Minor digestive symptoms and their impact in the general population: a cluster analysis approach

Worldwide population prevalence and impact of sub-diagnostic gastrointestinal symptoms

BACKGROUND

The Rome Foundation Global Epidemiology Study (RFGES) found that 40.3% of adults in 26 internet-surveyed countries met Rome IV criteria for disorders of gut-brain interaction (DGBI). However, additional people not meeting DGBI criteria may also be burdened by frequent gastrointestinal symptoms.

AIMS

To explore the prevalence and demographic distribution of sub-diagnostic gastrointestinal symptoms, and the hypothesised associated effects on quality of life (QoL), life functioning and healthcare needs.

METHODS

We analysed data from the RFGES survey, which included the Rome IV diagnostic questionnaire and QoL, psychological, work productivity and healthcare questions.

RESULTS

Of the 50,033 people without a history of organic gastrointestinal disorders, 25.3% classified in the sub-diagnostic group (no DGBI but one or more frequent gastrointestinal symptoms), 41.4% had DGBI and 33.4% had no frequent gastrointestinal symptoms (non-GI group). Sub-diagnostic prevalence in different world regions ranged from 22.2% (North America) to 30.5% (Middle East), was slightly higher among males than females and decreased with age. The sub-diagnostic group was intermediate between the non-GI and DGBI groups, and significantly different from both of them on QoL, anxiety, depression, somatisation, healthcare utilisation and life and work impairment.

CONCLUSIONS

One in four adults without organic gastrointestinal disorders or DGBI report frequent gastrointestinal symptoms. This sub-diagnostic group has reduced QoL, greater psychological and non-GI bodily symptoms, impaired work productivity and life activities and greater healthcare use compared to non-GI individuals. This suggests that many in this sub-diagnostic group might benefit from healthcare services or symptom self-management advice.

Impact of Gastroesophageal Reflux Disease (GERD) Symptoms on the Lifestyle and Academic Performance of Medical Students at King Faisal University

Background A number of symptoms and complications are associated with gastroesophageal reflux disease (GERD), which originates when stomach contents are refluxed into the esophagus. GERD has been associated with quality of life (QoL) issues as well as health-related problems. However, the evidence of this correlation among medical students is still unproven. This study aims to assess GERD severity and symptoms among medical students and investigate the effects of GERD on academic performance and quality of life among Saudi Arabian medical students. Methods This is a cross-sectional study design based on questionnaires distributed among medical students at King Faisal University, Saudi Arabia: Reflux-Qual Short form (RQS) and Frequency Scale for the Symptoms of GERD (FSSG). Demographic data include gender, academic year, and Grade Point Average (GPA). The participants included 382 studentsrandomly selected as the sample size, with a precision of 5% and a 95% confidence interval (CI). Results Data were collected from 382 medical students of King Faisal University. A total of 382 participants (215 (56.3%) females and 167 (43.7%) males) were evaluated. Among 382 students,325 (85.1%) were negative for GERD, while 57 (14.9%) had symptoms of GERD. In this study, the most frequent symptoms were feeling full while eating meals (8.9%), feeling of heaviness after meals (6.5%), bloating of the stomach (3.7%), and burping (3.7%). The most affected life domains were life satisfaction (18.1%), enjoyment of food (8.4%), avoidance of large meals (6.3%), and worrying about digestive problems (5.8%). This study shows a significant relationship between GERD and GPA (P < 0.005) and a significant negative relationship between GERD and QoL (P < 0.001). Conclusions GERD significantly affects the quality of life for medical students, primarily those with high GPAs. More research is needed to determine the reason behind this.

A poor diet quality is associated with more gas-related symptoms and a decreased quality of life in French adults

This study evaluated the association between dietary patterns, Gas-Related Symptoms (GRS) and their impact on quality of life (QoL) in a representative sample (n=936) of the French adult population. During the 2018-2019 "Comportements et Consommations Alimentaires en France" (CCAF) survey (Behaviors and Food Consumption in France), online evaluation of GRS in adult participants was performed using the validated Intestinal Gas Questionnaire (IGQ), which captures the perception of GRS and their impact on QoL via 6 symptom dimensions scores (range 0-100; 100=worse) and a global score (mean of the sum of the 6 symptom dimensions scores). Socio-demographics, lifestyle parameters and dietary habits (7-day e-food diary) were also collected online. Quality of diet was determined using the NRF9.3 score (range 0-900; 900=best). Univariate and multivariate linear regression models were applied to identify factors associated with IGQ global score. K-means was used to identify clusters of subjects based on their dietary records. Data from 936 adults who completed both the IGQ and the food diary showed a mean (SD) IGQ global score of 11.9 (11.2). Younger age and female gender were associated with a higher IGQ global score. Only 7% of subjects reported no symptom at all and nearly 30% of study participants reported a high impact of GRS on their QoL. Two dietary clusters were identified: cluster1, characterized by a higher consumption of fruits and vegetables, lower sugars intake and higher NRF9.3 score and cluster 2, characterized by higher intake of sugars, lower intake in dietary fibers and lower NRF9.3 score. The IGQ global score was lower in cluster1 and higher in cluster2 vs. the total sample average (p<0.001). Prevalence of GRS in the French adult population is high and is associated with impaired QoL and dietary patterns. A change in food habits towards healthier patterns could help reducing the burden of GRS.

