Digestive Symptoms Research Articles

The Prevalence of Small Intestinal Bacterial Overgrowth After Roux-en-Y Gastric Bypass (RYGB): a Systematic Review and Meta-analysis.

We reviewed the literature on the prevalence of small intestinal bacterial overgrowth (SIBO) after Roux-en-Y gastric bypass (RYGB). Eight studies examining 893 patients were included. The mean age of the patients was 48.11 ± 4.89years. The mean BMI before surgery and at the time of SIBO diagnosis was 44.57 ± 2.89kg/m2 and 31.53 ± 2.29kg/m2, respectively. Moreover, the results showed a 29% and 53% prevalence of SIBO at < 3-year and > 3-year follow-up after RYGB, respectively. Symptoms included abdominal pain, diarrhea, bloating, nausea, vomiting, constipation, soft stool, frequent defecation, flatulence, rumpling, dumping syndrome, and irritable bowel syndrome. SIBO is prevalent after RYGB; digestive symptoms should prompt the consideration of SIBO as a potential etiology. Antibiotic therapy has proven to be therapeutic.

Helicobacter pylori infection and small intestinal bacterial overgrowth: a systematic review and meta-analysis

BackgroundThere is a link between Helicobacter pylori (HP) infection and small intestinal bacterial overgrowth (SIBO) with nonspecific digestive symptoms. Nonetheless, whether HP infection is associated with SIBO in adults remains unclear. Based on a meta-analysis, we evaluated this relationship.ResultsObservational studies relevant to our research were identified by searching PubMed, Embase, the Cochrane Library, and the Web of Science. We evaluated between-study heterogeneity using the Cochrane Q test and estimated the I2 statistic. Random-effects models were used when significant heterogeneity was observed; otherwise, fixed-effects models were used. Ten datasets from eight studies, including 874 patients, were involved in the meta-analysis. It was shown that HP infection was related to a higher odds of SIBO (odds ratio [OR]: 1.82, 95% confidence interval: 1.29 to 2.58, p < 0.001) with mild heterogeneity (p for Cochrane Q test = 0.11, I2 = 7%). Subgroup analyses showed that HP infection was related to SIBO in young patients (mean age < 48 years, OR: 2.68, 95% CI: 1.67 to 4.28, p < 0.001; I2 = 15%) but not in older patients (mean age ≥ 48 years, OR: 1.15, 95% CI: 0.69 to 1.92, p < 0.60; I2 = 1%; p for subgroup difference = 0.02). Subgroup analyses further indicated that the association was not significantly affected by the country of study, comorbidities, exposure to proton pump inhibitors, or methods of evaluating HP infection and SIBO.ConclusionsHP infection may be related to SIBO in adults, which supports the detection of SIBO in patients with digestive symptoms and HP infection.

Long-term quality of life is better after laparoscopic compared to open pancreatoduodenectomy.

Three randomized controlled trials have reported improved functional recovery after Laparoscopic pancreatoduodenectomy (LPD), as compared to open pancreatoduodenectomy (OPD). Long-term results regarding quality of life (QoL) are lacking. The aim of this study was to compare long-term QoL of LPD versus OPD. A monocentric retrospective cross-sectional study was performed among patients < 75years old who underwent LPD or OPD for a benign or premalignant pathology in a high-volume center (2011-2021). An electronic three-part questionnaire was sent to eligible patients, including two diseases specific QoL questionnaires (the European Organization for Research and Treatment in Cancer Quality of Life Questionnaire for cancer (QLQ-C30) and a pancreatic cancer module (PAN26) and a body image questionnaire. Patient demographics and postoperative data were collected and compared between LPD and OPD. Among 948 patients who underwent PD (137 LPD, 811 OPD), 170 were eligible and 111 responded (58 LPD and 53 OPD). LPD versus OPD showed no difference in mean age (51 vs. 55years, p = 0.199) and female gender (40% vs. 45%, p = 0.631), but LPD showed lower BMI (24 vs 26; p = 0.028) and higher preoperative pancreatitis (29% vs 13%; p = 0.041). The postoperative outcome showed similar Clavien-Dindo ≥ III morbidity (19% vs. 23%; p = 0.343) and length of stay (24 vs. 21days, p = 0.963). After a similarmedian follow-up (3 vs. 3years; p = 0.122), LPD vs OPD patients reported higher QoL (QLQ-C30: 49.6 vs 56.3; p = 0.07), better pancreas specific health status score (PAN20: 50.5 vs 55.5; p = 0.002), physical functioning (p = 0.002), and activities limitations (p = 0.02). Scar scores were better after LPD regarding esthetics (p = 0.001), satisfaction (p = 0.04), chronic pain at rest (p = 0.036), moving (p = 0.011) or in daily activities (p = 0.02). There was no difference in digestive symptoms (p = 0.995). This monocentric study found improved long-term QoL in patients undergoing LPD, as compared to OPD, for benign and premalignant diseases. These results could be considered when choosing the surgical approach in these patients.

