Gender, age, society, culture, and the patient's perspective in the functional gastrointestinal disorders

The relationship between gastrointestinal symptoms in FGID patients and D-type personality and emotion regulation strategies

This study examines the relationship between gastrointestinal symptoms in patients with functional gastrointestinal disorders (FGIDs) and type D personality traits, as well as emotion regulation strategies. Analyzing a diverse group of FGID patients, we uncover significant effects of gender and age on gastrointestinal symptoms. Negative Affectivity emerges as a key predictor, positively associated with symptom severity, whereas Social Inhibition correlates negatively with Abdominal Pain. Additionally, our findings suggest that the expressive suppression strategy predicts heightened gastrointestinal symptoms, whereas cognitive reappraisal predicts lower levels of certain symptoms. These findings provide valuable insights for precise diagnosis and tailored treatments of FGIDs. Further research is warranted to explore underlying mechanisms and inform evidence-based interventions.

Sex difference in the associations among risk factors with gastroesophageal reflux disease in a large Taiwanese population study

BACKGROUND

Gastroesophageal reflux disease (GERD) is a common global health issue. Previous studies have revealed a higher prevalence of GERD in females than in males, however few studies have investigated sex differences in the risk factors associated with GERD. Therefore, the aim of this population-based study was to examine sex differences in the risk factors for GERD in a large cohort of over 120,000 Taiwanese participants.

METHODS

We enrolled 121,583 participants (male: 43,698; female: 77,885; mean age 49.9 ± 11.0 years) from the Taiwan Biobank. The presence of GERD was ascertained using self-reported questionnaires. Sex differences in the risk factors associated with GERD were examined using multivariable logistic regression analysis.

RESULTS

The overall prevalence of GERD was 13.7%, including 13.0% in the male participants and 14.1% in the female participants (p < 0.001). Multivariable analysis showed that older age, hypertension, smoking history, alcohol history, low fasting glucose, and low uric acid were significantly associated with GERD in the male participants. In the female participants, older age, diabetes, hypertension, smoking history, alcohol history, low systolic blood pressure, low fasting glucose, high hemoglobin, high total cholesterol, low high-density lipoprotein cholesterol (HDL-C), low low-density lipoprotein cholesterol, and low uric acid were significantly associated with GERD. Significant interactions were found between sex and age (p < 0.001), diabetes (p < 0.001), smoking history (p < 0.001), fasting glucose (p = 0.002), triglycerides (p = 0.001), HDL-C (p = 0.001), and estimated glomerular filtration rate (p = 0.002) on GERD.

CONCLUSIONS

Our results showed a higher prevalence of GERD among females compared to males. Furthermore, sex differences were identified in the risk factors associated with GERD, and older age, diabetes, smoking history, and low HDL-C were more closely related to GERD in females than in males.

Psychosocial quality-of-life correlates in functional gastrointestinal disorders

INTRODUCTION AND AIM

Functional gastrointestinal disorders (FGIDs) are complex illnesses characterized by gastrointestinal symptoms, with no underlying organic pathology. They are common, chronic, recurrent, and disabling disorders that significantly impair quality of life (QoL). The aim of the present cross-sectional analytical study was to assess QoL and its correlates in adult patients with FGIDs.

MATERIALS AND METHODS

A cross-sectional, observational, hospital-based study was conducted at the gastroenterology outpatient department of a tertiary care teaching hospital. The ROME IV diagnostic criteria were used to identify the FGIDs. Anxiety, depression, coping strategies, social support, and QoL were assessed by the hospital anxiety and depression scale, the coping strategies inventory, the multidimensional scale of perceived social support, and the functional digestive disorders quality-of-life questionnaire, respectively.

RESULTS

Of the 52 consecutive patients diagnosed with FGIDs, functional dyspepsia (51.92%) and irritable bowel syndrome (40.38%) were the most common. There were no significant associations between sociodemographic variables (age, sex, marital status, socioeconomic status, educational level, employment, occupation, dietary pattern) and QoL scores (all p values >0.05). Duration and social support were not significantly associated with QoL (all p values >0.05). In contrast, psychological variables, such as disengagement coping (r=-0.344, p=0.012), depression (r=-0.600, p=0.000), and anxiety (r=-0.590, p=0.000), were significantly correlated with QoL.

CONCLUSIONS

Despite advances in neurogastroenterology, patients continue to be disabled by FGIDs. Psychological factors, especially depression, significantly contribute to poor QoL in those patients and should be addressed in a holistic, multidisciplinary way. The biopsychosocial framework, as it applies to FGIDs, should lead to the inclusion of psychosocial assessments in the clinical management and research of those disorders.

Cognitive behavioural therapy-based interventions for gastroduodenal disorders of gut-brain interaction: A systematic review

OBJECTIVE

Cognitive behavioural therapy (CBT) is increasingly used to manage Disorders of Gut-Brain Interaction (DGBIs). This systematic review aimed to review the evidence for the effectiveness of CBT-based interventions for patients with gastroduodenal DGBIs.

METHODS

Medline, Embase, PubMed, Cochrane Central, and Scopus were searched in July 2022. Studies were included if they investigated the effects of a CBT-based intervention on gastrointestinal symptoms and/or psychological outcomes pre- and post-intervention in patients with gastroduodenal DGBIs. Case studies, studies not in English, and studies with patients under 18 years were excluded. Results were synthesised narratively, and standardised effect sizes were calculated where possible.

RESULTS

Nine studies (seven RCTs and two pre/post studies) were identified, with data reported in 10 articles (total N = 602). The studies investigated patients with functional dyspepsia (n = 7), rumination syndrome (n = 1), and supragastric belching (n = 1). The studies had heterogeneous interventions, methodologies, and outcomes, precluding meta-analysis, as well as a moderate-high risk of bias and high drop-outs rates. Findings demonstrated decreased gastrointestinal symptoms and improved anxiety, depression, and quality of life, from pre- to post-intervention, with medium to large effect sizes for symptoms and small to large effect sizes for psychological outcomes. Efficacy was maintained at follow-up, up to one year later.

CONCLUSIONS

This review suggests promising evidence that CBT effectively improves gastrointestinal symptoms and psychological outcomes in patients with gastroduodenal DGBIs. However, heterogeneity, risk of bias, and lack of statistical reporting were noted, indicating the need for more robust research and standardisation.

Automated anomalous child repetitive head movement identification through transformer networks

The increasing prevalence of behavioral disorders in children is of growing concern within the medical community. Recognising the significance of early identification and intervention for atypical behaviors, there is a consensus on their pivotal role in improving outcomes. Due to inadequate facilities and a shortage of medical professionals with specialized expertise, traditional diagnostic methods have been unable to effectively address the rising incidence of behavioral disorders. Hence, there is a need to develop automated approaches for the diagnosis of behavioral disorders in children, to overcome the challenges with traditional methods. The purpose of this study is to develop an automated model capable of analyzing videos to differentiate between typical and atypical repetitive head movements in. To address problems resulting from the limited availability of child datasets, various learning methods are employed to mitigate these issues. In this work, we present a fusion of transformer networks, and Non-deterministic Finite Automata (NFA) techniques, which classify repetitive head movements of a child as typical or atypical based on an analysis of gender, age, and type of repetitive head movement, along with count, duration, and frequency of each repetitive head movement. Experimentation was carried out with different transfer learning methods to enhance the performance of the model. The experimental results on five datasets: NIR face dataset, Bosphorus 3D face dataset, ASD dataset, SSBD dataset, and the Head Movements in the Wild dataset, indicate that our proposed model has outperformed many state-of-the-art frameworks when distinguishing typical and atypical repetitive head movements in children.

Endo Belly: What Is It and Why Does It Happen?-A Narrative Review

Endometriosis is a chronic inflammatory disease where endometrial-like lesions settle outside the uterus, resulting in extensive inflammatory reactions. It is a complex disease that presents with a range of symptoms, with pain and infertility being the most common. Along with severe dysmenorrhea, cyclic and acyclic lower abdominal pain, cyclic dysuria and dyschezia, dyspareunia, and infertility, there are also nonspecific complaints that can cause confusion and make endometriosis the chameleon among gynecological diseases. These symptoms include unspecific intestinal complaints, cyclic diarrhea, but also constipation, nausea, vomiting, and stomach complaints. It appears that in addition to general bowel symptoms, there are also specific symptoms related to endometriosis such as cyclic bloating of the abdomen, known as endo belly. During the second half of the menstrual cycle leading up to menstruation, the abdomen becomes increasingly bloated causing discomfort and pain due to elevated sensitivity of the intestinal wall. Patients with endometriosis exhibit a reduced stretch pain threshold of the intestinal wall. Here, we review the endo belly, for the first time, pathophysiology and the influence of other diseases (such as irritable bowel syndrome-IBS), microbiome, hormonal levels, inflammation, and diet on the presentation of this condition.

Patients' perspectives on irritable bowel syndrome: a qualitative analysis based on social media in China

AIM

To explore the perspectives, experience, and concerns of patients with irritable bowel syndrome (IBS) in China.

METHODS

We used data mining to investigate posts shared in Baidu Tieba concerned with IBS; we collected the data through the crawler code, and mined the cleaned data's themes based on Latent Dirichlet allocation (LDA) and the Grounded theory.

RESULTS

We found 5746 network posts related to IBS. LDA analysis generated 20 topics, and grounded theory analysis established eight topics. Combining the two methods, we finally arranged the topics according to five concepts: difficulty in obtaining disease information; serious psychosocial problems; dissatisfied with the treatment; lack of social support; and low quality of life.

