Abdominal Symptoms In Patients Research Articles

Fructose Malabsorption and Symptoms of Irritable Bowel Syndrome: Guidelines for Effective Dietary Management

Dietary fructose induces abdominal symptoms in patients with fructose malabsorption, but there are no published guidelines on its dietary management. The objective was to retrospectively evaluate a potentially successful diet therapy in patients with irritable bowel syndrome and fructose malabsorption. Tables detailing the content of fructose and fructans in foods were constructed. A dietary strategy comprising avoidance of foods containing substantial free fructose and short-chain fructans, limitation of the total dietary fructose load, encouragement of foods in which glucose was balanced with fructose, and co-ingestion of free glucose to balance excess free fructose was devised. Sixty-two consecutively referred patients with irritable bowel syndrome and fructose malabsorption on breath hydrogen testing underwent dietary instruction. Dietary adherence and effect on abdominal symptoms were evaluated via telephone interview 2 to 40 months (median 14 months) later. Response to the diet was defined as improvement of all symptoms by at least 5 points on a −10- to 10-point scale. Forty-eight patients (77%) adhered to the diet always or frequently. Forty-six (74%) of all patients responded positively in all abdominal symptoms. Positive response overall was significantly better in those adherent than nonadherent (85% vs 36%; P<0.01), as was improvement in individual symptoms ( P<0.01 for all symptoms). This comprehensive fructose malabsorption dietary therapy achieves a high level of sustained adherence and good symptomatic response.

Efficacy of Lower Than Standard Doses of Pancreatic Enzyme Supplementation Therapy During Acid Inhibition in Patients With Pancreatic Exocrine Insufficiency

To compare, during strong acid inhibition with omeprazole, the effect of 2 different doses of an enteric-coated pancreatic enzyme preparation on fecal fat excretion and abdominal symptoms in patients with exocrine insufficiency due to chronic pancreatitis (CP). Treatment with pancreatic enzymes reduces fecal fat excretion in patients with CP but is rather unsuccessful due to irreversible lipase inactivation at pH below 4. Sixteen patients with CP (3 women, 13 men; age 53+/-3 y) participated in this randomized double blind 2-way cross over study. Fecal fat excretion and fat intake were measured and abdominal symptoms (visual analog scales) were scored during a 2 weeks control period, during omeprazole 60 mg+pancreatic enzymes 10,000 Fédération Internationale Pharmaceutique IU lipase tid (treatment A) for 2 weeks and during omeprazole 60 mg+pancreatic enzymes, 20,000 Fédération Internationale Pharmaceutique IU lipase tid (treatment B) for 2 weeks. During acid inhibition with enzyme supplementation fecal fat excretion was significantly (P<0.01) reduced compared with control: 18+/-7 and 18+/-5 g/24 h versus 36+/-8 g/24 h for treatment A, B, and control, respectively. Abdominal symptom score and general well being improved significantly (P<0.05) during treatments A and B versus control. No differences in fat excretion or symptoms scores between treatments A and B were observed. During strong acid inhibition, lower than recommended oral doses of pancreatic enzymes are therapeutically effective with respect to fat absorption and symptom reduction.

The 5‐HT4 antagonist R216073 does not affect gastric motor and sensory function in patients with functional dyspepsia

Serotonin and the 5-HT4 receptor play an important role in gastrointestinal motor and sensory functions. While 5-HT4 agonists are known for their prokinetics properties, the effect of 5-HT4 antagonists on upper gastrointestinal functions is largely unknown. To assess the effect of a 5-HT4 receptor antagonist (R216073) on gastric relaxation and visceral sensitivity in patients with functional dyspepsia. Secondly, the influence of a functional polymorphism in the gene encoding the serotonin transport protein on drug response was determined. A double-blind, randomized, placebo-controlled, two-period crossover study was performed in 20 functional dyspepsia patients. The effect of a single dose of 2,000 mg R216073 on gastric relaxation and sensitivity was tested using three-dimensional ultrasonography and a nutrient drinktest. R216073 did not affect partial gastric volumes or upper abdominal sensations scored during three-dimensional ultrasonography (P > 0.05). The maximum tolerated volume or upper abdominal sensations induced by the drinktest were not affected by R216073 (P > 0.05). The serotonin transport protein promoter polymorphism was not associated with any of the end-points of the study. A single dose of R216073 had no effect on fundic relaxation, drinking capacity, or upper abdominal symptoms in patients with functional dyspepsia.

