Intestinal Symptoms Research Articles

OA13 Trust your gut: it has the answer

Abstract Introduction We report the case of a 51-year-old man who presented over seven years to multiple specialities, including rheumatology on several occasions, with arthralgia, fevers and weight loss. He was found to have raised inflammatory markers, lymphadenopathy and pericardial and pleural effusions but despite extensive investigation over this time, the cause for his presentation remained elusive. After many years, he developed gastrointestinal symptoms, which led us to the unifying diagnosis of Whipple’s disease. Case description This patient initially presented to rheumatology in 2017 with left ankle pain. His only medical history was renal calculi. He was diagnosed with gout and osteoarthritis and was discharged. Two years later, he presented with fevers. Investigations revealed raised inflammatory markers, small pericardial and pleural effusions and small-volume upper abdominal lymphadenopathy. He was treated with colchicine for pericarditis with some improvement. He presented again in 2021 with chest and flank pain and breathlessness. CTPA revealed an ongoing small pericardial effusion and small-volume intrathoracic and intra-abdominal lymphadenopathy. Inflammatory markers remained raised (CRP 30-50, ESR 20-30). He had now begun to lose weight. He was referred to the cancer of unknown primary service, who monitored his lymphadenopathy. In January 2022, he underwent an open biopsy of a mesenteric lymph node, which revealed non-caseating granulomas and no evidence of malignancy. He was referred again to rheumatology due to ongoing migratory joint pains in his wrists, ankles and knees. Rheumatoid factor, anti-CCP, antinuclear antibody and serum ACE had been negative on several occasions. He underwent a PET scan that revealed persistent lymphadenopathy with low to moderate avidity, borderline splenomegaly and a slightly prominent marrow signal. He then had a bone marrow biopsy that showed no significant abnormality. In December 2023, we settled on a probable diagnosis of sarcoidosis. He was treated with a trial of steroid without much symptomatic improvement and there was a plan to initiate Methotrexate. However, he then developed nausea and vomiting and was noted to have a new iron deficiency anaemia. He was referred to gastroenterology and underwent an upper endoscopy, which was macroscopically normal, but microscopically showed findings in keeping with Whipple’s disease (WD) with PAS-positive staining. Duodenal biopsy PCR confirmed this. He is now awaiting input from the infectious diseases team and long-term antibiotic treatment. Discussion WD is caused by the bacterium Tropheryma whipplei. There are four commonly recognised manifestations of T. whipplei infections: 1) classic WD, 2) localised chronic infections, 3) acute infections and 4) asymptomatic carriage. Our patient has classic WD, and his case exemplifies the disease course and diagnostic challenges. Classic WD is a rare, chronic, multisystem infectious disease. It is reported as most often affecting middle-aged white males of European ancestry. It can be divided into an early phase with intermittent arthralgias or arthritis and fever, a middle phase with gastrointestinal symptoms and weight loss, and a late phase with predominant neurological symptoms. Arthritis is the presenting symptom in 60-70% of cases and occurs in 90% of all cases. Given this, around half of patients are initially misdiagnosed as having an inflammatory rheumatic disease. As in the case of our patient, joint manifestations do not correlate with intestinal symptoms and can precede intestinal manifestations by a mean interval of six years. Joint involvement in WD is typically a migratory oligo- or polyarthritis or arthralgia primarily involving large and medium joints, most commonly the knees, ankles and wrists. Less commonly affected joints are elbows, hips and shoulders. WD should be considered in all patients with the four cardinal symptoms of arthralgias, diarrhoea, abdominal pain, and weight loss after more common differentials have been excluded. In patients without gastrointestinal symptoms, having suspicion of the disease is more difficult; however, consideration should be made in patients with seronegative arthritis, who do not respond to immunosuppressive treatment. Other clinical syndromes in which WD should be considered include fever of unknown origin, chronic serositis, generalised lymphadenopathy, progressive central nervous system disease or early onset cognitive deficits. Although histology revealing non-caseating granulomas is the hallmark of sarcoidosis, they are non-specific and can be found in many other diseases. Key learning points • WD has a reputation as a great mimicker of many diseases and there is still often a considerable delay to diagnosis, even in typical cases, given the natural history of the disease and its rarity. WD should be considered in patients with seronegative arthritis not following a typical disease course, particularly if they develop gastrointestinal symptoms. WD is also a pertinent differential in patients with persistent constitutional upset with unexplained lymphadenopathy or serositis. It should be remembered that non-caseating granulomas can be found in many diseases and that sarcoidosis remains a diagnosis of exclusion among granulomatous disorders.