CONCLUSION

Social media research improved patient-centric understanding of patients' experiences and perceptions. Our study may facilitate doctor-patient communication and assist in the formulation of medical policies.

Differences in Cholesterol Metabolism, Hepato-Intestinal Aging, and Hepatic Endocrine Milieu in Rats as Affected by the Sex and Age

Age and sex influence serum cholesterol levels, but the underlying mechanisms remain unclear. To investigate further, we measured cholesterol, precursors (surrogate synthesis markers), degradation products (oxysterols and bile acid precursors) in serum, the liver, jejunum, and ileum, as well as serum plant sterols (intestinal absorption markers) in male and female Wistar rats (4 and 24 months old). The analysis of histomorphometric and oxidative stress parameters (superoxide dismutase, catalase, glutathione-related enzyme activities, lipid peroxide, and protein carbonyl concentrations) in the liver and jejunum offered further insights into the age- and sex-related differences. The hepatic gene expression analysis included AR, ERα, and sex-specific growth hormone-regulated (Cyp2c11 and Cyp2c12) and thyroid-responsive (Dio1, Tbg, and Spot 14) genes by qPCR. We observed age-related changes in both sexes, with greater prominence in females. Aged females had significantly higher serum cholesterol (p < 0.05), jejunum cholesterol (p < 0.05), and serum plant sterols (p < 0.05). They exhibited poorer hepato-intestinal health compared with males, which was characterized by mild liver dysfunction (hydropic degeneration, increased serum ALT, p < 0.05, and decreased activity of some antioxidant defense enzymes, p < 0.05), mononuclear inflammation in the jejunal lamina propria, and age-related decreases in jejunal catalase and glutathione peroxidase activity (p < 0.05). Aged females showed increased levels of 27-hydroxycholesterol (p < 0.05) and upregulated ERα gene expression (p < 0.05) in the liver. Our study suggests that the more significant age-related increase in serum cholesterol in females is associated with poorer hepato-intestinal health and increased jejunal cholesterol absorption. The local increase in 27-hydroxycholesterol during aging might reduce the hepatoprotective effects of endogenous estrogen in the female liver.

Association of low occlusal force as an oral hypofunction with the prevalence of irritable bowel syndrome in Japanese adults

BACKGROUND AND AIM

We investigated whether oral-dental conditions may be associated with the prevalence of irritable bowel syndrome (IBS) in a cross-sectional study in Japan.

METHODS

Information on lifestyle and abdominal symptoms was collected, and oral-dental examinations were performed from 2013 to 2017. To investigate the association between oral-dental conditions and IBS, this study used logistic regression analyses adjusted for relevant confounding factors, such as age, sex, BMI, stress, and eating between meals.

RESULTS

The prevalence of IBS was 484 (13.4%) among 3626 participants. The mean maximum occlusal force in the IBS group was significantly lower than that in the non-IBS group (0.306 ± 0.192 kN vs. 0.329 ± 0.205 kN, P = 0.014). The maximum occlusal force of the constipation-type IBS was significantly lower than that of other types of IBS without constipation type (0.269 ± 0.164 kN vs. 0.317 ± 0.198 kN, P = 0.010). Compared with those who had high values of maximum occlusal force (≧0.265 kN), those with a low value of maximum occlusal force (<0.265 kN) had a significantly greater risk for IBS (OR, 1.426; 95% CI, 1.135-1.792; P = 0.002), by multivariate analyses, across different categories of oral-dental condition in women, not in men. Women who had lowest third occlusal force (<0.206 kN) had approximately 35% significantly greater odds of having IBS compared with those who had highest third occlusal force (≧0.386 kN).

CONCLUSIONS

Results suggest that a reduction in the maximum occlusal force increases the risk of IBS in Japanese women.

Association of mental health conditions and functional gastrointestinal disorders among Vietnamese new-entry medical students

BACKGROUND

Functional gastrointestinal disorders (FGIDs), also known as disorders of gut-brain interaction, occur not only in the elderly but also in young adults. This study aimed to evaluate the association between mental health conditions and FGIDs among Vietnamese new-entry medical students.

METHODS

This cross-sectional study was conducted in February 2022 among new-entry medical students in Ho Chi Minh City, Vietnam. A printed questionnaire was distributed to all students on the day of freshmen health screening. Their urine samples were collected to screen for Helicobacter pylori infection using rapid urinary test. FGIDs were diagnosed using ROME IV criteria. Gastroesophageal reflux disease (GERD) was defined as the presence of typical reflux symptoms at least twice a week. Mental health conditions, including generalized anxiety disorder (GAD) and major depressive disorder (MDD), were identified using Generalized Anxiety Disorder Assessment-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales, respectively.

RESULTS

Among 400 new-entry medical students who participated in the study, the overall prevalence of FGIDs was 10.3% (functional dyspepsia 6.5%, irritable bowel disease 5.5%). The overlap syndrome (OS) of GERD-FGIDs or different FGIDs was present in 3.0% of participants. The prevalences of GAD and MDD were 6.8% and 10.2%, respectively. The urinary test was positive in 180 (45.0%) participants. In the multivariable logistic regression analysis, MDD was significantly associated with not only the risk of FGIDs (OR = 5.599, 95%CI: 2.173-14.430, p<0.001) but also the risk of OS (OR = 10.076, 95CI%: 2.243-45.266, p = 0.003).

CONCLUSIONS

MDD is associated with FGIDs and OS among new-entry medical students.

Impact of closed management on gastrointestinal function and mental health of Chinese university students during COVID-19

BACKGROUND

The innovative closed management of universities may have influenced the physical and mental health of students during the fourth stage of the COVID-19 pandemic in China. The study aimed to assess the gastrointestinal and mental health status of students in this stage and to explore the possible risk factors and mechanisms to provide a reference for future school responses to similar stressful events.

METHOD

A multicenter, cross-sectional survey was administered to 598 college students from 10 Chinese universities. The study used the 7-item Generalized Anxiety Disorder Scale (GAD-7), 9-item Patient Health Questionnaire (PHQ-9), Fear of COVID-19 Scale (FCV-19 S), and the Diagnostic Tendency of Functional Bowel Disease Scale (DT-FBD) to evaluate anxiety, depression, fear of COVID-19 and likelihood of being diagnose diagnosed with functional bowel disease (FBD), respectively.

RESULTS

A total of 516 college students completed the questionnaire. The proportions of students with more severe anxiety, more severe depression, greater fear of COVID-19, and a greater likelihood of being diagnosed with FBD were 49.8%, 57.0%, 49%, and 49%, respectively. These symptoms were significantly and positively correlated with the frequency of irregular sleep and eating (p < 0.05). Students in high-risk areas were more likely to experience anxiety and depression than students in areas with low/medium risk (odds ratio [OR] = 1.90, 95% confidence interval [CI]: 1.12-3.24, p = 0.017; OR = 2.14, 95% CI: 1.11-4.11, p = 0.022). A high likelihood of being diagnosed with FBD was positively associated with the severity of anxiety and depression symptoms and fear of COVID-19 (all p < 0.001). Moreover, mediation analysis revealed the following pathway in college students: fear of COVID-19 → depression and anxiety → poor diet → likelihood of being diagnosed with FBD.

CONCLUSION

College students generally exhibited higher more severe anxiety and depression symptoms and psychological symptoms with a greater higher propensity likelihood of being to be diagnosed with FBD. Good lifestyle habits, especially adequate sleep and a regular diet, can alleviate these problems. In addition, appropriate psychological intervention is very important.

Post-infection functional gastrointestinal disorders following coronavirus disease-19: a prospective follow-up cohort study

BACKGROUND

Acute gastrointestinal infections can lead to post-infectious irritable bowel syndrome (PI-IBS). Moreover, coronavirus disease (COVID-19) is related to long-term gastrointestinal sequelae. In this study, the frequency, disease spectrum, and risk factors for post-infection functional gastrointestinal disease (PI-FGID) in COVID-19 patients and healthy controls were prospectively examined.

METHODS

Validated Rome III and Rome IV questionnaires and limited objective assessment were used to assess the incidence of PI-FGID in 190 COVID-19 patients, and 160 healthy controls prospectively followed for 1, 3, and 6 months.

RESULTS

Six(3.2%), 1(0.5%), 3(1.6%), 5(2.6%), 6(3.2%)COVID-19 patients had diarrhea, abdominal pain, constipation, dyspepsia and their overlap at 1 month, respectively, while 4(2.1%), 1(0.5%), 4(2.1%), 4(2.1%), and 6(3.2%)COVID-19 patients had diarrhea, abdominal pain, constipation, dyspepsia and their overlap at three months, respectively. Furthermore, 2(1.3%), 4(2.5%), and 3(1.9%)healthy controls developed constipation, dyspepsia, and their overlap at one month, respectively (P = 0.193), while 2(1.3%), 4(2.5%), and 2(1.3%)healthy controls developed constipation, dyspepsia and their overlap at three months, respectively (P = 0.286). FGIDs incidence was higher among COVID-19 patients(8.9%) than in healthy controls(3.1%) at 6-month follow-up (P = 0.025). Moreover, 7 (3.7%), 5 (2.6%), 3 (1.6%), and 2 (1.1%) COVID-19 patients developed IBS, functional dyspepsia(FD), functional diarrhea(FDr), functional constipation(FC)at six months, respectively, while only 2 (1.3%) and 3 (1.9%) healthy controls developed IBS and FD at six months, respectively. Notably, gastrointestinal(GI)symptoms at onset were the independent risk factors for post-COVID-19 FGIDs at six months.

