Functional Digestive Disorders Research Articles

Unmet needs of drugs for irritable bowel syndrome and inflammatory bowel diseases: interest of vagus nerve stimulation and hypnosis.

The gut and the brain communicate bidirectionally through the autonomic nervous system. The vagus nerve is a key component of this gut-brain axis, and has numerous properties such as anti-inflammatory, antinociceptive, anti-depressive effects. A perturbation of this gut-brain communication is involved in the pathogeny of functional digestive disorders, such as irritable bowel syndrome, and inflammatory bowel diseases. Stress plays a role in the pathogeny of these diseases, which are biopsychosocial models. There are presently unmet needs of pharmacological treatments of these chronic debilitating diseases. Treatments are not devoid of side effects, cost-effective, do not cure the diseases, can lose effects over time, thus explaining the poor satisfaction of patients, their lack of compliance, and their interest for non-drug therapies. The gut-brain axis can be targeted for therapeutic purposes in irritable bowel syndrome and inflammatory bowel disease through non-drug therapies, such as hypnosis and vagus nerve stimulation, opening up possibilities for responding to patient expectations.

Contextualization of the concept of nociplastic pain in irritable bowel syndrome.

The objective of this letter to the editor is to contextualize the concept of "nociplastic pain" in functional digestive disorders, especially in irritable bowel syndrome (IBS); and try to differentiate it from the term central sensitization, increasingly used in the literature, and with notable relevance in the pathophysiology of IBS.

Effect of Rebamipide on the Intestinal Barrier, Gut Microbiota Structure and Function, and Symptom Severity Associated with Irritable Bowel Syndrome and Functional Dyspepsia Overlap: A Randomized Controlled Trial.

Treatment of functional digestive disorders is not always effective. Therefore, a search for new application points for potential drugs is perspective. Our aim is to evaluate the effect of rebamipide on symptom severity, intestinal barrier status, and intestinal microbiota composition and function in patients with diarrheal variant of irritable bowel syndrome overlapping with functional dyspepsia (D-IBSoFD). Sixty patients were randomized to receive trimebutine (TRI group), trimebutine + rebamipide (T + R group), or rebamipide (REB group) for 2 months. At the beginning and end of the study, patients were assessed for general health (SF-36), severity of digestive symptoms (Gastrointestinal Symptom Rating and 7 × 7 scales), state of the intestinal barrier, and composition (16S rRNA gene sequencing) and function (short-chain fatty acid fecal content) of the gut microbiota. The severity of most digestive symptoms was reduced in the REB and T + R groups to levels similar to that observed in the TRI group. The duodenal and sigmoidal lymphocytic and sigmoidal eosinophilic infiltration was decreased only in the REB and T + R groups, not in the TRI group. Serum zonulin levels were significantly decreased only in the REB group. A decrease in intraepithelial lymphocytic infiltration in the duodenum correlated with a decrease in the severity of rumbling and flatulence, while a decrease in infiltration within the sigmoid colon correlated with improved stool consistency and decreased severity of the sensation of incomplete bowel emptying. In conclusion, rebamipide improves the intestinal barrier condition and symptoms in D-IBSoFD. The rebamipide effects are not inferior to those of trimebutine.

Yoghurts in Infants’ Nutrition: Opportunities of Infectious and Non-Communicable Diseases’ Prevention

This review provides data on the use of yogurts in infants’ nutrition. The properties of these fermented milk products and associated urgent and delayed sanogenetic effects are described. The experience of yogurts (enriched with pre- and probiotics) implementation in the nutrition therapy of children who have undergone infectious diseases is shown. The yogurt usage for intestinal microbiota disorders correction in children with functional digestive disorders and chronic somatic pathology is discussed.

