Chronic gastrointestinal symptoms and quality of life in the Korean population

The efficacy of probiotics, prebiotics or synbiotics in scleroderma: A systematic review

INTRODUCTION

Pathogenesis of systemic scleroderma is a complex subject. Previous research has emphasized a possible contribution of the intestinal microbiome in developing symptoms. The use of probiotic formulas brings benefit in treatment of various autoimmune diseases, but the evidence for scleroderma is still not exhaustive. No official recommendations have been formulated on this topic, nor has the existing evidence been evaluated.

OBJECTIVE

We aimed to assess the efficacy of probiotics, prebiotics, or synbiotics in patients with scleroderma with a focus on the improvement of symptoms and change in the quality of life (QoL) both measured using validated scales, small intestinal bacterial overgrowth (SIBO) eradication, as well as change in the intensity of interstitial lung disease and occurrence of pulmonary hypertension.

METHODS

We performed a systematic search for randomized trials that assessed the beneficial and harmful effects of pro-, pre-, and synbiotics in patients with scleroderma. Pairs of authors independently selected studies for inclusion, extracted data, and assessed the risk of bias (RoB) of the included studies. We examined the certainty of evidence in accordance with the GRADE approach.

RESULTS

We screened 1801 references (after the removal of duplicates), and assessed 16 citations in full text. We identified four randomized controlled trials (RCTs) with 103 participants in intervention and 87 in control groups. The evidence suggests that probiotic intake may not affect gastrointestinal symptoms measured with Visual Analogue Scale for Gastrointestinal Tract (VAS-GIT) (change in the VAS-GIT: MD 0.04, 95% CI -0.31 to 0.40, low certainty, n = 56 probiotic group, n = 57 placebo group) and the evidence is very uncertain about the effect on gastrointestinal symptoms measured with The University of California Los Angeles Scleroderma Clinical Trial Consortium GIT 2.0 instrument (UCLA GIT 2.0) (change in the UCLA GIT 2.0 - total score: MD -0.18 95% CI -0.44, 0.07, very low certainty, n = 76 probiotic group, n = 74 placebo group). Meta-analysis showed that probiotic intake may slightly improve the social functioning measured with UCLA GIT 2.0 compared to placebo (MD -0.21, 95% CI -0.32 to -0.10, low certainty, n = 57 probiotic group, n = 53 placebo group), yet may result in little to no difference in physical functioning measured with Health Assessment Questionnaire-Disability Index (HAQ-DI) (MD 0.08, 95% CI -0.15 to 0.32, low certainty, n = 56 probiotic group, n = 57 placebo group) and frequency of adverse events, change in QoL and SIBO eradication. We did not find any studies addressing the effect of pro-, pre-, or synbiotics on interstitial lung disease or pulmonary hypertension. The certainty of evidence was low to very low mainly due to high RoB (lack of blinding, incomplete reporting) and imprecision.

- CONCLUSIONS

We were unable to definitively prove a positive or negative effect of probiotic intake in patients with systemic sclerosis. The results should be interpreted with caution due to low or very low certainty of evidence and would need more confirmation from strain and dose specific RCTs at a lower RoB.

The effect of mindfulness-based cognitive therapy on the Clinical efficacy and psychological state in patients with functional dyspepsia

BACKGROUND AND AIM

To observe the clinical therapeutic effect and mental state of mindfulness-based cognitive therapy (MBCT) in patients with functional dyspepsia (FD).

METHODS

In this study, 80 patients suffering from FD in an outpatient clinic were enrolled from January to December 2020. Patients were randomly allocated into the control group (conventional treatment) and observation group (MBCT treatment). Patients in the control group were prescribed rabeprazole and mosapiride, and patients in the observation group were given MBCT therapy in addition to the above drugs. After treatment for 8 weeks, the changes in gastrointestinal symptom scores, anxiety, depression, mindfulness and sleep quality and gastric emptying testing were compared between these two groups.

RESULTS

The observation group showed strikingly lower gastrointestinal symptom scores, SAS, SDS, PSQI, and SCL-90 scale scores, and higher FFMQ scale scores than the control group (p < 0.05). There was no conspicuous change in gastric emptying monitoring (p > 0.05).

CONCLUSIONS

MBCT therapy can improve patients' gastrointestinal symptoms, attenuate their anxiety and depression levels, and ameliorate their sleep quality.

Trends in hospital admissions and prescribing due to diseases of the digestive system in England and Wales between 1999 and 2019: An ecological study

This study aimed to investigate the trends in diseases of the digestive system hospital admissions (DDSHA) in England and Wales between (1999-2019). Secondary objectives were to investigate the type of admission and medication prescribing related to the digestive system in England. This is an ecological study using data from the Hospital Episode Statistics (HES) database and the Patient Episode Database between April 1999 and March 2019. The rate of hospital admissions with 95% confidence intervals (CIs) was calculated by dividing the number of DDSHA by the mid-year population. The trend in hospital admissions was assessed using a Poisson model. Overall, the rate of DDSHA rose by 84.2% (from 2231.27 [95% CI 2227.26-2235.28] in 1999 to 4109.33 [95% CI 4104.29-4114.38] in 2019 per 100,000 persons, trend test, P < .001). The most remarkable rise in hospital admission was seen in liver diseases, followed by other diseases of intestines with 1.85-fold, and 1.59-fold, respectively. Between 2004 and 2019, the overall prescribing rate for medications related to the gastrointestinal system increased by 74.6%, and stoma care related medications prescribing rate increased by 2.25-fold, followed by drugs affecting intestinal secretions and antisecretory drugs and mucosal protectants. There was an increase in hospital admission rate due to GI diseases in the United Kingdom (UK) by 84.2% from 1999 to 2019. The most remarkable rise in the rate of hospital admissions was seen in diseases of the liver and intestine.

Negative Impact of Disorders of Gut-Brain Interaction on Health-Related Quality of Life: Results From the Rome Foundation Global Epidemiology Survey

BACKGROUND & AIMS

This study used the database from the Rome Foundation Global Epidemiology Survey to assess the differences in quality of life overall, and by age and sex, across individual disorders of gut-brain interaction (DGBI), gastrointestinal anatomical region(s), and number of overlapping DGBI.

METHODS

Data were collected via the Internet in 26 countries, using the Rome IV diagnostic questionnaire and a supplemental questionnaire including the Patient-Reported Outcomes Measurement Information Systems Global-10 quality of life measure. Factorial analyses of variance were used to explore physical and mental quality of life, adjusting for multiple comparisons.

RESULTS

Among the 54,127 respondents, quality of life deteriorated significantly with increasing number of overlapping DGBI, with respondents reporting ≥2 DGBI having significantly poorer quality of life than those with only 1 DGBI or those without any DGBI. Men with DGBI reported better quality of life than women, and those aged ≥65 years reported better quality of life than those <65 years. Age, sex, number of overlapping DGBI, somatization, anxiety, depression, and functional experiences (concern, embarrassment, or stress associated with bowel functioning) relating to DGBI, were significant predictors of poorer physical and mental quality of life.

CONCLUSIONS

This study is the most comprehensive assessment of quality of life to date in adults living with a DGBI. It provides a representative picture of DGBI impact on adults in the global adult population and highlights the significant detrimental impact of living with a DGBI on quality of life.

Quality of life in Indian patients with functional dyspepsia: Translation and validation of the Hindi version of Short-Form Nepean Dyspepsia Index

BACKGROUND/PURPOSE

Patients with functional dyspepsia (FD) have poor health-related quality of life (HRQOL), but Indian data are  lacking. Also, there is non-availability of validated disease-specific questionnaire to assess HRQOL in Hindi-speaking patients with dyspepsia. We aimed to develop and validate a reliable translation of Short-Form Nepean Dyspepsia Index (SF-NDI) in Hindi, and assess the impact of FD on HRQOL in Indian patients.

METHODS

Cross-cultural adaptation of English version of SF-NDI, translation to Hindi, and adaptation of Hindi version were performed using standard procedures. English and Hindi versions were assessed against Short Form-36 (SF-36), examining for internal consistency, test-retest reliability, and validity.