CONCLUSIONS

COVID-19 increases new-onset PI-FGID at six months compared with healthy controls. GI symptom at the onset of COVID-19 is an independent risk factor for post-COVID-19 FGIDs.

Sex differences in gastrointestinal dysfunction among patients with Parkinson's disease

BACKGROUND AND OBJECTIVE

Sex differences in gastrointestinal dysfunction have not been systematically analyzed in patients with Parkinson's disease (PD). This study was aimed to investigate the sex differences in gastrointestinal dysfunctions among the patients with PD using a multicenter trial dataset.

METHODS

We analyzed the baseline data of prospectively enrolled set of patients with gastrointestinal dysfunctions. Possible sex differences in gastrointestinal symptoms assessed on the Nepean Dyspepsia Index-Korean Version (NDI-K), gastrointestinal symptom diary, and Bristol stool scale were analyzed in association with clinical PD severity and antiparkinsonian drug dosages by multiple linear regression models. We also performed post hoc analysis of the dyspepsia symptom sub-items, adjusting for multiple comparisons.

RESULTS

Sixty-six of the 144 participants were female (45.8%). There were no differences in age, PD duration, Hoehn and Yahr stage, and daily dopaminergic medication dosages between sexes. NDI-K symptom and dyspepsia scores were correlated with the activity of daily living in females but not in males. In the multiple regression analysis controlling for all possible variables, female patients were shown to have worse gastrointestinal symptoms than males. When we performed post hoc analysis of the dyspepsia symptoms, inability to finish a regular meal and nausea were significantly worse in female patients. Gastrointestinal symptom diary supported that female patients more frequently complained of early fullness and bloating in the upper abdomen after meals than males, and burning pain in upper abdomen was more severe in female patients.

CONCLUSION

Gastrointestinal dysfunctions may differentially affect female and male PD patients.

Maternal separation and TNBS-induced gut inflammation synergistically alter the sexually differentiated stress response in rats

BACKGROUND

Neonatal maternal separation (MS) has been used to model long-lasting changes in behavior caused by neuroplastic changes associated with exposure to early-life stress. Earlier studies showed that transient gut inflammation can influence the development of irritable bowel syndrome (IBS). A prevailing paradigm of the etiology of IBS is that transient noxious events lead to long-lasting sensitization of the neural pain circuit, despite complete resolution of the initiating event. This study characterizes the changes in behaviors and neuroendocrine parameters after MS and early-phase trinitrobenzene sulfonic acid (TNBS)-induced colitis. We tested the hypothesis that MS and gut inflammation synergistically induce (1) hyperactivity in male rats and anxiety-like behaviors in female rats and (2) activation of the HPA axis in female rats and deactivation of the HPA axis in male rats after colorectal distention (CRD).

METHODS

Male and female rat pups were separated from their dams for 180 min daily from postnatal day (PND) 2 to PND 14 (MS). Early-phase colitis was induced by colorectal administration with TNBS on PND 8. The elevated plus-maze test was performed at 7 weeks. Tonic CRD was performed at 60 mmHg for 15 min at 8 weeks. Plasma ACTH and serum corticosterone were measured at baseline or after the CRD. Analysis of variance was performed for comparison among controls, TNBS, MS, and MS + TNBS.

RESULTS

In male rats, the time spent in open arms significantly differed among the groups (p < 0.005). The time spent in open arms in male MS + TNBS rats was significantly higher than that of controls (p < 0.009) or TNBS rats (p < 0.031, post hoc test). Female rats showed no difference in the time spent in open arms among the groups. MS and gut inflammation induced an increase in plasma ACTH in female rats but not in male rats at baseline.

CONCLUSIONS

These findings suggest that MS and gut inflammation synergistically induce hyperactive behavior or exaggerated hypothalamic-pituitary-adrenal axis function depending on sex.

Unraveling corticotropin-releasing factor family-orchestrated signaling and function in both sexes

Stress responses to physical, psychological, environmental, or cellular stressors, has two arms: initiation and recovery. Corticotropin-releasing factor (CRF) is primarily responsible for regulating and/or initiating stress responses via, whereas urocortins (UCNs) are involved in the recovery response to stress via feedback inhibition. Stress is a loaded, polysemous word and is experienced in a myriad of ways. Some stressors are good for an individual, in fact essential, whereas other stressors are associated with bad outcomes. Perceived stress, like beauty, lies in the eye of the beholder, and hence the same stressor can result in individual-specific outcomes. In mammals, there are two main biological sexes with reproduction as primary function. Reproduction and nutrition can also be viewed as stressors; based on a body of work from my laboratory, we propose that the functions of all other organs have co-evolved to optimize and facilitate an individual's nutritional and reproductive functions. Hence, sex differences in physiologically relevant outcomes are innate and occur at all levels- molecular, endocrine, immune, and (patho)physiological. CRF and three UCNs are peptide hormones that mediate their physiological effects by binding to two known G protein-coupled receptors (GPCRs), CRF1 and CRF2. Expression and function of CRF family of hormones and their receptors is likely to be sexually dimorphic in all organs. In this chapter, based on the large body of work from others and my laboratory, an overview of the CRF family with special emphasis on sex-specific actions of peripherally expressed CRF2 receptor in health and disease is provided.

Gastroesophageal reflux disease incidence among male patients with irritable bowel syndrome: A single-center cross-sectional study in southern Iran

Background and Aim

Gastrointestinal reflux disease (GERD) and irritable bowel syndrome (IBS) are among the most common gastrointestinal disorders in which the overlap of these diseases and their syndromes has been frequently reported. In this study, we aimed to evaluate GERD incidence among IBS patients and the related risk factors.

Methods

Male patients aged 18-60 years with an impression of IBS and referred to the gastrointestinal clinic from March 2019 to 2020 in Shiraz, Iran, were included in this study.

Results

Among the 163 enrolled patients with an average age of 31.53 ± 9.38 years, 64 (39.3%) were diagnosed with GERD. Based on statistical analysis, there was a significant association between GERD and the IBS patients' age (P = 0.006), smoking (P = 0.011), and alcohol consumption (P = 0.043). Also, GERD among IBS patients was significantly associated with the type of IBS (P < 0.001), with IBS-D having the lowest incidence (19.4%) and IBS-M the highest incidence of GERD (66.7%). Based on multivariate analysis, smoking had a reverse and significant correlation with lower incidence of GERD (OR = -1.364; P = 0.002).

Conclusion

Our results demonstrate that among male IBS patients, younger age, smoking, and alcohol consumption were among the risk factors for GERD. These findings may provide further insight into the best approach to treating these diseases.

Effectiveness of electroacupuncture versus prucalopride for women with severe chronic constipation: secondary analysis of a randomized controlled trial

PURPOSE

Electroacupuncture (EA) is a component alternative therapy for severe chronic constipation (SCC). Women are more vulnerable to SCC and gender might impact the response of patients with functional gastrointestinal disorders to therapy. We performed this secondary analysis to explore the effectiveness and safety of EA compared with prucalopride among women with SCC.

METHODS

Based on a multicenter, randomized, noninferiority trial, 446 female patients were randomly assigned to receive 28-session EA (n = 222) over 8 weeks with 24-week follow-up without treatment or to receive prucalopride (n = 224) over 32 consecutive weeks. The primary outcome was the proportion of overall complete spontaneous bowel movements (CSBMs) responders over weeks 1-8, defined as at least three CSBMs per week, and more than an increase of one CSBM from baseline meanwhile for at least 6 weeks during an 8-week treatment period. Secondary outcomes measure sustained CSBM responder, weekly responders, change from baseline in mean weekly CSBMs and SBMs, straining and stool consistency, quality of life, and adverse events (AEs).

RESULTS

The proportion of overall responders was 25.23% in the EA group, similar to 25.89% in the prucalopride group, with a between-group difference of - 0.67% (95% CI, - 8.80 to 7.40%; P = 0.872) during an 8-week treatment. In the secondary outcomes, EA and prucalopride groups had no significant difference, except that EA was inferior to prucalopride in improving SBMs. The AEs were less in the EA group than the prucalopride group.

CONCLUSION

EA may be a promising and safe treatment for women with SCC; its effect could sustain 24 weeks after treatment stopped.

Economic living standard and abdominal pain mediate the association between functional gastrointestinal disorders and depression or anxiety

BACKGROUND

Functional gastrointestinal disorders (FGIDs) are common and cause significant morbidity. Psychiatric comorbidities associated with FGIDs include anxiety and depression. However, little is understood about the factors that modulate this association. The aim of this study was to examine the association between FGIDs and depression and anxiety, and to determine the covariates influencing this association in a New Zealand cohort.

METHODS

The Christchurch IBS cOhort to investigate Mechanisms FOr gut Relief and improved Transit (COMFORT) study is an observational case-control study that recruited FGID cases and healthy controls between 2016 and 2018. In addition to the collection of a wide range of biological samples, participants completed questionnaires concerning socioeconomic status, physical activity, smoking, alcohol intake, anxiety, and depression (the latter two measured using the Hospital Anxiety and Depression Score [HADS]). A multivariate analysis was performed using the significant covariates from the univariate analyses to test whether their effect was independently significant on anxiety and depression.

