Appearance Of Gastrointestinal Symptoms Research Articles

Weight change and lifestyle modifications implemented during the COVID-19 pandemic lockdown are associated with the development of gastrointestinal symptoms

Introduction and aimsPandemic lockdown measures are a cause of concern, regarding their negative impact on the mental health of individuals. The results of numerous studies have associated the appearance of gastrointestinal symptoms with different psychologic disorders, such as stress, depression, and anxiety, due to gut-brain axis interaction. The aim of the present study was to determine the prevalence of, and factors associated with, gastrointestinal symptom onset related to the COVID-19 pandemic lockdown and various lifestyle modifications. MethodsAn analytic, observational, and cross-sectional study was conducted on an open population that agreed to participate within the time frame of January to May 2021. ResultsA total of 298 subjects, 165 of whom were women (55.4%), agreed to participate and the mean patient age was 36.1 ± 12.6 years. There was a significant increase in the frequency of several gastrointestinal symptoms: epigastric burning, early satiety, heartburn, regurgitation, constipation, and diarrhea. Changes in weight and modifications in lifestyle were found to be associated variables. ConclusionsThe results of this study showed a significant increase in a wide variety of gastrointestinal symptoms related to lifestyle changes due to the pandemic lockdown. Weight change, supplement and multivitamin intake, and reduced physical activity were the main associated risk factors. Public healthcare systems should take a multidisciplinary approach into consideration for the care of affected individuals.

Cambios en el peso y modificaciones en el estilo de vida implementados durante el confinamiento por la pandemia de COVID-19 se asocian como desencadenantes del desarrollo de síntomas gastrointestinales

AimsPandemic lockdown measures are a cause of concern, regarding their negative impact on the mental health of individuals. The results of numerous studies have associated the appearance of gastrointestinal symptoms with different psychologic disorders, such as stress, depression, and anxiety, due to gut-brain axis interaction. The aim of the present study was to determine the prevalence of, and factors associated with, gastrointestinal symptom onset related to the COVID-19 pandemic lockdown and various lifestyle modifications. MethodsAn analytic, observational, and cross-sectional study was conducted on an open population that agreed to participate within the time frame of January to May 2021. ResultsA total of 298 subjects, 165 of whom were women (55.4%), agreed to participate and the mean patient age was 36.1±12.6 years. There was a significant increase in the frequency of several gastrointestinal symptoms: epigastric burning, early satiety, heartburn, regurgitation, constipation, and diarrhea. Changes in weight and modifications in lifestyle were found to be associated variables. ConclusionsThe results of this study showed a significant increase in a wide variety of gastrointestinal symptoms related to lifestyle changes due to the pandemic lockdown. Weight change, supplement and multivitamin intake, and reduced physical activity were the main associated risk factors. Public healthcare systems should take a multidisciplinary approach into consideration for the care of affected individuals.

Causes of runner’s diarrhea and dietary recommendations to avoid it - systematic review

Complaints of diarrhea and other gastrointestinal symptoms are common among endurance runners. These problems may interfere with athletic activities and be the main cause of underperformance during sports events. It is estimated that this difficulty affects 30 to 90 percent of long-distance runners. The most important pathophysiological factors affecting the occurrence of gastrointestinal symptoms are ischemia and mechanical damage to the intestines, as well as the secretion of neuroendocrine substances. The diet before physical exercise is also one of the most significant factors related to the appearance of gastrointestinal symptoms. Avoiding the intake of fat, caffeine, protein, fiber, non-steroidal anti-inflammatory drugs and dehydration before performance is one of the suggestions for preventing runner’s diarrhea. There are new recommendations for athletes, such as avoidance of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) and the intake of multiple transportable carbohydrates. It seems that a short-term gluten free diet has no effect on the performance of athletes but further research is needed. Mechanisms of runner’s diarrhea are still poorly understood, so more research needs to be conducted to improve the recommendations to runners.