RESULTS

Total 211 FD patients (144 Hindi speaking, 67 English speaking) were enrolled (mean age 40.8 ± 11.7 years; male:female = 115:96). Median total SF-NDI scores for both languages were 38.75 and 40.0, respectively. Test-retest reliability intraclass correlation coefficients were 0.85 (Hindi) and 0.89 (English). Internal consistency evaluation revealed Cronbach's α coefficient of 0.79-0.86 (Hindi) and 0.78-0.89 (English). SF-NDI sub-scales showed moderate to good correlation with various domains of SF-36 (content validity). There was significant (p < 0.001) decline of HRQOL in patients with severe dyspepsia relative to those with mild dyspepsia (construct validity). On multivariate analysis, factors independently associated with HRQOL were duration of symptoms and dyspepsia severity.

CONCLUSION

Both English and Hindi versions of SF-NDI are reliable and valid for HRQOL assessment in Indian FD patients, and will be useful in future epidemiological and clinical studies. Indian FD patients have poor HRQOL, being worse in those with severe dyspepsia and longer duration of symptoms.

Associations between Abnormal Eating Styles and Irritable Bowel Syndrome: A Cross-Sectional Study among Medical School Students

(1) Background: Few studies have investigated the association between eating styles and IBS. This study aimed to explore the association between abnormal eating styles and irritable bowel syndrome (IBS). (2) Methods: This cross-sectional study investigated students in China Medical University and Shenyang Medical College. Eating styles were evaluated by the Dutch Eating Behavior Questionnaire (DEBQ), and IBS was diagnosed according to Rome III criteria. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). (3) Results: A total of 335 students were diagnosed with IBS. Students with the total scores in tertile 2 and 3 had 1.29 times and 2.75 times higher risk of IBS than students with the total scores in tertile 1, respectively. Simultaneously, the risk of IBS in the tertile 3 of external eating, emotional eating, and restraint eating trends was 3.87 times, 2.71 times, and 3.82 times higher than that of tertile 1, respectively. (4) Conclusions: this study showed that a high score in both total eating styles and each eating style was associated with the odds of having IBS and suggested that the psychological factors behind eating styles may play a critical role in controlling the IBS.

Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis

BACKGROUND

Functional constipation is a common functional bowel disorder in the community, which has a varying prevalence across cross-sectional surveys. We did a contemporaneous systematic review and meta-analysis of studies using comparable methodology and all iterations of the Rome criteria to estimate the global prevalence of functional constipation.

METHODS

In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Embase Classic from Jan 1, 1990, to Dec 31, 2020, to identify population-based cross-sectional studies comprising at least 50 participants that reported the prevalence of functional constipation in adults (age 18 years and older) according to Rome I, II, III, or IV criteria. We excluded studies that reported the prevalence of functional constipation in convenience samples. We extracted prevalence estimates of functional constipation from eligible studies, according to the study criteria used to define it. For each study, we extracted data for country; method of data collection; criteria used to define functional constipation; whether the study used the Rome I, II, III, or IV diagnostic questionnaires or approximated these definitions of the condition using another questionnaire; the total number of participants providing complete data; age; the number of participants with the condition; the number of male and female participants; and the number of male and female participants with the condition. We calculated pooled prevalence, odds ratios (OR), and 95% CIs.

FINDINGS

Of 8174 citations evaluated, 45 studies fulfilled the eligibility criteria, representing 80 separate populations and comprising 275 260 participants. The pooled prevalence of functional constipation was 15·3% (95% CI 8·1-24·4, I2=99·4%) in studies using the Rome I criteria, 11·2% (7·9-14·9; I2=99·6%) in studies that used Rome II criteria, 10·4% (6·5-14·9; I2=99·8%) in those that used Rome III criteria, and 10·1% (8·7-11·6; I2=98·2%) when Rome IV criteria were used. Prevalence of functional constipation was higher in women, irrespective of the Rome criteria used (OR 2·40 [95% CI 2·02-2·86] for Rome I, 1·94 [1·46-2·57] for Rome II, and 2·32 [1·85-2·92] for Rome III; no studies using Rome IV criteria reported prevalence by sex). There was significant heterogeneity between studies in all of our analyses, which persisted even when the same criteria were applied and similar methodologies used.

INTERPRETATION

Even when uniform symptom-based criteria are used to define the presence of functional constipation, prevalence varies between countries. Thus, environmental, cultural, ethnic, dietary, or genetic factors can influence reporting of symptoms. Future studies should aim to elucidate reasons for this geographical variability.

FUNDING

None.

Potential risk factors for constipation in the community

Constipation is a common community health problem. There are many factors that are widely thought to be associated with constipation but real-world evidence of these associations is difficult to locate. These potential risk factors may be categorised as demographic, lifestyle and health-related factors. This review presents the available evidence for each factor by an assessment of quantitative data from cross-sectional studies of community-dwelling adults published over the last 30 years. It appears that there is evidence of an association between constipation and female gender, residential location, physical activity and some health-related factors such as self-rated health, some surgery, certain medical conditions and certain medications. The available evidence for most other factors is either conflicting or insufficient. Therefore, further research is necessary to determine if each factor is truly associated with constipation and whether it can be regarded as a potential risk factor. It is recommended that studies investigating a broad range of factors are conducted in populations in community settings. Multivariate analyses should be performed to account for all possible confounding factors. In this way, valuable evidence can be accumulated for a better understanding of potential risk factors for constipation in the community.

The Influence of Gastroesophageal Reflux Disease on Daytime Sleepiness and Depressive Symptom in Patients With Obstructive Sleep Apnea

Background/Aims

As there is insufficient evidence for a relationship between gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA), we investigated whether OSA diagnosed by polysomnography (PSG) is related to GERD.

Methods

A total of 402 subjects was evaluated. Overnight PSG was performed and a few questionnaires on GERD, anxiety, depression, and daytime sleepiness were administered. An apnea-hypopnea index < 5 was the classification criterion for subjects without OSA. Subjects with heartburn or acid regurgitation at least once a week were classified as having GERD.

Results

Among the 402 subjects, 318 had OSA and 84 did not. The prevalence of GERD was 12.9% among patients with OSA and 10.7% among those without (P = 0.590). The prevalence of GERD did not correlate with OSA severity (P = 0.474). Patients with OSA with GERD had higher Stanford Sleepiness Scale (P = 0.004), Epworth Sleepiness Scale (P = 0.001), and depression (P < 0.001) scores than patients with OSA without GERD. Subjects with nocturnal gastroesophageal reflux symptoms had a higher body mass index, waist-to-height ratio, and waist circumference-to-height index than those without symptoms. Multiple logistic regression showed that higher Epworth Sleepiness Scale and depression scores were independent factors associated with GERD in patients with OSA.

Conclusions

The prevalence of GERD in patients with OSA was 12.9%. The prevalence of GERD did not correlate with OSA severity. Daytime sleepiness and depression seem to be associated with GERD in patients with OSA, while nocturnal reflux symptoms seem to be related to obesity in OSA.

Laxative Use in the Community: A Literature Review

Laxatives are widely available without prescription and, as a consequence, they are commonly used for self-management of constipation by community-dwelling adults. However, it is not clear to what extent laxatives are used. Nor is it clear how laxatives are chosen, how they are used and whether consumers are satisfied with their performance. This review of published literature in the last 30 years shows the prevalence of laxative use in community-dwelling adults varied widely from 1% to 18%. The prevalence of laxative use in adults with any constipation (including both chronic and sporadic constipation) also varied widely from 3% to 59%. Apart from any geographical differences and differences in research methodologies, this wide range of estimated prevalence may be largely attributed to different definitions used for laxatives. This review also shows that laxative choice varies, and healthcare professionals are infrequently involved in selection. Consequently, satisfaction levels with laxatives are reported to be low and this may be because the laxatives chosen may not always be appropriate for the intended use. To improve constipation management in community and primary healthcare settings, further research is required to determine the true prevalence of laxative use and to fully understand laxative utilisation.

Systematic review with meta-analysis: global prevalence of uninvestigated dyspepsia according to the Rome criteria

BACKGROUND

Prevalence of uninvestigated dyspepsia varies across cross-sectional surveys. This may be due to differences in definitions used or study methodology, rather than global variability.

AIM

To determine the global prevalence of uninvestigated dyspepsia according to Rome criteria.

