Gastrointestinal Symptom Rating Scale Questionnaire Research Articles

Differences Between Patients with Heartburn Refractory to Vonoprazan and Those Refractory to Proton Pump Inhibitors.

Vonoprazan, a potassium-competitive acid blocker, demonstrates more potent acid inhibition than proton pump inhibitors (PPIs). This study aimed to evaluate the effect of vonoprazan in patients with unproven gastroesophageal reflux disease (GERD) by comparing patients with vonoprazan-refractory heartburn with those with PPI-refractory heartburn. This study included 104 consecutive patients with vonoprazan- or PPI-refractory heartburn (52 patients each), no erosive esophagitis on endoscopy and who underwent combined multichannel intraluminal impedance-pH (MII-pH) testing with vonoprazan/PPI discontinuation. Patients' backgrounds, symptom scores from four questionnaires, MII-pH results and high-resolution manometry results were compared between the two groups. The vonoprazan group demonstrated significantly higher GERD symptoms and scores of abdominal pain and diarrhea on the Gastrointestinal Symptom Rating Scale questionnaire. MII-pH results revealed that the vonoprazan group demonstrated 40.4%, 17.3%, and 42.3% and the PPIs group exhibited 26.9%, 17.3%, and 55.8% of abnormal acid reflux [true non-erosive reflux disease (NERD)], reflux hypersensitivity and functional heartburn, respectively. The vonoprazan group demonstrated higher true NERD rates but with no significant difference (p = 0.307). Among the vonoprazan group, eight patients with true NERD underwent another MII-pH test on vonoprazan, and all cases demonstrated normal acid exposure times (0.0% [0.0-0.3]). Patients with unproven GERD with vonoprazan-refractory heartburn demonstrated more symptoms, including not only GERD symptoms but also functional dyspepsia and irritable bowel syndrome symptoms, than those with PPI-refractory heartburn.

Efficacy of inclusion of vitamin U and provitamin B5 combination in the complex therapy of primary osteoarthritis against the background of gastrogenic exocrine pancreatic insufficiency

Clinical comorbidities at osteoarthritis (OA) complicate its treatment. The number and nature of various comorbid conditions determine the severity of the condition in patients with multimorbidity. However, apart from the common risk factors such as aging and obesity, little is known about the biological plausibility of explaining the co‑occurrence of OA and comorbidities. According to the European Alliance of Associations for Rheumatology, EULAR, and the National Institute of Health and Nursing, the diagnosis and treatment of specific comorbidities, as well as understanding their nature in OA, are important for choosing the best treatment tactics.
 Objective — to investigate efficacy of inclusion of vitamin U and provitamin B5 combination in the complex therapy of patients with primary OA in comorbidity with gastrogenic exocrine pancreatic insufficiency (EPI) for the correction of clinical syndromes.
 Materials and methods. Examinations involved 61 patients with primary OA in comorbidity with gastrointestinal diseases, accompanied by EPI of gastrogenic genesis without exacerbation. The comparison group consisted of 30 practically healthy people. All patients were divided into two comparable groups: group 1 (n=30) received a course of basic therapy drugs, namely: nonsteroidal anti‑inflammatory drugs, chondroprotectors and/or chondrostimulators, antispasmodics, prokinetics, proton pump inhibitors, enzyme agents (pancreatin); group 2 (n=31), in addition to the course of basic therapy, received a course of the vitamin drug combination of vitamin U and provitamin B5, 2 tablets once a day for 6 weeks. The calculation of the WOMAC index (Western Ontario and McMaster University) was used to assess the articular status of patients with primary OA, as well as the effectiveness of the treatment measures. Gastrointestinal Symptom Rating Scale (GSRS) questionnaire was used to assess gastrointestinal symptoms.
 Results. The proposed complex treatment of patients with primary OA with gastrogenic EPI with the additional inclusion of a vitamin preparation combination of vitamin U and provitamin B5 contributed to more significant regression of WOMAC indices compared to that during protocol treatment (the total WOMAC index decreased by 16.03% against 9.10%, respectively) and indicators of the scales of the GSRS questionnaire in comparison with the subgroup that received treatment according to the protocol (in total — by 35.96% vs. 22.19%, p <0.05),
 Conclusions. The study results showed the advisability of using a vitamin medication, a combination of vitamin U and provitamin B5. in the treatment of patients with primary OA with gastrogenic EPI.

