Incidence Of Functional Gastrointestinal Disorders Research Articles

Psycho-emotional state during pregnancy and one year after childbirth in mothers of children with functional gastrointestinal disorders

Aim. To determine the relationship between the incidence of functional gastrointestinal disorders in children up to 1 year of age and the psycho-emotional state of their mothers during pregnancy and after childbirth.
 Materials and methods. A survey of 1203 mothers of children under 4 years of age was conducted using a questionnaire of functional gastrointestinal disorders according to the Rome IV criteria (2016). The questionnaire contained domains on general issues (the age of the mother at the time of the child's birth, the data of obstetric and gynecological anamnesis, the type of child's nutrition at the time of the survey), psycho-emotional state (retrospectively, the psychological component of the gestational dominant – PСGD – during pregnancy, Beck's anxiety and Beck's depression questionnaires) and questions on functional disorders in infants and young children.
 Results. Questionnaires of 487 mothers of children of the 1st year of life were analyzed. Only in 34.4% of cases, mothers' responses lacked anxious and depressive PCGD. In mothers with anxious PСGD, the risk of regurgitation in their children was statistically significantly 2-fold higher compared to mothers with depressive PСGD. In mothers with optimal PСGD, the rate of colic in their children was statistically significantly 2-fold lower compared to mothers with anxious and depressive PСGD. After childbirth, anxiety was noted in 17% mothers and signs of depression in 59% mothers. Significant and severe depression was diagnosed in 10% mothers; the children of these mothers had persistent regurgitation.. In the absence of depression in mothers, the probability of no regurgitation and colic in their children was statistically significantly 2-fold higher compared to the children of mothers with depression.
 Conclusion. The incidence of functional gastrointestinal disorders in a child up to 1 year of age is associated with maternal anxiety during pregnancy and maternal depression after childbirth.

Impact of Functional Gastrointestinal Disorders in Infancy and the Role of Nutrition

Functional gastrointestinal disorders (FGIDs) such as infantile colic, constipation and colic occur in almost half of the infants. Functional gastrointestinal disorders (FGID) are common among children and may cause a significant symptom burden. The Rome criteria are symptom-based guidelines for the assessment of FGID among children and adults. The most common FGID for children aged 0–12 months was infant regurgitation, the most common FGID for those aged 13–48 months were functional constipation and cyclic vomiting, and, for those aged over four years, functional constipation, functional dyspepsia, and irritable bowel syndrome. This reported overall incidence of FGID may be used as a benchmark of normative data among the general population and comparative data for those with comorbid disease. The aim of this mini review article is to provide a critical and updated review on the management of FGIDs and their impact on the health of the infant and family to health care physicians. Guidelines and expert recommendations were reviewed. FGIDs are a frequent cause of parental concern, impairment in quality of life of infants and relatives, and impose a financial burden to families, health care, and insurance. Therefore, primary management of the FGIDs should be focused on improving the infants’ symptoms and quality of life of the family. If more than parental reassurance is needed, available evidence recommends nutritional advice as it is an effective strategy and most of the time devoid of adverse effects. The role of healthcare providers in reassuring parents and proposing the correct behavior and nutritional intervention by avoiding inappropriate use of medication, is essential in the management of FGIDs.

Systematic Review of Pediatric Functional Gastrointestinal Disorders (Rome IV Criteria).

Functional gastrointestinal disorders (FGID) are common among children and may cause a significant symptom burden. The Rome criteria are symptom-based guidelines for the assessment of FGID among children and adults. The aim of this systematic review was to estimate the prevalence of FGID utilizing the revised Rome IV criteria. Nine health databases were searched. The inclusion criteria were: prospective FGID prevalence data using the Rome IV criteria for children up to 18 years, and the exclusion criteria were: cohorts with known gastrointestinal or organic conditions. The data were presented as a percentage of children experiencing at least one FGID, as well as in individual categories. The searches identified 376 papers, with 20 included in the final analysis, providing a pooled cohort of 18,935 children. The median prevalence of FGID for children aged up to four years was 22.2% (range 5.8–40%), and aged four–eighteen years was 21.8% (range 19–40%). The most common FGID for children aged 0–12 months was infant regurgitation, the most common FGID for those aged 13–48 months were functional constipation and cyclic vomiting, and, for those aged over four years, functional constipation, functional dyspepsia, and irritable bowel syndrome. This reported overall incidence of FGID may be used as a benchmark of normative data among the general population and comparative data for those with comorbid disease.

