Management Of Gastrointestinal Diseases Research Articles

Effects of Chios mastic gum on cardiometabolic risk factors.

Chios mastic gum (CMG), the resin produced by the trunk of Pistachia lentiscus var Chia, has been used for culinary and medicinal purposes since antiquity. Despite the fact that Pistacia species are widely distributed throughout the Mediterranean basin and in the circum-Mediterranean regions, CMG is a distinctive resin of the mastic trees grown exclusively in the southern part of the island of Chios. CMG has been used for centuries as a spice, a cosmetic, but its most important usage has been as a strong phytotherapeutic therapy, primarily for the management of gastrointestinal diseases. Recently, there are studies demonstrating that CMG has hypolipidemic, cardioprotective and antidiabetic properties. Therefore, the aim of the present review is to summarize the existing literature data regarding the potential beneficial effects of CMG on cardio-metabolic risk factors.

The utility and safety of paediatric endoscopy in a district general hospital in Southeast England.

This study was done to evaluate the appropriateness, diagnostic yield, and quality of paediatric gastrointestinal endoscopy in a large DGH with tertiary paediatric gastroenterology services. It was a retrospective cohort study of children who had at least one gastrointestinal endoscopy during 31 months (May 2018-Dec 2020) in a district general hospital in Southeast England. The participants were children (2–17 years). Two hundred ninety-three procedures were performed in total, 80% were diagnostic and 20% for surveillance. The median age was 12 years and 52.5% were males. Oesophago-gastro-duodenoscopy (OGD) corresponded to 79.5% of procedures, ileo-colonoscopy (IC) to 7.2% and the remaining had both procedures. The main diagnostic indication was persistent abdominal pain in 33.5% of cases, followed by suspected GORD (14.8%), recurrent vomiting (14.3%), dysphagia (9.1%) and blood loss per rectum (8.6%). A total of 64.7% showed abnormal macroscopic findings, and 69.2% showed histopathological signs of disease. The most common histological diagnosis was gastritis in 23% followed by coeliac disease in 13%, reflux oesophagitis in 12.2% and inflammatory bowel disease in 9.6%. Procedures were performed with utmost safety with two reported cases of complications, which were appropriately managed. The completion rate of diagnostic IC was 87%. A waiting time of 6 weeks was achieved in 50.4% of cases.Conclusion: Paediatric endoscopy can be safely performed in a district general hospital with the right setup and can aid in the management of gastrointestinal disease in the paediatric patient. It is important to monitor and regularly audit such practices to improve the quality of specialist services.What is Known:• Paediatric endoscopy is predominantly performed in large tertiary centres and included in the diagnostic algorithm for many paediatric gastrointestinal conditions.• There are recommendations on clinical indication endorsed by ESPGHAN and key quality indicators published jointly by JAG and BSPGHAN.What is New:• Paediatric endoscopy can be appropriately and safely performed in district general hospital by trained professionals, decreasing the workload in larger tertiary paediatric centres.• Adoption of regular audit practices is essential to ensure and improve quality and appropriateness of this specialist service.

Problems faced by patients and health service utilization experiences of gastrointestinal patients during lockdown due to COVID-19 pandemic.

Objectives:The COVID-19 pandemic undermined the health service delivery and utilization of essential health care services globally. The current study therefore aimed to explore the health-seeking behaviors and challenges faced by patients for the management of gastrointestinal diseases.Methods:A cross-sectional study was conducted at the outpatient department of Gastroenterology, Liaquat National Hospital, Karachi from March 2020 to July 2020 during the COVID-19 lockdown phase to explore patient experiences. Data was collected using a survey questionnaire. All patients of either gender were included after informed consent. Statistical analysis of the data was conducted using SPSS 21.0.Results:A total of 184 patients were included who visited the hospital to seek medical services during the COVID-19 lockdown phase. The mean age of the population was 42.7 years (±16.13). Of these, n=94 (51.1%) were males All patients had gastrointestinal issues with different comorbid conditions. One forty-seven n=147 (79.9%) presented with active complaints whereas, n=37 (20.1%) patients visited the hospital for their follow-up checkup. Out of 184 patients, n=33 (17.9%) patients reported of having fear of visiting hospital due to COVID-19 outbreak. A statistically significant difference p<0.001 was noted between the history of comorbidities and patient delaying a visit to the healthcare due to the fear of COVID-19. Additionally, 61 (73.5%) patients with co-morbidity faced difficulty in finding public transport (p=0.01). Nevertheless, n=171 (93.0%) patients expressed satisfaction with the services provided by the hospital during the lockdown phase.Conclusion:Patients with gastrointestinal conditions were largely affected by lockdown largely due to fear of contacting COVID-19 disease and inaccessibility to the public transportation. Widely available telemedicine service might overcome these shortcomings and ensure continuity of quality care.