Influence of Environmental Pollution on Animal Behavior

Summary Animals, like humans, act according to physiological patterns of behavior that change in response to various internal and external stimuli. Environmental pollutants represent “negative” stimuli and stressors. Air pollution is among pollution sources that pose the greatest threat to the environment and all living organisms. Exposure to pollutants causes behavioral changes in animals and disruption of organ functions and structures, which are often identical to those of humans working or living under the same conditions as animals (e.g., on a farm or in a city). Aside from a shorter life span and possible premature death, there are some diseases which commonly occur as a result of the exposure. Symptoms indicative of a disease or irritation, such as coughing, lameness, diarrhea, eye discharge and the like, cause the animal to make movements (actions) that are not part of their normal physiological routine and are considered behavioral changes. Behavioral changes are the earliest indicator that the animal is suffering from physical or mental disorders that can negatively affect its health and, in the case of livestock, production results. Various animal species serve as indicators of pollution, and domestic animals, including farm animals, can also serve this purpose. Behavioral changes resulting from exposure to various pollutants include disorientation, problems interacting with humans and other animals, reproductive problems, respiratory, digestive symptoms, etc. This review compiled data from a number of studies on changes in animal behavior after short or long exposure to various environmental pollutants. The focus was on the effects of air pollutants on animals, which are of particular importance to humans as they share living or working space with the animals or breed them for economic interest.

Effect of Pre-Transplantation Nutritional Status on the Early Related Complications of Allogeneic Hematopoietic Stem Cell Transplantation:a Cohort Study

Background Allogeneic hematopoietic stem cell transplantation is an effective method for the treatment of hematologic malignancies. Malnutrition is a common complication and has a negative impact on poor prognosis. It has been proved that blood biochemical indexes such as muscle mass ratio albumin etc. can reflect earlier the nutritional status of patients, but the influence of muscle mass pre-transplantation on the early transplantation related complications remains unclear. Objective To investigate the effect of pre-transplantation skeletal muscle mass (SMM) on the early outcome of allogeneic hematopoietic stem cell transplantation, and to provide clinical evidence for nutritional intervention and prognosis improvement. Method A cohort study was conducted in 77 patients with leukemia who received allogeneic hematopoietic stem cell transplantation in the Hematology Medical Center of Chongqing Xinqiao Hospital from January to October 2022 were selected. The skeletal muscle quality was evaluated by bioelectrical impedance method. According to the skeletal muscle mass, the patients were divided into normal skeletal muscle mass group(36) and low skeletal muscle mass group(41). The baseline data of the patients were collected, including personal information and clinical data. SPSS23.0 software was used to compare the differences in oral mucositis, digestive tract symptoms, infection and hematopoietic reconstitution time between the two groups. Result Before transplantation, the SMM of patients was poor, which was not up to the normal value in 53.25%.The incidence of oral mucitis in normal SMM group was 41.67%, significantly lower than that in low SMM group 92.68%( χ2=23.255, P&amp;lt;0.001).The severity of oral mucositis was significantly different (Z=6.461, P&amp;lt;0.001) between the normal SMM group and the low SMM group. The incidence of hypoalbuminemia in normal SMM group was 16.67%, significantly lower than that in low SMM group 46.34%( χ2=7.699， P&amp;lt;0.001).The incidence of overt gastrointestinal bleeding and infection in normal SMM group were significantly lower than those in low SMM group ( c ２=4.208， P=0.040； c ２=4.727， P=0.030). the neutrophils and platelets grafting time in the normal SMM group was significantly shorter than that in the low SMM group ( Z=2.943， P=0.003； Z=2.756， P=0.006). There was no significant difference in the incidence of diarrhea, nausea and vomiting, stomachache/ abdominal pain between the two groups. Conclusion The incidence of low skeletal muscle mass is high in patients before transplantation, and low skeletal muscle mass is associated with the onset of oral mucositis, the severity of oral mucositis, hypoalbuminemia,gastrointestinal bleeding ,infectionand the delay of neutrophil and platelet implantation time in patients at the early stage of transplantation. Patients should actively improve skeletal muscle mass before transplantation to improve the early outcome of transplantation.

