Functional Bowel Disease Research Articles

S2472 A Case of Functional Bowel Disease Misdiagnosed as Carcinoid Syndrome

Introduction: Carcinoid tumor is a well-differentiated neuroendocrine tumor (NET) that arises from enterochromaffin cells. NETs produce serotonin which is metabolized to the inactive 5-hydroxyindoleacetic acid (5-HIAA) by the liver and the lungs. Carcinoid syndrome results from the secretion of serotonin into the systemic circulation by a metastatic NET that originates from the midgut. The primary screening method for carcinoid syndrome is 24-hour urinary 5-HIAA (U-5HIAA) which has a 90 percent sensitivity and specificity in diagnosing carcinoid syndrome. This case illustrates a unique scenario of a markedly elevated U-5HIAA not due to NET. Case Description/Methods: A 29-year-old female presented to our clinic with abdominal pain, bloating, diarrhea, and weight loss associated with postprandial facial flushing. Medications included Dextroamphetamine and Fremanezumab. Based on her symptoms, U-5HIAA was ordered and was elevated at 148 mg (normal < 6). Carcinoid Syndrome was suspected based on symptoms and markedly elevated U-5HIAA. Imaging studies were ordered to identify primary or metastatic NET. These included negative CT abdomen/pelvis and a negative Ga68 Dotatate NETSPOT PET scan. Upper endoscopy and Colonoscopy were also negative. The patient expressed difficulty in stopping dextroamphetamine for the urine collection but due to the negative evaluation for NET she finally agreed to hold it for 3 days. Repeat U-5HIAA decreased down to 10.4 mg. Her symptoms were then believed to be secondary to functional bowel disease. The patient’s symptoms improved with mirtazapine and dicyclomine, and she regained the weight. Discussion: This is a unique case with a misleading U-5HIAA. While mildly elevated levels of U-5HIAA can be seen with tryptophan rich foods and certain drugs, including amphetamines, marked elevation, like in our case is more specific and usually seen with the carcinoid syndrome. Our patient had symptoms suspicious of carcinoid syndrome and a U-5HIAA of 148 mg, which is 25 times the upper normal. However, there was no evidence for NET on extensive work up, and the levels rapidly decreased with stopping dextroamphetamine. To our knowledge, this is the highest falsely positive U-5HIAA reported. This case shows the importance of a complete drug history, including over-the-counter medications. When the 5-HIAA is elevated, the test needs to be repeated after discontinuing all potentially interfering medications.

The low FODMAP diet supported by a mobile application for functional gastrointestinal and inflammatory bowel diseases

Diseases affecting the gastrointestinal tract such as functional gastrointestinal diseases – including irritable bowel syndrome – as well as inflammatory bowel diseases are on the rise in Hungary. More and more nutritional recommendations are emerging as part of the therapy, but so far there is no uniform recommendation for the dietary management of these gastrointestinal diseases. Among the dietary recommendations that have been made so far, the low FODMAP diet is noteworthy. FODMAP itself stands for the abbreviation of the initials of fermentable, short-chain, poorly absorbable carbohydrates: fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP). The low FODMAP diet is a scientifically and clinically proven therapeutic recommendation, which is supported in Hungary by the Ministry of Human Resources Guideline (2020). Research has shown that the low FODMAP diet has been shown to reduce gastrointestinal symptoms. The diet consists of 3 phases, the first of which is a step-by-step list of trigger and non-trigger foods that the doctor, with the help of a dietitian, determines. As this stage of the diet can be the most challenging, it is worth emphasizing that it should be developed in collaboration with a dietitian. The aim of the diet is to find a balance between keeping symptoms at a low level and expanding the diet. Low FODMAP diet has been shown to be an effective, successful, and accepted nutritional intervention in the management of symptoms of functional and inflammatory bowel disease. Its use can improve the success of pharmacological interventions and increase patient compliance, hence the need to expand the widespread dissemination of the diet. A mobile app developed by a research team at Monash University will support self-management and practical implementation of the diet and increase adherence to nutritional therapy.

