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Ray G, Ghoshal UC. Epidemiology of Disorders of the Gut-Brain Interaction: An Appraisal of the Rome IV Criteria and Beyond. Gut Liver 2024; 18:578-592. [PMID: 38680110 PMCID: PMC11249947 DOI: 10.5009/gnl230396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 05/01/2024] Open
Abstract
Disorders of the gut-brain interaction (DGBIs) are presently classified into mutually exclusive anatomical area-related symptom-based categories according to the Rome IV criteria. The pathophysiology of visceral nociception, which contributes to the wide range of symptoms of DGBIs, involves complex psychobiological processes arising from the bidirectional interactions of multiple systems at the gut and brain levels, which affect symptom expression and illness behaviors. The attitude toward an illness and expression of pain and bowel habit vary across cultures with variable interpretation based on sociocultural beliefs, which may not tally with the medical definitions. Thus, psychological factors impact DGBI definitions, their severity and health care utilization. Due to the poor localization and multisegment referral of visceral pain, the anatomical site of pain may not correspond to the affected segment, and there may be a variable degree of overlap among symptoms. The somewhat restrictively defined Rome IV criteria assume one-to-one correlation of symptoms with underlying pathophysiology and ignore overlapping DGBIs, nonstandardized symptom categories, and change or shift in category over time. The microorganic nature of DGBIs resulting from systemic, metabolic or motility disorders, gut dysbiosis and inflammation are not addressed in the Rome IV criteria. Although there is a multidimensional clinical profile that does address these factors, it is not followed rigorously in practice. Threshold changes for diagnostic criteria or addition/deletion of symptoms leads to wide variation among different DGBI criteria resulting in uncertain comparability of results. Although the Rome IV criteria are excellent for research studies and therapeutic trials in homogenous populations, further improvement is needed for their wider applicability in clinical practice.
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Affiliation(s)
- Gautam Ray
- Gastroenterology Unit, Department of Medicine, B. R. Singh Hospital, Kolkata, India
| | - Uday Chand Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Hsu CT, Azzopardi N, Broad J. Prevalence and disease burden of gastroparesis in Asia. J Gastroenterol Hepatol 2024; 39:649-657. [PMID: 38224680 DOI: 10.1111/jgh.16474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/26/2023] [Accepted: 12/18/2023] [Indexed: 01/17/2024]
Abstract
Gastroparesis is a gastrointestinal disorder characterized by significant prolongation of gastric emptying time caused by impaired motility of the stomach. Its estimated prevalence is 24.2 per 100 000 people. However, the prevalence of gastroparesis in Asian countries is unknown due to a limited number of epidemiological studies and significant phenotypic variability of the Asian population in these studies. Analysis of previous research on gastroparesis and functional bowel disorders reveals the possibility of an increased prevalence among Asian individuals. A comparison of ethnic constituents between the recent United Kingdom gastroparesis study and its mother database has demonstrated a higher prevalence of gastroparesis among British Asian patients when compared with British Caucasian patients. An estimated gastroparesis prevalence in the Asian population can be calculated by identifying the individuals who are likely to demonstrate a delayed gastric emptying from all diagnosed functional dyspepsia patients. We suggest that gastroparesis tends to be underdiagnosed in Asians due to a lack of studies on gastroparesis in the Asian continent, a lack of knowledge among practitioners, and poor availability of scintigraphy testing as well as limited therapeutic options for this disease. Given the high probability of Asian predominance in gastroparesis and its disease impact on quality of life, epidemiological research focusing on the Asian population is required.