Clinical case analysis of 32 children aged 0-6 years with lead poisoning in Nanning, China.

Lead is one of the heavy metals that is toxic and widely distributed in the environment, and children are more sensitive to the toxic effects of lead because the blood-brain barrier and immune system are not yet well developed. The objective of the study was to investigate the clinical characteristics of lead poisoning in children aged 0∼6 years in a hospital in Guangxi, and to provide scientific basis for the prevention and treatment of lead poisoning. We collected and analyzed the clinical data of 32 children with lead poisoning admitted to a hospital in Guangxi from 2010 to 2018. The results showed that most of the 32 cases presented with hyperactivity, irritability, poor appetite, abdominal pain, diarrhea, or constipation. The hemoglobin (HGB), mean corpusular volume (MCV), mean corpuscular hemoglobin (MCH), and hematocrit (HCT) of the lead-poisoned children were all decreased to different degrees and were below normal acceptable levels. Urinary β2-microglobulin was increased. Blood lead levels (BLL) decreased significantly after intravenous injection of the lead chelator, calcium disodium edetate (CaNa2-EDTA). In addition, HGB returned to normal levels, while MCV, MCH, and HCT increased but remained below normal levels. Urinary β2-microglobulin was reduced to normal levels. Therefore, in this cohort of children, the high-risk factors for lead poisoning are mainly Chinese medicines, such as baby powder. In conclusion, lead poisoning caused neurological damage and behavioral changes in children and decreased erythrocyte parameters, leading to digestive symptoms and renal impairment, which can be attenuated by CaNa2-EDTA treatment.

The Prokineticin System in Inflammatory Bowel Diseases: A Clinical and Preclinical Overview.

Inflammatory bowel disease (IBD) includes Crohn's disease (CD) and ulcerative colitis (UC), which are characterized by chronic inflammation of the gastrointestinal (GI) tract. IBDs clinical manifestations are heterogeneous and characterized by a chronic relapsing-remitting course. Typical gastrointestinal signs and symptoms include diarrhea, GI bleeding, weight loss, and abdominal pain. Moreover, the presence of pain often manifests in the remitting disease phase. As a result, patients report a further reduction in life quality. Despite the scientific advances implemented in the last two decades and the therapies aimed at inducing or maintaining IBDs in a remissive condition, to date, their pathophysiology still remains unknown. In this scenario, the importance of identifying a common and effective therapeutic target for both digestive symptoms and pain remains a priority. Recent clinical and preclinical studies have reported the prokineticin system (PKS) as an emerging therapeutic target for IBDs. PKS alterations are likely to play a role in IBDs at multiple levels, such as in intestinal motility, local inflammation, ulceration processes, localized abdominal and visceral pain, as well as central nervous system sensitization, leading to the development of chronic and widespread pain. This narrative review summarized the evidence about the involvement of the PKS in IBD and discussed its potential as a druggable target.

Liquid Biopsy Enhances Diagnostic Workup of Hereditary Alpha-Tryptasemia (HaT) and Systemic Mastocytosis (SM) in Patients with Mast Cell-Mediated Symptoms and Elevated Basal Tryptase Levels