Функціональна диспепсія в дітей (огляд літератури)

Functional digestive disorders account for a significant proportion of gastrointestinal diseases in children. In recent years, we have seen the growth of functional dyspepsia in children, which is an urgent problem for both children's gastroenterologists and pediatricians. Purpose - to conduct a systematic review of the literature on etiopathogenesis, clinical manifestations, laboratory and instrumental studies, as well as methods of treatment and prevention of functional dyspepsia in children. The scientific literature is analyzed and the data on the complex etiopathogenesis of functional dyspepsia, the multifaceted pathogenetic links, the role of psychoneurological factors are presented. The modern classification of functional dyspepsia in children is given. It should be noted that, despite the widespread prevalence of this pathology, doctors sometimes face significant difficulties at the stage of diagnosis. «Symptoms of anxiety», in the presence of which the diagnosis of functional dyspepsia becomes impossible. According to domestic and international studies, the treatment of functional dyspepsia should be comprehensive, include dietary recommendations, recommendations on regime and lifestyle, and drug therapy. No conflict of interests was declared by the authors.

Comorbidities, biomarkers and cause specific mortality in patients with irritable bowel syndrome: A phenome-wide association study.

Irritable bowel syndrome (IBS) is one of the most common functional digestive disorders. Our understanding about its comorbidities, biomarkers, or long-term risks is still incomplete. To characterize comorbidities and biomarkers for IBS and establish the effect of IBS on overall- and cause specific mortality. We analyzed data from the population-based cohort of the UK Biobank (UKB) with 493,974 participants, including self-reported physician-diagnosed (n=20,603) and ICD-10 diagnosed (n=7656) IBS patients, with a mean follow-up of 11years. We performed a phenome-wide association study (PheWAS) and competing risk analysis to characterize common clinical features in IBS patients. In PheWAS analyses, 260 PheCodes were significantly overrepresented in self-reported physician-diagnosed IBS patients, 633 in patients with ICD-10 diagnosed IBS (ICD-10-IBS), with 221 (40%) overlapping. In addition to gastrointestinal diseases, psychiatric, musculoskeletal, and endocrine/metabolic disorders represented the most strongly associated PheCodes in IBS patients. Self-reported physician-diagnosed IBS was not associated with increased overall mortality and the risk of death from cancer was decreased (hazard ratio [HR]=0.78 [95% CI=0.7-0.9]). Lastly, we evaluated changes in serum metabolites in IBS patients and identified glycoprotein acetyls (GlycA) as a potential biomarker in IBS. One standard deviation increase in GlycA raised the risk of self-reported IBS/ICD-10 coded by 9%-20% (odds ratio [OR]=1.09 [95% CI=1.1-1.1]/OR=1.20 [95% CI=1.1-1.3]) and the risk of overall mortality in ICD-10-IBS patients by 28% (HR=1.28 [95% CI=1.1-1.5]). Our large-scale association study determined IBS patients having an increased risk of several different comorbidities and that GlycA was increased in IBS patients.

Gastric pyrosis and hyperacidity: an outstanding task in clinical practice. The positioning of a new multicomponent medical device containing sodium alginate, tamarind seed extract, and carbonates

Gastric pyrosis associated with hyperacidity is a common symptom affecting up to 20% of the Western population. Pyrosis may depend on organic or functional digestive disorders, including gastric reflux, esophago-gastro-duodenal inflammatory diseases, dyspepsia, and gastrolesive drug use. A new medical device (Piromal®) has been recently marketed in Italy. This medical device contains tamarind seed extract, alginate, and carbonates. These components exert important activities. First, tamarind extract contains xyloglucans (polysaccharides) with mucin-like activity, acting as a protective agent. Second, alginate exerts a well-known antireflux activity. Finally, carbonates display a relevant buffering activity. These three components provide prompt symptom relief and guarantee adequate protection of digestive mucosa. In addition, tamarind extract and alginate promote the repair and regeneration of damaged mucosa. Based on this background, a practical algorithm for managing patients with pyrosis associated with hyperacidity is proposed.