Prevalence of Unexplained Upper Abdominal Symptoms in Patients with Migraine

Patients with functional gastrointestinal disorders frequently report migraine. We aimed to determine the prevalence of idiopathic upper abdominal symptoms in patients with migraine and compare it with a control population of healthy blood donors. We assessed abdominal symptoms using the Bowel Disease Questionnaire in a series of 488 consecutive blood donors without migraine and 99 patients with migraine. Upper abdominal symptoms were reported by 38%[95% confidence interval (CI) 32, 44] of blood donors compared with 81% (67, 91, P<0.001) of migraine patients. Of the blood donors, 23% (18, 28) reported frequent dyspepsia compared with 60% (44, 74, P<0.001) of the migraine patients. Migraine was associated with frequent upper abdominal symptoms (odds ratio 2.7, 95% CI 1.2, 6.1) after adjusting for age, gender, smoking and consumption of analgesics and alcohol. Upper abdominal symptoms are significantly more frequent in patients with migraine compared with healthy controls. The association between migraine and idiopathic upper abdominal symptoms may suggest common pathophysiological mechanisms.

Effects of Helicobacter pylori eradication therapy on gastric emptying measured using the 13C‐octanoic acid breath test and the acetaminophen method

The relationship between Helicobacter pylori eradication and gastric emptying has been reported; however, the effect of eradication therapy on gastric emptying is still unclear. This study evaluated the relationship between three gastric emptying techniques, the scintigraphic technique, the 13C-octanoic acid breath test, and the acetaminophen method, measured simultaneously, and the effect of H. pylori eradication therapy on gastric emptying and abdominal symptoms in patients with functional dyspepsia who were H. pylori positive. Fifty-three consecutive patients with positive H. pylori infection were enrolled in this study. In the first 14 patients, gastric emptying was measured using the three gastric emptying techniques. In 42 patients cured of H. pylori infection, the 13C-octanoic acid breath test and the acetaminophen method were performed before and 3 months after eradication. Significant correlations were found between the scintigraphic technique, the 13C-octanoic acid breath test, and the acetaminophen method. Gastric emptying determined by the 13C-octanoic acid breath test and the acetaminophen method was not changed after eradication, on average. In 14 (33.3%) patients a decrease in symptom score after eradication was observed. In four (9.5%) patients, accelerated gastric emptying after eradication may have led to a reduction in the abdominal symptoms. The 13C-octanoic acid breath test and the acetaminophen method are appropriate for investigating gastric emptying. A causal relationship between improvement of symptoms and accelerated gastric emptying was not found, and the efficacy of H. pylori eradication therapy in patients with functional dyspepsia was minimally exhibited.

Effect of single-dose administration of recombinant interferon-alpha2b on gastric myoelectrical activity in patients with chronic hepatitis C

Upper abdominal complaints during interferon therapy may result from impaired gastric motility and/or evacuatory function. We examined the effect of acute administration of interferon on gastric myoelectrical activity (GMA) with the use of surface electrogastrography. The study population comprised 25 patients with chronic hepatitis C. All of them were naive to interferon. On 2 days, after a 25-min basal GMA registration, in group A (5 men, 7 women, aged 44.3 +/- 2.8 years) placebo or 5 million i.u. recombinant interferon alpha-2b (IFNA) was administered s.c. and the GMA was recorded in the interdigestive state for two periods (2 h and 4 h), separated by a 15-min break. In group B (7 men, 6 women, aged 44.7 +/- 3.9 years) placebo or 5 million i.u. IFNA was injected s.c. after the ingestion of a semiliquid test meal of 364 kcal. Subsequently, the postprandial GMA was recorded for two periods (2 h and 4 h), separated by a 15-min break. A typical flu-like syndrome was observed in 91.7% of patients in group A, and in 92.3% of patients in group B, thus providing evidence of the pharmacodynamic efficiency of the IFNA administration. In the fasted state, IFNA brought about a negligible increase in the rhythmicity and power of the gastric slow waves. IFNA did not elicit any statistically significant effect on gastric slow-wave activity postprandially. Acute administration of interferon does not involve any deterioration of GMA that could be linked to the previously reported upper abdominal symptoms in patients undergoing treatment with this drug.