Frequency and severity of irritable bowel syndrome in cigarette smokers, Turkey 2019

INTRODUCTION

Cigarette smoking has recently been associated with several gastrointestinal symptoms, and smoking cessation has been recommended as a lifestyle change strategy for irritable bowel syndrome (IBS). This study assessed the prevalence of IBS in cigarette smokers based on the Rome IV criteria, the severity of nicotine dependence, and the effect of smoking cessation in smokers with IBS.

METHODS

This prospective study included 371 smokers who attended smoking cessation treatment at family medicine clinics in a tertiary hospital between January and April 2019, in Turkey. Data on demographic characteristics, IBS status according to the Rome IV criteria, and Fagerström test for nicotine dependence (FTND) scores were collected during face-to-face interviews.

RESULTS

The mean patient age was 40.7 ± 11.96 years. Out of the total patients, 29.4% were heavy smokers, and 18.1% had IBS. There was a significant difference in age (p=0.03), duration of smoking (p=0.05), FTND score (p=0.02), and sex (p<0.001) between those with and without IBS. Logistic regression analyses identified female sex as a predictor of IBS in smokers (adjusted odds ratio, AOR=1.78; 95% CI: 1.18-2.69; p=0.006). At follow-up at 1 year, IBS(+) smokers who had quit smoking showed decreased gastrointestinal symptoms (p=0.035).

CONCLUSIONS

FTND score was higher in IBS(+) smokers than in IBS(-) smokers. Smoking cessation ameliorated gastrointestinal symptoms but did not affect IBS status.

Functional gastrointestinal disorders in women with systemic lupus erythematosus: A case-control study

BACKGROUND

Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystemic involvement. Gastrointestinal (GI) manifestations are frequent but functional gastrointestinal disorders (FGIDs) have scarcely been studied in SLE. To determine the prevalence of FGIDs and their potential risk factors in SLE female patients vs controls.

METHODS

Systemic lupus erythematosus patients meeting the American College of Rheumatology (ACR) criteria and controls completed the Rome III questionnaire for FGIDs and a structured interview to assess sociodemographic, clinical, and treatment variables after excluding organic GI diseases. Logistic regression was used to determine risk factors (ie, alcohol drinking, medications) for FGIDs.

KEY RESULTS

Responders included 113 SLE patients and 122 age-matched controls. The presence of at least one FGIDs was higher in SLE (73.4%) vs controls (54.1%), P = .003. The most frequent FGIDs in SLE patients were nausea and vomiting disorders (NVD), belching disorders, globus, anorectal pain, functional heartburn (FH), and functional bloating (FB). After adjustment for confounding variables, SLE was associated with NVD (OR: 7.1, 95% CI: 2.7-19.1) globus (3.5, 1.3-9.3), anorectal pain (3.4, 1.4-8.4), and FH (2.5, 1.5-4.4). The simultaneous presence of >1 FGID was more common in SLE patients than controls (69.8% vs 31.8%). Glucocorticoids (5.2, 1.3-19.9) and non-steroidal anti-inflammatory drugs (NSAIDs; 3.0, 1.1-8.0) were associated with any FGID in SLE patients while alcohol drinking with gallbladder/sphincter of Oddi disorders 7.4 (1.1-47.3).

CONCLUSIONS AND INFERENCES

Functional gastrointestinal disorders are more frequent in SLE patients compared with controls. Medication that may alter gastrointestinal homeostasis, such as glucocorticoids and NSAIDs, are potential risk factors for FGIDs in SLE.

Consumption of a Fermented Milk Product Containing Bifidobacterium lactis CNCM I-2494 in Women Complaining of Minor Digestive Symptoms: Rapid Response Which Is Independent of Dietary Fibre Intake or Physical Activity

Background. Minor digestive symptoms are common and dietary approaches such as probiotic administration or fibre and fermentable carbohydrate intake adjustments are often recommended. A Fermented Milk Product (FMP) containing Bifidobacterium animalis subsp. lactis CNCM I-2494 and lactic acid bacteria has been shown to improve digestive symptoms after 4 weeks of consumption, but the speed of onset of this effect and its dependence on fibre intake or physical activity is unknown. To answer these questions, data from two previously published trials on FMP for minor digestive symptoms were combined. Methods. In total, 538 participants provided weekly assessments of bloating, abdominal pain/discomfort, flatulence, borborygmi/rumbling stomach from which a composite score was calculated. At baseline in one study (n = 336), dietary fibre consumption was recorded and physical activity classified as high, moderate or low. The speed of the FMP's effect was assessed by a repeated measure analysis of variance measuring the change from baseline for the composite score of digestive symptoms. Results. FMP consumption resulted in a significant decrease in the composite score of symptoms after only 2 weeks in both studies and the pooled data at week 1 (-0.35 [-0.69, 0.00]; p = 0.05), week 2 (-0.66 [-1.04, -0.27]; p < 0.001), week 3 (-0.49 [-0.89, -0.10]; p = 0.01) and week 4 (-0.46 [-0.88, -0.04]; p = 0.03). The interactions fibre intake-by-product group, physical activity-by-product group and time-by-product group were not statistically significant. Conclusion. FMP consumption leads to a rapid improvement in symptoms which is likely to encourage adherence to this dietary intervention. This effect is independent of dietary fibre and physical activity.