Diagnosis Of Gastrointestinal Disorders Research Articles

Photoacoustic Spectroscopy-Based Breath Analysis for SIBO.

Breath hydrogen (H2) and methane (CH4) monitoring play an important role in the diagnosis of gastrointestinal disorders, such as lactose intolerance and small intestinal bacterial overgrowth (SIBO). In this paper, the photoacoustic spectroscopy method is used for H2 gas and CH4 gas detection. We present a novel approach for H2 gas concentration measurement, which is the linear relationship between the resonant frequency of breath carbon dioxide (CO2) and the H2 concentration in a resonant photoacoustic cell. Experimental results show that the minimum detectable limits of H2, CH4, and CO2 are calculated to be 8.86, 0.56, and 145.14 ppm, respectively, which can meet the requirements of breath diagnosis.

Role of salivary miRNAs in the diagnosis of gastrointestinal disorders: a mini-review of available evidence.

MiRNAs are short, non-coding RNA molecules, which are involved in the regulation of gene expression and which play an important role in various biological processes, including inflammation and cell cycle regulation. The possibility of detecting their extracellular expression, within body fluids, represented the main background for their potential use as non-invasive biomarkers of various diseases. Salivary miRNAs particularly gained interest recently due to the facile collection of stimulated/unstimulated saliva and their stability among healthy subjects. Furthermore, miRNAs seem to represent biomarker candidates of gastrointestinal disorders, with miRNA-based therapeutics showing great potential in those conditions. This review aimed to highlight available evidence on the role of salivary miRNAs in different gastrointestinal conditions. Most salivary-based miRNA studies available in the literature that focused on pathologies of the gastrointestinal tract have so far been conducted on pancreatic cancer patients and delivered reliable results. A few studies also showed the diagnostic utility of salivary miRNAs in conditions such as esophagitis, esophageal cancer, colorectal cancer, or inflammatory bowel disease. Moreover, several authors showed that salivary miRNAs may confidently be used as biomarkers of gastric cancer, but the use of salivary miRNA candidates in gastric inflammation and pre-malignant lesions, essential stages of Correa's cascade, is still put into question. On the other hand, besides miRNAs, other salivary omics have shown biomarker potential in gastro-intestinal conditions. The limited available data suggest that salivary miRNAs may represent reliable biomarker candidates for gastrointestinal conditions. However, their diagnostic potential requires validation through future research, performed on larger cohorts.

STATUS OF ORAL MUCOSA MICROBIOTOPE IN PATIENTS WITH GASTROESOPHAGEAL REFLUX DISEASE

In recent years, the issues of "extraesophageal manifestations" of gastroesophageal reflux disease has been receiving more attention from researchers and clinicians that can be explained by the complexity in diagnosis and treatment of the disease, and the necessity in collaboration between medical professional of different specialties as extra-esophageal manifestations can come to the fore imitating diseases of other organs. In the oral cavity there is a favourable environment for the development of beneficial, pathogenic and opportunistic microorganisms. The aim of this study is to investigate the state of oral mucosa microbiotope in patients with gastroesophageal reflux disease. The study included 90 individuals aged from 25 to 55 years, the two test groups involved 30 people in each who had clinically and laboratory confirmed diagnosis of gastroaesophageal reflux disease with hyperacidity and hypoacidity; control group consisted of 30 healthy individuals. The study has demonstrated that the number of microorganisms in the oral cavity differs significantly in sick and healthy people. The most significant changes have been found on the tongue (presence of a large number of opportunistic microorganisms and pathogens) and observed in patients with gastroesophageal reflux disease, especially with high gastric juice acidity. Changes in the micro-biotope on the tongue can be used for confirming diagnosis of gastrointestinal disorders (chronic gastritis, peptic ulcer disease, duodenitis), and gastroesophageal reflux disease in particular.

Poorer Cognitive Performance Is Associated with Gastrointestinal Symptoms in Otherwise Healthy Young Adults

Introduction: Functional gastrointestinal disorders such as irritable bowel syndrome are often associated with abdominal discomfort, bloating, and cramping. There is growing evidence that gastrointestinal symptoms are also related to cognitive function, but this association has not been previously examined in young adults. Methods: We examined cross-sectional relationships between nonspecific gastrointestinal symptoms and cognition in 56 healthy young adults (41 female, 15 male) without diagnosis of gastrointestinal disorder. Results: Gastrointestinal symptoms were associated with poorer performance on objective tests of memory (p < 0.01 for all) and greater self-report of cognitive dysfunction (p < 0.01 for all). Conclusion: Results suggest that higher gastrointestinal symptoms are associated with greater subjective and objective cognitive difficulty. Future work is needed to clarify underlying mechanisms and the potential functional impact of these cognitive deficits.

