Rome IV Research Articles

Constantinople in the «Journey to Istanbul» by Joseph Brodsky

The article is devoted to the Joseph Brodsky's essay «Journey to Istanbul». The author considers one of the central subjects of the essay, which is connected with the plans of the Emperor Constantine for the foundation of New Rome and the spread of Christianity. Special attention is paid to the analysis of the reconstruction of the historical picture in the essay, the characteristics of the diverse tasks that Brodsky set for himself, as well as to the stylistic features of the essay text.The article shows that the ideological subtext, to which literary critics and colleagues in the pen often attached excessive importance, plays a rather secondary role in this habitual journey into the past for Brodsky, not to mention that the circumstance of his private life acts as an incentive for such an essay. While the idea of Constantine as emperor and the idea of Constantinople as the New Rome, which marks the idea of Christianity, comes to the fore.

Перекрест синдрома раздраженного кишечника и неисследованной диспепсии у жителей Иркутска

Study Objective: To study the overlap of irritable bowel syndrome (IBS) and uninvestigated dyspepsia in residents of Irkutsk. Study Design: Cross-sectional observational non-randomised study. Materials and Methods. We interviewed and examined 1,529 persons: 724 men and 805 women, the mean age of which was 51.0 years old. The questionnaire included questions to identify alarming symptoms. IBS and dyspepsia were diagnosed on the basis of Rome criteria IV. In our study, we used positive diagnosis of IBS and did not use instrumental examination; therefore, dyspepsia was treated as “uninvestigated dyspepsia”. Study Results. Prevalence of IBS was 12.3%, whereas uninvestigated dyspepsia was diagnosed in 19.1% of cases. Overlap of IBS and dyspepsia was recorded in 5.8% of subjects in the study group. Uninvestigated dyspepsia was diagnosed in 47.3% of patients with IBS and only in 13.6% of subjects without IBS (p < 0.001). The risk factors of overlap were the female sex (p < 0.001), age 50+ years old (p = 0.02), obesity (p = 0.03), and non-steroidal anti-inflammatory drugs and/or aspirin (p < 0.001). Conclusion. The overlap of IBS and uninvestigated dyspepsia was observed in Irkutsk. We assume that the results will be useful for improvements in the medical and preventive care to the population and for scientific developments. Keywords: syndrome of overlap, irritable bowel syndrome, dyspepsia, risk factors, Rome criteria IV.

Латентная дисфория в структуре эмоциональных расстройств у пациенток с функциональным запором

Psychoemotional disturbances are an important component of the functional gastrointestinal disorders. It was suggested that Latent Dysphoria along with anxiety and depression are important features of negative emotions in patients with functional constipation (FC) and it has a major impact on social functioning. 60 women with FC according to the IV Rome criteria, aged from 18 to 62 (34.72±11.43 years) and duration of the disease ― 12.84±11.34 years were included into the study. The assessment of emotional disorders and quality of life was performed by State-Trait Anxiety Inventory, Hamilton Depression Scale, the four-dimensional questionnaire (4DSQ), SF-36 Questionnaire, new Latent Dysphoria Checklist. The assessment of the severity of somatic symptoms was carried out using methods accepted in the practice of gastroenterologists. Results: 73% of patients showed increased anxiety, 50% ― signs of depression. Latent dysphoria by Latent Dysphoria Checklist was found in 48% of patients. The patients were divided into two subgroups according to the presence / absence of the latent dysphoria. There was no difference in severity of somatic symptoms between subgroups. As for emotional disturbances the difference was found. Indicators of emotional disturbances (anxiety, distress, depression, somatization) were significantly higher in the subgroup of patients with latent dysphoria (p<0.05) and the quality of life indicators ― significantly lower (p<0.05). Thus, our findings support the hypothesis that emotional disturbances in women with FC include latent dysphoria together with anxiety and depression. This complex but not severity of somatic symptoms negatively affects social functioning. The main limitations of the study are as follows: the small sample size, the absence of a comparison group, and the inapplicability of the findings for the male population. The study of the prevalence and specificity of latent dysphoria in other pathological conditions will be the subjects of the further research.

