Chronic gastrointestinal symptoms and quality of life in the Korean population

AIM

To evaluate the prevalence of chronic gastrointestinal symptoms and their impact on health-related quality of life (HRQOL) in the Korean population.

METHODS

A cross-sectional survey, using a reliable and valid Rome II based questionnaire, was performed on randomly selected residents, between 18 and 69 years in age. All respondents were interviewed at their homes or offices by a team of interviewers. The impact of chronic gastrointestinal symptoms on HRQOL was assessed using the Korean version of the 36-item Short-Form general health survey (SF-36).

RESULTS

Of the 1807 eligible subjects, 1417 (78.4%: male 762; female 655) were surveyed. Out of the respondents, 18.6% exhibited at least one chronic gastrointestinal symptom. The prevalence of gastroesophageal reflux disease (GERD), defined as heartburn and/or acid regurgitation experienced at least weekly, was 3.5% (95% CI, 2.6-4.5). The prevalence of uninvestigated dyspepsia, irritable bowel syndrome (IBS) and chronic constipation based on Rome II criteria were 11.7% (95% CI, 10.1-13.5), 2.2% (95% CI, 1.5-3.1), and 2.6% (95% CI, 1.8-3.5) respectively. Compared with subjects without chronic gastrointestinal symptoms (n=1153), those with GERD (n=50), uninvestigated dyspepsia (n=166) and IBS (n=31) had significantly worse scores on most domains of the SF-36 scales.

CONCLUSION

The prevalence of GERD, uninvestigated dyspepsia and IBS were 3.5%, 11.7% and 2.2% respectively, in the Korean population. The health-related quality of life was significantly impaired in subjects with GERD, uninvestigated dyspepsia and IBS in this community.

Health-care-seeking behaviors related to bowel complaints. Hispanics versus non-Hispanic whites

Health-care-seeking behaviors related to bowel complaints may vary between ethnic groups. A survey of a nonpatient population in El Paso, Texas, was conducted in order to examine differences in health care behavior related to bowel dysfunction, and in the perception of health and bowel function, in Hispanics and non-Hispanic whites. Data from 905 subjects who were either Hispanic (580) or non-Hispanic white (325) given a forced-choice, self-report questionnaire were used for analysis. Data on health care behavior variables were studied using logistic regression, in ethnic and gender groups, controlling for age and socioeconomic status. A log-linear analysis was applied to health perception variables in ethnic and gender groups. Hispanics were less likely than non-Hispanic whites to have seen a physician for bowel symptoms (P < 0.02). Of the subjects with symptoms compatible with irritable bowel syndrome, Hispanics were less likely to have seen a physician (P < 0.05). More Hispanics reported buying folk remedies (P < 0.001), and herbal teas were taken more often to maintain good bowel function (P < 0.02) and to treat bowel problems (P < 0.005). Additionally, Hispanics had a poorer perception of their health in general (P < 0.001), reported more concern about their health (P < 0.02), more concern about bowel function (P < 0.001), and more time spent attending to bowel function (P < 0.001). Therefore, data on health-care-seeking behaviors related to bowel dysfunction showed that Hispanics were less likely than non-Hispanic whites to seek health care for bowel complaints and that Hispanics were more likely to self-medicate with folk remedies to maintain good bowel function. The perception of health and bowel function is in part determined by ethnic differences.

Conducting multinational, cross-cultural research in the functional gastrointestinal disorders: issues and recommendations. A Rome Foundation working team report

BACKGROUND

Cross-cultural, multinational research can advance the field of functional gastrointestinal disorders (FGIDs). Cross-cultural comparative research can make a significant contribution in areas such as epidemiology, genetics, psychosocial modulators, symptom reporting and interpretation, extra-intestinal co-morbidity, diagnosis and treatment, determinants of disease severity, health care utilisation, and health-related quality of life, all issues that can be affected by geographical region, culture, ethnicity and race.

AIMS

To identify methodological challenges for cross-cultural, multinational research, and suggest possible solutions.

METHODS

This report, which summarises the full report of a working team established by the Rome Foundation that is available on the Internet, reflects an effort by an international committee of FGID clinicians and researchers. It is based on comprehensive literature reviews and expert opinion.

RESULTS

Cross-cultural, multinational research is important and feasible, but has barriers to successful implementation. This report contains recommendations for future research relating to study design, subject recruitment, availability of appropriate study instruments, translation and validation of study instruments, documenting confounders, statistical analyses and reporting of results.

CONCLUSIONS

Advances in study design and methodology, as well as cross-cultural research competence, have not matched technological advancements. The development of multinational research networks and cross-cultural research collaboration is still in its early stages. This report is intended to be aspirational rather than prescriptive, so we present recommendations, not guidelines. We aim to raise awareness of these issues and to pose higher standards, but not to discourage investigators from doing what is feasible in any particular setting.