Overweight and obese patients on gastroenterological visit

The article presents the results of a cross-sectional study conducted at the St. Petersburg City Hospital No. 26 to identify the most common complaints and diseases of the digestive system in overweight and obese patients at gastroenterological appointments. The work analyzed the outpatient admission cards of 298 patients who visited a gastroenterologist. Body mass index (BMI) more than 25 kg/m 2 was determined in 151 (50.67 %) patients. The most common complaints in overweight and obese patients were regurgitation, heartburn, bloating and rumbling in the stomach, diarrhea, morning cough and hoarseness, abdominal pain, feeling of heaviness and fullness after eating, constipation. Gastroesophageal disease was diagnosed in 103 (68.2 %) patients, functional bowel disease with a predominance of diarrhea in 54 (35.76 %) patients, biliary sludge in 54 (35.76 %) patients, non-alcoholic fatty liver disease in 50 (33.11 %), cholelithiasis in 49 (32.45 %), chronic gastritis in 43 (28.47 %), functional constipation in 32 (21.19 %), organic diseases of the colon in 24 (15.89 %), peptic ulcer of the stomach and duodenum in 11 (7.28 %) patients.

Features of the mucous barrier in functional bowel diseases and ulcerative colitis

Background. The intestinal mucosal barrier may change under the influence of exogenous and endogenous factors. Changes in its physical and chemical characteristics are observed in patients with gastrointestinal diseases, such as irritable bowel syndrome, ulcerative colitis, Crohn’s disease, and with other pathologies, such as diabetes mellitus, food allergies, rheumatoid arthritis, etc. Also, the permeability of the intestinal wall was influenced by tight junctions, which are weakened due to eating disorders, psycho-emotional factors, and chemical agents. The purpose of the study was evaluating of changes in the mucosal barrier in patients with functional and inflammatory bowel diseases. Materials and methods. 270 patients with different subtypes of irritable bowel syndrome and 218 patients with ulcerative colitis were examined. Colonoscopy followed by a morphological assessment of biopsy specimens and immunohistochemical studies using markers of claudin 1 and 7, mucins 1, 2, 3, 4, 5AC, and trefoil factors 1–3 was performed in all patients. Results. A decrease in the level of tight junction proteins called claudins was observed in patients with functional bowel disease. Patients with irritable bowel syndrome associated with diarrhea had a lower level of claudin-1 only, while patients with mixed form had also a lower level of claudin-7. A decrease in the level of both secretory and membrane-bound mucins and an increase in the level of the trefoil factors were observed at the same time among the patients with ulcerative colitis which may indicate a dysregulation and a violation of the protective function of mucus. Conclusions. The pathogenesis of a violation of the protective function of the mucosa of functional and inflammatory bowel disease is different, which may determine approaches to the treatment of patients with such pathologies.

Carbohydrate Maldigestion and Intolerance.

This review summarizes dietary carbohydrate intolerance conditions and recent advances on the possible role of carbohydrate maldigestion and dietary outcomes in patients with functional bowel disease. When malabsorbed carbohydrates reach the colon, they are fermented by colonic bacteria, with the production of short-chain fatty acids and gas lowering colonic pH. The appearance of diarrhoea or symptoms of flatulence depends in part on the balance between the production and elimination of these fermentation products. Different studies have shown that there are no differences in the frequency of sugar malabsorption between patients with irritable bowel disease (IBS) and healthy controls; however, the severity of symptoms after a sugar challenge is higher in patients than in controls. A diet low in ‘Fermentable, Oligo-Di- and Monosaccharides and Polyols’ (FODMAPs) is an effective treatment for global symptoms and abdominal pain in IBS, but its implementation should be supervised by a trained dietitian. A ‘bottom-up’ approach to the low-FODMAP diet has been suggested to avoid an alteration of gut microbiota and nutritional status. Two approaches have been suggested in this regard: starting with only certain subgroups of the low-FODMAP diet based on dietary history or with a gluten-free diet.

