Abdominal Pain Severity Is Mainly Associated with Bloating Severity in Patients with Functional Bowel Disorders and Functional Abdominal Pain

PURPOSE

Abdominal pain is a cardinal sign of functional bowel disorders (FBD), in favor of irritable bowel syndrome (IBS). However, the determinants of abdominal pain severity (APS) are unknown. The present study aimed to search the relationships between APS and demographic, psychological, and clinical parameters in tertiary care FBD outpatients.

PATIENTS AND METHODS

In this retrospective study, we included 2043 new outpatients with FBD or functional abdominal pain. They fulfilled the Rome III questionnaire, psychological evaluation, and four 10-points Likert scale for the perceived severity of constipation, diarrhea, bloating, and abdominal pain. Linear regression was performed for each phenotype to model the severity of abdominal pain with demographic, psychological parameters, and symptoms severity.

RESULTS

APS was positively associated with bloating severity in all phenotypes, but APS was also associated with other variables according to gender and phenotype. APS was negatively associated with age and positively with depression, constipation severity, and diarrhea severity in female patients. In male patients, APS was associated with state anxiety, constipation severity, and diarrhea severity. APS severity was associated with bloating severity and transit severity in IBS patients, while in non-IBS patients, APS was only associated with bloating severity.

CONCLUSION

Perceived abdominal pain severity is always associated with perceived bloating severity in FBD and FAP patients.

Perceived Gastrointestinal Symptoms and Association With Meals in a French Cohort of Patients With Irritable Bowel Syndrome

Background/Aims

The aim of our study is to evaluate the association between meals and perceived gastrointestinal symptoms in real life in a French cohort of irritable bowel syndrome (IBS) patients.

Methods

This prospective cross-sectional observational study included patients from the French association (association des patients souffrant du syndrome de l’intestin irritable [APSSII]) of IBS. Data were collected on demographics, IBS subtype, dietary food, and meal-induced gastrointestinal symptoms from patient filled self-questionnaires or questionnaires.

Results

Eighty-four patients with IBS were included; 82.3% female with a mean age of 46.9 ± 15.7 years. Each transit pattern subtype represented one-third of the population. Forty-five percent of patients had severe IBS according to IBS-Severity Scoring System; mean IBS Quality of Life score was 53.9 ± 18.3. Patients believed that food could trigger or exacerbate gastrointestinal symptoms in 73.3% and 93.4%, respectively. Eighty-nine percent had already tried diets, mostly lactose free diet and low fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols diet in 61.3% and 53.6% of cases. Thirty-nine percent of meals induced gastrointestinal symptoms. Meal-induced gastrointestinal symptoms were associated with severity and subtype but not with quality of life.

Conclusions

This study has confirmed the important link between gastrointestinal symptoms and food. Gastrointestinal symptoms induced by meals are frequent and associated with severity and IBS-diarrhea subtype. Our study also underlines patients’ interest in food and diet. More knowledge is needed on food that triggers IBS symptoms but also on diet conditions in order to improve this condition.

Lactose Sensitivity and Lactose Malabsorption: The 2 Faces of Lactose Intolerance

Background/Aims

Self-reported lactose intolerance (LI) is frequent in patients with functional bowel disorders (FBD) that could be interpreted as irritable bowel syndrome (IBS). The present study aims to characterize the responses of patients with FBD, without small intestinal bacterial overgrowth (SIBO), and LI, in terms of lactose malabsorption (LM) and lactose sensitivity (LS) according to psychological and clinical features.

Methods

One hundred and fifty-eight consecutive FBD outpatients with LI, and no SIBO, were classified according to the Rome III questionnaire and filled Beck Depression Inventory, and State and Trait Anxiety questionnaires. They underwent a lactose tolerance test in which glycemia during 60 minutes and digestive symptoms for 3 hours were recorded.

