Chronic Gastrointestinal Complaints Research Articles

Gulf War Illness Is Associated with Host Gut Microbiome Dysbiosis and Is Linked to Altered Species Abundance in Veterans from the BBRAIN Cohort.

Gulf War Illness (GWI) is a debilitating condition marked by chronic fatigue, cognitive problems, pain, and gastrointestinal (GI) complaints in veterans who were deployed to the 1990-1991 Gulf War. Fatigue, GI complaints, and other chronic symptoms continue to persist more than 30 years post-deployment. Several potential mechanisms for the persistent illness have been identified and our prior pilot study linked an altered gut microbiome with the disorder. This study further validates and builds on our prior preliminary findings of host gut microbiome dysbiosis in veterans with GWI. Using stool samples and Multidimensional Fatigue Inventory (MFI) data from 89 GW veteran participants (63 GWI cases and 26 controls) from the Boston biorepository, recruitment, and integrative network (BBRAIN) for Gulf War Illness, we found that the host gut bacterial signature of veterans with GWI showed significantly different Bray-Curtis beta diversity than control veterans. Specifically, a higher Firmicutes to Bacteroidetes ratio, decrease in Akkermansia sp., Bacteroides thetaiotamicron, Bacteroides fragilis, and Lachnospiraceae genera and increase in Blautia, Streptococcus, Klebsiella, and Clostridium genera, that are associated with gut, immune, and brain health, were shown. Further, using MaAsLin and Boruta algorithms, Coprococcus and Eisenbergiella were identified as important predictors of GWI with an area under the curve ROC predictive value of 74.8%. Higher self-reported MFI scores in veterans with GWI were also significantly associated with an altered gut bacterial diversity and species abundance of Lachnospiraceae and Blautia. These results suggest potential therapeutic targets for veterans with GWI that target the gut microbiome and specific symptoms of the illness.

Spread of Intestinal Parasites in Patients Presenting with Gastrointestinal Complaints.

The aim of this study is to determine the prevalence of intestinal parasites in patients admitted to University of Health Sciences Türkiye (UHS) Van Training and Research Hospital. A total of 300 patients between the ages of 18-90 who applied to UHS Van Training and Research Hospital with gastrointestinal complaints and were referred to the parasitology laboratory between September 2021 and December 2021, and 100 patients without any chronic disease and gastrointestinal complaints in the control group were included in the study. Stool samples taken from patients included in the study and individuals in the control group were analyzed by native-lugol and modified acid-fast staining methods. In the study, intestinal parasites were detected in 41 (13.3%) of 300 patients in the patient group and in seven (7%) of 100 individuals in the control group. The highest rate of Blastocystis species (Blastocystis spp.) (5.7%) was found in the patient group. Entamoeba coli 3%, G. intestinalis 2.7% and Cryptosporidium species (Cryptosporidium spp). 2.3% were found among the other species detected. In addition, a statistically significant correlation was found between the incidence of parasites and abdominal pain (p=0.022) and nausea (p=0.029). As a result; it was concluded that intestinal parasites are still an important health problem in patients with gastrointestinal complaints and intestinal parasites should definitely be considered in this patient group.

Qualitative study evaluating the expectations and experiences of Dutch parents of children with chronic gastrointestinal symptoms visiting their general practitioner

ObjectivesChronic gastrointestinal symptoms are common among children and affect their daily activities and quality of life. The majority will be diagnosed with a functional gastrointestinal disorder. Effective reassurance and education...

Evaluation of Some Extrinsic Factors Predisposing to Helicobacter Pylori-Associated Iron Deficiency Anemia

In the article, iron deficiency associated with Helicobacter pylori is associated with a number of external factors and bad habits in the development of anemia. Helicobacter pylori should be tested in all patients with chronic iron deficiency anemia and gastrointestinal complaints. In patients diagnosed with Helicobacter pylori-associated iron-deficiency anemia, it has been shown to have a highly reliable effect of first carrying out antibacterial eradication therapy and then prescribing an iron supplement according to the severity of the disease.