Effect of berberine on irritable bowel syndrome: A symptom-based review

Phytotherapeutic applications have gained a place in the symptomatic treatment of irritable bowel syndrome, one of the most common diseases globally among functional bowel diseases. This study aimed to compile evidence regarding the efficacy of berberine in relieving the symptoms of irritable bowel syndrome. In this review, the electronic databases of PubMed, Google Scholar, MEDLINE, and Web of Science were used, and current publications were searched without any language restrictions. The screening was performed by first performing a general search using the keyword "berberine and irritable bowel syndrome", followed by individual searches for each symptom. Although there are many preclinical studies investigating the effect of berberine on the gastrointestinal tract, human studies are still limited. Studies show that berberine may positively affect abdominal pain, diarrhea, inflammation, microbiota, and visceral hypersensitivity, although the mechanisms of action are not yet clear. However, available data suggest that the therapeutic use of berberine in irritable bowel syndrome may be limited to the predominant type of diarrhea and selected patients whose symptoms are evaluated individually. Evidence presented in this paper needs to be further supported by human clinical studies.

Factors affecting the use of herbal products in patients with Irritable Bowel Syndrome and their results: case\u2013control study

BackgroundIrritable bowel syndrome (IBS) is a functional bowel disease that is characterized by abdominal pain, discomfort, and changes in the frequency and form of stool without any organic pathology. In this study, the factors that affect the herbal treatment choices of IBS patients and their results were investigated.MethodsIncluded in the study were 248 IBS patients who were over the age of 18. A questionnaire that comprised 25 questions was applied to the participants. Survey questions were asked to the participants regarding their age, place of birth, gender, educational status, demographic details, social standing, socioeconomic status and job, place of residence, and marital status. In addition, The participants were asked about which IBS symptoms they had, from whom they had received the recommendation for use of herbal products, whether the media had an effect on their selection of herbal products, and whether they had benefited from herbal products.ResultsIt was observed that 41.1% of the patients with IBS who participated in the study used herbal medicine, 9.8% of whom used them regularly. It was found that the IBS patients participating in the study made their decision to use herbal products mostly based on the recommendations that they were given by acquaintances (57%) and the media (34%). When the patients were evaluated according to their gender, IBS was found to be more common in unemployed women who had a low level of education, while it was more common in working men (p = 0.015, P < 0.001, respectively). The IBS patients who were single used more herbal products that those who were married (P = 0.036). While the use of herbal herbs and oils was predominant in patients whose recommendation content comprised the media/internet and acquaintances, the herbal treatment content recommended by healthcare professionals consisted of traditional treatments and mixtures (P = 0.012). It was determined that a higher percentage of those who used herbal treatments lived in city centers when compared to those who did not (P < 0.001). In addition, it was determined that patients with constipation used herbal products more than those without (P < 0.001). Among the IBS patients, those who had diarrhea and those who were receiving medical treatment preferred to use significantly less herbal products (P = 0.007 and P = 0.041, respectively). It was found that the patients who visited the Gastroenterology Outpatient Clinic mostly used herbal therapy, while those who visited a family doctor used herbal therapy the least (P = 0.029 and P < 0.001, respectively).ConclusionThe IBS patients revealed whose recommendations they followed when purchasing herbal products, which of the products they preferred, and how useful/beneficial they felt that these products were. In this regard, the addition of training curricula related to herbal treatment for professional healthcare workers will further raise awareness on this topic.

Abnormal resting-state local spontaneous functional activity in irritable bowel syndrome patients: A meta-analysis

Background: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. The current understanding of the pathogenesis underlying IBS is still unclear. Numerous studies have reported local abnormal resting state spontaneous functional activity in IBS patients in widespread brain regions. However, the results have not yet yielded consistent conclusions. Thus, we investigated common spontaneous functional activity abnormalities in patients with IBS by conducting a voxel-based meta-analysis.Methods: Up to December 2021, we performed a systematic search of IBS studies in five databases. These studies investigated the differences of resting state spontaneous brain activity between patients with IBS and healthy controls (HCs). The reference lists of included studies, relevant reviews and meta-analyses were investigated manually. Anisotropic effect-size signed differential mapping (AES-SDM) was applied in this meta-analysis.Results: Twelve studies encompassing 335 patients with IBS and 327 HCs were included in this meta-analysis. The local brain activities of the left calcarine fissure and surrounding cortex, right postcentral gyrus, left postcentral gyrus, left cerebellum, left inferior temporal gyrus, and left inferior frontal gyrus of triangular part in IBS patients were significantly increased compared with HCs, while the brain activities of the left anterior cingulate and paracingulate gyrus, right middle frontal gyrus, right supramarginal gyrus, left middle frontal gyrus, left precuneus, right putamen and right insula were significantly decreased compared with HCs.Conclusion: The current study expands on a growing literature exploring resting state activity in IBS, which provides useful insights for understanding the underlying pathophysiology of nonorganic functional bowel disease and developing more targeted treatment and intervention strategies.