Global Prevalence of Chronic Idiopathic Constipation According to the Rome Criteria: Systematic Review and Meta-Analysis

Background: Chronic idiopathic constipation (CIC) is a common functional bowel disorder in the community, whose prevalence varies across cross-sectional surveys. We performed a contemporaneous systematic review of studies using comparable methodology, and all iterations of the Rome criteria, to estimate global prevalence. Methods: MEDLINE, EMBASE, and EMBASE Classic were searched (from 1990 to December 2020) to identify population-based studies reporting the prevalence of CIC in adults (≥18 years old) according to Rome I, II, III, or IV criteria. Prevalence of CIC was extracted, according to criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, odds ratios (OR), and 95% confidence intervals (CIs) were calculated. Findings: Of 8,174 citations evaluated, 45 studies fulfilled eligibility criteria, representing 80 separate populations, containing 275,260 subjects. Pooled prevalence was 15.3% (95% CI 8.1% to 24.4%) in studies defining CIC according to the Rome I criteria, 10.8% (95% CI 7.3% to 14.8%) using Rome II, 11.3% (95% CI 6.8% to 16.7%) with Rome III, and 10.1% (95% CI 8.7% to 11.6%) when Rome IV criteria were used. Prevalence of CIC was up to two times higher in women, irrespective of definition used. There was significant heterogeneity between studies in all our analyses, which persisted even when the same criteria were applied and similar methodology used. Interpretation: Even when uniform symptom-based criteria are used to define the presence of CIC, prevalence varies between countries. Thus, environmental, cultural, ethnic, dietary, or genetic factors may influence reporting of symptoms. Funding: None Declaration of Interest: None

Diagnostic Accuracy of the Rome IV Criteria for the Diagnosis of Functional Gastrointestinal Disorders in Children.

The diagnosis of functional gastrointestinal disorders (FGIDs) centers on symptoms-based criteria (Rome criteria). The last edition of the criteria was published in 2016. Still, few data on its validity support its use in children. We conducted a study aimed at determining the diagnostic accuracy of the Rome IV criteria through the application of questionnaires (Questionnaire of Pediatric Gastrointestinal Symptoms-Rome IV QPGS-IV) to diagnose FGIDs in children. We hypothesized that the Rome IV criteria has adequate diagnostic accuracy supporting its use for diagnosing FGIDs in children. School children ages 10 to 18 years from Cali (Colombia) completed the Spanish version of the QPGS-IV. Children with FGIDs were matched with a group of children without FGIDs. Both groups had a medical consultation with a blinded experienced pediatric gastroenterologist (criterion standard) who provided his diagnosis. The questionnaire-based diagnoses were compared with the consultation's diagnoses. Of 487 schoolchildren surveyed with the QPGS-IV, 97 (20.8%) had FGIDs. Eighty-nine with FGIDs were matched with 92 children without FGIDs (mean age 13.1 years [±1.3]). We found a higher prevalence of FGIDs during the medical visit than using the self-report QPGS-IV (66.3% vs 49.2%, P = 0.001), mainly in abdominal pain disorders (19.3% vs 10.5%, P = 0.013). The Rome IV diagnostic criteria using the QPGS-IV had a sensitivity of 75% (95% confidence interval, 59-79) and 90% specificity (95% confidence interval, 83-98). Positive predictive value is 85.8%, and negative predictive value is 79.9%. Our study suggests that the QPGS-IV has adequate diagnostic accuracy.