Sex differences in GABAergic neurotransmission to rat DMV neurons.

Functional gastrointestinal disorders, including delayed gastric emptying and decreased gastric motility, are more prevalent in women, suggesting a potential role for circulating gonadal hormones, including estrogen. Gastric motility is tuned by the vagal inputs arising from the dorsal motor nucleus of the vagus (DMV), which is itself controlled by tonic GABAergic inputs. Estrogen increases GABA functions in various central nervous system areas; however, the effect of the estrus cycle in modulating GABAergic inputs onto DMV neurons, hence vagal control of gastric motility, has not been investigated. The aim of the present study was to test the hypothesis that GABAergic tone to DMV neurons, hence the vagal output to the stomach, varies according to sex and the estrus cycle. Experiments were performed on age-matched Sprague-Dawley male and virgin female rats; females were subdivided according to the high-estrogen (HE) or low-estrogen (LE) period of their cycle. Whole-cell patch-clamp recordings were made from gastric-projecting DMV neurons, and the response to perfusion with the GABAA receptor antagonist bicuculline was examined. The response of corpus and antrum tone and motility to bicuculline microinjected in the dorsal vagal complex, recorded via strain gauges sewn to the anterior gastric surface, was also assessed. Bicuculline increased the firing rate of DMV neurons, as well as gastric tone and motility, to a larger extent in HE compared with LE or male rats, suggesting a higher GABAergic tone in HE female rats. Taken together, the data support the hypothesis that GABAergic tone to DMV neurons varies according to sex and estrus cycle.NEW & NOTEWORTHY GABAergic neurotransmission to the dorsal motor nucleus of the vagus (DMV) plays a pivotal role in the modulation of gastric tone and motility. Gastric motility is reduced in women and may contribute to the higher incidence of functional gastrointestinal disorders. In the present study, we report that GABAergic tone to rat DMV neurons, hence vagal output to the stomach, varies according to sex and estrus cycle, and the GABAergic tone is increased during the high-estrogen period of the estrus cycle.

Sex Differences And Stress Alter The Vagally‐Mediated Gastric Response To Oxytocin In Rats

Stress and stress maladaptation play critical roles in the development of functional gastrointestinal (GI) disorders. Females have a higher incidence of functional GI disorders, likely due to fluctuations in estrogen levels, which we have shown to correlate with increased inhibitory vagal output to the GI tract. Previous studies have shown that levels of anti‐stress hormone oxytocin vary in response to stress: the more oxytocin the better the individual copes with stressful events. Furthermore, our previous studies (PMC4287746) showed that acute stress induces plastic changes in the vagally‐mediated gastric response to oxytocin, however gastric motility responses to brainstem application of oxytocin in male vs female in response to chronic stress are not yet known.The aim of this study was to test the hypothesis that sex differences and stress alter the gastric, vagally‐mediated response to oxytocin.SD rats were divided into the following groups 1) male, 2) low estrogen female, and 3) high estrogen female. Rats were further subdivided into the following groups: i) control, and 5 consecutive days of ii) chronic repetitive homotypic stress (these rats adapt to stress; CHo), and iii) chronic repetitive heterotypic stress (these rats do not adapt to stress; CHe). At the end of the stress load, rats were anaesthetized and strain gauges were sewn to the anterior stomach to record antrum and corpus tone and motility variation upon oxytocin microinjected in the dorsal motor nucleus of the vagus to record the changes in corpus and antrum. The postganglionic vagal pathway affected by oxytocin was investigated via i.v. injection of L‐NAME, VIP antagonist or bethanechol.Focusing on antrum motility, but similar data were obtained with corpus tone and motility as well as antrum tone, our results suggest: i) in male rats (N=4 for all) the oxytocin induced inhibition in antral motility was attenuated significantly by L‐NAME only in controls (from 65±5% to 23±7% decrease from baseline), while in stressed animals, the response was mediated also via engagement of a VIP‐dependent pathway. ii) in all the groups from low or high estrogen females (N=3 for all), the oxytocin‐mediated gastric response was regulated via both L‐NAME (from 53±5% to 43±7% decrease from baseline, in high estrogen control) and VIP‐sensitive pathways (from 53±5 to 8±36% decrease from baseline, in high estrogen control).In conclusion, our data indicate that females appear to respond to oxytocin to a lesser extent than males, and the vagally‐mediated pathways controlling tone and motility by females are similar to those used by stressed males. These observations may lead to a better explanation of the higher incidence of functional GI disorders in females.Support or Funding InformationAmerican Physiological Society, Undergraduate Summer Research FellowshipThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Neonatal programming of functional gastrointestinal disorders in infants