Irritable bowel syndrome in adults: Prevalence and risk factors

IntroductionThe prevalence of irritable bowel syndrome (IBS) ranges from 7 to 18% over the world. We aimed to assess the prevalence and risk factors of irritable bowel syndrome in adults. MethodologyWe conducted a cross-sectional study of IBS prevalence and risk factors from March to May 2022 at KRL Hospital Islamabad. 300 people were given Pre-validated Performa's. Our research adheres to the principles outlined in the Helsinki Declaration. The PSS was used to measures how much stress a person has felt in the past month.The higher the score, the more stressed the person appears to be. A variety of mental health disorders can be evaluated using this method. Data on dietary and lifestyle factors associated with IBS for the last 12 months was also collected from the participants. ResultsThe majority of patients, 70%, were classed as Grade 1 and 146 (48.66%) reported abdominal pain associated with defecation. 162 (54%) individuals reported high levels of tea consumed, 81 (27%) consumed coffee and 57 (19%) reported carbonated drinks consumed. 139 individuals reported having Vigorous-Intensity activity, out of which 69 (49.64%) spend 60 min of vigorous activity in a day. ConclusionScreening patients for IBS on a regular basis is critical, especially in the younger demographic. If a patient experiences any symptoms of IBS, they should contact their doctor immediately. Consider the care of patients with chronic gastrointestinal complaints, particularly in women and those at greater risk of developing the illness.

The Validity of Somatic Symptom Disorder in Patients With Gastrointestinal Complaints.

The current diagnostic concept of somatic symptom disorder (SSD) aims to capture psychological burden due to bodily complaints independent of the medical cause. The aim of this study was to compare patients with chronic gastrointestinal (GI) complaints with SSD (SSD+) and without SSD (SSD-) along sociodemographic, clinical, and psychological characteristics. This cross-sectional study included 199 patients (n=92 SSD+ and n=107 SSD-) with distressing and chronic abdominal/lower GI complaints (≥6 mo) recruited from several primary, secondary, and tertiary medical care units. SSD+ patients were separated from SSD- patients by psychobehavioral positive criteria. Psychological distress (somatization, depression, anxiety, and illness anxiety) and risk factors (adverse childhood experiences, insecure attachment, mentalizing capacity, and levels of personality functioning) were measured. Nonparametric group comparisons were performed to analyze the differences of sociodemographic, clinical, and psychological characteristics between SSD+ and SSD- patients. About half of the SSD+ patients had a functional GI disorder and a third had an inflammatory bowel disease. SSD+ patients reported higher GI pain severity, higher health-related and work-related impairment, and higher psychological distress, especially illness anxiety, as well as higher mentalizing and personality functioning deficits. Overall, psychobehavioral positive criteria of SSD seem to be a valid identifier of patients exhibiting a high psychological burden, independent of the medical explanation of the GI complaints. There is a substantial overlap of SSD and general mental burden, but also evidence for a specific disease entity.

FODMAP intake in children with coeliac disease influences diet quality and health-related quality of life and has no impact on gastrointestinal symptoms

Children with coeliac disease (CD) following the gluten-free diet may experience ongoing gastrointestinal symptoms despite strict adherence. The study objective was to evaluate the association between foods high in fermentable oligo/di/monosaccharides, and polyols (FODMAP) and gastrointestinal symptoms, and the potential implications to diet quality and health-related quality of life in CD children. Dietary intake was studied in age-sex matched children 5–18 years (CD, n = 46; non-coeliac mild chronic gastrointestinal complaints [GIC], n = 46; healthy controls [HC], n = 46). CD children consumed fewer foods high in FODMAPs compared to GIC and HC (p < .0001). FODMAP intake was not related to gastrointestinal symptoms in CD children (p > 0.05) but was positively associated with child health-related quality of life (p < 0.05). FODMAP intake from fruits and vegetables was positively associated with diet adequacy and total diet quality in CD children (p < 0.05). FODMAP intake may influence diet quality and health-related quality of life but has no impact on gastrointestinal symptoms in CD children.

