Food Intolerance Research Articles

The factor structure and validity of a diagnostic interview for avoidant/restrictive food intake disorder in a sample of children, adolescents, and young adults.

There is a paucity of validated diagnostic interviews for avoidant/restrictive food intake disorder (ARFID) to aid identification and classification of cases for both clinical and research purposes. To evaluate the factor structure, construct validity, and criterion validity of the Pica ARFID and Rumination Disorder Interview (PARDI; ARFID module), we administered the PARDI to 129 children and adolescents ages 9-23 years (M=16.1) with ARFID (n=84), subclinical ARFID (n=11), and healthy controls (n=34). We used exploratory factor analysis to examine the factor structure of the PARDI in children, adolescents, and young adults with an ARFID diagnosis, the Kruskal-Wallis analysis of variance and Spearman correlations to test the construct validity of the measure, and non-parametric receiver operating characteristic curves to evaluate the criterion validity of the PARDI. Exploratory factor analysis yielded a 3-factor structure: (1) concern about aversive consequences of eating, (2) low appetite/low interest in food, and (3) sensory sensitivity. Participants with ARFID demonstrated significantly higher levels of sensory sensitivity, low appetite/low-food interest, and concern about aversive consequences of eating symptoms relative to control participants. The construct validity for each PARDI subscale was supported and clinical cutoffs for the low appetite/low interest in food (1.1) and sensory sensitivity subscales (0.6) were established. These data present evidence for the factor structure and validity of the PARDI diagnostic interview for diagnosing ARFID in children, adolescents, and young adults, supporting the use of this tool to facilitate ARFID clinical assessment and research. Due to the paucity of validated diagnostic interviews for avoidant/restrictive food intake disorder (ARFID), we evaluated the factor structure and validity of the Pica ARFID and Rumination Disorder Interview (ARFID module). Findings suggest that the interview assesses 3 components of ARFID: concern about aversive consequences of eating, low-appetite, and sensory sensitivity, and that clinical threshold scores on the latter two subscales can be used to advance ARFID assessment.

Life-threatening gastrointestinal bleeding caused by jejunal heterotopic gastric mucosa in an adult dog: a rare case report

BackgroundHeterotopic gastric mucosa has been scarcely reported in the veterinary literature. Its presence can be asymptomatic or associated with various clinical signs ranging from apathy, vomiting, to abdominal pain. This report illustrates the presence of heterotopic gastric mucosa in the jejunum of an adult dog. It is the first to describe severe anemia, requiring acute blood transfusion, following intestinal hemorrhage caused by heterotopic gastric mucosa.Case presentationA twelve-year-old, intact male Maltese dog was presented with a history of apathy, vomiting and anemia. The dog was on a strict diet for recurrent diarrhea, food intolerance and skin allergy. Clinical examination revealed severe anemic mucous membranes and painful abdominal palpation. Blood examination confirmed severe regenerative anemia. Ultrasonography showed an intestinal neoplasm, gall bladder sludge and non-homogeneous liver parenchyma. Three-view thoracic radiographs failed to show any metastatic lesions or enlarged lymph nodes. After initial stabilization and blood transfusion, a midline exploratory laparotomy was performed. Three different masses were found in the jejunum. Resection and anastomosis of approximately 40 cm of jejunum was performed, followed by liver and lymph node biopsy and placement of an esophagostomy tube. Two days after surgery the dog started to clinically improve and was discharged from the hospital on the sixth day after surgery. Histopathology revealed the intestinal masses to be heterotopic gastric mucosa associated with intramural cystic distensions, multifocal ulceration and bleeding into the intestinal lumen. Two years after surgery, the dog did not have a recurrence of anemia or gastrointestinal signs.ConclusionsThis case demonstrates that heterotopic gastric mucosa can be considered one of the differential diagnoses in case of severe anemia due to gastrointestinal hemorrhage and suspected intestinal tumors. Although in most described cases in literature the finding seems to be incidental on necropsy, our report shows that heterotopic gastric mucosa can be the etiology of life-threatening signs. In addition, because no recurrent diarrhea episodes occurred after surgical resection of the ectopic tissue, it is likely that the heterotopic gastric mucosa was the cause of the food intolerance signs in this dog.

Risk factors for food sensitization in children with atopic dermatitis: a single-center cross-sectional study.