Recomendaciones sobre la utilización de las fórmulas infantiles con proteína aislada de soya en la alimentación del lactante. Documento de posición basado en la evidencia

Soy infant formulas (SIF) have long been used as an alternative for infants with special nutritional requirements. However, the medical indications for their use, their allergenicity, safety and efficacy are still controversial. To present recommendations for the use of SIF based on the existing literature. We consulted systematic reviews and clinical practice guides, through validated search algorithms, and systems such as Appraisal of Guidelines for REsearch and Evaluation (AGREE)II and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). For the elaboration of the clinical recommendations, the most important topics were analyzed and discussed by the responsible researchers and the group of experts in the development of a position paper. The quality of the evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Several reports with variable quality of evidence were found. They support SIF's efficacy in the management of cow's milk allergy and infant's digestive tolerance, as well as its low cross allergy compared to cow's milk and other formulas. We also found other studies that indicate the safety of SIFs on different nutritional, immune and developmental parameters. There is also evidence that demonstrates that SIFs have important advantages in terms of cost-benefit, palatability and effects on the intestinal microbiota, compared to other formulas. Although evidence to recommend its use in functional digestive disorders is limited, SIFs have an adequate safety profile and are still a valid option for infant feeding.

Значение жировой глобулы женского молока для формирования липидома, физического и нервно-психического развития младенцев, находящихся на грудном вскармливании

This article presents information on human milk fat globules obtained using omics approaches. More than 420 unique lipids and 1104 types of proteins have been identified and suspended in an aqueous medium using a triple phospholipid layer membrane, the milk fat globule membrane (MFGM), which is present only in animal fat but not in vegetable oils. The structure of MFGM is dominated by proteins (xanthine oxidase, fatty acid-binding proteins, adipophilin, butyrophilin, CD36, mucin-1, lactadherin), polar lipids with high functional activities (phospholipids, gangliosides, sphingomyelin) and cholesterol. Experimental and clinical studies have established that nutrition enriched with MFGM promotes the formation of a lipidome similar to that of breastfeeding, improves brain development, cognitive, visual and neuropsychological functions. Components of MFGM may have a protective effect on the risk of cardiovascular diseases and functional digestive disorders and contribute to the programming of child health in subsequent age periods. The inclusion of MFGM-enriched ingredients in infant formulas is a new step towards their further adaptation to the composition of breast milk. Key words: infants, breastfeeding, breast milk, milk fat globule membrane

Incongruent Views of Functioning between Patients and Gastroenterologists: A Mixed Methods Study.

Gastrointestinal patients, especially those diagnosed with functional digestive disorders (FGIDs), usually present a complex clinical picture that poses a challenge for their management in primary care. The main objective of the current research was to examine the relationship of the congruence of the perception of severity and quality of life between gastroenterologists and their patients with psychological distress and the helping attitude experienced by the latter attended in primary care centres. Additionally, we wanted to explore patients' and practitioners' perceptions. We performed a cross-sectional study with a total of 2261 patients (1562 analysed) that attended three primary care centres. Patients completed questionnaires that measured physical functioning, distress, and perception of helping attitude. Gastroenterologists registered the functional status of each participating patient. Patients were then invited to take part in the qualitative part of the study if they were considered to have incongruent views on their functioning with their gastroenterologist. In total, 52 patients took part in one of eight focus groups. Additionally, four individual interviews were carried out with three gastroenterologists and one consultation-liaison psychiatrist specialised in FGIDs. Both incongruence and functional diagnosis correlated with distress. However, incongruent views between patients and gastroenterologists explained more variance. Statistically significant differences in patients' helping attitude perception were detected between diagnostic but no incongruence groups. In the second stage of the study, a total of five themes were identified from the patient focus groups and the gastroenterologist interviews: illness-emotional and personal problems, disease-health system interaction, health system, intervention, and patients. The current research allowed us to confirm that incongruence in the perception of severity and quality of life between gastroenterologists and patients is related to psychological distress and that this occurs in a multifactorial context where the characteristics of the disorder interact with those of the health system.