Predictive value of alarm symptoms in Rome IV irritable bowel syndrome: A multicenter cross-sectional study.

BACKGROUNDIrritable bowel syndrome (IBS) is a common functional bowel disease that shares features with many organic diseases and cannot be accurately diagnosed by symptom-based criteria. Alarm symptoms have long been applied in the clinical diagnosis of IBS. However, no study has explored the predictive value of alarm symptoms in suspected IBS patients based on the latest Rome IV criteria.AIMTo investigate the predictive value of alarm symptoms in suspected IBS patients based on the Rome IV criteria.METHODSIn this multicenter cross-sectional study, we collected data from 730 suspected IBS patients evaluated at 3 tertiary care centers from August 2018 to August 2019. Patients with IBS-like symptoms who completed colonoscopy during the study period were initially identified by investigators through medical records. Eligible patients completed questionnaires, underwent laboratory tests, and were assigned to the IBS or organic disease group according to colonoscopy findings and pathology results (if a biopsy was taken). Independent risk factors for organic disease were explored by logistic regression analysis, and the positive predictive value (PPV) and missed diagnosis rate were calculated.RESULTSThe incidence of alarm symptoms in suspected IBS patients was 75.34%. Anemia [odds ratio (OR) = 2.825, 95% confidence interval (CI): 1.273-6.267, P = 0.011], fecal occult blood [OR = 1.940 (95%CI: 1.041-3.613), P = 0.037], unintended weight loss (P = 0.009), female sex [OR = 0.560 (95%CI: 0.330-0.949), P = 0.031] and marital status (P = 0.030) were independently correlated with organic disease. The prevalence of organic disease was 10.41% in suspected IBS patients. The PPV of alarm symptoms for organic disease was highest for anemia (22.92%), fecal occult blood (19.35%) and unintended weight loss (16.48%), and it was 100% when these three factors were combined. The PPV and missed diagnosis rate for diagnosing IBS were 91.67% and 74.77% when all alarm symptoms were combined with Rome IV and 92.09% and 34.10% when only fecal occult blood, unintended weight loss and anemia were combined with Rome IV, respectively.CONCLUSIONAnemia, fecal occult blood and unintended weight loss have high predictive value for organic disease in suspected IBS patients and can help identify patients requiring further examination but are not recommended as exclusion criteria for IBS.

The relationship between hidradenitis suppurativa and irritable bowel syndrome: a cross-sectional study.

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder in which one experiences abdominal pain, tension, cramping, bloating, and changes in the form and frequency of defecation, without an underlying organic disease. Many skin diseases have been reported to be more common in people with functional bowel disease. To our knowledge, however, no previous study investigated the potential relationship between hidradenitis suppurativa (HS) and IBS. In this study, we aimed to examine the potential association between IBS and HS. Patients with HS and healthy subjects were enrolled in this cross-sectional study. All participants were assessed for the presence of IBS. ROME IV criteria were used to identify IBS cases. Hurley staging, modified Sartorius score, and physician's global assessment score were applied to define clinical severity and staging of HS. According to the Rome IV diagnostic criteria, 54 (67.50%) of 80 HS patients and 23 (28.75%) of 80 control group were diagnosed with IBS. The frequency of IBS was statistically significantly higher in the patient group than in the control group (P < 0.001). No statistically significant difference was found between the two groups in terms of abnormal stool frequency and family history of IBS (P = 0.28, P = 0.862, respectively). Abnormal stool form, mucus in stool, abdominal distension, feeling of incomplete evacuation were statistically significantly higher in HS patients compared to the controls (P = 0.01, P = 0.02, P < 0.001, P = 0.001, respectively).