To study the risk factors for food sensitization and the influence of food sensitization on quality of life and clinical signs in children with atopic dermatitis (AD). A retrospective analysis was performed on the medical data of 241 children with AD, including demographic features, age of onset, severity of AD, quality of life, physical examination results, skin prick test (SPT) results, serum total IgE levels, and eosinophil count. According to the results of SPT, the children were divided into a food sensitization group (n=127) and a non-food sensitization group (n=114). The multivariate logistic regression analysis was used to identify the risk factors for food sensitization in children with AD. The prevalence rate of food sensitization was 52.7% (127/241) in the children with AD. The multivariate logistic regression analysis showed that birth in autumn or winter, age of onset of AD<12 months, severe AD, and total IgE>150 IU/mL were risk factors for food sensitization (P<0.05). Compared with the non-food sensitization group, the food sensitization group had a significantly poorer quality of life (P=0.008) and significantly higher prevalence rates of non-specific hand/foot dermatitis and palmar hyperlinearity (P<0.05). Compared with the single food sensitization group, the multiple food sensitization group had more severe AD and a significantly higher proportion of children with exclusive breastfeeding or total IgE>150 IU/mL (P<0.05). The AD children born in autumn or winter, or those with early onset (<12 months), severe AD or total IgE>150 IU/mL have a higher risk of food sensitization. The AD children with food sensitization have a poorer quality of life and are more likely to develop non-specific hand/foot dermatitis and palmar hyperlinearity.

Aquafaba powder, lentil protein and citric acid as egg replacer in gluten-free cake: A model approach

Food allergies and intolerances have challenged the food industry to create alternatives for allergenic ingredients replacement. Furthermore, meeting vegan diet patterns is even more complicated due to the limited functional properties and sensory characteristics. This study aimed to develop a vegetable powder for egg replacement (VP) for gluten-free cake (GFC) using aquafaba powder (AP), lentil protein (LP), and citric acid (CA) according to a mixture design (MD) with lower and upper restrictions. Three mixtures were chosen based on responses foaming capacity (FC) and foam stability (FS). They were applied as eggs substitute in GFC. The dough physical parameters, proximal composition, microbiological quality, and sensory acceptance of GFC were determined. The AP utilization as raw material in VP is suitable, and mixtures containing 66% to 71.5% of AP, 20% of LP, and 8.5% to 14% of CA were considered suitable for GFC egg replacement. Although the physical characteristics were slightly below the control, GFC with VP had higher fiber content, lower lipid and carbohydrate content, and sensory characteristics as accepted as the control.

Growth and micronutrient levels of 6-12 years-old children with food allergies, food sensitisation, and food restrictions.

We investigated the association of food allergy, food sensitisation, and food restriction with growth and micronutrients levels in schoolchildren. A total of 195 schoolchildren (6-12 years old) from six elementary schools in Korea were enrolled, and questionnaires were administered to their parents during June and July 2015. Food allergy was defined by the presence of urticaria, skin rash, pruritus, throat tightness, gastrointestinal complaints, or respiratory difficulty after consumption of a food to which allergy was plausible during the past 12months. Skin prick tests were performed and serum levels of haemoglobin and micronutrients were measured. Among 195 participants (51.3% males) enrolled, 35 (17.9%) were reported to have food allergies, 17 (8.7%) were on food restriction, and 27 (14.0%) were sensitised to at least one food allergen. Food allergy and food restriction were associated with a lower height-for-age z-score (p for trend=0.018, p=0.048; p for trend=0.076, p=0.008). Food restriction was related to reduced serum calcium level (aOR: -0.094, 95% CI: -0.156 to -0.032). Signs and symptoms of food allergy and consequent food restrictions in children were related to lower height-for-age z-score and lower serum calcium levels.

When Knowledge Is Not Enough

When Knowledge Is Not Enough

Doubtful Guests, Harassed Hosts, and the Golden Rule

Doubtful Guests, Harassed Hosts, and the Golden Rule

Endoscopic marsupialization for severe candy cane syndrome: long-term follow-up.

Candy cane syndrome (CCS) is a clinical condition that may occur after gastrectomy or gastric bypass, when an excessively long or mispositioned blind jejunal loop proximal to the anastomosis is left in place. Preferential food passage in this loop results in symptoms such as fullness, pain, reflux, regurgitation, and postprandial vomiting. Surgical resection of the dilated loop is technically complex, and morbidity limits its use in fragile patients. An endoscopic approach, using dedicated active magnets, has recently been shown to be effective in the medium-term. We present here the case of a 71-year-old female patient who underwent endoscopic treatment for the first time. She presented with intractable vomiting, food intolerance, and cachexia due to CCS after total gastrectomy for gastric cancer. Surgical treatment was not an option in such a high-risk patient, and she accepted treatment with a novel endoscopic approach using a double-magnet device followed by septotomy to marsupialize the blind loop. Her symptoms were completely resolved, and she regained weight. We report here her clinical outcomes at 3 years, suggesting that endoscopic marsupialization for CCS is not only effective in the short term but also provides long-term clinical benefit.