Objectives: Functional gastrointestinal disorders (FGIDs) are common in infants, representing a frequent condition of pediatric referral. Predisposing or protective factors still need to be clarified. The aim of this study was to assess the influence of different neonatal factors on the incidence of FGIDs in the first months of life.

Umbilical Hernia Repair Increases the Rate of Functional Gastrointestinal Disorders in Children

To hypothesize that hernia repair would not change the incidence of functional gastrointestinal disorders (FGIDs) due to the benign and limited nature of the procedure. This cohort study assessed a randomized selection of children aged 4-18 years who underwent hernia repair more than 4 years prior at Ann and Robert H. Lurie Children's Hospital of Chicago. Controls were siblings who had not undergone surgery previously. Parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version by telephone for subjects and controls. The primary outcome was the presence of FGIDs. Fifty children with hernia repair and 43 sibling controls were identified. At the time of survey, subjects with hernia repair were average age 12.9 years (range 5-18 years, 60% male) and controls were average age 12.2 years (range 4-18 years, 49% male). Average age at surgical repair was 5.2 years (median 5.2 years, range 0.2-10.4 years) and average time since surgical repair was 7.8 years (range 4.8-13.7 years). FGIDs were diagnosed in 10/50 (20%) cases of hernia repair and 2/43 (5%) controls (P = .033, Fisher 2-tailed test). Umbilical hernia repair increases the likelihood of FGIDs in childhood. Additional studies are needed to identify aspects of surgery that may be associated with development of FGIDs.

Upper Functional Gastrointestinal Disorders in Young Adults

Functional Gastrointestinal disorders (FGID) are common disorders in gastroenterology which are common in young adults. The aim of this study is evaluating the prevalence of upper FGID in iranian young adults. This was a cross-sectional study which was on 995 persons who were going to marry. A ROME III based questionnaire was used to determine the frequency of upper GI Syndromes among the sample population. Our results determined 74 subjects had functional dyspepsia (36 subjects diagnosed as postprandial distress syndrome patient and Epigastric pain syndrome was seen in 38 subjects). Functional heartburn was diagnosed in 52 participants. Globus was seen in 35 subjects and 41 had unspecified excessive belching. Many epidemiologic studies were done all around the world but there are different reports about prevalence and incidence of FGIDs. Our results were agreed with reported prevalence of FGIDs in Iran in adults. And our findings were agreed with some other Asian studies.