A meta-analysis of the efficacy and safety of traditional Chinese medicine formula Ganmai Dazao decoction for depression

ETHNOPHARMACOLOGICAL RELEVANCE

Ganmai Dazao (GMDZ) decoction is a traditional Chinese herbal formula commonly used for the treatment of depression. The objective of this study was to assess the efficacy and safety of GMDZ, either alone or as co-therapy, for depression.

MATERIALS AND METHODS

We systematically searched key databases (9 Chinese and 7 English) up until May 2013 for randomized controlled trials (RCTs). The primary outcomes were effective rate and self-rated or clinician-rated severity of depression. The secondary outcome was the occurrence of adverse events. Methodological quality of the RCTs was assessed by the Cochrane׳s risk of bias assessment.

RESULTS

Ten RCTs were included. All were written in Chinese and the methodological quality was generally low. Pooled analysis of 5 studies which compared GMDZ with antidepressants showed that GMDZ was significantly more efficacious than antidepressants in effective rate (risk ratio: 1.14, 95% CI: 1.02 to 1.27, P=0.02, I(2)=0%), but comparable in Hamilton Depression Rating Scale (HDRS) score (mean difference: -2.10, 95% CI: -4.62 to -0.41, P=0.10, I(2)=92%). With regard to the other 5 studies which compared GMDZ plus antidepressants with antidepressants alone, there was no significant difference in effective rate (risk ratio: 1.24, 95% CI: 0.99 to 1.55, P=0.07, I(2)=93%), but the end-point HDRS score was significantly lower in GMDZ antidepressants combination (mean difference: -4.25, 95% CI: -6.50 to -2.00, P=0.0002, I(2)=96%). Adverse events were more common with antidepressants than GMDZ (rate ratio: 0.52, 95% CI: 0.32 to 0.82, P=0.005, I(2)=37%) and in antidepressants alone compared to GMDZ antidepressants combination (rate ratio: 0.23, 95% CI: 0.08 to 0.68, P=0.08, I(2)=0%).

CONCLUSION

The overall results suggest that GMDZ has few side effects and the potential as an antidepressant. Adding GMDZ to antidepressants reduces side effects and enhances efficacy of antidepressants. However, due to the small number of studies and their limitations, further studies with better methodological quality and more comprehensive safety assessment are needed to determine the benefits and risks of GMDZ in the treatment of depression.

Endoscopic findings of gastrointestinal involvement in Chinese patients with Behcet’s disease

AIM: To report the incidence, clinical features and outcomes of gastrointestinal (GI) involvement in Behcet’s disease (BD).

METHODS: A total of 168 consecutive patients with BD were screened and upper and lower GI endoscopies were performed in 148 patients. Four hundred age- and sex-matched controls were enrolled for comparison.

RESULTS: Fifty-two (35.1%) patients had GI lesions. After a mean follow-up of 10 mo, ileocecal ulcers had been confirmed in 20 patients, including active ulcer(s) in 18 patients, but no ileocecal ulceration was found in controls. GI symptoms were present in 14 patients with active ulcer(s), while 4 patients with smaller ulcer were asymptomatic. Endoscopic features of ileocecal ulcer were: a single ulcer (50%), larger than 1 cm in diameter (72.2%), and round/oval or volcano-type in shape (83.3%). Compared with patients without GI involvement, less ocular lesions, lower levels of albumin, erythrocyte count and hemoglobin, and higher levels of C-reactive protein and erythrocyte sedimentation rate were confirmed in the intestinal BD group. Four patients had esophageal ulcers in the BD group but no case in controls. The other endoscopic findings were similar between the two groups. The prevalence of Helicobacter pylori infection was similar in both groups. Most patients received an immunomodulator and responded well.

CONCLUSION: GI lesions commonly occur in Chinese BD patients. The most frequently involved area is the ileocecal region. Esophageal ulcer might be a rare but unique lesion.

Side-effects of antituberculosis drug treatment in patients with chronic renal failure

Patients with chronic renal failure (CRF) have a high incidence of tuberculosis (TB). Those from the Indian subcontinent are at particular risk. The frequency of side-effects associated with antituberculous treatment in a group of patients with CRF was studied. All cases of TB in patients with CRF occurring over a 13-yr period at the Manchester Royal Infirmary, from 1986-1999, were identified by diagnostic coding, microbiology records and a TB database. The case notes were then reviewed. Twenty-four cases were identified, eight predialysis and 16 requiring regular dialysis. TB occurring in the dialysis group was extrapulmonary in every case. Nineteen of 24 (79%) patients were of Indian subcontinent origin and 14 of 16 (87%) dialysis patients were non-Caucasian. Adverse effects of treatment occurred in two of eight (25%) in the predialysis group and nine of 16 (56%) of the dialysis group. These were most commonly neuropsychiatric (6), hepatic (4) and gastrointestinal (4). Neuropsychiatric symptoms occurred exclusively in dialysis patients. In conclusion, a high incidence of side-effects from antituberculous medication, especially neuropsychiatric, hepatic and gastrointestinal, was identified in patients with chronic renal failure. Careful monitoring for side-effects is essential in this group, and consideration should be given to administering antituberculous chemoprophylaxis to all high-risk groups.