Results

Abnormal lactose tolerance tests were found in 110 patients (70%), 44 (28%) with LM, 96 (61%) with LS, and 30 (19%) having both LM and LS. LM patients had a higher frequency of functional diarrhea (P = 0.040) and a lower frequency of dysphagia (P = 0.031). LS patients had a higher depression score (P = 0.007), higher frequency of globus (P = 0.042), irritable bowel syndrome (IBS) (P = 0.027) and mixed IBS (P = 0.049), and lower frequency of abdominal pain (P = 0.040). LS was significantly associated with a higher depression score (P = 0.002), and a higher frequency of globus (P = 0.046).

Conclusions

Thirty percent of LI patients have normal lactose absorption and normal LS. In the other 70% of patients, LI could be associated with LM and/or LS.

Efficacy and safety of pasireotide-LAR for the treatment of refractory bleeding due to gastrointestinal angiodysplasias: results of the ANGIOPAS multicenter phase II noncomparative prospective double-blinded randomized study

BACKGROUND

Gastrointestinal angiodysplasias (GIADs) could be responsible for recurrent bleeding and severe anemia. Somatostatin analogs could reduce transfusion requirements in these patients but no randomized controlled study is available. The main objective of the ANGIOPAS phase II double-blinded randomized, noncomparative study was to assess the effectiveness of pasireotide-LAR in reducing transfusion requirements in patients with refractory GIADs bleeding.

METHODS

A total of 22 patients with transfusion requirements ⩾6 units of packed red blood cells (pRBCs) during the 6 months prior to inclusion were randomized to receive pasireotide-LAR 60 mg (n = 10) or placebo (n = 12) every 28 days for 6 months. Patients were then followed for an additional 6 months after stopping treatment.

RESULTS

The pasireotide-LAR and placebo groups were equivalent for age, sex, comorbidities and transfusion requirement during the reference period (median 13 and 9.5 pRBCs). A 50 and 83% success rate (success defined as a decrease of at least 30% of transfused pRBCs) was observed in the pasireotide-LAR arm in the Intent to Treat (ITT) and per protocol (PP) analysis respectively. The need for transfusion during the intervention period was 3 pRBC units in the pasireotide-LAR group (range 0-26) and 11.5 pRBC units in the placebo group (range 0-23). Overall, three cases with glycemic control impairment were observed in the pasireotide-LAR group including one de novo diabetes.

CONCLUSION

This double-blinded noncomparative randomized phase II study suggests, for the first time, the effectiveness of pasireotide-LAR 60 mg every 28 days to decrease the transfusion requirement in patients with recurrent bleeding due to GIADs.

How many segments are necessary to characterize delayed colonic transit time?

BACKGROUND AND AIMS

Measuring colonic transit time with radiopaque markers is simple, inexpensive, and very useful in constipated patients. Yet, the algorithm used to identify colonic segments is subjective, rather than founded on prior experimentation. The aim of the present study is to describe a rational way to determine the colonic partition in the measurement of colonic transit time.

METHODS

Colonic transit time was measured in seven segments: ascending colon, hepatic flexure, right and left transverse colon, splenic flexure, descending colon, and rectosigmoid in 852 patients with functional bowel and anorectal disorders. An unsupervised algorithm for modeling Gaussian mixtures served to estimate the number of subgroups from this oversegmented colonic transit time. After that, we performed a k-means clustering that separated the observations into homogenous groups of patients according to their oversegmented colonic transit time.

RESULTS

The Gaussian mixture followed by the k-means clustering defined 4 populations of patients: "normal and fast transit" (n = 548) and three groups of patients with delayed colonic transit time "right delay" (n = 82) in which transit is delayed in the right part of the colon, "left delay" (n = 87) with transit delayed in the left part of colon and "outlet constipation" (n = 135) for patients with transit delayed in the terminal intestine. Only 3.7 % of patients were "erroneously" classified in the 4 groups recognized by clustering.

CONCLUSIONS

This unsupervised analysis of segmental colonic transit time shows that the classical division of the colon and the rectum into three segments is sufficient to characterize delayed segmental colonic transit time.

Isoniazid-induced recurrent pancreatitis

CONTEXT

Drug induced pancreatitis are rare but potentially serious. Thus, drug withdrawal is warranted.

