Assessing the gastrointestinal and psychological impacts of nicotine pouch use among adults in Saudi Arabia: A cross-sectional study

The COVID-19 Pandemic and Post-Infection Irritable Bowel Syndrome: What Lies Ahead for Gastroenterologists

Effect of Gastrointestinal Symptoms in Patients With COVID-19

Are Gastrointestinal Symptoms Specific for Coronavirus 2019 Infection? A Prospective Case-Control Study From the United States

IntroductionSpondyloarthritis (SpA) exhibits predominantly musculoskeletal symptoms but also significant gastrointestinal (GI) and psychological manifestations. Subclinical gut inflammation is common in SpA, with frequent symptoms such as abdominal pain and diarrhea. Psychological issues like depression and anxiety are also prevalent, with a negative impact on quality of life. This study aimed to evaluate the presence of GI and psychiatric symptoms in SpA patients without inflammatory bowel disease (IBD) and their association with disease characteristics.MethodsCross-sectional study, which included SpA patients from two rheumatology outpatient clinics. Patients were assessed for GI, and depressive symptoms (PHQ-9), perceived stress (PSS-10), disease activity (ASDAS, BASDAI) and functionality (BASFI). Laboratory tests included C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin, and Secretory IgA. Statistical analysis involved Spearman correlation, linear regression, and multiple correspondence discriminant analysis (MCDA).ResultsAmong 98 SpA patients, 79.6% had axial SpA. High disease activity and functional impairment were common. 65.3% reported ≥ 2 GI symptoms, predominantly abdominal pain and diarrhea. Depression (PHQ-9 ≥ 10) was observed in 46.7% of patients, being moderate to severe in 25.0%. Depression, perceived helplessness, and lack of self-efficacy were associated with high disease activity and GI symptoms. MCDA identified strong correlations between depression, GI symptoms, and disease activity.ConclusionThis study highlights the association between GI and psychological symptoms with disease activity and functionality in SpA patients. Depression and perceived helplessness are prevalent and closely associated with high disease activity and GI symptoms, suggesting the need for interdisciplinary management from early stages to improve patient outcomes.

Prevalence and Socioeconomic Impact of Upper Gastrointestinal Disorders in the United States: Results of the US Upper Gastrointestinal Study

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are chronic gastrointestinal (GI) syndromes in which both GI and psychological symptoms have been shown to negatively impact health-related quality of life (HRQOL). The objective of this study was to use structural equation modeling (SEM) to characterize the interrelationships among HRQOL, GI, and psychological symptoms to improve our understanding of the illness processes in both conditions. Study participants included 564 Rome positive IBS patients and 126 IBD patients diagnosed via endoscopic and/or tissue confirmation. All patients completed questionnaires to assess bowel symptoms, psychological symptoms (SCL-90R), and HRQOL (SF-36). SEM with its two components of confirmatory analyses and structural modeling were applied to determine the relationships between GI and psychological symptoms and HRQOL within the IBS and IBD groups. For both IBD and IBS, psychological distress was found to have a stronger direct effect on HRQOL (-0.51 and -0.48 for IBS and IBD, respectively) than GI symptoms (-0.25 and -0.28). The impact of GI symptoms on psychological distress was stronger in IBD compared with IBS (0.43 vs. 0.22; P<0.05). The indirect effect of GI symptoms on HRQOL operating through psychological distress was significantly higher in IBD than IBS (-0.21 vs. -0.11; P<0.05). Psychological distress is less dependent on GI symptom severity in IBS compared with IBD even though the degree that psychological distress impacts HRQOL is similar. The findings emphasize the importance of addressing psychological symptoms in both syndromes.