Nutritional management of feline chronic enteropathy

Feline chronic enteropathy covers a heterogeneous range of conditions, including food responsive enteropathies, inflammatory bowel disease and antibiotic-responsive diarrhoea. Dietary management can be extremely helpful, both as a diagnostic and therapeutic tool, when managing many of these patients. A high proportion of cats with chronic enteropathy are thought to be either food-sensitive or food-responsive, and appropriate nutritional support can help to optimise the short- and longer-term management of gastrointestinal disease. Three key dietary options exist: highly digestible gastrointestinal diets, hydrolysed diets and novel protein diets. Highly digestible diets and help to reduce exposure to dietary antigens, minimise complications associated with undigested food and aid nutrient absorption. Novel protein diets, based on a protein source a cat has not previously eaten, or a hydrolysed diet, where protein sources have been reduced in size to below the molecular weight of most food allergens, can help support cats with an underlying food sensitivity (allergy or intolerance), and may also benefit individuals in cases where a true food sensitivity does not underlie the clinical signs. Improvements with appropriate dietary intervention can be dramatic and rapid, with resolution of clinical signs within 2 weeks. This article explores the rationale for each of the three types of diet that can be considered for a diet trial, and the current evidence supporting their use. It also briefly covers recommendations for diet introduction and advice to support clients when considering a diet trial.

Histopathology: how to get the best from gastrointestinal biopsies

Sampling of the gastrointestinal tract by endoscopic, or full thickness (open abdominal surgical) biopsy is an invaluable tool in the diagnosis and management of gastrointestinal disease in companion animals. This article gives recommendations on how to collect and submit endoscopic and full thickness biopsies of the gastrointestinal tract, in order to maximise their diagnostic value. It also covers interpretation of the histopathology report and examples of when further samplsing or additional testing may be advisable. It is important to note that these are general recommendations and it is prudent to contact the reporting laboratory with any specific queries or requests.

Role of probiotics in the prevention of early childhood caries

Early childhood caries (ECC) is the most common childhood disease, deemed as a chronic, infectious, and preventable disease. The etiology of ECC is complex and multifactorial; hence, early preventive measures should be implemented. Several strategies have been investigated in the past for ECC prevention. The use of probiotics in the management of gastrointestinal diseases has shown promising results. In this context, effectiveness of probiotic bacteria to re-establish a balanced oral microbiota has gained interest in the dental research community during recent years, with focus on caries prevention. To our knowledge, there is only one review, published in 2016, on the prevention of ECC with probiotic bacteria. This paper aims to present an in-depth review of probiotics as a preventive strategy for ECC. The efficacy of probiotic bacteria may be strain specific. Results of the studies investigating the effect of probiotic administration on reduction of caries risk are contradictory, with some showing reduction in Mutans streptococcus and Lactobacillus counts, while others showing no change. Long-term studies also have reported contradictory findings, with either no difference or decrease in the prevalence of caries when evaluated later in life following early administration of probiotics. As these studies offer ample evidence of the potential of probiotics in the prevention of ECC, further long-term, controlled studies should be planned to study the benefits.

Managing gastrointestinal complications in patients with systemic sclerosis.

