Lower Gastrointestinal Complaints Research Articles

Colonoscopic finding in children with lower gastrointestinal complaints.

Colonoscopy is an important tool for the diagnosis and treatment of lower gastrointestinal (LGI) diseases in both children and adults. This study describes an endoscopic profile of children at the Shinnwari Gastroenterology Diagnostic Clinic in Jalalabad, Afghanistan. This is a cross-sectional descriptive study conducted in children ≤16 years, taken from recorded colonoscopy reports from 1 January 2021 to 30 December 2022. Of the 672 colonoscopy procedures, 250 were diagnostic in children (7.41 years median age; 2.5:1 male/female ratio) without serious complications. Abnormal findings were recorded in 201 (81.2%) procedures; the most common presentation was hematochezia, which was higher in 5-8-year-olds. More frequent findings were colorectal polyps (50%), infection (16.4%), internal hemorrhoid (IH; 10%), and inflammatory bowel disease (IBD; 1.2%). Incidences of colorectal polyps were higher in those aged <9 years (37.2% vs 12.8%; P < 0.001). Conversely, internal IH and IBD tended to be higher in older children (aged ≥9 years) (IH: 6.8% vs 3.2%; P < 0.005; IBD: 1.2% vs 0%; P < 0.02). Colonoscopy procedures were completed without major complications. Colonoscopy is an important and safe procedure for the diagnosis of LGI compliants, especially hematochezia, which is frequently accompanied by colorectal polyps.

Gastrointestinal complaints in runners and their relationship to diets

Background: Thesis: Runners are at risk of developing gastrointestinal complaints, dietary factors affect the occurrence of gastrointestinal symptoms. Objectives: 1. To examine the extent to which gastrointestinal ailments affect runners. 2. To indicate the type and timing of gastrointestinal complaints. 3. To determine whether the fact of the occurrence of gastrointestinal complaints is associated with the dietary behavior of these athletes. Material and methods: The study involved 67 runners including 47 women and 20 men from amateur running groups from several cities in Poland. To conduct the study, a proprietary questionnaire was created and made available at each group with the permission of the administrator. The results obtained on a quantitative scale are presented in descriptive form along with the percentages. Statistical analysis was performed using STATISTICA, and the significance of the results was assumed at p&lt;0.05. Results: Among runners of all running groups from different cities in Poland, 61% reported experiencing at least one gastrointestinal complaint. Lower gastrointestinal complaints were the most common, with the highest prevalence for diarrhea - 27%. Problems occurred mainly during the run. Women were shown to be at a higher risk of experiencing ailments compared to men - 83%, 17%. Conclusions: 1. surveyed runners, especially women, experience gastrointestinal symptoms, 2. Among the respondents, complaints occurred from the lower gastrointestinal tract and included: diarrhea (27%), increased urge to stool, gas, flatulence, abdominal pain, intestinal cramps, constipation and colic, as well as the upper gastrointestinal tract: nausea, heartburn, burping on an empty stomach, regurgitation, reflux. Most symptoms occur during running. 3 No significant correlations were found between dietary behavior and the occurrence of gastrointestinal complaints in runners.

1557 Readmission Rates Are Not A Surrogate for Poor Practice – An Audit of Readmissions to An Emergency Surgical Unit [Emsu]- The Devil Lies in The Detail!

Abstract Aim Readmission rates are considered an indicator of poor performance resulting in financial penalty to healthcare trusts. The national peer review figure for monthly readmission varies considerably (1.71%-7.53%). This metric can be misleading and requires detailed analysis. The aim of this audit was to critically review the readmissions to the EMSU. Method A 1-month review of all patients presenting to the EMSU via a prospectively maintained electronic database was interrogated. (October 2020). The primary outcome was “true” readmission rate (i.e., inclusion criteria - readmission within 30 days of discharge). Secondary outcomes were to assess the appropriateness of readmission and consequent morbidity. Results 331 patients were admitted with 39 readmissions (11.8%). 22 patients failed to meet the inclusion criteria. The true readmission rate was 17 (5.1%). 7/17 had a post-operative complication. The remainder had a miscellaneous minor upper and lower gastrointestinal complaints. 6/10 required cross-sectional imaging and blood work. There were no mortalities. Conclusions The readmission rate reported by Trust coding was erroneously high due to inaccurate recording of data. The accurate readmission rate was 5.1%. The majority of those readmitted could have been managed successfully in a Surgical Ambulatory Service [SAmS]. These data support the hypothesis that readmission rates can be misleading, and efforts should be directed not just in data recording and analysis but also in the utilization of SAmS.

