Gastrointestinal Pain Research Articles

Hyptis pectinata gel prevents alveolar bone resorption in experimental periodontitis in rats

Hyptis pectinata (L.) Poit., Lamiaceae, is an aromatic, abundant and broadly used plant species in Sergipe to treat oral and gastrointestinal pain and inflammation. The aim of the present study was to analyze the relation between periodontitis and changes in the corporal mass and alveolar bone structure after induction of experimental periodontal disease in rat treated or not treated with H. pectinata gel at 5% (GS5%) and 10% (GS10%), comparing their effects with doxycycline gel at 10% (D10%, positive control), vehicle gel (negative control) and a group with experimental periodontal disease, but non-treated. The gels were locally applied in the gingival region immediately after the experimental periodontal disease induction by ligature (3×/day, 11 days). Bone destruction was determined through clinical exam, histopathological analysis and cone beam computed tomography of the experimental animals (n=36). After 11 days of periodontitis induction, all groups that received ligature presented a decrease in the corporal mass, except to the naïve group (without experimental periodontal disease) (p<0.05). Computed tomography results have shown healthy bone structure in the group I and bone resorption for the test groups. Histopathological analysis confirmed the healthy bone structure for naïve group animals, while the test groups exhibited bone loss in several degrees. In particular, the non-treated group animals had an intense inflammatory process. When the periodontium of the animals treated with GS10% was histopathologically analyzed, insertion periodontium was preserved. The results for these groups were significantly different of the vehicle group (p<0.05). According to the results, the gel based in the aqueous extract of H. pectinata at 10% can prevent bone loss in experimental periodontal disease similarly to doxycycline 10%.

Cognitive Mediators of Treatment Outcomes in Pediatric Functional Abdominal Pain

Cognitive-behavioral (CB) interventions improve outcomes for many pediatric health conditions, but little is known about which mechanisms mediate these outcomes. The goal of this study was to identify whether changes in targeted process variables from baseline to 1 week posttreatment mediate improvement in outcomes in a randomized controlled trial of a brief CB intervention for idiopathic childhood abdominal pain. Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to 1 of 2 conditions: a 3-session social learning and CB treatment (N=100), or a 3-session educational intervention controlling for time and attention (N=100). Outcomes were assessed at 3-, 6-, and 12-month follow-ups. The intervention focused on altering parental responses to pain and on increasing adaptive cognitions and coping strategies related to pain in both parents and children. Multiple mediation analyses were applied to examine the extent to which the effects of the social learning and CB treatment condition on child gastrointestinal (GI) symptom severity and pain as reported by children and their parents were mediated by changes in targeted cognitive process variables and parents' solicitous responses to their child's pain symptoms. Reductions in parents' perceived threat regarding their child's pain mediated reductions in both parent-reported and child-reported GI symptom severity and pain. Reductions in children's catastrophic cognitions mediated reductions in child-reported GI symptom severity but no other outcomes. Reductions in parental solicitousness did not mediate outcomes. Results suggest that reductions in reports of children's pain and GI symptoms after a social learning and CB intervention were mediated at least in part by decreasing maladaptive parent and child cognitions.

Living through pelvic radiotherapy:A mixed method study of self-care activities and distressful symptoms

PurposeTo explore patients' experience of their illness when undergoing pelvic radiotherapy by describing the presence and severity of distressful symptoms and to explore initiated self-care activities in response to illness and symptoms. MethodsA mixed-method study was performed which included a core qualitative dataset and a supplementary quantitative dataset. Twenty-nine women undergoing five weeks of radiotherapy were prospectively interviewed during five weeks of treatment in order to capture experiences, distressful symptoms and quality of life during treatment. Grounded theory formed collection and analysis of the qualitative dataset and statistics were used to analyze the quantitative dataset. ResultsA maintained self-identity was concluded as being central during the trajectory of treatment. Initiated self-care activities served to alleviate physical, emotional, and social suffering; helping the respondents keep their integrity and sense of self. Previous life experiences influenced the process of being able to maintain self-identity. The gastrointestinal symptoms and pain caused most distress. ConclusionsIn order to be able to maintain self-identity patients endure treatment by focusing on symptoms, on getting cured and on their self-image. Several distressful symptoms implied social limitations and a sense that the body would not take the strain. The result of this study can help health care professionals to gain a better understanding of the struggle to endure pelvic radiotherapy. Further, health care professionals should be more proactive in alleviating their patients' distressful symptoms. The results imply that previous life experiences should precede initiated interventions because these life experiences affect the patients' self-care activities.