Impact of robotic surgery on postoperative gastrointestinal dysfunction following minimally invasive colorectal surgery: incidence, risk factors, and short-term outcomes

AimPostoperative gastrointestinal dysfunction (POGD) is a common complication following colorectal surgery. This study aimed to investigate the incidence and risk factors of POGD after minimally invasive surgery and to assess the relationship between robotic surgery, POGD, and their outcomes.MethodPatients who had undergone minimally invasive colorectal surgery at our institution between July 2018 and November 2023 were retrospectively enrolled. POGD was diagnosed based on the presence of two or more intestinal symptoms within 72 h or more after surgery. Risk factors were identified through regression analyses, and the impact of POGD on outcomes was assessed using linear regression.The association between those factors was assessed using subgroup analysis and hierarchical regression.ResultsA total of 226 patients were included in the analysis, including 33 with POGD. POGD occurred in 14.6% of patients, with a lower incidence in robotic surgery (7.3%) than in laparoscopic surgery (19.8%). Multivariate analysis indicated that robotic surgery had a protective effect, while blood loss exceeding 50 ml was an independent risk factor for POGD. POGD was also correlated with longer length of stays and higher costs. The association between POGD, length of stay, and cost varied depending on the surgical platform. Robotic surgery exacerbated the effect of POGD on short-term outcomes, which aligned with the observed significant interaction effect.ConclusionPOGD remains a prevalent postoperative disease. Preventive strategies, including meticulous hemostasis techniques and robotic surgery, should be prioritized by healthcare professionals to reduce POGD risk, improve short-term outcomes, and preserve healthcare resources.

Characterization of the emerging recombinant infectious bronchitis virus in China.

Infectious bronchitis virus (IBV) can cause serious harm to poultry industry. It is belong to Coronaviridae which is highly variable. A kind of emerging recombinant IBV (ahysx-1) has been detected in chicken from China in 2016. To understand the epidemiology and characterization of the emerging recombinant IBV, 35,455 samples of chickens from the 15 provinces in China were collected and detected. One hundred and ninety-six out of the 537 flocks (positive rate, 36.49%), and 908 out of 35,455 samples (positive rate, 2.56%) were positive in the detection. The results showed that the emerging recombinant IBV was pandemic in China. Thirteen emerging recombinant IBV isolates were selected and continuous subcultured to the fourth generation and analyzed by Next-generation sequencing. Compared with the reported sequence of ahysx-1, the genomic analysis showed that multiple position insertions and deletions were in 1a gene, 3b gene, M gene and N gene. The identity of the S gene nucleotide sequence between all the 13 emerging recombinant IBV isolates and reference stain ahysx-1 were 98.1-99.1%, while the identity of amino acid sequence were 98.0-99.8%. To better understand the recombination mechanism of the emerging recombinant IBV, the genomic sequence of the 13 isolates were compared with turkey coronavirus or guinea fowl coronavirus. The results suggest that all the 13 emerging recombinant IBV isolates were likely to be the recombination of turkey coronavirus or guinea fowl coronavirus with IBV. Turkey coronavirus or guinea fowl coronavirus as minor parents are the donors of S gene. The major parents donors of the genome backone of these recombination events were lineages GI-19 or GVI-1 of IBV. One isolate (IBV/chicken/Henan/H1173/2021) was selected for pathogenicity analysis. The results showed that IBV/chicken/Henan/H1173/2021 was avirulent to SPF embryonated eggs, but could cause intestinal symptoms in of chicks. This study provides a foundation for understanding the epidemic situation and characterization of the emerging recombinant IBV. It is of great significance for the prevention and control of avian coronavirus infection.

An unusual case of small-bowel obstruction: Broad ligament hernia.