The condition of the oral cavity at the time of\xa0diagnosis of\xa0inflammatory bowel disease in pediatric patients

Changes in the oral mucosa can appear in the course of inflammatory bowel disease in both children and adults. They often precede the appearance of gastrointestinal symptoms. The aim of the study was to determine the nature of changes in the oral cavity at the time of diagnosis of inflammatory bowel disease in children compared to children without systemic diseases. 49 children diagnosed with inflammatory bowel disease and 60 children without systemic diseases were examined. The prevalence of the aphthae stomatitis and angular cheilitis was 24.5% in the examined group and 10% in the control group (p = 0.0772). Changes in the oral mucosa occurred more frequently in children with Crohn's disease 35.3% than with ulcerative colitis 18.7%. In children with Crohn's disease, the most frequently observed lesion was aphthous stomatitis 23.5%, and in ulcerative colitis, angular cheilitis 12.5%. Changes in the oral mucosa are a therapeutic problem requiring in general diseases patients both local and systemic treatment and interdisciplinary cooperation between dentists, paediatricians and gastroenterologists. The finding of repeated changes in the oral mucosa during a dental examination should be the reason for referring the patient to a paediatrician for the foreclosure or make a diagnosis of inflammatory bowel diseases.

Análise da efetividade da terapia nutricional em pacientes sob cuidados paliativos do programa Melhor em Casa no município de Queimadas-PB

O Programa Melhor em Casa visa acompanhar com serviços especializados o paciente no aconchego do seu lar que é um ambiente mais saudável. A Terapia Nutricional é um conjunto de métodos de cuidados para manutenção ou recuperação do estado nutricional do paciente através da nutrição parenteral ou enteral, esta deve ser bem acompanhada para o restabelecimento da saúde da pessoa assistida. Assim, a presente pesquisa procurou avaliar a efetividade da terapia nutricional enteral nos pacientes em cuidados paliativos assistidos por este programa, no município de Queimadas-PB. Foi aplicado um estudo do tipo descritivo, qualitativo e quantitativo, onde a população foi composta por pacientes adultos e idosos, com patologias diversas. As informações foram coletadas dos prontuários com posterior análise dos registros em fichas individuais. Foram avaliados 10 pacientes, com idade média de 68,30 anos. O baixo peso e as afecções neurológicas estiveram presentes em 50% dos pacientes. Em relação à via de acesso 50% possuíam prescrição de sonda nasogástrica. Quanto à média do percentual de adequação proteica e de adequação energética ambas foram alcançadas. Embora a média geral de ingestão calórica e protéica tenham atendido as recomendações preconizadas, foi verificado uma incidência de baixo peso em metade dos indivíduos, o que pode ser justificada pelo surgimento de sintomas gastrointestinais, inadequação na administração da dieta ou avanço das patologias.

Changes in Heart Rate Variability in Patients with Spleen-Qi Deficiency Syndrome

Many functional diseases are related to dysautonomia, and heart rate variability has been used to assess dysautonomia. However, heart rate variability has not been studied in Spleen-Qi deficiency syndrome (SQDS). Healthy volunteers (n = 37) and patients with SQDS (n = 67), recruited from the Clinic of the State University of Ecatepec Valley were included in the study. Outcome measures were average heart rate, standard deviation of the normal-to-normal heartbeat intervals, low frequency (LF), high frequency (HF) power, and the LF/HF ratio. Also, intestinal peristalsis, gastrointestinal symptoms (GSs), fatigue, and level of attention were measured. Standard deviation of the normal-to-normal heartbeat intervals (17 ± 2.3%) and HF (14 ± 3.1%) were lower in SQDS patients (17 ± 1.3%) than in healthy volunteers. SQDS patients had higher heart rate, LF power, LF/HF ratio, and fatigue scores (9.6 ± 1.12%, 16 ± 2.1%, 22 ± 3.8%, and 21 ± 4.1%). The fatigue correlated positively with the LF/HF ratio and negatively with HF power. The SQDS group had lower concentration performance (16.2 ± 1.9%) in the d2 test. The intestinal peristalsis showed a reduction (15 ± 1.3%) as compared with control. GS score and peristalsis correlated negatively with HF. Our results suggest that the pathology of SDQS could be associated with a low vagal tone which causes a decrease in peristalsis, increased fatigue, reduced attention, and appearance of GSs.

