Gastrointestinal Quality Of Life Index Research Articles

P-360 The effect of dietary interventions, or no intervention, on Pain and Quality of Life in women diagnosed with Endometriosis

Abstract Study question Explore the influence of a dietary intervention, the Low FODMAP diet or endometriosis diet, on endometriosis-related pain and thereby Quality of Life. Summary answer After adhering to a dietary intervention for six months, women reported less pain and better Quality of Life (QoL). What is known already Standard endometriosis treatment, hormonal therapy, surgery and/or pain management, can be insufficient in treating endometriosis or may be accompanied with unacceptable side effects. Therefore, there is an increasing interest among endometriosis patients in the application of self-management strategies. The Low FODMAP diet has previously been studied and found effective in reducing pain symptoms in endometriosis patients. Guidelines for the Low FODMAP diet have been developed. Limited studies are available on the efficacy of the endometriosis diet. A survey study recently found that it was effective in improving QoL. Currently no guidelines on the implementation of the endometriosis diet exist. Study design, size, duration We performed a prospective pilot study. Women could choose between adherence to a diet (Low FODMAP diet or endometriosis diet) or no diet. It was aimed to include 60 participants, 20 participants per group. When adhering to a dietary intervention, women received extensive guidance by a student dietician for three months. After three months, women were asked to continue the diet independently for another three months. The follow-up period covered six months for all participants. Participants/materials, setting, methods Between April 2021 and December 2022, we included women diagnosed with endometriosis, surgically and/or by imaging, and reported VAS pain scores ≥ 3cm (dysmenorrhea, deep dyspareunia, chronic pelvic pain). Primary endpoint focused on pain reduction (VAS, scale 0-10cm) in the symptoms dysmenorrhea, deep dyspareunia, chronic pelvic pain, dysuria, tiredness and bloating. Secondary endpoints focused on QoL measured using the Endometriosis Health Profile (EHP-30) and Gastro-intestinal health measured using the Gastro-Intestinal Quality of Life Index (GIQLI). Main results and the role of chance Sixty-two women (22 Low FODMAP diet, 21 Endometriosis diet, 19 control) participated. Women adhering to a diet reported less pain in all symptoms but dysmenorrhea (range p < 0.001 to p = 0.012) and better EHP-30 scores in the domains pain, powerlessness, emotional wellbeing, self-image, work life and sexual intercourse (range p < 0.001 to p = 0.023) after six months dietary adherence. When differentiating between the diets, women adhering to the Low FODMAP diet reported less dysuria and bloating (p = 0.015; p < 0.001, resp.) and better scores in the domains pain, powerlessness and work life (p = 0.007; p = 0.002; p = 0.035, resp.). Women adhering to the endometriosis diet reported less bloating and tiredness (p = <0.001; p < 0.001, resp.) and better scores in the domains powerlessness, emotional wellbeing and self-image (p = 0.014; p = 0.022; p < 0.001, resp.) after six months dietary adherence. When comparing it to the control group, women adhering to a dietary intervention reported significant less bloating (p = 0.049), and better scores in the domains social support, medical profession and infertility (range p = 0.002 to p = 0.035) at six month’ follow-up. There was a high level of satisfaction with the dietary guidance. Three out of 43 women discontinued adherence to their diet prematurely. Ultimately, 35 out of 43 women wanted to continue their diet (partially) after six months. Limitations, reasons for caution No sample size was calculated since efficacy data in literature was lacking. There was no randomization to optimize dietary adherence, possibly resulting in selection bias. Women found it hard to express their pain in VAS; their pain was still present but less frequent. Wider implications of the findings Women adhering to a diet reported lower pain scores and better QoL after six months. It could therefore be recommended to endometriosis patients with therapy-resistant pain, wishing to apply self-management strategies. However, caution is implied because data on long-term effects (>6 months) is lacking and drawing up guidelines is needed. Trial registration number W20_534 # 20.593

The feasibility of a randomized controlled crossover trial to assess the effect of probiotic and prebiotic supplementation on the health of elite wheelchair athletes