Red cell distribution width-to-platelet count ratio is a promising predictor of functional bowel disease

Red cell distribution width-to-platelet count ratio is a promising predictor of functional bowel disease

Associations of clinical features of functional bowel disorders with gut microbiota characteristics in adolescents: A pilot study

Background. Obesity is a multifactorial disease that is one of the important public health problems in the 21st century. Functional bowel disorders in obese children and adolescents are one of the most common pathologies of the digestive tract. The aim: to characterize the bacteriological composition of the colon microbiota in obese adolescents and identify its associations with the clinical manifestations of functional bowel disorders.Materials and methods. The study included 20 adolescents aged 11–17 years. Stool consistency was assessed using the Bristol Stool Scale. The study of biological material was carried out using standard bacteriological methods. To assess the strength of the relationship between the nominal variables, Cramer’s V test was used.Results. It has been shown that in adolescents with obesity and functional bowel disorders, there is a decrease in the number of representatives of bifidoflora, an increase in the microbial density of Escherichia coli with altered enzymatic properties and an excessive growth of potentially pathogenic enterobacteria. In obese adolescents with functional bowel disorders, abdominal pain associated with the act of defecation is associated with the presence of enterobacteria and E. coli with altered enzymatic properties. Rare bowel movements are associated with an increased abundance of Enterococcus spp. and the presence of opportunistic Enterobacteriaceae microorganisms. Frequent bowel movements are associated with the presence of E. coli with altered enzymatic properties and Clostridium spp. In the presence of loose stool, Clostridium spp. is present; unstable stool (alternation of hard and liquid stools in one patient) is associated with a decrease in the number of lactobacilli and E. coli with normal enzymatic properties, the appearance of E. coli with altered enzymatic properties, opportunistic microorganisms of Enterobacteriaceae family and Clostridium spp. Conclusion. The relationship between the clinical symptoms of functional bowel disorders and changes in the composition of the gut microbiota in obese adolescents may be a justification for conducting in-depth studies aimed at finding early predictors of functional bowel diseases associated with obesity in the adult cohort.

Clinical and metabolic effects of metaprebiotic therapy for some functional bowel diseases

Aim of investigation: to assess the effectiveness and tolerance of dietary supplements (BAA) STIM and STIM LaxMaterials and methods: The analysis of the treatment of 73 patients who were divided into 2 groups. Group 1-32 patients with functional constipation (8 men and 24 women; mean age — 45.7 ± 12.4 years), Group 2-41 patients with functional diarrhea (19 men and 22 women; mean age — 41.0 ± 15,8 years). The study of clinical symptoms was carried out according to the data of an individual diary, using specialized questionnaires with a scoring of symptoms before and after the course of treatment, before and after treatment, the result of the carbolene test, the content of short-chain fatty acids in the feces was assessed. Tolerability was assessed by recording side effects and adverse events.Monotherapy was carried out with STIM LAX for patients with functional constipation at a dose of 1 tablet 3 times a day for 30 days. STIM for patients with functional diarrhea was prescribed in a dose of 2 tablets 3 times a day for 30 days.Results of the study: The results of the study showed that FC therapy with StimLax effectively reduces the frequency and intensity of symptoms such as difficulty / pain, discomfort during defecation, feeling of incomplete emptying, abdominal pain, time spent in the toilet and the number of failed bowel movements. We observed the normalization of transit time according to the carbolene test and an increase in stool frequency up to 5 times a week.Treatment of patients with FD with Stim led to a significant decrease in the intensity of abdominal pain, rumbling, flatulence, stool frequency, an increase in the time of the carbolene test and the normalization of its consistency.Adverse events were observed in 8 (10.9%) patients (4 patients with FD and 4 patients with FD). On the 3-5th day of treatment, there was an increase in flatulence, rumbling in the abdomen. A temporary decrease in the dose of the drug to 1-2 tablets per day removed these phenomena and the symptoms that appeared were resolved within 1-3 days. After that, the dose of the drug was gradually increased to the initial (effective), which the patients tolerated normally.Conclusions: The results of this study indicate high clinical efficacy and good tolerability of treatment with drugs StimLax and Stim in patients with FC and FD. In some cases, it is necessary to titrate the dose of the drug (downward), but this is not accompanied by a decrease in the effectiveness of therapy. The use of these drugs with metaprebiotic properties helps to modify the microbiota of patients with functional bowel diseases. With constipation, the number and activity of both lactic acid flora and microorganisms that produce butyric acid are stimulated; in addition, calcium lactate is an additional source of butyric acid due to metabolism. With diarrhea, along with the stimulation of the number and activity of the lactic acid flora, there is an improvement in the utilization of butyrate by intestinal cells.