Efficacy of mebeverin in treatment of abdominal pain

An original study evaluating the effectiveness and safety of mebeverin in treatment of abdominal pain in patients with irritable bowel syndrome (IBS) are presented. Materials and methods: 40 patients diagnosed with IBS, according to the Rome Criteria IV, were monitored. Patients depending on the type of therapy were divided into two groups: 20 patients of the first group had recommendations for lifestyle modification, a hypocaloric diet and took mebeverin per os at a dose of 135 mg three times a day 20 minutes before meals for a month; 20 patients of the second group received only recommendations for lifestyle modification and a hypocaloric diet. All patients were evaluated before and after treatment using the Gastrointestinal Symptom Rating Scale (GSRS), Visual-Analog Pain Intensity Rating Scale (0–10 points), SF‑36 Quality of Life Assessment Question, adverse events assessment. Colonoscopy was performed before treatment to exclude organic pathology of the colon. Results. After treatment patients in the first group had a faster and more significant relief of complaints compared to the second group, a significant improvement in the quality of life on the scales of physical and mental functioning, as well as almost complete disappearance of pain on a visual-analog scale (7.1 out of 10 points before treatment and 0.4 points after). Conclusions. Mebeverin in a dosage of 135 mg three times a day during a month contributes to a significant improvement in well-being, optimizes the quality of life of this category of patients, is effective and safe, which allows us to recommend its use as a first-line spasmolytic drug in the complex therapy of IBS, as well as in various variants of visceral abdominal pain.

Impact of Opioid Consumption in Patients With Functional Gastrointestinal Disorders.

Objective: We aimed to determine the burden of opioid consumption in a cohort of patients with functional gastrointestinal disorders. Methods: All patients diagnosed with functional gastrointestinal disorders and referred to our university hospital were evaluated from 2013 to the beginning of 2019. Irritable bowel syndrome and functional dyspepsia diagnoses were determined according to Rome criteria and severity according to irritable bowel syndrome severity scoring system. Vomiting was quantified using a 5-point Likert scale, and constipation severity was measured using the Knowles-Eccersley-Scott-Symptom questionnaires. Quality of life was quantified by the GastroIntestinal Quality of Life Index. Patients were categorized as being treated on a chronic basis with either tramadol, step II opioids, step III opioids or as being opioid-free. Results: 2933 consecutive patients were included. In our cohort, 12.5% had only irritable bowel syndrome, 39.3% had only functional dyspepsia, 24.9% had a combination of both, and 23.4% had other functional gastrointestinal disorders. Among them, the consumption of tramadol, step II (tramadol excluded) and step III opioids was 1.8, 1.3 and 0.3 % respectively in 2013 and 4.3, 3.4 and 1.9% in 2018 (p < 0.03). Opioid consumption was associated with increased vomiting (p = 0.0168), constipation (p < 0.0001), symptom severity (p < 0.001), more altered quality of life (p < 0.0001) and higher depression score (p = 0.0045). Conclusion: In functional gastrointestinal disorders, opioid consumption has increased in the last years and is associated with more GI symptoms (vomiting, constipation and GI severity), higher depression and more altered quality of life.

Derivation and validation of a novel method to subgroup patients with functional dyspepsia: beyond upper gastrointestinal symptoms.

Conventionally, patients with functional dyspepsia are subgrouped based on upper gastrointestinal symptoms, according to the Rome criteria. However, psychological co-morbidity and extraintestinal symptoms are also relevant to functional gastrointestinal disorders. To investigate whether it is possible to subgroup people with functional dyspepsia using factors beyond upper gastrointestinal symptoms. We collected demographic, symptom and psychological health data from adult subjects meeting the Rome III criteria for functional dyspepsia in two secondary care cross-sectional surveys in Canada and the UK. We performed latent class analysis, a method of model-based clustering, to identify specific subgroups (clusters). For each cluster, we drew a radar plot, and compared these by visual inspection, describing cluster characteristics. In total, 400 individuals met Rome III criteria for functional dyspepsia in the Canadian cohort, and 262 the UK cohort. A four-cluster model was the optimum solution and the characteristics of the clusters were almost identical between the two cohorts. The clusters were defined by a pattern of gastrointestinal symptoms and were further differentiated by the extent of extraintestinal and psychological co-morbidity. Cluster 1 (mean age 46.7years, 66.7% female) consisted of epigastric pain and nausea with high psychological burden, cluster 2 (mean age 41.5years, 77.7% female) high overall gastrointestinal symptom severity with high psychological burden, cluster 3 (45.8years, 67.2% female) oesophageal symptoms and early satiety with low psychological burden, and cluster 4 (mean age 40.4years, 71.5% female) postprandial fullness with low psychological burden. We validated the model derived using the Canadian study population externally by applying it to the UK dataset. We demonstrated reproducibility; it would perform similarly when applied to a different dataset. Latent class analysis identified four distinct functional dyspepsia subgroups characterised by varying degrees of gastrointestinal symptoms, extraintestinal symptoms and psychological co-morbidity. Further research is needed to assess whether they might be used to direct treatment.