Selenium deficiency is associated with polyneuropathy in primary Sjögren's syndrome.

Selenium plays an important role in the regulation of the immune system. Selenium deficiency is associated with Hashimoto's thyroiditis, a common comorbidity in primary Sjögren's syndrome (pSS). Therefore we aimed to identify whether or not selenium deficiency is also associated with pSS. 107 consecutive female patients with pSS and, as a control, 59 female patients with axial spondyloarthritis were recruited. Later, 11 male pSS patients, 5 of these suffering from polyneuropathy, and 15 male axSpA patients were additionally recruited in order to confirm the results from the female patients. All patients were consulted about their diet and food intolerances and their plasma selenium concentrations were analyzed. Current and previous extraglandular manifestations of pSS were recorded. Patients complaining of misperceptions and tingling paraesthesia underwent measurement of nerve conduction velocity. The proportion of patients and controls with a selenium deficiency was compared using Fisher's exact test. The proportion of female pSS patients with a low selenium concentration <0.63μmol/L (22.4%) was significantly higher than of the controls (1.7%) (p<0.001). Within the group of female patients with pSS, selenium deficiency was significantly associated with the presence of polyneuropathy (45.8% with vs 14.5% without polyneuropathy, p=0.003) and particularly polyneuropathy with motor nerve involvement measured by nerve conduction velocity (41.7% with vs 10.8% without motor neuropathy, p=0.001). The mean selenium concentrations of the 5 male pSS patients with polyneuropathy were significantly lower compared to the 6 pSS patients without polyneuropathy and to the 15 male axSpA controls. PSS and in particular its complication polyneuropathy is associated with selenium deficiency. Measurement of the selenium concentration in blood is advisable in patients with pSS and in particular in the subset of patients with polyneuropathy. Substitution of selenium may be a possible therapy of polyneuropathy associated with pSS.

Digesting Tensions and Change

Digesting Tensions and Change

Interpretation Challenge of Deep Peritoneal Lavage in a Trauma Patient with Liver Cirrhosis: A Case Report Study

Introduction: Trauma is one of the most common surgical emergencies. Deep peritoneal lavage (DPL) is an invasive rapid test for detecting intra-abdominal hemorrhage or hollow viscus damage. Objectives: However, there seems to be a defect in the interpretation of DPL in cirrhotic patients. Case Presentation: The authors reported a 54-year-old male patient who was a known case of cryptogenic liver cirrhosis and was referred due to falling. On the seventh day of admission, due to the persistence of abdominal distention and food intolerance, the medical team decided to conduct DPL to investigate hollow viscera damage. Since the peritoneum fluid analysis expressed a positive finding, the team decided that the patient should undergo explorative laparotomy. Intraoperative findings included cirrhotic liver with ascites without any evidence of bile secretions and intestinal contents. Unfortunately, however, the patient died on the 15th day. Conclusion: The present case report is the first study on the false-positive DPL results in cirrhotic patients. It showed that positive DPL findings were untrustworthy in cirrhotic patients, and more powerful diagnostic tools are required for laparotomy decisions.

Bacterial overgrowth and lactose intolerance: how to best assess.

To provide an up-to-date review on the clinical assessment of two important gastrointestinal problems with overlapping symptomatology but diverse cause and testing methods. Small intestinal bacterial overgrowth (SIBO) is characterized by the presence of excess bacteria in the small intestine associated with bloating, distention, gas, and diarrhea. Lactose intolerance is caused by lactase enzyme deficiency in the small bowel mucosa leading to lactose malabsorption and symptoms of bloating, gas, and diarrhea. SIBO is assessed by hydrogen/methane breath test using glucose as a substrate and/or small bowel aspirate and culture but these tests have shortcomings. Consequently, several new diagnostic techniques, including novel capsule technologies and other approaches are being evaluated. Lactose intolerance can be assessed by hydrogen/methane breath test using lactose as a substrate, or small bowel mucosal lactase assay, genetic testing and lactose tolerance test, although the efficacy and practicality of these diagnostic modalities are not equal. In clinical practice, gas, bloating, distention, pain, and diarrhea are common gastrointestinal symptoms that often remain unexplained when routine gastrointestinal endoscopy, imaging, and stool tests are negative. These patients should be evaluated for SIBO and/or food intolerances including lactose intolerance.

Orthorexia nervosa is a concern in gastroenterology: A scoping review.