BackgroundGastrointestinal (GI) problems represent a health burden in Para athletes and can ultimately reduce athletic performance. This study aimed to evaluate the feasibility of a randomized controlled crossover trial (RCCT) assessing the effects of probiotic and prebiotic supplementation on the health of Swiss elite wheelchair athletes.MethodsThe RCCT was conducted between March 2021 and October 2021. Athletes were randomized to receive either a daily probiotic (3 g of probiotic preparation, including eight bacterial strains), or a daily prebiotic (5 g of oat bran) supplementation first. After the first supplementation phase (4 weeks), a washout period (4 weeks) and the second crossover supplementation phase (4 weeks) followed. Data were collected at four study visits (every 4 weeks) and included 3-day training and nutrition diaries, the Gastrointestinal Quality of Life Index (GIQLI) questionnaire, stool samples, and fasting blood samples. The study assessed the feasibility criteria such as recruitment rate, retention rate, success of data collection, adherence to the protocol, willingness to participate, and safety.ResultsThis pilot study met the majority of the predefined minimum requirements for the feasibility criteria. Out of 43 invited elite wheelchair athletes, 14 (33%) consented (mean (standard deviation) age: 34 (9) years, eight females, 11 with a spinal cord injury). The desired sample size was not reached, but the achieved recruitment rate was modest, especially considering the population studied. All participating athletes completed the study. With the exception of one missing stool sample and two missing diaries, data were successfully collected for all athletes at all four visits. Most athletes adhered to the daily intake protocol for at least 80% of the days, both for probiotics (n = 12, 86%) and prebiotics (n = 11, 79%). Ten (71%) athletes would be willing to participate in a similar study again. No serious adverse events occurred.ConclusionDespite the limited number of elite wheelchair athletes in Switzerland and the modest recruitment rate, the implementation of a RCCT in elite wheelchair athletes is feasible. The data collected in this study provide essential information for the design of the subsequent study which will include a larger cohort of physically active wheelchair users.Trial registrationSwiss Ethics Committee for Northwest/Central Switzerland (EKNZ), 2020–02337). ClinicalTrials.gov, NCT04659408.

DOES BOWEL FUNCTION IMPACTS ON QUALITY OF LIFE AND SEXUAL FUNCTION IN WOMEN WITH DEEP INFILTRATING ENDOMETRIOSIS ACCORDING KIND OF TREATMENT?

•Women with intestinal endometriosis may have impaired quality of life and altered bowel habits. Intestinal endometriosis can be treated medically or surgically. The bowel function of these women is directly correlated with sexual function and quality of life, regardless of the type of treatment. Background - Women with intestinal endometriosis may have a higher incidence of constipation, which may influence their quality of life. Objective - To correlate bowel function with sexual function and quality of life in women with deep endometriosis according to the type of treatment. Methods - Cross-sectional study carried out with 141 women with bowel endometriosis from May 2020 to April 2021. Women were divided into two groups according to kind of treatment: 51 women with surgery treatment and 90 women with medical treatment. The Endometriosis Health Profile Questionnaire were used to assess quality of life e Female Sexual Function Index were used to assess sexual function. To access bowel function we used the following questionnaires: Gastrointestinal Quality of Life Index and Pelvic Floor Distress Inventory. Results - The mean age of women in the surgical group (37.98±5.91years) was higher than that of the medical group (35.68±5.45years) (P=0.006). There was no statistically significant difference between pain symptoms (P=0.905), water intake (P=0.573) or fiber (P=0.173) and physical activity (P=0.792) in both groups. There was no difference between quality of life and sexual function in both groups. There was a direct correlation of bowel function with quality of life and sexual function in both groups. Conclusion: Bowel function is directly correlated with sexual function and quality of life, regardless of the type of treatment.

Identifying Gut Microbiota associated with Gastrointestinal Symptoms upon Roux-en-Y Gastric Bypass

PurposeRoux-en-Y gastric bypasses (RYGB) are frequently accompanied by long-term gastrointestinal (GI) symptoms. Direct mechanistic insight into the causation of these symptoms is lacking, but changes in the intestinal microbiome have been proposed to play a role. With this study, we aimed to investigate whether a microbial predisposition exists before RYGB which is associated with GI symptoms during follow-up and to evaluate which microbial groups are involved.Materials and MethodsIn total, 67 RYGB patients were included. Shotgun metagenomic sequencing was performed on fecal samples obtained just before and 1 year after surgery. To assess GI symptoms, patients filled out Gastrointestinal Quality of Life Index (GIQLI) questionnaires and were divided into groups based on their total GIQLI score and change in score (postsurgery versus baseline). Extremely randomized tree predictor models were used to identify the most distinctive microbial species associated with postoperative GI symptoms.ResultsBeta diversity differed significantly between baseline and 1-year post-surgery samples, with the post-surgery microbiome resembling a more dysbiotic profile. The most predictive species regarding total GIQLI (AUC 0.77) or delta GIQLI score (AUC 0.83) were identified. Many of these species are known butyrate producers or species known to support them and/or species with anti-inflammatory properties, including Coprococcus eutactus, Faecalibacterium prausnitzii, and Ruminococcus callidus.ConclusionBeneficial commensal gut microbiota related to a high GI score were associated to adequate intestinal fermentative capacity, suggesting these species might have protective properties against postoperative GI malfunctioning.Graphical

Quality-of-Life and Recurrence Outcomes Following Laparoscopic Elective Sigmoid Resection vs Conservative Treatment Following Diverticulitis

