care FGID Specialty Clinic. Gastroenterol Res Pract 2020; 2020:9086340. [PMID: 32411207 PMCID: PMC7204123 DOI: 10.1155/2020/9086340] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/18/2019] [Accepted: 01/11/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Overlaps between different functional gastrointestinal disorders (FGIDs) are common. However, little is known about the impact of this overlap on patients' health status. This study is aimed at analyzing the differences between patients with multiple as compared to one single FGID. METHODS A retrospective, cross-sectional study was conducted with patients presenting to a tertiary care FGID specialty clinic between 06/2012 and 01/2015 (n = 294). They were characterized primarily according to their GI symptom severity (IBS-SSS) and secondarily to their physical as well as psychosocial symptom burden, quality of life, health care utilization, and work-related impairment. Differences between patients with >1 vs. 1 FGID were analyzed. RESULTS Of the 294 patients, 92.2% fulfilled the Rome III criteria for any FGID, and 48.0% had >1 FGIDs. FGID patients had a median age of 38 [23.0] years; 72.0% were female. Median GI symptom severity (IBS-SSS) scores were 339 [126] and 232 [163] in patients with >1 and 1 FGID, respectively (p < .001). Furthermore, patients with >1 FGIDs had higher general somatic symptom severity, higher illness anxiety, lower quality of life, and more work-related impairment. Almost no differences were found regarding their somatic as well as mental comorbidities. CONCLUSIONS Multiple FGIDs are associated with an increased risk for complicated courses of illness as reflected in higher GI and somatic symptom severity, as well as stronger psychosocial and diet- and work-related impairment. Stepped and interdisciplinary models of care including psychosocial expertise and dietary advice are needed, especially for patients with multiple FGIDs.
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Affiliation(s)
- Sabrina Berens
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Felicitas Engel
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Annika Gauss
- Department of Gastroenterology, Infectious Diseases and Intoxications, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Beate Niesler
- Institute of Human Genetics, Department of Human Molecular Genetics, University of Heidelberg, Im Neuenheimer Feld 366, D-69120 Heidelberg, Germany
| | - Esther Stroe-Kunold
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Rainer Schaefert
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
- Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Hebelstrasse 2, CH-4031 Basel, Switzerland
- Faculty of Medicine, University of Basel, Klingelbergstrasse 61, CH-4056 Basel, Switzerland
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Pohl D, Fried M, Lawrance D, Beck E, Hammer HF. Multicentre, non-interventional study of the efficacy and tolerability of linaclotide in the treatment of irritable bowel syndrome with constipation in primary, secondary and tertiary centres: the Alpine study. BMJ Open 2019; 9:e025627. [PMID: 31892640 PMCID: PMC6955540 DOI: 10.1136/bmjopen-2018-025627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES We evaluated the effectiveness and tolerability of linaclotide, a minimally absorbed guanylate cyclase-C agonist, in patients with irritable bowel syndrome with constipation (IBS-C) in routine clinical practice. SETTING A multicentre, non-interventional study conducted between December 2013 and November 2015 across 31 primary, secondary and tertiary centres in Austria and Switzerland. PARTICIPANTS The study enrolled 138 patients aged ≥18 years with moderate-to-severe IBS-C. Treatment decision was at the physician's discretion. Patients with known hypersensitivity to the study drug or suspected mechanical obstruction were excluded. The mean age of participants was 50 years, and >75% of the patients were women. 128 patients completed the study. PRIMARY AND SECONDARY OUTCOME MEASURES Data were collected at weeks 0 and 4 in Austria and weeks 0, 4 and 16 in Switzerland. The primary effectiveness endpoints included severity of abdominal pain and bloating (11-point numerical rating scale [0=no pain/bloating to 10=worst possible pain/bloating]), frequency of bowel movements and physicians' global effectiveness of linaclotide. Treatment-related adverse events (AEs) were recorded. RESULTS Following a 4-week treatment period, the mean intensity score of abdominal pain was reduced from 5.8 at baseline to 2.7, while the bloating intensity score was reduced from 5.8 at baseline to 3.1e (both indices p<0.001). The frequency of mean weekly bowel movements increased from 2.1 at baseline to 4.5 at week 4 (p<0.001). Global effectiveness and tolerability of linaclotide were assessed by the treating physicians as 'good' or 'excellent' in >70% of patients. In total, 31 AEs were reported in 22 patients, the most common being diarrhoea, reported by 6 (7%) and 8 (15.4%) patients in Austria and Switzerland, respectively. CONCLUSIONS Patients with IBS-C receiving linaclotide experienced effective treatment of moderate-to-severe symptoms in routine clinical practice. Linaclotide was safe and well tolerated and no new safety concerns were raised, supporting results from previous clinical trials.
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Affiliation(s)
- Daniel Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Fried
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Elmar Beck
- Anfomed Gesellschaft fur Angewandte Forschung in der Medizin mbH, Möhrendorf, Bayern, Germany
| | - Heinz F Hammer
- Division of Gastroenterology and Hepatology, Medical University Graz, Graz, Austria
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Wang B, Zhao W, Zhao C, Jin H, Zhang L, Chen Q, Wang B. What impact do Rome IV criteria have on patients with IBS in China? Scand J Gastroenterol 2019; 54:1433-1440. [PMID: 31829752 DOI: 10.1080/00365521.2019.1698650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: The Rome criteria for functional gastrointestinal diseases (FGIDs) have been updated from Rome III to Rome IV. This study aimed to investigate the impact of the update on patients with irritable bowel syndrome (IBS) in China.Methods: A previous database including consecutive patients with FGIDs (according to Rome III criteria) from gastrointestinal department of a tertiary hospital in China was re-analyzed. Demographic information, clinical symptoms, psychological status (Zung self-rating scale), and sleep quality (Pittsburgh sleep quality index) were compared between patients with Rome III and Rome IV IBS.Results: Of the 946 patients with FGIDs, only 58 (6.1%) were diagnosed with Rome IV IBS [less than 292 (30.9%) under Rome III criteria] with a surge of the number of unspecified functional bowel disorders (U-FBD). All patients with IBS were divided into three groups: group A [meeting both Rome III and IV criteria, accounting for 43 (4.6%) of patients with FGIDs], group B [meeting only Rome III criteria, 249 (26.3%)], and group C [meeting only Rome IV criteria,15 (1.6%)]. Significant differences in frequency and severity of symptoms, subtypes, and sleep quality among groups (all p < .05) were found. Patients with Rome III IBS having sleep disorder tended to be more serious than those without. On the contrary, it was not the case under Rome IV criteria.Conclusions: Number of IBS patients was greatly reduced accompanied by a surge in U-FBD. Besides, the updated criteria also had great impacts on clinical parameters, sleep quality and psychological state of IBS patients.HighlightsRome IV criteria removed the description of abdominal discomfort for IBS.The updated Rome criteria had great impacts on IBS patients in our database.Our study analyzed the characteristics of IBS patients who fulfilled both criteria.Alterations in the Rome criteria also led to changes in the disease spectrum of FBD.
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Affiliation(s)
- Bin Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Zhao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Chunshan Zhao
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Hong Jin
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lili Zhang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qiuyu Chen
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Bangmao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
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Hou Q, Huang Y, Zhu Z, Liao L, Chen X, Han Q, Liu F. Tong-Xie-Yao-Fang improves intestinal permeability in diarrhoea-predominant irritable bowel syndrome rats by inhibiting the NF-κB and notch signalling pathways. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 19:337. [PMID: 31775739 PMCID: PMC6882330 DOI: 10.1186/s12906-019-2749-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tong-Xie-Yao-Fang (TXYF) has been shown to be effective in diarrhoea-predominant irritable bowel syndrome (IBS-D) patients. However, the underlying mechanism remains to be clarified. The aim of this study was to investigate the efficacy and related mechanisms of TXYF in an IBS-D rat model. METHODS The IBS-D rat model was established with 4% acetic acid and evaluated by haematoxylin-eosin (HE) staining. Then, IBS-D rats were divided into control, TXYF and rifaximin groups and treated intragastrically with normal saline, TXYF and rifaximin, respectively, for 14 days. The following indicators were measured before and after treatment: defecation frequency, faecal water content (FWC) and colorectal distension (CRD). Histopathological changes in the distal colon were observed after treatment. The expression of OCLN and ZO1 in the distal colon of IBS-D rats reflected the intestinal mucosal permeability, as measured by qRT-PCR, western blot, and enzyme-linked immunosorbent assays (ELISAs). The NF-κB and Notch signalling pathways and inflammation-related factors were investigated. RESULTS After treatment with TXYF, the defecation frequency, FWC and CRD were significantly lower than those in the model group (P < 0.05). HE staining showed that colonic epithelial cells (CECs) in the IBS-D rats displayed significant oedema, impaired intestinal mucosal integrity and an increased influx of inflammatory cells. A significant reduction in granulocyte and CEC oedema was observed after the administration of TXYF and rifaximin compared to that of the model group and blank group (P < 0.05). TXYF significantly upregulated the expression of OCLN and ZO-1 and downregulated inflammation-related factors (IL-6, IL-1β, and TNF-α and the chemokine KC) in IBS-D rats compared to those in the model group rats (P < 0.05). In terms of the NF-κB and Notch signalling pathways, the expression of NICD, p-ERK, Hes-1 and p-P65 decreased significantly in the TXYF and rifaximin groups, while the expression of ATOH1 increased significantly compared to that in the model group (P < 0.05). CONCLUSION TXYF can effectively improve intestinal permeability and enhance intestinal mucosal barrier function, which may be related to inhibition of the inflammatory cascade and the NF-κB and Notch signalling pathways.
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Affiliation(s)
- Qiuke Hou
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Yongquan Huang
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhaoyang Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Liu Liao
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Xinlin Chen
- Department of Preventive Medicine and Health Statistics, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Quanbin Han
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China.
| | - Fengbin Liu
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
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Taki M, Oshima T, Li M, Sei H, Tozawa K, Tomita T, Fukui H, Watari J, Miwa H. Duodenal low-grade inflammation and expression of tight junction proteins in functional dyspepsia. Neurogastroenterol Motil 2019; 31:e13576. [PMID: 30790378 DOI: 10.1111/nmo.13576] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/29/2019] [Accepted: 02/05/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Duodenal changes in functional dyspepsia (FD) might be related to the development of symptoms. However, relationships among low-grade inflammation, Helicobacter pylori infection, and protein expression by tight junctions (TJs) in the duodenum are unclear. We therefore aimed to determine whether duodenal inflammation and genes associated with TJ proteins are associated with FD. METHODS We evaluated inflammatory cell infiltration of the duodenum, H pylori infection, and genes associated with TJ proteins in duodenal biopsy specimens from 35 patients with FD according to the Rome III diagnostic questionnaire and from 31 asymptomatic controls without structural diseases. We immunohistochemically detected eosinophils and mast cells and counted them. The expression of claudins, occludin, and zonula occludens (ZO)-1 mRNA was evaluated using quantitative RT-PCR. Infection with H pylori was determined by measuring serum antibodies, rapid urease or urea breath tests, and endoscopic findings. RESULTS Sex, age, and H pyloriinfection rates did not differ between patients with FD and controls. The numbers of eosinophils and mast cells were significantly increased in patients with FD compared with controls and were significantly correlated. Inflammatory cell counts in the duodenum were not associated with H pylori infection status. Claudin-3 mRNA expression was increased in the patients with FD. CONCLUSIONS Subtle inflammation identified in the duodenum of patients with FD might be associated with the onset and persistence of dyspeptic symptoms.