Colorectal Cancer in Uganda: A 10-Year, Facility-Based, Retrospective Study.

IntroductionColorectal cancer (CRC) is the most common type of gastrointestinal malignancies and the third leading cause of cancer-related deaths for both sexes worldwide. Although the burden of CRC is highest in developed countries, reports are indicating a rise in the incidence of early-onset CRC in developing countries. In this study, we aimed to determine the prevalence of CRC among patients hospitalized with lower gastrointestinal complaints at a tertiary health facility in Uganda.MethodsWe conducted a 10-year retrospective chart review of patients admitted to Mulago National Referral Hospital in Kampala, Uganda, between 1st January 2010 and 31st December 2020. We reviewed all charts of patients admitted to the lower gastrointestinal tract (GIT) ward. Charts with grossly missing data, pediatric patients, and those from other non-lower GIT specialties were excluded.ResultsData of 1476 unique eligible patients were analyzed. Of these,138 had a diagnosis of CRC (prevalence: 9.3%, 95% confidence interval (95% CI): 6.5–11.7%). Among patients with CRC, the female:male ratio was 1:1. The most common site for CRC was the rectum (59.8%, n= 79). For the 138 participants with CRC, 44 had staging data with 72.8% (n=32) having advanced disease, that is, stage 3 or 4. Factors independently associated with CRC were age ≥50 years (adjusted odds ratio (aOR): 4.3, 95% CI: 2.6–7.1, p < 0.001), female sex (aOR: 1.8, 95% CI: 1.2 −2.8, p = 0.005), being widowed (aOR: 2.5, 95% CI: 1.3–5.0, p = 0.006), and presence of any risk factor for CRC (aOR: 5.3, 95% CI: 2.9–9.9, p < 0.001).ConclusionCRC is relatively common among patients hospitalized with lower GIT complaints, particularly among women and those with known risk factors for CRC. Awareness creation and screening programs should be instituted to allow early diagnosis of CRC in our setting.

The MIND (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay) and Mediterranean Diets are differently associated with psychosomatic complaints profile in adults: Results from SEPAHAN Cross-sectional study

BACKGROUND: In spite of an obvious association between diet and mental health, there is only few report regarding the association between diet and psychosomatic complaints. OBJECTIVE: To investigate the association of the Mediterranean-DASH diet intervention for neurodegenerative delay (MIND) diet with psychosomatic complaints profile in comparison with the Mediterranean diet (aMED). METHODS: In this cross-sectional study on 2818 Isfahanian adults, a validated dish-based food frequency questionnaire was used to assess dietary intakes. Psychosomatic complaints profile was evaluated through a self-administered Persian validated questionnaire by using exploratory factor analysis. RESULTS: After controlling for potential confounders, individuals in the highest quintile of the MIND diet had lower risk for experiencing psychological (odds ratio (OR) = 0.60, 95% confidence interval (CI): 0.42, 0.86; P trend &lt; 0.0001), and pharyngeal-respiratory (OR = 0.57, 95% CI: 0.41, 0.79; P = 0.002). The association for neuro-skeletal complaints was marginally significant (OR = 0.66, 95% CI: 0.43, 1.03; P = 0.093). The aMED diet tended to lower gastrointestinal complaints (OR = 0.68, 95% CI: 0.46, 1.01; P = 0.062). CONCLUSION: The MIND diet was inversely associated with different psychosomatic complaints risk, but no evidence of such an association for the MED diet was observed.

Assessment of thyroid profile in patients with fissure in ano in the South Indian population

Background: Hard faeces result in local trauma to the rectal mucosa which secondarily activates internal anal sphincter hypertonia. This will compress end arteries of the anus and cause ischemia of the posterior commissure and eventually anal fissures. A precipitating history of constipation is found in approximately 20% of patients with anal fissures. Constipation is one of the classic signs of hypothyroidism.Methods: Patients who presented to the surgical OPD of Saveetha Medical College and Hospital, Thandalam, India during the months of March and April of 2019 with lower abdominal complaints were screened for fissure in ano. The thyroid profile of these patients was analysed.Results: 38.2% of patients with lower gastrointestinal complaints and 3.6% of the total number of patients presenting to the surgical OPD were attributed to an anal fissure. The incidence of hypothyroidism in patients with an anal fissure is 32%. Since the incidence of hypothyroidism in our study is higher than the prevalence of hypothyroidism in the general population as documented by multiple studies in the past, we can conclude that there is a significant association between hypothyroidism and development of anal fissures.Conclusions: By analysing the thyroid profile in patients with anal fissures, we found an association between the two entities. This information can be used to predict and prevent anal fissures in hypothyroid patients.