Both elective sigmoid resection and conservative treatment are options for patients with recurrent, complicated, or persistent painful diverticulitis; understanding outcomes following each can help inform decision-making. To compare outcomes of elective sigmoid resection and conservative treatment for patients with recurrent, complicated, or persistent painful diverticulitis at 2-year follow-up. This multicenter parallel open-label individually randomized clinical trial comparing elective sigmoid resection to conservative treatment in patients with recurrent, complicated, or persistent painful diverticulitis was carried out in 5 Finnish hospitals between September 2014 and October 2018. Follow-up up to 2 years is reported. Of 85 patients randomized and included, 75 and 70 were available for QOL outcomes at 1 year and 2 years, respectively, and 79 and 78 were available for the recurrence outcome at 1 year and 2 years, respectively. The present analysis was conducted from September 2015 to June 2022. Laparoscopic elective sigmoid resection vs conservative treatment (patient education and fiber supplementation). Prespecified secondary outcomes included Gastrointestinal Quality of Life Index (GIQLI) score, complications, and recurrences within 2 years. Ninety patients (28 male [31%]; mean [SD] age, 54.11 [11.9] years and 62 female [69%]; mean [SD] age, 57.13 [7.6] years) were randomized either to elective sigmoid resection or conservative treatment. After exclusions, 41 patients in the surgery group and 44 in the conservative group were included in the intention-to-treat analyses. Eight patients (18%) in the conservative treatment group underwent sigmoid resection within 2 years. The mean GIQLI score at 1 year was 9.51 points higher in the surgery group compared to the conservative group (mean [SD], 118.54 [17.95] vs 109.03 [19.32]; 95% CI, 0.83-18.18; P = .03), while the mean GIQLI score at 2 years was similar between the groups. Within 2 years, 25 of 41 patients in the conservative group (61%) had recurrent diverticulitis compared to 4 of 37 patients in the surgery group (11%). Four of 41 patients in the surgery group (10%) and 2 of 44 in the conservative group (5%) had major postoperative complications within 2 years. In per-protocol analyses, the mean (SD) GIQLI score was higher in the surgery group compared to the conservative treatment group by 11.27 points at 12 months (119.42 [17.98] vs 108.15 [19.28]; 95% CI, 2.24-20.29; P = .02) and 10.43 points at 24 months (117.24 [15.51] vs 106.82 [18.94]; 95% CI, 1.52-19.33; P = .02). In this randomized clinical trial, elective sigmoid resection was effective in preventing recurrent diverticulitis and improved quality of life over conservative treatment within 2 years. ClinicalTrials.gov Identifier: NCT02174926.

Early versus late reversal of diverting loop ileostomy in rectal cancer surgery: a multicentre randomized controlled trial

Diverting loop ileostomy has become routine in low anterior resection (LAR) for rectal cancer. The optimal time for stoma reversal is controversial. The aim of the present study was to compare the results after planned early (within 8–12 days) versus late (> 3 months) stoma reversal. The primary outcomes were morbidity and mortality, as measured by the Comprehensive Complication Index (CCI) within 30 days after stoma reversal, and the secondary outcomes were morbidity and mortality within 90 days after LAR. This was a multicentre trial including all patients scheduled for anterior low resection for rectal cancer with curative intent. Inclusion period was from April 2011 to December 2018. All patients were randomized 1:1 prior to surgery. Among 257 consecutive and eligible patients, a total of 214 patients were randomized: 107 patients to early stoma reversal and 107 to late reversal. A total of 68 patients were excluded for various reasons, and 146 patients completed the study, with 77 in the early reversal group and 69 in the late reversal group. The patients were asked to complete the Gastrointestinal Quality of Life Index before surgery (baseline) and at 6 and 12 months after LAR. Ostomy-related complications were evaluated by dedicated ostomy staff using the validated DET score. ClinicalTrials Identifier: NCT01865071. Fifty-three patients (69%) in the early reversal group and 60 patients (87%) in the late reversal group received the intended treatment. There were no significant differences in CCI within 90 days after index surgery with the LAR and within 30 days after stoma reversal between the two groups. There were no differences in patient-reported quality of life but significantly more stoma-related complications in the late reversal group. A total of 5 patients experienced anastomotic leakage (AL) after stoma reversal, 4 in the early reversal group and one in the late reversal group. Early and late stoma reversal showed similar outcomes in terms of overall complications and quality of life. The risk of developing anastomotic leakage after early ostomy reversal is a concern.