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Affiliation(s)
- Masato Taki
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tadayuki Oshima
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Min Li
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroo Sei
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Katsuyuki Tozawa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hirokazu Fukui
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Jiro Watari
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Luo L, Du L, Shen J, Cen M, Dai N. Benefit of small dose antidepressants for functional dyspepsia: Experience from a tertiary center in eastern China. Medicine (Baltimore) 2019; 98:e17501. [PMID: 31593119 PMCID: PMC6799471 DOI: 10.1097/md.0000000000017501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Traditional treatment of functional dyspepsia (FD) is unsatisfactory in a subgroup of patients with FD, and the potential role of antidepressant medications also has not been definitely clarified. To provide more evidence for future optimal practice recommendations, we reviewed a 1-year clinical database of antidepressant agents applied in outpatients with FD. METHODS Clinical presentations, treatment course, and outcomes were determined by chart review of patients referring to the functional gastrointestinal disorders specialist clinic. One hundred thirty patients with FD were included for further analysis. RESULTS Patients were treated with different antidepressant drugs according to individual symptoms. The most commonly used drugs were flupenthixol melitracen and fluoxetine. Improvement and complete remission occurred in 93.8% and 54.6% of patients, respectively. There was a trend toward superior outcome for citalopram compared to sulpiride and mirtazapine in overall analysis. Meanwhile, regimens containing fluoxetine had significant increased remission rate compared to any other antidepressant regimens in postprandial distress syndrome subgroup analysis. Furthermore, older patients were more likely to achieve remission. However, sex and symptom duration were not associated with symptom remission. Finally, 11.5% of patients experienced adverse events. CONCLUSIONS This retrospective cohort study indicated that small dose antidepressant therapy, especially citalopram and fluoxetine, is an effective and well tolerated treatment option for refractory FD.
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Affiliation(s)
- Liang Luo
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Lijun Du
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Jinhua Shen
- Department of Gastroenterology, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Mengsha Cen
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Ning Dai
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou
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Chain length of dietary fatty acids determines gastrointestinal motility and visceromotor function in mice in a fatty acid binding protein 4-dependent manner. Eur J Nutr 2019; 59:2481-2496. [PMID: 31562532 PMCID: PMC7413912 DOI: 10.1007/s00394-019-02094-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 09/19/2019] [Indexed: 12/14/2022]
Abstract
Purpose We hypothesize that different types of dietary fatty acids (FAs) affect gastrointestinal (GI) motility and visceromotor function and that this effect can be regulated by the fatty acid binding protein 4 (FABP4). Methods Mice were fed for 60 days with standard diet (STD), STD with 7% (by weight) coconut oil, rich in medium-chain FAs (MCFAs) (COCO), or with 7% evening primrose oil, rich in long-chain FAs (LCFAs) (EPO). In each group, half of the mice received FABP4 inhibitor, BMS309403 (1 mg/kg; i.p.) twice a week. Body weight (BW) and food intake were measured; well-established tests were performed to characterize the changes in GI motility and visceral pain. White adipose tissue and colonic samples were collected for cell culturing and molecular studies. Results COCO significantly increased GI transit, but not colonic motility. COCO and EPO delayed the onset of diarrhea, but none affected the effect of loperamide. EPO reduced BW and increased the visceromotor response (VMR) to colorectal distension (CRD). COCO and EPO reduced differentiation of preadipocytes. Treatment with BMS309403: (1) reversed the effects induced by COCO in physiological conditions and in mouse models of diarrhea; (2) prevented the effects of EPO on BW, VMR to CRD and castor oil-induced diarrhea; (3) affected proliferation of preadipocytes; (4) changed the expression of Fabp4 in colonic and adipocyte samples from COCO and EPO. Conclusion Modifying dietary intake of MCFAs and LCFAs may be used to control GI motility or visceral pain and thus modulate the symptoms of functional GI disorders. The effect is dependent on the expression of FABP4. Electronic supplementary material The online version of this article (10.1007/s00394-019-02094-2) contains supplementary material, which is available to authorized users.
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Kang SJ, Park B, Shin CM. Helicobacter pylori Eradication Therapy for Functional Dyspepsia: A Meta-Analysis by Region and H. pylori Prevalence. J Clin Med 2019; 8:E1324. [PMID: 31466299 PMCID: PMC6780123 DOI: 10.3390/jcm8091324] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/24/2019] [Accepted: 08/25/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous studies on the effect of Helicobacter pylori eradication on functional dyspepsia (FD) are conflicting. We performed a comprehensive meta-analysis on this issue according to region and prevalence of H. pylori. METHODS Randomized controlled trials (RCTs) evaluating the effect of eradication of H. pylori on functional dyspepsia up to December 2018 were searched through PubMed, EMBASE, and the Cochrane Library. Subgroup analyses by the outcome measure, region, and prevalence of H. pylori were performed. All data were analyzed with Review Manager 5.3. RESULTS Eighteen RCTs were included in our meta-analysis. Overall, the H. pylori eradication group showed significant improvement of symptoms compared with the control group (risk ratio (RR) = 1.18; 95% confidence interval (CI): 1.07-1.30, p < 0.01). There was moderate heterogeneity among studies (I2 = 34%) and the number needed to treat (NNT) was 15.0. Helicobacter pylori eradication improved dyspeptic symptoms both in low (<50%) and high (≥50%) H. pylori prevalence regions (RR = 1.21 and 1.17; 95% CI: 1.02-1.44 and 1.06-1.29, I2 = 49% and 5%, respectively.) In the analysis of studies from Asia, however, the effect of eradication on improvement of dyspepsia was not significant (RR = 1.14; 95% CI: 0.99-1.33, p = 0.08, I2 = 37%). CONCLUSION Overall, H. pylori eradication provides significant improvement of symptoms in functional dyspepsia patients regardless of H. pylori prevalence. However, in the analysis of studies from Asia, the eradication did not significantly improve dyspeptic symptoms. In this region, eradication for dyspepsia can be individualized.
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Affiliation(s)
- Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul 06236, Korea
| | - Boram Park
- Department of Public Health Science, Seoul National University, Seoul 08826, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea.
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Shen XR, Xie M, Chai J, Feng R, Cheng J, Liu R, Kadetz P, Wang D. Pathways of healthcare and antibiotics use following reported gastrointestinal illness: a cross-sectional study in rural Anhui, China. BMJ Open 2019; 9:e030986. [PMID: 31434785 PMCID: PMC6707665 DOI: 10.1136/bmjopen-2019-030986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To document the factors, and their pathways, that influence healthcare and antibiotics use following reported gastrointestinal illnesses in Anhui province, China. STUDY DESIGN This study uses cross-sectional design, descriptive statistical analysis, pathway mapping and multivariate logistic regression modelling. SETTING Households in 12 villages in Anhui province, China. PARTICIPANTS A total of 3659 residents who: (1) held a registered rural residence and were actually living in the sampled villages when this study was conducted; (2) were aged 18 years and older and (3) were willing to participate and able to answer the survey questions. OUTCOME MEASURES Planned and measured variables included the occurrence of gastrointestinal illness, professional care seeking and antibiotic use due to the illness and factors influencing these measures. RESULTS Of the 3659 informants, 29.0% reported gastrointestinal illness episodes in the past year. Of these episodes, 50.2% led to professional care seeking and 65.4% of antibiotic use. Multivariate logistic modelling identifies that: (1) reported gastrointestinal illnesses were more frequent in north compared with middle (OR 0.569, 95% CI 0.472 to 0.686) and south (OR 0.588, 95% CI 0.492 to 0.702) Anhui, and were positively associated with age (B=0.123, p<0.05), knowledge concerning (B=0.248, p<0.05) and practice of (B=0.184, p<0.05) prevention; (2) seeking professional care and antibiotic use following the illness was linked to the severity of symptoms and geographical locations, rather than to specific pathogenic features. CONCLUSIONS Reported gastrointestinal illnesses are quite prevalent in the sample population and a large proportion of these have resulted in professional care and antibiotics use. The factors associated with the reported illnesses and pathways of healthcare and antibiotic use, as identified in this study, should inform future research and intervention efforts.
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Affiliation(s)
- Xing Rong Shen
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Maomao Xie
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Jing Chai
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Rui Feng
- Department of Literature Review and Analysis, Anhui Medical University, Hefei, China
| | - Jing Cheng
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Rong Liu
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Paul Kadetz
- China Centre for Health and Humanity, University College London, London, UK
| | - DeBin Wang
- School of Health Service Management, Anhui Medical University, Hefei, China
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Hou Q, Zhu S, Zhang C, Huang Y, Guo Y, Li P, Chen X, Wen Y, Han Q, Liu F. Berberine improves intestinal epithelial tight junctions by upregulating A20 expression in IBS-D mice. Biomed Pharmacother 2019; 118:109206. [PMID: 31306972 DOI: 10.1016/j.biopha.2019.109206] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 12/18/2022] Open
Abstract
To investigate effects of berberine exerts on A20 expression and regulation of intestinal epithelial tight junctions via the TNF-α-NF-κB-MLCK pathway in Diarrhea-Predominant Irritable Bowel Syndrome (IBS-D). C57BL/6 wild type (WT) and A20 IEC-KO mice (48 each) were randomly divided into normal control (NC), model control (MC), rifaximin and berberine groups (12 mice per group). An experimental model of IBS-D was established using 4% acetic acid and evaluated by haematoxylin-eosin (HE) staining. rifaximin and berberine mice were treated with rifaximin and berberine, respectively. Intestinal epithelial space of WT berberine mice improved more than A20 IEC-KO berberine mice compared to MC mice. WT berberine mice exhibited greater expression of A20 compared with MC mice(P < 0.01). TNF-α, NF-kB p65, MLCK, MLC, TRAF6 and RIP1 levels in A20 IEC-KO and WT berberine mice were all decreased compared to MC mice(P all<0.05). NF-κB p65, MLCK and TRAF6 levels were increased in A20 IEC-KO berberine mice as compared to WT berberine mice (P all<0.05). Intestinal epithelial levels of occludin, claudin-1, ZO-1 and F-actin increased in all berberine mice (P all<0.01-0.05), while occludin, claudin-1, and ZO-1 levels were lower in A20 IEC-KO berberine mice(P < 0.05). Berberine downregulates abnormal activation of the TNF-α-NF-κB-MLCK pathway by upregulating expression of A20 in a mouse model of IBS-D, thereby protecting intestinal epithelial tight junctions and repairing the damage IBS-D causes to the intestinal epithelial barrier.