Characteristics and Progression of Preclinical Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a chronic disease usually diagnosed after the appearance of gastrointestinal symptoms. Little is known about IBD progression during its early and even preclinical phases. We aimed to determine the number of new incidental diagnoses of IBD in an older population, and evaluate disease progression from its early stages. We performed a retrospective analysis of 31,005 colonoscopies performed during colorectal cancer screening of patients with positive results from fecal immunochemical tests, at 11 centers in the Basque Country (Spain) from 2009 through 2014. We collected clinical and laboratory data from all asymptomatic individuals suspected to have IBD during screening colonoscopies, with histologic confirmation. Colonoscopy screening led to 79 new diagnoses of ulcerative colitis, 24 of Crohn's disease, and 7 of unclassified colitis (average patient age, 57 y; interquartile range, 52-62 y; 57% male). Eleven patients had symptoms before colonoscopy and were excluded from the analysis. Amongthose patients who were asymptomatic at diagnosis, 36% developed symptoms after a follow-up period of 25 months (interquartile range, 10.5-42 mo), mostly rectal bleeding and diarrhea. Treatment was prescribed for 81 patients (88%), and 2 cases required surgery. We analyzed data from a large cohort of patients with IBD diagnosed at early or even preclinical stages, from an older population. New incidental diagnoses of IBD were made in 0.35% of individuals undergoing a population-based screening colonoscopy-most were classified asulcerative colitis. Approximately one third of patients developed symptoms during the follow-up period.

Gluten Sensitivity among Egyptian Infants with Congenital Heart Disease.

BACKGROUND:Gastrointestinal symptoms are a common feature in infants with congenital heart disease.AIM:This study was designed to evaluate age-dependent serum levels of antigliadin antibodies among malnourished Egyptian infants with congenital heart disease (CHD) and gastrointestinal symptoms.SUBJECTS AND METHODS:This case-control study conducted on 60 infants with established congenital heart disease. They were subdivided into cyanotic and acyanotic groups, and each group includes 30 patients compared with thirty apparently healthy infants of matched age, sex, and social class. Serum antigliadin antibodies levels were measured using ELISA.RESULTS:The mean age of introduction of cereals in the diet and appearance of gastrointestinal symptoms were six months. On comparison with controls, patients showed highly significant higher serum levels of antigliadin antibodies (P < 0.000). On analysing risk factors using odds ratio, the age at onset of GIT symptoms, diarrhoea, abdominal pain, and distension had been found to be significantly associated with high serum antigliadin antibodies among malnourished CHD infants with a prediction of 95%.CONCLUSION:Serum IgA, IgM, and IgG class antibodies to gliadin play a significant role in the pathogenesis of malnutrition in infants with CHD. Gluten containing foods should never be introduced before the end of the six months.

Celiac Disease in a Patient with Baker’s Asthma and Wheat Allergy Due to Tri a 14

We describe the case of a patient that developed persistent severe asthma after having started to work in a bakery. The subsequent appearance of gastrointestinal symptoms was diagnosed as celiac disease (CD). She also experienced severe asthma attacks when cooking pasta, and expe-rienced anaphylactic shock a few minutes after wheat flour inhalation. The allergologic workup was positive for several cereal products and Tri a 14 (Tricum aestivum 14), while specific IgE titer to Pru p 3 (Prunus persica 3) was negative. Our patient had no recurrence of these episodes when she avoided cooking wheat flour products and wheat in processed foods. The pathogenic mechanisms underlying CD and IgE-mediated food allergy are different and the coexistence of both diseases seems to be rare. Tri a 14 is the major wheat allergen involved in our case; this allergen can sensitize through the respiratory and the oral route, and can give way to anaphylaxis. A possible role played by interleukin-15 (IL-15) and interleukin-21 (IL-21) in the induction of IgE-mediate hypersensitivity, as well as in the pathogenesis of CD, is prospected and discussed briefly herein.