Ethnomedicinal plants of Aydıncık District of Mersin, Turkey

ETHNOPHARMACOLOGICAL RELEVANCE

This survey presents crucial ethnopharmacological data on medicinal plants used by indigenous people who live in the Aydıncık district of Mersin in Turkey.

AIM OF THE STUDY

To provide a knowledge base of herbal therapies from the Aydıncık region with their traditional use, plant parts and administration methods besides computing some statistical values.

MATERIALS AND METHODS

Plant samples that have been collected by spice-sellers or residents from Aydıncık for therapeutic purposes were recorded by visiting the villages during the study period, and then brought to the laboratory to diagnose the taxa. In addition, the relative frequency citation (RFC), use values (UV), informant consensus factor (ICF) and fidelity level (FL) were computed.

RESULTS

In this research conducted between 2013 and 2015, 91 taxa associated with 41 families, including 1 fern & 2 gymnosperms were defined they have been used for centuries in terms of the healing by visiting 10 villages & 5 spice-sellers in Aydıncık. Lamiaceae, Rosaceae, Araceae, Asteraceae, Cupressaceae, Orchidaceae and Pinaceae have been determined as the most used families for therapeutic purposes. The study revealed that most of the locals concurred on the use of Juniperus oxycedrus fruits & leaves to cure gastro-intestinal diseases that demonstrated the highest fidelity level (0.98). 22 taxa have not matched with any studies conducted in and around the region.

CONCLUSION

The light of the information obtained during the investigation demonstrates that the medicinal plants have been mostly utilized as analgesics (0.78 ICF). The most data were acquired from the mountain villagers & Yuruk nomads, having average ages of 65. From the viewpoint of ethnobotany, the district has remained valuable due to the winding roads, ongoing hundreds of kilometers over the mountains and along the coast is very difficult to drive making Aydıncık too far from large cities and mass tourism centers.

Efficacy and safety of mycophenolate mofetil in patients with IgA nephropathy: an update meta-analysis

BACKGROUND

The application of mycophenolate mofetil (MMF) in treating patients with immunoglobulin A nephropathy (IgAN) remains uncertain. This update meta-analysis was performed to re-evaluate the therapeutic potential of MMF in IgAN.

METHODS

Articles were obtained by searching the electronic databases without language restriction. Randomized controlled trials studying the role of MMF in treating IgAN were collected. The quality of included studies was critically evaluated. Data analyses were performed by using RevMan 5.3 software.

RESULTS

A total of 297 articles were screened and eight articles were finally included. Among the eight randomized controlled trials, five and three were high quality and low quality, respectively. Both fixed-effect and random-effect model were used. Pooled results by combining all the eight studies suggested that IgAN patients in MMF group had a higher remission rate than that in control group. Compared to placebo or corticosteroid monotherapy, MMF monotherapy exerted a higher remission rate and side effect rate in both main analysis and subgroup analysis by human race. Compared to corticosteroid plus other immunosuppressive agent therapy, corticosteroid plus MMF therapy had a higher remission rate, lower serum creatinine doubling rate, progression to end-stage renal disease rate and side effects rate. Subgroup analysis by therapeutic regimen further confirmed these results between corticosteroid plus MMF therapy and corticosteroid plus cyclophosphamide therapy. Funnel-plot displayed a symmetrical figure, indicating no publication bias existed.

CONCLUSIONS

MMF has the potential in treatment of IgAN, especially for Asians. The evidence currently available shows that MMF monotherapy has a more efficacy but higher side effects when compared to placebo or corticosteroid monotherapy in treatment of Asians with IgAN. While MMF combined with corticosteroid regimen has a more efficacy and lower side effects when compared with corticosteroid plus cyclophosphamide regimen.

Clinical implications of a folk illness: empacho in mainland Puerto Ricans

The study of folk illnesses provides insight into client health beliefs and behaviors. This paper describes the expression of empacho in children living in a mainland Puerto Rican community. Etiology, symptom presentation, and treatment options in various health care sectors, as well as an investigation of overlapping folk/biomedical symptom domains are described. Implications regarding health and health care in the multicultural setting are discussed.