CASE REPORT

A 79-year-old woman who was treated with antituberculosis therapy for 5 weeks was admitted to our unit for pancreatitis. Usual etiologies of pancreatitis were eliminated. Because of vomiting, antituberculosis therapy was withdrawn and symptoms disappeared. Eight days later, the same treatment was reintroduced and the patient presented recurrent pancreatitis; thus, treatment was withheld again followed by disappearance of clinical and biological abnormalities. Two days later, a treatment without isoniazid was reintroduced and no recurrence of symptoms was observed.

CONCLUSIONS

We have experienced a case of isoniazid induced pancreatitis. This is a rare cause of pancreatitis but potentially fatal thus recognition of drug induced pancreatitis and definitive withdrawal of the drug is required.

Is the colonic response to food different in IBS in contrast to simple constipation or diarrhea without abdominal pain?

BACKGROUND

Colonic response to food (CRF) is abnormal in irritable bowel syndrome (IBS) patients.

AIMS

The aim of this study was to compare CRF in patients who complain of abnormal defecation pattern according to the presence or absence of abdominal pain.

METHODS

One hundred forty-nine patients and 50 controls were studied: 96 IBS patients (46 IBS-C, 13 IBS-D, 15 IBS-M, and 22 IBS-U not included), 43 patients with functional constipation (group C) and ten with functional diarrhea (group D). Clinical evaluation and visual analog scales about four items (constipation, diarrhea, abdominal bloating and abdominal pain) were filled by all subjects. Colonic transit time (CTT) was measured in fasting conditions and after eating a standard 1,000-cal test meal. CRF was quantified by calculating the variation in number of markers between the two films.

RESULTS

The frequency of meal-related symptoms did not vary among the different groups of patients but was significantly higher than in controls. Compared to IBS-C patients, constipated patients of the group C had longer total and segmental colonic transit time, and compared to IBS-D patients, diarrheic patients of the group D had shorter oro-anal and segmental colonic transit time except in the recto-sigmoid area. CRF was different in patients and controls, and differed between IBS and non IBS patients with similar transit abnormalities. Stool output was greater in patients of the group D than in patients of the IBS-D group.

CONCLUSION

The different subgroups of IBS patients have different CRF patterns, distinct from subjects with constipation and diarrhea, but without abdominal pain.

[Corticotherapy and giant hemangioma of the liver. Return to the normal values of cytokines]

We report the case of a 36 year-old woman presenting with a giant liver hemangioma revealed by febrile hepatomegaly and weight loss. The patient presented an inflammatory syndrome without hyperleucytose, anemia and a moderate anicteric cholestasis. Plasma concentrations of interleukine-6 were very high whereas interleukine-1 levels were relatively low and TNF levels were normal. Eight weeks of corticosteroid treatment (prednisone 40 mg/d) resulted in disappearance of symptoms after 48 hours and biological anomalies after 6 weeks. Clinical and radiological follow-up, for respectively 36 and 24 months, did not show any relapse of symptoms or evolution of the hemangioma.

[Endobronchial metastases of rectal adenocarcinoma]

INTRODUCTION

Diagnosis of endobronchial metastases is facilitated by immunolabeling techniques on bronchial biopsy samples.

CASE

Endobronchial tumors appeared in a 70-year-old woman with an adenocarcinoma of the crypts of Lieberkuhn, diagnosed two years previously. Immunohistochemical examinations made it possible to diagnose endobronchial metastases of the rectal adenocarcinoma.

COMMENTS

The endobronchial zone is a relatively rare metastatic site. Metastases associated with rectal adenocarcinoma account for 11-26% of secondary endobronchial lesions. After endoscopic biopsy, immunolabeling techniques help to differentiate between primary adenocarcinoma and endobronchial metastasis. Prognosis is poor.