Broad ligament hernias (BLHs) are rare internal hernias that can lead to serious complications if left untreated. In this case report, we present the case of a BLH in a female patient and discuss its clinical presentation, diagnosis and management. A 40-year-old woman presented with subacute intestinal obstruction symptoms, including the inability to pass flatus and faeces and recurrent bilious vomiting. A computed tomography (CT) scan confirmed small-bowel obstruction adjacent to the uterus within the left broad ligament. Diagnostic laparoscopy revealed a loop of obstructed small intestine within the broad ligament, which was released and found to be healthy. The defect between the broad and infundibulopelvic ligaments was closed with sutures. The patient had an uneventful recovery and was asymptomatic at a 6-month follow-up. BLHs can be congenital or acquired, with acquired defects often resulting from previous surgeries or pregnancy-related causes. The clinical presentation typically involves the symptoms of bowel obstruction, and a CT scan is the diagnostic modality of choice, showing characteristic findings such as closed-loop obstruction and bowel dilation. Laparoscopic management offers the advantages of faster recovery and less morbidity. Closure of the defect using nonabsorbable sutures is the standard surgical approach, although a wide opening of the defect has also been described. Recurrence is a possibility, particularly if absorbable sutures are used for closure. This case report highlights the importance of early diagnosis and intervention in BLHs to prevent the complications and emphasises the role of laparoscopy in their management.

Case report and literature review: A young man with giant intra-abdominal Ewing sarcoma.

Extraosseous Ewing sarcoma (EES) is a rare manifestation within the Ewing sarcoma tumor family (ESFT). Its clinical manifestations lack specificity, intestinal obstruction is the main symptom but can also present with abdominal pain, gastrointestinal bleeding, and other discomforts, making it prone to misdiagnosis as intestinal mesenchymal tumor. A 29-year-old male was admitted to the hospital with intestinal obstruction symptoms and abdominal CT suggesting "left abdominal occupation." The patient was initially misdiagnosed as intestinal mesenchymal tumor, and was later definitively diagnosed as abdominal Ewing sarcoma by postoperative pathology and genetic testing. Due to the patient's surgical indication, surgical resection with exploratory laparotomy was performed and then the patient underwent systemic chemotherapy. Intraoperatively, we found a 15-cm tumor originating from the proximal jejunum, with invasion into the peritoneum, duodenum, jejunum, and colon. Finally, the pathological report revealed Ewing sarcoma. Giant abdominal Ewing sarcoma with a diameter of 15 cm is rare. Considering postoperative pathology and genetic testing, abdominal Ewing sarcoma was suspected. The patient was successfully treated using surgery.

The impact of anxiety and depression on quality of life in a cohort of inflammatory bowel disease patients from Northeastern of Brazil

ObjectiveThis study aims to assess whether the association between chronic pathologies and depressive and/or anxious disorders is high, resulting in a reduction in the patient's quality of life. Patients and methodsThis is a prospective cross-sectional study with a descriptive and analytical design. Sociodemographic data and lifestyle habits were collected. Subsequently, the Inflammatory Bowel Disease Questionnaire (IBDQ) and the Hospital Anxiety and Depression Scale (HADS) were applied. ResultsA total of 141 patients participated in the study, with a mean age of 45.78 (SD 16.01) years, of which 60.3% were female (n=85) and 39.7% were male (n=56). 58.9% had ulcerative colitis (UC) (n=83), and 41.1% had Crohn's disease (CD) (n=58). 16.5% of patients had a previous diagnosis of generalized anxiety disorder (GAD) and/or major depression (MD) (n=23). Regarding IBDQ scores, participants with anxiety had significantly lower mean scores in all IBDQ items (p<0.001), while the depression diagnosis obtained significantly lower mean values for systemic (p=0.015), emotional (p=0.001), and intestinal symptoms (p=0.005). ConclusionThe results indicate that anxiety and depression negatively impact the quality of life of patients with IBD independently of the disease activity.

Correlation between Assemblages A and B Giardia lamblia infection with melatonin, ghrelin, Hsp70 and TFF3 biomarkers in patients

