Gastrointestinal Symptom Rating Scale Research Articles

Co-administration of probiotics and vitamin D reduced disease severity and complications in patients with Parkinson's disease: a randomized controlled clinical trial.

Probiotics have beneficial effects on the nervous system by modulating the gut-brain axis. Additionally, vitamin D supplementation presents a potential way for ameliorating neuropsychological disorders, particularly in regions with a high prevalence of vitamin D deficiency. The current clinical trial aimed to investigate the role of co-administered supplementation of probiotics and Vitamin D on the different inflammatory aspects of patients with Parkinson's disease. Forty-six patients with PD were recruited From the Functional Neurosurgery Research Center, Tehran, Iran. These patients were randomly allocated to one of the two treatment groups: Group A, who received probiotic/vitamin D supplements (n = 23), and Group B who received placebo capsules (n = 23) for 12 weeks. As primary outcomes, Interferon-Gamma (IFN-γ), interleukin 1 beta (IL-1β), IL-6, IL-10, Tumor Necrosis Factor-Alpha (TNF-α), total antioxidant capacity (TAC), and malondialdehyde (MDA) in serum were evaluated at the baseline and the end of the trial. Moreover, Additional questionnaire-based factors including gastrointestinal symptom rating scale (GSRS), Beck Anxiety Inventory (BAI), and Unified Parkinson's Disease Rating Scale (UPDRS) were evaluated. Our findings demonstrated that the consumption of probiotic/vitamin D supplements leads to a significant decrease in IL-1β, INF-γ, IL-6, and MDA levels, while showing a significant increase in IL-10 and TAC levels compared to the placebo group (P < 0.05). Additionally, it leads to a significant decrease in the disease severity, anxiety, and gastrointestinal problems in PD patients in comparison to the placebo group (P < 0.05). Given the acknowledged role of inflammation in the pathogenesis of Parkinson's disease on one hand, and the recognized anti-inflammatory and antioxidant effects associated with probiotics and vitamin D on the other hand, the concurrent administration of probiotics and vitamin D supplements emerges as a promising and potentially effective treatment option for individuals with PD.

Long-term gastrointestinal symptoms and sleep quality sequelae in adolescents after COVID-19: a retrospective study

ObjectiveTo evaluate the long-term gastrointestinal (GI) symptoms and sleep quality sequelae in adolescents with COVID-19.MethodsBetween June and July 2023, an online survey was done in Xiaoshan District, Hangzhou City, Zhejiang Province, China, using the GI Symptom Rating Scale (GSRS) and the Pittsburgh Sleep Quality Inventory (PSQI).ResultsGI symptoms in COVID-19 patients increased by 11.86% compared to before infection, while sleep quality decreased by 10.9%. Over time, there was a significant increase in the cumulative incidence rate of GI symptoms and sleep disorders (p &amp;lt; 0.001). Follow-up of COVID-19 positive patients within 6 months of infection showed that GI symptoms and sleep quality began to ease starting from the first month after infection. Further analysis indicated a significant linear relationship between the severity of GI symptoms and sleep quality (R &amp;gt; 0.5, p &amp;lt; 0.001). Moreover, females, older age, and higher education were identified as risk factors influencing the long-term effects of COVID-19.ConclusionSARS-CoV-2 affects GI symptoms and sleep quality in adolescents during both the acute phase and post-infection periods. Over time, these symptoms gradually alleviate. A significant correlation exists between GI symptoms and sleep quality.

Features of the effect of a probiotic, containing Lactobacillus and Bifidobacterium on the intestinal microbiota and clinical symptoms of irritable bowel syndrome