Strenges individuelles Therapiekonzept bei Morbus Crohn – ein Erfahrungsbericht

Strong Individual Therapy Concept in Patients with Crohn’s Disease – an Experience Report Background: Crohn’s disease is a chronic inflammatory bowel disease. Aim of the treatment is to achieve a quality of live as high as possible. Regarding the late outcome we investigated the patients treated at the Center for Surgery of the University of Leipzig for Crohn’s disease. Mainly we focused on patients suffering an early onset of the disease and anal complications, both related with a bad prognosis. Patients: We included all 56 patients suffering from Crohn’s disease who were treated at our clinic from 1984 until 1991 in a retrospective study. Results: A poor prognosis was assessed in 13 patients with anal manifestation and in 6 patients with an onset of the disease at age 16 years or earlier. 50% of the patients with anal Crohn’s disease finally were supplied with an anus praeter. The mean follow-up time was 15.8 years. Conclusion: An earlier bowel resection or the construction of a temporary anus praeter seems to be necessary to protect the proctium irrespective of abdominal symptoms in patients with recurrent severe perianal Crohn’s disease.

Impact of Sex and Psychological Factors on the Water Loading Test in Functional Dyspepsia

The pathogenesis of upper abdominal symptoms in patients with functional dyspepsia (FD) is still unclear. The water loading test (WLT) is a new method for evaluation of gastric function. Our aim was to determine the impact of sex, age and psychological factors on the results of WLT in FD patients, FD-subgroups and healthy controls (HCs), and to evaluate the safety of the test. Fifty-six HCs and 35 consecutive patients with FD drank mineral water (100 ml/min) until intolerable. Serum samples for sodium, potassium and creatinine was taken before and after drinking. Water quantity was registered and symptoms were assessed after maximal water intake and 30 min later using a VAS scale. Participants also completed questionnaires measuring psychological general well-being (PGWB) and gastrointestinal symptoms (GSRS and Mearin score). Healthy men drank more than healthy women, 2350 +/- 105 ml versus 1860 +/- 100 ml (P < 0.01), and the same gender difference was noted in FD patients, 1770 +/- 115 ml versus 1180 +/- 110 ml (P < 0.01). Maximal water intake was significantly higher in HC than in FD patients, both in males (P < 0.001) and females (P < 0.0001). Age had no impact on drinking capacity. FD patients had more symptoms 30 min after maximal water intake than HCs. Serum sodium decreased from 141 +/- 0.3 mmol/l to 138 +/- 0.5 mmol/l. Two of the assessed psychological factors, general health and depressed mood, correlated with water intake in FD patients (Rho = 0.47, P < 0.01 respectively Rho = 0.41, P < 0.05). WLT is a useful, simple and safe test for evaluating symptoms in FD patients. Sex, but not age affects the results of the WLT. Furthermore, psychological factors must also be taken into consideration when interpreting the WLT.

Crohn's disease: bowel resection to protect the proctium in severe perianal disease?

Patients with anal Crohn's disease generally have a bad prognosis. Up to 50% end up with an anus praeter or proctectomy. Many of these young people develop psychological and social problems causing them to become invalids. Local surgery and conservative therapy in such aggressive cases of Crohn's disease presenting with recurring perianal fistulae and abscesses are often unsuccessful; the destruction of the proctium continues. The purpose of our study was to look at the outcome of our patients with regard to these aspects. We included all 56 patients suffering from Crohn's disease treated at our clinic from 1984 until 1991 in a retrospective study and focused on the 13 patients with anal manifestation. The mean follow-up was 15.8 years (3-28 years). Often there was no improvement of perianal disease without resection of the involved bowel, especially in cases where both the colon and the rectum were affected. Anal destruction went on. Seven of the 13 patients suffering from anal complications finally received an anus praeter. An previous bowel-resection or the construction of a temporary anus praeter seem to be necessary to protect the proctium irrespective of abdominal symptoms in patients with recurrent severe perianal Crohn's disease.