Background: Giardiasis is considered one of the parasitic diseases affecting humans, caused by a flagellate protozoan known as Giardia lamblia. It is a common gastrointestinal pathogen that can lead to various clinical and other complications. Objective: Study aimed to diagnose infection with the G. lamblia in children aged (1-12 years) using a direct wet mount, and to determine Assemblages A and B Giardia lamblia by targeting the TPI gene using Nested-PCR, in addition to evaluating the relationship of infection of assemblages with (melatonin, ghrelin, Hsp70 and TFF3) using ELISA assay. Method: By examining 238 stool samples for children suffering from diarrhea and some intestinal symptoms visiting some hospitals in Salah al-Din Governorate. Results: 34 (14.2%) positive samples were recorded by microscopic examination. 100 fecal samples using the Nested-PCR, showed 60 (60%) positive samples for the G. lamblia, including 18 (30%) for the assemblage B, 31 (51.66%) samples for assemblage A, as well as 11 (18.33%) mixed infections of A+B. The study of biomarkers revealed a highly significant increase in the levels of (melatonin, ghrelin, Hsp70 and TFF3) in the serum of patients with mixed A + B infection, while the lowest average concentrations of biomarkers were recorded in children infected with group A. Conclusion: Direct microscopic examination of stool samples It has good sensitivity for detecting G. lamblia parasite, and the TPI gene targeted in Nested-PCR technology has high sensitivity and specificity for genotyping detection of the parasite. Group A is the most common among patient samples. Mixed infections (A+B) have the greatest effect.

Mediterranean Diet Effect on the Intestinal Microbiota, Symptoms, and Markers in Patients with Functional Gastrointestinal Disorders.

The Mediterranean diet (MD) has beneficial effects on the intestinal microbiota by the promotion of bacteria associated with a healthy gut. However, its impact on intestinal fungi, among others, is still unknown, and how it affects digestive symptoms and different biomarkers in patients with gastrointestinal (GI) disorders has hardly been explored. The present study evaluated the effect of the MD on gut microbial diversity and structure and intestinal symptoms and biomarkers after 6 weeks of dietary intervention in 46 patients with GI disorders. Dysbiosis in fungal composition and diversity was observed, with a significantly lower abundance of Sordariomycetes, Leotiomycetes, and Orbiliomycetes; a significantly higher abundance of Saccharomycetes; the Chytridiomycota and Mucoromycota phyla were significantly reduced; and the bacterial microbiota remained unchanged. In addition, various GI disorders decreased and associations between stool consistency and intestinal permeability were found with the bacterial genera Alistipes and Roseburia. Thus, the data suggest that MD can alter the fungal intestinal microbiota and improve GI disorders.

Colonic lipoma, a rare cause of intestinal intussusception: A narrative review and how to diagnose it.

Colonic lipomas (CLs) are benign tumors of the adipose tissue of the gastrointestinal tract that are often asymptomatic. A search of medical literature in English using PubMed and Google Scholar was conducted for articles related to CL. Occasionally, patients present with intestinal bleeding or obstructive symptoms. Although intussusception is commonly observed in children, it is rare in adults. Moreover, CL as the most common entity, is very rare, with an incidence rate of 0.035% to 4.4%. Although fatty composition can assist in diagnosis through computed tomography and magnetic resonance imaging, the latter cannot exclude local infiltration. CLs are distributed evenly between both sexes and can be located anywhere in the gastrointestinal tract; however, they are more frequently located in the colon, particularly in the right colon and cecum (39.6%), followed by the transverse colon (25%), descending colon (20.8%), and the sigmoid colon (14.6%). Symptoms included abdominal pain (79.2%), alterations in bowel habits (45.8%), rectal bleeding (22.9%), colocolic intussusception (50%), weight loss (6.2%), vomiting (14.6%), and nausea (12.5%). Surgical and endoscopic techniques are widely used to manage CLs. The challenge for physicians is differentiating this lesion from malignant colonic lesions, at the outset. The risk of misdiagnosis is possible, and the recommendation in cases of doubt is still segmental surgical resection, as it ensures correct collection of lymph nodes for appropriate staging of presumed colonic carcinoma.

Limosilactobacillus reuteri Alleviates Anxiety-like Behavior and Intestinal Symptoms in Two Stressed Mouse Models.

Limosilactobacillus (Lm.) reuteri is a widely utilized probiotic, recognized for its significant role in alleviating symptoms associated with gastrointestinal and psychiatric disorders. However, the effectiveness of Lm. reuteri is strain-specific, and its genetic diversity leads to significant differences in phenotypes among different strains. This study aims to identify potential probiotic strains by comparing the strain-specific characteristics of Lm. reuteri to better understand their efficacy and mechanisms in alleviating stress-induced anxiety-like behaviors and gastrointestinal symptoms. We cultivated 11 strains of Lm. reuteri from healthy human samples and conducted phenotypic and genomic characterizations. Two strains, WLR01 (=GOLDGUT-LR99) and WLR06, were screened as potential probiotics and were tested for their efficacy in alleviating anxiety-like behavior and intestinal symptoms in mouse models subjected to sleep deprivation (SD) and water avoidance stress (WAS). The results showed that the selected strains effectively improved mouse behaviors, including cognitive impairment and inflammatory response, as well as improving anxiety and regulating gut microbiota composition. The improvements with WLR01 were associated with the regulation of the NLRP3 inflammasome pathway in the SD model mice and were associated with visceral hypersensitivity and intestinal integrity in the WAS model mice. In summary, this study identified the Lm. reuteri strain WLR01 as having the potential to alleviate anxiety-like behavior and intestinal symptoms through the analysis of Lm. reuteri genotypes and phenotypes, as well as validation in mouse models, thereby laying the foundation for future clinical applications.