The association of depression and anxiety with pain: a study from NESDA.

Chronic pain is commonly co-morbid with a depressive or anxiety disorder. Objective of this study is to examine the influence of depression, along with anxiety, on pain-related disability, pain intensity, and pain location in a large sample of adults with and without a depressive and/or anxiety disorder. The study population consisted of 2981 participants with a depressive, anxiety, co-morbid depressive and anxiety disorder, remitted disorder or no current disorder (controls). Severity of depressive and anxiety symptoms was also assessed. In separate multinomial regression analyses, the association of presence of depressive or anxiety disorders and symptom severity with the Chronic Pain Grade and location of pain was explored. Presence of a depressive (OR = 6.67; P<.001), anxiety (OR = 4.84; P<.001), or co-morbid depressive and anxiety disorder (OR = 30.26; P<.001) was associated with the Chronic Pain Grade. Moreover, symptom severity was associated with more disabling and severely limiting pain. Also, a remitted depressive or anxiety disorder showed more disabling and severely limiting pain (OR = 3.53; P<.001) as compared to controls. A current anxiety disorder (OR = 2.96; p<.001) and a co-morbid depressive and anxiety disorder (OR = 5.15; P<.001) were more strongly associated with cardio-respiratory pain, than gastro-intestinal or musculoskeletal pain. These findings remain after adjustment for chronic cardio respiratory illness. Patients with a current and remitted depressive and/or anxiety disorder and those with more severe symptoms have more disabling pain and pain of cardio-respiratory nature, than persons without a depressive or anxiety disorder. This warrants further research.

PO-0016 Henoch Scholein Purpura In Children: About 24 Cases

Background Henoch Scholein Purpura is the most frequent vasculitis in children. Its diagnosis is clinical and prognosis is often favourable. Aim To precise the epidemiological, clinical, biological profiles and course of the disease. Methods Retrospective study over 10 years (January 2005–January 2014) of 24 children with Henoch-schonlein vasculitis. The diagnosis was based on the association of non-trombocytopenic purpura, arthritis or arthralgia and abdominal pain. Results The mean age of patients was 5,2 years with male predominance (sex-ratio: 1.8). Purpura was observed in all cases. Articular manifestations were noted in 16 cases (69, 5%). Digestive manifestations were noted in 11 cases; it involves acute gastro-intestinal bleeding (4 cases), abdominal pain (6 cases) and diarrhoea (1 case). Upper digestive gastrointestinal endoscopy was done in 3 cases; it showed erosive gastritis in one case. Ultrasonography showed intussusception in 2 patients. Moderate renal manifestations (microscopic hematuria, moderate proteinuria) were observed in 5 children. Five patients required corticosteroid therapy. The evolution was favourable in all cases. Conclusion The Henoch-Sconlein purpura is generally a benign disease. prognosis depends on the risk digestive complications at the acute phase and renal damage at long-term.