Utility of fecal calprotectin as a discriminative biomarker between ulcerative colitis and irritable bowel syndrome and its ability to be used for the assessment of the remission stage of ulcerative colitis

Fecal calprotectin (FC) has been proposed in recent studies as a sensitive, specific biomarker for the diagnosis of ulcerative colitis (UC). Hence, the present study sought to investigate the efficacy of FC for the diagnosis and monitoring of UC, as well as to assess the correlation of FC with other disease activity indexes. The present study included 96 consecutive patients who presented with lower gastrointestinal complaints. Patients were classified into two groups: group I (which included patients with UC) and group II (which included patients with irritable bowel syndrome); then, according to the disease activity, group I was subdivided into the following: group Ia (which included patients with active UC) and group Ib (which included only those patients of group Ia who were in the remission stage of UC). For all patients, erythrocyte sedimentation rate and C-reactive protein were determined; moreover, all patients underwent quantitative determination of calprotectin in stool samples, abdominal ultrasonography, and complete colonoscopy with biopsies for the histopathological examination to assess the disease severity by using the UC activity index according to the Mayo endoscopic and Geboes histological scores. The diagnostic validity of FC levels in correlation with Mayo Disease Activity Index (MDAI) was then investigated. FC levels showed highly significant increase in patients with active UC compared with inactive UC and irritable bowel syndrome (524.17 ± 48.0 vs. 184.48 ± 3.33 and 47.17 ± 5.32 mg/kg, respectively, P < 0.001). FC level has 100% accuracy, sensitivity, specificity, positive predictive value, and negative predictive value in distinguishing UC patients from the control group at a cutoff value of 140 mg/kg, but at a cutoff value of 223 mg/kg FC level shows 93.4% accuracy, 89.8% sensitivity, 97% specificity, 97.4% positive predictive value, and 55% negative predictive value to distinguish the active phase from the remission phase of UC. In addition, there was a statistically significant proportional correlation between FC and the MDAI, but the correlation between FC and histological inflammatory activity statistically was more significant than with MDAI (r = 0.75, P < 0.001). FC level is an accurate, noninvasive biomarker in clinical practice with high specificity and sensitivity for the diagnosis and monitoring of UC, as well as good marker for the evaluation of disease activity. Therefore, it can be used as a monitoring test to assess medical response and to predict clinical relapse of the disease.

Comorbidity of headache and functional constipation in children: a cross-sectional survey.

Constipation and headache are prevalent conditions among children worldwide. Previous studies have shown the relationship between upper gastrointestinal complaints and headache in children. However, the association with lower gastrointestinal complaints such as constipation has not been investigated until present. The aim of this study is to evaluate the relationship between headache and chronic functional constipation in children aged 4-12 years old. This cross-sectional study has evaluated the prevalence of headache in 326 children in Shiraz, Iran 2012. All the subjects and their parents were interviewed based on a structured questionnaire for the diagnosis of constipation and headache. Children with constipation were selected from the Pediatric Gastroenterology Clinic Affiliated to the Shiraz University of Medical Sciences. The control group was selected from healthy children attending Shiraz schools. Diagnosis of headache and constipation were made based on the second Edition of The International Headache Classification (ICHD-2) and ROME III criteria, respectively. Headache prevalence among children with constipation was significantly higher (19.8%) than that of the control group (5.6%) [Odds ratio (OR) 4.192, p<0.001], which was significant only in the non-migraine headache subtypes (15.1% vs 2.8%, OR 25, p<0.002). Among the headache subtypes of different severity (mild, moderate, severe), only mild headache was significantly more prevalent in constipated children (14.9% vs. 1.4%, in the control group, respectively, p<0.001). This study revealed a strong correlation between headache and chronic functional constipation, which can result from the effect of these comorbid conditions with emotional stress, depression, and anxiety.