Lead based remedies for empacho: patterns and consequences

This paper discusses research designed to investigate the patterns and consequences of the use of lead based folk remedies in the treatment of some gastrointestinal problems in Mexico. Use of lead is seen in 35% of the population sampled in Guadalajara who treated the folk illness empacho, and 5% of a similar population in Oaxaca. Lead use seems to be associated with mestizo ethnic background, and with lower levels of parental education and income.

A cross-sectional investigation of the health needs of asylum seekers in a refugee clinic in Germany

BACKGROUND

Over one million asylum seekers were registered in Germany in 2016, most from Syria and Afghanistan. The Refugee Convention guarantees access to healthcare, however delivery mechanisms remain heterogeneous. There is an urgent need for more data describing the health conditions of asylum seekers to guide best practices for healthcare delivery. In this study, we describe the state of health of asylum seekers presenting to a multi-specialty primary care refugee clinic.

METHODS

Demographic and medical diagnosis data were extracted from the electronic medical records of patients seen at the ambulatory refugee clinic in Dresden, Germany between 15 September 2015 and 31 December 2016. Data were de-identified and analyzed using Stata version 14.0.

RESULTS

Two-thousand-seven-hundred and fifty-three individual patients were seen in the clinic. Of these, 2232 (81.1%) were insured by the state indicating arrival within the last 3 months. The median age was 25, interquartile range 16-34. Only 786 (28.6%) were female, while 1967 (71.5%) were male. The most frequent diagnoses were respiratory (17.4%), followed by miscellaneous symptoms and otherwise not classified ailments (R series, 14.1%), infection (10.8%), musculoskeletal or connective tissue (9.3%), gastrointestinal (6.8%), injury (5.9%), and mental or behavioral (5.1%) categories.

CONCLUSIONS

This study illustrates the diverse medical conditions that affect the asylum seeker population. Asylum seekers in our study group did not have a high burden of communicable diseases, however several warranted additional screening and treatment, including for tuberculosis and scabies. Respiratory illnesses were more common amongst newly arrived refugees. Trauma-related mental health disorders comprised half of mental health diagnoses.

Medicinal plants used to treat "African" diseases by the local communities of Bwambara sub-county in Rukungiri District, Western Uganda

ETHNOPHARMACOLOGICAL RELEVANCE

In Africa, traditional medicine encompasses a diverse range of practices, including herbalism and spiritualism, where some diseases are believed to be "African" since they can only be traditionally treated. Indigenous knowledge on the management of "African" diseases using medicinal plants is still handed down orally from generation to generation by tribal societies of tropical Africa, and with the rapid westernization of these societies there is a pressing need to record local knowledge before it is lost forever.

AIM

This study documented medicinal plant species associated with the management of "African" diseases by the local communities of Bwambara sub-county in Rukungiri district, Western Uganda.

METHODS

A cross-sectional study was conducted using semi-structured questionnaires and interviews. The data collected included names of plant species, plant parts used, diseases treated, methods of preparation, and mode of administration of the herbal remedies. A total of 196 informants participated in the study. Data were analyzed and presented using descriptive statistics and the Informant consensus factor.

RESULTS

We documented 67 medicinal plant species distributed over 27 families and 62 genera. The most commonly reported species belong to Asteraceae family. The most frequently used medicinal species were Chenopodium opulifolium (27), Sesbania sesban (26), Thevetia peruviana (25), Leonotis nepetifolia (23), Momordica foetida (23), Euphorbia hirta (21) and Cassia mimosoides (20). Leaves were the most commonly used plants parts and decoctions were the main method of preparation. Water was the main medium used for the preparation of the remedies which were administered orally while petroleum jelly was the main medium for those which were used as ointments. The medicinal plant species reported are used to treat 39 conditions which were clustered into 10 International Classification of Primary Care (ICPC) disease categories. There is a high degree of consensus among the informants on which medicinal plant species they use for different diseases especially disorders in the following categories: neurological (FIC = 0.90), general and unspecified (FIC = 0.87), digestive (FIC = 0.86) and female genital (FIC = 0.82).

CONCLUSION

Local communities of Bwambara sub-county in Rukungiri district, Western Uganda use a rich diversity of medicinal plant species in the management of various "African" diseases. Therefore, collaboration between users of medicinal plants and scientists is paramount, to help in the discovery of new drugs based on indigenous knowledge.

