Fecal Urgency Research Articles

S1725 Case Report: Prostate Cancer Diagnosed on Rectosigmoid Biopsies in a Patient Presenting With Diarrhea

INTRODUCTION: Prostate cancer is the second most commonly diagnosed cancer in men worldwide. Despite the anatomic proximity, rectosigmoid involvement of prostate adenocarcinoma is rare. We present a case of metastatic prostate cancer diagnosed on rectosigmoid biopsies in a patient presenting with diarrhea and fecal urgency. CASE DESCRIPTION/METHODS: A 76-year-old male presented to clinic for evaluation of non-bloody diarrhea with associated fecal urgency. His medical history was significant for prostate adenocarcinoma diagnosed and treated nine years ago with prostatectomy, radiation, and androgen deprivation therapy (ADT). On current presentation, labs showed a normal complete blood cell count, TSH, and tissue transglutaminase IgA. Stool studies were negative for gastrointestinal pathogens. A colonoscopy was performed which demonstrated a normal terminal ileum, sigmoid diverticulosis, and mild radiation proctitis. Random colon biopsies showed changes consistent with collagenous colitis. Treatment for collagenous colitis was initiated, however, three months later the patient continued to have diarrhea as well as new onset abdominal pain, nausea, vomiting, and weight loss. Imaging showed sigmoid colon wall thickening, an ill-defined soft tissue mass in the pelvis, and lymphadenopathy. Flexible sigmoidoscopy revealed congested and erythematous mucosa beginning at 10cm from the anal verge with multiple clean based ulcerations. Targeted biopsies revealed a population of keratin positive cells with limited differentiation and positive PSA staining consistent with poorly differentiated adenocarcinoma of prostate origin, likely from lymphangitic spread. The patient was diagnosed with metastatic castrate-resistant prostate adenocarcinoma and started on ADT. DISCUSSION: Rectosigmoid involvement by prostate adenocarcinoma is rare and review of available literature suggests at least three potential routes of involvement including direct invasion through Denonvilliers’ fascia, lymphatic metastasis, and implantation after transrectal biopsy. Rectosigmoid involvement of prostate adenocarcinoma may present with symptoms including change in bowel habits, rectal urgency, lower gastrointestinal bleeding, and pelvic pain. The case presented here emphasizes the importance of including prostate adenocarcinoma on the differential diagnosis in men presenting with lower gastrointestinal symptoms and abnormal rectosigmoid mucosa on colonoscopy, especially in patients older than 65 years or with a history of prostate adenocarcinoma.Figure 1.: Congested and erythematous mucosa starting approximately 10 cm from the anal verge.Figure 2.: Rectosigmoid ulcerations with surrounding erythematous mucosa.Figure 3.: Ill-defined soft tissue mass in the peri-rectal region with lymphadenopathy.

S2243 Reversal Obstructive Lung Disease in Ulcerative Colitis: A Rare Extraintestinal Manifestation

INTRODUCTION: Ulcerative colitis (UC) is associated with several extraintestinal manifestations that may affect various organ systems, lungs involvement are relatively rare. Our case highlights a patient presenting with symptoms of reversible obstructive airway disease associated with UC disease activity. CASE DESCRIPTION/METHODS: A 23 YO male with history of Ulcerative pancolitis presented to Virginia Commonwealth University (VCU)-IBD Center with unresolving cough, wheezing, diarrhea, fecal urgency and abdominal pain. Physical exam was notable for moderate abdominal tenderness and minimal lung wheeze. Lab data reveled elevated CRP of 14 mg/dL and fecal calprotectin of 1285 µg/gm. CT abdomen/pelvis revealed active inflammation with diffuse colonic wall thickening. UC Treated initially with Mesalamine after diagnosis at age of 22 YO, combination therapy with Adalimumab and Methotrexate started few weeks prior to presentation.Pulmonary symptoms were manifested in cough and wheezing. These symptoms were exacerbated with worsening UC activity and more responsive to steroids courses. CT chest was negative for interstitial lung disease. Prior pulmonary function test (PFT) showed mild obstructive airway disease requiring albuterol and corticosteroids inhalers. He was found to have infectious colitis causing UC flare. GI and pulmonary symptoms improved with therapy optimization, steroids and methotrexate were stopped. Clinical remission were maintained with Adalimumab monotherapy. He remained off respiratory inhalers. Subsequent PFT with improved lung volumes and function. DISCUSSION: The prevalence and pathogenesis of lung involvement in IBD is poorly understood but it may be related to the underlying inflammatory process. Respiratory manifestations of ulcerative colitis are rare, they can be broadly categorized into airway disease and interstitial lung disease. These manifestations usually follow the IBD disease activity and often exacerbate during relapses. Patients with airway disease can have significant airway inflammation, which could potentially lead to airway narrowing. The most common presenting symptoms include cough and wheezing. Chest radiographs are often non-specific and pulmonary function testing may reveal obstruction pattern. CT scan of the chest may not show remarkable findings.This case report highlights that it is imperative to maintain a high index of suspicion for the development of pulmonary disease in the setting of IBD in order to institute appropriate treatment early and avoid complications.

