Functional Abdominal Disorders Research Articles

Fecal Calprotectin Elevations Associated with Food Intolerance/Malabsorption Are Significantly Reduced with Targeted Diets.

Inflammatory bowel disease (IBD) involves two clinically defined entities, namely Crohn's disease and ulcerative colitis. Fecal calprotectin (FCAL) is used as a marker to distinguish between organic IBD and functional bowel disease in disorders of the irritable bowel syndrome (IBS) spectrum. Food components may affect digestion and cause functional abdominal disorders of the IBS spectrum. In this retrospective study, we report on FCAL testing to search for IBD in 228 patients with disorders of the IBS spectrum caused by food intolerances/malabsorption. Included were patients with fructose malabsorption (FM), histamine intolerance (HIT), lactose intolerance (LIT), and H. pylori infection. We found elevated FCAL values in 39 (17.1%) of 228 IBS patients with food intolerance/malabsorption and H. pylori infection. Within these, fourteen patients were lactose intolerant, three showed fructose malabsorption, and six had histamine intolerance. The others had combinations of the above conditions: five patients had LIT and HIT, two patients had LIT and FM, and four had LIT and H. pylori. In addition, there were individual patients with other double or triple combinations. In addition to LIT, IBD was suspected in two patients due to continuously elevated FCAL, and then found via histologic evaluation of biopsies taken during colonoscopy. One patient with elevated FCAL had sprue-like enteropathy caused by the angiotensin receptor-1 antagonist candesartan. When screening for study subjects concluded, 16 (41%) of 39 patients with initially elevated FCAL agreed to voluntarily control FCAL measurements, although symptom-free and -reduced, following the diagnosis of intolerance/malabsorption and/or H. pylori infection. After the initiation of a diet individualized to the symptomatology and eradication therapy (when H. pylori was detected), FCAL values were significantly lowered or reduced to be within the normal range.

Is Celiac Disease Testing Necessary in Functional Abdominal Disorders? A Study in Predominantly Latino Children.

Functional abdominal pain disorders (FAPDs) are among the most common causes of consultation in general pediatrics and pediatric gastroenterology. The Rome IV criteria recommend testing for celiac disease (CD) in children with irritable bowel syndrome-diarrhea (IBS-D) and leaves testing in cases of other FAPDs to the practitioner's discretion. These recommendations were based on a single study that showed a 4-fold increase of CD among patients with IBS in Italy. It is unclear if these findings can be extrapolated to other populations. Understanding whether those results are reproducible in areas with different racial/ethnic backgrounds can optimize patient care. The aim of the study was to assess the prevalence of CD in a sample of children consulting for FAPDs to a tertiary care center in Miami. The charts of all pediatric patients consulting for FAPDs from January 2016 to November 2019 at the University of Miami were reviewed. Demographics, diagnosis, and CD testing for each child were analyzed. One hundred eighty-one children with FAPDs and celiac testing were seen. Mean age of 12.89 years, girls 61.34%. 84 (46.40%) had a diagnosis of IBS and 97 (53.59%) had a diagnosis of other FAPD. One of 181 children with FAPDs (0/84 with IBS and 1/97 with other FAPDs) had positive CD serological testing and EGD confirmation. Our study suggests that the prevalence of CD among children with FAPDs is similar to the community prevalence. This data questions the benefit of testing all children FAPDS (including IBS) for CD. Studies with larger sample size and various racial/ethnic makeup should be done to confirm our findings.