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Affiliation(s)
- Ching-Tung Hsu
- North Middlesex University Hospital NHS Trust, London, UK
| | | | - John Broad
- Institute of Health Science Education, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Frangakis C, Kohler B, Georgiades CS. CT-Guided Celiac Ganglion Block for Neurogenic Gastrointestinal Dysmotility. J Vasc Interv Radiol 2022; 33:1492-1499. [PMID: 35995120 DOI: 10.1016/j.jvir.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/02/2022] [Accepted: 08/12/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine whether celiac ganglion block can serve as a diagnostic test for dysautonomia as the cause of gastrointestinal dysmotility-related symptoms. MATERIALS AND METHODS This was an institutional review board-approved, prospective, single-arm, registered study, from January 2020 to May 2021, and included patients aged 14-85 years with gastrointestinal symptoms of food intolerance, abdominal pain, or angina. Patients with nonneurogenic causes (ie, chronic cholecystitis, peptic ulcer disease, gastroesophageal reflux, and malabsorption syndrome) were excluded. All 15 patients underwent computed tomography-guided celiac ganglion block with 100 mg of liposomal bupivacaine. Patients filled out the dysautonomia-validated questionnaire Composite Autonomic Symptom Score 31 (COMPASS-31) before and after intervention. Differences (before vs after) were compared with the exact permutation method. RESULTS Fifteen women (median age, 17 years; range, 14-41 years) were included. Average COMPASS-31 score improved significantly, from baseline 11 (SD ± 2.8) to 4 (SD ± 1.9) (improvement, 7 points ± 2.8; P < .001). All patients reported significant reduction in abdominal angina. Fourteen of the 15 patients (93%) reported complete resolution, and 14 of 15 (93%) reported a significant reduction in non-postprandial abdominal pain (P < .01). Only 1 patient reported no improvement. Eight of those 14 patients (57%) reported complete resolution of abdominal pain. There was a significant improvement in functional scores (vomiting, P = .01; constipation frequency, P = .02; constipation severity, P < .01; and nausea, P < .01). The rate of minor and major adverse events was 13% and 0%, respectively, per the Society of Interventional Radiology adverse event classification. CONCLUSIONS Celiac ganglion block is a safe diagnostic tool for confirming dysautonomia as the underlying condition in patients with gastrointestinal dysmotility-related symptoms. It could provide early diagnosis, lead to definitive treatment (ganglionectomy) earlier, or obviate unnecessary surgery.
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Affiliation(s)
| | - Beatriz Kohler
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Christos S Georgiades
- Division of Interventional Radiology, Johns Hopkins University, Baltimore, Maryland.
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Qi LY, Yang JW, Yan SY, Tu JF, She YF, Li Y, Chi LL, Wu BQ, Liu CZ. Acupuncture for the Treatment of Diarrhea-Predominant Irritable Bowel Syndrome: A Pilot Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2248817. [PMID: 36580333 PMCID: PMC9856830 DOI: 10.1001/jamanetworkopen.2022.48817] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Acupuncture is a promising therapy for irritable bowel syndrome (IBS), but the use of subjective scales as an assessment is accompanied by high placebo response rates. OBJECTIVES To preliminarily test the feasibility of using US Food and Drug Administration (FDA)-recommended end points to evaluate the efficacy of acupuncture in the treatment of IBS. DESIGN, SETTING, AND PARTICIPANTS This pilot, multicenter randomized clinical trial was conducted in 4 tertiary hospitals in China from July 1, 2020, to March 31, 2021, and 14-week data collection was completed in March 2021. Individuals with a diagnosis of IBS with diarrhea (IBS-D) were randomized to 1 of 3 groups, including 2 acupuncture groups (specific acupoints [SA] and nonspecific acupoints [NSA]) and a sham acupuncture group (non-acupoints [NA]) with a 1:1:1 ratio. INTERVENTIONS Patients in all groups received twelve 30-minute sessions over 4 consecutive weeks at 3 sessions per week (ideally every other day). MAIN OUTCOMES AND MEASURES The primary outcome was the response rate at week 4, which was defined as the proportion of patients whose worst abdominal pain score (score range, 0-10, with 0 indicating no pain and 10 indicating unbearable severe pain) decreased by at least 