S1675 Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Presenting as Chronic Diarrhea: An Unusual Presentation of a Common Lymphoproliferative Disorder

INTRODUCTION: B-cell chronic lymphocytic leukemia (CLL) is the most common form of leukemia in the United States. It has a variable presentation with most patients having asymptomatic lymphocytosis. CLL can present with extramedullary involvement. Most commonly this is in the form of skin or central nervous system involvement, though rarely it can present with gastrointestinal involvement. CASE DESCRIPTION/METHODS: We are highlighting a case of a 70-year-old male who presented with complaints of diarrhea for the last 4 months. He was having 4–5 bowel movement a day ranging from semi-solid to watery stools. He denied any history of fevers, abdominal pain, vomiting, weight loss, night sweats, skin rashes, travel history, or exposure to anyone with similar symptoms. On physical examination, his abdomen was soft, non-tender, and without apparent hepatomegaly or splenomegaly. The rest of the system examinations were unremarkable. The initial laboratory evaluation was unremarkable. After failing conservative treatment, a colonoscopy was performed which showed diffuse mucosal nodularities (Image 1 and 2). Histopathology of the biopsied tissue revealed multiple aggregates for small mature lymphocytes in the submucosa (Image 3). Immunohistochemical staining revealed a diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma. CT scan revealed extensive bilateral axillary, hilar, abdominal, and pelvic lymphadenopathy. He subsequently underwent bone marrow biopsy histopathology and flow cytometric immunophenotyping which were consistent with CLL. Oncology started him on chemotherapy and he went into remission from his CLL. On 3- and 6-month follow-ups, the patient was asymptomatic. DISCUSSION: A review of the literature revealed a total of n = 4 prior reported cases where the initial presentation of CLL/SLL was diarrhea. In the existing case reports with similar presentation a mean age of presentation was n = 74 years, ages ranging from 65 to 81 years. They had fecal urgency, abdominal pain, and weight loss as associated symptoms. Only one patient had history of CLL for which he had undergone treatment and was thought to be in remission. Imaging with CT with contrast in all cases revealed abdominal and pelvic lymphadenopathy. Histopathology of the colonic biopsy in all cases revealed lymphocytic infiltration. This patient was treated successfully with chemotherapy and his diarrhea improved. This is a differential to keep in mind in patients with chronic diarrhea, once the more common causes have been ruled out.Figure 1.: Image 1: Colonoscopy showing submucosal nodularity.Figure 2.: Image 2: Colonoscopy showing submucosal nodularity.Figure 3.: Image 3: Hematoxylin and eosin stain showing lymphoid aggregate with normal colon mucosa.