Intestinal disorders after acute diarrhea in young children and their coprological predictors

Background. After acute diarrhea in young children, intestinal disturbances and even chronic functional intestinal diseases may occur. To date, no pathogenetically based criteria have been found that would indicate the probability of chronic intestinal disorders, just as the mechanisms of their occurrence after acute diarrhea have not been fully elucidated. The objective: to evaluate the frequency and nature of bowel disorders in children of the younger age group within 6 months after a stay in hospital for acute diarrhea and to establish their relationship with coprological indicators — fecal calprotectin (FCР), the content of carbohydrates (reducing substances, RS), lactic acid (LA) and short-chain fatty acids (SCFA) — acetic, propionic and fatty (butyric). Materials and methods. The study involved 47 children aged 6–24 months who were hospitalized for acute diarrhea. Acute enterocolitis (group I) was diagnosed in 18 patients and was caused by Campylobacter jejuni in 12 cases, Escherichia coli O-18 and Escherichia coli O-44 in 3, Salmonella enteritidis in 2 and Yersinia enterocolitica in one case. Rotaviral gastroenteritis (group II) was diagnosed in 11 patients. Another 11 children had acute symptomatic (parenteral) diarrhea (group III) against the background of intestinal infection — acute otitis, pneumonia, pyelonephritis. In 7 children, diarrhea was classified as functional digestive disorder (group IV). Routine clinical tests were supplemented with an examination of feces for the presence of intestinal parasites, Clostridium difficile A/B toxins, adenoviruses, human hemoglobin, RS, FCP, SCFA and LA. Results. Six-month follow-up established that 14 of 18 children in group I had permanent or temporary loose stools. These complaints in 13 cases were combined with episodes of abdominal pain similar to intestinal colic. The same complaints were much less frequent in children of group II (6 and 3 of 11, respectively), group III (4 and 2 of 11) and group IV (only in 2 of 7 children). The rank correlation analysis did not reveal any significant relationships between the intensity and duration of complaints and FCP, RS, LA, and SCFA in patients of groups I and II. On the contrary, in group III, there were multiple correlations of complaints with FCP, RS, LA, and SCFA. In group IV, the association of loose stools with an increase in LA and acetic acid has been found. Conclusions. According to the 6-month follow-up, 57 % of young children with acute diarrhea complained of loose stools and/or recurrent abdominal pain after discharge from the hospital. Most often, intestinal disorders were detected in children who had acute bacterial enterocolitis. There were no correlations between the intensity of post-infectious (bacterial or viral) disorders with FCP, RS, LA and SCFA during hospitalization. In contrast, such associations were numerous in children with symptomatic (parenteral) and functional diarrhea. It was suggested that the studied coprological parameters can be used to predict the state of the intestine after acute diarrhea.

Modern patterns of eating behavior in children

Background. Nowadays, increasingly greater attention is paid to the problem of nutrition as a key factor in influencing a child’s health and development. Eating disorders can be observed already in early childhood, from the newborn period. Purpose: to study the modern patterns of eating behavior in children taking into account the age aspect. Material and methods. One hundred and thirty-eight children aged 6 months to 12 years were examined. The examination was anonymous and involved the use of the original questionnaire for parents, which consisted of 70 questions. Results. During the study, the peculiarities of eating behavior in children of different age were evaluated. In the newborn period, 5 main types of eating behavior were analyzed, which differed by the breastfeeding act, and there was a connection with the further development of functional digestive disorders. In infants, 3 main groups of eating disorders have been detected: regime disorders, functional gastrointestinal disorders, early termination of breastfeeding. Eating habits within the first 1,000 days were characterized by naughtiness in a third of children, the use of entertainment during meals, refusal to eat at the proper time. In older children, the general characteristics of the diet, family food habits and taste preferences, as well as the family’s cultural and educational level had a considerable influence on the formation of eating behavior. Conclusions. The identification of modern nutritional patterns, taking into account the age aspect and the set of factors affecting the formation, development and occurrence of eating behavior deviations, allows timely preventing the development of pathological conditions and determining the further approaches to the formation of healthy eating habits.