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Affiliation(s)
- Qiuke Hou
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China; School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China.
| | - Shuilian Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Changrong Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Yongquan Huang
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Yajuan Guo
- Inernational Institute for Translational Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Peiwu Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Xinlin Chen
- Department of Preventive Medicine and Health Statistics, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
| | - Yi Wen
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Quanbin Han
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China.
| | - Fengbin Liu
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Abstract
Beyond their well-known role in embryonic development of the central and peripheral nervous system, neurotrophins, particularly nerve growth factor and brain-derived neurotrophic factor, exert an essential role in pain production and sensitization. This has mainly been studied within the framework of somatic pain, and even antibodies (tanezumab and fasinumab) have recently been developed for their use in chronic somatic painful conditions, such as osteoarthritis or low back pain. However, data suggest that neurotrophins also exert an important role in the occurrence of visceral pain and visceral sensitization. Visceral pain is a distressing symptom that prompts many consultations and is typically encountered in both 'organic' (generally inflammatory) and 'functional' (displaying no obvious structural changes in routine clinical evaluations) disorders of the gut, such as inflammatory bowel disease and irritable bowel syndrome, respectively. The present review provides a summary of neurotrophins as a molecular family and their role in pain in general and addresses recent investigations of the involvement of nerve growth factor and brain-derived neurotrophic factor in visceral pain, particularly that associated with inflammatory bowel disease and irritable bowel syndrome.
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Masuy I, Van Oudenhove L, Tack J. Review article: treatment options for functional dyspepsia. Aliment Pharmacol Ther 2019; 49:1134-1172. [PMID: 30924176 DOI: 10.1111/apt.15191] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/03/2018] [Accepted: 01/23/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Functional dyspepsia, consisting of epigastric pain syndrome and postprandial distress syndrome, is a prevalent functional gastrointestinal disorder. To date, only limited treatment options are available and conflicting results in terms of efficacy have been reported. Consequently, nonpharmacological treatment options are increasingly being explored for functional dyspepsia. AIM To provide an overview of current pharmacological and nonpharmacological treatment options for functional dyspepsia. METHODS A literature search was conducted on Pubmed and other sources to identify relevant studies. RESULTS Acid suppressive therapy reduced symptoms in 30%-70% of the patients, with higher benefit in epigastric pain syndrome and superior effectiveness for proton pump inhibitors compared to H2 -antagonists. Prokinetic agents, primarily used to treat postprandial distress syndrome, showed variable efficiency: 59%-81% responder rate for dopamine receptor antagonists, 32%-91% for serotonin-4-receptor agonists and 31%-80% for muscarinic receptor antagonists. H Pylori eradication, recommended in infected patients, was effective in 24%-82%. Refractory symptoms are addressed with neuromodulators. However, their efficacy in functional dyspepsia remains incompletely elucidated, available data showing symptom reduction in 27%-71% of the patients. Regarding herbal agents, peppermint oil reduced symptoms in 66%-91%, rikkunshito in 29%-34% and iberogast in 20%-95%. Lastly, acupuncture, cognitive behavioural therapy and hypnotherapy may help to provide symptom control, but research on their efficacy remains sparse. CONCLUSIONS None of the available therapies is effective in the majority of patients without being associated with major side effects. Developing new treatment options is challenging due to the heterogeneity of functional dyspepsia, the lack of readily identified target mechanisms and the poor association between pathophysiological disturbances and symptoms.
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Affiliation(s)
- Imke Masuy
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
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Dong Y, Li S, Yin J, Chen JDZ. Ameliorating effects of optimized gastric electrical stimulation and mechanisms involving nerve growth factor and opioids in a rodent model of gastric hypersensitivity. Neurogastroenterol Motil 2019; 31:e13551. [PMID: 30790401 DOI: 10.1111/nmo.13551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/09/2018] [Accepted: 12/20/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastric electrical stimulation (GES) has been applied to treat gastric motility disorders for decades. This study was designed to investigate the effects and mechanisms of GES for visceral hypersensitivity in a rodent model of functional dyspepsia (FD). METHODS Male Sprague-Dawley rat pups at 10-days old received 0.1% iodoacetamide (IA) daily for 6 days. The experiments were performed when the rats reached 8-11 weeks of age, and visceral hypersensitivity was established. Then, GES parameters were optimized and the chronic effects of GES on gastric hypersensitivity were assessed by electromyogram (EMG). Naloxone (3 mg/kg), D-Phe-Cys-Tyr-D-Trp-Orn-Thr-Pen-Thr-NH2 (CTOP, 1 mg/kg), and anti-NGF (16 μg/kg) were individually intraperitoneally injected to investigate opioid and nerve growth factor (NGF) mechanisms. Tissues were analyzed for NGF expression. KEY RESULTS In the IA-treated rats, the visceromotor response to gastric distension was significantly increased, and both acute GES with optimized stimulation parameters (0.25 seconds on, 0.25 seconds off, 100 Hz, 0.25 ms, 6 mA) and chronic GES (7 days, 2 hours/day) normalized gastric hypersensitivity. The inhibitory effect of GES on gastric hypersensitivity was blocked by naloxone and CTOP. Anti-NGF normalized EMG responses in IA-treated rats. The expressions of NGF in the tissues of IA-treated rats were dramatically increased, and these increases were suppressed with GES. CONCLUSIONS AND INFERENCES GES with optimized parameters improves gastric hypersensitivity induced by neonatal treatment of IA mediated peripherally by suppressing NGF and via the opioid mechanism involving the µ receptor. GES as a potential therapy for treating visceral pain may be explored in clinical studies.
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Affiliation(s)
- Yan Dong
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, Oklahoma.,Institute of Chinese Traditional Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shiying Li
- Veterans Research and Education Foundation, VA Medical Center, Oklahoma City, Oklahoma.,Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jieyun Yin
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jiande D Z Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Wang XJ, Camilleri M. Personalized medicine in functional gastrointestinal disorders: Understanding pathogenesis to increase diagnostic and treatment efficacy. World J Gastroenterol 2019; 25:1185-1196. [PMID: 30886502 PMCID: PMC6421234 DOI: 10.3748/wjg.v25.i10.1185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/04/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
There is overwhelming evidence that functional gastrointestinal disorders (FGIDs) are associated with specific mechanisms that constitute important targets for personalized treatment. There are specific mechanisms in patients presenting with functional upper gastrointestinal symptoms (UGI Sx). Among patients with UGI Sx, approximately equal proportions (25%) of patients have delayed gastric emptying (GE), reduced gastric accommodation (GA), both impaired GE and GA, or neither, presumably due to increased gastric or duodenal sensitivity. Treatments targeted to the underlying pathophysiology utilize prokinetics, gastric relaxants, or central neuromodulators. Similarly, specific mechanisms in patients presenting with functional lower gastrointestinal symptoms, especially with diarrhea or constipation, are recognized, including at least 30% of patients with functional constipation pelvic floor dyssynergia and 5% has colonic inertia (with neural or interstitial cells of Cajal loss in myenteric plexus); 25% of patients with diarrhea-predominant irritable bowel syndrome (IBSD) has evidence of bile acid diarrhea; and, depending on ethnicity, a varying proportion of patients has disaccharidase deficiency, and less often sucrose-isomaltase deficiency. Among patients with predominant pain or bloating, the role of fermentable oligosaccharides, disaccharides, monosaccharides and polyols should be considered. Personalization is applied through pharmacogenomics related to drug pharmacokinetics, specifically the role of CYP2D6, 2C19 and 3A4 in the use of drugs for treatment of patients with FGIDs. Single mutations or multiple genetic variants are relatively rare, with limited impact to date on the understanding or treatment of FGIDs. The role of mucosal gene expression in FGIDs, particularly in IBS-D, is the subject of ongoing research. In summary, the time for personalization of FGIDs, based on deep phenotyping, is here; pharmacogenomics is relevant in the use of central neuromodulators. There is still unclear impact of the role of genetics in the management of FGIDs.
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Affiliation(s)
- Xiao Jing Wang
- Division of Gastroenterology and Hepatology, Clinical Enteric Neuroscience Translational and Epidemiological Research, Mayo Clinic, Rochester, MN 55905, United States
| | - Michael Camilleri
- Division of Gastroenterology and Hepatology, Clinical Enteric Neuroscience Translational and Epidemiological Research, Mayo Clinic, Rochester, MN 55905, United States
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Mano F, Ikeda K, Sato T, Nakayama T, Tanaka D, Joo E, Takahashi Y, Kosugi S, Sekine A, Tabara Y, Matsuda F, Inagaki N. Reduction in Gastroesophageal Reflux Disease Symptoms Is Associated with Miso Soup Intake in a Population-Based Cross-Sectional Study: The Nagahama Study. J Nutr Sci Vitaminol (Tokyo) 2019; 64:367-373. [PMID: 30381627 DOI: 10.3177/jnsv.64.367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dietary habits and lifestyles are considered to affect the frequency of epigastric symptoms. In our previous study, we found that three amino acids in Japanese broth promoted gastric emptying. We hypothesized that a higher consumption of miso soup which was mainly composed of Japanese broth and miso paste would be associated with a lower frequency of epigastric symptoms. We conducted a cross-sectional study of the association between frequency of miso soup intake and reflux or dyspepsia symptoms in a general Japanese population. Sixteen items of dietary habits were assessed using a self-reported questionnaire, and epigastric symptoms were evaluated using the Frequency Scale for Symptoms of Gastroesophageal Reflux Disease (FSSG). We fitted generalized linear models to analyze the association between miso soup intake and FSSG, reflux, or dyspepsia scores adjusted by age, sex, body mass index (BMI), another 15 dietary habits, smoking, drinking alcohol, and unfavorable dietary behaviors. A total of 9,364 subjects were included in the analysis. Trend analysis revealed that higher frequency of miso soup intake was associated with lower FSSG scores (p<0.001). In a generalized linear model, daily intake of miso soup was associated with lower FSSG, reflux, and dyspepsia scores independent of age, sex, BMI, other 15 dietary habits, smoking, drinking alcohol, and unfavorable dietary behaviors (estimate=-0.46, -0.22, and -0.27, respectively; 95% CI=-0.83, -0.12; -0.38, -0.07; and -0.47, and -0.08, respectively). Dairy intake of miso soup was associated with lower epigastric symptoms.