There is concern that use of restrictive therapeutic diets, such as those used in disorders of the gut‐brain interaction (DGBI), may increase disordered eating. In this issue of Neurogastroenterology and Motility, Burton Murray et al. and Peters et al. both demonstrate a high prevalence of disordered eating in patients with gastrointestinal conditions, particularly those with DGBI. Given these findings, it is likely that orthorexia is common in this patient group, although this was not directly examined in these studies. Orthorexia nervosa is described as an obsessive and unsafe focus on eating foods perceived as healthy. This mini‐review therefore focuses on orthorexia by conducting a scoping review, as per the PRISMA extension for scoping reviews, aimed to assess the prevalence of orthorexia, and associations between orthorexia and restrictive eating practices. While a wide range of orthorexia prevalence has been reported (0%–97%) across the 57 studies included, no studies assessed prevalence specifically in gastrointestinal conditions. Four of eight studies describing diseases associated with specific dietary patterns suggested that participants who followed a diet for “digestive issues” or “food intolerances” were at higher orthorexia risk. These results suggest that dietary modifications may be a factor contributing to orthorexia. Additionally, we provide a commentary on the clinical implications of the findings for gastrointestinal conditions including a clinical flow chart. Clinicians should consider if a restrictive diet is appropriate for individuals with DGBI and include screening for disordered eating prior to implementation of dietary modifications. Future prospective studies should evaluate orthorexia within this patient group.

Biogenic amines in fish: Prevention and reduction

High-quality proteins, vital vitamins, minerals, and essential fatty acids may be obtained from fish and fish products. Fish decomposition and the generation of toxicants such as biogenic amines may counteract the benefits of fish consumption on human health, such as protection against coronary heart disease and some cancers. Annually, histamine consumption is recognized as the cause of numerous cases of food poisoning. Even small or moderate doses of histamine or tyramine-containing fish might cause food sensitivity. Cadaverine, putrescine, and tyramine have also been identified as histamine poisoning potentiators. Biogenic amine accumulation in fresh fish and fish products has been linked mostly to the growth of bacteria with amino acid decarboxylase activity, which is aided by a lack of sanitary conditions and proper temperature control during storage. Biogenic amines are used to assess the hygienic quality of various marine and freshwater species and their potential toxicity. Different conventional and modern methods have been employed to control biogenic amine buildup. This review article aims to bring current knowledge concerning biogenic amine content in fresh fish and fish products, as well as the efficacy of present and emerging management techniques, up to date and combined. Novelty impact statement This article focuses on the current, emerging prevention and reduction methods of biogenic amines formation in fish and fish products, which is the strength of the manuscript. Furthermore, the first results of the control strategies that are currently the focus of research are discussed.

Improvement of digestive symptoms in fibromyalgia patients following a diet modification according to histamine release test - an observational study.

IntroductionThere is growing interest in the relationship between fibromyalgia and processes related to food, such as food intolerances. In fact, different associations have been described between the control of dietary habits and the improvement of the different symptoms of fibromyalgia.Material and methodsWe collected the results of applying a specific test of histamine release related to the diet of patients with fibromyalgia, and evaluated the changes in terms of the symptoms usually described by the patients. A total of 84 patients who met the established criteria were recruited; 40 of them underwent the exclusion diet for a period of 6 months, while the remaining ones continued with their usual dietary habits. All patients were instructed not to modify any other parameter during the study, such as medication, exercise, or other complementary treatments. The parameters studied were as follows: the Fibromyalgia Impact Questionnaire (FIQ), the Gastrointestinal Symptoms Rating Scale (GSRS), the pain Visual Analogue Scale (VAS), as well as the patients’ body weight was controlled.ResultsThere was a significant improvement (p < 0.05) in the group of patients who underwent the exclusion diet in assesment by GSRS and in total in total body weight. There were no differences compared to the rest of the patients in terms of VAS and FIQ.ConclusionsDiet modification in patients with fibromyalgia by specific histamine relase test improves certain clinical parameters related to the symptoms of the digestive sphere, compared to the control group. Our work opens a possible way of non-pharmacological treatment to improve some symptoms of this very prevalent disease.

How primary care providers can help prevent food allergies

IgE-mediated food allergy rates have increased in recent decades, yet treatment options remain limited. Prevention strategies are thus essential. We will review recent research and consensus guidelines for food allergy prevention. Research has continued to support that early introduction of allergens via the gastrointestinal tract induces tolerance and prevents development of food allergy. In contrast, allergen sensitization may occur via transcutaneous allergen exposure. This is supported by research that shows a decreased risk of food allergy with aggressive treatment of atopic dermatitis. More recent research suggests that transcutaneous sensitization could also be facilitated by frequent emollient use in the absence of atopic dermatitis but definitive research is lacking. Murine models have shown a likely role of dysbiosis, or disruption of the body's normal healthy microbiome, in development of food allergy, yet human studies have yet to show a conclusive benefit of probiotics in the prevention of food allergy. Important approaches for food allergy prevention are: introduction of peanut and cooked egg at 4-6 months, early introduction of other allergenic foods, and early diagnosis and treatment of atopic dermatitis (because of a predisposition to food sensitization through the damaged skin barrier). More research is needed to clarify the role, if any, of emollient use and probiotics.