METHODS

MEDLINE and EMBASE were searched to identify population-based studies reporting prevalence of uninvestigated dyspepsia in adults (≥18 years old) according to Rome I, II, III or IV criteria. Prevalence of uninvestigated dyspepsia was extracted, according to criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, odds ratios (OR), and 95% confidence intervals (CIs) were calculated.

RESULTS

Of 2133 citations evaluated, 67 studies fulfilled eligibility criteria, representing 98 separate populations, comprising 338 383 subjects. Pooled prevalence ranged from 17.6% (95% CI 9.8%-27.1%) in studies defining uninvestigated dyspepsia according to Rome I criteria, to 6.9% (95% CI 5.7%-8.2%) in those using Rome IV criteria. Postprandial distress syndrome was the commonest subtype, occurring in 46.2% of participants using Rome III criteria, and 62.8% with Rome IV. Prevalence of uninvestigated dyspepsia was up to 1.5-fold higher in women, irrespective of the definition used. There was significant heterogeneity between studies in all our analyses, which persisted even when the same criteria were applied and similar methodology was used.

CONCLUSIONS

Even when uniform symptom-based criteria are used to define the presence of uninvestigated dyspepsia, prevalence varies between countries. This suggests that there are environmental, cultural, ethnic, dietary or genetic influences determining symptoms.

Global Prevalence and Risk Factors of Gastro-oesophageal Reflux Disease (GORD): Systematic Review with Meta-analysis

Although gastro-oesophageal reflux disease (GORD) is a common medical complaint, there is currently no consensus on the global prevalence of GORD. The aim of this study was to conduct a systematic review and meta-analysis on GORD prevalence and risk factors at a global level. MEDLINE, EMBASE, CINAHL, Scopus, Cochrane library, and Google Scholar were systematically searched, without language restrictions, for studies on the prevalence and risk factors of GORD. Data were pooled using a random effects model (95% confidence interval), and the odds ratio and relative risk for each risk factor were calculated. Out of 34,355 search results, 96 records reporting the results from 102 studies fulfilled the inclusion criteria, representing 37 countries and all regions of the UN geoscheme. The global pooled prevalence of GORD was 13.98% and varied greatly according to region (12.88% in Latin America and the Caribbean to 19.55% in North America) and country (4.16% in China to 22.40% in Turkey). Using the United Nations 2017 Revision of World Population Prospects, the estimated number of individuals suffering from GORD globally is 1.03 billion. Multiple risk factors associated with a significant increase in the risk of GORD were also identified. This systematic review and meta-analysis revealed that although a substantial proportion (13.98%) of the global population suffers from GORD, there are significant variations between regions and countries. Risk factors for GORD were also identified which may allow clinicians to recognise individuals most at risk.

The burden of irritable bowel syndrome and chronic constipation on health-related quality of life in black Africans: a comparison with healthy control subjects in Côte d'Ivoire, West Africa

Background: Although patients with irritable bowel syndrome (IBS) and chronic constipation (CC) have an impaired health-related quality of life (HRQoL), little is known in black African patients compared with control subjects. This study provided the magnitude and the influencing factors of HRQoL impairment in black African outpatients with IBS or CC compared with control subjects using the generic SF-36 questionnaire. Materials and methods: One hundred and four consecutive black African outpatients complaining with IBS (n=72, mean age=38.9 years, female=62.5%) and CC (n=32, mean age=37.4 years, female=75%) met Rome 3 criteria were compared with 210 control subjects (mean age=37.4 years, 63.8% male). The SF-36 scores in all domains of HRQoL with the corresponding physical (PCS) and mental (MCS) composite scores between groups were compared with post hoc analysis and multivariate linear regression analysis for the assessment of the influencing factors. Results: Overall, IBS and CC patients exhibited low SF-36 scores in the 8 domains of HRQoL in comparison with control subjects. IBS patients scored less in mental health (mean difference=-10.3, p=0.001), bodily pain (mean difference=-23.5, p≤0.0001), and social functioning domains (mean difference =-15.1, p=0.01) in comparison with CC patients. Post hoc analysis demonstrated a trend down of PCS (mean difference=-12.9, p<0.0001) and MCS (mean difference=-11.2, p=0.01) disfavoring IBS patients than those with CC in comparison with control subjects. In multivariate linear regression analysis, besides the negative impact of IBS and CC, factors influencing PCS were BMI (β=0.4; p=0.01) and comorbidities (β=-5.9; p=0.002). Those influencing MCS were the presence of remunerated activity (β=2.7, p=0.02), and patient living alone (β=9.4; p=0.04). Conclusion: IBS and CC impact negatively on the HRQoL in black African subjects and more importantly in those with IBS than CC.

Burden of Gastrointestinal Symptoms in the United States: Results of a Nationally Representative Survey of Over 71,000 Americans

OBJECTIVES

Digestive diseases account for >100 million ambulatory care visits annually in the U.S. Yet, comparatively less is known about the true burden of gastrointestinal (GI) symptoms in the general U.S.

POPULATION

The aim of this study was to use data from the "National GI Survey"-a population-based audit of GI symptoms in >71,000 participants-to determine the prevalence and predictors of GI symptoms in community-dwelling Americans.

METHODS

We conducted the National GI Survey using a mobile app called MyGiHealth, which employs a computer algorithm that systematically collects participants' GI symptoms. We recruited a nationally representative sample of Americans to complete the survey, which guided respondents through National Institutes of Health (NIH) GI Patient Reported Outcome Measurement Information System (PROMIS®) scales along with questions about relevant comorbidities and demographics. We measured the prevalence of GI symptoms in the past week and employed logistic regression to adjust for confounding.

RESULTS

Overall, 71,812 individuals completed the survey, of which 61% reported having had ≥1 GI symptom in the past week. The most commonly reported symptoms were heartburn/reflux (30.9%), abdominal pain (24.8%), bloating (20.6%), diarrhea (20.2%), and constipation (19.7%). Less common symptoms were nausea/vomiting (9.5%), dysphagia (5.8%), and bowel incontinence (4.8%). Females, non-Hispanic whites, and individuals who were younger, highly educated, and had medical comorbidities were more likely to have symptoms (all adjusted p < 0.05).

CONCLUSIONS

In this large population-based study that combined digital health technology with NIH PROMIS questionnaires, we found that GI symptoms are highly prevalent, as nearly two thirds of surveyed Americans are burdened by these symptoms.

A Randomized, Double-Blind, Multicenter, Placebo-Controlled Trial of Qi-Zhi-Wei-Tong Granules on Postprandial Distress Syndrome-Predominant Functional Dyspepsia

BACKGROUND

Functional dyspepsia (FD) is a common upper gastrointestinal disorder worldwide, but the current treatments for FD are still unsatisfactory. The aims of this study were to investigate the efficacy and safety of Qi-Zhi-Wei-Tong granules in patients with postprandial distress syndrome (PDS)-predominant FD.

METHODS

The study was conducted as a randomized, double-blinded, multicenter, placebo-controlled design in 197 patients with PDS. All participants received placebo treatment for 1 week. Patients whose total symptom score decreased by <50% after the placebo treatment were recruited into the 4-week treatment period, in which they were randomly assigned to be treated with either Qi-Zhi-Wei-Tong granules or placebo. The patients were then followed for 2 weeks without any treatment. Dyspeptic symptoms were scored at weeks 2 and 4 during the random treatment period and 2 weeks after the treatment. Anxiety and depression symptoms were also scored and compared.

RESULTS

(1) The total effective rates in the Qi-Zhi-Wei-Tong granules group at weeks 2 and 4 during the random treatment period and 2 weeks after treatment were all significantly higher than those in the placebo group (38.82% vs. 8.75%, P < 0.001; 69.14% vs. 16.25%, P < 0.001; 77.65% vs. 21.25%, P < 0.001). (2) The total dyspeptic symptoms scores in the Qi-Zhi-Wei-Tong granules group at weeks 2 and 4 and 2 weeks after treatment were significantly lower than those in the placebo group. (3) The severity and frequency of each dyspeptic symptom at weeks 2 and 4 and the follow-up period were all significantly lower than those in the placebo group. (4) The anxiety scores in the Qi-Zhi-Wei-Tong granules group were significantly lower than those in the placebo group. (5) Qi-Zhi-Wei-Tong granules did not have more adverse effects than the placebo.