30% and the number of type 6 or 7 stool days decreased by 50% or greater. RESULTS Ninety patients (54 male [60.0%]; mean [SD] age, 34.5 [11.3] years) were enrolled, with 30 patients in each group. There were substantial improvements in the primary outcomes for all groups (composite response rates of 46.7% [95% CI, 28.8%-65.4%] in the SA group, 46.7% [95% CI, 28.8%-65.4%] in the NSA group, and 26.7% [95% CI, 13.0%-46.2%] in the NA group), although the difference between them was not statistically significant (P = .18). The response rates of adequate relief at week 4 were 64.3% (95% CI, 44.1%-80.7%) in the SA group, 62.1% (95% CI, 42.4%-78.7%) in the NSA group, and 55.2% (95% CI, 36.0%-73.0%) in the NA group (P = .76). Adverse events were reported in 2 patients (6.7%) in the SA group and 3 patients (10%) in NSA or NA group. CONCLUSIONS AND RELEVANCE In this pilot randomized clinical trial, acupuncture in both the SA and NSA groups showed clinically meaningful improvement in IBS-D symptoms, although there were no significant differences among the 3 groups. These findings suggest that acupuncture is feasible and safe; a larger, sufficiently powered trial is needed to accurately assess efficacy. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2000030670.
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Affiliation(s)
- Ling-Yu Qi
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jing-Wen Yang
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Shi-Yan Yan
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jian-Feng Tu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yan-Fen She
- School of Acupuncture-Moxibustion and Tuina, Hebei University of Traditional Chinese Medicine, Shijiazhuang, China
| | - Ying Li
- School of Graduate, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Li-Li Chi
- Department of Spleen and Stomach, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Bang-Qi Wu
- National Acupuncture and Moxibustion Clinical Medical Research Center, the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Cun-Zhi Liu
- International Acupuncture and Moxibustion Innovation Institute, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Sakata Y, Yago T, Mori S, Seto N, Matsunaga Y, Nakamura H, Tominaga T, Miyaji K, Takeda Y. Time Courses of Gastric Volume and Content after Different Types of Casein Ingestion in Healthy Men: A Randomized Crossover Study. J Nutr 2022; 152:2367-2375. [PMID: 36774103 DOI: 10.1093/jn/nxac158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/03/2022] [Accepted: 07/11/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few studies have evaluated differences in the curd-forming ability of casein on gastric volume and content directly after ingestion in humans. OBJECTIVES This study evaluated the time course of gastric volume and curd conditions in the stomach after protein ingestion. METHODS This was an open-labeled, randomized crossover trial. Ten healthy men [age: 33.4 ± 7.3 y; BMI (kg/m2): 21.9 ± 0.9] received 350 g of 3 isonitrogenous and isocaloric protein drinks containing 30 g micellar casein (MCN), sodium caseinate (SCN), or whey protein concentrate (WPC). The gastric antrum cross-sectional area (CSA) and curd in the stomach were measured using ultrasonography within 5 h after ingestion. The differences between test foods were tested using the MIXED model and post hoc tests using Fisher's protected least significant difference. RESULTS The incremental AUC of the gastric antrum CSA after MCN ingestion was 1.3-fold and 1.5-fold higher than that after the ingestion of SCN and WPC, respectively (both P < 0.05), but not different between SCN and WPC. The number of participants with curds ≥20 mm with a high echogenicity clot observed in the stomach within 5 h after MCN ingestion was significantly greater than that after the ingestion of other proteins (n = 9 for MCN, n = 2 for SCN, and n = 0 for WPC; bothP < 0.01). The regression line slopes on total plasma amino acid concentration and gastric antrum CSA were significantly different between the participants with and without curds. CONCLUSIONS In contrast to SCN and WPC, MCN ingestion resulted in slow kinetics of gastric antrum CSA. Differences in curd formation of casein in the stomach affect gastric emptying and plasma amino acid absorption kinetics after ingestion in healthy men. This trial was registered at University Hospital Medical Information Network Clinical Trials Registry as UMIN000038388 (https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000043746).