S2262 A Rare Manifestation of Cryptogenic Organizing Pneumonia in a Patient With Ulcerative Colitis Being Treated With an Anti-TNF Biosimilar

INTRODUCTION: Ulcerative colitis (UC) is an inflammatory bowel disorder (IBD) resulting in continuous mucosal inflammation from the rectum with variable extension to the proximal colon. Symptoms can include abdominal pain, hematochezia, or tenesmus. Anti-tumor necrosis factor (anti-TNF) therapy has been recognized as a treatment modality for moderate to severe UC. Extraintestinal manifestations of IBD have been well documented, with pulmonary manifestations being an uncommon presentation. One such manifestation is cryptogenic organizing pneumonia (COP). The most common finding is diffuse ground glass opacities and bilateral infiltrates on CT. In addition, COP has been described as a noninfectious complication associated with anti-TNF therapy. Here we present a case of COP in a patient being treated with an anti-TNF biosimilar for moderate to severe UC. CASE DESCRIPTION/METHODS: A 38 year-old female with left-sided UC presented to the hospital complaining of 2 weeks of progressively worsening shortness of breath. She had been on Inflectra and mesalamine for 2 years without complications. A chest CT revealed bilateral infiltrates concerning for organizing pneumonia. Bronchoscopy with bronchoalveolar lavage (BAL) was negative for fungal, pneumocystis jirovecii, bacterial, or viral etiologies. The patient was eventually discharged, however, she still required supplemental oxygen. She was started on prednisone and Bactrim for pneumocystis pneumonia prophylaxis. She was referred to gastroenterology for a concern of a possible association between Inflectra and COP. Mesalamine and Inflectra were stopped and the patient developed fecal urgency and rectal bleeding. The patient was started on vedolizumab and prednisone with an eventual prednisone taper, in addition to levalbuterol for her ongoing dyspnea. After two months of vedolizumab therapy, the patient noted significant improvement in her gastrointestinal symptoms as well as her pulmonary symptoms. DISCUSSION: There have been case reports detailing COP in patients undergoing therapy with Infliximab, however, this is the first known case of COP with a biosimilar. The improvement in pulmonary symptoms with discontinuing Inflectra, which was controlling her UC, and starting vedolizumab to continue control of the UC with subsequent improvement in her COP suggests the biosimilar, Inflectra, as opposed to an extra intestinal manifestation of UC, was the cause of COP.

Patients’ preferences for sphincter preservation versus abdominoperineal resection for low rectal cancer

BackgroundSurgery for low rectal cancer can be associated with severe bowel dysfunction and impaired quality of life. It is important to determine how patients value the trade-off between anorectal dysfunction versus abdominoperineal resection. Therefore, the objective was to determine patients’ preferences for treatment for low rectal cancer. MethodsAmbulatory patients without colorectal cancer at a single high-volume academic colorectal referral center from September 2019 to March 2020 were included. Patients with prior stoma or malignancy were excluded. Participants were presented with a hypothetic scenario describing a low rectal cancer. A threshold task identified preferences for functional and oncologic outcomes for sphincter preservation versus abdominoperineal resection. ResultsA total of 123 patients were recruited. Patients preferred abdominoperineal resection over sphincter preservation if there were more than a mean of 6.7 (standard deviation 4.0) daily bowel movements, 1.9 (standard deviation 2.6) daily episodes of stool incontinence, and 6.5 (standard deviation 3.2) gas incontinence. Abdominoperineal resection was preferred over sphincter preservation in 38% if daily activities were altered owing to fecal urgency. Patients were willing to accept a 10% (interquartile range, 5−25) absolute increase in risk of margin involvement with sphincter preservation to avoid abdominoperineal resection. Abdominoperineal resection was the preferred option overall for 18% of patients. ConclusionAn important proportion of patients would prefer abdominoperineal resection over sphincter preservation owing to the impairments in anorectal function associated with sphincter preservation. The decision to perform sphincter preservation or abdominoperineal resection should consider how the patients’ value functional outcomes with a low anastomosis.

Comparision of Efficacy and Safety of Orlistat vs Placebo in Obese Patients in Pakistan.