Background and Objectives Hereditary alpha-Tryptasemia (HaT) and Systemic Mastocytosis (SM) both display elevated basal serum tryptase (BST) levels and share mast cell-mediated digestive, neuropsychiatric, cardiovascular, cutaneous and musculoskeletal symptoms. Lack of awareness and numerous differential diagnoses complicate and often delay diagnosis, while patients suffer from impaired quality of life and do not receive suitable treatment. HaT is defined by an autosomal dominant inherited amplification of an alpha-Tryptase encoding TPSAB1 gene and is found in 5-6% of the general population. SM is characterized by an activating cKIT D816V mutation that can be detected in 90% of patients. Currently, there is no test available to discriminate between HaT and SM. We aimed to establish a non-invasive blood test supporting the diagnostic workup of these still unrecognized entities. Methods We established a customized digital droplet (dd)PCR triplex assay to detect HaT and a highly sensitive ddPCR singleplex assay for cKIT D816V mutation. We designed a clinical assessment form to record the symptoms. We identified the frequency of HaT and cKIT D816V mutation in genomic DNA isolated from peripheral blood buffy coat samples in 112 patients presenting to our institution with suspected mast cell-mediated symptoms and highly normal (&amp;gt;8-11.4ng/ml) or elevated (&amp;gt;11.4 ng/ml) BST levels (prevalence cohort, Fig. 1). For symptom assessment, we performed blood testing and symptom assessment in these 112 patients and 34 additional patients presenting with suspected SM (n=146, symptom cohort, Fig. 2). As a control cohort we tested 62 age- and sex-matched patients presenting with BST levels &amp;lt; 6 ng/ml (thus not suspected to have HaT or SM). Results HaT accounted for 82 out of 112 cases (73.2%) of BST levels of 8 ng/ml or higher, while cKIT D816V indicating SM was identified in only 5 cases. In 28 patients (24,1%) no HaT genotype or cKIT D816V mutation was detected. One patient with negative cKIT D816V testing but clinical signs of SM was confirmed by bone marrow biopsy, increasing SM prevalence to 6/112 (5.4%). Interestingly the HaT and SM proportions increased to 91% (HaT) and 7.5% (SM) when higher BST cut-off level of 11.4 ng/ml and to 92,9% (HaT) and 28.6% (SM) when higher BST cut-off level of 20 ng/ml were used (Fig. 1). Of note, 21.4% of patients with BST &amp;gt; 20 ng/ml had both, HaT and SM, and no patient with BST &amp;gt;20 ng/ml was tested negative for HaT and SM. In the symptom cohort, we found significant differences in type and severity of symptoms between HaT, SM and the control group. The occurrence of digestive symptoms was up to twice as high in HaT or SM compared to the control group, for flatulence (HaT 83.5%; control group 53.2%) and diarrhea (SM 68.8%; control group 25.8%) or heartburn (SM 56.3%; control group 25.8%). Nausea was significantly more common in HaT (51.7%) than in SM patients (21.9%). HaT patients more frequently reported neuropsychiatric symptoms compared to control group and SM patients. This included memory impairment (HaT 45.9%; SM 23.3%; control group 16.1%) sleep disturbances (HaT 55.8%; SM 43.8%; control group 33.3%) and fatigue (HaT 67.4%; SM 50.0%; control group 37.7%). Conclusions Simultaneous, non-invasive testing for cKIT D816V and HaT in patients with suspected mast cell mediator symptoms allows discrimination of HaT from SM. Adding BST &amp;gt; 8 ng/ml and &amp;gt;11,4ng/ml to the diagnostic workup in symptomatic individuals increases the pretest probability to detect HaT to 73.8% and 91.0%. Diagnosed patients experience mental relieve through personal and medical acknowledgement of their symptoms and suitable treatment can be initiated. According to our results, HaT testing should be initiated in all individuals presenting with mast cell mediator symptoms and BST &amp;gt; 8 ng/ml, and cKIT testing should be initiated in patients with BST &amp;gt;11.4 ng/ml. In patients with BST &amp;gt;20 ng/ml, cKIT D816V positive blood testing or signs of advanced SM, bone marrow based diagnostic workup is still mandatory to cover diagnostic criteria for SM according to WHO.

Investigating the Effect of Ginger as an Adjunctive Treatment along with SSRIs to Reduce Anxiety in Patients with GAD: A Clinical Trial Study