We sought to critically evaluate the literature published over the past 3 years on the management of gastrointestinal complications in systemic sclerosis (SSc). We emphasize interesting and important new findings to bring the reader up-to-date. We also discuss controversial discoveries and hypotheses currently of interest. We conducted a literature search on PubMed over the last 3 years using the key words "systemic sclerosis," "gastrointestinal," "scleroderma," and "treatment." We also screened clinicaltrials.gov for ongoing trials relevant to the gastrointestinal complications of SSc. Reference lists from recent reviews on the management of gastrointestinal complications of SSc to identify articles that might have been missed in the initial search. 103 publications and ongoing clinical trials were identified. We eliminated all case reports and review articles. Ultimately we had 58 articles remaining and we prioritized what we found to be the strongest and/or novel findings to discuss in this review. Advances in the management of gastrointestinal disease in SSc continue to evolve. The application of novel therapies and the repurposing of existing therapies for the management of gastrointestinal involvement are shaping the therapeutic arsenal so that we can more effectively manage these complex patients.

Digestive Surgery Services in COVID-19 Pandemic Period: Indonesian Society of Digestive Surgeons Position Statement

Digestive surgery service including surgical management of gastrointestinal disease and digestive cancers are experiencing the impact of COVID-19 pandemic. Therefore it is necessary to formulate recommendation for digestives surgery service, as guidelines to engage in case-by-case assessment of particular patients with digestive diseases. We are aware that the knowledge and science of COVID-19 are still evolving, with new progression every day. This recommendation reflect actual condition and are subject for future adjustment in the future.

Standard procedures in nonoperating room anesthesia.

This article provides an overview of standard procedures currently performed in nonoperating room anesthesia (NORA) and highlights anesthetic implications. Novel noninvasive interventional procedures remain on the rise, accelerating demand for anesthesia support outside the conventional operating room. The field of interventional oncology has introduced a variety of effective minimally invasive therapies making interventional radiology gain a major role in the management of cancer. Technical innovation brings newer ablative and embolotherapy techniques into practice. Flexible bronchoscopy has replaced rigid bronchoscopy for many diagnostic and therapeutic indications. Endobronchial ultrasonography now allows sampling of mediastinal, paratracheal, or subcarinal lymph nodes rendering more invasive procedures such as mediastinoscopy unnecessary. Similarly, endoscopic ultrasonosgraphy currently plays a central position in the management of gastrointestinal disease. Sophisticated catheter techniques for ablating cardiac arrhythmias have become state of the art; Watchman procedure gaining position in the prevention of stroke resulting from atrial fibrillation. NORA is a rapidly evolving field in anesthesia. Employing new technology to treat a wide variety of diseases brings new challenges to the anesthesiologist. Better understanding of emerging interventional techniques is key to safe practice and allows the anesthesia expert to be at the forefront of this swiftly expanding multidisciplinary arena.

The High-Dimensional Signal Classification of Electrogastrogram for Detection of Gastric Motility Disorders

The electrogastrogram (EGG) can detect the gastric electromyogram activity, and then reflect the relative change of the rhythm as well as amplitude of the slow wave of the electromyogram. As EGG has the advantages of convenient, painless, non-invasive and accurate measurement of gastric electromyogram activity, it can not only be used to evaluate the effects of gastromotor drugs and gastrointestinal hormones, but also to distinguish healthy people from functional dyspepsia, patients with gastric cancer and patients with low gastric motility according to the results of parameter analysis in EGG. This paper proposes an EGG signal processing and classification method to realize the potential role of EGG in the diagnosis and management of gastrointestinal diseases. First, EGG signal collection was conducted on normal people and patients, and then the test signal was described as accurately as possible according to some key features of the gastric waveform. Based on the collected data, we developed an indicator that can classify high-dimensional signals and provide an indicator that can distinguish or identify two kinds of signal-related indicators. In this way, EGG signals are associated with specific conditions for clinical diagnosis of gastrointestinal dysrhythmia and even for efficacy evaluation.

The Gluten-Free Diet: Use in Digestive Disease Management.