#5951 INFLUENCE OF DIETARY INTAKE ON GASTROINTESTINAL SYMPTOMS AND INFLAMMATION MARKERS IN PERITONEAL DIALYSIS PATIENTS IN SLOVENIA

Abstract Background and Aims Gastrointestinal symptoms are prevalent in patients with end-stage renal disease. Gastrointestinal symptoms in such patients are related to gastric hypomotility, increased medication intake, uremia, and changes in diet. In addition GI symptoms and problems associated with bowel dysfunction are a common cause of technique failure and poor dialysis efficacy. The reason for presence of some gastrointestinal symptoms is also chronic inflammatory state. Inflammation can have many negative effects, including decreased appetite, accelerated protein skeletal muscle breakdown and hypercatabolism. Method 14 peritoneal dialysis patients were included in single Department of Nephrology in the University Medical Center in Ljubljana. All patients were interviewed by a dietitian and nutritional assessment was conducted. Gastrointestinal symptom Rating Scale (GSRS) with 7-grade Likert scale was used to evaluate the intensity of GI symptoms and Bristol Stool Form Scale (BSFS) to classify patient's stool. The dietary intake of peritoneal dialysis patients was assessed using 7-day food diaries and analyzed with Prodi program (PRODI® 6.4 Expert program, Stuttgart, Deutschland). Body composition has been measured with bio impedance spectroscopy. Routine blood analysis was performed. Results Among 14 patients undergoing peritoneal dialysis, most of them were male (71.4%) with average age of 53.07 ± 12.32 years. Average energy intake of 14 patients was 21.05 ± 5.72 kcal/kg body weight per day, average protein intake was 0.87 ± 0.39 g/ kg body weight per day and average fiber intake was 13.75 ± 7.25 g per day. They were inadequate according to the dietary guidelines for peritoneal dialysis patients. Average dietary protein-fiber index was 6.86 ± 3.81 per day. Average PRAL value was 15.84 ± 13.44 for women and 6.52 ± 17.99 for men. Average dietary potassium intake was 1917.80 ± 790.08 mg per day which corresponds to the guidelines for peritoneal dialysis patients and average potassium serum value 4.45 ± 0.42 mmol/L. GSRS questionnaire showed peritoneal patients had minor to mild discomfort in abdominal pain, constipation and indigestion GI symptom cluster. Patients’ self-analysis of stool showed BSFS Types 3.23 ± 1.64 if BSFS Types 3–5 are defined as normal stools. Dietary protein intake strongly correlated with dietary energy intake (r = 0.76, p = 0.003), dietary protein-fiber index strongly correlated with PRAL value (r = 0.70, p = 0.007) and dietary potassium intake moderately to strongly correlated with dietary fiber intake (r = 0.62, p = 0.025). Serum value of IL-6 strongly correlated with dietary potassium intake (r = 0.72, p = 0.006) and moderately to strongly correlated with dietary fiber intake (r = 0.6, p = 0.034). The correlation between dietary potassium intake and serum hsCRP was significant (p = 0.042). The correlation between Bristol stool consistency value and serum hsCRP was significant (p = 0.0255). The correlation between total GSRS score and serum value of albumin was significant (p = 0.0010). The correlation between total GSRS score and dietary potassium intake was significant (p = 0.0015). The correlation between total GSRS score and dietary protein-fiber index was significant (p = 0.0403). Conclusion Gastrointestinal diseases in peritoneal dialysis patients are comparatively understudied in the literature, despite having a significant impact on dialysis efficacy and the quality of life. Analysis of GSRS questionnaire showed that abdominal pain, constipation and indigestion caused minor to mild discomfort in PD patients. The analysis also showed that fiber intake, potassium intake and gastrointestinal symptoms are significantly associated with inflammation markers and are important contributing factors to chronic inflammatory state in these patients. Patients still lack the basic knowledge of nutrition, thus in the future nutritional consultations, innovative teaching techniques and help will be crucial to prevent the decline in nutritional status.

Balneotherapy of epigastric pain syndrome: the meaning of motilin in the implementation of the therapeutic effect

Objective: to study the mechanism of action of low-mineralized sulfate-chloride-sodium mineral water on the clinical picture and motor function of the stomach in patients with epigastric pain syndrome using the regulatory peptide motilin as an example. Materials and methods: 113 people of both sexes were examined, the average age was 22.3±0.21 years. The observation group (57 people) included individuals with functional dyspepsia in the variant of epigastric pain syndrome, the comparison group included practically healthy individuals (56 people). The questionnaire method was used according to the Gastrointestinal Symptom Rating Scale questionnaire; ELISA method for determining the concentration of motilin in the blood. Mineral water in a volume of 200 ml was taken once by both groups of patients, patients with EPS additionally received a course. Results: in persons with epigastric pain syndrome, abdominal pain prevails. The course intake of mineral water provides a positive clinical trend, confirmed by a decrease in the syndromes of lesions of the upper gastrointestinal tract. A single and course intake of mineral water provides a stable increase in the level of motilin in functional dyspepsia. Conclusion: patients suffering from functional dyspepsia in the variant of epigastric pain syndrome have persistent disorders of motilin secretion compared with healthy individuals. Stimulation of the stomach on a drinking test model showed inadequacy of changes in the level of this hormone. Both a single and a course intake of low-mineralized sulfate-chloride-sodium mineral water contributes to an increase in the concentration of motilin, which should be considered as a physical adaptogenic factor leading to a stable ordering of the body’s functional relationships.