Background. One of the important links in the pathogenesis of irritable bowel syndrome (IBS) is a change in the composition of the microbiota, and therefore, the use of probiotics in complex therapy can be considered as a pathogenetic treatment of this functional disease. Aim. To study the effectiveness of probiotic use on the composition of the intestinal microbiota and the dynamics of symptoms in patients with IBS with predominance of diarrhea (IBS-D) or constipation (IBS-C). Materials and methods. 10 patients with IBS-D and 7 patients with IBS-C who took a probiotic for 28 days, which included: Lactobacillus acidophilus 1.25×109 CFU, Bifidobacterium lactis – 1.25×109 CFU, Lactobacillus paracasei – 1.25×109 CFU, Lactobacillus rhamnosus – 1.25×109 CFU. The dynamics of symptoms was assessed using the Gastrointestinal Symptom Rating Scale, and the composition of the microbiota before and after taking the probiotic was analyzed by sequencing 16S pRNA of stool samples. Results. In both groups, we found a statistically significant decrease in the level of Proteobacteria and an increase in Firmicutes. In patients with IBS-C, there was a decrease in Negativicutes, which, on the contrary, increased in patients with IBS-D. Shannon's diversity index in patients with IBS-C was statistically significantly lower than in patients with IBS-D 1.55 vs 2.74 (p=0.1). Against the background of the application, there was an increase in microbial diversity in patients with IBS-D, it increased to 3.01, and in patients with IBS-C to 2.68. Against the background of changes in the microbiota, there was a positive dynamics of disease symptoms against the background of taking probiotics. Conclusion. The results obtained reflect the positive effect of probiotics in patients with IBS-D and IBS-C, which makes it possible to clarify the role of microbiota in the development of IBS and recommend their use as part of complex therapy for this disease.

A Novel Herbal Composition Alleviates Functional Constipation, Reduces Gastrointestinal Transit Time, and Improves Bowel Function in Adults: A Double-Blind, Randomized Clinical Study

Background and objective A recent proof-of-concept pilot clinical study has demonstrated that consumption of CL18100F4, a proprietary herbal blend of Withania somnifera root and Abelmoschus esculentus fruit extracts, significantly relieved the participants from functional constipation and improved their quality of life. The objective of the present randomized, double-blind, placebo-controlled study was to reevaluate the efficacy and tolerability of CL18100F4 in a larger number of subjects. Methods Male and female subjects (n = 135; age: 25–60 years), selected through Rome-IV criteria for functional constipation, were randomized into placebo and 300 or 500 mg of CL18100F4 groups and supplemented daily over 60 consecutive days. The primary efficacy outcome measure was Patient Assessment of Constipation-Symptoms (PAC-SYM), evaluated at baseline and on days 7, 30, and 60 of supplementation. The secondary efficacy parameters included Patient Assessment of Constipation-Quality of Life (PAC-QOL), Gastrointestinal Symptom Rating Scale (GSRS) scores, Gastrointestinal Transit Time (GIT), and Complete Spontaneous Bowel Movement (CSBM). Serum levels of Interleukin (IL)-6, IL-10, cortisol, gastrin, serotonin, Diamine oxidase (DAO), and Zonulin were measured. Results CL18100F4 supplementation significantly (p < 0.001) reduced the PAC-SYM, PAC-QOL, GSRS scores, and GIT and improved CSBM scores. CL18100F4 significantly improved (p < 0.001) sleep quality and decreased depression and anxiety symptoms in the participants. Notably, relief in constipation symptoms and improved gastrointestinal (GI) function were reported starting from day 7. Furthermore, CL18100F4 supplementation significantly (p < 0.001) increased the serum levels of IL-10, DAO, serotonin, gastrin, reduced IL-6, cortisol, and Zonulin. No major adverse events were observed. Participants’ vital signs, hematology, clinical biochemistry, and urinalysis parameters were within the normal ranges. Conclusion The present investigation demonstrates that CL18100F4 is tolerable and efficacious in relieving functional constipation, alleviating GI dysfunction, and improving associated non-GI factors in male and female adults.

Beneficial Effect of Heat-Killed Lactic Acid Bacterium Lactobacillus johnsonii No. 1088 on Temporal Gastroesophageal Reflux-Related Symptoms in Healthy Volunteers: A Randomized, Placebo-Controlled, Double-Blind, Parallel-Group Study.

A randomized, placebo-controlled, double-blind, parallel-group clinical study was conducted to examine the effects of ingesting a heat-killed lactic acid bacterium, Lactobacillus johnsonii No. 1088 (LJ88) on temporal gastroesophageal reflux-related symptoms in healthy volunteers. A total of 120 healthy Japanese volunteers of both sexes, aged between 21 and 63 years, whose Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) total score was 8 or greater, but who were not diagnosed with functional dyspepsia according to the Rome IV classification, were enrolled. They were randomly assigned to either the LJ88 or placebo group and instructed to ingest the test food (1 billion heat-killed LJ88 or placebo) once a day for six weeks. Gastroesophageal reflux-related symptoms were evaluated using FSSG scores as a primary endpoint. The Gastrointestinal Symptoms Rating Scale (GSRS), stomach state questionnaire, and serum gastrin concentration were used as secondary endpoints. In the FSSG evaluation, the heartburn score was significantly improved at 6 weeks in the LJ88 group compared to the placebo group. No severe adverse events related to the test food were observed. In conclusion, daily ingestion of heat-killed LJ88 improved temporal heartburn symptoms in non-diseased individuals.