KEY RESULTS

A total of 315 participants (57 with diarrhea-predominant IBS (IBS-D), 30 with constipation-predominant IBS (IBS-C), 41 with mixed-IBS (IBS-M), 16 with functional diarrhea (FD), 42 with functional constipation (FC), and 129 controls); mean age 53 years (range 18-70 years), 221 (70%) female) completed the questionnaires. Anxiety (odds ratio [OR] 2.85 [95% confidence interval [CI] 1.64-4.94, p < 0.01) and depression (OR 3.40 [95% CI 1.35-8.55, p = 0.01]) were strongly associated with FGID cases versus controls. Lower economic living status (p < 0.01) was an independent covariate associated with depression, while lower economic living status (p < 0.005) and abdominal pain (p = 0.005) were both independently associated with anxiety.

CONCLUSIONS & INFERENCES

In addition to the established associations between FGIDs and anxiety and depression, we have shown that the economic standard of living, pain, and IBS phenotype are significant independent covariates. This study demonstrates the range of lifestyle and demographic factors that modulate morbidity associated with FGIDs and may provide targets for intervention.

Presence of gastrointestinal symptoms in IgA nephropathy: a cross-sectional study

BACKGROUND

Gastrointestinal (GI) symptoms are common in end-stage kidney disease. Mounting evidence indicates that the intestine plays an important role in the pathogenesis of IgA nephropathy (IgAN). However, no studies have addressed the obvious question; do IgAN patients suffer from GI symptoms?

METHODS

Presence of GI symptoms and health-related quality of life were evaluated using the validated Gastrointestinal Symptom Rating Scale (GSRS) and Psychological General Well-Being (PGWB) questionnaires in 104 patients with kidney biopsy-verified IgAN and in 147 healthy controls. A person was regarded to experience 'increased GI symptoms' if the GSRS score exceeded plus 1 standard deviation of the mean of the corresponding score in the healthy controls.

RESULTS

According to the GSRS total score, the IgAN patients had more GI symptoms than the healthy controls (2.0 vs. 1.7, p < 0.001). Female IgAN patients had higher GSRS total score than male patients (2.2 vs. 1.7, p = 0.001). More IgAN patients with preserved kidney function (eGFR > 60ml/min/1.73m²) suffered from increased symptoms of diarrhoea (76 vs. 25%, p = 0.028), constipation (81 vs. 19%, p = 0.046) and reflux (85 vs. 15%, p = 0.004) than did IgAN patients with reduced kidney function (eGFR < 60ml/min/1.73m²).

CONCLUSIONS

IgAN patients and especially female IgAN patients experienced more GI symptoms than healthy controls. More prevalent GI symptoms were already observed before kidney function was clearly reduced. Systematic enquiry of GI symptoms might increase the standard of care among IgAN patients. Moreover, GI symptoms may provide clues for future studies that examine the pathophysiology of IgAN.

When you are living and dying at the same time: A qualitative exploration of living with gastrointestinal motility disorders

BACKGROUND

An expanding base of evidence indicates that chronic gastrointestinal disorders not only impact physical wellbeing, but also affect many psychosocial aspects of life. However, less is known about gastrointestinal motility disorders. The present study aimed to explore how individuals experience gastrointestinal motility disorders and their impact on daily living.

METHODS

Eleven people with a gastrointestinal motility disorder participated in semi-structured interviews face-to-face or via telephone. The interviews explored how participants came to be diagnosed, their experiences with health professionals, as well as the impact of dysmotility on enjoyment of food, socialising, eating out and quality of life (QoL). Interviews were tape-recorded, transcribed and analysed using an inductive thematic analysis approach.

RESULTS

Analysis revealed an overarching theme of frustration that stemmed from three subthemes: (1) feeling misunderstood, judged and dismissed by health professionals leading to delayed diagnosis, misdiagnosis and multiple diagnoses; (2) severity and unpredictability of undesirable gastrointestinal symptoms; and (3) reduced QoL because of physical and social limitations, impairing their ability to have normal life experiences, including education, work and social activities.

CONCLUSIONS

Dysmotility is a complex illness that impacts almost all aspects of a person's life. In addition to managing reported physical symptoms, the social and psychological burden associated with dysmotility needs to be addressed to improve outcomes and QoL.

The relation between second-generation antipsychotics and laxative use in elderly patients with schizophrenia

BACKGROUND

We aimed to investigate factors associated with concomitant laxative use among elderly patients with schizophrenia, discharged on second-generation antipsychotics (SGAs), from two large public psychiatric hospitals in Taiwan.

METHODS

Elderly patients with schizophrenia who were discharged between 2006 and 2019 and received SGA monotherapy at discharge were included in the analysis. Multivariate logistic regression was used to identify factors associated with regular laxative use at discharge. The Cochrane-Armitage trend test was used to evaluate whether significant time trends existed for rates of laxative use at discharge.

RESULTS

A total of 2591 elderly patients with schizophrenia were discharged during the study period, and 1727 of 2591 patients who met the inclusion criteria were included for analysis. Of these 1727 patients, 732 (42.4%) also received concomitant laxatives. Female gender, mood stabiliser use and concomitant diabetes mellitus were found to be associated with increased laxative use. Among SGAs, clozapine was associated with the highest rate of laxative use, followed by zotepine, quetiapine, olanzapine and risperidone. Additionally, risperidone, amisulpride, aripiprazole, paliperidone and sulpiride were associated with comparable rates of laxative use. Laxative use rates grew over time from 30.8% in 2006 to 46.6% in 2019 (z = 4.83, P < 0.001).

CONCLUSIONS

Laxative use is common in elderly schizophrenia patients treated with SGAs. In cases of clinically significant constipation, switching to an SGA with a lower risk for constipation, or discontinuing the use of mood stabilisers should be considered, if clinically feasible.

Standardized system and App for continuous patient symptom logging in gastroduodenal disorders: Design, implementation, and validation

BACKGROUND

Functional gastroduodenal disorders include functional dyspepsia, chronic nausea and vomiting syndromes, and gastroparesis. These disorders are common, but their overlapping symptomatology poses challenges to diagnosis, research, and therapy. This study aimed to introduce and validate a standardized patient symptom-logging system and App to aid in the accurate reporting of gastroduodenal symptoms for clinical and research applications.

METHODS

The system was implemented in an iOS App including pictographic symptom illustrations, and two validation studies were conducted. To assess convergent and concurrent validity, a diverse cohort with chronic gastroduodenal symptoms undertook App-based symptom logging for 4 h after a test meal. Individual and total post-prandial symptom scores were averaged and correlated against two previously validated instruments: PAGI-SYM (for convergent validity) and PAGI-QOL (for concurrent validity). To assess face and content validity, semi-structured qualitative interviews were conducted with patients.

KEY RESULTS

App-based symptom reporting demonstrated robust convergent validity with PAGI-SYM measures of nausea (r_S  =0.68), early satiation (r_S  =0.55), bloating (r_S  =0.48), heartburn (r_S  =0.47), upper gut pain (r_S  =0.40), and excessive fullness (r_S  =0.40); all p < 0.001 (n = 79). The total App-reported Gastric Symptom Burden Score correlated positively with PAGI-SYM (r_S  =0.56; convergent validity; p < 0.001), and negatively with PAGI-QOL (r_S  = -0.34; concurrent validity; p = 0.002). Interviews demonstrated that the pictograms had adequate face and content validity.

CONCLUSIONS AND INFERENCES

The continuous patient symptom-logging App demonstrated robust convergent, concurrent, face, and content validity when used within a 4-h post-prandial test protocol. The App will enable standardized symptom reporting and is anticipated to provide utility in both research and clinical practice.

The Burden of Gastrointestinal Complaints in Kidney Transplant Recipients Using Tacrolimus With and Without Mycophenolate Mofetil: A Randomized Controlled Study

Background

Tacrolimus (TAC) combined with mycophenolate mofetil (MMF) is the immunosuppressive regimen in the majority of solid organ transplant recipients. Gastrointestinal complaints are frequent, which is considered predominantly a side effect of MMF. However, systematic research in this field is lacking. The aim of this study is to systematically investigate the burden of gastrointestinal complaints in TAC-treated kidney transplant recipients with and without MMF.

Methods

In a single-center, open-label, randomized controlled trial, low immunological risk recipients were randomized to either TAC and MMF or to TAC monotherapy from 6 months after kidney transplantation onwards [NTR4672],. They filled in the Gastrointestinal Symptom Rating Scale questionnaire, which covers five dimensions (abdominal pain, reflux, indigestion, constipation, and diarrhea), 6, 12, and 15 months after transplantation.

Results

Seventy-nine recipients were randomized and 72 completed all questionnaires (34 TACmono and 38 TAC/MMF). At baseline, the mean age was 59 years with 72% male, mean BMI 28 kg/m2, eGFR 55 ml/min/1.73m2, mean daily dose MMF 1200 mg and TAC 5.8 mg, with trough levels of 2.1 mg/L and 7.4 ug/L. Six months after transplantation, 75% of recipients reported troublesome symptoms (score ≥3). Diarrhea was the most troublesome (mean 3.3) and discontinuing MMF significantly reduced it (mean Δ score between month 6 and 15 TAC/MMF -0.9 vs. TACmono -1.8, p=0.03). In recipients with troublesome symptoms, abdominal pain (2.7 to 1.8, p=0.003), indigestion (2.8 to 2.3, p=0.012), and reflux (2.9 to 1.7, p=0.007) significantly decreased over time, independent of MMF use.