CONCLUSION

Qi-Zhi-Wei-Tong granules offer significant symptomatic improvement in PDS with no more adverse effects than placebo.

TRIAL REGISTRATION

https://clinicaltrials.gov/, NCT02460601.

Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis

OBJECTIVES

Gastro-oesophageal reflux symptoms are common in the community, but there has been no definitive systematic review and meta-analysis of data from all studies to estimate their global prevalence, or potential risk factors for them.

DESIGN

Medline, Embase and Embase Classic were searched (until September 2016) to identify population-based studies that reported the prevalence of gastro-oesophageal reflux symptoms in adults (≥15 years); gastro-oesophageal reflux was defined using symptom-based criteria or questionnaires. The prevalence was extracted for all studies, and according to the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, OR and 95% CIs were calculated.

RESULTS

Of the 14 132 citations evaluated, 102 reported the prevalence of gastro-oesophageal reflux symptoms in 108 separate study populations, containing 460 984 subjects. Prevalence varied according to country (from 2.5% in China to 51.2% in Greece) and criteria used to define gastro-oesophageal reflux symptoms. When only studies using a weekly frequency of heart burn or regurgitation to define presence were considered, pooled prevalence was 13.3% (95% CI 12.0% to 14.6%). Prevalence was higher in subjects ≥50 years (OR 1.32; 95% CI 1.12 to 1.54), smokers (OR 1.26; 95% CI 1.04 to 1.52), non-steroidal anti-inflammatory drug (NSAID)/aspirin users (OR 1.44; 95% CI 1.10 to 1.88) and obese individuals (OR 1.73; 95% CI 1.46 to 2.06).

CONCLUSIONS

The prevalence of gastro-oesophageal reflux symptoms varied strikingly among countries, even when similar definitions were used to define their presence. Prevalence was significantly higher in subjects ≥50 years, smokers, NSAID users and obese individuals, although these associations were modest.

Wake-up Call to Clinicians: The Impact of Sleep Dysfunction on Gastrointestinal Health and Disease

Sleep dysfunction is an epidemic affecting a large portion of the adult population. Recent studies have linked sleep dysfunction with an upregulation of proinflammatory cytokines (eg, tumor necrosis factor-α, interleukin-1 and interleukin-6), the implications of which can have a profound impact on a variety of gastrointestinal disease. In particular, sleep dysfunction seems to accelerate disease states characterized by inflammation (eg, gastroesophageal reflux disease, irritable bowel syndrome and functional dyspepsia, chronic liver disease, inflammatory bowel disease, and colorectal cancer). This article evaluates the complex interplay between sleep dysfunction and gastrointestinal health and disease.

Irritable bowel syndrome in Asia: Pathogenesis, natural history, epidemiology, and management

Historically, the epidemiology of gastrointestinal diseases in Asia was different from that in Western countries. Early studies suggested a low prevalence of irritable bowel syndrome (IBS) in Asia. As the diagnosis of IBS is symptom-based and as symptom perception, expression, and interpretation are influenced by sociocultural perspectives including language, the presentation of IBS is expected to vary in different communities. Furthermore, the pathogenesis is multifactorial with psychosocial (stress, illness, behavior, and diet) and biological (infection, gut microbiota, and immune activation) variables interacting, and so, the present study can anticipate that the development of IBS will vary in different environments. In recognition of this aspect of functional gastrointestinal disorders, the recently published Rome IV documents have provided greater focus on cross-cultural factors. In this review, the present study seeks to highlight Asian perspectives by identifying historical trends and recent publications from the region and comparing these with the observations from Western societies.

[Pharmacotherapy in Patients with Chronic Constipation]

Chronic constipation is one of the most common digestive diseases frequently observed in a clinical setting. It has been known to cause considerable damage to the quality of life of patients. Despite recent developments, there are considerable limitations in the use of constipation-modulating agents in Korea. Chloride channel inhibitors, such as lubiprostone and linaclotide, have not been introduced in Korea yet, and prucalopride and several kinds of polyethylene glycol are not covered under medical insurance. This article assesses medicines that are clinically available for the management of constipation in Korea, with a brief review of agents that have recently developed around the world.

Constipation: Prevalence and Associated Factors in Adults Living in Londrina, Southern Brazil

The aims of this study were to estimate the prevalence of constipation and identify associated factors among adults living in an urban area in Londrina, Brazil. This was a secondary analysis of an epidemiological, population-based study on bowel habit performed in 2008 with 2,162 individuals selected through cluster sampling. Interviews were administered using a sociodemographic questionnaire and the adapted and validated Brazilian version of the "Bowel Function in the Community" tool. Variables from the original database were used to determine the prevalence of constipation (according to the Rome Criteria III) and associated factors. The chi-square test and multivariate logistic regression were used for data analysis. The overall prevalence of constipation (14.6%; n = 315) was higher among women than among men (21.9% vs. 5.3%), increased with age among men, and was inversely related to family income. Overall, female gender, low socioeconomic status, history of anal fissure, anorectal surgery, stroke, nervous system disease, fistulae, and hemorrhoids were factors significantly associated with constipation. The variables low social economic status, stroke, anal fissure history, and anorectal surgery were statistically significant in all three tested statistical models.

The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review

OBJECTIVES

The global prevalence of IBS is difficult to ascertain, particularly in light of the heterogeneity of published epidemiological studies. The aim was to conduct a literature review, by experts from around the world, of community-based studies on IBS prevalence.

DESIGN

Searches were conducted using predetermined search terms and eligibility criteria, including papers in all languages. Pooled prevalence rates were calculated by combining separate population survey prevalence estimates to generate an overall combined meta-prevalence estimate. The heterogeneity of studies was assessed.

RESULTS

1451 papers were returned and 83, including 288 103 participants in 41 countries, met inclusion criteria. The mean prevalence among individual countries ranged from 1.1% in France and Iran to 35.5% in Mexico. There was significant variance in pooled regional prevalence rates ranging from 17.5% (95% CI 16.9% to 18.2%) in Latin America, 9.6% (9.5% to 9.8%) in Asia, 7.1% (8.0% to 8.3%) in North America/Europe/Australia/New Zealand, to 5.8% (5.6% to 6.0%) in the Middle East and Africa. There was a significant degree of heterogeneity with the percentage of residual variation due to heterogeneity at 99.9%.

CONCLUSIONS

The main finding is the extent of methodological variance in the studies reviewed and the degree of heterogeneity among them. Based on this, we concluded that publication of a single pooled global prevalence rate, which is easily calculated, would not be appropriate or contributory. Furthermore, we believe that future studies should focus on regional and cross-cultural differences that are more likely to shed light on pathophysiology.

Change in the Interstitial Cells of Cajal and nNOS Positive Neuronal Cells with Aging in the Stomach of F344 Rats

The gastric accommodation reflex is an important mechanism in gastric physiology. However, the aging-associated structural and functional changes in gastric relaxation have not yet been established. Thus, we evaluated the molecular changes of interstitial cell of Cajal (ICC) and neuronal nitric oxide synthase (nNOS) and the function changes in the corpus of F344 rats at different ages (6-, 31-, 74-wk and 2-yr). The proportion of the c-Kit-positive area in the submucosal border (SMB) and myenteric plexus (MP) layer was significantly lower in the older rats, as indicated by immunohistochemistry. The density of the nNOS-positive immunoreactive area also decreased with age in the SMB, circular muscle (CM), and MP. Similarly, the percent of nNOS-positive neuronal cells per total neuronal cells and the proportion of nNOS immunoreactive area of MP also decreased in aged rats. In addition, the mRNA and protein expression of c-Kit and nNOS significantly decreased with age. Expression of stem cell factor (SCF) and the pan-neuronal marker PGP 9.5 mRNA was significantly lower in the older rats than in the younger rats. Barostat studies showed no difference depending on age. Instead, the change of volume was significantly decreased by L-NG63-nitroarginine methyl ester in the 2-yr-old rats compared with the 6-wk-old rats (P = 0.003). Taken together, the quantitative and molecular nNOS changes in the stomach might play a role in the decrease of gastric accommodation with age.