Functional Gastrointestinal Disorders with Psychiatric Symptoms: Involvement of the Microbiome-Gut-Brain Axis in the Pathophysiology and Case Management.

Functional Gastrointestinal Disorders have been an important cause of poor life quality in affected populations. The unclear etiology and pathophysiological mechanism alter the clinical evolution of the patient. Although a strong connection with psychological stress has been observed, it was not until recently that the gut-brain axis involvement has been revealed. Furthermore, the current literature not only promotes the gut-brain axis modulation as a therapeutical target for functional digestive disorders but also states that the gut microbiome has a main role in this bi-directional mechanism. Psychiatric symptoms are currently recognized as an equally important aspect of the clinical manifestation and modulation of both the digestive and central nervous systems and could be the best approach in restoring the balance. As such, this article proposes a detailed description of the physiology of the microbiome-gut-brain axis, the pathophysiology of the functional gastrointestinal disorders with psychiatric symptoms and current perspectives for therapeutical management, as revealed by the latest studies in the scientific literature.

Psychosocial quality-of-life correlates in functional gastrointestinal disorders

Introduction and aimFunctional gastrointestinal disorders (FGIDs) are complex illnesses characterized by gastrointestinal symptoms, with no underlying organic pathology. They are common, chronic, recurrent, and disabling disorders that significantly impair quality of life (QoL). The aim of the present cross-sectional analytical study was to assess QoL and its correlates in adult patients with FGIDs. Materials and methodsA cross-sectional, observational, hospital-based study was conducted at the gastroenterology outpatient department of a tertiary care teaching hospital. The ROME IV diagnostic criteria were used to identify the FGIDs. Anxiety, depression, coping strategies, social support, and QoL were assessed by the hospital anxiety and depression scale, the coping strategies inventory, the multidimensional scale of perceived social support, and the functional digestive disorders quality-of-life questionnaire, respectively. ResultsOf the 52 consecutive patients diagnosed with FGIDs, functional dyspepsia (51.92%) and irritable bowel syndrome (40.38%) were the most common. There were no significant associations between sociodemographic variables (age, sex, marital status, socioeconomic status, educational level, employment, occupation, dietary pattern) and QoL scores (all p values >0.05). Duration and social support were not significantly associated with QoL (all p values >0.05). In contrast, psychological variables, such as disengagement coping (r=–0.344, p=0.012), depression (r=–0.600, p=0.000), and anxiety (r=–0.590, p=0.000), were significantly correlated with QoL. ConclusionsDespite advances in neurogastroenterology, patients continue to be disabled by FGIDs. Psychological factors, especially depression, significantly contribute to poor QoL in those patients and should be addressed in a holistic, multidisciplinary way. The biopsychosocial framework, as it applies to FGIDs, should lead to the inclusion of psychosocial assessments in the clinical management and research of those disorders.

Interpretation of a Quantitative Diagnosis Model of Traditional Chinese Medicine Syndromes Based on Computer Adaptive Testing.

Objectives The aim of this study is to interpret a quantitative diagnosis model of traditional Chinese medicine (TCM) syndromes based on computer adaptive testing (CAT), from the perspective of both patients and clinicians. Methods In this cross-sectional study, patients with postprandial distress syndrome completed the CAT model of TCM syndromes and the Chinese version of the Quality of Life Questionnaire for Functional Digestive Disorders (Chin-FDDQL); the clinicians' diagnosis was concurrently recorded. The patients completed this questionnaire again after 14 ± 2 days. The kappa test and paired chi-square test were used to evaluate the consistency between the CAT model and clinical diagnosis. Minimal clinically important differences (MCID) of the Chin-FDDQL scores were used to assess clinical efficacy from the patients' perspective. Logistic regression was used to examine the association between changes in the CAT model syndrome domain scores and changes in clinical outcomes. Results Changes in the CAT model syndrome domain scores may affect the clinical outcomes of patients with the total scores of Chin-FDDQL (all P < 0.05). There was a correlation between changes in the CAT model syndrome domain scores and the patients' clinical outcomes. Different syndrome elements had different effects on various Chin-FDDQL domains, which was consistent with the theory of TCM. Conclusions This study proposes a method for the clinical interpretation of the CAT model of TCM syndromes, including evidence derived from the application. It may provide a reference for future interpretation of other CAT models.

