Frequency Of Gastrointestinal Complaints Research Articles

Low‐Dose Prophylactic Oral Iron Supplementation (Ferrous Fumarate, Ferrous Bisglycinate, and Ferrous Sulphate) in Pregnancy Is Not Associated With Clinically Significant Gastrointestinal Complaints: Results From Two Randomized Studies

Background: Many pregnant women are reluctant to follow the recommendation concerning oral iron prophylaxis due to concerns about gastrointestinal (GI) side effects.Objective: To assess the frequency of GI complaints during low‐dose oral iron prophylaxis and compare three iron formulas in equipotent doses: ferrous fumarate versus ferrous bisglycinate versus ferrous sulphate, in healthy women with an uncomplicated single pregnancy.Methods: Results from two randomized, double‐blind studies are reported: the Gentofte study comprising 404 women allocated into four groups taking 20, 40, 60, and 80 mg of elemental iron as ferrous fumarate/day and the Naestved study comprising 78 women allocated into two groups: 25 mg of elemental iron as ferrous bisglycinate/day and 50 mg of elemental iron as ferrous sulphate/day between meals from 15 to 19 weeks of gestation to delivery. GI complaints (nausea, vomiting, epigastric pain/pyrosis, belching, meteorism, borborygmi, intestinal colic, flatulence, loose stools, constipation, and use of laxatives), as well as black stools, were recorded by interview at the time of inclusion and at regular intervals during gestation.Results: At inclusion, the frequency of total combined GI complaints in all women (n = 482) was 21%. The Gentofte study showed that in the groups taking 20–60 mg iron/day as fumarate, there was no association between the iron dose and the frequency of GI side effects. An iron dose of 80 mg as fumarate was associated with significantly higher frequencies of constipation and the use of laxatives. Comparing the three equipotent doses of iron formulas, which can prevent iron deficiency, ferrous bisglycinate 25 mg iron had the most favourable GI side effect profile, while ferrous fumarate 40 mg iron and ferrous sulphate 50 mg iron had higher but similar GI side effect profiles. The frequency of black stools increased with the iron dose. Ferrous bisglycinate 25 mg iron had a lower frequency of black stools (8%) than ferrous fumarate 40 mg iron (22%) and ferrous sulphate 50 mg iron (31%).Conclusion: Low‐dose iron supplementation appears to have no clinically significant GI side effects, as none of the included women presented with GI complaints of such severity that it necessitated either reduction of iron dose, change to an alternative iron formula, or discontinuation of iron supplement. However, ferrous bisglycinate 25 mg iron/day is associated with significantly fewer GI complaints than ferrous fumarate 40 mg iron/day and ferrous sulphate 50 mg iron/day. Ferrous bisglycinate may be preferred for iron prophylaxis, especially in women experiencing GI side effects when taking other conventional iron formulas.

Validation of the German Classification of Diverticular Disease (VADIS)\u2014a prospective bicentric observational study

PurposeThe German Classification of Diverticular Disease was introduced a few years ago. The aim of this study was to determine whether Classification of Diverticular Disease enables an exact stratification of different types of diverticular disease in terms of course and treatment.MethodsThis was a prospective, bicentric observational trial. Patients aged ≥ 18 years with diverticular disease were prospectively included. The primary endpoint was the rate of recurrence within 2 year follow-up. Secondary outcome measures were Gastrointestinal Quality of Life Index, Quality of life measured by SF-36, frequency of gastrointestinal complaints, and postoperative complications.ResultsA total of 172 patients were included. After conservative management, 40% of patients required surgery for recurrence in type 1b vs. 80% in type 2a/b (p = 0.04). Sixty percent of patients with type 2a (micro-abscess) were in need of surgery for recurrence vs. 100% of patients with type 2b (macro-abscess) (p = 0.11). Patients with type 2a reached 123 ± 15 points in the Gastrointestinal Quality of Life Index compared with 111 ± 14 in type 2b (p = 0.05) and higher scores in the “Mental Component Summary” scale of SF-36 (52 ± 10 vs. 43 ± 13; p = 0.04). Patients with recurrent diverticulitis without complications (type 3b) had less often painful constipation (30% vs. 73%; p = 0.006) when they were operated compared with conservative treatment.ConclusionDifferentiation into type 2a and 2b based on abscess size seems reasonable as patients with type 2b required surgery while patients with type 2a may be treated conservatively. Sigmoid colectomy in patients with type 3b seems to have gastrointestinal complaints during long-term follow-up.Trial registrationhttps://www.drks.de ID: DRKS00005576