Development of a scale to assess Hwa-Byung, a Korean culture-bound syndrome, using the Korean MMPI-2

This study documents the development of an MMPI-2 scale designed to assess features of the Korean culture-bound syndrome, Hwa-Byung (HB). An American research team and psychiatric practitioners in Korea created an 18-item HB scale via rational item selection and psycho-metric refinement. Principal components analysis of scale items revealed four components, reflecting content domains of general health, gastrointestinal symptoms, hopelessness, and anger. This four-component solution applied well to both Korean men and women, but not to an American sample. Although some findings were encouraging, future studies employing clinical samples are needed to provide further validation of this scale.

Prevalence of gastrointestinal and psychosomatic symptoms among Asian patients undergoing regular hemodialysis

AIM

Gastrointestinal (GI) symptoms are reported to be common among patients with chronic disorders including end-stage renal disease (ESRD). This questionnaire study assessed the prevalence of GI symptoms among patients undergoing hemodialysis (HD) and to correlate with the presence of diabetes mellitus and psychosomatic symptoms in Asian patients with ESRD.

METHODS

A total of 123 patients (male 47.2%) participated in this study. GI symptoms (upper GI: anorexia, nausea, vomiting, odynophagia, dysphagia, early satiety, heartburn, dyspepsia and lower GI: abdominal bloating, non-epigastrium abdominal pain, bowel habit and bleeding per rectum) and psychosomatic symptoms (anxiety, backache, depression, headache and insomnia) in the previous 12 months were enquired and compared with age and gender matched controls (n = 197).

RESULTS

The mean age of patients was 51.8 ± 12.9 years with mean duration of HD of 28 ± 38.2 months. Overall, 70.7% of ESRD patients had experienced any GI symptoms; upper GI, 65% and lower GI, 34.1%, significantly more than controls (P < 0.05). ESRD patients had more anorexia, nausea, vomiting, dyspepsia, irregular bowel habit and bleeding per rectum (all P < 0.05). Overlap of upper and lower GI symptoms was reported by 34.1%, significantly higher than control (14.2%, P < 0.05). ESRD patients also experienced significantly more anxiety, depressive symptoms and insomnia (all P < 0.05). Among the patients with ESRD, the presence of any psychosomatic symptoms correlated significantly with the presence of any upper or lower GI symptoms and overlapping of GI symptoms. Such correlations were not seen with diabetes mellitus.

CONCLUSION

Gastrointestinal and psychosomatic symptoms are common among our Asian patients with ESRD undergoing regular HD. The presence of underlying psychosomatic symptoms but not diabetes mellitus correlated significantly with the presence of GI symptoms.

Housing conditions associated with recurrent gastrointestinal infection in urban Aboriginal children in NSW, Australia: findings from SEARCH

OBJECTIVE

To examine the associations between housing and gastrointestinal infection in Aboriginal children in urban New South Wales.

METHODS

A total of 1,398 Aboriginal children were recruited through four Aboriginal Community Controlled Health Services. Multilevel regression modelling of survey data estimated associations between housing conditions and recurrent gastrointestinal infection, adjusting for sociodemographic and health factors.

RESULTS

Of the sample, 157 children (11%) had recurrent gastrointestinal infection ever and 37 (2.7%) required treatment for recurrent gastrointestinal infection in the past month. Children in homes with 3+ housing problems were 2.51 (95% CrI 1.10, 2.49) times as likely to have recurrent gastrointestinal infection ever and 6.79 (95% CrI 2.11, 30.17) times as likely to have received recent treatment for it (versus 0-2 problems). For every additional housing problem, the prevalence of recurrent gastrointestinal infection ever increased by a factor of 1.28 (95% CrI 1.14, 1.47) and the prevalence of receiving treatment for gastrointestinal infection in the past month increased by a factor of 1.64 (95% CrI 1.20, 2.48).

CONCLUSIONS

Housing problems were independently associated with recurrent gastrointestinal infection in a dose-dependent manner. Implications for public health: The role of housing as a potential determinant of health in urban Aboriginal children merits further attention in research and policy settings.

Medical comorbidity in black and white patients with Alzheimer's disease

BACKGROUND

Little is known about co-medical illnesses in black and white patients with probable Alzheimer's disease (AD).

METHODS

To address this question, we used two methods. In the first (Group I), black and white probable AD patients were matched on age at presentation to the clinic, age of onset of AD, duration of illness, and Mini-Mental State Examination scores; then, a variety of co-medical illnesses were compared between blacks and whites. In Group II, whites were randomly matched to blacks on the variables listed above.

RESULTS

In Group I, blacks were found to have a higher rate of hypertension than whites, whereas whites had a higher incidence of atrial fibrillation and cancer than blacks. In Group II, age at presentation to the clinic was found to be shorter for men than for women; duration of illness was shorter for black men than for white men, white women, and black women; and Mini-Mental State Examination scores were lower in blacks than whites. As in Group I, blacks were found to have a higher rate of hypertension, whereas whites had higher rates of atrial fibrillation, cancer, coronary artery disease, high cholesterol, and gastrointestinal disease.