Effects of a Modern Kefir on Conditions Associated with Moderate Severe Spastic Quadriparesis Cerebral Palsy.

Cerebral palsy (CP) in children constitutes a set of movement and body posture disorders caused by brain injury, which in turn is associated with a series of intestinal, respiratory, and malnutrition conditions. Twenty-four children were selected and included for the present study and subdivided into two groups: (1) children who included modern kefir (containing 12 probiotic species) in their diet; and (2) control group (not including kefir in their diet). The group supplemented with modern kefir received a beverage with multi probiotic species and the control group received commercial yogurt (which included the 2 typical lactic acid bacteria) for 7 weeks. Anthropometric variables, resting energy expenditure, presence, and diagnosis of functional digestive disorders (FDD), frequency of respiratory problems, presence of elevated C-reactive protein, differential count of leukocytes were evaluated. A significant increase in weight and height was found in the kefir group at the final time point. In addition, kefir intake promoted a significant reduction in functional constipation and stool hardness and increased the absolute value of blood lymphocytes. Since the fermented milk beverage modern kefir improves constipation, which is the most important FDD in children with CP and the nutritional and immune status, it could be considered an important strategy to improve health in these children.

Evaluation of surgical abdomen in pediatric subjects admitted for acute abdomen at our tertiary care centre

Acute abdominal pain is one of the most common problems in children admitted to the pediatric emergency department (ED), and often presents a diagnostic dilemma for primary clinicians. Acute abdominal pain in patients presenting to the ED is often diagnosed as a disorder that does not require surgical intervention, such as acute gastroenteritis, functional digestive disorders or constipation. Objectives of our study: to evaluate various etilogies of acute abdomen in children presenting to paediatric emergency department and to estimate the prevalence of surgical abdomen in children presenting to pediatric emergency department. Methodology: Demographic information of the patients was noted down from the hospital case records, which include age, gender. Presenting complaints, clinical signs, etiologies of acute abdomen, laboratory investigations results TLC, DC, CRP, USG findings, CT abdomen findings, time and date of admission, daily progress, time and date of discharge were noted. In traumatic group apart of these observations additional lab investigations like amylase, lipase, ALT, AST, total protein and A:G ratio were noted. Results: We had a total of 132 subjects in non-traumatic group out of which 73% had acute appendicitis, 14% had incarcerated hernia, 7% had instussception, 5% had perforation and 0.75% had torsion.

Correlatos psicosociales de calidad de vida en trastornos gastrointestinales funcionales

Introduction and aimFunctional gastrointestinal disorders (FGIDs) are complex illnesses characterized by gastrointestinal symptoms, with no underlying organic pathology. They are common, chronic, recurrent, and disabling disorders that significantly impair quality of life (QoL). The aim of the present cross-sectional analytical study was to assess QoL and its correlates in adult patients with FGIDs. Materials and methodsA cross-sectional, observational, hospital-based study was conducted at the gastroenterology outpatient department of a tertiary care teaching hospital. The ROME IV diagnostic criteria were used to identify the FGIDs. Anxiety, depression, coping strategies, social support, and QoL were assessed by the hospital anxiety and depression scale, the coping strategies inventory, the multidimensional scale of perceived social support, and the functional digestive disorders quality-of-life questionnaire, respectively. ResultsOf the 52 consecutive patients diagnosed with FGIDs, functional dyspepsia (51.92%) and irritable bowel syndrome (40.38%) were the most common. There were no significant associations between sociodemographic variables (age, sex, marital status, socioeconomic status, educational level, employment, occupation, dietary pattern) and QoL scores (all P values>.05). Duration and social support were not significantly associated with QoL (all P values>.05). In contrast, psychological variables, such as disengagement coping (r=−0.344, P=.012), depression (r=−0.600, P=.000), and anxiety (r=−0.590, P=.000), were significantly correlated with QoL. ConclusionsDespite advances in neurogastroenterology, patients continue to be disabled by FGIDs. Psychological factors, especially depression, significantly contribute to poor QoL in those patients and should be addressed in a holistic, multidisciplinary way. The biopsychosocial framework, as it applies to FGIDs, should lead to the inclusion of psychosocial assessments in the clinical management and research of those disorders.