Assessment of the Quality of Life of Patients with Comorbidity of Hypothireosis and Chronic Pancreatitis

Today, comorbidity has been recognized as a global problem of modern medicine around the world. The combined pathology of the thyroid gland and pancreas requires constant search and improvement of an individual approach to the treatment of patients and can improve large-scale socio-economic consequences. The article presents the analysis of quality of life (QL) of patients with comorbidity of hypothyroidism and chronic pancreatit is (CP). Materials and methods. The study included 62 inpatient patients with hypothyroidism and concomitant CP, who were treated at the gastroenterology center of the Yuriy Semeniuk Rivne Regional Clinical Hospital. The comparison group involved 48 patients with isolated CP. GSRS (Gastrointestinal Symptom Rating Scale) was used to evaluate the severity of gastroenterological symptoms and QL. Results. Analyzing the data of the GSRS questionnaire, it was found that in patients with hypothyroidism with concomitant CP, reflux, pain and dyspeptic syndromes were the most common clinical manifestations (p>0.05). According the GSRS questionnaire results, the clinical course of patients with the hypothyroidism was complicated by the comorbidity of the CP, namely: on the scale of gastric reflux – by 48.57 %, on a scale of dyspepsia – by 35.84 %, diarrhea – by 26.94 %, constipation – by 19.93 %, abdominal pain – by 40.81 %. Conclusions. As a result of the study, the lower level QL in patients with hypothyroidism with concomitant chronic pancreatitis (CP) was established compared to the isolated course of CP. It was determined that the comorbidity of hypothyroidism and CP leads to a complication of the clinical condition of patients.

Early Gastrointestinal Neuropathy Assessed by Wireless Motility Capsules in Adolescents with Type 1 Diabetes

To assess the prevalence of objective signs of gastrointestinal (GI) autonomic neuropathy (AN) in adolescents with type 1 diabetes (T1D). In addition, to investigate associations between objective GI findings and self-reported symptoms or other findings of AN. Fifty adolescents with T1D and 20 healthy adolescents were examined with a wireless motility capsule to assess the total and regional GI transit times and motility index. GI symptoms were evaluated with the GI Symptom Rating Scale questionnaire. AN was evaluated with cardiovascular and quantitative sudomotor axon reflex tests. There was no difference in GI transit times in adolescents with T1D and healthy controls. Adolescents with T1D had a higher colonic motility index and peak pressure than the controls, and GI symptoms were associated with low gastric and colonic motility index (all p < 0.05). Abnormal gastric motility was associated with the duration of T1D, while a low colonic motility index was inversely associated with "time in target range" for blood glucose (all p < 0.01). No associations were found between signs of GI neuropathy and other measures of AN. Objective signs of GI neuropathy are common in adolescents with T1D and it seems to require early interventions in patients at high risk of developing GI neuropathy.

Metabiotic based on metabolites of &lt;i&gt;Bacillus subtilis&lt;/i&gt; for correction of gastrointestinal symptoms in patients with post-COVID syndrome

Purpose of the study. To evaluate the efficacy and safety of using a metabiotic preparation, which includes biologically active metabolites of the culture fluid of the probiotic bacterium Bacillus subtilis (B. subtilis) and fructooligosaccharides, for the correction of gastrointestinal symptoms in patients with post-COVID syndrome.Materials and methods of the study. The study included 40 outpatients with post-COVID syndrome aged 18 to 60 years (mean age 38.25–8.70 years), who, after undergoing COVID-19, were disturbed by gastrointestinal complaints and asthenia. Patients were randomized into 2 groups. Group 1 (n = 20) consisted of patients who received metabiotic capsules in the regimen of 1 capsule 2 times a day for 28 days; group 2 (n = 20) – patients who did not receive additional support. The observation period was 28 days. The severity of gastroenterological symptoms was assessed using the GSRS (Gastrointestinal Symptom Rating Scale) quality of life questionnaire, and asthenia was assessed using the Asthenic Condition Scale (ASS) by L.D. Malkova. Patients of group 1 (n = 10) additionally underwent a study of feces to quantify the composition of the microbiota of the colon by real-time polymerase chain reaction (PCR), test Kolonoflor-16.Research results. According to the results of assessing the quality of life in patients with post-COVID syndrome using the GSRS questionnaire, the main gastrointestinal complaints included: diarrhea, abdominal pain and dyspepsia; the severity in points was 14.1 points, 7.9 points, and 15.2 points, respectively, which corresponded to moderate manifestations of symptoms. Against the background of taking a metabiotic in patients of group 1, there was a statistically significant decrease in gastrointestinal complaints on the scale of the total measurement of symptoms (p &lt; 0.0001), on the scales of abdominal pain syndrome (p &lt; 0.0170), dyspeptic syndrome (p &lt; 0.0001) and diarrheal syndrome (p &lt; 0.0001). In patients of group 2 on the 28th day of the study, there was no significant change in symptoms. When assessing asthenia after taking metabotics, patients of the 1st group showed positive dynamics, the severity of asthenia before treatment was 51.5 ± 7.9 points, after treatment – 43.3 ± 5.9 points (p &lt; 0.0500), in patients of group 2 there was no significant decrease in asthenic state indicators when assessed at the beginning and at the end of the observation period. On the 28th day, in patients of group 1 the representation of Lactobacillus spp. statistically significantly increased, normalization in the spectrum of Escherichia coli representation was noted, and the representation of UPM decreased. In the examined group, attention is drawn to the complete absence of Akkermansia muciniphila DNA in the feces of patients with post-COVID syndrome and the restoration of the representation of this bacterium after taking a metabiotic in 60 % of patients.Conclusions. In patients with post-COVID syndrome, the structure of gastrointestinal complaints is dominated by manifestations of abdominal pain, dyspeptic and diarrheal syndromes, and there are phenomena of colon dysbacteriosis, expressed in a decrease in the representation of obligate microflora and an increase in TMR. The use of metabolic tyranny in patients with post-COVID syndrome for 28 days in a regimen of 1 capsule 2 times a day is effective and safe.