Effectiveness of the Rehabilitation Program after Colorectal Surgery for Patients with Colorectal Cancer: A Quasi-Experimental Study

An effective rehabilitation program is essential for patients having surgery to regain full physical functions and improve their quality of life. This quasi-experimental study aimed to examine the effectiveness of a rehabilitation program on functional recovery and gastrointestinal quality of life among people with colorectal cancer undergoing surgery. This program was developed using integrated concepts from the Symptom Management Model and Self-Regulation Theory and involved nurse-patient co-operation. Sixty-four participants undergoing colorectal cancer surgery admitted at three tertiary hospitals in Bangkok, Thailand, were recruited into the experimental (n = 32) or control group (n = 32). The experimental group received the Rehabilitation Program after Colorectal Surgery in addition to usual care. The control group received only usual care. The instruments used for data collection were a demographic data record, a Pain Rating Scale, the Abdominal Distension Assessment Scale, the Gastrointestinal Function and Eating Record Form, a Six-Minute Walk Test, a digital spirometer for forced vital capacity, and the Gastrointestinal Quality of Life Index. The outcomes were measured before starting the program, on postoperative days 1 and 3, and two weeks after discharge. Data were analyzed using descriptive statistics, chi-square test, paired t-test, independent t-test, and repeated measures ANOVA.Results showed that the experimental group had significantly less pain severity and higher functional walking capacity than the control group. For the gastrointestinal quality of life, the experimental group achieved significantly better results in the symptom and physical function domains two weeks after discharge. In conclusion, the Rehabilitation Program after Colorectal Surgery could control symptoms, promote postoperative activities, and enhance recovery and some gastrointestinal quality of life domains. Nurses can use this program to increase functional ability and improve the quality of life among people with colorectal cancer receiving surgery. However, further testing using randomized controlled trials is needed before it can be widely used in practice.

Long-term outcomes of total colectomy for severe constipation.

Surgery for constipation is usually reserved for patients with severe and refractory symptoms because of concerns about perioperative morbidity and unpredictable functional outcomes. The aim of this paper is to identify the long-term outcomes of patients who have undergone total colectomy and ileorectal anastomosis for severe constipation. Patients who had undergone a total colectomy and ileorectal anastomosis for severe constipation were identified from a prospectively maintained database and sent a postal survey assessing functional symptoms, patient satisfaction and the impact of symptoms on quality of life. Information regarding the surgery, perioperative complications and hospitalizations were also collected. Functional outcomes of the surgery were evaluated with the Gastrointestinal Quality of Life Index, St Marks incontinence score, Wexner continence score, obstructed defaecation syndrome score and Cleveland Clinic constipation score. Seventy-one questionnaires were posted and 32 (45%) patients responded. The mean time since surgery was 15.3 years (range 2.9-30.4 years) Most patients were happy with the surgery. Ongoing symptoms were common, the most frequent of these were abdominal pain, experienced by 23 patients (71.9%), and faecal incontinence, experienced by 17 patients (53%). Fourteen patients (43.8%) required subsequent hospital admission due to bowel obstruction and eight patients (25%%) had subsequent surgery for adhesions. There was an association between patient quality of life and subsequent surgeries. Most patients were happy and viewed their life as improved following total colectomy for severe constipation. This is despite a high rate of ongoing functional symptoms.

Propensity score matching analysis of perioperative outcomes including quality of life after multi-port vs. single port laparoscopic cholecystectomy: a nationwide prospective multicenter study in Korea

Introduction The usefulness of single-port laparoscopic cholecystectomy (SPLC) as compared to multi-port laparoscopic cholecystectomy (MPLC) remains controversial. Between SPLC and MPLC, we compared outcomes, especially subjective aspects, such as quality of life (QoL). Material and methods This multi-center study, involving 20 institutions from 2016 to 2017, enrolled 2507 patients who underwent laparoscopic cholecystectomy. Various perioperative outcomes, pain assessed by the numeric rating scale (NRS) score, and QoL evaluated by the gastrointestinal QoL index (GIQLI) questionnaire, were compared between the two procedures. We generated balanced groups after propensity score matching (PSM) using preoperative factors that influence the decision to perform MPLC or SPLC. Results MPLC and SPLC were performed in 2176 and 331 patients, respectively. Nine hundred and twelve and 329 patients, respectively, were selected from the two groups by PSM. Operation time was longer and surgical difficulty was lower in SPLC. There were no significant differences in most outcomes, including biliary complications. Significant superiority of SPLC over MPLC was shorter hospitalization, lower NRS score, and favorable GIQLI. Conclusions From nationwide prospective data, SPLC showed outcomes comparable to MPLC. In SPLC, morbidity was not high and postoperative QoL was favorable. In the future, more implementations and studies are needed to ensure the safety and feasibility of SPLC.

The colonic interleukin-19 aggravates the dextran sodium sulfate/stress-induced comorbidities due to colitis and anxiety.