Gallbladder motility in children with chronic functional abdominal pain

Background: Chronic abdominal pain is a common gastrointestinal symptom in children that significantly lowers their quality of life. In adults, Gall bladder (GB) hypomotility / dyskinesia is associated with many functional abdominal disorders but there is scarcity of evidence on its role in childhood gastro-intestinal disorders. Aim of the study is to evaluate the GB motility in children with chronic functional abdominal pain (FAP).Methods: Children aged 5-15 years with chronic abdominal pain fulfilling ROME-III criteria and healthy controls were included and all study participants were subjected to ultrasonographic evaluation of the gall bladder volume in fasting state and post - Fatty test meal (FTM) and its ejection fraction was calculated.Results: Sixtysix children including 31 with chronic FAP underwent sonographic evaluation for GB motility. The mean ejection fraction (EF) of cases and controls were 51.72±17.76% and 57.3±23.26% (p value - 0.158). The mean EF of cases with upper abdominal pain and lower/peri-umbilical abdominal pain were 41.7±17.1% and 57.2±15.9% respectively (p value < 0.0001). Increasing BMI had no significant association with GB motility among the participants.Conclusions: There is lack of significant association between children with chronic FAP and GB hypomotility. Children with upper abdominal pain have lesser GB EF, suggesting a possible abnormal GB motility.

Overlap between functional abdominal pain disorders and organic diseases in children.

Functional abdominal pain disorders are highly prevalent in children. These disorders can be present in isolation or combined with organic diseases, such as celiac disease and inflammatory bowel diseases. Intestinal inflammation (infectious and non-infectious) predisposes children to the development of visceral hypersensitivity that can manifest as functional abdominal pain disorders, including irritable bowel syndrome. The new onset of irritable bowel syndrome symptoms in a patient with an underlying organic disease, such as inflammatory bowel disease, is clinically challenging, given that the same symptomatology may represent a flare-up of the inflammatory bowel disease or an overlapping functional abdominal pain disorder. Similarly, irritable bowel syndrome symptoms in a child previously diagnosed with celiac disease may occur due to poorly controlled celiac disease or the overlap with a functional abdominal pain disorder. There is little research on the overlap of functional abdominal disorders with organic diseases in children. Studies suggest that the overlap between functional abdominal pain disorders and inflammatory bowel disease is more common in adults than in children. The causes for these differences in prevalence are unknown. Only a handful of studies have been published on the overlap between celiac disease and functional abdominal pain disorders in children. The present article provides a review of the literature on the overlap between celiac disease, inflammatory bowel disease, and functional abdominal pain disorders in children and establish comparisons with studies conducted on adults.

Overlap between functional abdominal pain disorders and organic diseases in children

Functional abdominal pain disorders are highly prevalent in children. These disorders can be present in isolation or combined with organic diseases, such as celiac disease and inflammatory bowel diseases. Intestinal inflammation (infectious and non-infectious) predisposes children to the development of visceral hypersensitivity that can manifest as functional abdominal pain disorders, including irritable bowel syndrome. The new onset of irritable bowel syndrome symptoms in a patient with an underlying organic disease, such as inflammatory bowel disease, is clinically challenging, given that the same symptomatology may represent a flare-up of the inflammatory bowel disease or an overlapping functional abdominal pain disorder. Similarly, irritable bowel syndrome symptoms in a child previously diagnosed with celiac disease may occur due to poorly controlled celiac disease or the overlap with a functional abdominal pain disorder. There is little research on the overlap of functional abdominal disorders with organic diseases in children. Studies suggest that the overlap between functional abdominal pain disorders and inflammatory bowel disease is more common in adults than in children. The causes for these differences in prevalence are unknown. Only a handful of studies have been published on the overlap between celiac disease and functional abdominal pain disorders in children. The present article provides a review of the literature on the overlap between celiac disease, inflammatory bowel disease, and functional abdominal pain disorders in children and establish comparisons with studies conducted on adults.