483 On the Genetics of a Novel Arrhythmia Syndrome: Insight Into the Fundamentals of Human Pacemaking

Lifelong rhythmic contractions are the hallmark of the human heart and gut. They result from the pacemaking activity of specialized tissue, namely the sinoatrial node in the heart and the interstitial cells of Cajal in the gut. Here, we describe a new syndrome characterized by progressive loss of normal sinoatrial node function (sick sinus syndrome, SSS) and chronic intestinal pseudoobstruction (CIPO) in French-Canadians. Detailed chart review, family history, physical exam, ECG and echocardiography were performed in 11 carriers with SSS/CIPO. Whole exome sequencing was performed in three affected individuals and analyzed under the assumptions of a recessive mode of inheritance. Confirmation was performed using bidirectional Sanger sequencing in nine SSS/CIPO carriers. Age at onset of SSS was between 6 and 27 years of age, with all features of bradycardia-tachycardia syndrome being replicated in individual carriers of SSS/CIPO. Pacemaker implantation was required in five individuals to date (age 6 to 21 years). Two patients are awaiting further electrophysiological studies. Echocardiographic anomalies included left atrial dilation in four individuals and mild valve defects in three SSS/CIPO carriers. Appearance of gastrointestinal symptoms was between 5 and 14 years of age, but not in any particular order to SSS/CIPO. Two patients passed away from gastrointestinal complications. Unexpectedly, we found that a mutation in Shugoshin-like 1 (SGOL1), a component of the cohesin complex, leads to this hitherto undescribed syndrome. All affected individuals were homozygous carriers of a founder mutation in SGOL1 (c.67 T>C [p.Lys23Glu]) which results in a dramatic change of a highly conserved amino acid. This mutation lies on a 200kb haplotype identical by descent as defined by the three exomes. None of the unaffected first-degree relatives were homozygous for the mutation, and the mutation was neither detected in 360 French-Canadian controls, nor in 5377 controls of mixed ancestry. SGOL1 is known as a member of the cohesin complex, protecting sister chromatids from cleavage by separases during meiosis. A founder mutation in SGOL1 causes SSS/CIPO. The unanticipated finding of this gene in a human rhythm disorder suggests that maintenance of the cohesin complex or other biological functions of SGOL1 guard the lifelong function of pacemaking cells. Genetic analysis of the novel SSS/CIPO syndrome demonstrates a new fundamental link between the two main pacemakers in humans.

The prognosis of wheat hypersensitivity in children

The study was aimed to determine the natural history of wheat hypersensitivity, to define risk factors for persistent wheat hypersensitivity, and to evaluate the development of respiratory allergy in children with wheat hypersensitivity. The development and subsequent disappearance of wheat hypersensitivity, clinical findings, skin prick test (SPT) reactivity, and the development of allergic rhinoconjunctivitis and asthma were charted retrospectively in 28 children with wheat hypersensitivity proven by the open oral challenge at the median age of 21 months (range 6 to 75 months). Appearance of skin symptoms during the diagnostic wheat challenge was related to SPT-positive wheat hypersensitivity, while the appearance of gastrointestinal symptoms alone was associated with SPT-negative wheat hypersensitivity (p=0.002). Wheat was tolerated by 59%, 69%, 84%, and 96%, by age 4, 6, 10, and 16, respectively. Sensitization to gliadin with a SPT wheal of >or=5 mm at the time of the diagnostic challenge was associated with a slower course of recovery from wheat hypersensitivity (p=0.019), and a SPT wheal of >or=3 mm to gliadin at any time was associated with the development of asthma (p=0.022). SPT reactivity to wheat was associated with later SPT reactivity to birch pollen (p=0.001), and the development of allergic rhinoconjunctivitis (p=0.001). In conclusion, almost all children with wheat hypersensitivity can tolerate wheat by adolescence. Sensitization to gliadin is associated with a slower achievement of tolerance and an increased risk of asthma.