Epidemiology and risk factors of uninvestigated dyspepsia, irritable bowel syndrome, and gastroesophageal reflux disease among students of Damascus University, Syria

Uninvestigated dyspepsia (UD), irritable bowel syndrome (IBS), and gastroesophageal reflux disease (GERD) are common disorders universally. Many studies have assessed their epidemiological characteristics around the world. However, such information is not known for Syria. We aim to estimate the epidemiologic characteristics and possible risk factors for UD, IBS, and GERD among students at Damascus University, Damascus, Syria. A cross-sectional study was conducted in July-September 2015 at a campus of Damascus University. A total of 320 students were randomly asked to complete the survey. We used ROME III criteria to define UD and IBS, and Montreal definition for GERD. In total, 302 valid participants were included in the analysis. Prevalence for UD, IBS, and GERD was 25%, 17%, and 16%, respectively. Symptom overlap was present in 46 students (15%), with UD+IBS in 28 (9.3%), UD+GERD in 26 (8.6%), and IBS+GERD in 14 (4.6%) students. Eleven (3.6%) students had symptoms of UD+IBS+GERD. Each of these overlaps occurred more frequently than expected by chance. Significant risk factors included cigarettes smoking, waterpipe consumption, and body mass index <18.5kg/m² for UD; female gender and three cups of coffee/d for IBS; and two cups of tea and one to five cigarettes/d for GERD. Risk factors for these disorders remain poorly characterized and need further investigations.

Prevalence and Risk Factors of Gastroesophageal Reflux Disease in Patients with Type 2 Diabetes Mellitus

BACKGROUND

Gastrointestinal symptoms are common in patients with type 2 diabetes mellitus (T2DM). The prevalence of gastroesophageal reflux disease (GERD) in Korea appears to be increasing. Some studies have shown that T2DM is a risk factor for symptomatic GERD. However, this possibility is still debated, and the pathogenesis of GERD in T2DM is not yet fully understood. The aim of this study was to analyze the prevalence and risk factors (including autonomic neuropathy) of GERD in patients with T2DM.

METHODS

This cross-sectional case-control study enrolled T2DM patients (n=258) and healthy controls (n=184). All participants underwent physical examinations and laboratory tests. We evaluated medical records and long-term diabetes complications, including peripheral and autonomic neuropathy in patients with T2DM. Esophagogastroduodenoscopy was performed in all patients. The Los Angeles (LA) classification was used to grade GERD. GERD was defined as LA grade A (or higher) or minimal change with GERD symptoms. GERD symptoms were examined using a frequency scale. Data were expressed as mean±standard error. Independent t-tests or chi-square tests were used to make comparisons between groups.

RESULTS

The prevalence of GERD (32.6% vs. 35.9%, P=0.266) and GERD symptoms (58.8% vs. 59.2%, P=0.503) was not significantly different between T2DM patients and controls. We found no significant differences between T2DM patients with GERD and T2DM patients without GERD with respect to diabetic complications, including autonomic neuropathy, peripheral neuropathy, duration of DM, and glucose control.

CONCLUSION

The prevalence of GERD in patients with T2DM showed no difference from that of controls. GERD was also not associated with peripheral and cardiovascular autonomic neuropathy, age, or duration of DM in patients with T2DM.

Pharmacological and Safety Profile of Dexlansoprazole: A New Proton Pump Inhibitor - Implications for Treatment of Gastroesophageal Reflux Disease in the Asia Pacific Region

Although gastroesophageal reflux disease is not as common in Asia as in western countries, the prevalence has increased substantially during the past decade. Gastroesophageal reflux disease is associated with considerable reductions in subjective well-being and work productivity, as well as increased healthcare use. Proton pump inhibitors (PPIs) are currently the most effective treatment for gastroesophageal reflux disease. However, there are limitations associated with these drugs in terms of partial and non-response. Dexlansoprazole is the first PPI with a dual delayed release formulation designed to provide 2 separate releases of medication to extend the duration of effective plasma drug concentration. Dexlansoprazole has been shown to be effective for healing of erosive esophagitis, and to improve subjective well-being by controlling 24-hour symptoms. Dexlansoprazole has also been shown to achieve good plasma concentration regardless of administration with food, providing flexible dosing. Studies in healthy volunteers showed no clinically important effects on exposure to the active metabolite of clopidogrel or clopidogrel-induced platelet inhibition, with no dose adjustment of clopidogrel necessary when coprescribed. This review discusses the role of the new generation PPI, dexlansoprazole, in the treatment of gastroesophageal reflux disease in Asia.

Global prevalence of, and risk factors for, uninvestigated dyspepsia: a meta-analysis

OBJECTIVES

Many cross-sectional surveys have reported the prevalence of uninvestigated dyspepsia, but there has been no recent systematic review of data from all studies to determine its global prevalence and risk factors.

DESIGN

MEDLINE, EMBASE and EMBASE Classic were searched (until January 2014) to identify population-based studies that reported the prevalence of uninvestigated dyspepsia in adults (≥ 15 years old); dyspepsia was defined using symptom-based criteria or questionnaires. The prevalence of dyspepsia was extracted for all studies and according to the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, ORs and 95% CIs were calculated.

RESULTS

Of the 306 citations evaluated, 103 reported the prevalence of uninvestigated dyspepsia in 100 separate study populations, containing 312,415 subjects. Overall pooled prevalence in all studies was 20.8% (95% CI 17.8% to 23.9%). The prevalence varied according to country (from 1.8% to 57.0%) and criteria used to define dyspepsia. The greatest prevalence values were found when a broad definition of dyspepsia (29.5%; 95% CI 25.3% to 33.8%) or upper abdominal or epigastric pain or discomfort (20.4%; 95% CI 16.3% to 24.8%) were used. The prevalence was higher in women (OR 1.24; 95% CI 1.13 to 1.36), smokers (OR 1.25; 95% CI 1.12 to 1.40), non-steroidal anti-inflammatory drug (NSAID) users (OR 1.59; 95% CI 1.27 to 1.99) and Helicobacter pylori-positive individuals (OR 1.18; 95% CI 1.04 to 1.33).

CONCLUSIONS

The overall pooled prevalence of uninvestigated dyspepsia was 21%, but varied among countries and according to the criteria used to define its presence. Prevalence is significantly higher in women, smokers, NSAID users and H. pylori-positive individuals, although these associations were modest.

Systematic review: dietary fibre and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome

BACKGROUND

Dietary fibre supplements have been advocated for the management of chronic constipation (CC) and irritable bowel syndrome (IBS). Recently, a fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) restricted diet has been recommended for IBS.

AIM

To systematically examine recent evidence for dietary interventions with fibre in CC and IBS and FODMAP-restricted diet in IBS, and provide recommendations.

METHODS

We searched PUBMED, MEDLINE, OVID and COCHRANE databases from 2004 to 2014. Published studies in adults with CC and IBS and constipation-predominant IBS (IBS-C) that compared fibre with placebo/alternative and FODMAP-restricted diet with alternative were included.

RESULTS

Of 550 potentially eligible clinical trials on fibre, 11 studies were found and of 23 potentially eligible studies on FODMAPs, six were found. A meta-analysis was not performed due to heterogeneity and methodological quality. Fibre was beneficial in 5/7 studies in CC and 3/3 studies in IBS-C. FODMAP-restricted diet improved overall IBS symptoms in 4/4 and IBS-C symptoms in 1/3 studies and three studies did not meet inclusion criteria. There were significant disparities in subject selection, interventions and outcome assessments in both fibre and FODMAPs studies.

CONCLUSIONS

Fibre supplementation is beneficial in mild to moderate CC and IBS-C, although larger, more rigorous and long-term RCTs are needed (Fair evidence-Level II, Grade B). Although the FODMAP-restricted diet may be effective in short-term management of selected patients with IBS (Fair evidence-Level II, Grade C) and IBS-C (Poor evidence-Level III, Grade C), more rigorous trials are needed to establish long-term efficacy and safety, particularly on colonic health and microbiome.