Persistent Abdominal Symptoms in US Adults After Short‐Term Stay in Mexico

Postinfectious irritable bowel syndrome (PI-IBS) has been reported as a complication of bacterial diarrhea including travelers' diarrhea (TD). This study assessed the role of TD among US students in Mexico in triggering the onset of persistent abdominal symptoms (PAS) and IBS. We conducted a 6-month follow-up of a cohort of 817 US students in Mexico as short-term study to assess the frequency of PAS and IBS. Using Rome II criteria for IBS, groups of students with PAS were then categorized as PI-IBS if they met the symptom criteria for IBS or as suffering from functional abdominal disorder (FAD) if they did not meet the criteria. FAD and IBS were commonly found in US students 6 months after leaving Mexico. Important variables in their development were younger adult age, longer stays in Mexico and occurrence of acute diarrhea while in Mexico. Diarrhea while in Mexico occurred more commonly for those later diagnosed with FAD, 101/196 (52%), relative risk (RR) = 1.5 [confidence interval (CI) 1.2-1.8; p = 0.001]; IBS, 20/32 (63%), RR = 2.5 (CI 1.2-5.0; p = 0.007); and PAS (FAD + IBS), 121/228 (53%), RR = 1.5 (CI 1.2-1.8; p < 0.001) compared with subjects who had experienced diarrhea while in Mexico but were not diagnosed with PAS at 6 months, 227/589 (39%). Diarrhea caused by heat-labile enterotoxin-producing enterotoxigenic Escherichia coli or Providencia ssp. demonstrated a greater risk of developing PAS. PAS occurred commonly in a subset of younger adult travelers who stayed longer in Mexico and experienced acute diarrhea while there. Further studies with this cohort will focus on host genetic associations with the development of PAS.

Bildgebung bei unspezifischen Abdominalbeschwerden

Functional abdominal disorders are predominantly diagnosed on the basis of a thorough history and clinical examination. It is a challenge to clinicians to define the adequate place of imaging studies in order to rule out relevant organic disease. In functional dyspepsia, oesphago-gastroduodensoscopy and abdominal ultrasound are widely used as first line studies. Although irritable bowel syndrome is mainly diagnosed on clinical grounds, in patients over 50 years of age colonoscopy is almost mandatory, taking into account the importance of screening for colorectal cancer. In constipation-dominant irritable bowel syndrome, a marker study to determine colonic transit time will be helpful to differentiate this disorder from true slow transit constipation. Chronic or recurrent abdominal pain often warrants abdominal CT scan. Select cases are referred for laparoscopy.

Non-ulcer Dyspepsia and Duodenal Eosinophilia: An Adult Endoscopic Population-Based Case-Control Study

Functional abnormalities of the duodenum have been observed in non-ulcer dyspepsia. We aimed to identify whether eosinophils in the upper gastrointestinal tract are a biomarker for non-ulcer dyspepsia. A random sample of an adult Swedish population (n = 1001; mean age, 54 y; 51% female) underwent upper endoscopy. Non-ulcer dyspepsia cases (n = 51, Rome II) and randomly selected controls (n = 48) were identified. Two blinded independent observers assessed the gastroduodenal eosinophil counts. Eosinophils were quantified by counting the number per 5 high-power fields at each of 5 sites (cardia, body, antrum, D1 duodenal bulb, and D2 second portion of duodenum), and total counts were summed over the 5 fields at each site. The odds ratio for non-ulcer dyspepsia (vs asymptomatic controls) in subjects with high duodenal bulb eosinophil counts (median, >/=22, relative to <22) was 11.7 (95% confidence interval, 3.9-34.9), adjusting for age, sex, and H pylori; similar results were observed in D2 (odds ratio = 7.3; 95% confidence interval, 2.9-18.1). A significant association with the number of eosinophil clusters was detected in the duodenum, with higher values in non-ulcer dyspepsia (P < .01). By immunostaining with major basic protein antibody in a subset of duodenal biopsy specimens, eosinophil degranulation was observed in non-ulcer dyspepsia (7 of 15 vs 0 of 5 controls; P = .11). Gastric eosinophil counts were overall not significantly increased in non-ulcer dyspepsia vs controls. Early satiety was associated with eosinophilia in D1 (P = .01) and D2 (P = .02), adjusting for age, sex, and H pylori. Duodenal eosinophilia may characterize a subset of adults with non-ulcer dyspepsia.