Introduction: Generalized anxiety disorder (GAD) is characterized by exaggerated anxiety without any apparent cause of concern. The primary treatment of this disorder is usually SSRIs, which have many digestive side effects and do not provide complete treatment for the patient. The use of non-pharmacological methods may help reduce these complications. Therefore, the present study was conducted to investigate the effect of ginger as an adjunctive therapy along with SSRIs to reduce anxiety in patients with GAD. Materials and Methods: In this double-blind, controlled clinical trial study, a total of 80 patients with GAD were randomly assigned into two groups. For the intervention group, at the same time as SSRI drug, two 500-mg ginger capsules were used daily while in the control group, two starch capsules were used daily as a placebo along with SSRI. Data collection tools were Hamilton's anxiety questionnaire and a gastrointestinal symptom severity scale. Data were collected before the intervention and after the 12-week intervention. Results: There was no significant difference between the intervention and control groups in terms of average anxiety and severity of digestive symptoms before the intervention (P&gt;0.05), but there was a significant difference between the groups after the intervention (P&lt;0.05). Also, the average scores of anxiety and severity of gastrointestinal symptoms in the intervention group increased significantly from the beginning of the intervention to the follow-up (intragroup difference) (p&lt;0.05). Conclusion: The results of the study showed that the use of ginger along with SSRIs reduced anxiety and released the severity of gastrointestinal symptoms in patients with GAD. In addition, in this study, it was found that ginger, along with SSRIs, can have beneficial effects on indigestion, diarrhea, and nausea in patients with GAD. However, these findings require more extensive research.

HEMORRAGIE DIGESTIVE ABONDANTE REVELANT UNE TUMEUR DUODENALE: A PROPOS D1 CAS AU SERVICE URGENCE-DECHOQUAGE CHU MOHAMED VI MARRAKECH

Duodenal gastrointestinal tumors are very rare. Represents approximately 2% of grelic tumors [1]. The discovery is often fortuitous, through chronically evolving digestive symptoms (epigastric pain, digestive disorder, abdominal pain, mass,) or through intermittent digestive bleeding complicated by anemia [2]. But the discovery of a large digestive hemorrhage generally poses a major problem of diagnosis and emergency management because it requires adequate emergency treatment and sometimes emergency hemostasis measures. We report the observation of a duodenal tumor, revealed by a large digestive hemorrhage with hemodynamic impact in a 35-year-old male patient.

Identification of Core Symptom Cluster in Patients With Digestive Cancer: A Network Analysis.

A lack of identified core symptom clusters in digestive cancer patients hinders achieving precision symptom intervention. There are few studies on identifying digestive cancer symptom clusters based on network analysis. The aims of this study were to construct the symptom network of digestive cancer patients and identify the core symptom cluster. A cross-sectional study was conducted among 202 digestive cancer patients. The Chinese version of the MD Anderson Symptom Inventory for gastrointestinal cancer scale was used to assess the symptoms by convenience sampling. R software was used to construct a symptom network and identify core symptom clusters. Edge weight and centrality difference tests were used to test the accuracy of core symptom cluster identification. The most common symptoms were distress, poor appetite, and sadness. The most serious symptoms were poor appetite, disturbed sleep, and fatigue. The core symptom cluster of the psychoemotional symptom group was distress, sadness, and numbness. The centrality index showed that the top 3 in strength were distress (Rs = 1.11), fatigue (Rs = 1.09), and sadness (Rs = 1.04). The edge weight difference test showed that the psychoemotional symptom group had high stability. The psychoemotional symptoms of digestive cancer patients should be given priority for intervention. Network analysis must be extended to the symptom research of cancer patients as soon as possible to provide a scientific basis for symptom management. Nurses must perform comprehensive psychological and emotional assessments, initiate referrals for psychoemotional symptom management and psychological services, and administer pharmacologic and nonpharmacologic interventions to improve appetite loss in digestive cancer patients.

Safety and persistence of dimethyl fumarate as a treatment for relapsing-remitting multiple-sclerosis