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.

Influence of ethnic origin on the clinical characteristics and intestinal flora of irritable bowel syndrome: a prospective study between Han and Tibetan patients.

Few studies have focused on the clinical characteristics and intestinal flora of Tibetan patients with irritable bowel syndrome (IBS). The study aimed to compare the difference of between Tibetan and Han patients with IBS. Patients who met inclusion and exclusion criteria were divided into the Tibet and Han groups. A simplified Gastrointestinal Symptom Rating Scale (GSRS)-based questionnaire was used to assess the IBS severity. Fecal samples from all subjects were collected for the analysis of gut microbiota using 16sRNA Illumina sequencing. No significant difference was found in the total symptom scores between two groups. However, Tibetans with IBS are more prone to bloating than Hans (17.41% vs 9.09%, p < 0.001). A profit shift in the gut microbiota was shown between the two groups. The ratio of Firmicutes/Bacteroidetes was significantly lower in the Tibet group than in the Han group (2.954 ± 0.78 vs 8.23 ± 2.04, p = 0.004). In the Tibet group, the level of the genus Blautia decreased significantly compared to the Han group, and there was a significant negative correlation between the level of Blautia and the bloating scores (Pearson r = -0.33, p = 0.025). The characteristics of Tibetan patients differ from those of Han patients with IBS, not only in terms of the clinical symptoms, but also in the characteristics of intestinal flora. Tibetans with IBS are more prone to bloating, which might be due to the different gut microbiota. The genus Blautia may play a role in this mechanism.

The GUTFIT Cohort: Understanding of different gastrointestinal symptoms score variation between Chinese and non-Chinese individuals with functional constipation

The diagnosis of functional constipation (FC) relies on patient-reported outcomes evaluated as criteria based on the clustering of symptoms. Although the ROME IV criteria for FC diagnosis is relevant for a multicultural population(1), how an individual’s lifestyle, environment and culture may influence the pathophysiology of FC remains a gap in our knowledge. Building on insights into mechanisms underpinning disorders of gut-brain interactions (formerly functional gastrointestinal disorders) in the COMFORT Cohort(2), this study aimed to investigate the differences in gastrointestinal (GI) symptom scores among participants with FC in comparison to healthy controls between Chinese and non-Chinese New Zealanders. The Gastrointestinal Understanding of Functional Constipation In an Urban Chinese and Urban non-Chinese New Zealander Cohort (GUTFIT) study was a longitudinal cohort study, which aimed to determine a comprehensive profile of characteristics and biological markers of FC between Chinese and non-Chinese New Zealanders. Chinese (classified according to maternal and paternal ethnicity) or non-Chinese (mixed ethnicities) adults living in Auckland classified as with or without FC based on ROME IV were enrolled. Monthly assessment (for 3 months) of GI symptoms, anthropometry, quality of life, diet, and biological samples were assessed monthly over March to June 2023. Demographics were obtained through a self-reported questionnaires and GI symptoms were assessed using the Gastrointestinal Symptom Rating Scale (GSRS) and Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS). This analysis is a cross-sectional assessment of patient-reported outcomes of GI symptoms. Of 78 enrolled participants, 66 completed the study (male, n = 10; female, n = 56) and were distributed across: Chinese with FC (Ch-FC; n = 11), Chinese control (Ch-CON; n = 19), non-Chinese with FC (NCh-FC; n = 16), non-Chinese control (NCh-CON; n = 20). Mean (SD) age, body mass index, and waist circumference were 40 ± 9 years, 22.7 ± 2.5 kg/m2, and 78.0 ± 7.6 cm, respectively. Ethnicity did not impact SAGIS domain scores for GI symptoms (Ethnicity x FC severity interaction p&gt;0.05). Yet, the constipation symptoms domain of the GSRS was scored differently depending on ethnicity and FC status (Ethnicity x FC interaction p&lt;0.05). In post hoc comparison, NCh-FC tended to have higher GSRS constipation severity scores than Ch-FC (3.4 ± 1.0 versus 3.8 ± 0.8 /8, p&lt;0.1) Although constipation symptom severity tended to be higher in NCh-FC, on the whole, ethnicity did not explain variation in this cohort. FC status was a more important predictor of GI symptoms scores. Future research will assess differences in symptom burden to explore ethnicity-specific characteristics of FC.