Gut mucosa alterations after kidney transplantation: a cross sectional study.

Kidney transplant recipients (KTRs) rely on immunosuppressants like mycophenolate to prevent organ rejection. However, mycophenolate often causes intestinal symptoms and inflammation in various organs, including the skin and the colon. While KTRs have an increased risk for skin cancer, the risk of colorectal cancer is not increased. Elucidating the histological alterations in the colon of KTRs and comparing these changes with known skin alterations would help understand how immunosuppressants influence cancer development and progression. Whole slide images from gut biopsies (Non-transplanted subjects n = 35, KTRs n = 49) were analyzed using the ImageJ and R programming environment. A total of 22,035 epithelial cells, 38,870 interstitial cells, 3465 epithelial cell mitoses, and 7477 endothelial cells, each characterized by multiple microscopy parameters, from a total of 1788 glands were analyzed. The large database was subsequently analyzed to verify the changes of inflammatory milieu in KTRs and in cancer. KTRs without colon-cancer showed a significantly higher density of interstitial cells in the colon compared to non-transplanted patients. Moreover, the increase in interstitial cell number was accompanied by subtle modifications in the architecture of the colon glands, without altering the epithelial cell density. We could not identify significant structural modifications in cancer samples between KTRs and non-transplanted patients. Our findings demonstrate an increased number of resident interstitial cells in the colon of KTRs, as in other patients treated with mycophenolate. These changes are associated with subtle alterations in the architecture of colon glands.

Recurrent myocardial infarction in a patient with median arcuate ligament syndrome: a case report and literature review.

Median arcuate ligament (MAL) syndrome, otherwise known as celiac artery compression syndrome, is rare and is characterized by celiac artery compression by the median arcuate ligament. We report a unique case of MAL syndrome with recurrent myocardial infarction as the primary manifestation, and offer new pathophysiological insights. A man in his early 50s experienced recurrent upper abdominal pain, electrocardiographic changes, and elevated troponin concentrations, which suggested myocardial infarction. Contrast-enhanced computed tomography showed considerable celiac artery stenosis due to MAL syndrome. The patient was diagnosed with MAL syndrome and acute myocardial infarction. He declined revascularization owing to economic constraints, and opted to have conservative treatment with Chinese herbal extracts and medications. He succumbed to sudden cardiac death during a subsequent abdominal pain episode. The findings from this case show that MAL syndrome can present with recurrent myocardial infarction rather than typical intestinal angina symptoms. The pathophysiological link may involve intestinal and cardiac ischemia. An accurate diagnosis and appropriate management of MAL syndrome require careful evaluation and investigation.

Interleukin-1 blockade in patients with Wiskott-Aldrich syndrome: a retrospective multinational case series

AbstractUp to 70% of patients with Wiskott-Aldrich syndrome (WAS) develop autoimmune and inflammatory manifestations. Dysregulation of interleukin 1 (IL-1) may be involved in their pathogenesis, yet there is little evidence on treatment with anti–IL-1 agents in these patients. We conducted a multicenter retrospective analysis of 9 patients with WAS treated with anti–IL-1 agents (anakinra or canakinumab). All patients had prominent inflammatory manifestations, including systemic, cutaneous, articular, and intestinal symptoms; 3 patients presented with a severe systemic inflammatory syndrome since the first months of life. Corticosteroid therapy was associated with partial or no response, whereas treatment with anakinra or canakinumab resulted in prompt, often dramatic, responses in all patients, allowing bridging to gene therapy (4 patients) or hematopoietic stem cell transplantation (HSCT; 5 patients). Treatment was overall well tolerated. Low donor myeloid chimerism developed in 4 patients after HSCT and was associated with the appearance or the recurrence of inflammatory manifestations. A second HSCT was performed in 2 patients, achieving full-donor chimerism and resolution of inflammatory manifestation, whereas the other 2 patients were treated with prolonged therapy with anti–IL-1 agents. Our experience demonstrates that some inflammatory manifestations of WAS are dependent on IL-1 and respond well to its pharmacologic blockade.