Comorbidities due to inflammatory bowel disease (IBD) and anxiety are commonly acknowledged; however, their underlying basis is unclear. In the current study, we first conducted a clinical retrospective analysis to identify the enhancive incidence rate of IBD before or after the epidemic of Corona Virus Disease 2019 (COVID-19), with higher Generalized Anxiety Disorder-7 (GAD-7), as well as poorer Gastrointestinal Quality of Life Index (GIQLI). Then, the dextran sodium sulfate (DSS) and chronic unpredictable stress (CUS)-induced IBD and anxiety comorbid models were established with the correlational relations between symptoms of IBD and anxiety-related behaviors. We found dysfunctional up-regulation of a new inflammatory factor interleukin (IL)-19 in the colon of DSS/CUS treated mice. Overexpression of IL-19 in colon induced anxious phenotypes, and accelerated the anxious condition and symptoms of colitis in the DSS/CUS model by promoting the expression of inducible nitric oxide synthase (iNOS), IL-1β, and IL-6 pro-inflammatory factors, and activating signal transducer and activator of transcription 3 (STAT3) signaling pathway in the colon. Furthermore, overexpression of IL-19 in the colon also reduced the expression levels of brain-derived neurotrophic factor (BDNF), extracellular signal-regulated kinase (ERK), and cAMP-response element binding protein (CREB) signaling pathways activity in the hippocampus. These results suggest that IL-19 was a pivotal player in DSS/CUS-induced comorbidities of colitis and anxiety with different signaling pathways for the colon and hippocampus, which provides a candidate gene to explore the pathophysiology of comorbidities due to colitis and anxiety.

Recurrent Lower Abdominal Pain, Altered Bowel Habits, and Malaise: Conservative or Surgical Approach to a Common Disorder

Recurrent Lower Abdominal Pain, Altered Bowel Habits, and Malaise: Conservative or Surgical Approach to a Common Disorder

Long-Term Quality of Life after Acute Uncomplicated Diverticulitis: A Cross-Sectional Study

Background: Diverticulitis is a common medical condition that usually affects older patients. Antibiotic therapy in patients with acute uncomplicated diverticulitis (AUD) has been questioned. Currently, there is limited data on the quality of life (QoL) of patients after AUD. Objectives: The aim of this study was to investigate the long-term QoL in patients with AUD and to assess if antibiotic therapy or recurrent disease impacts the QoL of patients. Design: Cross-sectional questionnaire study. Setting: Two teaching hospitals in Southern Sweden. Patient and Methods: The records of patients who were treated for AUD from 2015 to 2017 were extracted, and their medical charts were used to gather data. Three questionnaires (EuroQol-5 Dimension-5L, the Gastrointestinal Quality of Life Index, and the short health scale) were sent 3–5 years after hospitalization (year 2020) to evaluate the QoL of the patients. Main Outcome Measure: Long-term QoL measured by the aforementioned questionnaires. Sample Size: The original cohort was reduced to 509 due to death, duplications, and sigmoid colectomy. The final patient cohort consisted of 273 patients after exclusion of non-responders or patients who declined participation. Results: In the EuroQol-5 Dimension scale, 147 (55%) patients reported problems in one or more QoL dimension but only 4% experienced severe problems. The Gastrointestinal Quality of Life Index median score was 105.0 (90.0–113.8), while the median short health scale score was 4.0 (0.9–12.5). Among the patients, 76% were treated with antibiotics, but no differences were observed between the antibiotics and no antibiotics groups in any QoL score. Recurrent disease was associated with lower QoL scores. Conclusion: This study showed that 161 (59%) of the patients with AUD experienced QoL problems, with recurrent disease being a risk factor. Antibiotic therapy did not affect the long-term QoL of the patients. Larger prospective studies are needed to confirm these results, and future efforts should be made to prevent the recurrence of AUD. Limitations: Limited sample size, non-randomized study. Conflict of Interest: The authors have no conflict of interest to declare.

Surgical treatment of achalasia: results and quality of life

Abstract Achalasia is a primary defect of esophageal motility of unknown aetiology, characterised by peristaltic dysfunction of the esophagus and impaired relaxation of the lower esophageal sphincter. The most common symptoms are dysphagia, regurgitation, weight loss, and chest burning. There are various treatment options for achalasia: botulinum toxin injections, pneumatic dilatation, Heller myotomy, and peroral endoscopic myotomy. The aim of the study was to access the efficacy and quality of life of patients with achalasia after surgical treatment — laparoscopic Heller myotomy and Dor fundoplication. All of the patients after surgery had a high gastrointestinal quality of life index. For all patients, during the follow-up period (median 2.4 years), the intensity of clinical symptoms after the procedure declined. Laparoscopic Heller myotomy with Dor fundoplication is a safe and effective method of treating achalasia and can reduce clinical symptoms and improve patients' quality of life.