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Affiliation(s)
- Fumika Mano
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University
| | - Kaori Ikeda
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University
| | - Tosiya Sato
- Department of Biostatistics, Kyoto University School of Public Health
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health
| | - Daisuke Tanaka
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University
| | - Erina Joo
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University
| | | | - Shinji Kosugi
- Department of Medical Ethics/Medical Genetics, Kyoto University School of Public Health
| | | | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University
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Bai T, Wang WF, Zhang L, Wang H, Qian W, Song J, Hou XH. Positive endoscopic and ultrasonographic findings in patients with symptom-diagnosed functional gastrointestinal disorder: Data from a Chinese cross-sectional study. J Dig Dis 2018; 19:759-765. [PMID: 30520233 DOI: 10.1111/1751-2980.12693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/15/2018] [Accepted: 11/22/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Few studies have systematically assessed symptom-based diagnoses of functional gastrointestinal disorders (FGID) in China. This study aimed to evaluate the positive endoscopic and ultrasonographic findings in patients with symptom-based FGID. METHODS Adult patients with gastrointestinal symptoms but not red flag symptoms who were empirically diagnosed with FGID underwent an upper or lower gastrointestinal endoscopy. An abdominal ultrasonography was also performed to screen for potential organic diseases. Patients' data were collected and the Rome III questionnaire was used for symptom-based assessment. RESULTS Positive endoscopic and ultrasonographic findings were detected in 31.8%, 26.2% and 9.9% of patients with esophageal, gastroduodenal and intestinal disorders, respectively. Among patients diagnosed with FGID using the questionnaire, the rates of positive endoscopic and ultrasonographic findings were higher in patients with upper gastrointestinal symptoms than in those with lower gastrointestinal symptoms. Moreover, patients elder than 34.5 years with upper gastrointestinal symptoms and those elder than 47.5 years with lower gastrointestinal symptoms were more likely to have positive endoscopic and ultrasonographic findings. CONCLUSIONS The Rome III questionnaire is a valuable diagnostic tool for screening FGID in China. However, the rates of positive endoscopic and ultrasonographic findings vary depending on the location of symptoms. Endoscopy and ultrasonography have irreplaceable value, especially for investigating upper gastrointestinal symptoms.
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Affiliation(s)
- Tao Bai
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wen Feng Wang
- Department of Gastroenterology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, Guangdong Province, China
| | - Lei Zhang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Huan Wang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wei Qian
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jun Song
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiao Hua Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Grundmann O, Yoon SL, Mason S, Smith K. Gastrointestinal symptom improvement from fiber, STW 5, peppermint oil, and probiotics use-Results from an online survey. Complement Ther Med 2018; 41:225-230. [PMID: 30477844 DOI: 10.1016/j.ctim.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Several common supplements are used by a significant number of patients affected by gastrointestinal (GI) disorders to improve symptoms and quality of life. We investigated the impact of GI symptom improvement with the use of fiber, STW 5, probiotics, and peppermint oil in relation to overall GI pain and quality of life via an online survey. DESIGN We used a cross-sectional, descriptive, correlation design. A Qualtrics online survey was utilized to collect data from January to June 2013 through various websites. Areas evaluated included participant demographics, use of supplements, and gastrointestinal symptom severity. RESULTS The rate of supplement use among patients with GI disorders was high (90% in past year) and consultation with healthcare providers was reported by 80%. Participants who completed the survey (n = 68) reported a strong correlation between GI symptom severity and overall quality of life (r2 = 0.8682, p < 0.001). The use of fiber improved GI symptom severity while both STW 5 and probiotics were linked to specific improvements. CONCLUSIONS Persons with chronic GI disorders often choose the complementary use of common supplements to mitigate GI symptoms and consult with their healthcare providers frequently. The use of STW 5 and probiotics specifically is linked to overall reduction in GI symptoms and improvement of quality of life.
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Affiliation(s)
- Oliver Grundmann
- College of Pharmacy, Department of Medicinal Chemistry, University of Florida, FL, 32610, USA; College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, FL, 32610, USA.
| | - Saunjoo L Yoon
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, FL, 32610, USA
| | - Sydney Mason
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, FL, 32610, USA
| | - Keore Smith
- College of Nursing, Department of Biobehavioral Nursing Science, University of Florida, FL, 32610, USA
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Dore MP, Pes GM, Bibbò S, Tedde P, Bassotti G. Constipation in the elderly from Northern Sardinia is positively associated with depression, malnutrition and female gender. Scand J Gastroenterol 2018; 53:797-802. [PMID: 29779417 DOI: 10.1080/00365521.2018.1473485] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Constipation is a common complaint in older adults. The rise in life expectancy may amplify the problem and increase social expenditure. We investigated the major risk factors associated with constipation in a large sample of elderly. METHODS Outpatients from Northern Sardinia attending a Geriatric Unit between 2001 and 2014 were enrolled. Demographic and anthropometric data, income, education and self-reported bowel function were collected. The presence of constipation was adjusted for cognitive status, assessed by the Mini-Mental State Examination (MMSE) test; single and cumulative illness rating scale (CIRS); current or past symptomatic depression and anxiety measured by the Geriatric Depression Scale (GDS); nutritional status, evaluated using the Mini-Nutritional Assessment (MNA); type and number of different medications used. RESULTS 1328 elderly patients (mean age 77.7 ± 7.2 years) were enrolled. Constipation was present in 32.1%, more commonly in women (35.4% vs 28.3%) and increased with age. The multivariate analysis showed a significantly greater risk of constipation in patients with a risk of malnutrition (OR = 1.745, 95% CI: 1.043-2.022; p = .034), female gender (OR = 1.735, 95% CI: 1.068-2.820; p = .026) and depression (OR = 1.079, 95% CI: 1.022-1.140; p = .006). Other potential predisposing factors assessed such as MMSE, CIRS, body mass index, marital status, smoking habit, education, income and number of taken drugs did not show a statistically significant association. Aging was a risk for constipation also in patients free of medications. CONCLUSIONS Knowledge of risk factors associated with bowel alterations in elderly individuals may provide important clues for caregivers to prevent or reduce constipation.
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Affiliation(s)
- Maria Pina Dore
- a Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali , University of Sassari , Sassari , Italy
| | - Giovanni Mario Pes
- a Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali , University of Sassari , Sassari , Italy
| | - Stefano Bibbò
- a Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali , University of Sassari , Sassari , Italy
| | - Patrizia Tedde
- a Dipartimento di Scienze Mediche, Chirurgiche e Sperimentali , University of Sassari , Sassari , Italy
| | - Gabrio Bassotti
- b Dipartimento di Medicina , University of Perugia , Perugia , Italy
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Zhang F, Weng ZJ, Wu LY, Bao CH, Yang L, Zhao M, Wu HZ, Liu HR, Zhou CL. Etiology related irritable bowel syndrome animal models. Shijie Huaren Xiaohua Zazhi 2018; 26:1772-1777. [DOI: 10.11569/wcjd.v26.i30.1772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common chronic functional disease of the gastrointestinal tract. Its incidence is increasing worldwide. However, its etiology and pathogenesis are not clear yet, although some factors, such as visceral hypersensitivity, intestinal infection, mental state, gastrointestinal hormones, intestinal flora, and genetic factors, are widely accepted. Great progress has been made in the study of animal models related to the etiology and pathogenesis of IBS. This article summarizes the domestic and international etiology related animal models of IBS, in order to provide reference for choosing appropriate animal models in the basic research of IBS.
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Affiliation(s)
- Fang Zhang
- Department of Acupuncture and Immunity, Shanghai Institute of Acupuncture and Moxibustion, Shanghai 200030, China
| | - Zhi-Jun Weng
- Department of Acupuncture and Immunity, Shanghai Institute of Acupuncture and Moxibustion, Shanghai 200030, China
| | - Lu-Yi Wu
- Shanghai Qigong Research Institute, Shanghai 200030, China
| | - Chun-Hui Bao
- Department of Acupuncture and Immunity, Shanghai Institute of Acupuncture and Moxibustion, Shanghai 200030, China
| | - Ling Yang
- Department of Acupuncture and Immunity, Shanghai Institute of Acupuncture and Moxibustion, Shanghai 200030, China
| | - Min Zhao
- Department of Acupuncture and Immunity, Shanghai Institute of Acupuncture and Moxibustion, Shanghai 200030, China
| | - Huan-Zhen Wu
- Department of Acupuncture and Immunity, Shanghai Institute of Acupuncture and Moxibustion, Shanghai 200030, China
| | - Hui-Rong Liu
- Department of Acupuncture and Immunity, Shanghai Institute of Acupuncture and Moxibustion, Shanghai 200030, China
| | - Ci-Li Zhou
- Department of Acupuncture and Immunity, Shanghai Institute of Acupuncture and Moxibustion, Shanghai 200030, China
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Abstract
PURPOSE OF REVIEW The purpose of this article is to review the recent literature and discuss the new approaches to the diagnosis and treatment of functional dyspepsia (FD). RECENT FINDINGS According to the recent American College of Gastroenterology (ACG) and Canadian Association of Gastroenterology (CAG) guideline for dyspepsia, Helicobacter pylori (H. pylori) eradication is recommended as a first treatment option, and proton pump inhibitors (PPIs), tricyclic antidepressants, and prokinetics are listed as second-line therapy. On the other hand, in the Japanese guideline for FD, PPIs and prokinetics are recommended as the first-line treatment. In Japan, acotiamide, a recently launched prokinetic, showed significant efficacy in several clinical trials performed either in Japan or Europe. Regarding non-pharmacological treatment, recent topics include acupuncture, electrical stimulation, gastric peroral endoscopic myotomy, and meal and lifestyle modification. These treatments have provided significant efficacy, which provides some insights into the main pathophysiology of this disease. Although FD is common among functional gastrointestinal disorders, it is not easy to relieve the dyspeptic symptoms of FD patients. Combinations of pharmacological and non-pharmacological treatment options are expected.
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80
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Oshima T, Miwa H. Functional Dyspepsia - A Revolution in Management. Am J Gastroenterol 2018; 113:1420-1422. [PMID: 30181534 DOI: 10.1038/s41395-018-0264-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/15/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Tadayuki Oshima
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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81
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Lin MJ, Yu BP. Role of High-affinity Choline Transporter 1 in Colonic Hypermotility in a Rat Model of Irritable Bowel Syndrome. J Neurogastroenterol Motil 2018; 24:643-655. [PMID: 30347940 PMCID: PMC6175564 DOI: 10.5056/jnm18040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/13/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Irritable bowel syndrome (IBS) is a common disease characterized by intestinal dysmotility, the mechanism of which remains elusive. We aim to determine whether the high-affinity choline transporter 1 (CHT1), a determinant of cholinergic signaling capacity, modulates intestinal motility associated with stress-induced IBS. Methods A rat IBS model was established using chronic water avoidance stress (WAS). Colonic pathological alterations were evaluated histologically and intestinal motility was assessed by intestinal transit time and fecal water content (FWC). Visceral sensitivity was determined by visceromotor response to colorectal distension. RT-PCR, western blotting, and immunostaining were performed to identify colonic CHT1 expression. Contractility of colonic muscle strips was measured using isometric transducers. enzyme-linked immunosorbent assay was used to measure acetylcholine (ACh). We examined the effects of MKC-231, a choline uptake enhancer, on colonic motility. Results After 10 days of WAS, intestinal transit time was decreased and fecal water content increased. Visceromotor response magnitude in WAS rats in response to colorectal distension was significantly enhanced. Protein and mRNA CHT1 levels in the colon were markedly elevated after WAS. The density of CHT1-positive intramuscular interstitial cells of Cajal and myenteric plexus neurons in WAS rats was higher than in controls. Ammonium pyrrolidine dithiocarbamate partly reversed CHT1 upregulation and alleviated colonic hypermotility in WAS rats. Pharmacological enhancement of CHT1 activity by MKC-231 enhanced colonic motility in control rats via upregulation of CHT1 and elevation of ACh production. Conclusion Upregulation of CHT1 in intramuscular interstitial cells of Cajal and myenteric plexus neurons is implicated in chronic stress-induced colonic hypermotility by modulation of ACh synthesis via nuclear factor-kappa B signaling.