Transcutaneous vagal nerve stimulation for treating gastrointestinal symptoms in individuals with diabetes: a randomised, double-blind, sham-controlled, multicentre trial

Aims/hypothesisDiabetic gastroenteropathy frequently causes debilitating gastrointestinal symptoms. Previous uncontrolled studies have shown that transcutaneous vagal nerve stimulation (tVNS) may improve gastrointestinal symptoms. To investigate the effect of cervical tVNS in individuals with diabetes suffering from autonomic neuropathy and gastrointestinal symptoms, we conducted a randomised, sham-controlled, double-blind (participants and investigators were blinded to the allocated treatment) study.MethodsThis study included adults (aged 20–86) with type 1 or 2 diabetes, gastrointestinal symptoms and autonomic neuropathy recruited from three Steno Diabetes Centres in Denmark. Participants were randomly allocated 1:1 to receive active or sham stimulation. Active cervical tVNS or sham stimulation was self-administered over two successive study periods: 1 week of four daily stimulations and 8 weeks of two daily stimulations. The primary outcome measures were gastrointestinal symptom changes as measured using the gastroparesis cardinal symptom index (GCSI) and the gastrointestinal symptom rating scale (GSRS). Secondary outcomes included gastrointestinal transit times and cardiovascular autonomic function.ResultsSixty-eight participants were randomised to the active group, while 77 were randomised to the sham group. Sixty-three in the active and 68 in the sham group remained for analysis in study period 1, while 62 in each group were analysed in study period 2. In study period 1, active and sham tVNS resulted in similar symptom reductions (GCSI: −0.26 ± 0.64 vs −0.17 ± 0.62, p=0.44; GSRS: −0.35 ± 0.62 vs −0.32 ± 0.59, p=0.77; mean ± SD). In study period 2, active stimulation also caused a mean symptom decrease that was comparable to that observed after sham stimulation (GCSI: −0.47 ± 0.78 vs −0.33 ± 0.75, p=0.34; GSRS: −0.46 ± 0.90 vs −0.35 ± 0.79, p=0.50). Gastric emptying time was increased in the active group compared with sham (23 min vs −19 min, p=0.04). Segmental intestinal transit times and cardiovascular autonomic measurements did not differ between treatment groups (all p>0.05). The tVNS was well-tolerated.Conclusions/interpretationCervical tVNS, compared with sham stimulation, does not improve gastrointestinal symptoms among individuals with diabetes and autonomic neuropathy.Trial registrationClinicalTrials.gov NCT04143269FundingThe study was funded by the Novo Nordisk Foundation (grant number NNF180C0052045)Graphical

A Study on Footballers: Is the Mediterranean diet a Good Defender of the Gastrointestinal System?

In football, diet has a highly important role in the development of performance. Assessing the nutrition-related knowledge of footballers and increasing their awareness may affect their health and performance. In this study, which was carried out for this purpose, whether the Mediterranean diet had an effect on the gastrointestinal health of professional footballers was investigated. The sample of the study included a total of 196 active licensed male footballers who were professional players in the 2nd and 3rd football leagues of Turkey. The mean age of the participants was 23.46±4.18 and their mean experience in licensed football was 11.73±5.07 years. The adherence of the participants to the Mediterranean diet was assessed using the Mediterranean Diet Adherence Screener, while the frequencies of gastrointestinal symptoms were examined using the Gastrointestinal Symptom Rating Scale. The data were transferred to the SPSS 26.0 program and analyzed using Pearson’s Correlation Analysis, Independent-Samples T-Tests, One-Way ANOVA and descriptive statistics. According to the results of the analyses, no significant relationship was found between adherence to the Mediterranean diet and gastrointestinal symptoms (p&gt;0.05). While the gastrointestinal symptom scores of the participants did not vary significantly based on their league tiers or positions (p&gt;0.05), their Mediterranean diet adherence scores varied significantly based on their league tiers (p&lt;0.05). Consequently, it was determined that the adherence of the participants to the Mediterranean diet increased as their league tier increased, but adherence to the Mediterranean diet did not create any positive or negative effect on their gastrointestinal system symptoms.

Milk or Kefir, in Comparison to Water, Do Not Enhance Running Time-Trial Performance in Endurance Master Athletes.