Whistler Summary: “The Slow Rate of Rapid Progress”

Whistler Summary: “The Slow Rate of Rapid Progress”

Corrigendum: Natural History of Gastroesophageal Reflux Disease and Functional Abdominal Disorders: A Population-Based Study.

Natural history of gastroesophageal reflux disease and functional abdominal disorders: a population-based study

Natural history of gastroesophageal reflux disease and functional abdominal disorders: a population-based study.

Symptomatic gastroesophageal reflux disease (GERD), dyspepsia, and irritable bowel syndrome (IBS) are generally considered to be chronic conditions, but community-based studies are sparse, and long-term natural history data are unavailable. We aimed to determine the natural history of these conditions. A representative Swedish sample (20-79 yr) completed a validated questionnaire over the preceding 3 months. The survey was repeated after 1 and 7 yr in the same target group (n = 1290, 1260, and 1065; response rates 90%, 87%, and 82%, respectively; 79% responded to all three mailings). The prevalence of GERD symptoms remained stable, whereas the prevalence of IBS increased over time, independent of aging. Dyspepsia decreased with advancing age. Although more than half of those with IBS reported the same symptom profile after 1 and 7 yr, there was a substantial symptom fluctuation and symptom profile flux between those reporting dyspepsia, IBS, or minor symptoms. Only a minority with GERD (<10%) changed to dyspepsia and/or IBS, or vice versa. The symptom-free patients remained symptom-free or reported only minor symptoms in > or = 90% of cases. There seem to be two distinct populations of symptom reporters, those with dyspepsia or IBS, and those with GERD.

Natural history of gastroesophageal reflux disease and functional abdominal disorders: a population-based study

OBJECTIVE: Symptomatic gastroesophageal reflux disease (GERD), dyspepsia, and irritable bowel syndrome (IBS) are generally considered to be chronic conditions, but community-based studies are sparse, and long-term natural history data are unavailable. We aimed to determine the natural history of these conditions. METHODS: A representative Swedish sample (20–79 yr) completed a validated questionnaire over the preceding 3 months. The survey was repeated after 1 and 7 yr in the same target group (n = 1290, 1260, and 1065; response rates 90%, 87%, and 82%, respectively; 79% responded to all three mailings). RESULTS: The prevalence of GERD symptoms remained stable, whereas the prevalence of IBS increased over time, independent of aging. Dyspepsia decreased with advancing age. Although more than half of those with IBS reported the same symptom profile after 1 and 7 yr, there was a substantial symptom fluctuation and symptom profile flux between those reporting dyspepsia, IBS, or minor symptoms. Only a minority with GERD (<10%) changed to dyspepsia and/or IBS, or vice versa. The symptom-free patients remained symptom-free or reported only minor symptoms in ≥90% of cases. CONCLUSION: There seem to be two distinct populations of symptom reporters, those with dyspepsia or IBS, and those with GERD.

The Role of Motility in Functional Abdominal Disorders in Children

The Role of Motility in Functional Abdominal Disorders in Children

Evidence of central neuronal sensitization associated with colorectal hypersensitivity in an animal model of the irritable bowel syndrome