Possibilities of intestinal dysfunction treatment in period of convalescence of COVID-19

The article presents a clinical example of the treatment of persistent intestinal dysfunction in a patient with a relapse and in the period of COVID-19 convalescence. Differential approaches to the clinical and laboratory diagnosis of gastrointestinal disorders in patients with COVID-19 or SARS-CoV-2 infection and with a high risk of pseudomembranous colitis are considered. The role of bacteriophages in restoring the normal function of the gastrointestinal tract is considered. The total duration of treatment of a patient with a gastrointestinal disorder on the background of relapse and subsequent convalescence of COVID-19 from the moment of treatment was 8 weeks with the active use of anti-inflammatory, sorbing, anticoagulant, antiviral and antibacterial therapy. A significant contribution to the process of clinical improvement was made by the use of intestinal bacteriophage, reducing the risk of pseudomembranous colitis.Conclusions. COVID-19 is a disease characterized by a multisystem lesion and long-term consequences for immunocompetent organs, including the gastrointestinal tract. This fact forces us to reconsider some aspects of traditional therapy for intestinal dysfunction and provides opportunities for new, less aggressive treatments.

The efficacy of autofluorescence imaging in the diagnosis of colorectal diseases.

Image-enhanced endoscopy (IEE) has been developed and is applied in the clinical setting throughout the world. Most reports regarding IEE have evaluated the efficacy of narrow-band imaging (NBI) in the diagnosis of gastrointestinal disorders. Although autofluorescence imaging (AFI) is a form of IEE, its usefulness remains unclear. The present review focused on the efficacy of AFI in the diagnosis of colorectal disease, particularly neoplasia and ulcerative colitis (UC). AFI-based diagnoses are made via the subjective judgment of the color on the monitor. The efficacy of AFI in detection and differentiation in patients with colorectal neoplastic lesions remains controversial, which may be dependent on the study design and the diagnostic procedures. Although the number of the reports related to UC is very small, most suggest that AFI is effective in UC patients. AFI is distinct from other modalities in that it can quantitatively assess the lesion based on the fluorescence intensity without any morphological assessments. AFI could be useful for patients with colorectal disease.

Compliance with Pharmacotherapy and Direct Healthcare Costs in Patients with Parkinson’s Disease: A Retrospective Claims Database Analysis

BackgroundParkinson’s disease (PD) is a progressive neurological disorder for which, at present, there is no cure. Current therapy is largely based on the use of dopamine agonists and dopamine replacement therapy, designed to control the signs and symptoms of the disease. The majority of current treatments are administered in tablet form and can involve multiple daily doses, which may contribute to sub-optimal compliance. Previous studies with small groups of patients suggest that non-compliance with treatment can result in poor response to therapy and may ultimately increase direct and indirect healthcare costs.ObjectiveTo determine the extent of non-compliance within the general PD population in the USA as well as the patient characteristics and healthcare costs associated with compliance and non-compliance.MethodsA retrospective analysis from a managed care perspective was conducted using data from the USA PharMetrics patient-centric claims database. PharMetrics claims data were complete from 31 December 2005 to 31 December 2009. Patients were included if they had at least two diagnoses for PD between 31 December 2005 and 31 December 2008, were older than 18 years of age, were continuously enrolled for at least 12 months after the date of the most recent PD diagnosis, and had no missing or invalid data. The follow-up period was the most recent 12-month block of continuous enrollment that occurred between 2006 and 2009. Patients were required to have at least one PD-related prescription within the follow-up period. The medication possession ratio (MPR) was used to categorise patients as compliant or non-compliant. Direct all-cause annual healthcare costs for patients with PD were estimated for each patient, and regression analyses were conducted to determine predictors for non-compliance.ResultsA total of 15,846 patients were included, of whom 46 % were considered to be non-compliant with their prescribed medication (MPR <0.8). Predictors of non-compliance included prescription of a medication administered in multiple daily doses (p < 0.0001), a period of <2 years since the initial PD diagnosis (p = 0.0002), a diagnosis of gastrointestinal disorder (p < 0.0001), and a diagnosis of depression (p < 0.0001). Non-compliance was also found to be related to age, with a lower odds of non-compliance in patients aged 41–80 years than in patients aged ≥81 years (p < 0.05). Although total drug mean costs were higher for compliant patients than non-compliant patients (driven mainly by the cost of PD-related medications), the mean costs associated with emergency room and inpatient visits were higher for patients non-compliant with their prescribed medication. Overall, the total all-cause annual healthcare mean cost was lower for compliant ($77,499) than for non-compliant patients ($84,949; p < 0.0001).ConclusionNon-compliance is prevalent within the general USA PD population and is associated with a recent PD diagnosis, certain comorbidities, and multiple daily treatment dosing. Non-compliance may increase the burden on the healthcare system because of greater resource usage compared with the compliant population. Treatments that require fewer daily doses may have the potential to improve compliance, which in turn could reduce the economic burden associated with PD.