S0481 Overlap in Gastrointestinal Manifestations Among Small Fiber Neuropathy, Postural Tachycardia Syndrome, Ehlers-Danlos Syndrome, and Mitochondrial Disease Adult Patients

INTRODUCTION: Small fiber neuropathy (SFN) is characterized by damage to thinly myelinated A-delta and/or unmyelinated C-fibers in the peripheral nervous system; these fibers regulate automatic functions, including digestion. SFN is known to cause abnormalities in the neural control of smooth muscle, however, the gastrointestinal (GI) manifestations of these abnormalities have not been reported. Structural and functional small fiber abnormalities are common in patients with postural tachycardia syndrome (POTS), Ehlers-Danlos syndrome (EDS), and mitochondrial disease (MD), and clinicians frequently see overlapping GI manifestations in these patient populations. METHODS: Among adult (ages 18–74) patients, we examined the relative GI manifestations of SFN, POTS, EDS, and MD to determine whether these diseases have unique GI phenotypes. We conducted a retrospective cohort analysis of SFN (N = 506, 75.5% female), POTS (N = 255, 90.1% female), EDS (N = 413, 87.1% female), and MD (N = 175, 68.0% female) patients reporting GI symptoms presenting to an academic medical center between 2004 and 2019. Patient diagnoses were categorized by symptom clusters: esophageal, gastric, lower GI, and abdominal pain with examination of the frequency of individual diagnoses as well. RESULTS: Overall, GI diagnoses were common and most frequent in MD (92.0%) relative to POTS (86.7%), EDS (81.1%), and SFN (70.4%). Abdominal pain was common among all conditions, led by MD (69.1%) and POTS (61.2%) (Table 1). There were significant differences in symptom distribution across all disease groups (Figure 1): there was a relatively-even distribution of diagnoses in SFN, gastric diagnoses were most common in POTS (65.1%), esophageal diagnoses most common in EDS (43.8%), and esophageal diagnoses (70.9%) and lower GI diagnoses (69.1%) most common in MD. Among individual diagnoses, >50% of patients with POTS experienced nausea/vomiting, constipation, and abdominal pain and >50% of MD patients experienced GERD, nausea/vomiting, constipation, and abdominal pain. CONCLUSION: Despite similar demographics and chronic GI complaints, GI phenotypes differed significantly between patients with SFN, POTS, EDS, and MD. Patients with MD and POTS were most likely to present with GI complaints, with abdominal pain the most common manifestation among all of the disorders.Table 1.: Characteristics of adults patients diagnosed with SFN, POTS, EDS, or MD. Note. SFN = small fiber neuropathy; POTS = postural tachycardia syndrome; EDS = Ehlers-Danlos syndrome; MD = mitochondrial disease. 1. Continuous variables analyzed with ANOVA and categorical variables analyzed with Chi-Square TestFigure 1.: Overall prevalence of GI diagnoses in SFN, POTS, EDS, and MD patients. Note. Patients may have more than one diagnosis.

Giant Fecaloma Causing Large Bowel Obstruction: A Case Report

Fecalomas are masses of hardened stool that are typically impacted in the sigmoid colon and rectum. Fecalomas are commonly associated with chronic constipation, Hirschsprung’s disease, Chagas disease, and multiple psychiatric conditions. We present a case of a giant fecaloma resulting in complete large bowel obstruction and suggest a five-year abdominal ultrasound monitoring of adults presenting with chronic constipation and/or chronic nonspecific gastrointestinal (GI) complaints.

Diet patterns in an ethnically diverse pediatric population with celiac disease and chronic gastrointestinal complaints

Celiac disease (CD) is an autoimmune disease requiring lifelong adherence to the gluten-free diet (GFD). The GFD has significant nutritional limitations which may result in poor diet quality (DQ). We hypothesized that biopsy-proven children with CD (CCD) would have dietary patterns characterized by high saturated fat/simple sugar intake with a low micronutrient density contributing to lower DQ when compared to children with mild-gastrointestinal complaints (GI-CON). In addition, we hypothesized that ethnicity may further impact DQ. Socio-demographic (age, CD duration, parent/child ethnicity, education), household characteristics, anthropometric, dietary intake (24-h recalls), gastrointestinal pain and adherence was collected in CCD (n=243) and GI-CON (n=148). Dietary patterns were determined using k-mean Cluster Analysis. GI-CON had significantly lower DQ than CCD (p<0.001). Most CCD and GI-CON (>80%) had dietary patterns characterized by1) Western Diet (Cluster 1: %BMR: 110-150, low DQ, high fat, moderate CHO, high sodium) and 2) High Fat-Western Diet (Cluster 2: %BMR:130-150, low DQ, high Fat, high processed meats, high fat dairy products, CHO. Fewer children (<20%) had Prudent, Lower Fat/High Carbohydrate dietary patterns (% BMR:100-150, higher DQ, lower fat/sodium, higher CHO) with a greater proportion of non-Caucasian CCD consuming a Prudent dietary pattern. Seventy-seven percent and 37.5% of CCD and GI-CON, respectively, did not meet estimated average requirements for folate (p<0.001). CCD and GI-CON have predominantly Western dietary patterns with low DQ, particularly GI-CON. Non-caucasian CCD consume more prudent dietary patterns with higher DQ. Nutrition education is warranted to ensure optimal DQ in children with chronic gastrointestinal diseases.