Rome III, Rome IV, and Potential Asia Symptom Criteria for Functional Dyspepsia Do Not Reliably Distinguish Functional From Organic Disease.

INTRODUCTION:Although the Rome criteria were created primarily for research purposes, it was an important question whether the Rome criteria can distinguish organic dyspepsia from functional dyspepsia (FD). We evaluated the accuracy of the Rome IV criteria in identifying patients with FD and compared the differences between the Rome IV, Rome III, and potential Asia criteria in identifying patients with FD.METHODS:In this cross-sectional study, we analyzed data from patients who met the inclusion and exclusion criteria from March 2018 to January 2019 at 2 tertiary hospitals.RESULTS:A total of 600 patients were enrolled in this study, including 381 individuals met the Rome IV criteria for FD, 438 individuals met the Rome III criteria for FD, and 525 individuals met the potential Asia criteria for FD. The Rome IV criteria identified patients with FD with 67.3% sensitivity and 38.4% specificity, and the positive and negative likelihood ratios of FD identified by Rome IV criteria were 1.09 (95% confidence interval 0.97–1.24) and 0.85 (95% confidence interval 0.67–1.08), respectively. There was no significant difference in the area under Rome IV, Rome III, or potential Asia criteria receiver operating characteristic curves in identifying FD (P > 0.05).DISCUSSION:The Rome IV criteria were no better than the Rome III or potential Asia criteria in identifying FD and were not helpful in identifying patients with FD. Hence, although the Rome criteria remain useful for defining patients with FD for inclusion into clinical treatment trials, they should not be used for diagnosing FD.

A Study of Psychological Factors Associated with Functional Gastrointestinal Disorders and Use of Health Care.

ObjectiveThe purpose of this study was to analyze the symptoms of depression, anxiety, and childhood trauma in functional gastrointestinal disorder (FGID) patients who visited the brain-gut axis clinic.MethodsThe study participants included 99 individuals who were diagnosed with FGID by gastroenterologists, 88 individuals who had no FGID but showed symptoms of FGID based on the Rome criteria, and 79 individuals who did not show any symptoms or were diagnosed with FGID. Symptoms of depression, anxiety, and childhood trauma were evaluated by the Korean version of Beck-depression inventory-II (K-BDI-II), Korean version of Beck anxiety inventory (K-BAI), and Korean version of childhood trauma questionnaire (K-CTQ), respectively.ResultsThe BDI score, BAI score, and CTQ score were significantly different between the groups. The group also had higher odds for developing anxiety as compared to the control group (odds ratio [OR] = 10.215, 95% confidence intervals [CI] 2.49−41.76). Additionally, the FGID group had higher odds for developing symptoms of depression (OR = 5.554, 95% CI 2.06−14.97) and experiencing physical violence (OR = 3.128, 95% CI 1.53−6.38) than the non-FGID group.ConclusionThis study showed that FGID patients were more likely to have symptoms of depression, severe anxiety, and childhood trauma, which were the risk factors of FGID.

Psychopathological profile in COVID-19 patients including healthcare workers: the implications.