A Case Control Study of Post Infectious Sequelae Following Outbreaks of Norovirus in U.S. Military Populations

Purpose: The U.S. CDC estimates over 5.4 million norovirus infections annually in the U.S., and numerous others among international travelers. Noroviruses cause numerous outbreaks, outpatient visits and nearly 15,000 hospitalizations and 150 deaths each year. While the burden associated with the acute consequences of norovirus are sizeable, emerging data suggests norovirus may be associated with chronic gastrointestinal problems. However, no studies looking at pathogen-specific norovirus post-infectious risks have been reported. We identified known outbreaks in Department of Defense (DOD) recruits and utilized the DOD Medical Encounter Database (DMED) to identify the risk of new onset functional gastrointestinal disorders (FGD) and gastroesophageal reflux disease (GERD). Methods: Subjects reporting for norovirus-related care during three known norovirus outbreaks were identified from the DMED. Each AGE case was matched with up to four subjects with unrelated medical encounters. Medical encounter history was analyzed for the duration of military service time (or a minimum of 1 year) to assess for incident FGD or GERD. Relative risks were calculated using Poisson regression models to determine the relationship between pathogen-attributable gastroenteritis and each postinfectious sequelae while controlling for important covariates. Results: We identified 1,718 cases from 3 separate norovirus outbreaks among recruits (Jan - Feb 04, San Diego, CA: 203; Dec - Apr 05, San Diego, CA: 1360; Jan - Feb 07, Parris Island, SC: 155). After controlling for covariates, the incidence of constipation, dyspepsia and GERD was approximately 1.5 fold higher (p<0.01) in outbreak-associated AGE cases than in matched subjects without an outbreak associated AGE illness, though noted significant variability in the incidence of FGD and GERD among outbreak subjects across the three studied outbreaks. Conclusion: This is the first study which reports risk of post-norovirus infectious sequelae in a generally healthy population and finds that risk of dyspepsia, constipation and GERD are higher among those who have AGE during a confirmed norovirus outbreak compared to non-ill controls. Relatively little is known about the pathogenesis of norovirus, and while these findings should be confirmed in additional studies, they suggest that dysmotility may result subsequent to these infections. Further studies are needed to evaluate the possible transient nature of such post-infectious sequelae and if risk differs based on infections with different genotypes. If confirmed, the costs associated with the chronic consequences of norovirus should be considered in the enhanced implementation of control measures in outbreaks and high risk populations.

Delayed Colonic Transit is Associated With a Decrease of the Normal Predominant Bacteria in the Colon Microbiota

Introduction/Aims: Post-infectious irritable bowel syndrome (PI-IBS) may develop in 4% to 30% of affected patients following bacterial gastroenteritis (GE), but limited information is available on outcome of viral GE. During summer 2009 a massive outbreak of viral GE associated with contamination of municipal drinking water (Norovirus and Enterovirus) occurred in San Felice del Benaco (Lake Garda, Italy) [1]. In order to investigate the natural history of a community outbreak of viral GE and to assess the incidence of functional gastrointestinal disorders and PI-IBS, we carried out a prospective population-based cohort study with control group. Methods: Baseline questionnaires were administered to the resident community within one month of the outbreak. Follow-up questionnaires of the Italian version of Gastrointestinal Symptom Rating Scale (GSRS, a 15 item survey scored according to a 7-point Likert scale) were mailed to all patients responding to baseline questionnaire at 3 and 6 months and to a cohort of unaffected controls, living in the same geographical area, at 6 months after the outbreak. GSRS itemwere grouped into five dimensions: abdominal pain, reflux, indigestion, diarrhea and constipation. At month 12 all patients and controls were interviewed by an health assistant in order to verify Rome III criteria of IBS. T-test and χ2 or fisher's exact test were used as appropriate. Results: Baseline questionnaires were returned by 348 patients: mean age ± SD 45 ± 22 years, 53% female. At outbreak nausea (scored ≥4), vomiting and diarrhea lasting 2-3 days or more were reported by 66%, 60% and 77% of patients, respectively. Fifty percent reported fever and 19% referred weight loss (mean 3 Kg). Follow-up surveys were returned at month 6 by 185 patients and 168 controls: mean of GSRS score for each dimension is reported in the figure. At month 12 we identified 40 patients with a new diagnosis of IBS (Rome III criteria), in comparison with 3 subjects in the control cohort (p<0.0001; OR 11.40, 3.44-37.82, 95%CI). The 40 cases of PI-IBS, according to the subclassification of IBS by predominant stool pattern [2], were subtyped as follow: 4 IBS with constipation, 7 IBS with diarrhea, 16 with mixed IBS and 13 with unsubtyped IBS. Conclusion: Our study provides evidence that mixed Norovirus and Enterovirus GE may lead to post-infectious gastrointestinal disordes which persist for at least 12 month after infection. PI-IBS following viral infections develops in a substantial proportion of patients (22%) similar to that reported after bacterial GE.