Prevalence of constipation in the general adult population: an integrative review

Constipation affects multiple aspects of a person's health, including health-related quality of life. It is one of the most frequently reported functional gastrointestinal disorders. The purpose of this integrative review of the literature was to identify research findings pertaining to the prevalence of constipation and factors are associated with constipation in the general population. Electronic databases were searched for articles published between 2005 and 2011. All retrieved studies were evaluated with respect to quality according to the guidelines for critical appraisal of health research literature on prevalence and incidence. Eleven studies were retrieved; they reveal a prevalence of constipation that varied from 2.6% to 26.9%. The most frequently cited associated factors were female gender and advanced age, which were cited in 11 and 7 of the studies, respectively. Prevalence rates reported by the selected studies were heterogeneous. This may be partially attributed to variability in methods used to measure prevalence, including differences in criteria for constipation.

A rapid, simple questionnaire to assess gastrointestinal symptoms after oral ferrous sulphate supplementation

BACKGROUND

Oral iron supplementation is often associated with rapid onset of gastrointestinal side-effects. The aim of this study was to develop and trial a short, simple questionnaire to capture these early side-effects and to determine which symptoms are more discriminating.

METHODS

The study was a double-blind placebo-controlled randomized parallel trial with one week treatment followed by one week wash-out. Subjects were randomized into two treatment groups (n = 10/group) to receive either ferrous sulphate (200 mg capsules containing 65 mg of iron) or placebo, both to be taken at mealtimes twice daily during the treatment period. Subjects completed the questionnaires daily for 14 days. The questionnaire included gastrointestinal symptoms commonly reported to be associated with the oral intake of ferrous iron salts (i.e. nausea, vomiting, heartburn, abdominal pain, diarrhoea, and constipation).

RESULTS

Seventy five per cent of participants reporting the presence of one or more symptoms in the first week of the study were in the ferrous sulphate group. In the second week of the study (i.e. wash-out), 67% of the participants reporting one or more symptom(s) were in the ferrous sulphate group. In the first week of the study (treatment) the number of symptoms reported by participants in the ferrous sulphate group (mean ± SEM = 6.7 ± 1.7) was significantly higher than that for participants in the placebo group (1.2 ± 0.5) (p = 0.01). In the second week of the study (wash-out) the number of symptoms reported by participants in the ferrous sulphate group (4.6 ± 2.0) appeared higher than for participants in the placebo group (1.0 ± 0.7) although this did not reach significance (p = 0.12). Events for which the gastrointestinal symptom questionnaire was most discriminatory between ferrous sulphate and placebo groups were: heartburn, abdominal pain and the presence of black stools (all p ≤ 0.03).

CONCLUSIONS

A tool for the detection of commonly-occurring side effects should not require large study numbers to be effective. With just 10 subjects per group (iron or placebo), this simple questionnaire measures gastrointestinal side-effects associated with oral iron (ferrous sulphate) supplementation, and would be appropriate for use in intervention studies or clinical trials.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02146053 (21/05/2014).

Estimating the burden of irritable bowel syndrome: analysis of a nationwide korean database

Background/Aims

Management of irritable bowel syndrome (IBS) imposes a heavy economic burden. This study was to estimate the epidemiologic features of IBS and to report the IBS burden for the first time in the Korean population.

Methods

A cross-sectional study was conducted using the National Health Insurance (NHI) system database, which covers the entire population of Korea. IBS was defined as diagnostic code −10 in adults with any outpatient clinic visits or hospitalization related to IBS. We excluded diseases that mimic IBS symptoms.

Results

A total of 2.42 million (58.2% female) individuals were identified as patients with IBS, yielding an age- and gender-adjusted prevalence of 5.1% in males and 6.9% in females. The prevalence of IBS increased proportionally with age, with higher medical costs in middle-aged patients. Outpatient clinics were visited by 98.6% of IBS patients, and 1.9% were treated upon admission. Of these patients, 87.6% were given a prescription. Co-morbidities that commonly accompanied IBS included upper gastrointestinal (36.1%), respiratory (12.3%), musculoskeletal (8.0%) disease, somatoform (4.3%) and depression/anxiety disorders (3.1%). The NHI costs of IBS, which include the NHI covered cost and beneficiary copayment charges, were estimated to be 155 million USD, which accounts for 0.46% of the total NHI costs for the entire Korean population.

Conclusions

According to the Korean national claims database, about 6% of the Korean population seeks medical care for IBS at least once per year. This high prevalence places a large economic burden on the Korean healthcare system, accounting for 0.46% of overall national medical expenditure.

Association Between Non-erosive Reflux Disease and High Risk of Obstructive Sleep Apnea in Korean Population

Background/Aims

Obstructive sleep apnea is becoming more important in gastroesophageal reflux disease (GERD) patients. This study investigated the prevalence of high risk for obstructive sleep apnea in GERD patients in comparison with that in healthy controls using the Berlin Questionnaire. We also investigated the risk factors for obstructive sleep apnea in GERD patients.

Methods

We enrolled 1,007 subjects: 776 healthy controls, 115 individuals with erosive reflux disease, and 116 with non-erosive reflux disease. GERD was diagnosed and classified using endoscopy and a reflux questionnaire. The Berlin Questionnaire was used to evaluate obstructive sleep apnea.

Results

More patients in the GERD group (28.2%) had higher risk for obstructive sleep apnea than healthy controls (20.4%, P = 0.036). More patients with non-erosive disease (32.8%) had higher risk for obstructive sleep apnea (OSA) than patients with erosive disease (20.9%) and controls (20.4%, P = 0.010). On multivariate analysis, non-erosive disease was a high risk factor for obstructive sleep apnea (odds ratio [OR], 1.82; P = 0.011). Age ≥ 55 years (OR, 1.83; P < 0.001) and a high body mass index (≥ 25 kg/m²) (OR, 2.76; P < 0.001) were also identified as risk factors. Nocturnal GERD was related to high risk for OSA in non-erosive disease patients (OR, 2.97; P = 0.019), but not in erosive disease patients.

Conclusions

High risk for OSA is more prevalent in GERD patients than in controls. Non-erosive reflux disease, age ≥ 55, and a high BMI are associated with high risk for OSA.

Prevalence and characteristics of dyspepsia among college students in Zhejiang Province

AIM: To investigate the prevalence and characteristics of uninvestigated dyspepsia among college students in Zhejiang Province.

METHODS: Young adult students attending undergraduate (within the 4-year program) and graduate (only first-year students) colleges in Zhejiang Province were recruited between November 2010 and March 2011 to participate in the self-report survey study. The questionnaire was designed to collect data regarding demographics (sex and age), general health [weight and height, to calculate body mass index (BMI)], and physical episodes related to gastrointestinal disorders. Diagnosis of dyspepsia and irritable bowel syndrome (IBS) was made according to the Rome III criteria. Gastroesophageal reflux disease (GERD) was defined by episodes of heartburn and/or acid reflux that occurred at least once a week, according to the Montreal definition.

RESULTS: Of 2520 students recruited for survey participation, only 1870 (males: 967; age range: 17-32 years, mean age: 21.3 years) returned a completed questionnaire. One hundred and eight (5.67%) of the student participants fit the criteria for dyspepsia diagnosis. Stratification analysis of dyspepsia and non-dyspepsia cases showed no statistically significant differences in age or BMI; however, the prevalence of dyspepsia was significantly higher in women than in men (7.53% vs 4.14%, P < 0.05). Stratification analysis of dyspepsia by grade level showed that year 4 undergraduate students had a significantly higher prevalence of dyspepsia (10.00% vs undergraduate year 1: 5.87%, year 2: 3.53% and year 3: 7.24%, and graduate year 1: 3.32%). Nearly all (95.37%) students with dyspepsia reported symptoms of postprandial distress syndrome, but only a small portion (4.63%) reported symptoms suggestive of abdominal pain syndrome. The students with dyspepsia also showed significantly higher rates of IBS (16.67% vs non-dyspepsia students: 6.30%, P < 0.05) and GERD (11.11% vs 0.28%, P < 0.05).

CONCLUSION: Although the prevalence of dyspepsia among Zhejiang college students is low, the significantly higher rates of concomitant IBS and GERD suggest common pathophysiological disturbances.