This study compared flavored kefir (KFR) and flavored milk (MLK) as a recovery drink in endurance master athletes. Using a randomized, placebo-controlled, non-blinded crossover design, 11 males and females completed three testing visits whilst acutely ingesting either KFR, MLK, or water as a placebo (PLA). KFR supplementation occurred for 14 days before the KFR-testing day, followed by a 3-week washout period. Testing visits consisted of an exhausting-exercise (EE) bout, a 4-h rest period where additional carbohydrate feeding was provided, and a treadmill 5 km time trial (TT). The Gastrointestinal Symptom Rating Scale (GSRS) survey was assessed at four timepoints. Blood was collected at baseline and after the TT and was analyzed for I-FABP levels. No significant difference (PLA: 33:39.1 ± 6:29.0 min, KFR: 33:41.1 ± 5:44.4 min, and MLK: 33:36.2 ± 6:40.5 min, p = 0.99) was found between the groups in TT performance. The KFR GSRS total score was significantly lower than the PLA after EE (p = 0.005). No differences in I-FABP were observed between conditions. In conclusion, acute KFR supplementation did not impact TT performance or I-FABP levels but may have reduced subjective GI symptoms surrounding exercise when compared to MLK or PLA.

Effects of the Prolong Life With Nine Turn-Method Qigong on Fatigue, Insomnia, Anxiety, and Gastrointestinal Disorders in Patients With Chronic Fatigue Syndrome: Protocol for a Randomized Controlled Trial.

Chronic fatigue syndrome (CFS) is a debilitating multisystem disorder that can lead to various pathophysiological abnormalities and symptoms, including insomnia, gastrointestinal disorders, and anxiety. Due to the side effects of currently available drugs, there is a growing need for safe and effective nondrug therapies. The Prolong Life With Nine Turn (PLWNT) Qigong method is a system of mind-body exercise with restorative benefits that can alleviate the clinical symptoms of CFS and impart a significant inhibitory effect. Various studies have proven the treatment efficacy of PLWNT; however, the impact on insomnia, gastrointestinal disorders, and anxiety in patients with CFS has not yet beeninvestigated. This study aims to evaluate the efficacy and safety of the PLWNT method in terms of its effects on fatigue, insomnia, anxiety, and gastrointestinal symptoms in patients with CFS. We will conduct a randomized, analyst-blinded, parallel-controlled trial with a 12-week intervention and 8-week follow-up. A total of 208 patients of age 20-60 years will be recruited. The patients will be randomly divided into a PLWNT Qigong exercise group (PLWNT Group) and a control group treated with cognitive behavioral therapy at a ratio of 1:1. Participants from the treatment groups will be taught by a highly qualified professor at the Shanghai University of Traditional Chinese Medicine once a week and will be supervised via web during the remaining 6 days at home, over 12 consecutive weeks. The primary outcome will be the Multidimensional Fatigue Inventory 20, while the secondary outcomes include the Pittsburgh Sleep Quality Index, Gastrointestinal Symptom Rating Scale, Hospital Anxiety and Depression Scale, functional magnetic resonance imaging, gut microbiota, and peripheral blood. The study was approved by the ethics committee of Shanghai Municipal Hospital of Traditional Chinese Medicine in March 2022 (Ethics Approval Number 2022SHL-KY-05). Recruitment started in July 2022. The intervention is scheduled to be completed in December 2024, and data collection will be completed by the end of January 2025. Over the 3-year recruitment period, 208 participants will be recruited. Data management is still in progress; therefore, data analysis has yet to be performed. This randomized trial will evaluate the effectiveness of the PLWNT method in relieving fatigue, insomnia, anxiety, and gastrointestinal symptoms in patients with CFS. If proven effective, it will provide a promising alternative intervention for patients with CFS. China Clinical Trials Registry ChiCTR2200061229; https://www.chictr.org.cn/showproj.html?proj=162803. PRR1-10.2196/53347.