IntroductionObesity has become a rising health concern in Pakistan. Several primary measures, such as dietary restrictions and regular exercise, are taken to limit the severe consequences of obesity. Still, such measures alone have been proven to be often short term and therefore, inadequate. In this study, we will evaluate the role of pharmacological management via orlistat in obesity.Methods and MaterialsA total of 120 patients were enrolled in this study and were divided randomly into two groups (drug arm and placebo arm) of 60 patients each. A standard dose of 120 mg capsules of orlistat given three times a day was administered to the participants of the drug arm group. A placebo was given to the participants in the second group. Baseline investigations were conducted on day 0 of the study, and follow-up visits were planned to take place in week 24 for all participants. Any side effects or adverse events were inquired about and documented in these visits.ResultsIn the orlistat arm, we noted a significant reduction in both body mass index (BMI) (0.04) and waist circumference (0.04). Reduction in weight was more in the orlistat arm than in the placebo arm. However, it is non-significant when compared between day 0 and week 24. Adverse events, such as oily spotting (31.91%), flatus with discharge (27.65%), faecal urgency (25.53%) and fatty stool (35.553%), were significantly higher in the orlistat arm.ConclusionOrlistat has shown positive results in reducing weight, BMI and waist circumference; however, patients should be counselled about potential side effects caused by the mechanism of action of Orlistat.

Gastrointestinal consequences of cancer treatment: evaluation of 10 years’ experience at a tertiary UK centre

ObjectiveUp to 90% of patients treated for pelvic cancers experience chronic gastrointestinal (GI) symptoms. This study characterises this patient cohort at a single centre, addressing a paucity of publications reporting...

Anal incontinence and unrecognized anal sphincter injuries after vaginal delivery\u2013 a cross-sectional study in Norway

BackgroundAim of the study was to estimate the prevalence of postpartum anal incontinence among women who delivered vaginally, and to assess the extent to which obstetric injuries to the anal sphincters are missed.MethodsAll women (both primiparous and multiparous) who delivered vaginally and received any kind of sutures in the perineal area at Innlandet Hospital Trust Elverum in Norway between January 1, 2015 and June 30, 2016 were invited to answer a questionnaire on St. Mark’s incontinence score and to participate in a clinical examination of the pelvic floor including endoanal sonography.ResultsIn total 52,3% (n = 207) of the 396 invited women participated in the study. Mean St. Mark’s score was 1.8 points (95% CI 1.4 to 2.1) at examination 14 months (mean) postpartum, and none of the participants suffered from weekly fecal leakage. Fecal urgency affected 11.7% (95% CI 7.1 to 16.3) of the participants, and 8.7% (95%CI 5.1 to 12.8) had weekly involuntary leakage of flatus. Nine women (9.3%, 95% CI 4.1 to 15.5) had a previously undetected third degree obstetric anal sphincter injury.ConclusionThe prevalence of anal incontinence among women who have delivered vaginally and received sutures due to 1st and 2nd degree perineal lacerations is low. Some obstetric anal sphincter injuries remain unrecognized at the time of delivery, but the symptoms of anal incontinence due to these injuries are in the lower half of the St. Mark’s incontinence score. Women with persistent symptoms like fecal urgency or leakage of gas and/or feces should be referred to evaluation by a colorectal surgeon in order to achieve optimal treatment.

Clinical nursing management of low anterior resection syndrome – a practical guide to understanding and managing symptoms

Low anterior resection with total mesorectal excision and reconstruction with coloanal anastomosis is the optimal treatment of nondisseminated rectal cancer in selected patients and has seen a decrease in permanent stomas. However, up to 60% of patients can suffer from bothersome functional bowel complaints associated with the surgery and neo-adjuvant and adjuvant therapies, which are known as low anterior resection syndrome (LARS). LARS symptoms include faecal urgency, incontinence, frequency, constipation and incomplete emptying, in which patients may suffer from one or multiple symptoms. Patients should be informed about the possibility of permanent changes to their bowel function and what impact it could have on their quality of life. Nursing involvement is key to optimising symptoms and patient quality of life for patients suffering with LARS. Nursing management includes performing a physical assessment and determining the severity of LARS symptoms and effect on quality of life. Treatments available for LARS are based around the symptoms the patient is suffering and can include dietary modifications; biofeedback and pelvic floor physiotherapy; dietary fibre supplements / bulking agents; medications; transanal irrigation; surgical options and education.

Fecal Urgency: Clinical and Manometric Characteristics in Patients With and Without Diarrhea.