Epidemiology of chronic constipation in adults

Chronic constipation is a common gastrointestinal motility disorder worldwide, having a significant impact on quality of life and affecting both physical and emotional health. The development of economy and the improvement in living standards have led to an increase in the incidence of constipation, which has aroused the concern of the medical staff and patients. At present, there have been only scattered data about chronic constipation in adults. This review aims to elucidate the epidemiology of chronic constipation in adults.

Nitric oxide synthase gene polymorphisms in functional dyspepsia

OBJECTIVE

Nitrinergic control is important in meal-induced satiety. The aim of this study was to assess functional polymorphisms in nitric oxide synthase (NOS) genes in the susceptibility to functional dyspepsia (FD).

METHODS

Genomic DNA from 89 patients with FD and 180 healthy subjects matched for age and gender were typed for the gene of neuronal NOS (nNOS, rs2682826), inducible NOS (iNOS, rs2297518) and a variable number tandem repeat in intron 4 of endothelial NOS (eNOS). Patients ingested 500 mL of Ensure(®) during a 20 min period and dyspeptic symptoms were scored.

RESULTS

Genotype frequencies of eNOS and iNOS were not significantly different between FD patients and controls. The frequency of the T allele in nNOS was significantly higher in FD patients compared to the controls (49 vs. 16 %; odds ratio 5.01; 95 % confidence interval 2.83-9.01; p < 0.05). Patients with the T allele in the nNOS polymorphism reported a higher satiation score than those with the CC genotype during the nutrition drink test (median 179 vs. 117; p < 0.05).

CONCLUSION

The nNOS gene polymorphism is associated with susceptibility to FD and influences satiation in FD patients. Our data support the importance of NOS gene polymorphisms in the pathogenesis of FD.

High degree of duodenal inflammation in Nigerians with functional dyspepsia

BACKGROUND

Functional dyspepsia (FD) is a heterogeneous disorder associated with diverse pathophysiological mechanisms, including immune activation and low-grade mucosal inflammation. Genetic factors, physiological functions, and environmental factors may determine the relative importance of various pathophysiological mechanisms. This study was designed to determine the histological alterations in the duodenal mucosa of Nigerian patients with FD.

METHODS

Consecutive patients with dyspepsia seen over a 27-month period in two gastrointestinal endoscopy facilities in Enugu, South-East Nigeria were further evaluated with upper gastrointestinal endoscopy and duodenal mucosal biopsies if no lesion was found in the upper gastrointestinal tract. Patients with heartburn and/or regurgitation who did not have any dyspeptic symptoms and did not have any lesion in the upper gastrointestinal tract on endoscopy were presumed to have non-erosive reflux disease (NERD) and they served as controls. The control subjects also had duodenal biopsies. The histopathological findings in the cases and controls were compared.

RESULTS

There were 68 patients with FD and 52 patients with NERD. The total inflammatory score was 242 in FD and 66 in NERD (Mann-Whitney U =1168, P=0.0011). Similarly, the scores for chronic inflammation, gastric metaplasia, neutrophilic activity, eosinophilic infiltration, and Helicobacter pylori were significantly higher in FD than NERD.

CONCLUSION

Functional dyspepsia is associated with a high degree of inflammation in the duodenal mucosa. This may reflect the high prevalence of gastrointestinal infections in a tropical environment such as Nigeria. These findings may have therapeutic potential that further studies might elucidate.

Concomitant functional gastrointestinal symptoms influence psychological status in Korean migraine patients

BACKGROUND/AIMS

Migraine is frequently accompanied by symptoms consistent with functional gastrointestinal disorders (FGIDs). This study evaluated the prevalence of functional gastrointestinal symptoms and assessed the symptoms' relationship with the concomitant functional symptoms of anxiety, depression, and headache-related disability.

METHODS

This prospective study included 109 patients with migraine who were recruited from a headache clinic at a teaching hospital. The participants completed a self-administered survey that collected information on headache characteristics, functional gastrointestinal symptoms (using Rome III criteria to classify FGID), anxiety, depression, and headache-related disability.

RESULTS

In total, 71% of patients met the Rome III criteria for at least one FGID. In patients with FGID, irritable bowel syndrome was the most common symptom (40.4%), followed by nausea and vomiting syndrome (24.8%) and functional dyspepsia (23.9%). Depression and anxiety scores were significantly higher in patients meeting the criteria for any FGID. The number of the symptoms consistent with FGID in individual patients correlated positively with depression and anxiety.

CONCLUSIONS

FGID symptoms defined by the Rome III criteria are highly prevalent in migraine. These symptoms correlate with psychological comorbidities, such as depression and anxiety.

Irritable bowel syndrome is associated with gastroesophageal reflux symptom but not erosive esophagitis

BACKGROUND/AIMS

Although several studies have suggested overlaps between gastroesophageal reflux symptom and irritable bowel syndrome (IBS), the studies for the association between erosive esophagitis and IBS are rare. The aim of this study was to evaluate the association among IBS, non-erosive reflux disease (NERD), and erosive esophagitis.

METHODS

A total of 2,769 participants completed questionnaires and underwent esophagogastroduodenoscopy and colonoscopy. IBS was diagnosed by Rome III; NERD was defined as heartburn or acid regurgitation occurring at least once per week without erosive esophagitis. Erosive esophagitis was defined by Los Angeles classification. Psychological distress was evaluated with modified 4 dimensions from revised Hopkins symptom checklist 90.

RESULTS

Psychological distress was associated with both IBS and NERD, but not with erosive esophagitis. IBS was associated with somatization (adjusted OR, 2.88; 95% CI, 1.55-5.36; P < 0.001), anxiety (adjusted OR, 2.82; 95% CI, 1.36-5.88; P = 0.005), and hostility (adjusted OR, 2.06; 95% CI, 1.10-3.87; P = 0.024) and NERD was associated with somatization (adjusted OR, 5.65; 95% CI, 2.92-10.98; P < 0.001) and anxiety (adjusted OR, 3.29; 95% CI, 1.47-7.34; P = 0.004). Erosive esophagitis was associated with somatization (adjusted OR, 2.69; 95% CI, 1.26-7.91; P < 0.001). Hiatal hernia and male sex were related with erosive esophagitis but not with IBS or NERD. H. pylori had an inverse relationship with erosive esophagitis, but had no association with IBS. Whereas IBS was positively associated with NERD (adjusted OR, 2.72; 95% CI, 1.84-4.03; P < 0.001), it had no association with erosive esophagitis.

CONCLUSIONS

IBS shared many risk factors with NERD but not with erosive esophagitis. It partially explains why IBS was associated with NERD, but not with erosive esophagitis.

Development and Validation of the Korean Rome III Questionnaire for Diagnosis of Functional Gastrointestinal Disorders

Background/Aims

A self-report questionnaire is frequently used to measure symptoms reliably and to distinguish patients with functional gastrointestinal disorders (FGIDs) from those with other conditions. We produced and validated a cross-cultural adaptation of the Rome III questionnaire for diagnosis of FGIDs in Korea.

Methods

The Korean version of the Rome III (Rome III-K) questionnaire was developed through structural translational processes. Subsequently, reliability was measured by a test-retest procedure. Convergent validity was evaluated by comparing self-reported questionnaire data with the subsequent completion of the questionnaire by the physician based on an interview and with the clinical diagnosis. Concurrent validation using the validated Korean version of the Short Form-36 Health Survey (SF-36) was adopted to demonstrate discriminant validity.

Results

A total of 306 subjects were studied. Test-retest reliability was good, with a median Cronbach's α value of 0.83 (range, 0.71-0.97). The degree of agreement between patient-administered and physician-administered questionnaires to diagnose FGIDs was excellent; the κ index was 0.949 for irritable bowel syndrome, 0.883 for functional dyspepsia and 0.927 for functional heartburn. The physician's clinical diagnosis of functional dyspepsia showed the most marked discrepancy with that based on the self-administered questionnaire. Almost all SF-36 domains were impaired in participants diagnosed with one of these FGIDs according to the Rome III-K.

Conclusions

We developed the Rome III-K questionnaire though structural translational processes, and it revealed good test-retest reliability and satisfactory construct validity. These results suggest that this instrument will be useful for clinical and research assessments in the Korean population.

Preoperative constipation is associated with poor prognosis of rectal cancer: a prospective cohort study

Purpose

It is unknown whether patients with advanced rectal cancer develop severe constipation. Therefore, the objective of this study was to assess whether constipation severity is associated with pathologic progression of rectal cancer.