ObjectiveDimethyl fumarate is a medication approved for the treatment of relapsing-remitting multiple sclerosis. The purpose of the study was to evaluate the safety and persistence of dimethyl fumarate in clinical practice and analyze the occurrence of lymphopenia is patients treated with dimethyl fumarate over a period of at least 6 months. MethodThis is a retrospective longitudinal observational study carried out between August 2015 and March 2019. The study cohort was made up of patients who had been treated with dimethyl fumarate for at least 6 months. Lymphocyte counts were recorded at different points of time (pre-treatment, at 3, 6, 12 months, and at the end of the study period). The evolution of lymphopenia was evaluated by means of a logistic regression statistical model. An analysis was performed of the relationship between a decreased lymphocyte count over the first 6 months of treatment and the development, by the end of the study, of grade II-III lymphopenia necessitating discontinuation of dimethyl fumarate. Other safety indicators were also evaluated including adverse events and interruptions or discontinuations of treatment. Persistence was determined by measuring the time to discontinuation of treatment. ResultsThe study included a total of 55 patients, of whom 80% were female. The most common adverse events were lymphopenia (27), rubefaction (16), digestive symptoms (11), fatigue (9), headache (3) and sleep disturbances (2). Eleven subjects interrupted/discontinued their treatment during the study period; reasons were as follows: pregnancy (2), personal decision (2), John Cunningham virus infection (1), allergy to the drug (2), and lymphopenia (4). Median duration of treatment was 23 months (4-43 months). A statistically significant association was found between a lower lymphocyte count over the first 6 months of treatment and the development of severe lymphopenia by the end of the study [OR = 1.34 (1.27-11.41); 95% CI (p = 0.001)]. ConclusionsThe adverse events observed in the present study are in line with those reported in previous analyses. Lymphopenia was the most common adverse event. The persistence of the medication was similar to that found in pivotal trials. The significant association found between a decreased lymphocyte count over the first 6 months of treatment and the development of severe lymphopenia by the end of the study suggests a connection between both variables, which could be instrumental in being able to predict and even prevent the occurrence of such lymphopenias.

Digestive manifestations of Covid-19 in children: a retrospective study.

The world is currently facing a pandemic due to a new species of the Coronaviridae family called SARS-CoV-2, discovered in the city of Wuhan in China in December 2019. The WHO has named the resulting disease COVID-19 (Coronavirus Disease 2019). It has been a global health problem due to its major socio-economic damage. The aim of this study was to show the prevalence of gastrointestinal and hepatic manifestations in symptomatic children with COVID-19. We performed a retrospective study, including 36 symptomatic children infected by SARS-CoV-2 hospitalized at the mother and child hospital of university hospital of Mohammed VI, Marrakech in Morocco, over a period of 7 months. Clinical and biological manifestations of the digestive system were evaluated for all patients. The digestive symptomatology came in second place after the respiratory manifestations. 14 patients (38.89 % of symptomatic patients) in our study had digestive symptoms on admission: 12 (33.33%) presented with diarrhea, 4 (11.11%) had abdominal pain and only one child (2.78%) had vomiting. Aspartate aminotransferase (AST) was elevated in one patient, while alanine transaminase (ALT) was elevated in 6 patients. The prothrombin level was normal in all patients. All patients were discharged with good general condition without morbidity and mortality. This study concludes with the high prevalence of digestive manifestations of COVID-19 in symptomatic children. There were no severe clinical or biological abnormalities in our study. Digestive manifestations during COVID-19 in children are frequent, which requires the awareness of health professionals.

S1731 Improvements in Digestive Symptoms After Participation in a Digital Digestive Chronic Care Program

S1731 Improvements in Digestive Symptoms After Participation in a Digital Digestive Chronic Care Program

Assessment of Combined Administration of Hypoglycemic Agents and Herbal Extracts (&lt;i&gt;Pyeongwi-san&lt;/i&gt; or &lt;i&gt;HyangsaPyongwi-san&lt;/i&gt;) on Blood Glucose Levels in Type 2 Diabetes Mellitus: A Retrospective Study

Abstract: This retrospective study delved into the effects and safety considerations associated with the concomitant usage of hypoglycemic agents and herbal extracts, specifically &lt;i&gt;Pyeongwi-san&lt;/i&gt; (PWS) or &lt;i&gt;HyangsaPyongwi-san&lt;/i&gt; (HSPWS) in the context of type 2 diabetes mellitus management.Methods: The investigation involved 38 inpatients with type 2 diabetes mellitus who received PWS or HSPWS treatment at Kyung Hee University Korean Medical Hospital from January 2012 to December 2022. By investigating clinical attributes and conducting laboratory assessments, this study aimed to discern the impact of these herbal extracts on blood glucose levels, encompassing fasting blood sugar (FBS) and mean 2-hour postprandial glucose (PP2) levels. Furthermore, the safety profile of the herbal extracts was assessed by comparing liver function indicators, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ-glutamyl transferase (GGT), alongside kidney function markers, such as blood urea nitrogen (BUN) and creatinine (Cr).Results: Following the administration of the herbal extracts, no statistically significant alterations in FBS and mean PP2 levels emerged compared to the baseline levels. Notably, the safety evaluation revealed no significant differences in liver and kidney function parameters following herbal extract administration.Conclusion: The results of this research indicate that using PWS or HSPWS alongside hypoglycemic medications could be a beneficial additional method for addressing digestive symptoms in individuals with type 2 diabetes mellitus. Notably, this combination seems to have no negative interactions with other drugs.