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Affiliation(s)
| | - Takumi Yago
- R&D Division, Morinaga Milk Industry, Kanagawa, Japan
| | - Sadahiro Mori
- Department of Physiological Laboratory, Japanese Red Cross Sagamihara Hospital, Kanagawa, Japan
| | - Namiko Seto
- R&D Division, Morinaga Milk Industry, Kanagawa, Japan
| | - Yutaka Matsunaga
- Department of Sports Sciences, The University of Tokyo, Tokyo, Japan
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Andreev DN, Bordin DS, Vyuchnova ES, Lebedeva EG, Dicheva DT, Umyarova RM, Maev IV. [Prevalence of combination of functional dyspepsia and irritable bowel syndrome: a meta-analysis of studies using the Rome III-IV Criteria]. TERAPEVT ARKH 2022; 94:1099-1108. [PMID: 36286762 DOI: 10.26442/00403660.2022.09.201849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
AIM To systematize data on the prevalence of the combination of functional dyspepsia (FD) and irritable bowel syndrome (IBS) using the Rome IIIIV Criteria. MATERIALS AND METHODS A search in electronic databases MEDLINE/PubMed, EMBASE, and Cochrane was conducted. The depth of search was 17 years (from January 2006 to May 2022). Original publications from peer-reviewed periodicals that applied the Rome IIIIV Criteria for diagnosis of FD and IBS in an adult patient population with detailed descriptive statistics to allow the resulting data to be included in the meta-analysis were selected for final analysis. RESULTS The final analysis included 38 studies involving 17,993 patients with FD and 15,883 patients with IBS. In the overall pool of studies using the Rome IIIIV Criteria, the pooled prevalence of FD in patients with IBS was 34.625% (95% confidence interval [CI] 28.15941.390), and the pooled prevalence of IBS in patients with FD was 37.549% (95% [CI] 31.51143.787). A random-effects model was used in the analyses since significant heterogeneity between results was found (p0.0001; I298%). Using the Rome III Criteria, the pooled prevalence of FD in patients with IBS was 31.993% (95% CI 26.13538.150; I2=98.17%), while the prevalence of IBS in patients with FD was 34.694% (95% [CI] 29.31940.273; I2=97,89%). An analysis of papers using the Rome IV Criteria demonstrated that the pooled prevalence of FD in patients with IBS was 42.614% (95% CI 18.58868.675; I2=98.97%), and the prevalence of IBS in patients with FD was 50.444% (95% CI 37.95662.904; I2=94,39%). CONCLUSION This meta-analysis demonstrated that the prevalence of the combination of FD and IBS identified using the Rome IIIIV Criteria is high and is reported in approximately 1 in 3 patients with the functional gastrointestinal disorders concerned. The prevalence of a combination of FD and IBS identified using the Rome IV Criteria is at least 10% higher than that using the Rome III Criteria.