CLINICAL NUTRITION PROGRAM IMPROVES CHRONIC FATIGUE AND INTESTINAL PAIN IN 50 YEAR OLD MAN WITH HASHIMOTO’S

Event Abstract Back to Event CLINICAL NUTRITION PROGRAM IMPROVES CHRONIC FATIGUE AND INTESTINAL PAIN IN 50 YEAR OLD MAN WITH HASHIMOTO’S David J. Clark1* 1 Carrick Institute, United States Background: A 50 year old man presented with a history of chronic fatigue, gastrointestinal pain, cramping and gas. Within one hour after eating he experienced pain and gas, and then 3 to 4 hours later, he suffered severe lower intestinal cramping. He also suffered constipation (only one to two bowel movements per week). Frequently, a few hours after waking , he would be so fatigue that he needed to nap. This also occurred after doing any kind of exercising such as cycling. Eight years prior to presentation he was diagnosed with hypothyroidism and prescribed levothyroxine. Three years later he demonstrated elevated thyroid autoantibodies (Hashimoto’s) and was switched to bioidentical thyroid replacement. He followed various interventions including acupuncture, low FODMAPS diet and Small Intestine Bacterial Overgrowth protocol— but with no positive effects on his symptoms. He followed a gluten-free diet at time of presentation. He was taking Armour daily as well as vitamin D. Methods: Blood chemistry revealed high homocysteine (13.9), potassium (5.4), TSH (13.26), TPO antibodies (144) and thyroglobulin antibodies (2), low HDL (39), T4 (4.2), Reverse T3 (6), free T4 (0.7), normal T3 and Free T3, clinically significantly high BUN (25), clinically significantly low B12 (375), vitamin D (35). Urea Breath Test for H. pylori was negative. Urinary Organic Acids testing revealed high Arabinose (36), 4-Hydroxybenzoic (0.90), oxalic (135), 3-Hydroxyglutaric (6.8), Suberic (4.0), and 2-Hydroxyhippuric (1.2) acids. Dried urine testing for hormones revealed low levels of epitestosterone, clinically significantly low levels of beta-pregnanediol, alpha-pregnanediol, DHEA sulfate, androsterone, testosterone, 5-alpha DHT, He was placed on an anti-inflammatory diet and a supplement protocol utilizing turmeric, resveratrol, sublingual vitamin D, high EPA fish oil, broad-spectrum digestive enzyme formula, pregnenolone, a multi-nutrient formula for lowering homocysteine and a multi-multi-nutrient formula for support of normal tissue glucose levels. Results: At 60 day follow up, the patient reported a 60% increase in his energy. He no longer needed to nap in the mornings, nor after exercise. He reported a 50% improvement in the frequency of gastrointestinal pain and cramping. Frequency of bowel movements had increased to four to five times per week. In addition, blood chemistry showed improved B12 (580), vitamin D (68.4), homocysteine (11.1). Conclusion: The author suggests further investigation into clinical nutrition, diet and supplementation in the treatment of chronic fatigue and gastrointestinal complaints in patients with Hashimoto’s. Keywords: Hashimoto's autoimmune thyroiditis, HPA axis (hypothalamus-pituitary-adrenal), supplementation, Anti-inflammatory diet, Clinical Nutrition Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Clark DJ (2019). CLINICAL NUTRITION PROGRAM IMPROVES CHRONIC FATIGUE AND INTESTINAL PAIN IN 50 YEAR OLD MAN WITH HASHIMOTO’S. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00025 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Apr 2019; Published Online: 27 Sep 2019. * Correspondence: Mx. David J Clark, Carrick Institute, Cape Canaveral, Florida, 32920, United States, mail@doctordavidclark.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers David J Clark Google David J Clark Google Scholar David J Clark PubMed David J Clark Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