B-102 Screening Food Allergies in Our Health Primary Care Area

Abstract Background Allergy is the immunological disease with the greatest impact in the world. Food allergy typically manifests with cutaneous, digestive and/or respiratory symptoms, of immediate onset, usually immunoglobulin E-mediated. Doctors from primary health-care providers are often challenged with these patients, becoming the first-line for the recognition and management of food allergies. As a laboratory, our duty is to provide the health care system with the most effective diagnostic tools. Methods We recollected all the results from Primary care of our health area analyzed in our laboratory for one year. Screening assay included a panel of specific IgE antibodies to the most common food allergens: egg yolk, egg white, milk, cod, wheat, peanut and soybean. They were detected semi-quantitatively by enzyme-labeled chemiluminescent immunoassay using the Immulite Allergy Food Panel FP5 kit (Siemens Diagnostic Products Corporation, Los Angeles, USA), according to the test procedure. If the assay was positive, all specific IgE allergens contained in the mixture were analyzed separately to determine their responsibility for the positive screening test. Results Our laboratory processed 24 125 samples from primary care patients. Of these, 1251 were positive (greater than 0.35 Ku/L), which represented 5.19% positive of the total analyzed. Once all the specific IgE allergens contained in the mixture were analyzed, the results were: 608 positive for egg yolk, 753 positive for egg white, 523 positive for milk, 109 positive for cod, 405 positive for wheat, 597 positive for peanut and 480 positive for soybean. Conclusion As with most medical disorders, a thorough medical history is the initial step in diagnosing adverse food reactions. The medical history is extremely useful, especially in acute reactions, but it can be unreliable in chronic disorders such as atopic dermatitis and asthma. In vitro assays help in the diagnosis, but they must be considered as a screening and no diagnosis tool, especially when no symptoms are associated with the positive food allergen result. That’s why in vitro results must be confirmed by prick test, which is considered gold standard for allergy diagnosis. In our study, egg white is the most prevalent allergen detected (60.19%), followed in order by egg yolk (48.60%), peanut (47.72%), milk (41.81%), soybean (38.37%), wheat (32.37%) and being cod the least allergen detected (8.71%).

The causal relationship between COVID-19 and seventeen common digestive diseases: a two-sample, multivariable Mendelian randomization study

ObjectivesIn clinical practice, digestive symptoms such as nausea, vomiting are frequently observed in COVID-19 patients. However, the causal relationship between COVID-19 and digestive diseases remains unclear.MethodsWe extracted single nucleotide polymorphisms associated with the severity of COVID-19 from summary data of genome-wide association studies. Summary statistics of common digestive diseases were primarily obtained from the UK Biobank study and the FinnGen study. Two-sample Mendelian randomization analyses were then conducted using the inverse variance-weighted (IVW), Mendelian randomization-Egger regression (MR Egger), weighted median estimation, weighted mode, and simple mode methods. IVW served as the primary analysis method, and Multivariable Mendelian randomization analysis was employed to explore the mediating effect of body mass index (BMI) and type 2 diabetes.ResultsMR analysis showed that a causal association between SARS-CoV-2 infection (OR = 1.09, 95% CI 1.01–1.18, P = 0.03), severe COVID-19 (OR = 1.02, 95% CI 1.00–1.04, P = 0.02), and COVID-19 hospitalization (OR = 1.04, 95% CI 1.01–1.06, P = 0.01) with gastroesophageal reflux disease (GERD). Mediation analysis indicated that body mass index (BMI) served as the primary mediating variable in the causal relationship between SARS-CoV-2 infection and GERD, with BMI mediating 36% (95% CI 20–53%) of the effect.ConclusionsWe found a causal relationship between SARS-CoV-2 infection and gastroesophageal reflux disease. Furthermore, we found that the causal relationship between SARS-CoV-2 infection and GERD is mainly mediated by BMI.

Effect of Rebamipide on the Intestinal Barrier, Gut Microbiota Structure and Function, and Symptom Severity Associated with Irritable Bowel Syndrome and Functional Dyspepsia Overlap: A Randomized Controlled Trial.