Value of serum brain-derived neurotrophic factor and glial fibrillary acidic protein for detecting depression in patients with Helicobacter pylori infection

ObjectiveInfection with helicobacter pylori (H. pylori) is associated with depression, and depression can affect the outcome of H. pylori treatment. This study aimed to evaluate the value of serum brain-derived neurotrophic factor (BDNF) and glial fibrillary acidic protein (GFAP) for predicting depression in H. pylori-positive patients. MethodA total of 82H. pylori-positive and 82H. pylori-negative patients were recruited for this study. All patients underwent neuropsychological and gastrointestinal assessments and blood sampling. BDNF and GFAP levels were measured in serum. The least absolute shrinkage and selection operator (LASSO) model was used to determine a composite marker. ResultsH. pylori-positive patients showed significantly increased serum GFAP levels and significantly decreased serum BDNF levels compared to H. pylori-negative patients. Among H. pylori-positive patients, serum levels of gastrin 17 (G-17), pepsinogen (PG) I/PGII, BDNF, and GFAP, as well as Gastrointestinal Symptom Rating Scale (GSRS) scores, were significantly correlated with Hamilton Depression Scale (HAMD-24) overall scores and factor scores. Interactions between serum BDNF/GFAP and gastrointestinal serum indices or GSRS scores were significantly associated with HAMD-24 scores in H. pylori-positive patients. The LASSO model indicated that the combination of serum BDNF, GFAP, and G-17 and GSRS scores could identify H. pylori-positive patients with depression with an area under the curve of 0.879. ConclusionCirculating changes in BDNF and GFAP were associated with the occurrence of depression in H. pylori-positive patients. A composite marker including neural and gastrointestinal function-related indices may be of value for identifying depression among H. pylori-positive patients.

Probiotics and Prebiotics Affecting Mental and Gut Health.

The effects of the gut microbiota on mental and intestinal health are an area of great interest. This study aimed to reveal the relationship between the intake of probiotic and prebiotic foods and mental and gut health. Data were obtained using an online survey from young adults (n = 538) enrolled at Afyonkarahisar Health Sciences University who agreed to participate in this study in the 2022-2023 academic year. This study included 538 participants, mostly (85.5%) females. Participants who never consumed yogurt had 7.614 times higher Gastrointestinal Symptom Rating Scale scores than those who consumed yogurt daily (p < 0.01). Similarly, the frequency of ayran consumption had a statistically significant effect on Bristol Stool Scale scores (p < 0.05). The ratio of normal defecation to constipation was 68.7% lower in participants who consumed ayran daily, whereas the ratio of diarrhea to constipation was 76.4% lower in participants who never consumed ayran. However, the frequency of prebiotic consumption did not have a significant effect on Bristol Stool Scale scores (p > 0.05). The consumption of probiotic and prebiotic foods exerted a significant effect on GSRS total scores and subfactors of the Depression Anxiety Stress Scale-42, namely depression, anxiety, and stress.

Influence of Helicobacter pylori Infection and Eradication on Small Intestinal Bacterial Overgrowth and Abdominal Symptoms.

The relationship between Helicobacter pylori (H. pylori) infection and small intestinal bacterial overgrowth (SIBO) has attracted attention recently. To analyze the influence of H. pylori infection and eradication on SIBO, IMO, and abdominal symptoms. Patients with gastrointestinal symptoms were tested for 13C urea breath test and if positive, treated with bismuth-based quadruple therapy. Lactulose hydrogen methane breath test (HMBT) was performed and symptoms were assessed using gastrointestinal symptom rating scale (GSRS) before and 6weeks after eradication. Of the 102 subjects, 53 were H. pylori positive. The prevalence of SIBO and IMO were higher in patients with H. pylori infection than in those without infection (49.1% vs 24.5%, P = 0.019 for SIBO; 24.5% vs 8.2%, P = 0.027 for IMO). GSRS scores were similar between H. pylori-infected and uninfected patients (2 (IQR: 1;3) vs 2 (IQR: 1;2), P = 0.211). Patients with SIBO or IMO presented higher GSRS scores than patients with both SIBO and IMO negative (2 (IQR: 2;3), 2 (IQR: 2;3) vs 2 (IQR: 1;2), P = 0.011, 0.001, respectively). For the 50 patients who successfully eradicated H. pylori, the response rates for SIBO and IMO were 66.7% and 76.9%, respectively. GSRS scores also significantly decreased (2 (IQR: 1;3) to 0 (IQR: 0;1), P < 0.001) after eradication. Helicobacter pylori infection was associated with higher prevalence of SIBO and IMO, both of which led to more pronounced abdominal symptoms. H. pylori eradication also achieved therapeutic effects on SIBO and IMO, accompanied by relief of abdominal symptoms.