The efficacy of cognitive behavior stress management on functional dyspepsia: A protocol for systematic review and meta-analysis.

Background:Functional dyspepsia and digestive disorders are common, debilitating and costly. Little information is available about the role of stress management in terms of cognitive-behavioral treatment of dyspepsia. We performed a protocol for systematic review and meta-analysis to evaluate the effectiveness of cognitive behavior stress management for the treatment of functional dyspepsia.Methods:A comprehensive search of several databases from 1966 to March 2022 will be conducted. The databases include Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. The primary outcome for this study was the rate of successful treatment (presence of no more than mild pain or discomfort after treatment). The secondary outcomes were improvement of dyspepsia at short-term (<1 year) and long-term (≥1 year) follow up, improvement in quality of life, and development of treatment-related adverse events. The risk of bias in each included study will be assessed utilizing the Cochrane Collaboration's risk of bias tool. The Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) will be used to analyze the data.Results:We will synthesize the current studies to evaluate the effectiveness and safety of cognitive behavior stress management on functional dyspepsia.Conclusion:The result of this review will provide more reliable references to help clinicians make decisions when dealing with functional dyspepsia.

Pediatric Functional Abdominal Pain Disorders following COVID-19.

Background: Functional abdominal pain disorders (FAPD) are a group of functional gastrointestinal disorders with multifactorial etiology and are subclassified using Rome IV criteria into a series of clinically distinct entities represented by irritable bowel syndrome, functional dyspepsia, abdominal migraine and functional abdominal pain that is not otherwise specified. Digestive functional disorders associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) may be mediated by the involvement of complex pathogenic mechanisms, which have been under investigation in children since the beginning of the coronavirus disease pandemic (COVID-19). Methods: In this retrospective, observational descriptive and analytical study, we investigated the presence of chronical functional abdominal pain in preschool children (4–6 years old) from the south-west of Romania in the pre-pandemic (18 cases) and COVID-19 pandemic period (34 cases), as well as the association with the COVID-19 positive and COVID-19 negative statuses, gender, environment origin, and viral infection-associated symptoms. Age-specific Rome IV criteria were used to diagnose functional abdominal pain. We performed an integrated statistical analysis of the results utilizing an electronic database in which we compared the data in order to assess the impact of COVID-19 on the clinical-epidemiological parameters analyzed. Results: In the pre-pandemic group, irritable bowel syndrome predominated (77.8%), followed by functional dyspepsia (22.2%), the other types of functional abdominal pain being absent, while for the pandemic group, irritable bowel syndrome was the most common (79.4%), followed by abdominal migraine (11.8%), abdominal dyspepsia (5.9%) and functional abdominal pain not otherwise specified (2.9%). We found a female/male ratio difference of 0.84 and an urban/rural ratio of 1.83 in favor of the pandemic group. These discrepancies were mainly caused by the differences between the COVID-19 positive and negative pandemic groups, where we observed statistical association of the positive pandemic group with IBS and urban environment, and a tendency of FAPDs diagnostic mainly with males. The predominant symptoms associated with COVID-19 positive cases were digestive (60.9%) or respiratory (39.1%). Conclusions: Our study demonstrates viral-mediated sensitivity of the gastrointestinal tract in preschool children, considering different clinical-epidemiological profiles related to the prevalence of FAPD and according to gender and environment origin, while the contribution of the pandemic context remains to be demonstrated in larger studies