Gut Involvement by COVID-19

Isolated Gastrointestinal Alpha-gal Meat Allergy Is a Cause for Gastrointestinal Distress Without Anaphylaxis

Objective: To determine the clinical significance of gastrointestinal (GI) symptoms in mild hospitalized patients with Covid-19 infection. Material and Methods: This study included adult patients who were hospitalized with a confirmed diagnosis of Covid-19 infection. The demographical features, symptoms, clinical presentations, medical history, medications and clinical progress and outcomes were noted using data collection form by the clinicians. The effect of GI symptoms on clinical outcomes in patients with mild Covid-19 infection was statistically evaluated. Results: 307 patients were included to the study. 159 of patients (51.7%) had an at least one GI symptoms, 18.2% of those presented only GI symptoms while 21.2% only non-GI symptoms. 27% were asymptomatic at admission. The most common GI symptom was loss of appetite that presenting 16.9% patients. The second and third most common GI symptoms were diarrhea in 15% patients, nausea and loss of taste in 14% patients, respectively. There was no significant difference in laboratory parameters between GI and non-GI symptoms groups. When age, gender, smoking status, and comorbidities of patients with GI and non-GI symptoms groups were compared, there was no difference in mean age, gender, smokers, and comorbidities. In addition, the length of hospital stay (p=0.377), complete healing (p=0.372) and mortality (p=0.351) was similar in patients with GI and non-GI symptoms groups respectively. Conclusion: Early diagnosis of Covid-19 infection presenting with GI symptoms can help prevent infection spread. The majority of these symptoms were mild, and their presence was not associated with worse clinical outcomes.

In a prior retrospective analysis of 32 infants diagnosed with cow's-milk protein-induced enterocolitis (CMPIE), gastrointestinal (GI) symptoms were observed with the introduction of milk-free infant cereal. The aim of this randomized controlled trial was to compare the incidence of new GI symptoms with the introduction of either milk-free infant rice cereal or carrots as the first complementary food at 6 months of age in infants previously diagnosed as having CMPIE. Thirty-nine infants were enrolled in the study. Twenty were randomized to start with pureed carrots and 19 were randomized to start with milk-free infant rice cereal. GI signs and symptoms developing within 2 weeks were recorded. No significant differences were noticed in the incidence of new GI symptoms and the change in the frequency of GI symptoms upon solid-food introduction, whether it was carrots or milk-free infant rice cereal. A high overall incidence rate (47%) of new GI symptoms was observed in the whole cohort. The mean number of days for onset of new symptoms was 6. The most common GI signs and symptoms observed were related to alteration of stool characteristics. Breast-feeding was not shown to have a protective effect on the development of new GI symptoms during solid-food introduction. Many infants with CMPIE will develop GI signs and symptoms following the introduction of solid food, whether milk-free infant rice cereal or carrots are introduced, and their onset may be delayed.

Redux: Do Little Bellyachers Grow up to Become Big Bellyachers?

Despite the fact that food and diet are central issues, that concern patients with irritable bowel syndrome (IBS), the current understanding about the association between the intake of certain foods/food groups and the gastrointestinal (GI) symptom pattern, psychological symptoms, and quality of life is poor. The aim of this study was to determine which food groups and specific food items IBS patients report causing GI symptoms, and to investigate the association with GI and psychological symptoms and quality of life. We included 197 IBS patients (mean age 35 (18-72) years; 142 female subjects) who completed a food questionnaire in which they specified symptoms from 56 different food items or food groups relevant to food intolerance/allergy. The patients also completed questionnaires to assess depression and general anxiety (Hospital Anxiety and Depression), GI-specific anxiety (Visceral Sensitivity Index), IBS symptoms (IBS-Severity Scoring System), somatic symptoms (Patient Health Questionnaire-15), and quality of life (Irritable Bowel Syndrome Quality of Life Questionnaire). In all, 84% of the studied population reported symptoms related to at least one of the food items surveyed. Symptoms related to intake of food items with incompletely absorbed carbohydrates were noted in 138 (70%) patients; the most common were dairy products (49%), beans/lentils (36%), apple (28%), flour (24%), and plum (23%). Of these, 58% experienced GI symptoms from foods rich in biogenic amines, such as wine/beer (31%), salami (22%), and cheese (20%). Histamine-releasing foods, such as milk (43%), wine/beer (31%), and pork (21%), were also considered causes of symptoms in IBS patients. GI symptoms were also frequently reported after intake of fried and fatty foods (52%). With increasing IBS symptom severity, patients reported more food items responsible for their GI symptoms (P=0.004), and this was also found in patients with more severe somatic symptoms (P<0.0001). Women tended to report more food items causing symptoms than men (P=0.06). A high number of food items causing GI symptoms was also associated with reduced quality of life and this was significant for the following domains: sleep (r=-0.25; P=0.001), energy (r=-0.21; P=0.005), food (r=-0.29; P<0.001), social functioning (r=-0.23; P=0.001), and physical status (r=-0.16; P<0.05). However, the number of food items reported to provoke GI symptoms was unrelated to body mass index, age, IBS subtype, anxiety, depression, or GI-specific anxiety. The majority of IBS patients believe that certain food items are important triggers of their GI symptoms. This is especially true for foods containing carbohydrates and fat, and also may be relevant for histamine-releasing food items and foods rich in biogenic amines. Self-reported food intolerance is associated with high symptom burden and reduced quality of life.