Unanticipated hospital admissions during or soon after radiation therapy: Incidence and predictive factors

PurposeUnplanned hospital admissions in cancer patients undergoing treatment is an understudied area with important implications for both health care costs and patient outcomes. The goal of this retrospective study was to evaluate the rate, reasons for, and predictors of unplanned hospital admissions during or soon after palliative or curative radiation therapy for cancer, with or without chemotherapy. Methods and materialsA total of 1116 consecutive patients who received external beam radiation therapy for a malignancy at the University of North Carolina at Chapel Hill from January 1 through December 31, 2010, were studied. The primary outcome was unplanned hospitalization within 90 days of starting radiation therapy (ie, during or soon after). Multivariable logistic regression was used to examine patient and treatment factors associated with admissions. ResultsTwenty percent of patients experienced an unplanned admission, which was especially likely in patients with lung (25% of such patients admitted), head and neck (22%), and gastrointestinal (21%) cancers, as well as those treated with palliative intent (31%). The most common causes for admission were gastrointestinal symptoms, neurologic symptoms, respiratory symptoms, pain, and fever or infection. Forty-seven percent of admitted patients were seen in the clinic within 2 weeks of unplanned hospital admission, and 61% of those patients had a related complaint in the clinic. Multivariate analysis showed that married patients (odds ratio [OR] = 0.58; P < .001), curative intent (OR = 0.38; P < .001), and no concurrent chemotherapy (OR = 0.55; P < .001) were associated with decreased odds for admission. ConclusionsUnplanned admissions are relatively common during or soon after radiation therapy in our patient series. Additional work is needed to gather data from other centers and to better understand, and hopefully reduce, these unplanned admissions.

Neuroplasticity and dysfunction after gastrointestinal inflammation.

The gastrointestinal tract is innervated by several distinct populations of neurons, whose cell bodies either reside within (intrinsic) or outside (extrinsic) the gastrointestinal wall. Normally, most individuals are unaware of the continuous, complicated functions of these neurons. However, for patients with gastrointestinal disorders, such as IBD and IBS, altered gastrointestinal motility, discomfort and pain are common, debilitating symptoms. Although bouts of intestinal inflammation underlie the symptoms associated with IBD, increasing preclinical and clinical evidence indicates that infection and inflammation are also key risk factors for the development of other gastrointestinal disorders. Notably, a strong correlation exists between prior exposure to gut infection and symptom occurrence in IBS. This Review discusses the evidence for neuroplasticity (structural, synaptic or intrinsic changes that alter neuronal function) affecting gastrointestinal function. Such changes are evident during inflammation and, in many cases, long after healing of the damaged tissues, when the nervous system fails to reset back to normal. Neuroplasticity within distinct populations of neurons has a fundamental role in the aberrant motility, secretion and sensation associated with common clinical gastrointestinal disorders. To find appropriate therapeutic treatments for these disorders, the extent and time course of neuroplasticity must be fully appreciated.

Evaluation of plasma muscle enzyme activity as an indicator of lesion characteristics and prognosis in horses undergoing celiotomy for acute gastrointestinal pain.

BackgroundIn horses undergoing celiotomy for acute gastrointestinal pain, identification of variables correlating with lesion severity and location, and survival provide veterinarians and owners with information that aids in making informed decisions regarding appropriate treatment. Muscle enzyme activity is often increased in horses undergoing celiotomy for acute gastrointestinal pain and it is not known if muscle enzyme activity increase is specific to lesion type or impacts prognosis for survival. The objective of this study was to evaluate the relationship of pre-operative increase in muscle enzyme activities with intestinal lesion characteristics, specifically lesion location (large versus small intestine) and whether it was strangulating versus nonstrangulating, and case survival in horses undergoing celiotomy for acute gastrointestinal pain.MethodsRecords of 241 horses undergoing exploratory laparotomy for colic were reviewed retrospectively. Evaluation of preoperative plasma aspartate aminotransferase (AST), creatine kinase (CK), sorbitol dehydrogenase (SDH), and gamma-glutamyltransferase (GGT) activities, fibrinogen and glucose concentrations, and hematocrit (HCT) and their association with gastrointestinal lesion characteristics and survival was performed.ResultsPre-operative increase in plasma CK and AST activity, and HCT and decrease in plasma bilirubin concentration were significantly associated with presence of lesions resulting in intestinal ischemia. Increase in plasma CK activity and HCT were significantly associated with a decreased probability of survival to hospital discharge. Plasma GGT and SDH activity, and glucose and fibrinogen concentration were not significantly associated with survival or severity of disease in multivariate analysis.ConclusionsPlasma muscle enyzme activity may be useful as a prognostic indicator in equine colic cases. Given that increases in plasma CK and AST activity were significantly associated with nonsurvival and the presence of intestinal ischemia, preoperative increase in these enzyme activities could assist in identification of disease severity and prognosis of horses undergoing celiotomy for acute gastrointestinal pain. Further study is indicated to elucidate the etiology of increased muscle enzyme activity in horses with surgical colic disease observed in this preliminary study.