CLINICAL SIGNS AND QUALITY OF LIFE ANALYSIS IN THE PATIENTS WITH HYPOTHYREOSIS AND CHRONIC PANCREATITIS.

Aim: To analyze the clinical condition and evaluate the quality of life of patients with a comorbid course of Ht and CP and patients with isolated CP based on the results of testing according to the GSRS and SF-36 questionnaires. Materials and methods: Were examined 62 patients with comorbid course of Ht and CP. The comparison group consisted of 48 people with isolated CP, the control group consisted of 30 healthy people, comparable in age and sex. The average age of all patients was (51.4±26.7) years. Two questionnaires were used in the study: the GSRS (Gastrointestinal Symptom Rating Scale) questionnaire was used to assess the severity of gastroenterological symptoms and QoL, and the general SF-36 questionnaire was used to assess the clinic and health status. Results: Analyzing the data of the GSRS questionnaire, it was found that in patients with a comorbid course of Ht and CP, reflux, pain and dyspepsia syndromes took the leading place in the clinic of the disease (p>0.05). They should be considered as the main factor in reducing the quality of life in patients with a comorbid course of Ht and CP. According to the GSRS questionnaire, the comorbidity of Ht and CP caused a complication of the clinical condition compared to patients with isolated CP of a gastroenterological patient: according to the scale of gastric reflux - by 48.57%, according to the scale of dyspepsia - by 35.84%, diarrhea - by 26.94%, constipation - by 19.93%, abdominal pain - by 40.81% (p<0.05). As a result of the study, a significantly lower level of quality of life was established in patients with a comorbid course of Ht and CP. Conclusions: It has been proven that the quality of life of patients with a comorbid course of Ht and CP was significantly lower compared to that of isolated CP (the total difference between groups on all scales of the GSRS questionnaire was 33.59% (p<0.05)). According to the SF-36 questionnaire, the overall quality of life of patients with a comorbid course of Ht and CP, compared to the group of patients with isolated CP, was reduced by 34.9% and 20.9% on the scales of physical and psychological health (р<0, 05).

Bowel symptoms associated with coronavirus disease 19 in hospitalized patients with moderate to severe illness

Bowel symptoms, such as diarrhea, have higher prevalence during coronavirus disease 2019 (COVID-19). The correlation between the severity of these symptoms and their prognosis has not been defined yet. Furthermore, higher prevalence of gastrointestinal symptoms after recovery from COVID-19 has been reported. This study aimed to analyze the correlation of potential factors with the severity of diarrhea during COVID-19 and to assess the progression of post-COVID-19 bowel symptoms. This prospective longitudinal cohort included 109 patients with moderate to severe COVID-19 symptoms who were hospitalized from May to July 2021. Patients were interviewed to assess the presence and intensity of bowel symptoms during COVID-19 and 3–6 months after hospital discharge using the Gastrointestinal Symptom Rating Scale questionnaire. Demographic and clinical data were obtained and their correlations with the intensity of bowel symptoms were examined. The presence of severe diarrhea was correlated with the need for ventilatory support and the use of anticoagulants but not with the use of antibiotics. In addition, bowel symptoms, such as loose stools and incomplete evacuation but not diarrhea, constipation, or abdominal pain, persisted for at least 3–6 months after hospital discharge. These results suggest that the severity of diarrhea during COVID-19 may be associated with worsening of the disease and that only loose stools and incomplete evacuation are present after COVID-19. The chronicity of these bowel symptoms should be evaluated to improve the treatment of patients with COVID-19.

The Burden of Gastrointestinal Complaints in Kidney Transplant Recipients Using Tacrolimus With and Without Mycophenolate Mofetil: A Randomized Controlled Study.