Fecal urgency is classically associated with diarrhea, but is also common in individuals with normal bowel habits or constipation. Its etiology, particularly in non-diarrhea individuals, is unclear. We examined data from 368 individuals with and without diarrhea who underwent three-dimensional high-resolution anorectal manometry and balloon expulsion test. All patients completed the Rome III constipation module and the pelvic floor distress inventory (PDFI-20) survey. Patients were considered to have fecal urgency if they reported being bothered "moderately" or "quite a bit" by it in the past 3months. A total of 103 patients (28.0%) met our definition of fecal urgency. These patients were significantly more likely to meet criteria for irritable bowel syndrome and to report fecal incontinence, urinary incontinence, and diarrhea. Fecal urgency was associated with rectal hypersensitivity in those with diarrhea, but not in those without diarrhea. Fecal urgency was associated with urinary urge incontinence in those without diarrhea, but not those with diarrhea. In patients with diarrhea, fecal urgency is associated with rectal hypersensitivity, whereas in patients without diarrhea, fecal urgency is associated with urinary urge incontinence. This suggests that fecal urgency has different pathophysiological mechanisms in patients with different underlying bowel habits.

Treatment of traveler's diarrhea - clinical review

Travelers’ diarrhea is defined as the passage of three or more unformed stools per 24 hours plus at least one additional symptom such as nausea, vomiting, abdominal cramps, fever, blood/mucus in the stools, or fecal urgency that develop while abroad or within 14 days of returning from any resource-limited destinations.The aim of this study was to show the methods of treatment of traveler's diarrhea. Our study material consisted of publications, which were found in PubMed, ResearchGate and Google Scholar databases. In order to find the proper publications, the search has been conducted with the use of a combination of key words like: '' traveler's diarrhea,'', ''travel'', ''diarrhea'', ''antibiotic". The first step was to find proper publications from the last 30 years .The second step was to carry out an overview of the found publications.Major goals of treatment of the traveler's diarrhea are: to maintain optimal hydration level, to reduce the severity and duration of diarrhea and to eradicate pathogenic agents responsible for causing this disease. The choice of the best possible method of tretament of traveler's diarrhea depends on the patient's general condition, his medical history, severity and duration of diarrhea and the pathogenic agent that causes this disease.

Prevention of acute radiation-induced Proctitis by Aloe vera: a prospective randomized, double-blind, placebo controlled clinical trial in Pelvic Cancer patients

BackgroundAcute radiation-induced proctitis (ARP) is the most common side effect following radiotherapy for malignant pelvic disease. This study evaluated the efficacy of Aloe vera ointment in prevention of ARP.MethodsForty-two patients receiving external-beam radiotherapy (RT) for pelvic malignancies were randomized to receive either Aloe vera 3% or placebo topical ointment during radiotherapy for 6 weeks. These patients were evaluated based on the severity (grade 0–4) of the following symptoms weekly: rectal bleeding, abdominal/rectal pain, diarrhea, or fecal urgency. RTOG acute toxicity criteria and psychosocial status of the patients were also recorded weekly. Lifestyle impact of the symptoms, and quantitative measurement of C-reactive protein (CRP), an indicator of systemic inflammation, were also measured.ResultsThe results of present study demonstrated a significant preventive effect for Aloe vera in occurrence of symptom index for diarrhea (p < 0.001), rectal bleeding (p < 0.001), and fecal urgency (p = 0.001). The median lifestyle score improved significantly with Aloe vera during RT (p < 0.001). Intervention patients had a significant lower burden of systemic inflammation as the values for quantitative CRP decreased significantly over 6 weeks of follow-up (p = 0.009).ConclusionThis study showed that Aloe vera topical ointment was effective in prevention of symptoms of ARP in patients undergoing RT for pelvic cancers.Trial registrationIRCT201606042027N6. Registration date: 2016-09-04.