Methods

We analyzed 472 patients with rectal cancer who underwent elective surgical resection between January 2005 and December 2010. Constipation severity was prospectively evaluated in 407 patients (86.2%) using the Cleveland Clinic Constipation Score System. Linear regression analysis was performed to identify clinicopathologic variables associated with constipation. Kaplan-Meier analysis and Cox proportional hazard models were used to evaluate the prognostic value of constipation severity on disease-free and overall survival.

Results

Multivariable analysis showed that sex (regression coefficient [B] = 1.55; 95% confidence interval [CI], 0.79 to 2.60; P < 0.001), body mass index (B = -0.95; 95% CI, -1.83 to -0.64; P = 0.036), tumor size (B = 1.04; 95% CI, 0.20 to 1.88; P = 0.016), T stage (B = 0.75; 95% CI, 0.23 to 1.27; P = 0.005), and distant metastasis (B = 1.16; 95% CI, 0.03 to 2.30; P = 0.045) were associated with constipation severity. Severe constipation (score ≥ 8) was independently associated with 3-year disease-free survival (vs. scores of 0-3; hazard ratio [HR], 2.39; 95% CI, 1.15 to 4.98; P = 0.020) and 5-year overall survival (HR, 2.30; 95% CI, 1.23 to 4.30; P = 0.009) in multivariable analysis.

Conclusion

Our results suggest that preoperative constipation severity is associated with advanced pathologic stage and poor oncologic outcomes in patients with rectal cancer.

Impact of persistent constipation on health-related quality of life and mortality in older community-dwelling women

OBJECTIVES

Very little is known about whether the reported health-related impact of constipation is worse in people who experience constipation over a long period of time vs. those with more transient symptoms. We aimed to determine the impact of persistent vs. transient constipation on health-related quality of life (QOL), depression, and mortality.

METHODS

We analyzed data from 5,107 women (aged 70-75 years in 1996) who answered "Have you had constipation in the past 12 months?" in all five surveys sent out every 3 years of the Australian Longitudinal Study on Women's Health.

RESULTS

Of the 5,107 women, 20.9, 54.1, and 24.7% reported having persistent constipation on at least 4 out of 5 surveys, transient constipation reported on 1-3 surveys, or none reported over the 15-year time frame, respectively. Women who reported persistent constipation had significantly lower scores for all domains of QOL on the SF-36 except role-emotional, and had higher levels of self-reported depression, even after adjusting for number of chronic illnesses and fluid intake. Mortality rates were increased when comparing women with no reported constipation with persistently reported constipation (8.2% vs. 11%, odds ratio = 1.32, 95% confidence interval 1.0, 1.74, P = 0.05) controlling for specific chronic illnesses.

CONCLUSIONS

Persistent constipation among older women is associated with poor health outcomes.

A school-based study with Rome III criteria on the prevalence of functional gastrointestinal disorders in Chinese college and university students

BACKGROUND

Functional gastrointestinal disorders, including functional dyspepsia, irritable bowel syndrome and functional constipation are very common worldwide.

OBJECTIVE

This research aims to estimate the prevalence and associated factors involved in functional gastrointestinal disorders in Chinese college and university students using the Rome III criteria.

METHODS

A total of 5000 students from Shandong University in China were asked in January-May 2012 to complete questionnaires, including the Rome III questionnaire, hospital anxiety and depression scale, and negative life events scale.

RESULTS

Based on the 4638 students who completed the questionnaire, the prevalence of functional dyspepsia, irritable bowel syndrome and functional constipation in college and university students of North China worked out to be 9.25%, 8.34% and 5.45% respectively. They were more frequent in female students. The factors of anxiety (OR 1.07; 95% CI 0.99 to 1.16, P=0.002<0.05) and depression (OR 0.55; 95% CI 0.15 to 1.05, P=0.045<0.05) indicated a high risk of causing irritable bowel syndrome.

CONCLUSION

Functional dyspepsia, irritable bowel syndrome and functional constipation were common in college and university students of North China. Psychological disorders such as anxiety and depression provide significant risk factors for irritable bowel syndrome patients.

The use of Resolor (prucalopride) for chronic constipation in women

Chronic constipation is a common problem among women, is associated with anxiety and depression and can adversely affect quality of life (Mason et al, 2002). Chronic constipation is often unrelieved by simple laxatives, dietary manipulation or lifestyle modification, with other specialist treatment options being invasive and often not widely available. More recently attention has turned to newer prokinetic agents, such as prucalopride (Resolor®), which increase gut motility and intestinal transit, for the relief of chronic constipation. While these are not effective for everyone, there is evidence that prucalopride can increase bowel frequency, relieve bothersome symptoms associated with constipation and improve quality of life for women who have failed to achieve satisfactory relief from two other laxatives (National Institute for Health and Clinical Excellence).

Epidemiology of functional diarrhea and comparison with diarrhea-predominant irritable bowel syndrome: a population-based survey in China

Background

The epidemiology of functional diarrhea and its impacts on Chinese remain unclear, and there are no data on the comparative epidemiology of functional diarrhea and diarrhea-predominant irritable bowel syndrome (IBS-D). This study was to explore the epidemiology of functional diarrhea and its impacts, and to identify its distinction from IBS-D.

Methods and Findings

A cross-sectional survey was conducted in 16078 respondents, who were interviewed under a randomized stratified multi-stage sampling design in five cities of China. All respondents completed the modified Rome II questionnaire, and the 36-item Short Form health survey (SF-36) was used for assessing health-related quality of life in 20% of the sample. Overall, 248 respondents (1.54%) had functional diarrhea and 277 (1.72%) had IBS-D. Functional diarrhea was positively associated with increasing age and body mass index (trend test P<0.05). The three most common symptoms for at least 3 weeks in the past months were loose, mushy or watery stools (n = 203, 81.85%), more than three bowel movements a day (n = 100, 40.32%) and having to rush to the toilet to have a bowel movement (n = 72, 29.03%). Meaningful impairment was observed in 5 of the 8 SF-36 domains in respondents with functional diarrhea. The demographics are mostly similar between the respondents with functional diarrhea and IBS-D; however, respondents with IBS-D had more frequent symptoms of diarrhea and even lower scores in SF-36 domains than those with functional diarrhea.

Conclusions

The prevalence of functional diarrhea in China is substantially lower than that in Western countries and relatively higher than that in other Asian countries. It impaired health-related quality of life, and respondents with IBS-D have even worse quality of life. Further population-based studies are needed to investigate the epidemiology of functional diarrhea and the differences between functional diarrhea and IBS-D.

Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis

BACKGROUND & AIMS

Many cross-sectional surveys have reported the prevalence of irritable bowel syndrome (IBS), but there have been no recent systematic review of data from all studies to determine its global prevalence and risk factors.

METHODS

MEDLINE, EMBASE, and EMBASE Classic were searched (until October 2011) to identify population-based studies that reported the prevalence of IBS in adults (≥15 years old); IBS was defined by using specific symptom-based criteria or questionnaires. The prevalence of IBS was extracted for all studies and based on the criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated.

RESULTS

Of the 390 citations evaluated, 81 reported the prevalence of IBS in 80 separate study populations containing 260,960 subjects. Pooled prevalence in all studies was 11.2% (95% CI, 9.8%-12.8%). The prevalence varied according to country (from 1.1% to 45.0%) and criteria used to define IBS. The greatest prevalence values were calculated when ≥3 Manning criteria were used (14%; 95% CI, 10.0%-17.0%); by using the Rome I and Rome II criteria, prevalence values were 8.8% (95% CI, 6.8%-11.2%) and 9.4% (95% CI, 7.8%-11.1%), respectively. The prevalence was higher for women than men (OR, 1.67; 95% CI, 1.53-1.82) and lower for individuals older than 50 years, compared with those younger than 50 (OR, 0.75; 95% CI, 0.62-0.92). There was no effect of socioeconomic status, but only 4 studies reported these data.

CONCLUSIONS

The prevalence of IBS varies among countries, as well as criteria used to define its presence. Women are at slightly higher risk for IBS than men. The effects of socioeconomic status have not been well described.