The time course of health-related Quality of Life in rectal cancer patients undergoing combined modality treatment

Background and purposeThis exploratory prospective observational study investigated the changes in Health-related Quality of Life (HRQoL) in rectal cancer patients (RCPs), from diagnosis to one-year-post-surgery follow-up and explored the role of physical symptoms and psychological determinants on HRQoL at the different time points. Materials and methodsWe assessed HRQoL, psychological distress, coping, affectivity, alexithymia and social support in 43 RCPs treated with preoperative (chemo)radiation and surgery, at three different assessment time points: diagnosis (T0), one month after the end of preoperative treatment (T1), one month after resection surgery (T2), and at follow-up (T3). ResultsThe data showed that HRQoL decreased during active treatments, especially between T1 and T2 (p = 0.005), before increasing again at follow-up (p = 0.002).Baseline intestinal symptoms (p < 0.001) and negative affectivity trait (p = 0.03) significantly predicted HRQoL at T0. Baseline pain (p < 0.001), intestinal (p = 0.003) and urinary (p = 0.009) symptoms at T1 significantly predicted HRQoL at T1. A fatalistic coping style at T1 (p = 0.013), psychological distress (p = 0.003), mouth symptoms (p = 0.001) at T2 significantly predicted HRQoL at T2. Similarly, a fatalistic coping style at T1 (p = 0.006), psychological distress (p = 0.004), mouth (p = 0.002) and pain symptoms (p = 0.002) at T3 significantly predicted HRQoL at T3. ConclusionSeveral physical and psychological factors are involved in the changes occurring after diagnosis in RCPs’ HRQoL. While cancer-related symptoms and treatment-related physical side effects are the main predictors of HRQoL at diagnosis and during active treatments, early psychological reactions have a higher predictive weight in post-treatment HRQoL.These data emphasise the importance of active screening, early diagnosis, and preventive psychological interventions immediately after diagnosis to improve HRQoL and psychological health outcomes.

The prevalence of self-reported gluten sensitivity (SRGS) in irritable bowel syndrome (IBS)in a Brazilian community. A pilot study

Background – A significant number of irritable bowel syndrome (IBS) patients report onset of symptoms after ingestion of a specific food, including those containing gluten. NCGS includes both intestinal and extra-intestinal symptoms which are related to the ingestion of gluten containing food-after exclusion of celiac disease (CD) and wheat allergy. The overlap between irritable bowel syndrome (IBS) and NCGS has been described but the knowledge of the etiopathogenesis of this clinical entity is incomplete. In Brazil, data on the prevalence of IBS and its association with food intolerance are scarce. Objective – To study the prevalence of SRGS in a group of volunteers diagnosed with IBS in a Brazilian community. Methods – A total of 400 volunteers over 18 years old were selected from students and staff of the Medical School of the Fluminense Federal University, Brazil. Participants completed a questionnaire divided in basic demographic information (age, sex), evaluation of IBS diagnosis in accordance with the Rome III criteria and self-reported food intolerance, including gluten. Results – Eighty-seven (21.7%) (Group I) [mean age 30.4±12.65 (77.4%) females] fulfilling the Rome III criteria for IBS. Twenty-six (32%) reported gastrointestinal symptoms after ingestion of food in general and 28 (32.1%) after gluten ingestion. Within the 313 volunteers non-IBS (78.2%) (Group II) [mean age 30.6±21.77, 215 (68.2%) females] 66 (21%) and 50 (15.9%) reported gastrointestinal symptoms after ingestion of food in general and gluten respectively. Demographic data (mean age and sex) were not statistically different when we compared the two groups of volunteers (p&gt;0.05). Conclusion – The report of gastrointestinal symptoms after ingestion of food in general and gluten-containing foods were statistically different in the two groups (p&lt;0.05). The interaction between IBS, food intolerance and NCGS needs to be better defined, since the role of diet in IBS and its feeding management is an essential condition for the treatment of most of those patients

Effect of continuous nursing on treatment compliance and side effect management of coronary heart disease.