Development of Crohn’s disease following anti‐tumour necrosis factor therapy (etanercept)

Inhibition of tumour necrosis factor (TNF)-alpha is effective in the treatment of rheumatoid arthritis and other inflammatory rheumatic diseases. Anti-TNF antibodies such as infliximab, etanercept and adalimumab are commonly used. There are structural and functional differences among these agents. We describe development of Crohn's disease in a patient with ankylosing spondylitis receiving anti-TNF therapy. This case suggests that the appearance of gastrointestinal symptoms in patients on anti-TNF therapy must be evaluated to find out whether this is a new onset or an exacerbation of underlying inflammatory bowel disease.

Beneficial effects of oral tilactase on patients with hypolactasia

A lactose-free diet is commonly prescribed to subjects with hypolactasia. We tested the effectiveness of a single ingestion of tilactase (a beta-D-galactosidase from Aspergillus oryzae) in adults with hypolactasia, previously assessed by lactose H(2)-breath test. After measurement of orocecal transit time (OCTT, by lactulose H(2)-breath test) and lactose H(2)-breath testing plus placebo, a total of 134 subjects were positive to hypolactasia and underwent lactose H(2)-breath testing plus either low (6750 U) or standard (11,250 U) doses of tilactase. The appearance of gastrointestinal symptoms during the tests was monitored. OCTT was longer in malabsorbers (subjects without bloating, abdominal pain and/or diarrhoea, n = 25) than in intolerants (bloating, abdominal pain and/or diarrhoea, n = 109, P < 0.02). Malabsorbers had longer time to H(2) peak (P < 0.03), lower H(2) peak levels (P < 0.002) and smaller integrated H(2) excretion levels (P < 0.005) than intolerants. After tilactase ingestion, integrated H(2) levels were decreased by 75% (low dose) and 87% (standard dose) in malabsorbers, and by 74% (low dose) and 88% (standard dose) in intolerants. In the latter group, total symptom score were decreased by 76% (low dose) and by 88% (standard dose) (P < 0.0001). A single oral administration of tilactase is highly effective in decreasing symptoms and hydrogen excretion of hypolactasia assessed by lactose H(2)-breath test. If confirmed by long-term observations, ingestion of tilactase might be a better option than exclusion diets in intolerant subjects with hypolactasia.

Whipple Disease: Unusual Presentation of a Protean and Sometimes Confusing Disease

To describe an unusual case of Whipple disease (WD) with confusing clinical features at onset and to discuss the diagnostic challenges for the clinician. Description of a new case of this rare disease and thorough discussion of the atypical clinical manifestations at onset. A literature review, concerning the unusual onset, by means of a MEDLINE search from 1966 to 2007 was done. A 39-year-old man with sudden bilateral blurred vision due to retinal vasculitis and concomitant rapidly evolving symmetrical neurosensory bilateral hearing loss as initial features of WD is described. Due to the clinical manifestations resembling systemic vasculitis, high-dose corticosteroid and pulse cyclophosphamide therapy were started with subsequent appearance of gastrointestinal symptoms (diarrhea and weight loss) and spiking fever, suggesting superimposed infection. After a complete evaluation, including gastroscopy, extensive duodenal-jejunal mucosal involvement was seen, while diffuse infiltration of the duodenal lamina propria with periodic acid-Schiff-positive foamy macrophages was observed on the histological sample. The diagnosis was confirmed by reverse transcriptase-polymerase chain reaction for the DNA of Tropheryma whippelii. To our knowledge, no previous similar clinical onset of WD has been described. To avoid misdiagnosis and therapeutic mistakes, clinicians should be aware of unusual presentations of WD. Because this etiological agent is a difficult to isolate bacterium, diagnosis may be especially problematic in cases without intestinal involvement at onset.