Nutritional Therapy in Vegans with Anorexia Nervosa from a Diaetological Point of View

Veganism is a form of nutrition that is becoming increasingly popular. There is also a pandemic-related increase in mental illness, which often manifests itself in the form of an eating disorder among children and adolescents. Particularly challenging in nutritional therapy is anorexia nervosa in combination with veganism.There is consensus that a correctly implemented vegan diet can generally cover the daily nutritional requirements. However, this does not apply to people who are in a growth period. Therefore, this article attempts to highlight the special requirements of a vegan diet along the dietary process development.The basis is provided by a specific anamnesis as well as the elicitation of nutritional status by means of nutrition protocol and bioelectrical impedance analysis. The treatment and goal setting are influenced by the motives behind a vegan diet and further diagnoses such as orthorexia or food intolerance. Regarding the course of action, it must be clarified how an adequate vegan diet can be guaranteed and which conditions are needed to create a space where different diets can be accepted simultaneously. Withing the daily care, nutritional aspects such as the reduction of anorexia-related digestive complaints as well as the selection, quantity and preparation of vegan foods are foregrounded. This is illustrated by nutritional analyses. The objective is to achieve a high level of compliance and to ensure a sufficient nutrient supply in order to make food, as well as vegan food, enjoyable.

Allergic sensitization trajectories to age 8 years in the Singapore GUSTO cohort

BackgroundAllergic sensitization is linked to allergy development, with early sensitization often associated with worse outcomes. We aimed to identify if distinct allergic sensitization trajectories existed within a diverse and multi-ethnic Asian cohort. MethodsWe administered modified ISAAC questionnaires in the first 8 years and conducted skin prick testing at ages 18 months, 3, 5 and 8 years in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. We used latent class analysis to derive allergic sensitization trajectories, and adjusted odds ratios (AOR) to evaluate predictive risk factors and associations with allergic comorbidities. ResultsAmong 997 children, three trajectories were identified: early food and mite sensitization (16.2%), late mite sensitization (24.2%) and no/low sensitization (59.6%). Early food and mite sensitization was associated with early eczema by 6 months [AOR (95%CI) 4.67 (1.78–12.28)], increased risk of wheeze by 3–8 years (ARR 1.72–1.99) and eczema in the first 8 years of life (ARR 1.87–2.41). Late mite sensitization was associated with female sex [AOR 0.58 (0.35–0.96)], cesarean section [AOR 0.54 (0.30–0.98)], early eczema by 6 months [AOR 3.40 (1.38–8.42)], and increased risk of eczema by 18 months [ARR 1.47 (1.03–2.08)] and 8 years [ARR 1.35 (1.05–1.73)]. ConclusionEarly onset of eczema and early allergic sensitization were strongly associated. Early sensitization, especially to house dust mites, was associated with increased risks of developing wheeze and eczema, pointing to the importance of developing preventive perinatal interventions and effective therapeutics for sensitized toddlers.

Small bowel stomas are associated with higher risk of circulating food-specific-IgG than patients with organic gastrointestinal conditions and colostomies

ObjectiveThe effects of food sensitivity can easily be masked by other digestive symptoms in ostomates and are unknown. We investigated food-specific-IgG presence in ostomates relative to participants affected by other...

Melkersson-Rosenthal Syndrome: A Mysterious Path to Recurrent Facial Palsy

Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous syndrome of unknown etiology with chronic and progressive course, and clinical diagnosis is usually by exclusion. Rarely, it presents with the full triad of recurrent or persistent facial swelling, relapsing facial palsy, and a fissured, geographic tongue. It is rarely possible to observe all aspects of the classical triad at the same time, since these symptoms may appear in different times of life cycle. Although etiology of MRS is unclear, various factors such as infections, genetic predisposition, immune deficiency, food intolerance and stress have been held responsible. The differential diagnosis of MRS includes also chronic inflammatory and infective diseases characterized by granulomatous infiltration, as well as rosacea, contact dermatitis, allergic reactions and Bell’s palsy. The therapeutic options are varied, though most commonly include corticosteroid therapy and nerve decompression surgery