Conclusion

The majority of kidney transplant recipients with TAC and MMF experienced troublesome gastrointestinal symptoms 6 months after transplantation. While constipation remained troublesome, indigestion, abdominal pain, and reflux improved over time by month 15. Diarrhea only improved after discontinuing MMF.

The role of mood state and emotion regulation in the discrepancy between gastrointestinal symptom burden recorded prospectively and via recall questionnaire

BACKGROUND

There is limited empirical evidence of the magnitude of the discrepancy between prospectively recorded gastrointestinal symptom burden and that reported in recall questionnaires. Further, potential sources of the discrepancy are largely unknown. This study sought to quantify the discrepancy and to evaluate the potential role of mood disorder and emotion regulation in the discrepancy.

METHODS

One hundred and forty nine subjects (mean age 20 years, 75% female) who met Rome IV criteria for irritable bowel syndrome and/or functional dyspepsia completed a 7-day prospective recording of the symptoms on a smartphone implemented ecological momentary assessment app, and then on day 8 were asked to recall their symptoms for the preceding 7 days.

KEY RESULTS

Gastrointestinal symptom burden assessed by recall was exaggerated relative to that recorded prospectively. The discrepancy was moderate for overall score (Cohen d = 0.52), abdominal pain (d = 0.61) and indigestion (d = 0.49). The discrepancy was generally larger among subjects who reported a physician diagnosis of a gastrointestinal condition with d = 0.87 for overall score and d = 0.89 for abdominal pain. A number of correlations between the discrepancy and psychological traits were identified, including neuroticism with diarrhea discrepancy (r = 0.23, p = 0.004) and visceral-specific anxiety with abdominal pain discrepancy (r = -0.18, p = 0.03). There was no evidence of recency or Hawthorne (observer) effects.

CONCLUSIONS AND INFERENCES

Reports of gastrointestinal symptoms obtained via recall are likely to be exaggerated relative to the actual patient experience, particularly among healthcare seekers. While psychological traits are likely to play some role, much more needs to be understood about the discrepancy.

Clinical value of positive BET and pelvic floor dyssynergia in Chinese patients with functional defecation disorder

BACKGROUND

Functional defecation disorder (FDD) is a common subtype of functional constipation (FC). Balloon expulsion test (BET) and high resolution anorectal manometry (HR-ARM) are significant tools but their results are not always consistent.

AIMS

To investigate the characteristics of patients with positive BET and pelvic floor dyssynergia (PFD) and explore the value of both positive results in FDD diagnosis.

METHODS

We retrospectively diagnosed FC subtypes and enrolled FDD patients based on Rome-IV criteria. They underwent HR-ARM, BET and CTT tests. Then they were classified to two groups and further stratified by FDD subtypes. Validated questionnaires were applied to investigate patients' constipation, anxiety/depression and quality of life.

RESULTS

335 FDD patients were finally enrolled. They were classified into two groups according to whether BET and PFD were both positive (consistent or not). 84.48% showed consistent results. These patients had significantly higher anal residual pressure, lower anal relaxation rate, manometric defecation index (MDI) and a more negative rectoanal pressure gradient (RAPG) (Ps < .05). The specific distribution of FDD phenotypes in two groups showed significant difference (p = .021). Males suffered a more negative RAPG (p < .001) and age was correlated with anal relaxation rate (p < .001). A subset (177 individuals) was investigated with validated questionnaires. Scores for Defecation Symptoms, Physical Discomfort and GAD-7 score were significantly high in Consistent Group (Ps < .05). GAD-7 score was associated with Defecation Symptoms (p < .001) while anal residual pressure, GAD-7 and Defecation Symptoms score were linked to Physical Discomfort (Ps < .05). The diagnostic specificity and PPV for FDD rose significantly with positive BET and PFD.

CONCLUSION

FDD patients with positive BET and PFD suffered from severe defecation symptoms, anxiety and impaired QOL. Positive BET and PFD could be an ideal tool for screening FDD.

Prevalence and risk factors of functional gastrointestinal disorders in early period medical students: a pilot study in Tunisia

Functional gastrointestinal disorders (FGIDs) are highly prevalent in medical students around the world. However, there is no specific data on FGIDs in Tunisia. The objectives of this study were to evaluate the prevalence of FGIDs in medical students according to the rome III criteria and to identify risk factors associated with these disorders. A self-administered questionnaire survey was carried out among the students from the first and the second year of medical studies. We studied the influence of socio-demographic characteristics, lifestyle, health care seeking, psychosomatic symptoms and hospital anxiety and depression scale on the prevalence of FGIDs among these students. Three hundred and forty-three students (20.3 ± 0.8years) were included in our study. The prevalence of FGIDs was 54.2%. The main FGIDs found were the unspecified functional bowel disorder (46.6%), functional constipation (11.6%), irritable bowel syndrome (7.6%) and functional dyspepsia (6.7%). In logistic regression, abnormal BMI (OR = 2.1, 95% CI= 1–4.3), living in school dormitory (OR = 3.7, 95% CI = 1.7–7.8), low water intake (OR = 2.2, 95% CI = 1.1–4.2), digestive medication use (OR = 3.4, 95% CI= 1.3–8.5), and probable or definite anxiety (OR = 2.5, 95% CI = 1.1–5.8) were the five risk factors associated with FGIDs. We demonstrate a high prevalence of FGIDs (54.2%) among our students. Risk factors for FGIDs were abnormal BMI, living in school dormitory, low water intake, digestive medication use and anxiety.

Effective Communication Strategies and Tools for Improving Treatment Outcomes in Patients With Chronic Idiopathic Constipation and Irritable Bowel Syndrome With Constipation

Patients with chronic idiopathic constipation and irritable bowel syndrome with constipation experience an array of gastrointestinal symptoms. Given the subjective nature of these disorders, patient self-reporting is critical to diagnosis and monitoring response to therapy. Unfortunately, many patients are reluctant to discuss bowel symptoms with their healthcare providers. Differences in sex, health literacy, and age can influence symptom reporting. Negative patient-physician relationships and dissatisfaction with care lead patients to seek alternative treatments, switch healthcare providers, or discontinue care. Thus, adopting a patient-centered communication style can help create a shared understanding of patients' symptoms, achieve accurate symptom reporting, expedite diagnosis, and facilitate appropriate treatment plans. Currently, there are multiple symptom and quality-of-life scales available to assist healthcare providers in this endeavor. These scales also allow for the monitoring of constipation-related symptoms and symptom severity. When using patient self-assessments to measure treatment responses, scale selection may depend on the number of symptoms being assessed, the duration and frequency of assessments, and patients' comprehension and language skills.

Global prevalence and burden of meal-related abdominal pain

BACKGROUND

Patients with disorders of gut-brain interaction (DGBI) report meal intake to be associated with symptoms. DGBI patients with meal-related symptoms may have more severe symptoms overall and worse health outcomes, but this subgroup has not been well characterized. We aimed to describe the global prevalence of meal-related abdominal pain and characterize this subgroup.

METHODS

The data analyzed originated from the Internet survey component of the population-based Rome Foundation Global Epidemiology Study, completed in 26 countries (n = 54,127). Adult subjects were asked whether they had abdominal pain and how often this was meal-related. Respondents were categorized into "no," "occasional," and "frequent" meal-related abdominal pain groups based on 0%, 10-40%, and ≥50% of the pain episodes being meal-related, respectively. DGBI diagnoses, frequency of other GI symptoms, psychological distress, non-GI somatic symptoms, quality of life, and healthcare utilization were compared between groups. Mixed linear and ordinal regression was used to assess independent associations between psychological distress, non-GI somatic symptoms, quality of life, other GI symptoms, and meal-related abdominal pain.

RESULTS

Overall, 51.9% of the respondents reported abdominal pain in the last 3 months, and 11.0% belonged to the group with frequent meal-related abdominal pain, which included more females and younger subjects. DGBI diagnoses were more common in subjects with frequent meal-related abdominal pain, and the frequency of several GI symptoms was associated with having more frequent meal-related abdominal pain. Having meal-related abdominal pain more frequently was also associated with more severe psychological distress, non-GI somatic symptoms, and a poorer quality of life. The group with frequent meal-related abdominal pain also more often consulted a doctor for bowel problems compared to the other groups of meal-related abdominal pain.

CONCLUSION

Reporting frequent meal-related abdominal pain is common across the globe and associated with other GI and non-GI somatic symptoms, psychological distress, healthcare utilization, and a poorer quality of life. Individuals who frequently experience meal-related abdominal pain also more frequently fulfill the diagnostic criteria for DGBI. Assessing meal-related symptoms in all DGBI patients could be of major importance to improve and individualize symptom management.

Effects of Reproductive Factors on Lauren Intestinal-Type Gastric Cancers in Females: A Multicenter Retrospective Study in South Korea

Background/Aims

Gastric cancers (GCs), particularly the Lauren intestinal type, show a male predominance. The aim of this study was to investigate the effects of reproductive factors on GCs in females, according to Lauren classification.

Methods

Medical records of 1,849 males and 424 females who underwent radical gastrectomy or endoscopic resection for GCs between 2010 and 2018 were reviewed. The incidences of intestinal-type GCs were compared between males and groups of females stratified according to postmenopausal period. Associations between reproductive factors in females and intestinaltype GCs were analyzed using multivariate models.