Multiple, persistent gastropancreato-neuroendocrine tumours accompanying sigmoid bowel adenocarcinoma: A rare case report

IntroductionGastropancreato-neuroendocrine tumours (GETs) are rare, especially when they occur alongside colorectal adenocarcinoma. Furthermore, multiple GETs occurring within the small bowel are less frequent with only two cases described within the literature.Presentation of caseA healthy 58-year old woman presented with severe gastrointestinal pain and faecal incontinence. Family history revealed consanguineous parents and a brother who had recently died of a gastric GET. First biopsy showed a sigmoid adenocarcinoma. Histology of the resected sigmoid revealed both adenocarcinoma and GET. After this, she presented with small bowel obstruction secondary to multiple ileal and jejunal GETs, also treated with resection. All imaging modalities gave no evidence of extra-intestinal metastasis. The patient received multiple operations and chemotherapy but died 18 months after the original presentation.DiscussionA case of such persistent and multiple small bowel GET without extra-intestinal metastasis has yet to be reported within the literature. GETs are rare and typically asymptomatic with a small proportion giving the classical carcinoid syndrome. Surgery is usually reserved for smaller GETs with high five-year survival. Despite this, surgery and chemotherapy were performed and both proved to be ineffective. Furthermore, a genetic basis for GETs is supported in this case with her brother suffering a similar fatal tumour.ConclusionThis case highlights a rare GET that has a likely underlying familial origin. It illustrates the non-specific presentation of these tumours and the importance of taking a thorough family history. It also demonstrates that these tumours can be fatal even in the absence of extra-intestinal metastasis.

Malabsorption of fermentable oligo-, di-, or monosaccharides and polyols (FODMAP) as a common cause of unclear abdominal discomfort

Carbohydrate malabsorption is a frequent but underestimated cause of unexplained gastrointestinal symptoms like meteorism, flatulence, pain and diarrhea. By means of hydrogen and/or methane breath test after ingestion of the respective carbohydrate it can be identified and diagnosed easily, fast and reliably by successful nutritional therapy. Besides the well known complaints caused by lactose and fructose malabsorption, other fermentable oligo-, di-, or monosaccharides and polyols (akronym: FODMAP) can cause abdominal discomfort and IBS-like symptoms. In addition to lactose (dairy products) and fructose (apples, pears, mango, watermelon), FODMAPs comprise galactans (legumes), fructans (wheat, onions, garlic, artichoke) and the artificial sweeteners sorbitol, mannitol, maltitol and xylitol (sugar free candy, light products). A general restriction of all FODMAP components can be beneficial in relieving symptoms and improving quality of life in patients with functional gastrointestinal complaints.

Novel orally available salvinorin A analog PR-38 inhibits gastrointestinal motility and reduces abdominal pain in mouse models mimicking irritable bowel syndrome.