Gluten is a commonly ingested polymeric protein found in wheat, barley, and rye that has gained recent notoriety because of its relationship to disease and health. Avoidance of gluten is appropriate in patients with a diagnosed gluten-related disorder and may have treatment implications in other diseases of the digestive tract. This review highlights current knowledge of gluten related disorders and the use of a gluten-free diet in gastrointestinal disease management. Gluten-free diets should be used in patients with a diagnosed gluten-related disorder including celiac disease, non-celiac gluten sensitivity, and wheat-sensitive eosinophilic esophagitis. Use of this diet in management of other digestive conditions including gastroesophageal reflux disease, irritable bowel syndrome, and inflammatory bowel disease is controversial and not currently supported by the literature. This review provides a framework for classifying gluten-related disorders in terms of pathogenesis, understanding the literature that supports dietary avoidance in modulation of gastrointestinal disease, and identifies limitations of dietary restriction in patients.

Surgical endoscopy: essential skills in gastrointestinal surgery

The impact of flexible endoscopy in the management of gastrointestinal disease has grown from a merely diagnostic role to one of great therapeutic potential, supplanting many of the previously utilized surgical procedures. Surgeons have had an integral role in the development and advancement of these many techniques, and it has become imperative that surgeons take an active role in training and utilizing these tools.

Probiotic use in clinical practice: Results of a national survey of gastroenterologists and nutritionists.

Probiotics are effective in gastrointestinal disease management. In Mexico, there are no studies on the use and prescription of probiotics by healthcare professionals. Our aim was to evaluate probiotic use and prescription on the part of gastroenterologists and nutritionists. An online survey questionnaire was sent to members of the Asociación Mexicana de Gastroenterología (n = 1042), the Asociación Mexicana de Nutriología (n = 220), and healthcare professionals registered at the Fourth International Symposium: Intestinal Microbiota (n = 1328). Response was 34% (997 questionnaires answered) and 570 (64%) of the respondents were women. Mean participant age was 36.2 years (range 18-83). Thirty-six percent of the participants were gastroenterologists, 46% were nutritionists, and 18% were chemists and microbiologists. Seventy-one percent of the respondents knew the Food and Agriculture Organization (FAO) definition of probiotics and recommended them «always» (64.9%), «rarely» (31.7%), and «never» (3.6%). Gastroenterologists indicated probiotics for the treatment of disease (56.5%) and nutritionists for health maintenance (39%). Ninety-seven percent of the gastroenterologists and 98% of the nutritionists evaluated probiotics as effective in gastrointestinal symptom management and considered them safe. The majority of the respondents did not know which probiotic strain was contained in the commercial probiotic product. The survey results showed that the participating gastroenterologists and nutritionists understood the concept of probiotics, recommended them frequently, and considered them safe. The gastroenterologists prescribed probiotics as therapeutic agents and the nutritionists to maintain health. There was a lack of knowledge about the microbial composition of the products containing probiotics available in Mexico.

MicroRNA Determines the Fate of Intestinal Epithelial Cell Differentiation and Regulates Intestinal Diseases.

The rapid self-renewal of intestinal epithelial cells enhances intestinal function, promotes the nutritional needs of animals and strengthens intestinal barrier function to resist the invasion of foreign pathogens. MicroRNAs (miRNAs) are a class of short-chain, non-coding RNAs that regulate stem cell proliferation and differentiation by down-regulating hundreds of conserved target genes after transcription via seed pairing to the 3' untranslated regions. Numerous studies have shown that miRNAs can improve intestinal function by participating in the proliferation and differentiation of different cell populations in the intestine. In addition, miRNAs also contribute to disease regulation and therefore not only play a vital role in the gastrointestinal disease management but also act as blood or tissue biomarkers of disease. As changes to the levels of miRNAs can change cell fates, miRNA-mediated gene regulation can be used to update therapeutic strategies and approaches to disease treatment.

The Immunomodulatory Properties of Extracellular Vesicles Derived from Probiotics: A Novel Approach for the Management of Gastrointestinal Diseases.