CONCLUSION

In both groups, black patients with probable AD had a higher rate of hypertension than white patients with probable AD, and whites had higher rates of atrial fibrillation and cancer. This finding suggests that these comorbid illnesses in black and white patients with probable AD is not due to a statistical Type II error, but rather to differences in these groups.

Helicobacter pylori infection among non-Native educators in Alaska

OBJECTIVES

To determine seroprevalence of H. pylori infection in non-Native educators residing in urban or rural settings in Alaska, and to determine potential risk factors associated with infection in this population.

STUDY DESIGN

A cross-sectional survey of non-Native educators residing in urban or rural settings in Alaska.

METHODS

Participants completed a questionnaire detailing aspects of residential life; H. pylori antibody status was determined by a commercial assay.

RESULTS

Of the 203 non-Native participants, 49 (24%) had antibody to H. pylori. Univariate analysis demonstrated that the mean age of seropositive participants was higher than of seronegatives (48 vs. 42 years, respectively, p = .001). In addition, participants who had experienced childhood crowding were more likely to test seropositive for H. pylori (p = .058). On multivariate analysis, only age > or = 40 was associated with infection. No difference in median hemoglobin or ferritin levels were noted among seropositive and seronegative participants. There was no increased risk of seropositivity among participants who had lived in an Alaska Native village or in a developing country for > or = 6 months.

CONCLUSIONS

Overall, 24% of non-Native educators residing in rural Alaska tested positive by serology for H. pylori. Age > or = 40 years was associated with infection. Median hemoglobin or ferritin levels did not differ significantly among seropositive and seronegative participants.

A prospective evaluation of 200 upper endoscopies performed in Alaska Native persons

OBJECTIVES

To characterize the nature and prevalence of disease in Alaska Native patients referred for evaluation of upper gastrointestinal signs and symptoms.

STUDY DESIGN

Cross-sectional.

METHODS

Two hundred consecutive Alaska Native patients referred to a statewide tertiary center were prospectively evaluated. A standardized data collection form documenting EGD findings was utilized. Routine biopsies of the antrum and fundus were taken on all patients. Additional tissue was obtained from any areas of clinical concern.

RESULTS

Among 200 patients who underwent EGD during the study period, 130 (65%) tested H. pylori-positive on histology. Among 173 patients with histologic evidence of gastritis, 114 (66%) tested H. pylori-positive on histology. Chronic gastritis (87%), gastric ulcer (GU 12%), duodenal ulcer (DU 3%) and gastric cancer (2%) were the predominant findings. The GU:DU ratio was 4:1, the inverse of that reported in the general U.S. population.

CONCLUSIONS

Alaska Native patients referred for upper endoscopy have a high rate of H. pylori infection with predominantly gastric manifestations of disease and a GU:DU ratio, which is the inverse of what is typically seen in the U.S. and other developed countries. The high prevalence of H. pylori in Alaska Native patients resembles prevalence patterns reported from developing countries and may be linked to a rate of gastric cancer that is over three times that found in the U.S. population at large.

Breastfeeding as a means to prevent infant morbidity and mortality in Aboriginal Canadians: A population prevented fraction analysis

OBJECTIVES

Canadian Aboriginal infants experience poor health compared with other Canadian infants. Breastfeeding protects against many infant infections that Canadian Aboriginals disproportionately experience. The objective of our research was to estimate the proportion of select infant infection and mortality outcomes that could be prevented if all Canadian Aboriginal infants were breastfed.

METHODS

We used Levin's formula to estimate the proportion of three infectious outcomes and one mortality outcome that could be prevented in infancy by breastfeeding. Estimates were calculated for First Nations (both on- and off-reserve), Métis and Inuit as well as all Canadian infants for comparison. We extracted prevalence estimates of breastfeeding practices from national population-based surveys. We extracted relative risk estimates from published meta-analyses.

RESULTS

Between 5.1% and 10.6% of otitis media, 24.3% and 41.4% of gastrointestinal infection, 13.8% and 26.1% of hospitalizations from lower respiratory tract infections, and 12.9% and 24.6% of sudden infant death could be prevented in Aboriginal infants if they received any breastfeeding.

CONCLUSION

Interventions that promote, protect and support breastfeeding may prevent a substantial proportion of infection and mortality in Canadian Aboriginal infants.