Incidence of functional intestinal disorders and postinfectious irritable bowel syndrome following a waterborne viral gastroenteritis outbreak

IntroductionPostinfectious irritable bowel syndrome (PI-IBS) may develop in 4–30% of patients following bacterial gastroenteritis (GE), but limited information is available on outcome of viral GE. On summer 2009 a massive...

Protease-activated receptors: novel central role in modulation of gastric functions

Protease-activated receptors (PARs) are members of a subfamily of G-protein-coupled receptors that regulate diverse cell functions in response to proteolytic cleavage of an anchored peptide domain that acts as a 'tethered' receptor-activating ligand. PAR-1 and PAR-2 in particular are present throughout the gastrointestinal (GI) tract and play prominent roles in the regulation of GI epithelial function, motility, inflammation and nociception. In a recent article in Neurogastroenterology and Motility, Wang et al. demonstrate, for the first time, that PAR-1 and PAR-2 are present on preganglionic parasympathetic neurons within the rat brainstem. As in other cellular systems, proteases such as thrombin and trypsin activate PAR-1 and PAR-2 on neurons of the dorsal motor nucleus of the vagus (DMV), leading to an increase in intracellular calcium levels via signal transduction mechanisms involving activation of phospholipase C and inositol triphosphate (IP3). The authors also report that the level of PAR-1 and PAR-2 transcripts in DMV tissue is increased following experimental colitis, suggesting that inflammatory conditions may modulate neuronal behavior or induce plasticity within central vagal neurocircuits. It seems reasonable to hypothesize, therefore, that the activity and behavior of vagal efferent motoneurons may be modulated directly by local and/or systemic proteases released during inflammation. This, in turn, may contribute to the increased incidence of functional GI disorders, including gastric dysmotility, delayed emptying and gastritis observed in patients with inflammatory bowel diseases.

Functional gastrointestinal disorders and visceral hypersensitivity in children and adolescents suffering from Crohnʼs disease

Symptoms of abdominal pain are reported by children with active Crohn's disease (CD). During remissions abdominal pain improves in most children but some of them continue to experience pain. We hypothesized that these patients may suffer from protracted abdominal pain related to functional gastrointestinal disorders (FGID) and visceral hypersensitivity. The objective was to characterize the symptoms and to measure the rectal sensory threshold for pain (RSTP) by barostat in CD children and adolescents suffering from abdominal pain despite remission. Eight patients (median age 14.5 years; range 9.8-17) with quiescent CD but suffering from chronic abdominal pain were studied by rectal barostat. At the same time they completed validated questionnaires to assess FGID, anxiety, and depression. They were compared to 10 control children and 8 children with FGID also investigated in our laboratory. All patients fulfilled Rome II criteria for irritable bowel syndrome (n = 5), functional abdominal pain (n = 2), and functional dyspepsia (n = 1). RSTP was significantly lower in CD patients compared to the normal controls: median (range) 25 mmHg (15-29) versus 40 mmHg (30-48) (P < 0.01). RSTP was similar in patients and children with FGID. Rectal compliance was similar in patients, children with FGID, and controls. Seven of the 8 patients had scores indicating an anxiety problem. Protracted abdominal pain that affects children and adolescents with quiescent CD is related to FGID associated with visceral hypersensitivity and anxiety. The incidence of FGID in children suffering from CD requires further investigation.