Impact of Sex and Psychological Factors on the Water Loading Test in Functional Dyspepsia

Background: The pathogenesis of upper abdominal symptoms in patients with functional dyspepsia (FD) is still unclear. The water loading test (WLT) is a new method for evaluation of gastric function. Our aim was to determine the impact of sex, age and psychological factors on the results of WLT in FD patients, FD-subgroups and healthy controls (HCs), and to evaluate the safety of the test. Methods: Fifty-six HCs and 35 consecutive patients with FD drank mineral water (100 ml/min) until intolerable. Serum samples for sodium, potassium and creatinine was taken before and after drinking. Water quantity was registered and symptoms were assessed after maximal water intake and 30 min later using a VAS scale. Participants also completed questionnaires measuring psychological general well-being (PGWB) and gastrointestinal symptoms (GSRS and Mearin score). Results:

H. pylori Infection and Visceral Hypersensitivity in Patients with Irritable Bowel Syndrome

Background/Aim: Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity (VH) is a key factor in the pathophysiology of IBS. The role of Helicobacter pylori infection in the induction of VH in the upper gastrointestinal tract is controversially discussed. The aim of this study is to evaluate the value of rectal barostat in eliciting abdominal symptoms in patients with IBS in relation to H. pylori infection. Patients and Methods: 31 patients (19 female, 12 male, mean age 45.6 ± 10 years) with normal colonoscopy and clinical signs of IBS were examined by rectal barostat (pressure-controlled balloon distension in the rectum). Induction of typical abdominal discomfort (far from the balloon) defined the examination positive. Level of nonpainful perception (L1), feeling of defecation (L2), and pain or stool urgency (L3) were registered in comparison with a healthy control group (CG; n = 15, 9 female, 6 male). The H. pylori status was defined by ¹³C-urea breath test (n = 46). Results: Typical abdominal discomfort was induced in 9 patients (pain group, PG) by pressure-controlled rectal distension (H. pylori status: 8 positive, 1 negative). Patients not presenting with abdominal pain to rectal distension (nonpain group, NPG) were all H. pylori negative (p < 0.001). L3 as an indicator of VH was reached at a lower pressure threshold in PG than in NPG or CG (p < 0.05). The perception was not different between NPG and CG (p > 0.05). Conclusions: The induction of typical abdominal discomfort in patients with IBS by the use of rectal barostat occurred predominantly in H. pylori infected patients and suggests that H. pylori infection may be involved in triggering VH in patients with IBS. Further studies in larger patient groups and after H. pylori eradication therapy are needed to confirm and extend this observation.

Age-dependent expression of abdominal symptoms in patients with Yersinia enterocolitica infection.

The aim of the present study was to determine the relationship between the expression of abdominal symptoms and the age of patients with Yersinia enterocolitica infections. Twenty-four patients with positive fecal cultures of Yersinia enterocolitica participated in the present study. The abdominal symptoms were taken from medical records. Statistical analysis was performed by Mann-Whitney U-test. Patients with diarrhea were younger than those without diarrhea (P = 0.014). Older children had abdominal pain or irritability more frequently than younger children (P = 0.004). In Yersinia enterocolitica infections, younger children are predisposed to diarrhea and older children are predisposed to abdominal pain.

Gastric Meal Accommodation Studied by Ultrasound in Diabetes: Relation to Vagal Tone

Background: Disturbed gastric meal accommodation may cause abdominal symptoms in patients with functional dyspepsia and diabetes mellitus who have poor vagal control of gastric motility. In the present study we aimed to explore the relation between gastric meal accommodation and vagal tone in diabetic patients with vagal neuropathy. Methods

UNUSUAL CAUSES OF ABDOMINAL PAIN

Common and uncommon GI and other intraperitoneal illnesses may present in unusual ways. In addition, many systemic or extraperitoneal disease processes frequently include abdominal pain as a clinical manifestation. The clinician should suspect an unusual cause of abdominal symptoms in patients with repeated visits to the ED without a diagnosis, those who appear ill or complain of severe abdominal pain with disproportionately negative abdominal physical examination findings, those with constitutional or extraperitoneal symptoms or signs, and the elderly or immunocompromised. After initial resuscitation and stabilization have taken place, early evaluation of the need for urgent surgical evaluation and operative management is crucial in the patient with abdominal pain, even when the cause of the symptoms is unclear. A thorough history and careful and complete abdominal and nonabdominal physical examination, paired with appropriate but judicious diagnostic testing, are essential to detecting these unusual causes of abdominal pain and to preventing needless morbidity and mortality.