Salivary immunoreactive endothelin in patients with upper gastrointestinal diseases

Endothelins have been implicated in gastric mucosal damage in a variety of animal models. Furthermore, clinical reports also show elevated gastric mucosal endothelin-1 levels in patients suffering from peptic ulcer diseases. We have demonstrated, first, the presence of immunoreactive endothelin (IR-ET) in human saliva. We also show that endothelins are rather stable in human saliva. The present study was undertaken to determine whether patients with endoscopically proven upper gastrointestinal diseases have a salivary excess of IR-ET, compared with patients with a normal esophagogastroduodenoscopy. Saliva was collected from fasting subjects prior to esophagogastroduodenoscopy. The levels of IR-ET were measured by the radioimmunoassay method. The salivary concentrations of IR-ET in the studied subjects were as follows: 8.9 +/- 1.0 fmol/mL (mean +/- standard error of the mean) for patients with gastric ulcers (n = 18); 7.3 +/- 1.0 fmol/mL for patients with duodenal ulcers (n = 22); and 6.8 +/- 0.6 fmol/mL for patients with gastritis (n = 28). These values are all higher than that of normal subjects (4.4 +/- 0.5 fmol/mL, n = 20; P < 0.001, P < 0.01, and P < 0.05, respectively). No significant differences in salivary IR-ET were noted between patients with a normal esophagogastroduodenoscopy and patients with esophagitis (3.8 +/- 0.7 fmol/mL, n = 4) or gastric cancer (5.3 +/- 1.4 fmol/mL, n = 4). There were no significant differences in the salivary IR-ET levels between males and females. However, the salivary IR-ET levels in the smokers (8.0 +/- 0.6 fmol/mL, n = 38) were significantly higher (P < 0.01) than those of the non-smokers (6.0 +/- 0.4 fmol/mL, n = 58). There was no correlation of IR-ET levels with age. Our findings suggest that salivary endothelin may have a contributing role in certain gastroduodenal diseases.

Functional gastrointestinal disorders in New Zealand

BACKGROUND

Functional gastrointestinal disorders are common worldwide.

AIM

To review functional gastrointestinal disorder prevalence, diagnosis and treatment in New Zealand.

METHODS

A Medline search was performed to identify all published studies relating to prevalence, diagnosis and treatment of functional gastrointestinal disorders in New Zealand.

RESULTS

Reflux prevalence is 30% and non-reflux dyspepsia is 34.2%. Helicobacter pylori prevalence varies considerably in NZ by geographical area and ethnicity and overall prevalence of infection is 24% in adults. 50% of patients with dyspepsia presenting for endoscopy in NZ will have no mucosal abnormality identified. National Dyspepsia Guidelines assist in management of patients. Guidelines exist for undifferentiated dyspepsia, Gastro-oesophageal Reflux Disease (GORD), H. pylori, peptic ulcer, NSAID's and gastrointestinal complications. Irritable Bowel Syndrome (IBS) is reported by 21% of adults. Symptoms were more than twice as frequent and severe in females than males. Access to colonoscopy for investigation of bowel symptoms is limited in NZ and priority is given to patients with "alarm features". Non-invasive markers of inflammation, such as faecal calprotectin, are being used to differentiate the patient with functional diarrhoea from inflammatory bowel disease. Treatment for irritable bowel symptoms is targeted to the predominant symptom.

CONCLUSIONS

Functional gastrointestinal disorders are common in New Zealand. There is increasing awareness of dietary management for functional bowel symptoms.

Medicinal plants for gastrointestinal diseases among the Kuki-Chin ethnolinguistic groups across Bangladesh, India, and Myanmar: A comparative and network analysis study

ETHNOPHARMACOLOGICAL RELEVANCE

The Kuki-Chin is a composite ethnolinguistic group made up of many distinct groups and subgroups that are linked by a common history, culture, and population distribution in the Kuki-Chin region, shared geopolitically by Bangladesh, India, and Myanmar. This region is shown to be in a hotspot of digestive disease activity based on official reports and in concordance with data from related ethnopharmacological field surveys. Our work provides a comparative analysis of medicinal plant knowledge for the treatment of gastrointestinal diseases (GAS-Ds) among the Kuki-Chin ethnic groups found across the three countries.

AIM OF THE STUDY

The objectives were (1) to identify the medicinal plants and herbal therapies for the treatment of GAS-Ds reported in related Kuki-Chin ethnobotanical publications, (2) to find the similarities and differences in medicinal plant knowledge among the country-affiliated groups by comparing plant and disease information, and (3) to determine significant plant taxa and their pattern(s) of use as digestive disease herbal remedies by analyzing disease-plant networks.

MATERIALS AND METHODS

Secondary data were gathered from 34 related studies through internet search of ethnobotanical information from field studies published in journals, reports, books, and dissertations/theses. These data represented 22 Kuki-Chin ethnolinguistic groups inhabiting 23 districts across six states comprising the Kuki-Chin region: the Chittagong Division (Bangladesh); Mizoram, Assam, Manipur, and Tripura States (India); and Chin State (Myanmar). Scientific names of plants and digestive diseases collated from secondary sources were validated and standardized following the Plant List and the International Classification of Primary Care Second Edition, respectively.