Evaluation of Prevent ID and Quantum Blue rapid tests for fecal calprotectin

Tests for fecal calprotectin are usually either enzyme-linked immunosorbent assays (ELISA) or a time-resolved fluorimetric immunoassay (TRFIA). These time-consuming tests are performed only once every 1 or 2 weeks. Before the results of the tests are known most patients have already undergone colonoscopy. A rapid test, performed on outpatients, could minimize the number of necessary colonoscopies. To establish optimal cut-off values minimizing the necessity for colonoscopies, we compared two commercially available rapid tests with a quantitative TRFIA. Fecal samples were collected from 85 patients with lower gastrointestinal complaints. Calprotectin was measured using quantitative TRFIA as well as using two rapid tests: Prevent ID CalDetect and Quantum Blue calprotectin. We used the TRFIA method as the golden standard with a cut-off value of 50 μg/g. The percentage correct classification, sensitivity, specificity and positive and negative predictive value were calculated for both rapid tests at various cut-off levels. Correlation between both of the rapid tests with TRFIA was significant. Quantum Blue calprotectin (κ 0.77) correlated better than Prevent ID CalDetect (κ 0.46). Optimal cut-off levels for Prevent ID CalDetect and Quantum Blue calprotectin rapid tests were 15 μg/g and 40 μg/g with a reduction in the number of necessary colonoscopies of 39% and 62%, respectively. The Quantum Blue calprotectin rapid test demonstrated better analytical performance than the Prevent ID CalDetect in reducing the number of colonoscopies. Furthermore, the former test has the advantage of using a point of care reader for quantitative measurement and for establishing an optimal cut-off level.

Japanese phytotherapy (Kampo) in functional dyspepsia and diarrhea-type irritable bowel syndrome: Clinical observation in German patients

The administration of plant-based crude drug formulae has a history of more than 1500 years in Japan. Originating in China, Japanese Phytotherapy (Kampo) obtained specific features in Japan. Recent decades saw a revival of Kampo accompanied by a scientific reevaluation and critical examination of its relevance in modern health care. Meanwhile, Kampo has already proven considerable value in the treatment of chronic and functional disorders of modern Japanese society. One specific formula, Rikkunshi-to (TJ-43), has been widely accepted for its use in functional disorders of the stomach and the gastrointestinal motility in Japan. Patients often present with an overlap of symptoms of the upper gastrointestinal tract accompanied by diarrhea-type irritable bowel syndrome. We here present data of clinical observations in outpatients treated with this Kampo medicine in Germany. 22 patients, mean age 52 (±7) with symptomatic functional upper and lower gastrointestinal complaints were scored according to a five-scale symptom score before treatment, after 1 month, 2 months and 3 months of treatment. The symptoms evaluated were: epigastric fullness, epigastric pain, nausea, abdominal pain, bloating and diarrhea. For each symptom intensity and frequency from 0 to 4 were scored. Primary endpoint was the change in the total functional gastrointestinal disorder score. A clinically meaningful improvement of symptoms by more than 50% was found after 3 months of treatment with Rikkunshi-to. Especially the improvement of epigastric pain, bloating and diarrhea was remarkable. In this clinical observation with a limited Western study population, preliminary evidence could be obtained that Rikkunshi-to (TJ-43) is a safe, tolerable and efficacious treatment for symptomatic functional upper and lower gastrointestinal complaints, especially accompanied by diarrhea. The data should be confirmed by a randomized placebo-controlled clinical trial.

Training the Gut for Competition

The gut is an important athletic organ because it mediates water and nutrient uptake during exercise. But upper- and lower-gastrointestinal complaints, common to many athletes during exercise, can negatively impact performance, and in severe cases put health at risk. The gut is sensitive to water and nutrient intake during exercise and to hypovolemia, hyperthermia, hypoglycemia, hypoxia, and ischemia. Most gastrointestinal complaints during exercise are mild and of no risk to health, but hemorrhagic gastritis, hematochezia, and ischemic bowel can present medical challenges. Proper training and nutrition minimize the risk of gastrointestinal discomfort during exercise by assuring rapid gastric emptying and absorption of water and nutrients and by maintaining adequate perfusion of the splanchnic vasculature.

The Effect of Two Sports Drinks and Water on GI Complaints and Performance During an 18-km Run