The opioid and cannabinoid systems play a crucial role in multiple physiological processes in the central nervous system and in the periphery. Selective opioid as well as cannabinoid (CB) receptor agonists exert a potent inhibitory action on gastrointestinal (GI) motility and pain. In this study, we examined (in vitro and in vivo) whether PR-38 (2-O-cinnamoylsalvinorin B), a novel analog of salvinorin A, can interact with both systems and demonstrate therapeutic effects. We used mouse models of hypermotility, diarrhea, and abdominal pain. We also assessed the influence of PR-38 on the central nervous system by measurement of motoric parameters and exploratory behaviors in mice. Subsequently, we investigated the pharmacokinetics of PR-38 in mouse blood samples after intraperitoneal and oral administration. PR-38 significantly inhibited mouse colonic motility in vitro and in vivo. Administration of PR-38 significantly prolonged the whole GI transit time, and this effect was mediated by µ- and κ-opioid receptors and the CB1 receptor. PR-38 reversed hypermotility and reduced pain in mouse models mimicking functional GI disorders. These data expand our understanding of the interactions between opioid and cannabinoid systems and their functions in the GI tract. We also provide a novel framework for the development of future potential treatments of functional GI disorders.

Guanylate cyclase-C/cGMP: an emerging pathway in the regulation of visceral pain

Activation of guanylate cyclase-C (GC-C) expressed predominantly on intestinal epithelial cells by guanylin, uroguanylin or the closely related GC-C agonist peptide, linaclotide, stimulates generation, and release of cyclic guanosine-3′,5′-monophosphate (cGMP). Evidence that the visceral analgesic effects of linaclotide are mediated by a novel, GC-C-dependent peripheral sensory mechanism was first demonstrated in animal models of visceral pain. Subsequent studies with uroguanylin or linaclotide have confirmed the activation of a GC-C/cGMP pathway leading to increased submucosal cGMP mediated by cGMP efflux pumps, which modulates intestinal nociceptor function resulting in peripheral analgesia. These effects can be reproduced by the addition of exogenous cGMP and support a role for GC-C/cGMP signaling in the regulation of visceral sensation, a physiological function that has not previously been linked to the GC-C/cGMP pathway. Notably, targeting the GC-C/cGMP pathway for treatment of gastrointestinal pain and abdominal sensory symptoms has now been validated in the clinic. In 2012, linaclotide was approved in the United States and European Union for the treatment of adult patients with irritable bowel syndrome with constipation.

Clinical effect and safety of 125I particle stent on treatment of postoperative esophageal stricture for patients with advanced esophageal cancer

Objective To investigate clinical effect and safety of the 125I particle stent for treatment of postoperative esophageal stricture on patients with advanced esophageal cancer.Methods Sixty patients with postoperative esophageal stricture after esophageal cancer operation were randomly assigned to receive treatment with a conventional self-expanding stent (control group) or a stent loaded with 125I seeds (irradiation group).After stent implantation,the outcomes were compared in terms of the success rate of stent implantation,relief of dysphagia,survival time,and complications related to the procedure.Dysphagia was assigned a grade 0-4.The t test and the x2 test were used to make statistical analysis.Results The success rate of stents placement of two groups were 100％ (30/30).The results of preoperative dysphagia score showed that the patients of control group with 0,1,2,3,4 degree were 0,2,3,22 and 3 patients ; the patients of radiation group with 0,1,2,3,4 degree were 0,2,2,23 and 3 patients; in postoperative 1 week,the control group turned to 1,17,6,6 and 0 patients,the radiation group turned to 4,21,3,2 and 0 patients ; the difference between the 2 groups was not statistically significant (x2 =1.214,P =0.675) ; in postoperative 2 months,the patients with the above degree of dysphagia score of control group were 25,3,2,0,0; and the radiation group were 27,2,1,0,0,the difference between the 2 groups was not statistically significant (x2 =1.043,P =0.894).Followed up for 6 months,1 patient gastrointestinal bleeding,4 patients gastrointestinal pain and 8 patients esophageal restenosis were occurred in control group,corresponding in irradiated group were 0,5,and 3 patients respectively,the incidence of postoperative esophageal restenosis of irradiated group was lower than control group,and the difference was statistically significant (x2 =4.384,P =0.036).After follow-up for 18 months,10 patients were survival among the 30 patients of control group,the live time of the 20 patients dead patients were 2 to 14 months,control group of 30 patients,10 patients of survival of 20 deaths of patients from 2 to 14 months,the average value was (4.8± 1.7)months ; there were 15 survival patients among irradiation group,the survival time of the 15 deaths was 4 to 15 months,and the average value was (9.8 ± 2.9) months.By the end of follow-up,the average survival time for all patients of irradiated group was longer than the control group,the difference was statistically significant (t =8.917,P =0.002).Conclusion In patients with postoperative esophageal stricture and advanced esophageal cancer,stent loaded with 125I stent has potential benefit in that it allows a longer relief of dysphagia and a longer survival time. Key words: Esophageal neoplasms ; Stents ; Esophageal stenosis