The effects of COVID-19 seem to extend beyond the physical pain and is showing psychiatric implications as well. Moreover, psychopathological implications seem to last also after patients' discharge. Our goal is to investigate the psychological impact and psychopathological outcome of patients affected by COVID-19. We have engaged 34 patients with COVID-19 conditions [eight of them were healthcare workers patients (HCW)] hospitalized at "Policlinico Gemelli Foundation" of Rome, Italy. All patients were evaluated through the Impact of Event Scale-Revised (IES-R) and the Symptom Checklist 90-R (SCL-90-R) first, during their hospitalization (baseline), and then, after 4 months from hospital discharge (follow-up), through phone interviews. At baseline, 82% of patients revealed from mild to severe psychological impact of COVID-19, according to the IES-R. At follow-up, the mean IES-R total score was significantly decreased (p<0.001) even if almost half (46.6%) of our cohort still showed it. HCW patients showed a significantly higher score than other patients at IES-R scale, both at baseline (p=0.005) and at follow-up (p<0.001). Moreover, at 4 months from discharge, they showed a significantly higher percentage of moderate and severe distress (p=0.015). In addition to this, at follow-up, our cohort of patients showed an increase of anxiety symptoms, even if not significant compared to baseline (46.7% vs. 35.3% respectively; p=1.000), and HCW patients suffered more sleep disorders (p=0.019) and anxiety symptoms (p=0.019) compared to other patients. We indicate the importance of assessing psychopathology of COVID-19 survivors, monitoring their changes over time, and providing psychological support to improve their psychological well-being.

Worries and concerns of inflammatory bowel disease (IBD) patients in Belgium – a validation of the Dutch rating form

Objectives Worry is the most common psychological complaint among patients with Inflammatory Bowel Disease (IBD). This study aimed to translate and test the psychometric properties the Rating Form of IBD Patient Concerns (RFIPC) among Dutch-speaking patients with IBD in Belgium. It also aimed to describe worries and concerns, and to examine possible differences in worry patterns between patients with different disease types and disease activities. Methods The RFIPC was translated into Dutch following the guidelines of the Rome Foundation and was completed by patients with Crohn’s disease (CD, n = 336) and ulcerative colitis (UC, n = 160). To test concurrent validity, the Depression Anxiety Stress Scales (DASS-21) were used. Factor structure was examined with confirmatory factor analysis. Results The four-factor structure including subscales ‘impact of the disease’, ‘sexual intimacy’, ‘complications of the disease’ and ‘body stigma’ was confirmed in the Dutch sample. All factors had high internal consistency (>.70). Correlations with DASS-21 suggest good concurrent validity, all rs>.30, ps<.001. No differences in the RFIPC scores were observed between patients with CD and UC. Patients with active disease (53%) had higher scores than patients in remission (47%). Across all groups, the order of top concerns was consistent and included worries about energy level, side effects of medication, having an ostomy bag/surgery, and uncertain nature of the disease. Conclusions The Dutch version of the RFIPC is a valid and reliable measure of IBD-specific worries and concerns which can be used in both research and clinical settings.

Are functional gastrointestinal disorders a clinically significant comorbid factor for acute respiratory infection in children?

Rationale: Functional gastrointestinal disorders (FGID) are highly prevalent in children worldwide. Current concept of FGID pathophysiology implies contributions from various mechanisms. Information in the role of acute respiratory infections in the development of FGID in children is lacking.Aim: To determine the prevalence of FGID in children hospitalized to the department of infectious diseases with acute respiratory tract infections (ARTI) and their association with demographic, medical biological factors and clinical manifestations.Materials and methods: We performed observational and cross-sectional study with continuous patient sampling. The study included 180 ARTI patients, whose mothers agreed to fill in the proposed questionnaire of 41 items. The diagnosis of FGID during in-hospital stay was made based on clinical data in accordance with the Rome criteria IV (2016) and by standard collection of the information from the parents. The stool characteristics were assessed with the Bristol scale. The rate of recurrent ARTI was assessed by the resistance index of above 0.5. We considered clinical symptoms of ARTI at the admittance, the rates of bacterial complications and the need in antibacterial treatment.Results: The prevalence of FGID in hospitalized children with ARTI below 4 years of age (n = 134) was 35.1% (95% confidence interval [CI]) 27.0– 43.9); they had higher rates of functional diarrhea (14.9%, 95% CI 9.4–22.1) and constipation (14.2%, 95% CI 8.8–21.3). Among those above 4 years of age (n = 46), FGID were diagnosed in 50% (95% CI 34.9–65.1) of the cases; with most frequent symptoms being abdominal pain (39.1%, 95% CI 25.1–54.6) and irritable bowel syndrome (10.8%). Irrespective of their age, the children with FGID had higher rates of ARTI recurrence (by 34.0%, 95% CI 20.0–48.1; relative risk 1.98, 95% CI 1.47–2.69; odds ratio 4.13, 95% CI 2.18–7.85) and intestinal infections in their past history, compared to those without any gastrointestinal symptoms during the index hospitalization. In children with FGID, ARTI were more frequently complicated by otitis and they had higher requirement in antibiotics. The mothers of the infants and toddlers with FGID had lower educational level (smaller proportion of those with high school education) and were less satisfied with their home and living conditions, whereas their fathers were older and more frequently employed in vehicle operations and less frequently were occupied in communication-related professions.Conclusion: Acute respiratory infections, especially recurring, may plaу a significant role in the development and maintenance of FGID in children. Further studies are necessary, which may result in useful information for the development of tailored strategies to treatment and prevention.