From psychological to physical health: Exploring temporal precedence throughout emotion regulation therapy

The frequency of Helicobacter pylori (HP) infection in 208 patients with upper gastrointestinal tract symptoms from the Southern Province of Saudi Arabia was studied prospectively. The occurrence of HP was documented histologically and using a rapid urease test in antral endoscopic biopsies. Our results showed that 82.2% of the 208 patients included were positive for HP with a male:female ratio of approximately 1:1 (88:83). The age range was 14 to 80 years and the median age was 38.2 years. The frequencies of HP infection among Saudi and non-Saudi patients were 86% and 71%, respectively. Frequencies of HP infection were 88%, 77.5%, and 93% during the second, third, and fourth decades of life. Among the 140 patients with histologically proven antral gastritis, 128 cases (91%) were positive for HP whereas 29 cases (17%) of the 171 patients positive for HP did not show histologic evidence of antral gastritis. Our data showed that HP was present in 92.5% of patients with endoscopic diagnosis of duodenal ulceration, 81% of patients with duodenitis, 80% of patients with both duodenitis and gastritis, 69% of patients with gastric antral erythema, and 81% of patients with non-ulcer dyspepsia (normal upper gastrointestinal endoscopy). Histologically proven antral gastritis was seen in 80% of patients with endoscopic diagnosis of duodenal ulceration, 76% of patients with antral erythema, 70% of patients with both duodenitis and gastritis, 33% of patients with duodenitis only, and 66% of patients with non-ulcer dyspepsia. Among the 208 patients included in the study, gastric ulcerationw as only seen in two cases, both positive for HP.

BackgroundCOVID‐19 frequently presents with acute gastrointestinal (GI) symptoms, but it is unclear how common these symptoms are after recovery. The purpose of this study was to estimate the prevalence and characteristics of GI symptoms after COVID‐19.MethodsThe medical records of patients hospitalized with COVID‐19 between March 1 and June 30, 2020, were reviewed for the presence of GI symptoms at primary care follow‐up 1 to 6 months later. The prevalence of new GI symptoms was estimated, and risk factors were assessed. Additionally, an anonymous survey was used to determine the prevalence of new GI symptoms among online support groups for COVID‐19 survivors.Key ResultsAmong 147 patients without pre‐existing GI conditions, the most common GI symptoms at the time of hospitalization for COVID‐19 were diarrhea (23%), nausea/vomiting (21%), and abdominal pain (6.1%), and at a median follow‐up time of 106 days, the most common GI symptoms were abdominal pain (7.5%), constipation (6.8%), diarrhea (4.1%), and vomiting (4.1%), with 16% reporting at least one GI symptom at follow‐up (95% confidence interval 11 to 23%). Among 285 respondents to an online survey for self‐identified COVID‐19 survivors without pre‐existing GI symptoms, 113 (40%) reported new GI symptoms after COVID‐19 (95% CI 33.9 to 45.6%).Conclusion and inferencesAt a median of 106 days after discharge following hospitalization for COVID‐19, 16% of unselected patients reported new GI symptoms at follow‐up. 40% of patients from COVID survivor groups reported new GI symptoms. The ongoing GI effects of COVID‐19 after recovery require further study.