Frequency and Burden of Gastrointestinal Symptoms in Patients With Familial Dysautonomia

Introduction: Familial dysautonomia (FD) is a rare hereditary neuropathy caused by a mutation in the IKBKAP gene. Despite sensory impairments, patients with FD report a range of gastrointestinal symptoms. As the type and frequency of GI disorders has never been systematically studied, we aimed to establish the frequency of GI symptoms in FD patients relative to the average US population, with the long-term goal of gaining mechanistic insight into the cause of GI symptoms in FD and potentially broader populations. Methods: We distributed a modified version of the validated GI National Institute of Health (NIH) PROMIS questionnaire to 202 FD patients from the NYU FD Registry (the largest known prospective registry). The survey included 61 questions of eight domains (swallowing, nausea, constipation, fecal incontinence, diarrhea, belly pain, reflux, bloating). In addition, participants were asked to identify which bodily system was associated with the most bothersome symptoms, and their use of gastrostomy tubes, which are commonly used in FD patients. The questionnaire was completed by patients, or when appropriate by their primary caregivers. Raw PROMIS scores were normalized against a published validation cohort of 1177 American adults representative of the general population. Results: Seventy-nine (40%) of surveys were returned, with 53% completed by patients directly. Median age of subjects was 24 years old, and 53% were female (Table 1). A quarter of patients received nutrition by gastrostomy solely, while 53% were reliant on them only for liquid intake. Demographics and G tube use were similar between survey responders and non-responders from the FD registry. GI symptoms were more bothersome (42%) than orthopedic (23%), respiratory (14%), visual (13%), or psychiatric (4%) manifestations of the disease. In the previous week, 42% of patients reported watery or loose stools, 25% reported fecal incontinence, 52% reported nausea, and 52% reported borborygmus (Figure 1). Compared to the average American population (mean age 46), patients with FD reported more frequent and severe gastrointestinal symptoms of incontinence, nausea, bloating, and diarrhea (all in second highest quartile) (Figure 2).474_A Figure 1. Demographics. This is a representative sample of the demographics contained in the FD registry.474_B Figure 2. Percentages of FD patients (n=79) reporting gastrointestinal symptoms within the last seven days.Conclusion: Our results show that despite a variety of significant disease complications, GI symptoms are most commonly identified as the worst problem among FD patients. Further research is needed to better understand the underlying mechanism of these GI symptoms in order to improve quality of life.474_C Figure 3. Comparison of severity and frequency of gastrointestinal complaints in FD patients (n=79) versus average American population (n=1177).

Ferrous bisglycinate 25 mg iron is as effective as ferrous sulfate 50 mg iron in the prophylaxis of iron deficiency and anemia during pregnancy in a randomized trial