S0457 Six-Month Efficacy of Polyethylene Glycol (PEG) 3350 in the Treatment of Chronic Idiopathic Constipation: Analysis Using FDA Endpoints

INTRODUCTION: PEG 3350 is an osmotic laxative approved by the FDA for the treatment of constipation in 1999 and available OTC since 2006. Studies establishing the efficacy of PEG 3350 were performed prior to the establishment of standard constipation efficacy endpoints. This post-hoc analysis re-evaluates data from a previously published trial (DiPalma J, et al. Am J Gastroenterol 2007;102:1436-1441; NCT00153153) using the FDA weekly responder definition for chronic idiopathic constipation (CIC). The overall response was analyzed using multiple intervals across 6 months. METHODS: This randomized, double-blind, placebo-controlled, multicenter trial evaluated the efficacy of PEG 3350 vs placebo in patients with CIC (modified ROME criteria). Adults with CIC were randomized (2:1) to receive PEG 3350 17g or placebo once daily for 6 months (24 weeks). This new analysis assesses the FDA CIC endpoint, defined as a weekly CSBM response (i.e., ≥3 complete spontaneous bowel movements (CSBMs) per week and an increase of ≥1 CSBM from baseline) during at least 9 of 12 treatment weeks, including 3 of the last 4 weeks of this period. Similar criteria were used to assess weekly CSBM response for the full duration of the study using an 18/24-week endpoint. Additionally, less stringent weekly CSBM response rate was analyzed using 6/12- and 12/24-week endpoints. All analyses were also completed for weekly spontaneous bowel movement (SBM) response. RESULTS: The intention-to-treat population included 204 PEG 3350–treated and 100 placebo-treated patients. At baseline, mean CSBMs (<1/wk) and mean SBMs (≤4/wk) rates were similar in both treatment arms. Weekly CSBM response for 9/12 weeks (FDA CIC endpoint) was significantly higher in the PEG 3350 group vs placebo (42% vs 13%; P < 0.0001) (Table 1). Response remained consistent for the 18/24-week CSBM analysis (43% vs 11%; P < 0.0001). Similar results were seen across the 9/12-week and 18/24-week SBM endpoints. Response rates for the 6/12-week and 12/24-week endpoints were higher for both CSBM and SBM showing overall consistency in the clinical benefits of PEG 3350 for CIC patients (P < 0.0001; Figure 1). CONCLUSION Using current definitions of treatment response based on the FDA CIC CSBM endpoint and improvements in SBM, once-daily PEG 3350 demonstrated substantial and sustained efficacy in patients with CIC over a period of 6 months.Figure 1.: CSBM and SBM response rates using different time intervalsTable 1.: CSBM and SBM outcomes

Functional digestive disorders in children. Guidelines of Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists. Part 1

A group of leading experts in the field of pediatric gastroenterology prepared clinical recommendations for the diagnosis and treatment of functional digestive disorders (FDD) in children; they have summarized international recommendations and domestic experience and suggested the tactics for a pediatrician in everyday practice. The first part of the recommendations discusses modern views on functional digestive disorders, their development mechanisms and terminology. The article considers the biopsychosocial model of functional digestive disorders, as well as an updated classification based on the Rome criteria IV, including domestic views and experience. The article discusses the diagnostic criteria and principles of treatment of functional digestive disorders in infants (infant colic, infant regurgitation, Infant dyshesia), as well as cyclic vomiting syndrome. In all cases the authors provide a deflnition, classification (if it is developed), ICD-10 codes, an examination and treatment plan at various levels of the healthcare system, and indications for hospitalization of the children.