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Affiliation(s)
- D N Andreev
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - D S Bordin
- Yevdokimov Moscow State University of Medicine and Dentistry
- Loginov Moscow Clinical Scientific Center
- Tver State Medical University
| | - E S Vyuchnova
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - E G Lebedeva
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - D T Dicheva
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - R M Umyarova
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - I V Maev
- Yevdokimov Moscow State University of Medicine and Dentistry
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Zaghloul MS, Elshaer YA, Ramadan ME, ElBatae HE. Different patterns of esophageal motility disorders among patients with dysphagia and normal endoscopy: A 2-center experience. Medicine (Baltimore) 2022; 101:e30573. [PMID: 36197212 PMCID: PMC9509117 DOI: 10.1097/md.0000000000030573] [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
Esophageal motility disorders (EMDs) are the main etiology of nonobstructive dysphagia (NOD), but they are underestimated in Egypt. High-resolution manometry (HRM) with Chicago Classification version 3.0 (CC v3.0) is the current gold standard diagnostic modality to assess EMD in patients with NOD. In this HRM-based study, we aimed to classify EMD among Egyptian patients and explore the relationship between the severity of symptoms and the various groups of EMD. From January 2020 to January 2021, patients with dysphagia were subjected to diagnostic workup, which included symptom questionnaire for Eckardt score, esophagogastroduodenoscopy, barium esophagogram, and HRM. All patients were categorized based on the HRM results using CC version 3.0 after exclusion of those with obstructive esophageal lesions. Of 252 patients with dysphagia, 55 patients with NOD were analyzed according to CC version 3.0. Achalasia was diagnosed in 31 patients (56.4%) (type I: 18 [58.06%]; type II: 9 [29.03%], and type III: 4 [12.9%]), 3 patients (5.5%) with esophagogastric junction outflow obstruction, 2 patients (3.6%) with absent contractility, 4 patients (7.3%) with distal esophageal spasm, 7 patients (12.7%) with ineffective esophageal motility, and 8 patients (14.5%) with normal manometry. Patients with achalasia experienced significantly high regurgitation (96.8% vs 70.8%; P = .016) compared with those without achalasia. Achalasia was the most common EMD in Egyptian patients with NOD. Eckardt score was higher in patients with outflow obstruction and major motor disorder, but it could not differentiate different categories of CC of EMD. HRM is effective in characterization of EMD.
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Affiliation(s)
- Mariam S. Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Yasmine A. Elshaer
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
- *Correspondence: Yasmine A. Elshaer, Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt (e-mail: )
| | - Mohamed E. Ramadan
- Department of General Surgery, Faculty of Medicine, Benha University, Egypt
| | - Hassan E. ElBatae
- Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
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Jadallah KA, Khatatbeh MM, Sarsak EW, Sweidan AN, Alzubi BF. Irritable bowel syndrome and its associated factors among Jordanian medical students: A cross-sectional study. Medicine (Baltimore) 2022; 101:e30134. [PMID: 35984126 PMCID: PMC9387975 DOI: 10.1097/md.0000000000030134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Very scarce studies investigated the prevalence of irritable bowel syndrome (IBS) and its correlates in the Middle East, particularly in college students. We aimed to investigate the prevalence of IBS and its associated factors among Jordanian medical students. We conducted a cross-sectional study at 2 medical facilities in northern Jordan. We recruited 1135 medical students. Participants completed an anonymous questionnaire addressing sociodemographic, lifestyle, and clinical characteristics. An interview questionnaire was used to diagnose IBS according to the Rome III criteria. Comorbid anxiety and depression were diagnosed by using the Hospital Anxiety and Depression Scale. Of the 1135 completed questionnaires, 1094 (94%) had complete data. The prevalence of IBS in our sample was 30.9%. Binary logistic regression analysis of factors associated with IBS indicated having a family history of IBS as a strong predictor of the disease (odds ratio [OR]: 8.09; 95% confidence interval [CI]: 5.84-11.19). Students in the second and third years of their study had ORs of approximately 4 (95% CI: 2.20-6.54) and 3 (95% CI: 1.70-5.30) for suffering from IBS, respectively, compared with those in the first year (P = .001). Increased anxiety score (OR: 1.88; 95% CI: 1.30-2.71), poor sleep quality (OR: 1.76; 95% CI: 1.13-2.76), female sex (OR: 1.59; 95% CI: 1.14-2.20), and living in a school dormitory (OR: 1.35; 95% CI: 1.00-1.84) were significantly associated with IBS (P < .05). IBS is a highly prevalent disorder among Jordanian medical students, with several factors associated with its occurrence.