A19 THE IMPACT OF FOOD INSECURITY ON ADHERENCE TO A GLUTEN-FREE DIET IN THE ADULT CELIAC DISEASE POPULATION ATTENDING A DEDICATED CELIAC CLINIC

Abstract Background A strict gluten-free diet (GFD) is currently the only treatment for celiac disease (CeD), but a GFD can be inconvenient and expensive. CeD patients who are food insecure (FI) face threats to GFD adherence, overall health, and quality of life. Aims To evaluate the prevalence of FI in patients with CeD attending a dedicated Adult Celiac Disease Clinic (ACDC) at an academic hospital and to examine the relationship between FI and GFD adherence, quality of life and various gastrointestinal symptoms. Methods Patients were invited to participate in the CeD registry when they attended the ACDC; those who agreed to participate then provided verbal and signed consent. Patients had the option to complete the CeD registry forms in the clinic on an iPad or at home using a card with a QR code and a unique ID to access the online CeD registry. The CeD registry uses REDCap (v. 11.1, 2021, US) and includes six validated questionnaires (Celiac Diet Adherence Test (CDAT), Celiac Disease Quality of Life Questionnaire (CD QoL), Celiac Symptom Index (CSI), Gastrointestinal Symptom Rating Scale (GSRS), Hospital Anxiety and Depression Scale (HADS), and Household Food Security Survey Module (HFSSM)). Continuous data are expressed as mean (SD), and categorical data as proportions of patients. The chi-squared test with Fisher correction and t-test were used to assess differences between groups. Results A total of 653 patients attended the ACDC from November 2, 2022, to September 20, 2023, and 411 patients were invited to participate in this study. Of them, 204 completed the CeD registry. Food insecurity was identified in 16% of CeD patients, of whom 11 (5%) were marginally FI, 16 (8%) were moderately FI, and 7 (3%) were severely FI. Compared to CeD patients who are food secure, a greater proportion of FI CeD patients reported nonadherence to GFD (26/34 vs 70/170; p&amp;lt;0.001), reduced QoL (32/34 vs 98/170; p&amp;lt;0.001), greater anxiety (27/34 vs 84/170; p=0.001) and greater depression (13/34 vs 26/170; p=0.004) compared with normal values. CeD patients with FI also reported lower QoL [61.0(14.9) vs 49.6(16.7); p=0.001] and increased gastrointestinal symptoms [GSRS 37.7(14.7) vs 29.0(12.8); p=0.001] compared with food secure CeD patients. Conclusions Food insecurity is common in patients with CeD and is associated with significantly worse adherence to treatment, symptom control, and quality of life. There is an important need for programs and societal measures to abolish food insecurity and ensure adequate access to treatment for patients with CeD. Funding Agencies TRIANGLE Summer Studentship

A176 RESTORATION OF IMPAIRED MICROBIOTA-MEDIATED ARYL HYDROCARBON RECEPTOR SIGNALING IN PATIENTS WITH CELIAC DISEASE BY ORAL TRYPTOPHAN SUPPLEMENTATION: AN EXPLORATORY STUDY

Abstract Background Celiac disease (CeD) is an autoimmune condition driven by gluten in individuals expressing celiac-specific genes (HLA-DQ2 and/or DQ8). A strict gluten-free diet (GFD) is currently the only treatment. 30-40% of celiac patients exhibit persistent symptoms despite following a GFD ampersand:003E1 year and are considered non-responsive. Tryptophan is an essential amino acid metabolized by gut microbiota to produce indoles that activate aryl hydrocarbon receptor (AhR), contributing to intestinal barrier homeostasis. Our previous study showed CeD patients have altered tryptophan metabolism and limited AhR activation, only partially improving with a GFD. In healthy volunteers, oral tryptophan supplementation improved AhR activation in the small intestine, thus, indicating its feasibility as adjuvant to the GFD in non-responsive CeD. Aims The study aims were to: 1) determine whether tryptophan supplementation improves celiac specific symptoms in non-responders; and 2) if tryptophan supplementation modifies gut microbiota composition, intestinal indole production and AhR activity. Methods The study is a double-blind, randomized, placebo-controlled trial with the aim to recruit 50 adults from the McMaster University Celiac Clinic. At visit 1, consented participants are randomized 1:1 to L-tryptophan (3g/day) or placebo and receive intervention capsules to be taken for 3 weeks after Visit 2. At Visits 2 and 3, participants complete dietary and symptom questionnaires, provide blood, stool, and urine samples, and undergo endoscopy. The primary outcome, improvement in symptoms, is assessed using the Celiac Symptoms Index (CSI); general GI symptoms by Gastrointestinal Symptoms Rating Scale (GSRS); mood symptoms by Hospital Anxiety and Depression Scale (HADS); quality of life by Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life questionnaire (PAGI-QoL). Results To- date we have recruited 10 participants. We will present blinded results from participants that have completed the study at the time of presentation based on responses to questionnaires pre, and post tryptophan/placebo intervention. At the time of analysis of this abstract, 5 participants had completed the study showing reduced CSI scores post intervention. The GSRS was also significantly reduced post intervention however, no change was observed in HADS and PAGI-QoL. Conclusions As all these results are currently blinded, we cannot attribute the symptom improvement to either tryptophan or the placebo effect. After unblinding the data, we will analyze the data to determine the extent of symptom reduction in relation to tryptophan metabolites (from urine, stool and duodenal aspirates) and AhR activation (from duodenal biopsy samples). Funding Agencies Weston Family Foundation