Central sensitization is one of the mechanisms proposed to explain the development and spread of secondary hypersensitivity following tissue injury. It accompanies skin, joint as well as visceral organ inflammation, but as yet was not evidenced in functional abdominal disorders. Aim: In this study, we use electrophysiological means to test the hypothesis that colorectal hypersensitivity in a new animal model of chronic functional visceral pain is associated with central neuronal sensitization. Methods: Experiments were done on 20 adult male Sprague Dawley rats (300-350 gms). Thirteen rats received colon irritation as neonates (Colorectal distension: CRD, n=6; Mustard Oil: MO, n=7) and developed chronic visceral hypersensitivity to CRD and 7 rats served as controls. Under anesthesia (Pentobarbital 50 mglkg, ip followed by 5mg/kglhr, iv), a laminectomy was made to expose the spinal cord at the level of the L6-SI segments. Extracellular single neuron recordings were made using a high impedance tungsten microelectrode. Isolated neurons were tested with a range of CRD (20, 40, 60 and 80 mmHg) induced by inflating a balloon inserted rectally into the descending colon. The responses of the colonsensitive neurons to CRD and to somatic stimulation were recorded and compared between groups. Results: A total of 67 neurons (Control, n=25; CRD, n= 19; MO, n=22) were isolated in the gray matter of the spinal cord at the level of L6-SI and were tested with graded CRD and somatic stimulation. The distribution of the somatic receptive fields was similar in all groups. Neurons isolated in rats with neonatal colon irritation (both groups) showed on average a significantly higher baseline activity (24.7+/2.8) compared to neurons in control rats(6.8 +/1.3) in addition to significantly higher responses to CRD and somatic stimulation (p<0.05). Conclusions: Our results indicate that in rats, chronic visceral hypersensitivity residual to neonatal colon irritation is associated with central neuronal sensitization manifested by a heightened baseline firing rate and increased responses to CRD and somatic stimulation. Reducing this neuronal sensitization may be a promising start to target chronic visceral pain.

Stress and gastrointestinal motility in animals: a review of the literature

AbstractIn the last decade an increasing number of studies have been published dealing with the effects of experimental stress on gastrointestinal functions in animals and humans. Initial interest in gastrointestinal stress responses in the late 1940s and early 1950s1 was followed by continued interest only in experimental ulcer research.2 The recent ‘revival’ of interest in stress is due to some methodological progress: first, our understanding of gastrointestinal functions, specifically gastrointestinal motility has grown after new measurement techniques became widely available to enable gastrointestinal stress effects to be determined directly‐instead of its indirect outcome such as stool frequency or gastrointestinal symptoms. Second, interest has grown in functional abdominal disorders such as the irritable bowel syndrome or non‐ulcer dyspepsia, which are often believed to be, at least in part, stress related.3 Finally, stress has become a major paradigm by which to investigate brain‐gut interactions, specifically with respect to the yet unanswered question of the extent of autonomy or CNS control to regulate gastrointestinal functions.4Our review is split into two parts. The first part focused on clinical aspects in human studies.1 This part will deal with animal studies and discusses their relevance with respect to basic research questions.

Associations between symptoms of irritable colon and psychological and social conditions and lifestyle.

In a survey of risk factors for coronary heart disease 14 102 middle aged men and women answered a questionnaire on lifestyle, diet, and health, including symptoms of functional abdominal disorders. The overall prevalence of reports of one or both of the abdominal symptoms of "bloating and rumbling" or "cramping abdominal pain" was 28% in men and 35% in women. Only a weak negative association between age and prevalence of reported pain was found in both sexes. Women reported abdominal symptoms, especially cramping abdominal pain, significantly more commonly than men. In a multiple regression analysis abdominal symptoms were much more strongly associated with symptoms of mental stress such as depression, sleeping difficulties, problems of coping, and the use of analgesics than with lifestyle, dietary, and social variables together. The association was stronger in subjects reporting both symptoms. This strong and consistent association between functional abdominal disorders and psychological and social problems suggests that action other than prescribing drugs, diets, or radiography is required.

The Doctor-Patient Relationship in the Practice of Medicine

The patient-doctor relationship is based on the principles of interaction, collecting data and integration of both interaction and data into an overall diagnosis/therapy. Patients with functional abdominal disorders are seen as representatives of today's general patients and a study of their management in present medical practice is reported, as revealed through literature. The literature reveals an almost complete neglect of intractional and intergrational principles. This holds true even for psychosomatically oriented literature, which offers some crude clinical guidelines at best. Thus the primary physician gets little support from psychosomatic medicine in understanding the full meaning of the doctor-patient relationship. The clinical implications of the relationship are demonstrated through a short case history and implications for future training are described which are based on the primary physician's actual working experiences.