Association between Insomnia and Irritable Bowel Syndrome among Adolescents in South Korea: A Quantitative Cross-Sectional Study

Insomnia refers to having difficulty sleeping even when given the opportunity and environment to sleep. Irritable bowel syndrome is a functional bowel disease that is accompanied by abdominal pain and irregular defecation but not organic lesions. Although insomnia and irritable bowel syndrome are pathophysiologically related, studies on their relationship among adolescents are lacking. This study aimed to determine the prevalence of insomnia and irritable bowel syndrome among adolescents and the association between them. In May 2021, a survey was conducted among high school adolescents from Daegu Metropolitan City, South Korea, using the Korean version of the Insomnia Severity Index and the Rome IV diagnostic criteria for irritable bowel syndrome. Data were analyzed using chi-square and Mann–Whitney tests and logistic regression analyses. The incidence of insomnia (Insomnia Severity Index score ≥ 10) was 18.4% (n = 74) while that of irritable bowel syndrome was 10.7% (n = 43). Irritable bowel syndrome was strongly associated with an increased incidence of insomnia (odds ratio = 3.30, 95% confidence interval: 1.66–6.53). Therefore, the association between insomnia and irritable bowel syndrome has relevance in the treatment of insomnia in adolescents.

The effectiveness of herbal acupoint application for functional diarrhea: Protocol for a meta-analysis and data mining.

Background:Functional diarrhea (FDr), one of the most common functional gastrointestinal diseases, is a kind of functional bowel disease characterized by repeated paste feces or watery feces. However, no relevant systematic review or meta-analysis has been designed to evaluate the effects of herbal acupoint application (HAA) on FDr. There is also a lack of systematic evaluation and analysis of acupoints and herbs.Methods:We will search the following 8 databases from their inception to October 15, 2021, without language restrictions: the Cochrane Central Register of Controlled Trials, PubMed, Embase, the Web of Science, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database, the Wan-Fang Database, and the China National Knowledge Infrastructure. The primaryoutcome measures will be clinical effective rate, functional outcomes, and quality of life. Data that meets the inclusion criteria will be extracted and analyzed using RevMan V.5.3 software (Available at: https://community.cochrane.org/help/tools-and-software/revman-5). Two reviewers will evaluate the studies using the Cochrane Collaboration risk of bias tool. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to assess the overall quality of evidence supporting the primary outcomes. We will also use SPASS software (Version 19.0 (Available at: https://www.ibm.com/analytics/spss-statistics-software)) for complex network analysis to explore the potential core prescription of acupoint herbal patching for FDr.Results:This study will analyze the clinical effective rate, bristol stool scale, number of daily bowel movements, clinical symptom scale of diarrhea, and effective prescriptions of HAA for patients with FDr.Conclusion:The conclusion of our findings will provide evidence for the effectiveness and potential treatment prescriptions of HAA for patients with FDr.

COVID-19 as a trigger of irritable bowel syndrome: A review of potential mechanisms.

In December 2019 a novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), started spreading from Wuhan city of Chinese Hubei province and rapidly became a global pandemic. Clinical symptoms of the disease range from paucisymptomatic disease to a much more severe disease. Typical symptoms of the initial phase include fever and cough, with possible progression to acute respiratory distress syndrome. Gastrointestinal manifestations such as diarrhoea, vomiting and abdominal pain are reported in a considerable number of affected individuals and may be due to the SARS-CoV-2 tropism for the peptidase angiotensin receptor 2. The intestinal homeostasis and microenvironment appear to play a major role in the pathogenesis of COVID-19 and in the enhancement of the systemic inflammatory responses. Long-term consequences of COVID-19 include respiratory disturbances and other disabling manifestations, such as fatigue and psychological impairment. To date, there is a paucity of data on the gastrointestinal sequelae of SARS-CoV-2 infection. Since COVID-19 can directly or indirectly affect the gut physiology in different ways, it is plausible that functional bowel diseases may occur after the recovery because of potential pathophysiological alterations (dysbiosis, disruption of the intestinal barrier, mucosal microinflammation, post-infectious states, immune dysregulation and psychological stress). In this review we speculate that COVID-19 can trigger irritable bowel syndrome and we discuss the potential mechanisms.