The Role of Resilience in Irritable Bowel Syndrome, Other Chronic Gastrointestinal Conditions, and the General Population

Resilience is the ability to adapt positively to stress and adversity. It is a potential therapeutic target as it is reduced in irritable bowel syndrome (IBS) compared to healthy controls and associated with worse symptom severity and poorer quality of life. The aim of this study was to examine if these findings are generalizable by comparing resilience between IBS versus the general population and other chronic gastrointestinal (GI) conditions. Participants in the general population completed an online survey containing questionnaires measuring demographics, diagnosis of IBS and other GI conditions, symptom severity, psychological symptoms, resilience, and early adverse life events (EALs). IBS was defined as having a physician diagnosis of IBS and/or meeting Rome criteria without co-morbid GI disease. All others were included in the general population group. The chronic GI conditions group included those with inflammatory bowel disease, celiac disease and/or microscopic colitis. Resilience was lower in IBS (n = 820) than the general population (n = 1026; p < 0.001) and associated with worse IBS symptom severity (p < 0.05). Global mental health affected resilience differently in IBS compared to the general population (all p's < 0.05). EALs were associated with decreased ability to bounce back from adversity in both IBS and the general population (p < 0.001). Resilience scores were similar in IBS and other chronic GI conditions that present with similar symptoms. Resilience is lower compared to the general U.S. population but does not appear to be specific to IBS as it is comparable to other chronic GI conditions. Low resilience negatively affects symptom severity and mental health and thus, may serve as a novel therapeutic target.

Irritable Bowel Syndrome: Straightening the road from the Rome criteria.

A sequence of consensus-based Rome criteria for irritable bowel syndrome (IBS) has been published since 1989. The fundamental definition based on abdominal pain in association with bowel dysfunction has been consistent. However, two major changes occurred in the Rome II and IV criteria. The former change involved "splitting off" of symptoms that were not consistently associated with pain, such as functional, constipation, diarrhea, and bloating. In Rome IV, the main changes were the exclusion of discomfort (in contrast to pain) and the more stringent frequency criteria for the pain to be eligible for diagnosis of IBS (specifically, on average, at least 1day per week in the last 3months). Validation studies of the consensus, symptom-based criteria have identified multiple deficiencies that question the rationale for "splitting" the different syndromes, and favor a simpler identification of the classical symptoms of abdominal pain, bowel dysfunction, and bloating, and exclusion of alarm symptoms. Advances in the identification of actionable biomarkers related to the symptoms suggestive of functional gastrointestinal disorders have the potential to usher a change in practice from positive diagnosis of symptom complexes followed by empirical treatment to identification of the mechanisms causing the symptoms and targeted therapy.

Functional gastrointestinal disorders are increased in joint hypermobility‐related disorders with concomitant postural orthostatic tachycardia syndrome

Individuals with hypermobility spectrum disorders/hypermobile Ehlers-Danlos syndrome (HSD/hEDS) frequently fulfill criteria for Rome IV functional gastrointestinal disorders (FGIDs). Postural orthostatic tachycardia syndrome (POTS) is also commonly reported in HSD/hEDS and may impact on co-morbidity with and severity of FGIDs, although this remains to be studied. We determined the impact of concomitant POTS and HSD/hEDS on their association with Rome IV FGIDs. With the help of the charity organization Ehlers-Danlos Support UK, an online cross-sectional health survey was completed by individuals with HSD/hEDS. The survey enquired for (a) self-reported doctor diagnosis of POTS, chronic fatigue syndrome, and fibromyalgia, (b) the presence and symptom frequency of Rome IV FGIDs, and (c) anxiety and depression scores. Of 616 subjects with HSD/hEDS, 37.5% reported a doctor diagnosis of POTS. POTS-positive individuals were significantly younger than POTS-negative subjects (37 vs 40years, P=0.002), more likely to report chronic fatigue syndrome (44% vs 31%, P<0.0001), and showed a trend toward increased prevalence of fibromyalgia (44% vs 37%, P=0.06) and higher depression score (P=0.07). POTS-positive subjects were also more likely to fulfill criteria for Rome IV FGIDs across various organ domains and experienced both upper and lower gastrointestinal symptoms significantly more frequently. The increased associations for FGIDs and GI symptom frequency remained unchanged in HSD/hEDS subjects with POTS following adjustments for age, chronic fatigue syndrome, fibromyalgia, and depression scores. The high FGID burden in HSD/hEDS is further amplified in the presence of POTS. Future studies should elucidate the mechanism by which POTS arises in HSD/hEDS and is associated with increased GI symptoms.