Tacrolimus (TAC) combined with mycophenolate mofetil (MMF) is the immunosuppressive regimen in the majority of solid organ transplant recipients. Gastrointestinal complaints are frequent, which is considered predominantly a side effect of MMF. However, systematic research in this field is lacking. The aim of this study is to systematically investigate the burden of gastrointestinal complaints in TAC-treated kidney transplant recipients with and without MMF. In a single-center, open-label, randomized controlled trial, low immunological risk recipients were randomized to either TAC and MMF or to TAC monotherapy from 6 months after kidney transplantation onwards [NTR4672],. They filled in the Gastrointestinal Symptom Rating Scale questionnaire, which covers five dimensions (abdominal pain, reflux, indigestion, constipation, and diarrhea), 6, 12, and 15 months after transplantation. Seventy-nine recipients were randomized and 72 completed all questionnaires (34 TACmono and 38 TAC/MMF). At baseline, the mean age was 59 years with 72% male, mean BMI 28 kg/m2, eGFR 55 ml/min/1.73m2, mean daily dose MMF 1200 mg and TAC 5.8 mg, with trough levels of 2.1 mg/L and 7.4 ug/L. Six months after transplantation, 75% of recipients reported troublesome symptoms (score ≥3). Diarrhea was the most troublesome (mean 3.3) and discontinuing MMF significantly reduced it (mean Δ score between month 6 and 15 TAC/MMF -0.9 vs. TACmono -1.8, p=0.03). In recipients with troublesome symptoms, abdominal pain (2.7 to 1.8, p=0.003), indigestion (2.8 to 2.3, p=0.012), and reflux (2.9 to 1.7, p=0.007) significantly decreased over time, independent of MMF use. The majority of kidney transplant recipients with TAC and MMF experienced troublesome gastrointestinal symptoms 6 months after transplantation. While constipation remained troublesome, indigestion, abdominal pain, and reflux improved over time by month 15. Diarrhea only improved after discontinuing MMF.

The Quality of Life as a Criterion for the Effective Surgical Treatment of &#x0D; the Gastric Cardia Disease

The aim of the study was to assess the quality of life (QoL) in patients exposed to proximal resection of the stomach in various modifications. Materials and methods. The study included 97 patients who underwent surgical treatment of the gastric cardia disease; of them, 87.6% having malignant neoplasms. The patients were exposed to proximal gastric resection using isoperistaltic jejunogastroplasty (Merendino-Dillard-modified) (50 patients, main group I) and conventional proximal gastric resection using direct esophagogastroanastomosis (47 patients, control group II). The Russian language versions of the Medical Outcomes Study 36-item Short-Form Health Survey (MOS SF-36 scale) (psychometric parameters) and Gastrointestinal Symptom-Rating Scale (GSRS) (gastrointestinal parameters) were used to assess health-related quality of life (HRQoL) in the patients before surgery and 12 and 24 months after it.Results. The results obtained demonstrated deterioration in the quality of life of patients both in physical (on average, by 36,51,8 scores or 31,4%) and psychological (on average, by 34,31,8 scores or 34,3%) health parameters according to MOS SF-36 scale before surgical treatment. In the postoperative period, in 12 and especially in 24 months, there was an improvement in physical and psychological health parameters above 70 scores; the patients of group I recovered faster and averaged 84,84,1 scores (significantly closer to the population norm - 86,52,7 scores), and in patients of group II this parameter was 75,33,1. As assessed using the GSRS questionnaire, there were the least disturbances in the digestive system functioning after proximal gastric resection with the Merendino-Dillard-modified gastroplasty (in 12,0% of cases), compared to esophago-gastrostomy (in 30,0% of cases); the results are relevant (rxy=0,6970,009; p0,01). Proximal gastric resection with the Merendino-Dilard-modified digestive tract reconstruction creates more optimal conditions for the rapid rehabilitation of functional parameters, which positively affects the quality of life of patients. Conclusion. The results obtained reflect the impact of the gastric cardia disease and its symptoms on the health and vital activity of patients before surgery and demonstrate how significant and effective the surgical treatment is.

Эффективность применения природной минеральной воды «Увинская» в комплексной эрадикации Helicobacter pylori у больных хроническим гастритом на фоне сахарного диабета 2 типа

The purpose — to assess the effectiveness of therapeutic use of «Uvinskaya» natural mineral water for Helicobacter Pylori eradication in patients with chronic gastritis and type 2 diabetes mellitus. Material and methods. The study included 120 patients with type 2 diabetes mellitus, who were diagnosed with chronic gastritis associated with Helicobacter Pylori. The average age of patients was 61.6 ± 4.13 years, the duration of diabetes — from 2 to 15 years (on average – 9.9 ± 2.5 years), gender composition — 21 men and 99 women. The patients were divided into two groups by simple randomization. In the first group (n = 60), the first line eradication therapy was carried out according to Maastricht V recommendations, in the second group (n = 60) underwent eradication therapy combined with «Uvinskaya» mineral water. The diagnosis of «chronic gastritis» was histologically verified in all patients. The eradication control was carried out 4 weeks after therapy. Changes in the severity of gastroenterological symptoms in patients were determined by the Gastrointestinal Symptom Rating Scale questionnaire. Statistical processing was carried out with the calculation of average values and standard errors of the average. The differences were considered reliable at p ≤ 0.05. Results. The study shows the positive effect of the «Uvinskaya» mineral water inclusion into the Helicobacter Pylori eradication treatment complex in patients with type 2 diabetes mellitus: the condition of patients improved, inflammatory changes in the stomach mucosa were reduced and the efficiency of eradication therapy increased. Conclusion. The amplification of the positive therapeutic effects of drug treatment and drinking balneotherapy provides a significant increase in the efficiency of eradication, improving the clinical course and forecast of chronic gastritis associated with Helicobacter Pylori in patients with type 2 diabetes mellitus. It enables to recommend the intake of «Uvinskaya» mineral water as part of eradication therapy in patients with type 2 diabetes mellitus.