Effects of pitolisant, a histamine H3 inverse agonist, in drug-resistant idiopathic and symptomatic hypersomnia: a chart review

ObjectiveTo evaluate the benefits and risks of pitolisant (a wake-enhancing drug that increases the histamine release in the brain by blocking presynaptic H3 histamine reuptake) in patients with idiopathic (IH) and symptomatic (SH) hypersomnia plus sleepiness refractory to available stimulants (modafinil, methylphenidate, mazindol, sodium oxybate, and d-amphetamine). MethodsThrough retrospective analyses of patient files, the benefit (the score from the Epworth Sleepiness Scale [ESS], authorization renewal) and tolerance (side-effects) of pitolisant were assessed. ResultsA total of 78 patients with IH (n=65%, 78% women) and SH (n=13%, 54% women) received pitolisant 5–50mg once per day over the course of five days to 37months. The median (interquartile range) ESS scores of patients with IH decreased from 17 (15.5–18.5) to 14 (12–17). There were 36% responders (ESS fall of ⩾3). The improvement in ESS score (−1.9±2.6) was different from 0 in IH without long sleep time (P<0.002) and in IH with a long sleep time (P<0.0001), but not in SH. Forty-four (63%) patients with IH and 12 (77%) patients with SH stopped pitolisant, mostly due to a lack of efficacy. Side-effects included gastrointestinal pain (15.4%), increased appetite and weight gain (14.1%), headache (12.8%), insomnia (11.5%), and anxiety (9%), as well as exceptional reports of depression and persistent genital arousal. ConclusionPitolisant had a long-term favorable benefit/risk ratio in 23–38% of drug-resistant patients with IH and SH, suggesting that histamine neurons can be stimulated in severe idiopathic and symptomatic hypersomnia.

The early administration of Lactobacillus reuteri DSM 17938 controls regurgitation episodes in full-term breastfed infants

Forty breastfed full-term infants were randomly, double blind assigned to receive orally Lactobacillus reuteri (L. reuteri) DSM 17938, 5 drops/daily (108 colony-forming units), for 4 weeks (n = 20) or an identical placebo (n = 20), starting before third day of life. They underwent basal and final visit to monitor growth parameters and gastrointestinal (GI) disease. Parents registered daily: crying minutes, stool frequency and consistency, numbers of regurgitations, adverse events. Secretory IgA (sIgA) has been measured in saliva on 28th day. Treated infants demonstrated a reduction in daily regurgitations at the end of treatment (p = 0.02), three neonates in the placebo group only needed simethicone for GI pain, sIgA level was similar in both groups. Random casualty produced an unbalanced gender distribution in the groups, but this bias did not affect the results. Therefore, early administration of L. reuteri DSM 17938 resulted beneficial in preventing regurgitation episodes during the first month of life.

Enhanced recovery pathway following radical cystectomy

To evaluate perioperative enhanced recovery protocols for patients undergoing radical cystectomy and urinary diversion and describe our unique protocol. Radical cystectomy is a morbid procedure with rather long hospital stay and complication rates. The main reason for lengthy hospital stay is bowel complication including paralytic ileus. Different perioperative care plans have been recommended to decrease hospital stay and complication rate. Most of this recovery plans focus on enhancing gastrointestinal function recovery, pain management and early mobility. Enhanced recovery after surgery protocol includes pre, intra and postoperative evidence-based modifications for improving perioperative care of cystectomy patients. Significant shortening of hospital stay without increasing early complication or readmission rate could be achieved safely in most of the patients.