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Affiliation(s)
- Meng-Juan Lin
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, Hubei, China
| | - Bao-Ping Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.,Key Laboratory of Hubei Province for Digestive System Diseases, Wuhan, Hubei, China
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Hou Q, Huang Y, Zhang C, Zhu S, Li P, Chen X, Hou Z, Liu F. MicroRNA-200a Targets Cannabinoid Receptor 1 and Serotonin Transporter to Increase Visceral Hyperalgesia in Diarrhea-predominant Irritable Bowel Syndrome Rats. J Neurogastroenterol Motil 2018; 24:656-668. [PMID: 30347941 PMCID: PMC6175558 DOI: 10.5056/jnm18037] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/01/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022] Open
Abstract
Background/Aims MicroRNAs (miRNAs) were reported to be responsible for intestinal permeability in diarrhea-predominant irritable bowel syndrome (IBS-D) rats in our previous study. However, whether and how miRNAs regulate visceral hypersensitivity in IBS-D remains largely unknown. Methods We established the IBS-D rat model and evaluated it using the nociceptive visceral hypersensitivity test, myeloperoxidase activity assay, restraint stress-induced defecation, and electromyographic (EMG) activity. The distal colon was subjected to miRNA microarray analysis followed by isolation and culture of colonic epithelial cells (CECs). Bioinformatic analysis and further experiments, including dual luciferase assays, quantitative real-time polymerase chain reaction, western blot, and enzyme-linked immunosorbent assay, were used to detect the expression of miRNAs and how it regulates visceral hypersensitivity in IBS-D rats. Results The IBS-D rat model was successfully established. A total of 24 miRNAs were differentially expressed in the distal colon of IBS-D rats; 9 were upregulated and 15 were downregulated. Among them, the most significant upregulation was miR-200a, accompanied by downregulation of cannabinoid receptor 1 (CNR1) and serotonin transporter (SERT). MiR-200a mimic markedly inhibited the expression of CNR1/SERT. Bioinformatic analysis and luciferase assay confirmed that CNR1/SERT are direct targets of miR-200a. Rescue experiments that overexpressed CNR1/SERT significantly abolished the inhibitory effect of miR-200a on the IBS-D rats CECs. Conclusions This study suggests that miR-200a could induce visceral hyperalgesia by targeting the downregulation of CNR1 and SERT, aggravating or leading to the development and progression of IBS-D. MiR-200a may be a regulator of visceral hypersensitivity, which provides potential targets for the treatment of IBS-D.
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Affiliation(s)
- Qiuke Hou
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yongquan Huang
- Department of Orthopedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Changrong Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Shuilian Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Peiwu Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xinlin Chen
- Department of Preventive Medicine and Health Statistics, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhengkun Hou
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Fengbin Liu
- Department of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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QIANG L, JIANG Y. Electroacupuncture for functional dyspepsia and the influence on serum Ghrelin, CGRP and GLP-1 levels. WORLD JOURNAL OF ACUPUNCTURE-MOXIBUSTION 2018. [DOI: 10.1016/j.wjam.2018.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Acupuncture for Diarrhoea-Predominant Irritable Bowel Syndrome: A Network Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:2890465. [PMID: 29977312 PMCID: PMC5994265 DOI: 10.1155/2018/2890465] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/30/2018] [Indexed: 12/15/2022]
Abstract
Background The objective of this study was to compare the efficacy and side effects of acupuncture, sham acupuncture, and drugs in the treatment of diarrhoea-predominant irritable bowel syndrome. Methods Randomized controlled trials (RCTs) assessing the effects of acupuncture and drugs were comprehensively retrieved from electronic databases (such as PubMed, Cochrane Library, Embase, CNKI, Wanfang Database, VIP Database, and CBM) up to December 2017. Additional references were obtained from review articles. With document quality evaluations and data extraction, Network Meta-Analysis was performed using a random-effects model under a frequentist framework. Results A total of 29 studies (n = 9369) were included; 19 were high-quality studies, and 10 were low-quality studies. NMA showed the following: (1) the ranking of treatments in terms of efficacy in diarrhoea-predominant irritable bowel syndrome is acupuncture, sham acupuncture, pinaverium bromide, alosetron = eluxadoline, ramosetron, and rifaximin; (2) the ranking of treatments in terms of severity of side effects in diarrhoea-predominant irritable bowel syndrome is rifaximin, alosetron, ramosetron = pinaverium bromide, sham acupuncture, and acupuncture; and (3) the treatment of diarrhoea-predominant irritable bowel syndrome includes common acupoints such as ST25, ST36, ST37, SP6, GV20, and EX-HN3. Conclusion Acupuncture may improve diarrhoea-predominant irritable bowel syndrome better than drugs and has the fewest side effects. Sham acupuncture may have curative effect except for placebo effect. In the future, it is necessary to perform highly qualified research to prove this result. Pinaverium bromide also has good curative effects with fewer side effects than other drugs.
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Hantoro IF, Syam AF, Mudjaddid E, Setiati S, Abdullah M. Factors associated with health-related quality of life in patients with functional dyspepsia. Health Qual Life Outcomes 2018; 16:83. [PMID: 29720190 PMCID: PMC5930843 DOI: 10.1186/s12955-018-0913-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/25/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) assessment is important for patients with functional dyspepsia. However, no studies have assessed factors associated with HRQoL reduction in such patients in an Asian population. This study aimed to determine the contribution of clinical, psychosocial, and demographic factors to HRQoL in affected patients in Indonesia. METHODS In a cross-sectional study, we recruited 124 patients in a tertiary hospital with functional dyspepsia according to Rome III criteria. HRQoL was measured using the Medical Outcomes Study Short-Form 36 (SF-36) physical component summary (PCS) and mental component summary (MCS) and compared with 2009 United States population norms. The factors investigated were age, gender, symptom severity, education level, employment status, anxiety, depression, and ethnicity. Factors associated with reduced HRQoL were identified using linear regression analysis. RESULTS All domains of HRQoL except vitality were impaired in patients with functional dyspepsia. The mean PCS was 42.3 (SD = 8.4); and the mean MCS was 47.8 (SD = 10). Increasing age (p = 0.002), female gender (p = 0.006), low-to-mid education level (p = 0.015) and greater symptom severity (p < 0.001) were significantly associated with impaired PCS (R2 = 0.36). Female gender (p = 0.047), greater symptom severity (p = 0.002), anxiety (p = 0.001), and depression (p = 0.002 were all significantly associated with an impaired MCS (R2 = 0.41). There were no significant associations between HRQoL and with ethnic group (Javanese/non-Javanese) or employment status. CONCLUSIONS There was significant HRQoL impairment in these patients with functional dyspepsia in Indonesia. Anxiety, depression, increasing age, female gender, greater symptom severity, and low-to-mid education level were significant factors associated with low HRQoL. TRIAL REGISTRATION: ClinicalTrials.gov NCT03321383 . Registered 18 October 2017 retrospectively registered.
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Affiliation(s)
- Ibnu Fajariyadi Hantoro
- Departement of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430 Indonesia
| | - Ari Fahrial Syam
- Division of Gastroenterology, Departement of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430 Indonesia
| | - Endang Mudjaddid
- Division of Psychosomatic, Departement of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430 Indonesia
| | - Siti Setiati
- Clinical Epidemiology Unit, Departement of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430 Indonesia
| | - Murdani Abdullah
- Division of Gastroenterology, Departement of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430 Indonesia
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Hantoro IF, Syam AF, Mudjaddid E, Setiati S, Abdullah M. Factors associated with health-related quality of life in patients with functional dyspepsia. Health Qual Life Outcomes 2018; 16:83. [PMID: 29720190 PMCID: PMC5930843 DOI: 10.1186/s12955-018-0913-z;] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/25/2018] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) assessment is important for patients with functional dyspepsia. However, no studies have assessed factors associated with HRQoL reduction in such patients in an Asian population. This study aimed to determine the contribution of clinical, psychosocial, and demographic factors to HRQoL in affected patients in Indonesia. METHODS In a cross-sectional study, we recruited 124 patients in a tertiary hospital with functional dyspepsia according to Rome III criteria. HRQoL was measured using the Medical Outcomes Study Short-Form 36 (SF-36) physical component summary (PCS) and mental component summary (MCS) and compared with 2009 United States population norms. The factors investigated were age, gender, symptom severity, education level, employment status, anxiety, depression, and ethnicity. Factors associated with reduced HRQoL were identified using linear regression analysis. RESULTS All domains of HRQoL except vitality were impaired in patients with functional dyspepsia. The mean PCS was 42.3 (SD = 8.4); and the mean MCS was 47.8 (SD = 10). Increasing age (p = 0.002), female gender (p = 0.006), low-to-mid education level (p = 0.015) and greater symptom severity (p < 0.001) were significantly associated with impaired PCS (R2 = 0.36). Female gender (p = 0.047), greater symptom severity (p = 0.002), anxiety (p = 0.001), and depression (p = 0.002 were all significantly associated with an impaired MCS (R2 = 0.41). There were no significant associations between HRQoL and with ethnic group (Javanese/non-Javanese) or employment status. CONCLUSIONS There was significant HRQoL impairment in these patients with functional dyspepsia in Indonesia. Anxiety, depression, increasing age, female gender, greater symptom severity, and low-to-mid education level were significant factors associated with low HRQoL. TRIAL REGISTRATION: ClinicalTrials.gov NCT03321383 . Registered 18 October 2017 retrospectively registered.
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Affiliation(s)
- Ibnu Fajariyadi Hantoro
- Departement of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430 Indonesia
| | - Ari Fahrial Syam
- Division of Gastroenterology, Departement of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430 Indonesia
| | - Endang Mudjaddid
- Division of Psychosomatic, Departement of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430 Indonesia
| | - Siti Setiati
- Clinical Epidemiology Unit, Departement of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430 Indonesia
| | - Murdani Abdullah
- Division of Gastroenterology, Departement of Internal Medicine, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430 Indonesia
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Lapina TL, Trukhmanov AS. Herbal Preparation STW 5 for Functional Gastrointestinal Disorders: Clinical Experience in Everyday Practice. Dig Dis 2018; 35 Suppl 1:30-35. [PMID: 29421814 DOI: 10.1159/000485411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The most common functional gastrointestinal disorders (FGID) are functional dyspepsia (FD) and irritable bowel syndrome (IBS), with a prevalence in the general population of 15-20% (FD) and 10% (IBS), respectively. The complexity of pathophysiologic mechanisms and limitations in therapeutic options make the management of FD and IBS patients a challenge in routine clinical practice. SUMMARY Syndromes classified as FGID frequently overlap, and coexist with gastroesophageal reflux disease (GERD). Patients with overlapping symptoms are more likely to seek medical care. The challenge for routine clinical practice is to find the best approach for treatment of multiple symptoms. STW 5, a combination of 9 herbal extracts, was shown to have multi-target effects: it normalizes the disturbed gastrointestinal motility, alleviates hypersensitivity, inhibits inflammation, suppresses gastric hypersecretion, and modulates the microbiota. Controlled randomized studies proved STW 5 to be efficacious both in FD and IBS, with control over the full spectrum of upper and lower gastrointestinal symptoms. STW 5 reduced concomitant heartburn in FD patients. STW 5 was well tolerated in the examined populations, independent of concomitant diseases and concomitant medication. Key Messages: The clinical use of the herbal preparation STW 5 in FD and IBS is evidence-based. STW 5 is an example for the concept of multi-target therapy. It offers treatment opportunities in routine clinical practice with high prevalence of overlap of FGID and concomitant GERD. Considering that FD and IBS are typically chronic and recurrent conditions, the clinically observed good tolerability and safety of STW 5 is an advantage.