Irritable Bowel Syndrome in Dialysis Patients and Symptom Check List Revised (SCL 90-R) Screening.

Irritable bowel syndrome (IBS) is a frequently seen functional bowel disease. Although not lifethreatening, it impairs quality of life and leads to economic losses. IBS symptoms are widespread in dialysis patients. Psychopathological disorders are known to increase in both IBS and dialysis patients. The purpose of this study was to investigate the prevalence of IBS, IBS-related factors, and psychopathological disorders in patients. One hundred fifty patients followed-up in hemodialysis (HD) or peritoneal dialysis (PD) programs were included in this prospective study. Patients were divided into groups with and without diagnoses of IBS based on the Rome-III diagnostic criteria. The Symptom Check List Revised (SCL90-R) test was then applied to the patients. Patients with and without IBS were compared according to the scores obtained from the questionnaire. IBS was determined in 59 (39.3%) of the dialysis patients. The prevalence of IBS was significantly higher in women (P = .030). The presence of coronary artery disease (CAD) and use of erythropoietin (EPO) were significantly higher in patients with IBS (P = .029, P = .031). Somatization, obsessive-compulsive disorder, interpersonal sensitivity, depression, anxiety, phobic anxiety, psychoticism, and additional items were also higher in patients with IBS. Subscale scores for somatization, depression, and additional parameters in dialysis patients with IBS were above the threshold values for screening. IBS is common in dialysis patients. The presence of CAD or use of EPO were frequently observed in dialysis patients with IBS, and psychopathologies in depression, somatization, and additional subparameters were also higher in these patients.

Vitamin D Supplementation and Mental Health in Inflammatory Bowel Diseases and Irritable Bowel Syndrome Patients: A Systematic Review.

Inflammatory bowel diseases (IBDs) and irritable bowel syndrome (IBS) are associated with decreased quality of life and mental health problems. Among various approaches to supportive therapy that aims to improve mental health in affected individuals, vitamin D supplementation is considered to be an effective method which may also be beneficial in alleviating the symptoms during the course of IBDs and IBS. The aim of the present study was to conduct a systematic review of the literature presenting the data regarding the influence of vitamin D supplementation on mental health in adults with inflammatory and functional bowel diseases, including IBDs and IBS. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (Registration number CRD42020155779). A systematic search of the PubMed and Web of Science databases was performed, and the intervention studies published until September 2021 were included. The human studies eligible to be included in the review should have described any intervention involving vitamin D as a supplement in a group of adult patients suffering from IBDs and/or IBS and should have assessed any component of mental health, but studies presenting the effects of combined supplementation of multiple nutrients were excluded. After eliminating the duplicates, a total of 8514 records were screened and assessed independently by two researchers. Further evaluation was carried out on the basis of title, abstract, and full text. Finally, 10 studies (four for IBDs and six for IBS) were selected for the current systematic review, and their quality was assessed using the Newcastle–Ottawa Scale (NOS). The studies analyzed the influence of various doses of vitamin D on bowel diseases, compared the results of vitamin D supplementation with placebo, or administered specific doses of vitamin D to obtain the required level in the blood. Supplementation was performed for at least 6 weeks. The analyzed mental health outcomes mainly included disease-specific quality of life/quality of life, anxiety, and depression. The majority of studies (including high-quality ones) confirmed the positive effect of vitamin D supplementation on the mental health of IBD and IBS patients, which was proven by all research works evaluating anxiety and depression and by the majority of research works evaluating quality of life. Although the studies followed different dosage regimens and supplementation protocols, the positive influence of vitamin D on mental health was found to be consistent. The number of studies on patients suffering from ulcerative colitis and the availability of trials randomized against the placebo group was low in the current review, which is considered to be a limitation of the present study and could also reflect the final outcome of the analysis. The conducted systematic review established the positive effect of vitamin D supplementation on the mental health of IBD and IBS patients, but this result requires further investigation, particularly in relation to other mental health outcomes.