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Affiliation(s)
- Khaled A. Jadallah
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- *Correspondence: Khaled A. Jadallah, Department of Internal Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, 7th Floor, Wing C, Room 52, Irbid 22110, Jordan (e-mail: )
| | - Moawiah M. Khatatbeh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Enas W. Sarsak
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Aroob N. Sweidan
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Bara F. Alzubi
- Department of Internal Medicine, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Inczefi O, Bacsur P, Resál T, Keresztes C, Molnár T. The Influence of Nutrition on Intestinal Permeability and the Microbiome in Health and Disease. Front Nutr 2022; 9:718710. [PMID: 35548572 PMCID: PMC9082752 DOI: 10.3389/fnut.2022.718710] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/22/2022] [Indexed: 01/09/2023] Open
Abstract
The leakage of the intestinal barrier and the disruption of the gut microbiome are increasingly recognized as key factors in different pathophysiological conditions, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), chronic liver diseases, obesity, diabetes mellitus, types of cancer, and neuropsychiatric disorders. In this study, the mechanisms leading to dysbiosis and "leaky gut" are reviewed, and a short summary of the current knowledge regarding different diseases is provided. The simplest way to restore intestinal permeability and the microbiota could be ideal nutrition. Further therapeutic options are also available, such as the administration of probiotics or postbiotics or fecal microbiota transplantation.
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Affiliation(s)
- Orsolya Inczefi
- Department of Gastroenterology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Péter Bacsur
- Department of Gastroenterology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Tamás Resál
- Department of Gastroenterology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Csilla Keresztes
- Department for Medical Communication and Translation Studies, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- Department of Gastroenterology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary,*Correspondence: Tamás Molnár,
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Yu LM, Weng MN, Chen HJ, Ye W, Fan YH. Study of efficacy and mechanism of low FODMAPs diet on diarrhea-type irritable bowel syndrome based on a gut microbiota-dependent metabolite. Shijie Huaren Xiaohua Zazhi 2021; 29:1421-1427. [DOI: 10.11569/wcjd.v29.i24.1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The changes in gut microbiota-dependent metabolites can cause irritable bowel syndrome (IBS). It is important to investigate whether a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) plays a therapeutic role in IBS treatment by affecting the production of phenylalanine (PHE), a gut microbiota-dependent metabolite.
AIM To investigate the efficacy of a low FODMAPs diet in diarrhea-type irritable bowel syndrome (IBS-D) and its molecular mechanism for regulating GLP-1 secretion by affecting PHE, a gut microbiota-dependent metabolite.
METHODS Thirty patients who met the Rome IV diagnostic criteria for IBS-D were enrolled and treated with a low FODMAPs diet for 4 wk. Thirty healthy volunteers served as baseline controls. The changes of clinical symptom scores, and serum PHE, GLP-1, and TNF-α, as well as IFN-γ before and after treatment were recorded. In in vitro experiment, different doses of PHE were added into NCI-H716 cells to observe the regulatory effect of PHE on GLP-1.
RESULTS The clinical symptom scores after treatment in the IBS group were significantly lower than those before treatment (P < 0.0001 & P < 0.001). After treatment, the levels of PHE and GLP-1 increased (P < 0.05), but those of TNF-α and IFN-γ decreased significantly (P < 0.0001 & P < 0.001). No adverse reactions occurred in the IBS group. In in vitro experiment, GLP-1 expression levels were found to rise with increasing PHE concentrations, and 1 mmol/L PHE could significantly increase GLP-1 secretion.
CONCLUSION Low FODMAPs diet improves the symptoms in IBS-D patients via mechanisms that may be related to the regulation of GLP-1 by affecting PHE and thereby inhibiting the secretion of pro-inflammatory cytokines.
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Affiliation(s)
- Lei-Min Yu
- Department of Gastroenterology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310007, Zhejiang Province, China
| | - Min-Na Weng
- Department of Gastroenterology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310007, Zhejiang Province, China
| | - Hui-Jun Chen
- Department of Gastroenterology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310007, Zhejiang Province, China
| | - Wei Ye
- Department of Gastroenterology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 310007, Zhejiang Province, China
| | - Yi-Hong Fan
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
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