Evaluation of the Influence of &lt;i&gt;CYP2C9* 2, CYP2C9*3&lt;/i&gt; Gene Polymorphisms on the Efficacy and Safety of Postoperative Analgesia with Ketoprofen in Patients after Cardiac Surgery

Aim. The aim of the study was to evaluate the efficacy and safety of ketoprofen as an analgesic therapy in patients with CYP2C9*2 (430C&gt;T) rs179985 and CYP2C9*3 (1075A&gt;C) rs1057910 gene polymorphisms after cardiac surgery.Material and methods. The study included 90 patients. Postoperative analgesia was perfomed by ketoprofen 100 mg intramuscularly twice daily. The evaluation of pain was determined daily by Numeric Rating Scale for 5 days after cardiac surgery. The safety of ketoprofen was determined by assessing the severity of gastroenterological symptoms using the Gastrointestinal Symptom Rating Scale questionnaire and determining the frequency of episodes of acute kidney injury. The material for DNA was venous blood. To determine the single nucleotide genetic polymorphisms CYP2C9*2 (430C&gt;T) rs179985 and CYP2C9*3 (1075A&gt;C) rs1057910, the real-time polymerase chain reaction was used.Results. In patients with the AA genotype of CYP2C9*3 polymorphism, the intensity of pain on the numeric rating scale scale (points) was significantly higher than in patients with the AC genotype: 7 [6; 8] vs 6 [5; 6] (р=0,003), 7 [6; 8] vs 6 [5; 6] (р=0,04), 6 [5; 7] vs 5 [4; 5] (р=0,04), 5 [3; 6] vs 3 [3; 4] points (р=0,02) on days 1, 2, 3 and 5 of the postoperative period, respectively. The severity of gastroenterological symptoms was higher in patients with a heterozygous CT genotype for the allelic variant CYP2C9*2 than in patients with a wild CС genotype and amounted to 19 [19; 22] vs 18 [16; 20] points, respectively, (p=0,04). The distribution of genotypes for CYP2C9*2 polymorphisms and CYP2C9*3 polymorphisms between the groups of acute renal injury did not differ significantly.Conclusion. Associations of polymorphisms CYP2C9*3 with a lower intensity of pain syndrome and CYP2C9*2 with a greater severity of gastroenterological symptoms were revealed.

ANÁLISE DA SENSIBILIDADE NÃO CELÍACA AO GLÚTEN EM PACIENTES COM ENDOMETRIOSE

Overview and Aims: Identify patients with surgically confirmed endometriosis and with gastrointestinal symptomatology by assessing whether there is clinical improvement of these from the adoption of gluten-free diet (GFD). Study design: They were invited to participate in the study by the researchers through telephone calls and instant messaging applications after selection in the clinics of attending physicians. Population: Through the GSRS (Gastrointestinal Symptom Rating Scale) questionnaire, the relationship of GFD adherence to symptomatology attenuation and benefit in the quality of life of 48 patients was analyzed. Methods: Inclusion criteria: female patients with surgical confirmation of endometriosis who agreed to participate in the study in accordance with the Informed Consent Form (ICF). Exclusion criteria: patients who already performed GFD, patients diagnosed with celiac disease, gluten allergy or non-celiac sensitivity to gluten, presence of gastrointestinal comorbidities, severe diseases or cognitive alterations that prevented the study from being performed. The patients who obtained the top 20 scores were invited to adopt GFD for one month, among those selected, only 12 proposed to participate in the diet. However, three of these presented personal complications that prevented the continuation of the same. After this period, a new questionnaire was applied to measure the impact of the diet on quality of life. Results: Nine patients finished the proposed period for the diet, with the average score obtained in the pre-diet questionnaire reducing from 57.2 to 36 in the post-diet. Conclusion: There was an improvement in gastrointestinal complaints of most patients and consequently in quality of life with GFD.