Effects of cisapride in patients with cystic fibrosis and distal intestinal obstruction syndrome

In a double-blind, placebo-controlled, crossover trial, we investigated the effects of the prokinetic drug cisapride in patients with cystic fibrosis and chronic recurrent distal intestinal obstruction syndrome (DIOS). After a baseline period, 17 patients (12.9 to 34.9 years; 12 boys) received, in random order, cisapride (7.5 to 10 mg) and placebo three times daily by mouth, each for 6 months. Gastrointestinal symptoms (flatulence, abdominal pain, fullness, abdominal distension, nausea, anorexia, heartburn, diarrhea, vomiting and regurgitation) were scored three times monthly and physical examinations assessed. At baseline and at each 6-month period, assessment included food intake for 7 days, 3-day stool collection, pulmonary function tests, and abdominal radiographs. During cisapride therapy compared with placebo, there were significant reductions in flatulence (p less than 0.005), fullness, and nausea (p less than 0.05). Patients with the worst symptom scores benefited most from cisapride. With cisapride, 12 patients felt better and three worse (p less than 0.05); physicians judged 11 patients improved and two worse (p less than 0.05). No side effects were noted. There were no significant differences between cisapride and placebo periods in nutritional status, x-ray scores, pulmonary function, food intake (fat, protein, calories), stool size and consistency, and fecal losses of fat, bile acids, chymotrypsin, and calories. For acute episodes of DIOS, intestinal lavage was needed 6 times in 4 patients during treatment with cisapride, and 11 times in 6 patients receiving placebo. In comparison with unselected patients with cystic fibrosis and pancreatic insufficiency who were receiving enzyme supplements and who had no distal intestinal obstruction, fecal fat losses (percentage of intake) were almost twice as high in the study group with DIOS (31.2 +/- 20.6% vs 16.2 +/- 17.6%; p less than 0.01). We conclude that in the dosage used, long-term treatment with cisapride appears to improve chronic abdominal symptoms in patients with cystic fibrosis and DIOS, but fails to abolish the need for intestinal lavage. Cisapride treatment had no effect on digestion and nutritional status of cystic fibrosis patients with pancreatic insufficiency.

Association of Non-Hodgkin's Lymphoma of Stomach, and Colonic Carcinoma; Practical Implications for Management

The incidence of adenocarcinoma of the colon in patients with gastric non-Hodgkin's lymphoma (NHL) was much higher than that in patients with other forms of NHL. Abdominal symptoms in patients with previously treated gastric NHL should be investigated and treated carefully with this association in mind.

Sonographic findings in the gallbladder in mucoviscidosis patients

The improved survival time of patients with mucoviscidosis has revealed some new complications. 137 patients were studied by sonography. The findings in the gall bladder have been compared with liver echogenicity. A micro-gall bladder was found in 37 patients (27%). 74 patients had a normal gall bladder (54%). Concretions were found in 22 (16%) of patients. 10 out of the 22 patients with concretions showed sonographic changes in the liver. In view of the frequent abdominal symptoms in patients with mucoviscidosis, sonography should be used routinely as a non-invasive method of investigation.

Spontaneous Peritonitis And Systemic Lupus Erythematosus

Primary Gram-positive bacterial peritonitis developed in three patients with systemic lupus erythematosus (SLE). These cases suggest a possible association between these two entities. Furthermore, they emphasize the importance of accurate diagnosis when evaluating abdominal symptoms in patients with SLE.

The postfenestration syndrome.

The diagnosis of the cause of abdominal symptoms in patients who have been submitted to biliary fenestration (external choledocho-duodenostomy) tends to be approached with prejudice. This attitude is analysed to show that the proper approach is to assume that the cause of the symptoms is probably unconnected with the biliary system or the previous operation, unless the latter is very recent.