To compare the effects of oral ferrous bisglycinate 25 mg iron/day vs. ferrous sulfate 50 mg iron/day in the prevention of iron deficiency (ID) and iron deficiency anemia (IDA) in pregnant women. Randomized, double-blind, intention-to-treat study. Antenatal care clinic. 80 healthy ethnic Danish pregnant women. Women were allocated to ferrous bisglycinate 25 mg elemental iron (Aminojern®) (n=40) or ferrous sulfate 50 mg elemental iron (n=40) from 15 to 19 weeks of gestation to delivery. Hematological status (hemoglobin, red blood cell indices) and iron status (plasma iron, plasma transferrin, plasma transferrin saturation, plasma ferritin) were measured at 15-19 weeks (baseline), 27-28 weeks and 36-37 weeks of gestation. Occurrence of ID (ferritin <15 μg/L) and IDA (ferritin <12 μg/L and hemoglobin <110 g/L). At inclusion, there were no significant differences between the bisglycinate and sulfate group concerning hematological status and iron status. The frequencies of ID and IDA were low and not significantly different in the two iron groups. The frequency of gastrointestinal complaints was lower in the bisglycinate than in the sulfate group (P=0.001). Newborns weight was slightly higher in the bisglycinate vs. the sulfate group (3601±517 g vs. 3395±426 g, P=0.09). In the prevention of ID and IDA, ferrous bisglycinate was not inferior to ferrous sulfate. Ferrous bisglycinate in a low dose of 25 mg iron/day appears to be adequate to prevent IDA in more than 95% of Danish women during pregnancy and postpartum.

Gastrointestinal Discomfort In Moderate Running: Effect Of Body Mass Adjusted Carbohydrate-electrolyte Drink Volume

Especially in endurance exercise such as marathon and triathlons, is not uncommon to see an increased incidence of GI symptoms associated with food and beverage intake before and during exercise. PURPOSE: To investigate the effect of two volume of carbohydrate-electrolyte (CHO) drink according to the body mass (BM) during one-our running performance on the gastrointestinal (GI) tract and to verify if BM could be an optional parameter of fluid replacement. METHODS: Thirty-two individuals;16 men (23.3 ± 1.3 years) and 16 women(21.7 ± 1.7 years) performed three runs on a treadmill at 75% VO2max during 60 min. In this time, the subjects drank a 6% CHO solution in set volumes of 2 or 3 mL. kg-1 BM (LV and HV; respectively) every 15 minutes. GI complaints were evaluated by a short questionnaire requested to verbally answer at every 15 minutes. Glycemia, ratings of perceived exertion (RPE), and thirst sensation were also evaluated at this same period of time. RESULTS: The most occurrences of GI complaints were observed in men than women. The most frequency of GI complaints was related at 45 and 60 min. The most frequent symptom in HV was urging to urinate indicated by 75% men at 60 min and 81.2% women at 45 min. In LV this perceptual were of 62.5% and 50% for men and women respectively. There were no register of severe symptoms for women in all the trials and for men during LV trial. Only one man in HV indicated a score 6 for severe symptoms (stomach problems, bloated feeling and stomach cramps) from 30 minutes. At 15 min both in HV and in LV was observed the lower glycemic mean for men (5.19 ± 0.57 mmol.L-1; 5.16 ± 0.72 mmol.L-1 respectively) and women (5.06 ± 0.61 mmol.L-1; 4.83 ± 0.46 mmol.L-1). At 60-min LV women presented a light lower thirst sensation than men (p = 0.02). In all the trials RPE was higher (p < 0.001) at 60 min than at 15 min and at 45 min than at 30 min. CONCLUSION: The data demonstrate that ingestion of 2 or 3 mL.kg-1 BM of a 6% CHO drink at every 15-min during 60-min run is effective in maintenance of blood glucose and did not caused severe GI symptoms that would compromise performance and health, presuming that, the use of body mass as an optional parameter of fluid replacement is rising such as practical and nonaggressive method for studies involving the GI tract.