Treatment of functional digestive disorders is not always effective. Therefore, a search for new application points for potential drugs is perspective. Our aim is to evaluate the effect of rebamipide on symptom severity, intestinal barrier status, and intestinal microbiota composition and function in patients with diarrheal variant of irritable bowel syndrome overlapping with functional dyspepsia (D-IBSoFD). Sixty patients were randomized to receive trimebutine (TRI group), trimebutine + rebamipide (T + R group), or rebamipide (REB group) for 2 months. At the beginning and end of the study, patients were assessed for general health (SF-36), severity of digestive symptoms (Gastrointestinal Symptom Rating and 7 × 7 scales), state of the intestinal barrier, and composition (16S rRNA gene sequencing) and function (short-chain fatty acid fecal content) of the gut microbiota. The severity of most digestive symptoms was reduced in the REB and T + R groups to levels similar to that observed in the TRI group. The duodenal and sigmoidal lymphocytic and sigmoidal eosinophilic infiltration was decreased only in the REB and T + R groups, not in the TRI group. Serum zonulin levels were significantly decreased only in the REB group. A decrease in intraepithelial lymphocytic infiltration in the duodenum correlated with a decrease in the severity of rumbling and flatulence, while a decrease in infiltration within the sigmoid colon correlated with improved stool consistency and decreased severity of the sensation of incomplete bowel emptying. In conclusion, rebamipide improves the intestinal barrier condition and symptoms in D-IBSoFD. The rebamipide effects are not inferior to those of trimebutine.

Safety and efficacy of adding postbiotics in infant formula: a systematic review and meta-analysis.

Postbiotics, as emerging products, were added to infant formula, but their safety and efficacy are unclear. To clarify this issue, we wrote this meta-analysis. We searched PubMed, Embase, Web of Science and ProQuest from its establishment to February 2023. The review was registered on PROSPERO database (CRD42022352405). The effects of infant formula with and without postbiotics were compared, and the incidence of serious adverse events (SAEs), digestive symptoms, concentration of stool secretory immunoglobulin A (SIgA), and growth and development indexes were analyzed. Nine randomized controlled trials with 2065 participants were included. The addition of postbiotics to infant formula was found to increase the concentration of stool SIgA (P < 0.05) with very low certainty of evidence, without significantly impacting the incidence of SAEs, infantile colic, flatulence, diarrhea, vomiting, abdominal pain and gastrointestinal disorders, the daily weight gain, the total gain in body length and the daily head circumference gain (all P > 0.05). Adding postbiotics to the formula is safe for infants, which would not increase the incidence of SAEs, infantile colic, flatulence, diarrhea, vomiting, abdominal pain, and gastrointestinal disorders, and could increase the concentration of stool SIgA. IMPACT: Our study provides evidence that the addition of postbiotics to infant formula is safe but not effective. This is the first systematic review and meta-analysis of postbiotics. This study provides strong evidence for the safety of postbiotics and lays a foundation for related clinical trials.

The Intertwining Roads between Psychological Distress and Gut Microbiota in Inflammatory Bowel Disease.

Inflammatory bowel disease represents one of the most life-altering gastrointestinal pathologies, with its multifactorial nature and unclear physiopathology. The most relevant clinical forms, ulcerative colitis and Crohn's disease, clinically manifest with mild to severe flares and remission periods that alter the patient's social, familial and professional integration. The chronic inflammatory activity of the intestinal wall determines severe modifications of the local environment, such as dysbiosis, enteric endocrine, nervous and immune system disruptions and intestinal wall permeability changes. These features are part of the gastrointestinal ecosystem that modulates the bottom-to-top signaling to the central nervous system, leading to a neurobiologic imbalance and clinical affective and/or behavioral symptoms. The gut-brain link is a bidirectional pathway and psychological distress can also affect the central nervous system, which will alter the top-to-bottom regulation, leading to possible functional digestive symptoms and local inflammatory responses. In the middle of this neuro-gastrointestinal system, the microbiome is a key player, as its activities offer basic functional support for both relays. The present article presents current scientific information that links the pathophysiology and clinical aspects of inflammatory bowel disease and psychiatric symptomatology through the complex mechanism of the gut-brain axis and the modulatory effects of the gut microbiota.