Promising new technique for treatment of hemorrhoids- Our experience

Background: Stapled Hemorrhoidopexy (SH) is a new technique with less pain than conventional hemorrhoidectomy and can be used in the management of second, third and fourth degree hemorrhoidal disease.&#x0D; Objective: To show the effectiveness of Stapled Hemorrhoidopexy as a treatment option of symptomatic hemorrhoid.&#x0D; Methods: This is an observational study. The medical records of 72 patients who had under gone Stapled Hemorrhoidopexy for symptomatic hemorrhoid disease from July 2011 to June 2013 in BIRDEM General Hospital under a same surgeon were evaluated. Data regarding postoperative pain, early and late postoperative outcome were recorded. Patient's satisfaction assessed at 18 months follow up.&#x0D; Results: The study included 72 patients (50 men, 22 women) between 22 - 74 years of age (median age 39 years). The operating time was around 35 minutes. The median hospital stay was 40 hours (11- 72 hours). Early complications were fecal urgency (13.8%), urinary retention (22%), and rectal bleeding (2.77%). Late complication was pruritus ani (12.5%), thrombosis external hemorrhoids (1.38%), staple line stenosis (1.38%), recurrent hemorrhoid (2.77%), anal fissure (2.77%), and persistent mucous discharge (5.55%). The recurrence rate was 2.77% at 18 months follow up.&#x0D; Conclusion: Stapled hemorrhoidopexy can be safely performed with low recurrence and complication rates while offering a relatively painless postoperative period for the patient.&#x0D; Journal of Surgical Sciences (2017) Vol. 21 (2): 65-69

PREDICtors for health-related quality of life after elective sigmoidectomy for DIVerticular disease: the PREDIC-DIV study protocol of a prospective multicentric transnational observational study

IntroductionDiverticulitis is among the most common abdominal disorders. The best treatment strategy for this complicated disease as well as for recurrent stages is still under debate. Moreover, little knowledge exists...

Complications of stapled hemorrhoidectomy

Background: Stapled hemorrhoidectomy (SH), a new approach to the treatment of hemorrhoids, removes a circumferential strip of mucosa about four centimeters above the dentate line. Immediate complications (first week) were: severe pain in all patients, bleeding, thrombosis, urinary retention, anastomotic Dehiscence, fissurePerineal intramural hematoma, and submucosal abscess The most common complication after 1 week was recurrence of hemorrhoids in of patients, severe pain, stenosis, fissure, bleeding, skin tag, thrombosis, papillary hypertrophy, fecal urgency, staples problems, gas flatus and fecal incontinence, intramural abscess, partial dehiscence, mucosal septum, and intussusceptions. The most common complication in the first 25 cases of the surgeon’s experience was the pain. Even though SH and banding are necessary before recommending the procedure. It was a prospective and retrograde study conducted in R.D. Gardi Medical College, Ujjain. Study Duration was from November 2017 to November 2019. All the patients who were post-op (stapled hemorrhoidectomy) case of hemorrhoid disease. The total number of patients operated with stapled hemorrhoidectomy in the 2 years period (2017-2019) was 400.

P127 FACTORS ASSOCIATED WITH FECAL URGENCY IN INFLAMMATORY BOWEL DISEASE PATIENTS: A CROSS-SECTIONAL STUDY FROM SPARC IBD

Abstract Background Fecal urgency among patients with inflammatory bowel disease (IBD) can lead to psychological, functional, and social distress. Factors associated with urgency remain poorly understood. Objective To examine the association between urgency and fecal calprotectin concentration, rectal bleeding, stool frequency, perianal disease, rectal involvement, and disease duration. Methods The results are based on data obtained from the IBD Plexus program of the Crohn’s &amp; Colitis Foundation. This cross-sectional study used data from Study of a Prospective Adult Research Cohort with IBD (SPARC IBD), a multicenter longitudinal study. We included patients with an urgency score at their first study visit. Urgency was rated on a 5-point Likert scale from no to severe urgency. The Kruskal-Wallis test was used to compare fecal calprotectin levels across fecal urgency scores. Logistic regression models were used to evaluate the association of fecal urgency with the amount of rectal bleeding, stool frequency, perianal disease (for Crohn’s disease (CD)), disease involving the rectum (for CD), disease duration, while adjusting for age and gender in each model. Results 2289 patients were included (54% female, 67% CD, mean age 43). The fecal calprotectin concentration was significantly associated with fecal urgency scores (P-value= 0.01). In adjusted models of the overall population, CD vs UC was not associated with urgency (odds ratio [OR] 0.89; 95% confidence interval [CI] 0.70–1.13). Fecal urgency was associated with stool frequency (&amp;gt; 4 stools more than normal, OR 2.49; 95% CI 1.46–4.25) but not amount of bleeding. Among patients with CD, perianal disease (OR, 3.40; 95% CI, 1.18–9.79) was associated with fecal urgency. Conclusion In this study of patients in SPARC IBD, factors associated with fecal urgency were fecal calprotectin levels, stool frequency, and perianal disease.