[Langerhans cell histiocytosis in an adult patient associated with sclerosing cholangitis and cerebellar atrophy]

Langerhans' cell histiocytosis is a disorder in children or young adults, characterized by clonal proliferation of histiocytic cells, staining for CD1a, with uni or multifocal organ involvement. It's a rare condition in adults. We report a case of Langerhans' cell histiocytosis in an adult with sclerosing cholangitis which rapidly progressed to fatal liver failure and progressive cerebellar atrophy. Langerhans cell histiocytosis is a rare cause of sclerosing cholangititis in adults.

[Inflammatory pseudotumor of lymph node]

INTRODUCTION

Inflammatory pseudotumor of lymph node is a rare case in the etiology of fever of unknown origin.

OBSERVATION

We report the observation of a woman, aged 40, hospitalized with intermittent fever revealing under-diaphragm adenopathy related to inflammatory pseudotumor of lymph node.

CONCLUSION

Inflammatory pseudotumor of lymph node is a rare pathology whose nosological definition is unclear. It should probably be considered as belonging to a category different from the inflammatory pseudotumor of other organs. The diagnosis presents itself in case of isolated adenopathy or prolonged fever and is based on an anatomopathology that essentially calls to mind a lymphoma. The evolution of the condition is shown to be favorable : it can lead to a spontaneous remission, or call for a non-steroid anti-inflammatory treatment, or a steroid therapy.

Ulcère œsophagien secondaire à la prise de bacampicilline

INTRODUCTION

Many drugs may provoke oesophageal disorders. In France, doxycyclin, potassium chloride non-steroidal anti-inflammatories are the most frequent agents incriminated.

OBSERVATION

A 27 year-old man consulted for dysphagia and odynophagia due to oesophagitis following administration of bacampicillin.

COMMENTS

Several drugs can provoke oesophageal disorders including ulcerations. Predisposing circumstances exist. Ingestion of the drugs with a sufficient quantity of water (60 to 100 ml), whilst standing or sitting should be able to limit this type of event.

[Common variable immunodeficiency and celiac disease]

Variable immunodeficiency is frequently associated with subtotal villous atrophy, unchanged by gluten free diet. We report two cases of common variable immunodeficiency associated with chronic symptoms of malabsorption due to total villous atrophy. Symptoms of malabsorption disappeared and histological abnormalities improved after a gluten free diet. The association between celiac disease and common variable immunodeficiency should not be considered as fortuitous. Clinicians should be aware of this association and of the low sensitivity of serologic testing in this setting.

Hyperphagia contributes to the normal body composition and protein-energy balance in HIV-infected asymptomatic men

Wasting can occur at an early stage of HIV infection. Both reduced energy intake and increased resting energy expenditure (REE) have been considered as factors in wasting with predominant lean body mass loss, suggesting disturbances of protein metabolism. Our aim was to study protein-energy metabolism in relation to body composition and oral energy intake in asymptomatic patients with HIV infection but receiving no active antiretroviral therapy. Stable-weight asymptomatic male patients (n = 8) at stage A of HIV infection with a detectable viral load were compared with 9 healthy control men. Protein metabolism was studied in the postabsorptive state using a primed constant infusion of l-[1-(13)C]leucine and l-[2-(15)N]glutamine. REE was studied by indirect calorimetry, body composition by bioelectrical impedance, and energy intake by dietary records. BMI and lean body mass did not differ between patients and controls. In HIV-infected subjects, energy intake, protein breakdown, protein synthesis, and REE were 57% (P < 0.05), 18% (P < 0.05), 22% (P < 0.05) and 14% (P < 0.05) greater than in controls, respectively. REE and protein breakdown were correlated (r = 0.73, P < 0.05). The hormonal profile was normal in HIV-infected subjects with the exception of low urinary C-peptide and plasma reverse triiodothyronine. Plasma interleukin-6 and tumor necrosis factor-alpha were greater than in controls, but energy intake was 1.53 times the REE in the HIV-infected men. Thus, at the asymptomatic stage of HIV infection, increased protein turnover contributes to the increase in the REE. Moderate hyperphagia, which occurred despite increased levels of cytokines, in conjunction with increased protein synthesis maintains a normal body composition, without significant loss of lean body mass.