Assessment of Exocrine Pancreatic Function Following Bariatric/Metabolic Surgery: a Prospective Cohort Study

BackgroundExocrine pancreatic insufficiency (EPI) can be seen after bariatric/metabolic surgery. Fecal elastase level is a simple test in diagnosing and grading EPI. Quality of life changes in patients with bariatric/metabolic surgery related to gastrointestinal complaints is debated.AimThis study aimed to investigate rates and grades of EPI via fecal elastase levels and association between EPI and quality of life in bariatric surgery patients.MethodsA prospective study was performed for patients with bariatric/metabolic surgery at their second-year follow-up. Fecal elastase levels were used to diagnose and grade EPI as severe or moderate. Patient’s gastrointestinal quality of life index (GIQLI) was calculated. Patients were grouped as sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), single-anastomosis sleeve ileal bypass (SASI), and transit bipartition (TB). Rates of severe or moderate EPI were primary outcome. Secondary outcome was an association between fecal elastase and GIQLI.ResultsThere were 17, 29, 21, and 15 patients in OAGB, SG, TB, and SASI groups. There was no significant difference between groups in GIQLI scores and fecal elastase levels (p = 0.152 and p = 0.361). Rates of patients with moderate EPI in the groups OAGB, SG, TB, and SASI were 23.5%, 17.2%, 14.3%, and 20.0%. GIQLI scores were not significantly correlated with age, postoperative morphometric data, and fecal elastase values (p > 0.05).ConclusionRates of patients with moderate EPI ranged from 14.3 to 23.5% at second-year follow-up. There was no patient with severe EPI. GIQLI scores were not significantly correlated with fecal elastase levels and different types of bariatric/metabolic surgery.Graphical

8795 Impact of Surgical Procedures on Intestinal Function and Quality of Life in Patients with Deep Endometriosis: A Prospective Study

<h3>Study Objective</h3> To analyze the prevalence of intestinal discomforts in patients with deep endometriosis (DE) and the alteration of different surgical procedures on their intestinal function and quality of life at short-term follow-up. <h3>Design</h3> A prospective cohort study. <h3>Setting</h3> A university-based tertiary obstetrics and gynecology hospital. <h3>Patients or Participants</h3> Patients with deep endometriosis infiltrating the rectum treated in the same medical team since April 1, 2018. <h3>Interventions</h3> Patients underwent rectal shaving, disk excision or segmental bowel resection depending on the severity of DE. <h3>Measurements and Main Results</h3> The primary end point was the prevalence of intestinal discomforts, pain symptoms ranked by VAS (visual analogue score). The secondary end points were values of gastrointestinal questionnaires, including GIQLI(gastrointestinal quality of life index), Wexner constipation score, CRADI-8 (colorectal-anal distress inventory 8),and SF 36 to evaluate quality of life. As of March 15, 2019,88 patients were enrolled, including 58 patients in group rectal shaving, 25 in disk excision and 5 in segmental bowel resection.59.04% (49/88) of patients had intestinal symptoms preoperatively, manifested as menstrual diarrhea 26(53.06%), bulge 19(38.78%)and hematochezia 13 (26.53%). However, postoperatively, the discomforts were mainly caused by diarrhea 10.23% (9/17) at 1-month follow-up(V1), constipation 40% (4/10) at 6-month follow-up(V6). According to the follow-up, there are significant improvement in dysmenorrhea in all three group, but the improvement of intestinal discomfort only in group shaving were significant 0(0,2) vs 0(0,0) at V1 and 0(0,2) vs 0(0,0) at V6,<i>P</i><0.05,respectively.Patients in group shaving had mild symptoms preoperatively, who had lower CRADI-8 and Wexner constipation scores than the other two groups. After surgical treatment, patients' gastrointestinal function were mild improved, but the SF-36 and the GIQLI score did not reach statistical significance among these 3 groups compared to the baseline. <h3>Conclusion</h3> For patients with complaints of periodic diarrhea, anal bulge and hematochezia, endometriosis should be considered. Although surgical procedures can improve patients' dysmenorrhea and intestinal discomfort, but, the occurrence of constipation in short term after surgery should be alert, especially in radical procedures.

Long-term outcome of patients with epiphrenic diverticula: A retrospective single-center analysis over 20 years

BackgroundEpiphrenic diverticula are extremely rare. Evidence-based treatment recommendations are scarce. The primary study outcome was to examine whether surgical treatment in patients with epiphrenic diverticula leads to improved quality of life by outweighing the perioperative risks compared with conservative treatment. MethodsAll patients with an epiphrenic diverticula at our institution between 2001 and 2021 were retrospectively reviewed and followed-up using a specific questionnaire, including the Eating Assessment Tool, and Gastrointestinal Quality of Life Index quality-of-life scores. ResultsOf 51 patients with epiphrenic diverticula, 28 had surgery and 23 had conservative treatment. The most common symptom at presentation was dysphagia. Although 16 patients underwent open surgery, 12 had minimally invasive procedures. A prophylactic stent was applied intraoperatively in 6 patients. The morbidity rate in surgically treated patients was 50% (14/28), with a leakage in 43% (12/28; 33% for prophylactic stenting). Mortality was nil. At a median follow-up of 139 months, patients with surgery had better outcomes than those without (ie, less dysphagia [6/12 vs 11/12; P = .025]), a less likely pathologic Eating Assessment Tool score (4/12 vs 9/12; P = .041), and a nonsignificant better Gastrointestinal Quality of Life Index score (122 vs 112; P = .929). The rate of recurrence/progression of symptoms was significantly higher for conservatively treated patients (11/18 vs 6/27 for any surgery; P = .008), as well as for patients with minimally invasive procedure (5/12 vs 1/15 for open surgery; P = .030). ConclusionDespite the high perioperative morbidity, surgical treatment of epiphrenic diverticula leads to an improved long-term quality of life and lower recurrence rates than conservative treatment.