Discontinuation of low-dose acetylsalicylic acid therapy in UK primary care: incidence and predictors in patients with cardiovascular disease.

BackgroundDiscontinuation of low-dose acetylsalicylic acid (ASA) leads to an increased risk of cardiovascular and cerebrovascular events in patients taking low-dose ASA for secondary cardiovascular prevention. However, little is known about the rate of discontinuation in everyday clinical practice.ObjectivesTo assess the rate of low-dose ASA discontinuation in primary care, and identify factors that predict discontinuation.MethodsThe Health Improvement Network, a large UK primary care database, was used to identify patients aged 50–84 years who received at least two consecutive prescriptions for low-dose ASA for secondary cardiovascular or cerebrovascular prevention in 2000–2007 (n = 35,639). Discontinuation was defined as a period of at least 90 days after completion of the last prescribed course of ASA during which no repeat prescription was issued.ResultsDuring the study, 11,729 patients (32.9%) discontinued ASA therapy (mean follow-up 2.5 years). The discontinuation rate was lower in patients with ASA indicated for myocardial infarction than for other indications. The diagnosis of gastrointestinal disorders during the study (overall odds ratio: 1.74; 95% confidence interval: 1.61–1.88) was associated with increased rates of ASA discontinuation, whereas co-prescription of a proton pump inhibitor from the start of ASA therapy was associated with a decreased rate of discontinuation (odds ratio: 0.80; 95% confidence interval: 0.75–0.86). Co-prescription of several other cardioprotective medications was also associated with a reduced risk of discontinuation, as were increasing age, prior hospitalization and overall number of co-medications.ConclusionContinuous co-prescription of a PPI with low-dose ASA may improve adherence and outcomes, particularly in patients at both cardiovascular and gastrointestinal risk.

Adherence to local guidelines for venous thromboprophylaxis: a cross-sectional study of medical inpatients in Argentina

BackgroundVenous thromboembolism prophylaxis has been shown to safely and cost-effectively reduce the incidence of thromboembolic events in medical inpatients. However, there is a gap between evidence and medical practice. The aim of this study was evaluate the appropriateness of prescribing venous thromboembolism prophylaxis in accordance with local recommendations for medical inpatients.MethodsThis cross-sectional study included 310 prescriptions of medical general-ward admitted patients of two university hospitals of Buenos Aires, Argentina.Data was collected using filled-out prescriptions, medical records and interviews with the head attending physician. Information was gathered at different times during 16 days randomly selected over September 2007 and January 2008.ResultsOne hundred eighty eight patients' prescriptions (60.6%) were appropriate according to the institutional guidelines. Inappropriateness was due to excessive (14.2%), insufficient (15.8%) and absent (9.4%) prescribing. According to the recommendations of the American College of Chest Physicians, 256 (82.6%) patients received appropriate prophylaxis. Twenty-nine patients (9.4%) were considered at low risk for thromboembolism and did not need pharmacologic or mechanical prophylaxis. One hundred three patients (33.2%) had at least one major risk factor for venous thromboembolism. Compliance with the institutional guidelines was more frequently in the case of high risk patients. Complex preventive measures and low risk patients were related to lower adherence to recommendations. In the multivariate analysis, predictors of inappropriateness were the requirement of a surgical procedure and absence of prophylaxis prescribing at admission. In contrast, patients with a diagnosis of gastrointestinal disorders had lower odds of inappropriateness than those with an infectious disease.ConclusionsMost medical inpatients received some thromboprophylaxis measure, but the compliance with recommendations was less frequent. Efforts should be made to improve the appropriate prescription.