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Cheung CKY, Lan LL, Kyaw M, Mak ADP, Chan A, Chan Y, Wu JCY. Up-regulation of transient receptor potential vanilloid (TRPV) and down-regulation of brain-derived neurotrophic factor (BDNF) expression in patients with functional dyspepsia (FD). Neurogastroenterol Motil 2018; 30. [PMID: 28782273 DOI: 10.1111/nmo.13176] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/06/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The role of immune activation in Functional Dyspepsia (FD) patients without previous infection is unclear. We compare the gastric and circulating brain-derived neurotropic factor (BDNF), receptor potential vanilloid type (TRPV) families and various cytokines in FD patients. METHODS Consecutive adult FD patients (Rome III) with no recent history of gastroenteritis and asymptomatic healthy controls were recruited for upper endoscopy. Subjects with GERD and IBS as predominant symptoms, diabetes mellitus, current or previous Helicobacter pylori infection, psychiatric illness and recent use of NSAID or PPI were excluded. Corpus biopsies and serum samples were collected. KEY RESULTS Forty three [M:F=8:35, mean age: 35.0 (9.3)] FD patients were compared with 23 healthy controls [M:F=8:15, mean age: 36.6 (10.2)]. FD patients had postprandial distress syndrome (PDS) as predominant sub-type (PDS: 36, EPS: 2). There was no significant difference in the median inflammation score (FD:0 (0-1) vs Control:0 (0-1), P=.79). However, FD patients had significantly higher mRNA expression of TRPV1 (FD:0.014±0.007, Control:0.003±0.001, 4.6 fold, P=.02) and TRPV2 (FD:0.012±0.006, Control:0.003±0.001, 4 fold, P=.02) compared to controls. The serum (FD:258.0±12.3 ng ml-1 , Control:319.7±18.1 ng ml-1 , P<.01) and gastric BDNF mRNA (FD:0.06±0.008, Control:0.092±0.01, 0.65 fold, P=.02)levels significantly lower in FD patients. Secretion of cytokines (IL-4, IL-5, IL-6, IL-8, IL-10, G-CSF, TGF-β2, MCP-1)was also highly correlated with dyspeptic symptoms in patients with FD. CONCLUSIONS & INFERENCES Despite lacking gastric mucosal inflammation, up-regulation of TRPV1 and TRPV2, down-regulation of BDNF were observed in FD patients. These suggest that immune alteration may contribute to the pathogenesis of FD without any previous infection.
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Affiliation(s)
- C K Y Cheung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - L L Lan
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - M Kyaw
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - A D P Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - A Chan
- Department of Anatomical, Cellular and Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Y Chan
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
| | - J C Y Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China
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Mishima T, Fukae J, Fujioka S, Inoue K, Tsuboi Y. The Prevalence of Constipation and Irritable Bowel Syndrome in Parkinson's Disease Patients According to Rome III Diagnostic Criteria. JOURNAL OF PARKINSONS DISEASE 2018; 7:353-357. [PMID: 28157108 PMCID: PMC5438471 DOI: 10.3233/jpd-160982] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Gastrointestinal symptoms are one of the most common non-motor features of Parkinson’s disease (PD). Recently, a report from Taiwan revealed that irritable bowel syndrome (IBS) may be associated with an increased risk of developing PD; however, the prevalence of IBS in PD patients has not been fully evaluated. Rome III criteria are widely assessed with a questionnaire to determine functional gastrointestinal disorders. Objective: We assessed the prevalence of constipation and IBS in PD patients in our cohort using Rome III criteria. Methods: Between October 2014 and April 2015, 118 patients with PD were treated at Fukuoka University Hospital and were enrolled in this study. Rome III criteria were used to diagnose constipation and IBS. Results: Constipation and IBS were detected in 32 (27.1%) and 20 patients (17.0%), respectively. The most common symptom related to constipation was straining during defecation (77.1%). Among constipation symptoms, patients’ self-awareness of constipation was mostly related to straining during defecation (odds ratio 5.27, 95% confidence interval 1.475–18.811). The number of constipation symptoms was correlated with the severity of the Hoehn-Yahr Stage (p < 0.05) and total levodopa equivalent dose (p < 0.05). Conclusions: This is the first report to investigate the prevalence of IBS in PD patients with Rome III criteria. We found a higher prevalence of IBS compared with the general population. The prevalence of constipation based on Rome III criteria was much lower than that reported in previous studies. Further studies are warranted to evaluate gastrointestinal symptoms in PD patients using comparable questionnaires.
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Affiliation(s)
| | | | | | | | - Yoshio Tsuboi
- Correspondence to: Yoshio Tsuboi, MD., Department of Neurology, Fukuoka University, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan. Tel.: +81 92 801 1011/ Ext. 3525; Fax: +81 92 865 7900 (direct); E-mail:
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Avramidou M, Angst F, Angst J, Aeschlimann A, Rössler W, Schnyder U. Epidemiology of gastrointestinal symptoms in young and middle-aged Swiss adults: prevalences and comorbidities in a longitudinal population cohort over 28 years. BMC Gastroenterol 2018; 18:21. [PMID: 29374473 PMCID: PMC5787318 DOI: 10.1186/s12876-018-0749-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/18/2018] [Indexed: 12/12/2022] Open
Abstract
Background Although subacute and chronic gastrointestinal symptoms are very common in primary care, epidemiological date are sparse. The aim of the study was to examine and quantify the prevalence of subacute and chronic gastrointestinal symptoms and their associations with somatic and mental disorders in the general population. Methods Data were collected prospectively between 1981 (age m = 22, f = 23) and 2008 (age 49/50) from the Zurich Cohort Study (n = 292 men, 299 women), a representative general population survey. The participants were assessed using a semi-structured interview, the “Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology” (SPIKE). Prevalence rates were computed to be representative of the general population aged 22–50. Associations were quantified by odds ratios (ORs) and their 99% confidence intervals (CI). Results The prevalences of intestinal and of gastric symptoms were significantly higher among women in all categories examined. For example, any gastric symptoms: f. 26.4% vs m.15.2%; any intestinal symptoms: 27.6% vs 14.6%; nausea/vomitus: 19.1% vs 4.5%; constipation: 15.8% vs 6.5% (all p < 0.001). Strong associations (all p < 0.0001) were found between fatigue (1 month) and chronic stomach (OR = 9.96, 99%-CI: 5.53–17.94) and chronic intestinal symptoms (OR = 9.02, 99%-CI: 4.92–16.54). Panic attacks were associated with subacute intestinal symptoms (OR = 4.00, 99%-CI: 2.43–6.59). Anxiety was more strongly associated with subacute intestinal symptoms (OR = 3.37, 99%-CI: 2.23–5.08) than with subacute stomach symptoms (OR = 1.85, 1.20–2.86). Bipolar disorders were associated with subacute stomach symptoms (OR = 1.83, 1.18–2.17) and unipolar depression with subacute intestinal symptoms (OR = 2.05, 1.34–3.15). Conclusions Remarkably high prevalence rates of gastric and intestinal complaints were observed in women (over 1/4; men 1/7). Fatigue/neurasthenia was the strongest co-factor in both conditions. Various syndromes related to anxiety, phobia, and panic disorders showed further significant associations. The integration of psychiatric and/or psychological treatment could help address the functional part of gastric and intestinal syndromes.
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Affiliation(s)
- Maria Avramidou
- Research Department, Rehabilitation Clinic ("RehaClinic"), Quellenstrasse 34, 5330, Bad Zurzach, Switzerland.
| | - Felix Angst
- Research Department, Rehabilitation Clinic ("RehaClinic"), Quellenstrasse 34, 5330, Bad Zurzach, Switzerland
| | - Jules Angst
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - André Aeschlimann
- Research Department, Rehabilitation Clinic ("RehaClinic"), Quellenstrasse 34, 5330, Bad Zurzach, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of São Paulo, São Paulo, Brazil.,Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Ulrich Schnyder
- Department of Psychiatry und Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Kawachi K, Sakata Y, Hara M, Takeshita E, Kawakubo H, Yamaguchi D, Okamoto N, Shimoda R, Iwakiri R, Tsuruoka N, Kusano M, Fujimoto K. Higher frequency of upper gastrointestinal symptoms in healthy young Japanese females compared to males and older generations. Esophagus 2018; 15:83-87. [PMID: 29892932 PMCID: PMC5884897 DOI: 10.1007/s10388-017-0598-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/11/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the differences in upper gastrointestinal symptoms between generations and genders in relatively healthy Japanese subjects. METHODS Altogether, 4086 healthy Japanese male and female (M/F) adults (M/F: 2244/1842) were analyzed. Among them, 3505 subjects (M/F: 1922/1583) were underwent a routine medical checkup at one of five hospitals in Saga, Japan from January 2013 to December 2013. The others were 581 (M/F: 322/259) healthy young volunteers at the Saga Medical School from April 2007 to March 2013. The participants were asked to complete the frequency scale for the symptoms of gastroesophageal reflex disease (FSSG) questionnaire, undergo upper gastrointestinal endoscopy, and submit to a rapid urease test to diagnose Helicobacter pylori infection. Among the 4086 subjects, the 2414 who had no H. pylori infection and no positive endoscopic findings were enrolled in the study. RESULTS Subjects' average age was 46.9 ± 12.2 years, with males' and females' ages being almost equivalent. The total FSSG score were high in females compared to males (P < 0.01) and decreased significantly with aging (P < 0.05). Among the generations, FSSG scores were the highest for those 20-29 years old, and they were significantly decreased with ageing in both males and females (P < 0.05). CONCLUSION The FSSG score was significantly higher in healthy Japanese females than in males, and the scores decreased with aging.