Clinical effectiveness of fecal microbiota transplantation combined with nutritional support and psychological intervention in patients with "Tetralogy of Tongji"

Objective: To summarize and analyze the clinical effect of fecal microbiota transplantation (FMT) combined with nutritional support and psychotherapy in patients with "Tetralogy of Tongji" (comprising chronic gastrointestinal dysfunction, mental and psychological disorders, malnutrition, and endocrine disorders). Methods: A longitudinal study was conducted. The inclusion criteria were as follows: (1) patients were under 70 years of age; (2) patients exhibited chronic gastrointestinal dysfunction (in accordance with the Rome IV diagnostic criteria for irritable bowel syndrome ie. chronic functional constipation, diarrhea, abdominal pain and abdominal distention) with onset occurring more than one year previously; (3) patients exhibited malnutrition (body mass index ≤ 18.5 kg/m2); (4) patients exhibited depression, anxiety, or state as diagnosed by a psychologist using the Hamilton anxiety rating scale (HAMA) and the Hamilton depression scale (HAMD); (5) patients were women of childbearing age with amenorrhea or menstrual disorder with a duration ≥6 months. Patients were excluded if they exhibited gastrointestinal bleeding, short bowel syndrome, radiation-induced intestinal injury, intestinal obstruction or inflammatory bowel disease, recurrent/metastatic tumors, systemic infectious diseases, life-threatening systemic comorbidities, intorlerate to nasojejunal, percutaneous gastrostomy / jejunostomy or FMT. The clinical data of 43 patients at Shanghai Tenth People's Hospital exhibiting the "Tetralogy of Tongji" and who received microflora transplantation combined with nutritional support and psychotherapy from June 2017 to June 2021 was prospectively collected. There were 12 males and 31 females with a mean age of 35.2±16.7 years. All 43 patients had chronic gastrointestinal dysfunction. Of these, 24 patients had depression and 19 had anxiety. There were 26 women of reproductive age, including 13 cases of menstrual disorder and 9 cases of amenorrhea. The treatment intervention was a combination of FMT (microflora solution or microflora capsule), nutritional support (enteral nutrition) and psychological intervention. The following were assessed before treatment and 1, 3, 6 months after treatment: (1) gastrointestinal function was assessed using the gastrointestinal symptoms rating scale (GSRS), where a higher score is indicative of more serious gastrointestinal symptoms, and the gastrointestinal quality of life index (GIQLI), where a higher score is indicative of higher quality of life; (2) psychological status was assessed using HAMA and HAMD scores, where a lower score is indicative of reduced severity of anxiety or depression symptoms, respectively; (3) nutritional status was assessed by measurements of total blood protein, albumin, fibrinogen and prealbumin, as well as measurements of body mass and body mass index (BMI); (4) neuroendocrine function was assessed by measurement of blood levels of cortisol, dopamine and noradrenaline, as well as menstruation in women of reproductive age. Results: The follow-up rates at 1, 3 and 6 months after treatment were 90.7% (39/43), 72.1% (31/43) and 55.8% (24/43), respectively. The total effective rate for chronic gastrointestinal dysfunction was 81.4% (35/43), of which the average GSRS score decreased from 29.35±3.56 before treatment to 18.25±2.56 in the sixth month (P<0.001). The average GIQLI score increased from 56.23±10.34 before treatment to 91.04±20.39 in the sixth month (P<0.001). All patients had malnutrition before treatment. After 6 months, their body weight had increased from 40.61±8.88 kg to 50.45±6.23 kg (P<0.001), and BMI had increased from 15.17±1.87 kg/m2 to 19.58±1.42 kg/m2 (P<0.001). The average total protein level was 60.99± 5.99 g/L before treatment. After 6 months, this had increased to 64.21±4.23 g/L (F=2.715, P=0.022). The average prealbumin level increased from 150.14±56.04 mg/L before treatment to 258.17±86.94 mg/L after 6 months (F=15.124, P<0.001). In this study, 24 patients with depression/depressed state were included. After treatment, the average HAMD score in these patients decreased from 22.79±6.63 before treatment to 9.92±7.24 after 6 months (P<0.001). There were 19 patients with anxiety disorder/anxiety state. After treatment, the average HAMA score in these patients decreased from 17.15±4.34 before treatment to 7.73±4.10 after 6 months (P<0.001). Observing the endocrine efficacy of 26 women of childbearing age, it was found that the effective rate of this treatment on endocrine regulation was 69.2% (18/26). Although there was no significant change in blood cortisol levels after 6 months, average blood dopamine levels decreased from 32.91±10.65 nmol/L before treatment to 13.02±5.58 nmol/L after 6 months (P<0.001). Average blood norepinephrine levels decreased from 49.75±15.23 ng/L before treatment to 19.21±9.58 ng/L after 6 months (P<0.001). Conclusion: The strategy of FMT combined with nutritional support and psychological intervention is effective in improving the symptoms of the "Tetralogy of Tongji".