Quality of life of treated patients with Mirizi syndrome

Objective. To compare the quality of life of patients with spontaneous internal biliary fistula (SIBF) and without them, before and after surgery.&#x0D; Materials and methods. 82 (38.7%) patients were diagnosed with Mirizzi syndrome (MS) type I, and 130 (61.3%) patients with type II (II-V) type MS. During the study, the classification of A. Csendes - M. Beltran was used. By sex, patients were distributed as follows: there were 68 men (32.0%), women - 144 (68.0%). The age of patients ranged from 37 to 80 years (average - 66.4 years). The GSRS (Gastrointestinal Symptom Rating Scale) questionnaire was used to assess quality of life. When comparing groups, the use of Student's T test comparative mean values and quadratic deviations. The reliability of the obtained p values were checked by the method of Bonferoni and False Discovery Rate (FDR).&#x0D; Results. Multiple comparisons with Bonferon and FDR correction revealed statistically significant differences in the results between QOL of patients with MS I and II both before and after surgery. When compared on the scale of total measurement, it was found that the quality of life of patients without SIBF improved by 11% after cholecystectomy in MS I type. When comparing the results of QOL assessment before and after surgery in patients with type II MS, it was found that QOL after surgery in patients improved by 10% from baseline.&#x0D; Conclusions. The quality of life of patients with MS I type is higher compared to patients with SIBF both before and after surgery (p=0.0001), which is due to impaired bile duct and gastrointestinal tract in SIBF. Elimination of SIBF improves the level of QOL of patients by 10%, which is characterized by a decrease in all items of the GSRS scale.

Effects of colorectal endoscopic submucosal dissection on postoperative abdominal symptoms: a prospective observational study.

Endoscopic submucosal dissection (ESD) is an effective procedure to resect large superficial gastrointestinal neoplasms. In gastric ESD, several studies showed the relationship between postoperative abdominal symptoms and endoscopic treatment. However, the influence of colorectal ESD on abdominal symptoms after treatment is still unknown. To the best of our knowledge, this is the first prospective multicenter study performed to investigate the impact of colorectal ESD on postoperative abdominal symptoms. This study aimed to clarify the association between change of abdominal symptoms and ESD. This study was a prospective multicenter observational trial that enrolled 141 out of 171 patients who underwent colorectal ESD and answered the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire from March 2015 to August 2019. We evaluated abdominal symptoms in the patients using the GSRS questionnaire before ESD and a few weeks after ESD. Comparing the GSRS before and after ESD, overall scores changed from 1.58 ± 0.58 to 1.48 ± 0.48, and the five subscales (reflux syndrome, abdominal pain, indigestion syndrome, diarrhea syndrome, and constipation syndrome) were slightly improved. Overall scores, indigestion syndrome, and constipation syndrome were statistically significantly different before and after ESD (P < 0.05). In GSRS, a score of ≥ 3 is often treated as a clinically significant symptom. Therefore, our findings indicated that there was no clinically significant difference. For this reason, colorectal ESD does not affect postoperative abdominal symptoms and is considered a minimally invasive treatment. The analysis of the impact of colon ESD on gastrointestinal symptoms UMIN000016914.

Disorders of social functioning and quality of life in patients with gastroesophageal reflux disease while combined with undifferentiated connective tissue dysplasia

Introduction. It has been scientifically confirmed that the risk of developing gastroesophageal reflux disease (GERD) increases especially with generalized or regional disruption of connective tissue structure, which is widespread among the population. Patients with such comorbid pathology may have a wide range of symptoms that may go beyond the general symptoms of heartburn and regurgitation. The symptoms and complications of GERD affect general health, daily and social functioning, physical and emotional activity. It also affects the quality of life (QoL) associated with health through frequent breaks during sleep, work and social activities.&#x0D; Purpose. study the dynamics of the level of quality of life and social functioning in patients with gastroesophageal reflux disease in combination with the syndrome of undifferentiated connective tissue dysplasia.&#x0D; Methodology. A total of 120 patients were included in the study: 65 men and 55 women: in 75 of them (Group II) GERD occurred on the background of UCTD, in 45 (Group I) as an independent disease. The control group consisted of 12 healthy individuals. The study was comprehensive. The Medical Outcomes Study 36-Item Short-Form Health Status (SF-36),the Gastrointestinal Symptom Rating Scale (GSRS) and the scale of "Personal and social performance" (PSP) -  were used to study patients in detail.&#x0D; Results and Discussion. Analyzing the results obtained on the basis of the GSRS questionnaire (Table 1), in patients with GERD on the background of UCTD, compared with patients of group I and the control group, there is a significant increase in three and four from the five scales. QoL in patients of Group II on the scale "Abdominal pain" were 14.3 ± 0.4 points, in Group I - 5.6 ± 1.3 points, in the Control Group - 2.4 ± 0.8 points, on the scale "Reflux syndrome": 13.7 ± 0.9, 10.5 ± 1.3 and 3.1 ± 0.9, respectively. "Dyspeptic syndrome" - 15.3 ± 0.4 points in Group II, 12.2 ± 0.6- in Group I and 6.1 ± 0.3- in the control group. "Constipation syndrome" 9.5 ± 0.8, 5.6 ± 1.03 and 5.7 ± 0.4, respectively (p &lt;0,05).&#x0D; Conclusions: In this research we investigated the effect of comorbid pathology on QoL in patients with GERD, which developed against the background of UCTD. The results confirm that patients with such combined pathology have a lower level of quality of life and social functioning, and the tactics of treatment of such patients should take into account these changes

Effects of a non-caffeinated coffee substitute on functional dyspepsia.