RESULTS AND DISCUSSION

A total of 482 species in 330 genera and 118 families of vascular plants were recorded for the treatment of 29 standardized GAS-Ds. On the basis of the number of use-reports, regional native species Phyllanthus emblica, Centella asiatica, and Aegle marmelos, as well as the non-natives Carica papaya, Portulaca oleracea, and Psidium guajava were found to be the most preferred. Comparative analysis of medicinal species showed that groups in India revealed the highest number of medicinal plant taxa, followed by those in Bangladesh and Myanmar. The most prevalent GAS-Ds were shown to be abdominal pain epigastric, gastroenteritis presumed infections, and diarrhoea, as supported by the number of use-reports and medicinal taxa used for their treatment, and their informant consensus factor values. Analyses of disease-plant networks graphically showed both GAS-Ds distribution patterns in the region and potential medicinal plant (group) candidates for further studies.

CONCLUSION

Overall, this study revealed an astonishingly rich diversity of medicinal plants used to treat digestive diseases among the Kuki-Chin. A comparative analysis showed variations and remarkable distinctions in medicinal plant knowledge among country-affiliated groups, as likely influenced by external sociocultural factors and geopolitical barriers, as well as the availability of ethnobotanical data. The use of network analysis reflected not only shared common affinities and patterns of plant use based on the taxonomic composition and species selection, but also disease prevalence and distribution patterns. The information found here can hopefully spur interest among future researchers and policy makers to better improve both the (ethno) medicinal research capacity and healthcare system in the region.

Child health care decision making and experiences of Caribbean women

INTRODUCTION

The purposes of this study were to (a) obtain data about the child health care decision making and practices of immigrant English-speaking women from the Caribbean region and (b) describe their experiences with the U.S. health care system and providers of care.

METHOD

A qualitative design with purposeful sampling was used. Data were obtained from 12 women through focus group interviews.

RESULTS

Three descriptive categories were identified: child/family focus, childhood illnesses and remedies, and relationships with providers. Findings included use of "parallel utilization" practices by the caretakers; use of herbs and other alternative practices; a strong informal social support network within the community; and frustration with and lack of trust in health care providers.

DISCUSSION

Immigrant children and children of immigrant Caribbean adults are a vulnerable population that may be at risk for poor health and mental health outcomes when receiving care from multiple or inconsistent providers, when providers are unaware of folk practices administered to these children by caretakers, and because of a lack of research about the efficacy of folk medicines used in children either alone or in combination with prescribed Western medicines.

What is the qualitative evidence concerning the risks, diagnosis, management and consequences of gastrointestinal infections in the community in the United Kingdom? A systematic review and meta-ethnography

BACKGROUND

Gastrointestinal (GI) infections cause a significant public health burden worldwide and in the UK with evidence pointing to socio-economic inequalities, particularly among children. Qualitative studies can help us understand why inequalities occur and contribute to developing more effective interventions. This study had two aims: 1. Conduct a systematic review to determine the extent and nature of UK qualitative evidence on gastrointestinal infections; 2. Use meta-ethnography to examine the influences of the differing social contexts in which people live.

METHODS

MEDLINE, Scopus, Web of science, CINAHL and JSTOR were searched for UK qualitative studies engaging with the risk, diagnosis, management or consequences of gastrointestinal infections from 1980 to July 2019. Five reviewers were involved in applying inclusion and exclusion criteria, extracting and synthesising data (PROSPERO CRD 42017055157).

RESULTS

Searches identified 4080 studies, 18 met the inclusion criteria. The majority (n = 16) contained data relating to the risk of gastrointestinal infection and these made up the main synthesis. The tenets of meta-ethnography were used to glean new understandings of the role of social and environmental contexts in shaping the risk of gastrointestinal infection, specifically with respect to foodborne GI illness. Three main explanations concerning risk emerged from the data: explanations of risk in the community were underpinned by understandings of 'bugs', dirt and where food comes from; risks were negotiated in households alongside diverse processes of decision making around food; and resources available to households shaped food practices.

CONCLUSION

This systematic review highlights the scarcity of UK qualitative evidence examining gastrointestinal infections. Apart from risk, questions around diagnosis, management and consequences of illness were largely untouched. No studies investigated patterning by socio-economic status. Nevertheless, the meta-ethnography yielded wider contextual theories and explanations as to why people might not follow food hygiene guidance, giving pointers to the types of qualitative enquiry needed to develop more effective interventions.