Patients with Fabry Disease after Enzyme Replacement Therapy Dose Reduction Versus Treatment Switch

Because of the shortage of agalsidase-beta in 2009, many patients with Fabry disease were treated with lower doses or were switched to agalsidase-alfa. This observational study assessed end-organ damage and clinical symptoms during dose reduction or switch to agalsidase-alfa. A total of 105 adult patients with Fabry disease who had received agalsidase-beta (1.0 mg/kg body weight) for ≥1 year were nonrandomly assigned to continue this treatment regimen (regular-dose group, n=38), receive a reduced dose of 0.3-0.5 mg/kg (dose-reduction group, n=29), or switch to 0.2 mg/kg agalsidase-alfa (switch group) and were followed prospectively for 1 year. We assessed clinical events (death, myocardial infarction, severe arrhythmia, stroke, progression to ESRD); changes in cardiac, renal, and neurologic function; and Fabry-related symptoms (neuropathic pain, hypohidrosis, diarrhea, and disease severity scores). Organ function and Fabry-related symptoms remained stable in the regular-dose group. In contrast, estimated GFR decreased by about 3 ml/min per 1.73 m(2) (P=0.01) in the dose-reduction group, and the median albumin-to-creatinine ratio increased from 114 (0-606) mg/g to 216 (0-2062) mg/g (P=0.03) in the switch group. Furthermore, mean Mainz Severity Score Index scores and frequencies of pain attacks, chronic pain, gastrointestinal pain, and diarrhea increased significantly in the dose-reduction and switch groups. In conclusion, patients receiving regular agalsidase-beta dose had a stable disease course, but dose reduction led to worsening of renal function and symptoms. Switching to agalsidase-alfa is safe, but microalbuminuria may progress and Fabry-related symptoms may deteriorate.

Conditioned Pain Modulation in Women With Irritable Bowel Syndrome

Evidence suggests that patients with irritable bowel syndrome (IBS) are more vigilant to pain-associated stimuli. The aims of this study were to compare women with IBS (n = 20) to healthy control (HC, n = 20) women on pain sensitivity, conditioned pain modulation (CPM) efficiency, and salivary cortisol levels before and after the CPM test and to examine the relationship of CPM efficiency with gastrointestinal pain, somatic pain, psychological distress symptoms, and salivary cortisol levels in each group. Women, aged 20-42 years, gave consent, completed questionnaires, and kept a symptom diary for 2 weeks. CPM efficiency was tested with a heat test stimulus and cold water condition stimulus in a laboratory between 8 and 10 a.m. on a follicular phase day. Salivary cortisol samples were collected just before and after the experimental testing. Compared to the HC group, women with IBS reported more days with gastrointestinal and somatic pain/discomfort, psychological distress, fatigue, and feeling stressed. During the CPM baseline testing, women with IBS reported greater pain sensitivity compared to the HC group. There was no significant group difference in salivary cortisol levels nor in CPM efficiency, though a post-hoc analysis showed a higher prevalence of impaired CPM efficiency among IBS subjects with more severe lower-GI symptoms. In the IBS group, reduced CPM efficiency was associated with daily abdominal pain/discomfort and psychological distress. Overall, women with IBS exhibited an increased sensitivity to thermal stimuli. Impaired CPM was present in a subset of women with IBS.

Torsion of Arteriovenous Malformation – A Rare Case of Acute Abdomen

Arteriovenous malformation (AVM) is a rare finding in gastrointestinal tract usually asymptomatic, although sometimes causes gastrointestinal bleeding or pain. Even more rarely it can be found in other abdominal organs like liver, pancreas, spleen etc. We present a unique case of acute abdominal pain – a patient with torsion of arteriovenous malformation of gastroepiploic arteries with following ischemia and thrombosis causing severe pain. A search at the literature has not yielded any other case report describing similar cause of the acute abdomen.