There are relatively few studies on continuing care of coronary heart disease (CHD), and its research value needs to be further clarified. To investigate the effect of continuous nursing on treatment compliance and side effect management in patients with CHD. This is a retrospective study with patients from January 2021 to 2023. The study was divided into two groups with 30 participants in each group. Self-rating anxiety scale (SAS) and Self-rating depression scale (SDS) were used to assess patients' anxiety and depression, and medical coping questionnaire was used to assess patients' coping styles. The pelvic floor dysfunction questionnaire (PFDI-20) was used to assess the status of pelvic floor function, including bladder symptoms, intestinal symptoms, and pelvic symptoms. SAS score decreased from 57.33 ± 3.01before treatment to 41.33 ± 3.42 after treatment, SDS score decreased from 50.40 ± 1.45 to 39.47 ± 1.57. The decrease of these two indexes was statistically significant (P < 0.05). PFDI-20 scores decreased from the mean 16.83 ± 1.72 before treatment to 10.47 ± 1.3the mean after treatment, which was statistically significant (P < 0.05). The results of this study indicate that pioneering research in continuous care of CHD has a positive impact on improving patients' treatment compliance, reducing anxiety and depression levels, and improving coping styles and pelvic floor functional status.

Prevalence of chronic pelvic pain and associated factors among indigenous women of reproductive age in Ecuador

BackgroundChronic pelvic pain is a common disease that affects approximately 4% of women of reproductive age in developed countries. This number is estimated to be higher in developing countries, with a significant negative personal and socioeconomic impact on women. The lack of data on this condition in several countries, particularly those in development and in socially and biologically vulnerable populations such as the indigenous, makes it difficult to guide public policies.ObjectivesTo evaluate the prevalence of chronic pelvic pain (dysmenorrhea, dyspareunia, non-cyclical pain) and identify which variables are independently associated with the presence of the condition in indigenous women from Otavalo-Ecuador.DesignA cross-sectional study was carried out including a sample of 2429 women of reproductive age between 14 and 49 years old, obtained from April 2022 to March 2023. A directed questionnaire was used, collected by bilingual interviewers (Kichwa and Spanish) belonging to the community itself; the number of patients was selected by random sampling proportional to the number of women estimated by sample calculation. Data are presented as case prevalence, odds ratio, and 95% confidence interval, with p < 0.05.ResultsThe prevalence of primary dysmenorrhea, non-cyclic pelvic pain, and dyspareunia was, respectively, 26.6%, 8.9%, and 3.9%.all forms of chronic pain were independently associated with each other. Additionally, dysmenorrhoea was independently associated with hypertension, intestinal symptoms, miscegenation, long cycles, previous pregnancy, use of contraceptives and pear body shape. Pain in other sites, late menarche, exercise, and pear body shape were associated with non-cyclic pelvic pain. And, urinary symptoms, previous pregnancy loss, miscegenation, and pear body shape were associated with dyspareunia.ConclusionThe prevalence of primary dysmenorrhea and non-cyclical chronic pelvic pain was notably high, in contrast with the frequency of reported dyspareunia. Briefly, our results suggest an association between dysmenorrhoea and conditions related to inflammatory and/or systemic metabolic disorders, including a potential causal relationship with other manifestations of pelvic pain, and between non-cyclical pelvic pain and signs/symptoms suggesting central sensitization. The report of dyspareunia may be influenced by local cultural values and beliefs.

Changes in Serum Oncostatin M Levels During Treatment of Inflammatory Bowel Disease

Abstract Background Inflammatory bowel diseases (IBD) consist of Crohn’s disease (CD) and ulcerative colitis (UC). They are characterized by a chronic relapsing and remitting disease course that results in intestinal symptoms but also frequently in extra-intestinal manifestations. Among potential targets and biomarkers, oncostatin M (OSM) has gained a lot of interest. OSM is a pleiotropic cytokine produced by activated T cells, monocytes, macrophages, and neutrophils. It is considered proinflammatory given its ability to promote leukocyte recruitment. Objective To evaluate the changes in serum Oncostatin M levels during treatment of inflammatory bowel disease. Patients and Methods To elucidate this aim 30 IBD patients and 30 controls were included in this study. Results The mean Oncostatin M in IBD cases before treatment was 120.13 while after treatment was 91.17 with high significant difference. There was high statistical correlation in between Fecal Calprotectin Level after treatment and Oncostatin M After Treatment. The relation between UC, CD and Oncostatin level before and after treatment shows high statistical significant difference. There was no statistical relation in between Oncostatin level (after treatemnt) and type of treatment. That there was a high statistically significant difference in between cases and control group regarding to HB, WBCs, ESR, CRP, Urea, ALT, Oncostatin M and a statistically significant difference in between cases and control group regarding to Platelets. Conclusion Oncostatin M is a promising marker for the diagnosis and follow up of IBD patients, however it has a limited predictive performance for the prediction of the response for IBD treatment.