Results

The proportions of intestinal-type GCs were significantly lower in premenopausal (19%), less than 10 years postmenopausal (30.4%), and 10 to 19 years postmenopausal females (44.1%) than in males (61.0%) (p<0.05 for all). Females ≥20 years postmenopause had a proportion of intestinal-type GCs similar to that in males (60.6% vs 61.0%; p=0.948). Multivariate analysis revealed that age (odds ratio [OR], 1.075; 95% confidence interval [CI], 1.039 to 1.113; p<0.001) and parity ≥3 (OR, 1.775; 95% CI, 1.012 to 3.114; p=0.045) were positively associated with an increased risk of intestinal-type GCs in postmenopausal females, while long fertility duration (OR, 1.147; 95% CI, 1.043 to 1.261; p=0.005) was positively associated with an increased risk of intestinal-type GCs in premenopausal females.

Conclusions

There were no significant differences in the proportions of intestinal-type GCs between males and females ≥20 years postmenopause, suggesting that female reproductive factors play a role in the prevention of intestinal-type GC.

Role of psychological questionnaires in clinical practice and research within functional gastrointestinal disorders

Functional gastrointestinal (GI) disorders, also known as disorders of gut-brain interaction (DGBI), affect 40% of the global population. Up to two-thirds of patients with FGIDs experience a major psychological disorder making a thorough psychosocial assessment a critical part of patient care as it can impact treatment approach. Many psychological questionnaires exist in the clinical realm serving different purposes including screening for anxiety and depression, somatization symptoms, health-related anxiety, illness impact, and health-related quality of life. Given the abundance of questionnaires used to screen for similar psychiatric comorbidities, correlation between different instruments is needed to allow for pooling of data. In this issue of Neurogastroenterology & Motility, Snijkers et al. conducted the first comparative study to assess the correlation between the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) to determine optimal cutoffs for diagnosis of depressive and anxiety disorders in a cohort of irritable bowel syndrome patients. The biopsychosocial framework as it applies to FGID has led to the inclusion of both psychosocial assessments in clinical management and research protocols. Future directions include the development of symptom-specific questionnaires for groups of FGIDs, culturally specific psychosocial questionnaires, and inclusion of psychosocial well-being as primary or secondary outcomes in clinical research trials. In this review, we aim to explore the role of psychological questionnaires in clinical care and research trials and share practical tips on incorporating a biopsychosocial framework in the care of patients with FGIDs.

Defecation disorders are crucial sequelae that impairs the quality of life of patients after conventional gastrectomy

BACKGROUND

Defecation disorders are obscure sequelae that occurs after gastrectomy, and its implication on daily lives of patients have not been sufficiently investigated.

AIM

To examine the features of defecation disorders after gastrectomy and to explore its implication on daily lives of patients in a large cohort using the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45.

METHODS

We conducted a nationwide multi-institutional study using PGSAS-45 to examine the prevalence of postgastrectomy syndrome and its impact on daily lives of patients after various types of gastrectomy. Data were obtained from 2368 eligible patients at 52 institutions in Japan. Of these, 1777 patients who underwent total gastrectomy (TG; n = 393) or distal gastrectomy (DG; n = 1384) were examined. The severity of defecation disorder symptoms, such as diarrhea and constipation, and their correlation with other postgastrectomy symptoms were examined. The importance of defecation disorder symptoms on the living states and quality of life (QOL) of postgastrectomy patients, and those clinical factors that affect the severity of defecation disorder symptoms were evaluated using multiple regression analysis.

RESULTS

Among seven symptom subscales of PGSAS-45, the ranking of diarrhea was 4^th in TG and 2^nd in DG. The ranking of constipation was 5^th in TG and 1^st in DG. The symptoms that correlated well with diarrhea were dumping and indigestion in both TG and DG; while those with constipation were abdominal pain and meal-related distress in TG, and were meal-related distress and indigestion in DG. Among five main outcome measures (MOMs) of living status domain, constipation significantly impaired four MOMs, while diarrhea had no effect in TG. Both diarrhea and constipation impaired most of five MOMs in DG. Among six MOMs of QOL domain, diarrhea impaired one MOM, whereas constipation impaired all six MOMs in TG. Both diarrhea and constipation equally impaired all MOMs in DG. Male sex, younger age, division of the celiac branch of vagus nerve, and TG, independently worsened diarrhea, while female sex worsened constipation.

CONCLUSION

Defecation disorder symptoms, particularly constipation, impair the living status and QOL of patients after gastrectomy; therefore, we should pay attention and adequately treat these relatively modest symptoms to improve postoperative QOL.

Functional gastrointestinal disorders. Overlap syndrome Clinical guidelines of the Russian Scientific Medical Society of Internal Medicine and Gastroenterological Scientific Society of Russia

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Association of stress and functional gastrointestinal disorders in high school graduates

BACKGROUND

Psychosocial factors are seemed as important causes of functional gastrointestinal disorders (FGIDs). However, the role of stress in FGIDs in high school students under the pressure of college entrance examination is largely unknown. The aim of this study is to investigate the association between the stress and FGIDs in high school graduates.

METHODS

A cross-sectional survey was conducted in randomly selected high school fresh graduates. Questionnaires concerned health condition, living habits, gastrointestinal symptoms and life stress were given out and be finished voluntarily. Participants were diagnosed as FGIDs based on the Rome IV criteria.

RESULTS

Stress level of FGIDs population was higher than control group and stress was independent predicted factor of high risk of FGIDs. The stressor "changes" was significantly correlated with functional gastroduodenal disorders (OR1.118(1.011-1.238)). Stressor "frustration" was significantly correlated with functional bowel disorders (OR1.038(1.006-1.071)). "Physiological reaction" was correlated with functional bowel disease and functional gastroduodenal disorders + functional bowel disorders (OR1.027(1.007-1.046) and OR1.055(1.000-1.113)). Students with more than one gastrointestinal symptom exhibited higher stress level. Moreover, there was mediation effect of stress in the association between gender, sleep quality, allergies and FGIDs.

LIMITATIONS

This was a cross-section study and the sample included in the study were only from Wuhan, China.

CONCLUSIONS

Our findings illustrated the predicted and mediated role of stress in FGIDs in high school fresh graduates. Different stressors and reactions to stressors contributed to different FGIDs. Intervening measures aimed at stress coping strategies were warranted for students in daily school life.

Bowel dysfunction after elective spinal surgery: etiology, diagnostics and management based on the medical literature and experience in a university hospital

BACKGROUND

Bowel dysfunction after spinal surgery is often underestimated and if not treated in a timely manner can lead to undesirable surgical interventions or fatal complications. The current medical literature primarily focuses on bowel dysfunction as a result of spinal injury.

OBJECTIVE

The purpose of this review is to explore this topic in evaluating current evidence regarding the causes of acute bowel dysfunction after elective spinal surgery, primarily the thoracolumbar spine. Since available evidence for recommendations of treatment is scarce, an interdisciplinary management approach for treatment of bowel dysfunction following spinal surgery is also formulated.

MATERIAL AND METHODS

An extensive literature search was carried out on PubMed. Keywords that were used in the search included bowel dysfunction, obstruction, postoperative ileus, spinal surgery, spinal fusion, constipation, opioid-induced constipation, colonic pseudo-obstruction, ischemic colitis, immobility-induced bowel changes, epidural anesthesia and diet. Relevant studies were chosen and included in the review. The treatment approach used in the spine center of a university hospital was included.

RESULTS

Current research mainly focuses on investigating the nature and symptomatology of chronic bowel dysfunction after spinal cord injury. Emphasis on the acute phase of bowel dysfunction in patients after elective spinal surgery is lacking. The comorbidities that exacerbate bowel dysfunction postoperatively are well-defined. There has been refinement and expansion of the pharmacological and nonpharmacological treatment that could be implemented. Enough evidence exists to provide sufficient care.

CONCLUSION

Management of acute bowel dysfunction after spinal surgery requires a comprehensive and individualized approach, encompassing comorbidities, behavioral changes, medications and surgery. Close supervision and timely treatment could minimize further complications. Research is required to identify patients who are at a higher risk of developing bowel dysfunction after specific spinal procedures.

Gender difference in the overlap of irritable bowel syndrome and functional dyspepsia: a prospective nationwide multicenter study in Korea

BACKGROUND

The overlap between functional dyspepsia (FD) and irritable bowel syndrome (IBS) is associated with more severe gastrointestinal (GI) symptoms and lower quality of life. However, the gender differences in FD-IBS overlap remain unclear. This study aimed to investigate the gender differences in patients with FD-IBS overlap.

METHODS

Controls and cases were prospectively enrolled from July 2019 to June 2020 at nine tertiary referral centers. The patients underwent esophagogastroduodenoscopy, and their symptoms were evaluated using a questionnaire including GI symptom-related items and the Hospital Anxiety Depression Scale (HADS). FD and IBS were diagnosed according to the Rome IV criteria, and the clinical characteristics of the FD-IBS overlap group were compared with those of the FD-only or IBS-only group.

RESULTS

Among 667 subjects (334 healthy controls, 168 with FD-only, 37 with IBS-only, 128 with FD-IBS overlap), the FD-IBS overlap group (19.2%) showed a higher rate of preference for dairy products, a higher rate of history of Helicobacter pylori eradication, and higher HADS scores than the non-overlap group (P < 0.05). In the FD-IBS overlap group, men complained of reflux symptom and loose/watery stools more than women (P < 0.05), whereas women showed more severe GI symptoms, especially epigastric pain/burning symptoms, and higher depression scores than men (all P < 0.05).