Eosinophilic Gastroenteritis Due To Egg Allergy Presenting As Acute Pancreatitis

RationaleEosinophilic gastroenteritis (EGE) is a disease characterized by eosinophilic infiltration of the gastrointestinal tract. Most patients present with nonspecific symptoms of gastrointestinal pain, bloating, nausea, vomiting, diarrhea, malabsorption and ascites. Here we present a case of acute pancreatitis in a 25 year-old female within 1 hour after ingestion of an egg-containing product.MethodsSerologic testing by Immunocap performed to commonly allergic foods. Endoscopy performed during admission for acute pancreatitis.ResultsDuring one of these attacks, her lipase was elevated to 2400 U/L. Endoscopic biopsies revealed increased eosinophils in the duodenum without villous blunting or acute inflammation. Charcot Leyden crystals were also noted on a stool sample. In vitro allergy testing demonstrated a level III sensitization to egg, all other tested foods were negative. Removal of egg from this patient’s diet has lead to complete resolution of her symptoms.ConclusionsOne previous case report discussed a patient with milk allergy resulting in EGE with acute pancreatitis. A possible mechanism by which food-hypersensitivity related EGE may cause acute pancreatitis is due to obstruction of the pancreatic duct from local duodenal inflammation. When unexplainable gastrointestinal symptoms are observed in patients with positive food allergy testing, EGE triggered by food allergies should be included in the diagnosis. RationaleEosinophilic gastroenteritis (EGE) is a disease characterized by eosinophilic infiltration of the gastrointestinal tract. Most patients present with nonspecific symptoms of gastrointestinal pain, bloating, nausea, vomiting, diarrhea, malabsorption and ascites. Here we present a case of acute pancreatitis in a 25 year-old female within 1 hour after ingestion of an egg-containing product. Eosinophilic gastroenteritis (EGE) is a disease characterized by eosinophilic infiltration of the gastrointestinal tract. Most patients present with nonspecific symptoms of gastrointestinal pain, bloating, nausea, vomiting, diarrhea, malabsorption and ascites. Here we present a case of acute pancreatitis in a 25 year-old female within 1 hour after ingestion of an egg-containing product. MethodsSerologic testing by Immunocap performed to commonly allergic foods. Endoscopy performed during admission for acute pancreatitis. Serologic testing by Immunocap performed to commonly allergic foods. Endoscopy performed during admission for acute pancreatitis. ResultsDuring one of these attacks, her lipase was elevated to 2400 U/L. Endoscopic biopsies revealed increased eosinophils in the duodenum without villous blunting or acute inflammation. Charcot Leyden crystals were also noted on a stool sample. In vitro allergy testing demonstrated a level III sensitization to egg, all other tested foods were negative. Removal of egg from this patient’s diet has lead to complete resolution of her symptoms. During one of these attacks, her lipase was elevated to 2400 U/L. Endoscopic biopsies revealed increased eosinophils in the duodenum without villous blunting or acute inflammation. Charcot Leyden crystals were also noted on a stool sample. In vitro allergy testing demonstrated a level III sensitization to egg, all other tested foods were negative. Removal of egg from this patient’s diet has lead to complete resolution of her symptoms. ConclusionsOne previous case report discussed a patient with milk allergy resulting in EGE with acute pancreatitis. A possible mechanism by which food-hypersensitivity related EGE may cause acute pancreatitis is due to obstruction of the pancreatic duct from local duodenal inflammation. When unexplainable gastrointestinal symptoms are observed in patients with positive food allergy testing, EGE triggered by food allergies should be included in the diagnosis. One previous case report discussed a patient with milk allergy resulting in EGE with acute pancreatitis. A possible mechanism by which food-hypersensitivity related EGE may cause acute pancreatitis is due to obstruction of the pancreatic duct from local duodenal inflammation. When unexplainable gastrointestinal symptoms are observed in patients with positive food allergy testing, EGE triggered by food allergies should be included in the diagnosis.