CLINCIAL NUTRITION PROGRAM IMPROVES FATIGUE, STOMACH PAIN, CONSTIPATION AND WIDESPREAD PAIN IN 39 YEAR OLD WOMAN

Event Abstract Back to Event CLINCIAL NUTRITION PROGRAM IMPROVES FATIGUE, STOMACH PAIN, CONSTIPATION AND WIDESPREAD PAIN IN 39 YEAR OLD WOMAN David J. Clark1* 1 Carrick Institute, United States Background: A 39 year old woman presented with a thirteen year history of gastrointestinal complaints originally diagnosed as diverticulitis. In the few years prior to presentation she developed stomach pain within twenty minutes of eating, bloating, constipation and malodorous gas. She complained of severe exhaustion between 2:00 PM and 4:00 PM. She was so tired that would fall asleep at 7:00 pm. She had developed aches and pains throughout her joints and muscles. She has been diagnosed with Factor V Leiden clotting disorder. She had to take senna in order to have any kind of bowel movement. In addition, she took ibuprofen and peppermint oil. She was following a reduced gluten diet. Methods: Ingestion of Th1 cytokine boosters provoked her symptoms. Laboratory examination revealed a positive urea breath for Helicobacter pylori as well as clinically significantly low levels of calcium (8.9), vitamin D (30.1 ng/ml), and clinically significantly high levels of B12 (1234 pg/mL) despite not using any B12 supplements. She was placed on an anti-anti-inflammatory diet and supplement protocol utilizing vitamin D, turmeric, resveratrol, omega 3 fatty acids, sublingual glutathione, a multi-nutrient formula for glucose support and multi-nutrient formula for eradication of the Helicobacter pylori. Results: After 30 days of her protocol, the patient reported her stomach pain was completely resolved, as was the bloating and constipation. She no longer needed the senna to have a bowel movement. The fatigue was essentially resolved as she no longer experienced the evening crash and was able to go to sleep at 10:00 PM. The aches and pains had completely resolved. Conclusion: The author recommends further investigation into the use of diet and supplementation in the treatment of patients with chronic fatigue, pain and gastrointestinal complaints. Keywords: Helicobacter pylori, Clinical Nutrition, supplementation, Anti-inflammatory diet, Stomach pain Conference: International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019. Presentation Type: Poster Presentation Topic: Clinical Neuroscience Citation: Clark DJ (2019). CLINCIAL NUTRITION PROGRAM IMPROVES FATIGUE, STOMACH PAIN, CONSTIPATION AND WIDESPREAD PAIN IN 39 YEAR OLD WOMAN. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience. doi: 10.3389/conf.fneur.2019.62.00048 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Apr 2019; Published Online: 27 Sep 2019. * Correspondence: Mx. David J Clark, Carrick Institute, Cape Canaveral, Florida, 32920, United States, mail@doctordavidclark.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers David J Clark Google David J Clark Google Scholar David J Clark PubMed David J Clark Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

When Long-Lasting Food Selectivity Leads to an Unusual Genetic Diagnosis: A Case Report

Hereditary fructose intolerance is an autosomal recessive disorder of fructose metabolism caused by catalytic deficiency of aldolase B enzyme [1].The disease is typically expressed when fructose- and sucrose-containing foods are first introduced in the diet; acute manifestations include nausea, vomiting, abdominal distress, and symptomatic hypoglycemia [1,2]. Chronic fructose ingestion eventually leads to poor feeding, growth retardation and gradual liver and/or renal failure [3,4]. Some patients may remain undiagnosed until adulthood because of a self-protective avoidance of sweet tasting food that prevents the development of acute toxicity from fructose containing food; however, these subjects may suffer intermittent symptoms throughout life, leading to potentially serious misdiagnosis [4].We report the case of a patient with unrecognized hereditary fructose intolerance in which chronic gastrointestinal complaints, low body weight, and unexplained food avoidance were addressed as manifestations of an eating disorder during adolescence.