CONCLUSIONS

FD-IBS overlap patients are associated with severe upper GI symptoms and depression compared to non-overlap patients. Moreover, women with FD-IBS overlap experience more severe GI and depression symptoms than men.

Treatment of faecal incontinence with autologous expanded mesenchymal stem cells: results of a pilot study

AIM

Management of faecal incontinence (FI) remains challenging because no definitive optimal treatment for this condition has yet been determined. Regenerative medicine could be an attractive therapeutic alternative for treating FI. Here, we aimed to determine the safety and feasibility of autologous expanded mesenchymal stem cells derived from adipose tissue (AdMSCs) in the treatment of patients diagnosed with structural FI.

METHOD

This was a randomized, multicentre, triple-blinded, placebo-controlled pilot study conducted at four sites in Spain with 16 adults with FI and a sphincter defect. Autologous AdMSCs were obtained from patients from surgically excised adipose tissue. These patients were intralesionally infused with a single dose of 4 × 10⁷ AdMSCs or a placebo while under anaesthesia. We assessed the safety and feasibility of the treatment as the cumulative incidence of adverse events and the treatment efficacy using the Cleveland Clinic Faecal Incontinence Score, Faecal Incontinence Quality of Life score and Starck criteria to classify sphincter defects and anorectal physiology outcomes.

RESULTS

Adipose tissue extraction, cell isolation and intralesional infusion procedures were successful in all the patients. There was only one adverse event connected to adipose tissue extraction (a haematoma), and none was associated with the injection procedure. There were no significant differences in any of the assessed clinical, manometric or ultrasonographic parameters.

CONCLUSION

This study indicates that this infusion procedure in the anal sphincter is feasible and safe. However, it failed to demonstrate efficacy to treat patients with structural FI.

Different doses of prucalopride in treating chronic idiopathic constipation: a meta-analysis and Bayesian analysis

OBJECTIVE

This study aims to explore the incremental benefit of different doses of prucalopride in treating chronic idiopathic constipation (CIC).

METHODS

PubMed, EMBASE, MEDLINE, Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, VIP medicine information and Wanfang databases were comprehensively searched up to March 2020. Prospective trials with different doses of prucalopride versus placebo were selected. The frequency of spontaneous bowel movements (SBMs) per week and the treatment-emergent adverse events (TEAEs), such as headache, arrhythmia, diarrhoea, dizziness, nausea and vomiting, were first synthesised in a meta-analysis. The probability of optimal dose of prucalopride was then ranked by random-effects within Bayesian analysis.

RESULTS

14 high-quality randomised controlled trials with 4328 patients were ultimately included. SBMs per week increased significantly after using 1 mg (OR: 2.40, 95% CI 1.32 to 4.37), 2 mg (OR: 2.55, 95% CI 1.93 to 3.36) and 4 mg (OR: 2.51, 95% CI 1.92 to 3.28) prucalopride. Bayesian analysis demonstrated 1 mg dose obtained the maximum SBMs per week (OR: 3.31, 95% credible interval 1.72 to 6.16, probability rank=0.70) indirectly compared with 2 mg and 4 mg doses. TEAEs were higher significantly in 2 mg (risk ratio (RR): 1.20, 95% CI 1.09 to 1.33) and 4 mg (RR: 1.14, 95% CI 1.07 to 1.22) prucalopride. The 1 mg dose did not reach statistical significance (RR: 1.17, 95% CI 0.94 to 1.44).

CONCLUSIONS

The study concludes that 1 mg dose at commencement could be safer in treating CIC and that 2 mg prucalopride could be more efficacious in terms of SBMs per week outcome receiving.

PROSPERO REGISTRATION NUMBER

CRD42019136679.

Mechanophysiological analysis of anorectal function using simulated feces in human subjects

INTRODUCTION

Defecation is a complex process that is difficult to study and analyze.

OBJECTIVES

Here, we present new analytical tools to calculate frictional force and tension during expulsion of the Fecobionics simulated stool in human subjects.

METHODS

The 12-cm-long Fecobionics device contained pressure sensors, motion processor units for measurement of orientation and bending, and impedance rings for measurement of cross-sectional areas. Eight normal subjects defecated Fecobionics. The bending angle of the device, frictional force between the device and the surrounding tissue, and the stretch tensions were calculated.

RESULTS

The bending angle and pressures changed during expulsion with the maximum pressure recorded at the rear. The averaged circumferential tension, longitudinal tension and friction force in each subject were associated with the front-rear pressure difference (r > 0.7, p < 0.005). The peak circumferential tension, longitudinal tension, and friction force immediately before expulsion of the rear were significantly higher compared to when the front entered the anal canal (F = 164.7, p < 0.005; F = 152.1, p < 0.005; F = 71.4, p < 0.005; respectively.).

CONCLUSION

This study shows that Fecobionics obtained reliable data under physiological conditions. Mechanical features such as frictional force and stretch tensions were assessable during Fecobionics expulsion.

Prevalence and trigger factors of functional gastrointestinal disorders among male civil pilots in China

Functional gastrointestinal disorders (FGIDs) are common among the aircrew due to their arduous working environment. This study investigated the prevalence of FGIDs in Chinese male pilots and assessed the effects of trigger factors on the FGIDs. A cross-sectional study including 212 male pilots was performed in a Chinese large civil airline company. FGIDs were diagnosed according to the Rome IV diagnostic criteria. The psychological performance, dietary pattern, sleep situation, and physical activity of the respondents were assessed. Logistic regression analysis and structural equation modeling were used to explore the association between these trigger factors and FGIDs. FGIDs were observed in 83 (39.22%) respondents, of which 31 (37.35%) had overlap syndromes. Age, flight level, flight time, high-salt food pattern, anxiety, and sleep performance were found to be associated with FGIDs (all P < 0.05). Stepwise logistic regression analysis revealed that the flight level (OR 0.59, 95% CI 0.31-0.080), high-salt food pattern (OR 2.31, 95% CI 1.28-4.16), and sleep performance (OR 2.39, 95% CI 1.11-5.14) were the influencing factors associated with FGIDs. Structural equation modeling confirmed the correlations between FGIDs and the occupational, dietary, and psychological factors with a reasonable fit. The preventive strategies were necessitated according to occupational and psychological characteristics.

Prevalence and trigger factors of functional gastrointestinal disorders among male civil pilots in China

Functional gastrointestinal disorders (FGIDs) are common among the aircrew due to their arduous working environment. This study investigated the prevalence of FGIDs in Chinese male pilots and assessed the effects of trigger factors on the FGIDs. A cross-sectional study including 212 male pilots was performed in a Chinese large civil airline company. FGIDs were diagnosed according to the Rome IV diagnostic criteria. The psychological performance, dietary pattern, sleep situation, and physical activity of the respondents were assessed. Logistic regression analysis and structural equation modeling were used to explore the association between these trigger factors and FGIDs. FGIDs were observed in 83 (39.22%) respondents, of which 31 (37.35%) had overlap syndromes. Age, flight level, flight time, high-salt food pattern, anxiety, and sleep performance were found to be associated with FGIDs (all P < 0.05). Stepwise logistic regression analysis revealed that the flight level (OR 0.59, 95% CI 0.31–0.080), high-salt food pattern (OR 2.31, 95% CI 1.28–4.16), and sleep performance (OR 2.39, 95% CI 1.11–5.14) were the influencing factors associated with FGIDs. Structural equation modeling confirmed the correlations between FGIDs and the occupational, dietary, and psychological factors with a reasonable fit. The preventive strategies were necessitated according to occupational and psychological characteristics.

Early-life malnutrition causes gastrointestinal dysmotility that is sexually dimorphic

BACKGROUND

Slow gastrointestinal (GI) transit occurs in moderate-to-severe malnutrition. Mechanisms underlying malnutrition-associated dysmotility remain unknown, partially due to lack of animal models. This study sought to characterize GI dysmotility in mouse models of malnutrition.

METHODS

Neonatal mice were malnourished by timed maternal separation. Alternatively, low-protein, low-fat diet was administered to dams, with malnourished neonates tested at two weeks or weaned to the same chow and tested as young adults. We determined total GI transit time by carmine red gavage, colonic motility by rectal bead latency, and both gastric emptying and small bowel motility with fluorescein isothiocyanate-conjugated dextran. We assessed histology with light microscopy, ex vivo contractility and permeability with force-transduction and Ussing chamber studies, and gut microbiota composition by 16S rDNA sequencing.

KEY RESULTS

Both models of neonatal malnutrition and young adult malnourished males but not females exhibited moderate growth faltering, stunting, and grossly abnormal stomachs. Progression of fluorescent dye was impaired in both neonatal models of malnutrition, whereas gastric emptying was delayed only in maternally separated pups and malnourished young adult females. Malnourished young adult males but not females had atrophic GI mucosa, exaggerated intestinal contractile responses, and increased gut barrier permeability. These sex-specific abnormalities were associated with altered gut microbial communities.

CONCLUSIONS & INFERENCES

Multiple models of early-life malnutrition exhibit delayed upper GI transit. Malnutrition affects young adult males more profoundly than females. These models will facilitate future studies to identify mechanisms underlying malnutrition-induced pathophysiology and sex-specific regulatory effects.

Expectations of IBS patients concerning disease and healthcare providers: Results of a prospective survey among members of a French patients' association

BACKGROUND AND AIMS

IBS patients have an impaired quality of life (QoL) and feel dissatisfaction with medical care. We aim to describe the expectations of members of the French Association of IBS patients (APSSII) concerning health care providers (HCPs) and a patients' organization.