P026 TOP GOALS AND CONCERNS REPORTED BY INDIVIDUALS WITH INFLAMMATORY BOWEL DISEASE AT OUTPATIENT GASTROENTEROLOGY CLINIC VISITS

Abstract Background The goals of managing inflammatory bowel disease (IBD) include eliminating disease symptoms, improving quality of life, and preventing disease progression/complications. In patients with chronic illnesses, their perception of the illness, emotional reactions, and concerns about the disease/treatment can influence self-management behaviors and their quality of life.[1] Studies of IBD patients’ self-reported disease concerns and subjective perceptions of quality of life are lacking. Here, we aim to understand IBD patients’ top concerns and goals using survey data collected within IBD Qorus, a nationwide Learning Health System for IBD with approximately 40 participating sites. Methods We conducted a qualitative content analysis on an open-ended question that was sent to IBD patients prior to their clinic visits with an IBD Qorus provider: “Currently, what is your number ONE concern or goal related to your IBD? This could be related to a specific symptom (e.g., diarrhea), worry for the future (e.g., need for surgery, cost of care) or how IBD might impact an upcoming life event (e.g., wedding, travel). Or you can report that you have no current concerns or goals.” Using the inductive approach, two independent researchers (who are not involved with direct clinical care of IBD Qorus patients) coded the responses into major and minor themes, which were then discussed with a third independent coder (an IBD Qorus provider). Each response received one or more codes (if multiple themes were mentioned). Results In the first 100 responses from a purposeful sample of six IBD Qorus sites (3 academic and 3 community sites in diverse rural and urban geographic locations), four domains of goals/concerns were identified: symptoms and goals for the symptoms (28/100), medication and their efficacy/side effects (28/100), IBD clinical course and management (29/100), and psychosocial effects of IBD (29/100) (Figure 1). The most common themes in each domain were: abdominal pain and fecal urgency (symptoms), biologics and side effects (medications), surgery and nutrition (IBD clinical course and management), and fear/worry and traveling (psychosocial effects) (Figure 1). Fives responses contained no concerns/goals and three were uncodeable. Conclusion IBD patients’ disease-related concerns and goals are broad and diverse, and our study suggests that they are evenly distributed between symptoms, medications, disease course, and psychosocial effects. Understanding patients’ perceptions about the disease and the types of information they desire can aid providers to create and achieve shared treatment goals. Reference

Efficacy of sucralfate ointment in the prevention of acute proctitis in cancer patients: A randomized controlled clinical trial.

Background:Acute radiation proctitis (ARP) is a usual adverse effect in patients undergoing pelvic radiotherapy. The symptoms include diarrhea, rectal blood or mucus discharge, fecal urgency and tenesmus with pain. Sucralfate, an aluminum-based salt of sucrose octasulfate, is a cytoprotective agent that forms a coating barrier at injured sites by adhering to mucoproteins. It has been used in topical management of a wide variety of local lesion. This study was designed to evaluate the preventive effect of rectal sucralfate on acute radiotherapy induced proctitis.Methods:Seven percent sucralfate ointment was prepared for topical use. Drug quantification, chemical stability and microbial limit tests were performed carefully. In this randomized double blind placebo controlled trial, fifty-seven patients with pelvic malignancies undergoing radiotherapy were allocated to receive either 1 g of sucralfate or 1 g of placebo, given as a twice daily ointment, one day before and during radiotherapy for six weeks. The eligible patients were evaluated based on RTOG acute toxicity criteria and the following ARP symptoms weekly: rectal hemorrhage, diarrhea, rectal pain, and fecal urgency. The influence of symptoms on lifestyle was also recorded weekly.Results:Acute proctitis was significantly less prevalent in patients in the sucralfate group. The incidence of rectal bleeding (P=0.003), diarrhea (P=0.002), rectal pain (P=<0.001) and fecal urgency (P=0.002) was significantly less common in the sucralfate group. No statistical significant difference was observed for radiotherapy induced cystitis in the placebo and sucralfate groups (P=0.27).Conclusion:This study suggests that sucralfate7% ointment reduces the incidence of symptoms associated with acute radiation proctitis.