Predictors of response to a dietary intervention in patients with irritable bowel syndrome

BackgroundDifferent diets have emerged as potential therapeutic options for patients with irritable bowel syndrome (IBS). ObjectiveTo identify predictors of improvement after a low-FODMAP, low-starch and low-sucrose diet among patients with IBS. MethodsWe performed a descriptive cross-sectional study including patients with IBS according to Rome IV criteria undertaking a social-media based program with a two-week dietary intervention. Patients completed an online survey before and after the intervention including the presence of intestinal and extra-intestinal symptoms, the IBS-SSS (irritable bowel syndrome symptoms severity scale) and the PHQ-9 (patient health questionnaire-9). Clinical improvement was defined as a decrease of at least 50% in IBS-SSS post dietary intervention. Variables associated with symptomatic response were identified with logistic regression analysis. A clinical score to predict response was created and tested with a with a receiver operating characteristic (ROC) curve analysis. ResultsA total of 3583 patients with IBS were included. Mean IBS-SSS before and after dietary intervention was 295.5±52.32 and 240±48.66, respectively (p=0.01); 1178 (32.8%) patients showed clinical improvement. A mean basal IBS-SSS >400 (OR 3.04), chronic headache (OR 1.96), and chronic fatigue (OR 1.81) were significantly associated with symptomatic response. Patients with arthralgia (OR 0.41) and/or fibromyalgia (OR 0.33) were less likely to improve. Each variable received the following individuals scores: IBS-SSS >400: +2, chronic headache: +1.5, chronic fatigue: +1, arthralgia: −1, and fibromyalgia: −1. The ROC curve analysis of the proposed score showed an area under the curve of 0.72 (95% CI 0.69–0.76). A score ≥3 had a sensitivity of 72.64% and specificity of 60.56% for predicting symptomatic improvement. ConclusionsThere are clinical variables that could serve as reliable predictors of response to a low-FODMAP, low-sucrose, low-starch diet among patients with IBS. Further research is needed to understand the link between the presence of extra-intestinal symptoms and clinical improvement after dietary interventions for IBS.

Molecular Mechanisms Underlying Loss of Vascular and Epithelial Integrity in Irritable Bowel Syndrome

The pathophysiology of irritable bowel syndrome (IBS) is multifactorial and includes epithelial barrier dysfunction, a key element at the interface between the gut lumen and the deeper intestinal layers. Beneath the epithelial barrier there is the vascular one representing the last barrier to avoid luminal antigen dissemination The aims of this study were to correlate morpho-functional aspects of epithelial and vascular barriers with symptom perception in IBS. Seventy-eight healthy subjects (controls) and 223 patients with IBS were enrolled in the study and phenotyped according to validated questionnaires. Sugar test was used to evaluate invivo permeability. Immunohistochemistry, western blot, and electron microscopy were used to characterize the vascular barrier. Vascular permeability was evaluated by assessing the mucosal expression of plasmalemma vesicle-associated protein-1 and vascular endothelial cadherin. Caco-2 or human umbilical vein endothelial cell monolayers were incubated with soluble mediators released by mucosal biopsies to highlight the mechanisms involved in permeability alteration. Correlation analyses have been performed among experimental and clinical data. The intestinal epithelial barrier was compromised in patients with IBS throughout the gastrointestinal tract. IBS-soluble mediators increased Caco-2 permeability via a downregulation of tight junction gene expression. Blood vessel density and vascular permeability were increased in the IBS colonic mucosa. IBS mucosal mediators increased permeability in human umbilical vein endothelial cell monolayers through the activation of protease-activated receptor-2 and histone deacetylase 11, resulting in vascular endothelial cadherin downregulation. Permeability changes correlated with intestinal and behavioral symptoms and health-related quality of life of patients with IBS. Epithelial and vascular barriers are compromised in patients with IBS and contribute to clinical manifestations.