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Affiliation(s)
- Kojiro Kawachi
- Departments of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Yasuhisa Sakata
- Departments of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Megumi Hara
- Departments of Preventive Medicine, Saga Medical School, Saga, Japan
| | - Eri Takeshita
- Departments of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Hiroharu Kawakubo
- Departments of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Daisuke Yamaguchi
- Departments of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Norihiro Okamoto
- Departments of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Ryo Shimoda
- Departments of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Ryuichi Iwakiri
- Departments of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Nanae Tsuruoka
- Departments of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Motoyasu Kusano
- Department of Endoscopy and Endoscopic Surgery, Gunma University Hospital, Gunma, Japan
| | - Kazuma Fujimoto
- Departments of Internal Medicine, Saga Medical School, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
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Vicari E, Salemi M, Sidoti G, Malaguarnera M, Castiglione R. Symptom Severity Following Rifaximin and the Probiotic VSL#3 in Patients with Chronic Pelvic Pain Syndrome (Due to Inflammatory Prostatitis) Plus Irritable Bowel Syndrome. Nutrients 2017; 9:nu9111208. [PMID: 29099760 PMCID: PMC5707680 DOI: 10.3390/nu9111208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/29/2017] [Accepted: 10/30/2017] [Indexed: 12/13/2022] Open
Abstract
This study investigated the effects of long-term treatment with rifaximin and the probiotic VSL#3 on uro-genital and gastrointestinal symptoms in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) plus diarrhoea-predominant irritable bowel syndrome (D-IBS) compared with patients with D-IBS alone. Eighty-five patients with CP/CPPS (45 with subtype IIIa and 40 with IIIb) plus D-IBS according to the Rome III criteria and an aged-matched control-group of patients with D-IBS alone (n = 75) received rifaximin and VSL#3. The primary endpoints were the response rates of IBS and CP/CPPS symptoms, assessed respectively through Irritable Bowel Syndrome Severity Scoring System (IBS-SSS) and The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and performed at the start of therapy (V0) and three months after (V3). In IIIa prostatitis patients, the total NIH-CPSI scores significantly (p < 0.05) decreased from a baseline mean value of 21.2 to 14.5 at V3 , as did all subscales, and in the IIIb the total NIH-CPSI score also significantly decreased (from 17.4 to 15.1). Patients with IBS alone showed no significant differences in NIH-CPSI score. At V3, significantly greater improvement in the IBS-SSS and responder rate were found in IIIa patients. Our results were explained through a better individual response at V3 in IIIa prostatitis of urinary and gastrointestinal symptoms, while mean leukocyte counts on expressed prostate secretion (EPS) after prostate massage significantly lowered only in IIIa cases.
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Affiliation(s)
- Enzo Vicari
- Section of Endocrinology, Andrology and Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
| | - Michele Salemi
- IRCCS Oasi Institute for Research on Mental Retardation and Brain Aging, Via Conte Ruggiero 73, 94018 Troina, Italy.
| | - Giuseppe Sidoti
- UOSD Medicina Interna Ambulatorio Andrologia & Endocrinologia ARNAS-Garibaldi, 95123 Catania, Italy.
| | - Mariano Malaguarnera
- Research Center "The Great Senescence", University of Catania, 95100 Catania, Italy.
| | - Roberto Castiglione
- Section of Endocrinology, Andrology and Internal Medicine, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
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Lee HS, Lee KJ. Alterations of Food-specific Serum IgG4 Titers to Common Food Antigens in Patients With Irritable Bowel Syndrome. J Neurogastroenterol Motil 2017; 23:578-584. [PMID: 28992678 PMCID: PMC5628991 DOI: 10.5056/jnm17054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/26/2017] [Accepted: 07/23/2017] [Indexed: 12/13/2022] Open
Abstract
Background/Aims The role of dietary factors in the pathogenesis of irritable bowel syndrome (IBS) is still unclear. The aim of this study was to compare IgG4 levels to common food antigens between patients with IBS and healthy controls. Methods Thirty-two patients diagnosed as IBS according to the Rome III criteria (12 diarrhea subgroup; 20 non-diarrhea subgroup) and 32 sex and age-matched healthy controls participated in the study. Serum IgG4 titers to 90 common foods were measured in each subject. The number of subjects with positivity defined as the cut-off value ≥ 0.7 U/mL was compared. Results Patients with IBS had significantly higher IgG4 titers to wheat, leek and taro compared to those of controls. Serum IgG4 titers to ginger, cocoa, walnut, white radish, onion, and lettuce in IBS patients tended to be higher than controls. IgG4 titers to wheat, gluten and gliadin in the diarrhea subgroup, and lettuce, leek and taro in the non-diarrhea subgroup tended to be higher compared with controls. The number of subjects with positivity to apple, orange, lettuce, and leek was significantly higher in IBS patients than controls. The number of subjects with positivity to apple, orange, gluten, and gliadin in the diarrhea subgroup, and egg white, pineapple, soybean, lettuce, and leek in the non-diarrhea subgroup was significantly higher compared with controls. Conclusions Serum IgG4 antibody levels to some common foods are abnormally elevated in IBS patients. The type of foods with abnormally elevated serum IgG4 titers in the diarrhea subgroup may be different from that in the non-diarrhea subgroup.
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Affiliation(s)
- Hong Sub Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea.,Department of Gastroenterology, Myongji Hospital, Goyang, Korea
| | - Kwang Jae Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
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94
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Kawoos Y, Wani ZA, Kadla SA, Shah IA, Hussain A, Dar MM, Margoob MA, Sideeq K. Psychiatric Co-morbidity in Patients With Irritable Bowel Syndrome at a Tertiary Care Center in Northern India. J Neurogastroenterol Motil 2017; 23:555-560. [PMID: 28738451 PMCID: PMC5628988 DOI: 10.5056/jnm16166] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 03/21/2017] [Accepted: 04/02/2017] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Irritable bowel syndrome (IBS) is a chronic psycho-physiological disorder. It is considered to be the most common functional gastrointestinal disorder, and about 50–90% of IBS patients have associated psychiatric co-morbidity. We aimed to study psychiatric co-morbidities in patients with IBS visiting a tertiary care center. Methods This was a cross-sectional case-control study conducted over a duration of one and a half years from January 2014 to July 2015. Patients were selected from the out-patient department of gastroenterology. About 160 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. The healthy attendants of cases were selected as controls. A total of 200 controls were selected. Rome-III criteria were used to diagnose IBS. For diagnosing psychiatric disorders, we used the Mini International Neuropsychiatric Interview Schedule Plus. Results Mean age of our cases and controls was 39.7 ± 11.4 and 37.7 ± 9.6 years, respectively. Females outnumbered males in our cases as well as their controls by a ratio of 2:1 approximately. Psychiatric disorders were seen in 84.4% of IBS patients as compared to 41.5% in controls. Major psychiatric disorders seen in our patients were generalized anxiety disorders (30.0%) and depression (28.0%). Conclusions The majority of patients with IBS who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.
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Affiliation(s)
- Yuman Kawoos
- Department of Psychiatry, Government Medical College Srinagar, Srinagar, Jammu and Kashimir, India
| | - Zaid A Wani
- Department of Psychiatry, Government Medical College Srinagar, Srinagar, Jammu and Kashimir, India
| | - Showkat A Kadla
- Department of Gastroenterology, Government Medical College Srinagar, Srinagar, Jammu and Kashimir, India
| | - Irfan A Shah
- Department of Neurology, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Arshad Hussain
- Department of Psychiatry, Government Medical College Srinagar, Srinagar, Jammu and Kashimir, India
| | - M Maqbool Dar
- Department of Psychiatry, Government Medical College Srinagar, Srinagar, Jammu and Kashimir, India
| | - Mushtaq A Margoob
- Department of Psychiatry, Government Medical College Srinagar, Srinagar, Jammu and Kashimir, India
| | - Kouser Sideeq
- Department of Preventive and Social Medicine, Government Medical College Srinagar, Srinagar, Jammu and Kashimir, India
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95
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Kawanishi K, Shojima K, Nishimoto M, Abe H, Kakimoto T, Yasuda Y, Hara T, Kato J. Superior Mesenteric Artery Syndrome May Be Overlooked in Women with Functional Dyspepsia. Intern Med 2017; 56:2549-2554. [PMID: 28883239 PMCID: PMC5658518 DOI: 10.2169/internalmedicine.8647-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective Superior mesenteric artery (SMA) syndrome is characterized by the compression of the third segment of the duodenum between the SMA and aorta, resulting in duodenal obstruction. Because the symptoms of the syndrome are similar to those of functional dyspepsia (FD), this study aimed to examine whether or not patients with SMA syndrome were present among those diagnosed with FD. Methods Patients with an FD diagnosis underwent measurement of the angle and distance between the SMA and aorta by ultrasonography or computed tomography. Patients with an angle of ≤22° or with a distance of ≤8 mm between the SMA and aorta were diagnosed with SMA syndrome. Bacterial culture of the duodenal aspirate was also performed. Results Of the 46 FD patients, 5 (11%) met the criteria. All 5 were women with a body mass index significantly lower than the remaining 41 patients (18.7 vs. 24.0 kg/m2, p=0.003). In addition, all 5 patients had 105/mL or more bacteria in the duodenum. The symptoms of these five patients were treated through dietary and postprandial posture counselling with or without medication. Conclusion Patients with SMA syndrome were observed among underweight women diagnosed with FD. Their symptoms may be associated with bacterial overgrowth.
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Affiliation(s)
- Koki Kawanishi
- Department of Gastroenterology, Wakayama Rosai Hospital, Japan
| | - Kensaku Shojima
- Department of General Internal Medicine, Hashimoto Municipal Hospital, Japan
| | | | - Hiroko Abe
- Department of Gastroenterology, Wakayama Rosai Hospital, Japan
| | | | - Yuko Yasuda
- Department of Gastroenterology, Wakayama Rosai Hospital, Japan
| | - Takeshi Hara
- Department of Gastroenterology, Wakayama Rosai Hospital, Japan
| | - Jun Kato
- Second Department of Internal Medicine, Wakayama Medical University, Japan
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96
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Choi YJ, Kim N, Yoon H, Shin CM, Park YS, Kim JW, Kim YS, Lee DH, Jung HC. Overlap between irritable bowel syndrome and functional dyspepsia including subtype analyses. J Gastroenterol Hepatol 2017; 32:1553-1561. [PMID: 28160607 DOI: 10.1111/jgh.13756] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/16/2016] [Accepted: 01/23/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Coexistent gastrointestinal symptom profiles and prevalence or associated factors for the overlap between each functional dyspepsia (FD) and irritable bowel syndrome (IBS) group remain unclear. Thus, the aim of the present study was to evaluate the clinicodemographic features of FD, IBS, and IBS-FD overlap and assess the risk factors thereof, including subtype and genetic polymorphisms for IBS-FD. METHODS Consecutive patients were enrolled from the outpatient Gastroenterology clinics of Bundang Seoul National University Hospitals in Korea. All gastrointestinal symptoms occurring at least once per week in the previous 3 months were recorded. Diagnostic criteria of functional gastrointestinal disorders were based on the Rome III criteria. Risk factors including genetic polymorphisms of 5-HTTLPR and ADRA2A 1291 G alleles and CCK-1R intron 779T>C were assessed using a multivariate logistic regression model. RESULTS A total of 632 subjects (278 control subjects, 308 FD, 156 IBS, and 110 who met the criteria for both FD and IBS) were included in this study. Patients with IBS-FD overlap had more severe symptoms (such as bloating, nausea, vomiting, hard or lumpy stools, defecation straining, and a feeling of incomplete bowel movement) and higher depression scores compared with non-overlap patients. Single/divorced or widowed marital status, nausea, bloating, and a feeling of incomplete emptying after bowel movements were independent risk factors for IBS-FD overlap among IBS patients. In contrast, young age, depression, bloating, and postprandial distress syndrome were positively associated with IBS-FD overlap among FD patients. 5-HTTLPR L/L was a risk factor for the co-occurrence of IBS-C among FD patients (OR: 12.47; 95% CI: 2.00-77.75; P = 0.007). CONCLUSIONS Bloating was a risk factor for IBS-FD overlap. Patients with postprandial distress syndrome have a higher risk of coexisting IBS, particularly constipation-dominant IBS.