Comparison of the impact of bovine milk β-casein variants on digestive comfort in females self-reporting dairy intolerance: a randomized controlled trial

Lactose malabsorption (LM) is a major cause of digestive discomfort from dairy products. Recently, a role for bovine β-casein A1 has been proposed. We examined whether there are distinct symptoms of digestive discomfort due to either lactose or differing bovine β-casein types. Women (n=40; age: 25.2 ± 0.5 y) with self-reported varying dairy tolerance underwent a 50-g lactose challenge. Based on postchallenge LM and digestive discomfort, participants were classified as either lactose intolerant (LI; n=10, self-reported intolerant, diagnosed lactose intolerant), nonlactose dairy intolerant (NLDI; n=20, self-reported intolerant, diagnosed lactose tolerant), or dairy tolerant (DT; n=10, self-reported tolerant, diagnosed lactose tolerant). In a double-blinded randomized sequence, participants consumed 750 mL conventional milk (CON; containing A1 and A2 β-casein and lactose), a2 Milk (A2M; exclusively containing A2 β-casein with lactose), or lactose-free conventional milk (LF-CON; containing A1 and A2 β-casein without lactose). Subjective digestive symptoms and breath hydrogen (measuring LM) were recorded regularly over 3 h, and further ad hoc digestive symptoms over 12h. LI subjects experienced prolonged digestive discomfort with CON milk. A2M reduced (P<0.05) some symptoms (nausea: A2M 8 ± 3 mm compared with CON 15 ± 3mm; fecal urgency: A2M 4 ± 1 compared with CON 10 ± 3 mm), and attenuated the rise in breath hydrogen over 3 h, relative to CON milk (A2M 59 ± 23 compared with CON 98 ± 25 ppm at 150 min; P<0.01). In contrast, NLDI subjects experienced rapid-onset, transient symptoms (abdominal distension, bloating, and flatulence) without increased breath hydrogen, irrespective of milk type. In LI individuals, LM and digestive comfort with lactose-containing milks was improved with milk containing exclusively A2 β-casein. Furthermore, self-reported dairy intolerance without LM (NLDI) is characterized by early-onset digestive discomfort following milk ingestion, irrespective of lactose content or β-casein type. This trial was registered at www.anzctr.org.au as ACTRN12616001694404.

Prevalencija sindroma niske prednje resekcije kod bolesnika sa karcinomom rektuma koji su bili podvrgnuti hirurškom lečenju u Gradskoj bolnici Isfahan tokom 2012-2018

Objective. We aimed to determine the relative frequency of low anterior resection syndrome (LARS) in patients with rectal cancers who underwent surgical treatment in Isfahan. Methods. We evaluated all patients who were referred to the surgery clinic of Saint Al-Zahra hospital in Isfahan within six years. If LARS was identified, according to the LARS score tool, the frequency of resection complications, factors affecting the LARS, morbidity, and mortality, the frequency distribution of defecation, stool consistency, and rate of significant improvement was evaluated. Results. Fifty-two patients were evaluated. The prevalence of LARS was 78.8%. Postoperative fecal and gas incontinence, clustering, fecal frequency, and fecal urgency in LARS patients were significantly higher than in patients without LARS (P&lt;0.05). There was no significant difference between the two groups in terms of factors affecting the LARS (p&lt;0.05). In most of the patients with LARS, the defecation frequency was more than seven times a week (82.1%), and they mostly had liquid stool (61.5%). 95.5% of the patients with LARS showed significant improvement, which was mostly after 7-11 months (38.5). There was a significant difference between the frequency distribution of defecation, stool consistency, and significant improvement status in patients with and without LARS. Conclusion. LARS occurs commonly among patients undergoing LAR with TME and it is associated with more resection complications. Patients with LARS have significantly higher frequency of defecation per week and liquid stools and mostly achieve significant improvements. Other factors might not be significantly different between patients with or without LARS.