Health and environmental assessment of mercury exposure in a gold mining community in Western Mindanao, Philippines

The small-scale gold mining activities using mercury began in the late 1980s in Sibutad, Western Mindanao. It is located very near the Murcielagos Bay with tailing ponds directly discharging into bodies of water. This cross-sectional study aimed to determine the health and environmental effects of gold mining activities on the community. Residents were randomly selected and classified into two groups, namely, the directly exposed and indirectly exposed populations using a set inclusion criteria. Complete medical and laboratory examinations were performed. Environmental and biologic samples were collected for total mercury and methylmercury determinations. The results showed that the directly exposed group had significantly higher mean blood total mercury and methylmercury levels in comparison with the indirectly exposed population. Although there were no significant differences between hair total mercury and methylmercury levels, there was a trend for higher levels of these biomarkers among the directly exposed residents as compared with the unexposed group. The absence of statistically significant differences may be attributable to the small sample size. Ambient air quality monitoring for mercury exceeded the allowable levels. However, levels of mercury in drinking water and sediments were within allowable limits. Frequency of gastrointestinal complaints was significantly associated with elevated hair methylmercury levels ( p=0.02). Also, there appears to be a trend towards higher blood total mercury levels and frequency of gastrointestinal complaints ( p=0.09). An interesting finding in this study was the increasing incidence of elevated diastolic blood pressure with elevated hair total mercury levels ( p=0.07). Mercury storage at home is a risk factor.

Plazebokontrollierte Studie zur Wirkung einer standardisierten MORA-Bioresonanztherapie auf funktionelle Magen-Darm-Beschwerden

Hintergrund und Fragestellung: Über die positive Wirkungder MORA-Bioresonanztherapie bei psychosomatischen Beschwerdenwird von vielen naturheilkundlich orientiertenPraktikern und in einer unkontrollierten Studie berichtet. Dievorliegende plazebokontrollierte Studie prüft die Auswirkungender MORA-Bioresonanztherapie auf nichtorganischeMagen-Darm-Beschwerden. Patienten und Methode: Eswurde eine randomisierte, plazebokontrollierte Studie mit20 Versuchspersonen (10 in der Plazebogruppe, 10 in derVerumgruppe) in einer internistischen Arztpraxis durchgeführt.Primäre Zielkenngrössen waren die Patienteneinschätzungund die Therapeuteneinschätzung der Intensitätund Häufigkeit der Magen-Darm-Beschwerden und diedurch den Therapeuten erfassten Untersuchungsbefunde:palpatorisch erfasster Bauchschmerz, perkutorisch erfassterMeteorismus und auskultatorisch erfasste Darmgeräuschevor und nach der Behandlungsserie. Sekundär wurde der Effektder MORA-Bioresonanztherapie auch anhand von elektrischenLeitwertmessungen an Händen und Füssen, anhandvon bestimmten Stuhl-, Urin- und Blutparametern undanhand des subjektiven, körperlich-seelisch-geistigen Allgemeinzustandsüberprüft. Ergebnisse: Nach Einschätzungender Patienten und des Therapeuten verbesserten sich dieMagen-Darm-Beschwerden in der Verumgruppe deutlichund signifikant (p < 0,01). Dies galt auch für den palpatorischerfassten Bauchschmerz (p < 0,01) und den perkutorischerfassten Meteorismus (p < 0,05) in der Verumgruppe,allerdings nicht für die Darmgeräusche (p > 0,05). In der Plazebogruppezeigte sich in den Zielkenngrössen nur eine kleinemittlere Verbesserung (p > 0,05). Schlussfolgerung: DieMORA-Bioresonanztherapie verbessert deutlich nichtorganischeMagen-Darm-Beschwerden.Placebo Controlled Study on the Effects of a StandardizedMORA Bioresonance Therapy on Functional Gastro-Intestinal Complaints

Esophageal Disease in Patients with AIDS: Diagnosis and Treatment

Patients with HIV infection often present with symptoms suggesting esophageal disease: these include odynophagia (pain with swallowing), dysphagia (difficulty in swallowing), and retrosternal chest pain. Esophageal symptoms rank second only to diarrhea in frequency of gastrointestinal complaints among patients with AIDS. Also, esophageal opportunistic infections have been associated with a poor outcome, the mean survival after diagnosis being less than 6 months in one study. Such short survival may be explained by the underlying immunosuppression, as well as a decrease in nutritional intake due to difficulty swallowing.