Functional disorders of the biliary tract: modern diagnostic criteria and principles of pharmacotherapy

The review article presents current data on functional disorders of the biliary system, taking into account the latest recommendations of experts of the Rome Foundation (Rome Criteria IV, 2016) and the Russian Gastroenterological Association (specialized clinical recommendations, 2018). According to modern concepts, biliary dysfunction is a group of functional disorders of the biliary system caused by motor disorders and increased visceral sensitivity. According to the literature data, the prevalence of functional disorders of GB and OS is 10-15%, and violation of OS function is revealed in 30-40% of patients who underwent cholecystectomy (CE). The presence of biliary pain is an obligatory condition in the diagnosis of functional disorders of GB and OS. Bilirubin and serum transaminases (AST, ALT) levels may increase in biochemical blood analysis in patients with functional OS disorder of biliary type, and pancreatic amylase and lipase in case of functional OS disorder of pancreatic type. Ultrasound examination of abdominal organs is considered to be the priority among instrumental methods. This technique allows to exclude organic lesions of both the GB and visualized ducts, and adjacent organs (GSD, biliary tract, liver and pancreas neoplasms). Magnetic resonance cholangiopancreatography (MRCP) is used as a clarifying method, which allows to visualize the state of biliary ducts throughout. Ultrasonic cholecystography is used to assess the contractile activity of the GB. When duct dilation is detected and/or when liver/pancreatic enzyme levels are elevated in the absence of changes according to MRCP data, it is reasonable to perform an endoscopic ultrasound examination. According to the latest recommendations of the Russian Gastroenterological Association (2018), the foundation of pharmacotherapy for this group of diseases are antispasmodics and ursodeoxycholic acid (UDCA).

Hospital reengineering against COVID-19 outbreak: 1-month experience of an Italian tertiary care center.

The recent outbreak of SARS-CoV-2 infection in Italy has resulted in a sudden and massive flow of patients into emergency rooms, and a high number of hospitalizations with the need for respiratory isolation. Massive admission of patients to the Policlinico "Agostino Gemelli" Foundation of Rome, Italy, determined the need for reengineering the entire hospital. In this article, we consider some of the structural and organizational changes that have been necessary to deal with the emergency, with particular reference to non-intensive medicine wards, and the preventive measures aimed at limiting the spread of SARS-CoV-2 infection among hospital staff and patients themselves. 577 staff members were subjected to molecular tests in 1-month period and 3.8% of the total were positive. 636 patients admitted to the COVID-19 pathway were included and analyzed: 45.4% were identified as SARS-CoV-2 positive. More SARS-CoV-2 negative patients were discharged in comparison to SARS-CoV-2 positive patients (59% vs. 41%, respectively). On the other hand, more SARS-CoV-2 positive patients were transferred to ICUs in comparison to SARS-CoV-2 negative patients (16% vs. 1%, respectively). Occurrence of death was similar between the two groups, 11% vs. 7%, for SARS-CoV-2 negative and positive patients, respectively. 25% of ≥80 years old SARS-CoV-2 positive patients died during the hospitalization, while death rate was lower in other age groups (5% in 70-79 years old patients and 0% in remaining age groups). Rapid hospital reengineering has probably had an impact on the management of patients with and without SARS-CoV-2 infection, and on in-hospital mortality rates over the reporting period.