Protocol for the Gut Bugs in Autism Trial: a double-blind randomised placebo-controlled trial of faecal microbiome transfer for the treatment of gastrointestinal symptoms in autistic adolescents and adults

IntroductionAutism (formally autism spectrum disorder) encompasses a group of complex neurodevelopmental conditions, characterised by differences in communication and social interactions. Co-occurring chronic gastrointestinal symptoms are common among autistic individuals and...

Protocol of efficacy of bifidobacteria intake on gastrointestinal symptoms in symptomatic type 2 diabetes mellitus patients in abdominis: An open-label, randomized controlled trial (Binary STAR study).

This randomized, parallel-group study aims to investigate the effects of the probiotic Bifidobacterium bifidum G9-1 (BBG9-1) on the symptoms of diarrhea or constipation in patients with type 2 diabetes mellitus (T2DM). This study will examine 100 patients with T2DM who suffering from symptoms of diarrhea or constipation. Eligible patients will be randomly assigned 1:1 to two groups (group A, BBG9-1 group; group B, control group), after the baseline examination. Patients assigned to group A will receive probiotic BBG9-1 oral administration along with their current treatment for 12 weeks, and patients assigned to group B will continue the current treatment for 12 weeks without probiotic BBG9-1 oral administration. Subsequently, examinations similar to the baseline examinations will be performed. The primary endpoint will be a change in the Gastrointestinal Symptom Rating Scale (GSRS) total score from baseline to week 12. Secondary endpoints will include the following: change and percent change in parameters such as GSRS subdomain scores, fecal properties/Bristol stool form scale, defecation frequency, biomarkers, gut microbiota, and macronutrients and factors that affect GSRS total score or constipation/diarrhea subdomain scores from baseline to week 12. The results of this study will clarify the utility of probiotic BBG9-1 in the treatment of diarrhea or constipation in patients with T2DM. jRCTs051220127.

Different Food Preferences in Patients with Gastrointestinal Disorders.

Objective Gastrointestinal (GI) disorders such as functional dyspepsia (FD), irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and inflammatory bowel disease (IBD) can exhibit overlapping GI symptoms, including abdominal pain and alterations in bowel habits. The symptoms of GI disorders are commonly considered to be triggered and exacerbated by fatty food intake. Therefore, this study aimed to compare the food preferences of patients with GI disorders. Methods Forty food images (including fatty and light foods) and 20 animal images were selected to evaluate food preferences. The preference score was assessed using a visual analog scale ranging from 1 to 100. GI symptoms were evaluated using the GI Symptom Rating Scale (GSRS), and correlations between the GSRS and preference scores were investigated. Results Overall, 22 healthy controls and 23, 29, 27, and 20 patients with FD, IBS, GERD, and IBD, respectively, were enrolled. The preference score for all foods in patients with FD was significantly lower than that in healthy controls and those with IBS, GERD, and IBD (52.9 vs. 66.5 vs. 68.5 vs. 69.1 vs. 70.7, p<0.01). The score of fatty foods was lower in patients with FD than in healthy controls and those with IBS, GERD, and IBD (43.8 vs. 72.3 vs. 77.5 vs. 77.4 vs. 80.7, p<0.01), whereas that of light foods and animal images was not different among the groups. No significant correlation was found between the preference score and symptom severity. Conclusions Patients with FD had a negative preference for foods, particularly fatty foods, independent of the severity of GI symptoms.