Functional dyspepsia (FD) is a debilitating functional gastrointestinal disorder characterized by early satiety, post-prandial fullness or epigastric pain related to meals. FD is diagnosed when organic etiology for the symptoms is not identified. It is widely believed that FD may be linked to the consumption of certain foods. In a clinical setting, it is often recommended that coffee be avoided in patients with FD. The lack of clinical research on non-caffeinated coffee substitute's effects on functional dyspepsia (FD) prompted the need to explore the topic clinically. The purpose of this study is to investigate the effect of drinking non-caffeinated coffee substitute on FD symptoms in order to determine if recommending a non-caffeinated coffee substitute in patients with pre-existing FD relieves the patient's symptoms. This is a quantitative study with 51 patients diagnosed with FD. A patient-reported outcomes (PRO) instrument called the Gastrointestinal Symptom Rating Scale (GSRS) was used to determine the results. After the participants enrolled, they completed the pre-GSRS questionnaire. The participants were instructed to stop their daily consumption of caffeinated and/or decaffeinated coffee and replace it with the non-caffeinated coffee substitute. After one month, the participants returned to the physician's office to complete a post intervention GSRS questionnaire. The Wilcoxon Signed Rank test was used to test for significant change across time. Our study showed a statistically significant decrease from pre-intervention to post-intervention for functional dyspepsia symptoms, (3.67-1.00), p<0.001. To our knowledge, this study is the first to evaluate whether removing coffee from a person's diet and replacing it with a non-caffeinated coffee substitute would result in the improvement of functional dyspepsia symptoms. Our results indicate that replacing a caffeinated or decaffeinated coffee with a non-caffeinated coffee substitute decreases FD symptoms.

Effect of L-Ornithine L-Aspartate on the quality of life in patients with esophageal and gastric variceal bleeding

Annotation. The aim of the study was to evaluate the dynamics of changes in the quality of life of patients with liver cirrhosis complicated by esophageal and gastric variceal bleeding while taking L-Ornithine L-Aspartate. 67 patients with a confirmed diagnosis of liver cirrhosis complicated by esophageal and gastric variceal bleeding were included in the study. All patients were randomly divided into two groups – experimental group (34 patients, standard therapy, supplemented with L-Ornithine L-Aspartate) and comparison group (33 patients, standard therapy). To evaluate the effectiveness of the treatment, the quality of life was assessed using the Gastrointestinal Symptom Rating Scale questionnaire on days 1st–2nd, 7th and 30th. Parametric values were evaluated using Student's t-test, non-parametric values - using the Mann-Whitney test. The intensity of the studied syndromes at the beginning of the study did not differ significantly in both groups. It is explained by the homogeneity of the patient population. In patients of the experimental group, there was a tendency to a more rapid progressive decrease in the intensity of the studied parameters both during their stay in the hospital and after discharge. The improvement in the quality of life after discharge of patients of the experimental group from the hospital is associated with the continuation of the course of taking L-Ornithine L-Aspartate in the form of granules. A moderate decrease in the intensity of the studied syndromes during hospitalization in patients of the comparison group can be explained by the appointment of only standard intensive care. After the patients of the comparison group were discharged from the hospital and the intensive care was stopped, no changes in the quality of life were observed. Thus, the administration of L-Ornithine L-Aspartate to patients with liver cirrhosis complicated by esophageal and gastric variceal bleeding can significantly improve the quality of life and reduce the intensity of dyspeptic, pain, diarrheal, constipation and reflux syndromes. It is planned to evaluate the long-term results of the use of L-Ornithine L-Aspartate in this patient population.

Risk factors for the development of digestive system diseases and prevalence of gastrointestinal symptoms in adolescents

Digestive diseases are a very common pathology in children and adolescents. Analysis of risk factors for the development of diseases of the digestive system and prevalence of gastrointestinal symptoms in students of professional educational organizations are presented in the article. 265 students of vocational education organizations aged 15 to 18 years were examined. The study design was a one-time cross-sectional study (active screening). Standardized formalized maps were used (complaints, medical history, physical examination results, regime and nature of diets, lifestyle and social and economic aspects were studied) to assess frequency of gastrointestinal symptoms. Gastrointestinal Symptom Rating Scale (GSRS) – an internationally validated questionnaire for the study of quality of life developed by the Hassle Company (division of Astra) – was used to study gastrointestinal symptoms. Statistical data processing was carried out using «MS Excel 2002» program. The study was conducted in accordance with the requirements of bioethics, after receiving informed consent of adolescents and their parents. A number of adolescents who previously have been diagnosed with diseases of the digestive system are found; gastrointestinal symptoms are systematized and analyzed (symptom group according to the scales abdominal pain, reflux, dyspepsia diarrhoea, constipation) using the GSRS questionnaire; main risk factors for the development of digestive system diseases characteristic of adolescents are studied: (the nature and regime of diet, smoking, consumption of alcohol), awareness of students about the main factors of a healthy lifestyle were examined as results of the study. The results of the study must be taken into account when developing and implementing preventive and hygiene and educational measures that are aimed at maintaining health and improving the quality of life of the population and require an interdisciplinary approach.