Probiotics, included in functional foods, nutritional supplements, or nutraceuticals, exhibit different beneficial effects on gut function. They are extensively used to improve the digestive processes as well as reduce the symptoms and progression of different diseases. Probiotics have shown to improve dysbiosis and modulate the immune response of the host by interacting with different cell types. Probiotics and the host can interact in a direct way, but it is becoming apparent that communication occurs also through extracellular vesicles (EVs) derived from probiotics. EVs are key for bacteria–bacteria and bacteria–host interactions, since they carry a wide variety of components that can modulate different signaling pathways, including those involved in the immune response. Interestingly, EVs are recently starting to be considered as an alternative to probiotics in those cases for which the use of live bacteria could be dangerous, such as immunocompromised individuals or situations where the intestinal barrier is impaired. EVs can spread through the mucus layer and interact with the host, avoiding the risk of sepsis. This review summarizes the existing knowledge about EVs from different probiotic strains, their properties, and their potential use for the prevention or treatment of different gastrointestinal diseases.

Informed consent for endoscopic procedures in Portugal – do we need a thoroughly detailed consent form?

Endoscopy is an invaluable tool for all Gastroenterologists but most importantly it is a crucial procedure/method in screening, diagnosis and management of gastrointestinal diseases which in turn affect a relevant proportion of citizens. The number and technical difficulty of endoscopic procedures have greatly increased in the past two decades, and even the simpler ones are not purely diagnostic examinations which are exempt from risks [1]. A small but real risk is present in all endoscopic procedures, even if there are no additional diagnostic (e. g., biopsies) or therapeutic manoeuvres (such as polypectomy).

Probiotic use in clinical practice: Results of a national survey of gastroenterologists and nutritionists

Introduction and aimsProbiotics are effective in gastrointestinal disease management. In Mexico, there are no studies on the use and prescription of probiotics by healthcare professionals. Our aim was to evaluate probiotic use and prescription on the part of gastroenterologists and nutritionists. Materials and methodsAn online survey questionnaire was sent to members of the Asociación Mexicana de Gastroenterología (n = 1042), the Asociación Mexicana de Nutriología (n = 220), and healthcare professionals registered at the Fourth International Symposium: Intestinal Microbiota (n = 1328). ResultsResponse was 34% (997 questionnaires answered) and 570 (64%) of the respondents were women. Mean participant age was 36.2 years (range 18-83). Thirty-six percent of the participants were gastroenterologists, 46% were nutritionists, and 18% were chemists and microbiologists. Seventy-one percent of the respondents knew the Food and Agriculture Organization (FAO) definition of probiotics and recommended them «always» (64.9%), «rarely» (31.7%), and «never» (3.6%). Gastroenterologists indicated probiotics for the treatment of disease (56.5%) and nutritionists for health maintenance (39%). Ninety-seven percent of the gastroenterologists and 98% of the nutritionists evaluated probiotics as effective in gastrointestinal symptom management and considered them safe. The majority of the respondents did not know which probiotic strain was contained in the commercial probiotic product. ConclusionsThe survey results showed that the participating gastroenterologists and nutritionists understood the concept of probiotics, recommended them frequently, and considered them safe. The gastroenterologists prescribed probiotics as therapeutic agents and the nutritionists to maintain health. There was a lack of knowledge about the microbial composition of the products containing probiotics available in Mexico.

Advances in Synbiotic Therapy in the Management of Gastrointestinal Diseases (Enteric Diseases) in Farm Animals

Advances in Synbiotic Therapy in the Management of Gastrointestinal Diseases (Enteric Diseases) in Farm Animals

Gut microbiome as a clinical tool in gastrointestinal disease management: are we there yet?

Spurred on by ever-evolving developments in analytical methodology, the microbiome, and the gut microbiome in particular, has become the hot topic in biomedical research. Ingenious experiments in animal models have revealed the extent to which the gut microbiota sustains health and how its disruption might contribute to disease pathogenesis. Not surprisingly, associations between the microbiota and disease states in humans have been the subject of considerable interest and many links proposed. However, with rare exceptions, the incrimination of an altered microbiota in disease pathogenesis seems premature at this time given our incomplete understanding of the composition of the gut microbiota in health and the effect of many confounding factors in the interpretation of supposedly abnormal microbial signatures. Future studies must account for these variables and the bidirectionality of host-microorganism interactions in health and disease. In this Perspectives, the status of microbiota signatures in the clinical arena (for facilitating diagnosis or refining prognosis) will be critically assessed and guidance toward future progress provided.

Covering the Cover

Covering the Cover