Effect of HCH Nutrition Management Combined with Early Exercise Nursing on Nutrition Status and Postoperative Rehabilitation of Patients after Gastric Cancer Surgery.

Objective The study aimed to analyze the effect of hospital-community-family (HCH) nutrition management combined with early exercise nursing on nutrition status and postoperative rehabilitation of patients after gastric cancer surgery. Methods A total of 80 patients with gastric cancer admitted from January 2019 to June 2021 were selected and divided by the odd-even grouping method into two groups, i.e., 40 cases in the control group adopting routine nursing combined with early exercise nursing and 40 cases in the study group adopting HCH nutrition management; the nutrition status and postoperative rehabilitation of the two groups were compared. Results The times of feeding, bowel sound, anal exhaust, and defecation in the study group after surgery were shorter than those in the control group, with a difference of statistical significance (P < 0.05). 3 months after discharge, the scores of Patient-Generated Subjective Global Assessment (PG-SAG) in the study group were lower than those in the control group, while the body mass index (BMI), prealbumin, albumin, hemoglobin, and the score of the Gastrointestinal Quality of Life Index (GIQLI) were higher than those of the control group (P < 0.05). Conclusion Hospital-community-family nutrition management combined with early exercise nursing can improve the postoperative nutrition status of patients undergoing gastric cancer surgery and advance the time of postoperative exhaust and defecation.

Démanteler l’islamophobie genrée en médecine

OBJECTIVE: Patients with systemic sclerosis (SSc) may develop psychological problems in addition to physiologic symptoms. We investigated whether demographic and clinical factors are associated with comorbid depression. METHODS: From a university hospital9s rheumatology clinic, 72 SSc patients who completed 3 questionnaires [Center for Epidemiologic Studies Depression (CES-D) scale, an abbreviated version of a functional status instrument, the Scleroderma Health Assessment Questionnaire (SHAQ), and the Gastrointestinal Quality of Life Index (GIQLI)] during an examination were recruited into the study. Correlations among scores on the 3 questionnaires [including upper and lower gastrointestinal (GI) tract subscales of the GIQLI] were calculated, and associations between CES-D scores and a variety of demographic and clinical characteristics were examined using stepwise linear regression. RESULTS: Higher CES-D scores (i.e., more depression symptoms) were significantly correlated with upper (r = -0.48, p &lt; 0.0001) and lower (r = -0.41, p &lt; 0.001) GI tract dysfunction and worse overall functional status (r = 0.51, p &lt; 0.0001). Stepwise regression indicated that higher levels of depression were independently associated with lower levels of education (p &lt; 0.01), worse upper GI tract functioning (p = 0.019), worse functional status (p = 0.34), current corticosteroid use (p = 0.061), and cardiac involvement (p = 0.086). CONCLUSION: Decreased functional status and abnormal GI functioning are significantly correlated with depression among patients with SSc. Other demographic and clinical indicators are also associated with depression.

Health-Related Quality of Life After Laparoscopic Cholecystectomy.

BackgroundThis study aimed to determine the mean improvement in the quality of life (QoL) after laparoscopic cholecystectomy (LC) in patients with symptomatic cholelithiasis.MethodologyAfter obtaining approval from the hospital’s ethical committee, the Gastrointestinal Quality of Life Index (GIQLI) proforma was filled on admission (T0) and at week six (T1) postoperatively. All data were collected, and GIQLI scores were calculated for individual patients.ResultsIn our study, among the 70 patients undergoing LC, 20% (n = 14) were aged 18-30 years and 80% (n = 56) were aged 31-60 years, with the mean ± standard deviation calculated as 41.56 ± 10.13 years. Overall, 44.29% (n = 31) of patients were men and 55.71% (n = 39) were women. GIQLI scores were 94.64 ± 2.24 for pre-treatment and 106.09 ± 2.40 for post-treatment, with a mean change of 11.44 ± 3.29, and a p-value of 0.001, showing a significant difference.ConclusionsThe mean improvement in QoL after LC in patients with symptomatic cholelithiasis is significantly higher when compared with pretreatment.