Ingestible wireless capsules for enhanced diagnostic inspection of gastrointestinal tract

Wireless capsule endoscopy has become a common procedure for diagnostic inspection of gastrointestinal tract. This method offers a less-invasive alternative to traditional endoscopy by eliminating uncomfortable procedures of the traditional endoscopy. Moreover, it provides the opportunity for exploring inaccessible areas of the small intestine. Current capsule endoscopes, however, move by peristalsis and are not capable of detailed and on-demand inspection of desired locations. Here, we propose and develop two wireless endoscopes with maneuverable vision systems to enhance diagnosis of gastrointestinal disorders. The vision systems in these capsules are equipped with mechanical actuators to adjust the position of the camera. This may help to cover larger areas of the digestive tract and investigate desired locations. The preliminary experimental results showed that the developed platform could successfully communicate with the external control unit via human body and adjust the position of camera to limited degrees.

Feasibility of confocal endomicroscopy in the diagnosis of pediatric gastrointestinal disorders

To evaluate the feasibility and utility of confocal laser endomicroscopy (CLE) in the description of normal gastrointestinal (GI) mucosa and in the diagnosis of GI disorders in children, in comparison to histology. Forty-four patients (19 female) median age 10.9 years (range 0.7-16.6 years) with suspected or known GI pathology underwent esophago-gastro-duodenoscopy (OGD) (n = 36) and/or ileocolonoscopy (IC) (n = 31) with CLE using sodium fluorescein and acriflavine as contrast agents. Histological sections were compared with same site confocal images by two experienced pediatric and GI histopathologists and endoscopists, respectively. Duodenum and ileum were intubated in all but one patient undergoing OGD and IC. The median procedure time was 16.4 min (range 7-25 min) for OGD and 27.9 min (range 15-45 min) for IC. A total of 4798 confocal images were compared with 153 biopsies from the upper GI tract from 36 procedures, and 4661 confocal images were compared with 188 biopsies from the ileocolon from 31 procedures. Confocal images were comparable to conventional histology both in normal and in pathological conditions such as esophagitis, Helicobacter pylori gastritis, celiac disease, inflammatory bowel disease, colonic heterotopia, and graft versus host disease. CLE offers the prospect of targeting biopsies to abnormal mucosa, thereby increasing diagnostic yield, reducing the number of biopsies, decreasing the burden on the histopathological services, and reducing costs.

Endoscopic Ultrasound in Pediatric Gastroenterology

Purpose: The value of endoscopic ultrasound (EUS) in the evaluation and diagnosis of gastrointestinal disorders in adults is well recognized. Although the number of publications and reports of EUS applications in pediatric patients has been increasing in recent years, the medical literature is still limited. We describe our initial experience with EUS as a diagnostic tool in pediatric patients. Methods: We reviewed all EUS procedures performed at our institution between Sept 2002 and May 2006. EUS was performed using conventional adult echoendoscopes (Pentax EG-3630 UR and EG-3630 U models) by a single endosonographer (AAG). Patients younger than 18 years of age were included in the study. We obtained demographic data, indications and EUS findings as well as follow-up information and outcomes of these patients. Results: A total of seven pediatric patients underwent EUS in the period reviewed. The mean age was 11.7 years (range 7–17), 3 male and 4 female. All patients were >18 kg in weight. EUS was performed with a pediatric anesthesiologist providing IV sedation in all cases. All patients had radial endosonography, two undergoing linear array EUS for FNA of abnormal lesions found during the study. The indications for the procedure included recurrent pancreatitis of unknown origin (4 patients), submucosal lesions of the stomach (2 patients), and an apparent rectal adenocarcinoma for staging (1 patient). All procedures were performed safely without immediate or long-term complications. EUS findings included gallstone disease (2 patients), chronic pancreatitis (1 patient), non-obstructive jaundice (1 patient), and UC in the patient with apparent malignancy of the rectum. The two submucosal gastric masses undergoing EUS-FNA were reported as benign lesions. EUS provided valuable information and had a direct impact in the management decisions made for all patients. Conclusions: In experienced hands, EUS and EUS-FNA can be safely performed in pediatric patients who weigh more than 18 kg using regular adult echoendoscopes, always under assistance of a pediatric anesthesiologist. Our most common indications for EUS in pediatric patients included the evaluation of recurrent pancreatitis of unknown etiology and the presence of submucosal lesions of the GI tract found during routine endoscopy. EUS and EUS-FNA, when indicated, can provide useful information in the decision-making process for the evaluation and treatment of selected pediatric patients.