PATIENTS AND METHODS

From January to June 2013, APSSII members were asked to answer questionnaires on their expectations and experiences concerning IBS and HCP.

RESULTS

222/330 (67%) responded (women: 68.5%, 46.5±17.7 years, disease duration: 8.8±0.7 years, IBS-D 33.6%, IBS-C 26.7%, IBS-M 38.2%. IBS-SSS>300 in 53% and HAD score>19 in 45%). QoL impairment was correlated with disease severity and HAD score (r=-0.707 and r=-0.484, P<0.001 respectively), but not with IBS subtype. Expectations for IBS were "improved health", "better information on causes and treatments" (94%) and "better disease recognition" (86%). A significant gap was observed between expectations and experiences with HCPs. Better information, less isolation, recognition of the disease and a decrease in medical expenses were the main expectations for joining a patients' organization.

CONCLUSIONS

French IBS patients have a severe disease with a significant psychological impact and impaired QoL in half of the patients, certain unsatisfied expectations concerning HCP and high expectations in joining a patients' organization.

Patient-Reported Gastrointestinal Symptoms and the Association With Quality of Life Following Kidney Transplantation

Background

There has been limited study of the prevalence of gastrointestinal symptoms and their impact on the quality of life (QOL) in kidney transplant recipients. The aim of this study was to examine the prevalence and predictors of gastrointestinal symptoms and the association with QOL in kidney transplant recipients.

Methods

All chronic kidney transplant recipients at the Princess Alexandra Hospital were provided with 3 questionnaires, the Gastrointestinal Quality of Life Index (GIQLI), the Gastrointestinal Symptoms Rating Scale (GSRS), and Structured Assessment of Gastrointestinal Symptoms (SAGIS) scale, to ascertain QOL impairment and to screen gastrointestinal symptom severity. Linear regression was used to determine the predictors of gastrointestinal QOL and gastrointestinal symptom severity.

Results

Of the 343 participants, the median age was 47 (interquartile range [IQR] 36–55) years, 58% were men, 79% were white, 39% had chronic glomerulonephritis, 83% had received their first graft, and median time since transplant was 6.3 (IQR 1.8–13.1) years. Using GSRS, 88% of participants reported at least 1 gastrointestinal symptom, most commonly indigestion (57%) and diarrhea (54%). Using GIQLI, 42% and 38% of participants reported mild and moderate QOL impairment, respectively. Gastrointestinal symptoms were predicted by female sex (coefficient −0.11, 95% CI −0.21 to −0.02) and mycophenolate (coefficient 0.0001, 95% CI 0.0001 to 0.0002), and were associated with poorer QOL (coefficient −0.38, 95% CI −0.45 to −0.30). Similar findings were observed using SAGIS for gastrointestinal symptoms.

Conclusions

Gastrointestinal symptoms are frequent in kidney transplant recipients, particularly in women and those receiving mycophenolate, and are strongly associated with poorer QOL.

Postmenopausal women with irritable bowel syndrome (IBS) have more severe symptoms than premenopausal women with IBS

BACKGROUND

Although irritable bowel syndrome (IBS) is more common in women, little is known about the role of hormonal changes and menopause in IBS. This study aimed to evaluate for differences in gastrointestinal (GI) and psychological symptoms between pre- and postmenopausal women with IBS compared to age-matched men with IBS.

METHODS

Patients with Rome-positive IBS were identified. Premenopausal women were <45 years of age with regular menses. Postmenopausal women were ≥45 years without menses for at least 1 year. Younger men were <45 years, and older men were ≥45 years. Questionnaires measured severity of IBS symptoms, somatic symptoms, health-related quality of life (HRQOL), and psychological symptoms. Multivariable linear or logistic regressions evaluating relationships between age and sex were performed.

KEY RESULTS

190 premenopausal women (mean age 30.25 years), 52 postmenopausal women (mean age 54.38 years), 190 men <45 years (mean age 30.45 years), and 52 men ≥45 years (mean age 53.37 years) were included. Postmenopausal IBS women had greater severity of IBS symptoms (P = .003) and worse physical HRQOL (P = .048) compared to premenopausal women. No differences were observed between age-matched older and younger IBS men. Constipation increased with age for both sexes but was the principal IBS subtype in women only.

CONCLUSIONS AND INFERENCES

Postmenopausal women with IBS have more severe IBS symptoms than premenopausal women, while no comparable age-related changes were seen in IBS men. The modulatory effect of female sex hormones on brain-gut interactions which affect visceral perception and GI function likely contributes to these findings.

Population-based assessment of gastrointestinal symptoms and diseases: Cappadocia Cohort, Turkey

BACKGROUND/AIMS

The aim of this study was to determine the prevalence of symptoms and diseases of the lower and upper gastrointestinal system (GIS) in a population-based sample.

MATERIALS AND METHODS

The cross-sectional cohort study was conducted in Cappadocia cohort comprising the Gülşehir and Avanos districts. The "Gastrointestinal Symptom Questionnaire" was applied to persons over the age of 18 years.

RESULTS

The GI Symptom Questionnaire was applied to 3369 subjects, and height and body weight were measured in 2797 consenting subjects. Of the participants, 61% were female and the mean patient age was 50±15 years. At least one GI symptom was present in 70.6% of the cohort. The most common upper GI symptoms were gastric bloating (31.0%) and heartburn (29.1%). The most common lower GI symptom was abnormal defecation (33.5). The prevalence of upper GIS and lower GIS diseases was 32.7% and 12.9%, respectively, and the prevalence of togetherness of upper and lower GIS diseases was 9.9%. Prevalence of GIS disease was approximately 3 times higher in females (p<0.001). All of the upper and lower GI symptoms and the prevalence of upper GIS disease increased in line with Body mass index (BMI).

CONCLUSION

This first population-based, cross-sectional cohort study revealed that the prevalence of GIS diseases is critically high for optimal public health. Special attention must be paid to these diseases while planning health policies and reimbursements.

Abdominal Massage Reduces Visceral Hypersensitivity via Regulating GDNF and PI3K/AKT Signal Pathway in a Rat Model of Irritable Bowel Syndrome

Changes in gut motility and visceral hypersensitivity are two major features of irritable bowel syndrome (IBS). Current drug treatments are often poorly efficacious, with many side effects for patients with IBS. Complementary therapies, such as acupuncture or abdominal massage, have received more attention in recent years. In this study, a rat model of IBS with diarrhea (IBS-D) was established by instillation of acetic acid from the colon. The effects of abdominal massage on changes in gut motility, visceral hypersensitivity, and the possible mechanism were investigated. Continuous abdominal massage could decrease the stool consistency score and increase the efflux time of glass beads compared with model groups, while also decreasing mast cell counts in IBS-D rats. The mRNA and protein expressions of neuronal nitric oxide synthase (nNOS), choline acetyl transferase (CHAT), and protein gene product 9.5 (PGP9.5) were significantly upregulated by continuous abdominal massage compared with model groups. Continuous abdominal massage also improved the ultrastructure of enteric glial cells (EGCs) by decreasing the number of mitochondria and increasing the level of the heterochromatin. Meanwhile, continuous abdominal massage could upregulate the expression of glial cell line-derived neurotrophic factor (GDNF) and P-Akt/Akt. Furthermore, it could reduce visceral hypersensitivity and improve the IBS-D symptoms by regulating the phosphoinositide 3-kinase (PI3K)-Akt pathway, which would provide a novel method for the treatment of IBS-D in the clinical setting.

Diagnostic Utility of Carbohydrate Breath Tests for SIBO, Fructose, and Lactose Intolerance

BACKGROUND

Unexplained bloating, gas, and pain are common symptoms. If routine tests are negative, such patients are often labeled as irritable bowel syndrome.

AIMS

To determine the diagnostic utility of breath tests that assess for small intestinal bacterial overgrowth (SIBO), fructose or lactose intolerance, and the predictive value of symptoms.

METHODS

Patients with gas, bloating, diarrhea, abdominal pain (≥ 6 months), and negative endoscopy and radiology tests were assessed with symptom questionnaires, glucose (75 g), fructose (25 g), or lactose (25 g) breath tests. Breath tests were categorized as positive when H₂ (≥ 20 ppm) or CH₄ (≥ 15 ppm) increased above baseline values or as hypersensitive when symptoms changed significantly without rise in H₂/CH₄ or as negative.

RESULTS

1230 patients (females = 878) underwent 2236 breath tests. The prevalence of SIBO was 33% (294/883), fructose intolerance was 34% (262/763), and lactose intolerance was 44% (260/590). Hypersensitivity was found in 16% and 9%, respectively, during fructose and lactose breath tests. Although gas (89%), abdominal pain (82%), and bloating (82%) were highly prevalent, pretest symptoms or their severity did not predict an abnormal breath test, but symptoms during the breath test facilitated diagnosis of SIBO, fructose, and lactose intolerance and hypersensitivity.

CONCLUSIONS

Approximately 45% of patients with unexplained gas and bloating had SIBO, fructose, or lactose intolerance; another 9-16% had visceral hypersensitivity. Pretest symptoms were poor predictors, but symptoms during the breath tests were useful. Breath tests are safe, provide significant diagnostic yield, and could be useful in routine gastroenterology practice.

Expression of Tight Junction Proteins According to Functional Dyspepsia Subtype and Sex

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.