A possible association between early life factors and burden of functional bowel symptoms in adulthood

Objective The studies of early life factors and development of functional bowel diseases show inconsistent results. We therefore examined associations between certain early life factors and functional bowel symptoms in adulthood. Design Population-based cross-sectional study. Setting Weight and height were measured and questionnaires were completed at the time point of enrollment in MOS. Subjects 1013 participants in the Malmö Offspring Study (MOS) without organic bowel disease with data available from the Swedish Medical Birth Registry. Main outcome measures Associations were calculated between gestational age, birth weight, small-for-gestational-age and Apgar score from the Birth Registry, and symptoms according to the visual analog scale for irritable bowel syndrome (VAS-IBS) (abdominal pain, diarrhea, constipation, bloating and flatulence, vomiting and nausea, and symptoms’ influence on daily life) or self-reported IBS using logistic regression. Results In all, 253 (25.0%) participants reported bowel symptoms during the past 2 weeks and 179 (17.7%) self-reported IBS; conditions which were strongly associated (p < 0.001). Female sex and chronic stress were two independent factors more common among participants with bowel symptoms compared with asymptomatic participants (p < 0.001). Early life factors were not associated with presence of overall bowel symptoms (p = 0.080), any specific bowel symptoms or self-reported IBS. Lower birth weight (p = 0.038) and being born small for gestational age (p = 0.043) were associated with severe influence of intestinal symptoms on daily life in adulthood. Conclusions Lower birth weight and small for gestational age are not associated with the presence of overall bowel symptoms but with more pronounced influence of such symptoms on daily adult life. Key points Lower gestational age tended to be associated with functional bowel symptoms in adulthood. Lower birth weight and being small for gestational age are associated with increased negative influences of symptoms on daily life in adulthood. Patients born preterm or with low birth weights may be at increased risk to develop functional bowel symptoms later in life.

S2947 A Case of Small Bowel Neuroendocrine Tumor Presenting With Elevated Fecal Calprotectin

Introduction: Fecal calprotectin (FC) is a marker of intestinal inflammation most useful in the management of inflammatory bowel diseases (IBD). It is mostly found in the cytoplasm of granulocytes, and to a lesser extent, monocytes. Conditions such as diverticular disease, Microscopic colitis, and Graft versus Host Disease have been associated with elevated FC levels. Historically, this calcium and zinc binding protein has been used to distinguish between IBD and functional bowel disease. We find that any mechanism causing gut mucosal injury can lead to increased migration of neutrophils into the gut lumen, with eventual release of calprotectin by these leukocytes. Gastrointestinal malignancy, particularly colorectal cancer, is one such entity that has been studied to show elevated FC. On the other hand, no cases of neuroendocrine tumors (NET) of the gastrointestinal tract with elevated FC have been reported. Case Description/Methods: Our patient is a healthy 48-year old male who presented to gastroenterology clinic for evaluation of abdominal cramping and loose stools. Initial EGD and colonoscopy with biopsies were normal. His symptoms persisted and stool studies resulted an elevated FC of 595 μg/g (normal 0-120 μg/g). CT enterography showed a small bowel stricture near the ileocecal valve (Figure 1). Suspecting Crohn’s disease, we performed a push enteroscopy and repeat colonoscopy with biopsy-once again which were negative. Subsequent laparoscopic resection of small bowel, 12.5 x 5.0cm in diameter, was performed. A 1.0 x 1.0 x 0.4cm well-circumscribed tan mass was identified within the aforementioned small bowel stricture. Pathology sent was consistent with well-differentiated neuroendocrine tumor. Patient had resolution of symptoms and follows with oncology for surveillance. Discussion: FC is a biomarker of gastrointestinal inflammation that can be elevated in multiple conditions. The most studied medical pathologies linked with elevated FC include IBD, infectious gastroenteritis/colitis, microscopic colitis, and diverticular disease. Perhaps due to the wide use of other neuroendocrine biomarkers such as Chromogranin A and 5-hydroxyindoleacetic acid, coupled with the infrequency of small bowel NETs, FC level correlation has not been investigated. Neuroendocrine tumors of the small bowel are uncommon and often present with vague symptoms and metastatic disease. The differential diagnosis for unexplained elevated FC remains broad and it should include small bowel malignancies such as neuroendocrine tumors.Figure 1.: Coronal view of CT enterography showing small bowel stricture and dilated proximal small bowel.