Sinnhaftigkeit von IgG-Bestimmungen bei chronischen gastrointestinalen Beschwerden?

A 23-year-old patient has suffered from meteorism and occasional diarrhea for 8 years. Specific IgG antibodies directed towards multiple foods had been determined elsewhere. A concordant elimination diet had led to loss of body weight of 10 kg (remaining body weight 40 kg) without any improvement of the symptoms. At the time of first presentation in our Allergy Unit, a concise allergological work-up had not been performed. The skin prick testing of inhalant allergens, foods, spices, flour, preservatives and latex-associated foods showed 3+-positive reactions to grass pollen, rye pollen, dermatophagoides pteronyssinus, pepper, wheat flour and rye flour; 2+-positive reactions to curry, sodium proprionate and sorbic acid. Determination of specific IgE antibodies to rye flour, wheat flour, pepper and curry were negative, as well as serology for celiac disease. After dramatic weight loss due to elimination diet of 87 foods according to IgG antibodies identified elsewhere, positive prick test results were found to the above mentioned foods and food additives (pepper, wheat- and rye flour, curry as well as sodium proprionate and sorbic acid). A clinically relevant IgE-mediated allergy could be ruled out by an elimination diet to these positive tested foods that did not lead to any improvement of the clinical symptoms. A double-blind placebo-controlled food challenge (DBPCFC) to wheat and rye flour was refused by the patient. A Pillcam endoscopy revealed an inflammatory alteration of the mucous membran of the terminal ileum. Due to a suspected early stage of Crohn's disease, a coloscopy and a double-ballon endoscopy is scheduled. As in the presented case, determination of IgG antibodies raised against foods is not a feasible measure for diagnosis of gastrointestinal disorders and may lead to a significant delay in correct diagnosis and therapy of the underlying disease.

Specific IgG and IgA Antibodies and Related Subclasses in the Diagnosis of Gastrointestinal Disorders or Atopic Dermatitis Due to Cow's Milk and Egg

Today the only investigation considered valid for the diagnosis of reactions to food is the oral stimulation test following a period of diet during which the suspected food item has been withdrawn. This test is, however, not without a certain risk, due to the possibility of the onset of an unexpected anaphylactic reaction. Researchers are therefore focusing attention on new, more reliable and less risky diagnostic techniques. The aim of this investigation was to evaluate, by means of ELISA, the serum levels of specific IgG and IgA antibodies and of their subclasses for casein, alpha lactalbumin, bovine beta-lactoglobulin and ovalbumin in 72 children with gastointestinal disorders or atopic dermatitis due to food. The diagnosis of food intolerance was made following a double blind oral stimulation test: 16 healthy age-matched children were used as controls. The results of the investigation demonstrated that specific IgA levels for all the food antigens were statistically higher compared with those of controls, irrespective of the clinical features, whereas the IgG class antibodies were statistically higher only for casein in the children with atopic dermatitis. Studies on the antibody subclasses, showed a statistically significant increase particulary of IgG, but also of IgA1, especially in children with gastointestinal disorders. In conclusion, the results show that total specific IgA may play a role, although modest, in the diagnosis of food intolerance. The IgG subclasses, and to a lesser extent the IgA subclasses, appear to be useful in the diagnostic work-up, particularly in children with gastrointestinal symptoms.

Abdominal Angina and Mesenteric Insufficiency

Chronic bowel ischemia is not uncommon. If it is considered in the differential diagnosis of gastrointestinal disorders, it can be corrected surgically. In selected cases symptomatic relief can be achieved, and thus high mortality and morbidity can be prevented.