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Affiliation(s)
- Yoon Jin Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Yong Sung Kim
- Department of Gastroenterology, Wonkwang Digestive Disease Research Institute, Wonkwang University Sanbon Hospital, Gunpo, South Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, South Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Chae Jung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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97
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Xu JH, Lai Y, Zhuang LP, Huang CZ, Li CQ, Chen QK, Yu T. Certain Dietary Habits Contribute to the Functional Dyspepsia in South China Rural Area. Med Sci Monit 2017; 23:3942-3951. [PMID: 28809820 PMCID: PMC5567766 DOI: 10.12659/msm.902705] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Functional dyspepsia (FD) refers to a group of upper gastrointestinal syndromes, subdivided into two types: postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). The etiology of FD remains unclear; however, unhealthy dietary habit is one potential underlying cause. We aim to explore the association of poor dietary habits with FD and its subtypes. MATERIAL AND METHODS A validated epidemiological questionnaire was designed to investigate dietary habits and gastrointestinal syndromes. Citizens in the Baotun community of Dongguan were invited to complete the study questionnaire. All participants were asked to undergo a physical examination and a blinded physician interview. The study was conducted from June 2015 to June 2016. FD was diagnosed using ROME III criteria. The association between investigated dietary habits and dyspeptic symptoms were explored. RESULTS There were 1,304 adult residents recruited for the study survey; 165 residents had existing organic dyspepsia (OD), 203 residents were diagnosed with FD, and the other 936 participants, who were without dyspeptic symptoms or functional gastrointestinal diseases, were regarded as the control group. Subtype diagnosis indicated 61 participants had EPS, 66 participants had PDS, and 76 participants had coexisting EPS and PDS. Unhealthy dietary habits were more prevalent in the FD group than in the control groups (75.86% versus 37.50%; p<0.001). FD was found to be associated with irregular mealtime, dining out, fatty food, sweet food, and coffee (p<0.05). The impact of each dietary factor varied with FD subtypes. CONCLUSIONS Certain types of dietary habits were positively correlated with the prevalence of FD. FD subtypes showed relatively different associations with dietary factors.
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Affiliation(s)
- Ji-Hao Xu
- Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Yu Lai
- Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Li-Ping Zhuang
- Department of Internal Medicine, Baotun Community Health Station, Houjie Township, Dongguan, Guangdong, P.R. China
| | - Can-Ze Huang
- Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Chu-Qiang Li
- Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Qi-Kui Chen
- Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
- Corresponding Authors: Tao Yu, e-mail: ; Qikui Chen, e-mail:
| | - Tao Yu
- Department of Gastroenterology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
- Corresponding Authors: Tao Yu, e-mail: ; Qikui Chen, e-mail:
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98
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Stasi C, Bellini M, Gambaccini D, Duranti E, de Bortoli N, Fani B, Albano E, Russo S, Sudano I, Laffi G, Taddei S, Marchi S, Bruno RM. Neuroendocrine Dysregulation in Irritable Bowel Syndrome Patients: A Pilot Study. J Neurogastroenterol Motil 2017; 23:428-434. [PMID: 28460516 PMCID: PMC5503293 DOI: 10.5056/jnm16155] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/07/2017] [Accepted: 02/16/2017] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Irritable bowel syndrome (IBS) is a multifactorial disorder, involving dysregulation of brain-gut axis. Our aim was to evaluate the neuroendocrine activity in IBS. Methods Thirty IBS and 30 healthy volunteers were enrolled. Psychological symptoms were evaluated by questionnaires. Urinary 5-hydroxyindoleacetic acid, plasma serotonin (5-hydroxytryptamine, 5-HT), endothelin, and neuropeptide Y (NPY), and plasma and urinary cortisol levels were evaluated. Fourteen IBS subjects underwent microneurography to obtain multiunit recordings of efferent postganglionic muscle sympathetic nerve activity (MSNA). Results Prevalent psychological symptoms in IBS were maladjustment (60%), trait (40%) and state (17%) anxiety, obsessive compulsive-disorders (23%), and depressive symptoms (23%). IBS showed increased NPY (31.9 [43.7] vs 14.8 [18.1] pmol/L, P = 0.006), 5-HT (214.9 [182.6] vs 141.0 [45.5] pg/mL, P = 0.010), and endothelin [1.1 [1.4] vs 2.1 [8.1] pg/mL, P = 0.054], compared to healthy volunteers. Moreover, plasma NPY, endothelin, cortisol and 5-HT, and urinary 5-hydroxyindoleacetic acid were associated with some psychological disorders (P ≤ 0.05). Despite a similar resting MSNA, after cold pressor test, IBS showed a blunted increase in MSNA burst frequency (+4.1 vs +7.8 bursts/min, P = 0.048; +30.1% vs +78.1%, P = 0.023). Baseline MSNA tended to be associated with urinary cortisol (ρ = 0.557, P = 0.059). Moreover, changes in heart rate after mental stress were associated with urinary cortisol (ρ = 0.682, P = 0.021) and changes in MSNA after mental stress were associated with plasma cortisol (ρ = 0.671, P = 0.024).” Conclusion Higher concentrations of endothelin, NPY, and 5-HT were found to be associated with some psychological disorders in IBS patients together with an altered cardiovascular autonomic reactivity to acute stressors compared to healthy volunteers.
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Affiliation(s)
- Cristina Stasi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Massimo Bellini
- Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Dario Gambaccini
- Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Emiliano Duranti
- Gastrointestinal Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nicola de Bortoli
- Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Bernardo Fani
- Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Eleonora Albano
- Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Salvatore Russo
- Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Isabella Sudano
- Cardiovascular Center, University Hospital, Zürich, Switzerland
| | - Giacomo Laffi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Taddei
- Gastrointestinal Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Santino Marchi
- Gastrointestinal Unit, Department of Gastroenterology, University of Pisa, Pisa, Italy
| | - Rosa Maria Bruno
- Gastrointestinal Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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99
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Toghiani A, Maleki I, Afshar H, Kazemian A. Translation and validation of the Farsi version of Rome III diagnostic questionnaire for the adult functional gastrointestinal disorders. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 21:103. [PMID: 28250780 PMCID: PMC5322693 DOI: 10.4103/1735-1995.193175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/01/2016] [Accepted: 08/03/2016] [Indexed: 12/15/2022]
Abstract
Background: The aim of this study was to validate the Farsi version of Rome III modular questionnaire which contains all functional gastrointestinal disorders (FGIDs). Materials and Methods: We used Rome foundation guidelines for translation of English version into Farsi, and all the steps were performed. In the first step, 2 forward translations into Farsi were completed by two authors separately, and then translators, who participated in Step 1, together with our monitor, compared the two target-language versions and made some changes. The product of Phase 2 was translated back into English by an American-Iranian physician. The final step was comparison of the two English versions and validation of the translation. In this step, we compared the final version item by item, and also we used focus groups of patients after pretesting. Results: Our results showed that FGIDs questionnaire diagnosed 153 patients among 169 patients who were diagnosed to have different types of FGIDs. The sensitivity of this questionnaire was 90.5%. It was determined that the odd questions' values of Cronbach’s alpha was 0.77 (very reliable), and it was 0.71 (very reliable) in other sections. The split-half test reliability of whole items value was 0.72, which is statistically significant. Conclusion: Our findings showed that the Farsi version of Rome III diagnostic questionnaire for the adult functional gastrointestinal disorders demonstrated good validity and reliability and could be used in clinical studies.
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Affiliation(s)
| | - Iradj Maleki
- Department of Internal Medicine, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
| | - Hamid Afshar
- Psychosomatic Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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100
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He YQ, Lang XQ, Lin L, Ji L, Yuan XY, Chen Q, Ran YM, Chen HS, Li L, Wang JM, Wang ZG, Gregersen H, Zou DW, Liang HP, Yang M. P2X3 receptor-mediated visceral hyperalgesia and neuronal sensitization following exposure to PTSD-like stress in the dorsal root ganglia of rats. Neurogastroenterol Motil 2017; 29. [PMID: 27781340 DOI: 10.1111/nmo.12976] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 09/22/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with posttraumatic stress disorder (PTSD) often share co-morbidity with chronic pain conditions. Recent studies suggest a role of P2X3 receptors and ATP signaling in pain conditions. However, the underlying mechanisms of visceral hyperalgesia following exposure to PTSD-like stress conditions remain unclarified. METHODS The behavior and hormones relevant for PTSD were studied. Visceromotor responses (VMR) and the abdominal withdrawal reflexes (AWR) to colorectal distention (CRD) were recorded to determine P2X3-receptor-mediated alteration of hyperalgesia following single-prolonged stress (SPS) exposure. Immunofluorescence, Western blotting, and patch-clamp were used. KEY RESULTS The escape latency, adrenocorticotropic hormone and cortisol were increased on days 7-14. Visceromotor responses and AWR was reduced at day 1 in SPS rats but increased to higher levels than in controls after exposure to day 7. Intrathecal administration of the P2X3-receptor antagonist TNP-ATP abolished the CRD response. Based on immunofluorescence and Western blotting analysis, SPS-treated rats exhibited reduced P2X3 expression in dorsal root ganglia (DRG) after day 1 compared with controls. P2X3 expression in DRG was enhanced on day 7 after SPS and the increase of the P2X3 expression was maintained on day 14 and 21 compared with controls. The P2X3-receptor agonist α,β-me ATP (10 μM) induced a fast desensitizing inward current in DRG neurons of both control and SPS-treated rats. The average peak current densities in SPS-treated group were increased 3.6-fold. TNP-ATP (100 nM) markedly blocked all fast α,β-me ATP-induced inward currents in the DRG neurons both in control and SPS-treated rats. CONCLUSIONS & INFERENCES The data indicate an important role of P2X3 signaling in visceral hyperalgesia following PTSD-like stress.
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Affiliation(s)
- Y-Q He
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - X-Q Lang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - L Lin
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - L Ji
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - X-Y Yuan
- Department of Gastroenterology, The Ninth People's Hospital of Chongqing, Chongqing, China
| | - Q Chen
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Y-M Ran
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - H-S Chen
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing, China
| | - L Li
- Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
| | - J-M Wang
- Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Z-G Wang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China.,Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
| | - H Gregersen
- GIOME and the Key Laboratory for Biorheological Science and Technology of Ministry of Education, Bioengineering College of Chongqing University, Chongqing, China
| | - D-W Zou
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - H-P Liang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China.,Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
| | - M Yang
- State Key Laboratory of Trauma, Burns and Combined Injury, Department of Gastroenterology, Daping Hospital, Third Military Medical University, Chongqing, China.,Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, China
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