Postinfectious irritable bowel syndrome may occur after non‐gastrointestinal and intestinal infection

Postinfectious functional gastrointestinal disorders (FGIDs) may not be specific to gastroenteritis. This pilot study aimed to ascertain the 3- and 6-month incidence of functional gut disorders in people with non-gastrointestinal (GI) infection, gastroenteritis and healthy controls. This was a prospective study of three cohorts recruited from hospital (non-GI infections) and the community (others). FGIDs were diagnosed using self-completed Rome II modular questionnaires administered at baseline, 3 and 6 months. Thirty-six subjects with non-GI infection, 219 healthy subjects and 108 with bacterial gastroenteritis participated. No difference in incidence of FGID was detected between the GI and non-GI infection cohorts. Any FGID was more frequent in people who had a non-GI infection than in controls at both 3 [odds ratio: 4.34 (95% CI: 3.60-16.45)] and 6 months [4.76 (4.42-27.92)]. Irritable bowel syndrome (IBS) alone was more frequent in people with non-GI infections than in controls at 3 months (6.12 [1.30-29.12]) but did not quite reach statistical significance at 6 months (4.58 [0.79-26.46]). Our findings were unexpected. Postinfectious FGIDs may be related to non-GI and GI infection, although not all potential biases were controlled in study design. Further studies need to explore these preliminary findings and, if confirmed, the underlying mechanisms.

Relaxin Depresses Small Bowel Motility Through a Nitric Oxide-Mediated Mechanism. Studies in Mice1

Gastrointestinal motility is reduced and the incidence of functional gastrointestinal disorders is increased in pregnancy, possibly due to hormonal influences. This study aims to clarify whether the hormone relaxin, which attains high circulating levels during pregnancy and has a nitric oxide-mediated relaxant action on vascular and uterine smooth muscle, also reduces bowel motility and, if it does, whether nitric oxide is involved. Female mice in proestrous or estrous were treated for 18 h with relaxin (1 microg s.c.) or vehicle (controls). Isolated ileal preparations from both groups were used to record contractile activity, either basal or after acute administration of relaxin (5 x 10(-8) M). Drugs inhibiting nitric oxide biosynthesis or neurotransmission were used in combination with relaxin. Expression of nitric oxide synthase isoforms by the ileum was assessed by immunocytochemistry and Western blot analysis. Relaxin caused a clear-cut decay of muscle tension and a reduction in amplitude of spontaneous contractions upon either chronic administration to mice or acute addition to isolated ileal preparations. These effects were significantly blunted by N(G)-nitro-L-arginine, but not by the neural blockers we used. Moreover, relaxin increased the expression of nitric oxide synthases II and III, but not synthase I. Relaxin markedly inhibits ileal motility in mice by exerting a direct action on smooth muscle through the activation of intrinsic nitric oxide biosynthesis.

Irritable bowel syndrome: towards an integrated approach

Functional Gastrointestinal Disorders are defined as chronic or recurrent gastrointestinal symptoms characterized by abdominal pain, constipation and/or diarrhoea (Tally, 1994; University of North Carolina, 1998). These disorders are of concern because of their high incidence, associated morbidity, expense and the impact of these disorders on people's quality of life. Drossman (1993, in University of North Carolina (UNC), 1998) found that of 5 400 U.S. households, 69% of people met the criteria for at least one of the functional gastrointestinal disorders which represents a 59% increase in the incidence of functional gastrointestinal disorders since 1983 (Drossman, in UNC, 1998; Drossman, 1983). In particular, Irritable Bowel Syndrome (IBS) sufferers account for 2,4 - 3,5 million visits to doctors annually. Furthermore, IBS sufferers spend $40 million annually on treatment for their condition. They also tend to have 3 to 4 times more disability days than other workers, which illustrates the debilitating effect of this disorder (Drossman, in UNC, 1998). It is therefore necessary that the etiology of IBS be researched, as well as the course and management of this debilitating disease. The studies presented in this series aimed to improve the understanding of the multiple agents that influence the development and course of IBS.