Use of complementary and alternative medicine among paediatric patients with hepatogastrointestinal diseases.

The use of complementary and alternative medicine (CAM) is becoming increasingly popular in Middle Eastern countries; it is often used for paediatric medical conditions such as chronic gastrointestinal complaints and failure to thrive. It is also commonly used in patients with chronic hepatic conditions such as cirrhosis and in hepatic transplant patients. This study aimed to evaluate the prevalence, types and associated factors of CAM use in children with hepatogastrointestinal disease in Shiraz, Islamic Republic of Iran. In a cross-sectional study carried out during September 2013-January 2014, 238 parents of children attending a paediatric gastroenterology and hepatology clinic at Shiraz University of Medical Sciences received a self-administered questionnaire covering associated factors of complementary and alternative medicine use; 210 questionnaires were completed and returned. Complementary and alternative medicine was used by 103 patients (49%); 74 (71.8%) of these used herbal remedies. Older age of the child significantly increased CAM use. Those with previous positive experience of CAM (62.1% of users, 40.2% of non-users) and those who had received recommendation for CAM by health care providers (24.3% of users, 6.6% of non-users) were significantly more likely to use CAM. This survey demonstrated the high prevalence of CAM use (especially herbal remedies) in paediatric patients with hepatogastrointestinal diseases.

Reference values of fecal calgranulin C (S100A12) in school aged children and adolescents

Calgranulin C (S100A12) is an emerging marker of inflammation. It is exclusively released by activated neutrophils which makes this marker potentially more specific for inflammatory bowel disease (IBD) compared to established stool markers including calprotectin and lactoferrin. We aimed to establish a reference value for S100A12 in healthy children and investigated whether S100A12 levels can discriminate children with IBD from healthy controls. In a prospective community-based reference interval study we collected 122 stool samples from healthy children aged 5-19 years. Additionally, feces samples of 41 children with suspected IBD (who were later confirmed by endoscopy to have IBD) were collected. Levels of S100A12 were measured with a sandwich enzyme-linked immunosorbent assay (ELISA) (Inflamark®). The limit of detection was 0.22 μg/g. The upper reference limit in healthy children was 0.75 μg/g (90% confidence interval: 0.30-1.40). Median S100A12 levels were significantly higher in patients with IBD (8.00 μg/g [interquartile range (IQR) 2.5-11.6] compared to healthy controls [0.22 μg/g (IQR<0.22); p<0.001]). The best cutoff point based on receiver operating characteristic curve was 0.33 μg/g (sensitivity 93%; specificity 97%). Children and teenagers with newly diagnosed IBD have significantly higher S100A12 results compared to healthy individuals. We demonstrate that fecal S100A12 shows diagnostic promise under ideal testing conditions. Future studies need to address whether S100A12 can discriminate children with IBD from non-organic disease in a prospective cohort with chronic gastrointestinal complaints, and how S100A12 performs in comparison with established stool markers.

Selecting children with suspected inflammatory bowel disease for endoscopy with the calgranulin C or calprotectin stool test: protocol of the CACATU study

IntroductionThe introduction of the faecal calprotectin (FC) test to screen children with chronic gastrointestinal complaints has helped the clinician to decide whether or not to subject the patient to endoscopy....

Giardiasis and Subsequent Irritable Bowel Syndrome: A Longitudinal Cohort Study Using Health Insurance Data

Giardia intestinalis is the most commonly reported human intestinal parasite in the United States. Increased incidence of chronic gastrointestinal complaints has been reported after some giardiasis outbreaks. We examined the relationship between giardiasis diagnosis and irritable bowel syndrome (IBS) diagnosis. We used the 2006-2010 MarketScan commercial insurance database. Persons with at least 1 giardiasis diagnosis were individually matched on age group, sex, and enrollment length in months to 5 persons without a giardiasis diagnosis. Persons diagnosed with IBS before the date of study entry were excluded. We calculated crude incidence rates (IRs) and developed Cox proportional hazards models. The matched cohort included 3935 persons with giardiasis and 19663 persons without giardiasis. One-year incidence of IBS was higher in persons with giardiasis (IR = 37.7/1000 person-years vs 4.4/1000 person-years). The unadjusted hazard ratio was 4.8 (95% confidence interval [CI] = 3.6-6.4), attenuated slightly to 3.9 (95% CI = 2.9-5.4) after adjusting for anxiety, depression, and healthcare utilization. In a large insurance database, individuals diagnosed with giardiasis were more likely to have a subsequent IBS diagnosis, despite accounting for confounders. Future research on risk factors for IBS among giardiasis patients and the pathophysiology of postinfectious IBS is needed.

Les règles hygiéno-diététiques dans la constipation chronique de l’adulte : du fantasme à la réalité…

Chronic constipation is one of the most common chronic gastrointestinal complaints and a frequent reason for consultation. Lifestyle modification and dietary advice attract a lot of patients, often dissatisfied with a long-term drug intake. These behavioral modifications are recommended as a first-line approach in the treatment of chronic mild constipation in the majority of current guidelines despite a low level of evidence. Fiber supplementation is probably the most relevant measure because of a satisfactory level of proof. It improves stool frequency and consistency. It has a positive effect on excessive straining and colonic transit time. The recommended daily fiber intake is at least 20 to 25g. To avoid side effects like bloating and abdominal pain, it must be gradually adjusted after a several days period. The benefice of increasing water intake or daily physical exercise in the treatment of chronic constipation have a lack of evidence, except specific situations such as elderly, hospitalized, institutionalized, dehydrated people or people consuming fluids less than 500mL/day. Change in environmental defecation conditions or bowel habits are probably anecdotal recommendations.

The Immunological Enigma of Human Giardiasis

Giardiasis is a major cause of enteritis in humans worldwide. The disease is caused by two very distinct genetic groups (referred to as assemblages A and B) of the species complex Giardia duodenalis. The trophozoites stage colonizes the duodenum and jejunum of the small intestine and may cause a broad variety of disease outcomes that reach from asymptomatic carriers to patients with acute or chronic severe gastrointestinal complaints. Studies in immunocompromised patients imply that antibody-mediated acquired immune responses and a minimal T cell availability are of major importance for parasite clearance. These mechanisms likely play in concert with natural resistance mechanisms that are present in the intestinal mucosa. In humans no sterile immunity is acquired after infection. Epidemiological studies further suggest passive protection from symptomatic giardiasis in breastfed children. However, there is a fundamental lack of knowledge about the underlying immunological mechanisms of human giardiasis.

Gastrointestinal problems in modern wars: clinical features and possible mechanisms.

Gastrointestinal problems are common during wars, and they have exerted significant adverse effects on the health of service members involved in warfare. The spectrum of digestive diseases has varied during wars of different eras. At the end of the 20th century, new frontiers of military medical research emerged due to the occurrence of high-tech wars such as the Gulf War and the Kosovo War, in which ground combat was no longer the primary method of field operations. The risk to the military personnel who face trauma has been greatly reduced, but disease and non-battle injuries (DNBIs) such as neuropsychological disorders and digestive diseases seemed to be increased. Data revealed that gastrointestinal symptoms such as constipation, diarrhea, dyspepsia, and noncardiac chest pain are common among military personnel during modern wars. In addition, a large number of deployed soldiers and veterans who participated in recent wars presented with chronic gastrointestinal complaints, which fulfilled with the Rome III criteria for functional gastrointestinal disorders (FGIDs). It was also noted that many veterans who returned from the Gulf War suffered not only from chronic digestive symptoms but also from neuropsychological dysfunction; however, they also showed symptoms of other systems. Presently, this broad range of unexplained symptoms is known as “Gulf War syndrome”. The mechanism that underlies Gulf War syndrome remains unclear, but many factors have been associated with this syndrome such as war trauma, stress, infections, immune dysfunction, radiological factors, anthrax vaccination and so on. Some have questioned if the diagnosis of FGIDs can be reached given the complexity of the military situation. As a result, further studies are needed to elucidate the pathogenesis of gastrointestinal disease among military personnel.