Gastrointestinal (GI) complaints are frequently experienced during running. Sports drinks to prevent dehydration and hypoglycemia during exercise are generally used. The aim was to investigate the effect of 3 different drinks on GI complaints and performance during competitive running in a controlled field study. Ninety-eight well-trained subjects (90 M, 8 F, age 41 +/- 8 y) performed a competitive 18-km run three times within 8 days. The study was a controlled, standardized field experiment following a randomized, crossover design. Three different drinks were compared: water, a sports drink (CES), and a sports drink with added 150 mg/l caffeine (CAF). The incidence of GI complaints and the effect of the drinks on performance was studied. Each subject consumed 4 times 150 ml as follows: at the start, after 4.5 km, 9 km, and 13.5 km. Fluid intake was controlled. Incidence and intensity of GI complaints during the run were determined using a 10 points scale questionnaire. There were no significant differences in performance between the 3 drinks. Run time (18 km, mean +/- SD): WAT 1 : 18 : 03 +/- 08 : 30, CES 1 : 18 : 23 +/- 08 : 47, CAF 1 : 18 : 03 +/- 08 : 42. The use of carbohydrate-containing sports drinks led to higher incidences of all types of GI complaints compared to water. Significant differences (p < 0.05) were reached for flatulence; incidence: WAT 17.9 %, CES 28.6 %, CAF 30.6 %, and reflux; incidence: WAT 55.7 %, CES 78.6 %, CAF 72.5 %. There were no significant differences in intensity of the GI complaints. Addition of caffeine to CES had no effect on GI complaints, compared to CES alone. We conclude that sports drinks used during an 18-km run in cool environmental conditions do not support the performance better than mineral water. The use of sports drinks during an 18-km run leads to a higher incidence of both upper and lower GI complaints compared to water. Addition of caffeine to the sports drink has no effect on either running performance or GI complaints.

Colonoscopy is a useful diagnostic tool for transplant recipients with lower abdominal symptoms

Transplant recipients are at higher risk for infection and malignancy due to therapies aimed at preventing rejection. Early detection and successful treatment of such complications is of pivotal importance for both patient and graft survival. In this study, we evaluated findings of 91 colonoscopies and colonic histopathologic findings in recipients who presented with lower gastrointestinal system complaints between January 1996 and January 2003. The study group included 79 renal and liver transplant patients. The indications for colonoscopy were diarrhea (n = 58), abdominal pain (n = 5), hematochezia (n = 19), unexplained anemia (n = 5), thickening of a colonic segment detected on computerized tomography (n = 2), screening for lymphoma (n = 1), and Kaposi's sarcoma (n = 1). During the procedures, all suspicious lesions were biopsied and specimens of normal-appearing mucosa collected when deemed necessary in relation to the clinical complaints. The endoscopic findings were classified as follows: 0 = “normal,” with clear visualization of the vascular network and normal-appearing mucosa; 1 = “erythema”, with tissues showing erythema, edema, hyperemia, and loss of normal vascular network; 2 = “ulcerative,” with tissues exhibiting ulceration and fragility; and 3 = “coincidental findings,” such as polyp or angiodysplasia. Colonoscopic and/or histopathologic abnormalities were detected in 44.5% of the 91 colonoscopy procedures. The results indicate that colonoscopy is a valuable diagnostic tool for evaluation of transplant recipients with lower gastrointestinal complaints. After an initial workup colonoscopy is important to establish an accurate diagnosis.

Gastrointestinal manifestations of epidermolysis bullosa. A study of 101 patients.

One hundred one patients with EB were evaluated by a combination of prospective and retrospective review, and analyzed regarding the nature, incidence, and prevalence of their gastrointestinal (GI) manifestations. Involvement of the GI tract is a well-known extracutaneous manifestation of dystrophic EB, but it also occurred in more than one-half and one-third, respectively, of those with junctional and simplex EB. Most of the serious consequences, such as esophageal strictures and microstomia, occurred in recessive dystrophic EB but were also seen, although infrequently, in the junctional and simplex forms. The majority of patients with dysphagia had an esophageal stricture, and the cervical esophagus was the most common location. The onset of dysphagia generally occurred in the first decade of life, in patients much younger than previously recognized. Diagnostic endoscopy did not reveal lesions which could not have been detected radiographically. Lower GI complaints were common, especially constipation and perianal blistering, and affected all types of EB. These complaints contributed substantially to management problems but they did not correlate with colonic pathology and appeared to reflect anal or perianal disease.

Ranitidine Compared with the Dimethylprostaglandin E2Analogue Enprostil as Adjunct to Pancreatic Enzyme Replacement in Adult Cystic Fibrosis

In a double-blind cross-over randomized study adjunct therapy with ranitidine (2 x 150 mg) was compared with enprostil (2 x 35 micrograms) in eight adult cystic fibrosis (CF) patients receiving a fixed dose of enteric-coated microsphere capsules of pancreatin (Pancrease). The study consisted of two consecutive 14-day treatment periods. All patients kept a fixed daily fat intake during the last 5 days of each treatment period and performed 72-h faecal collections during the last 3 days of each treatment period. Gastrointestinal complaints were scored at the end of each treatment period. During treatment with ranitidine there was less faecal fat excretion (18.9% versus 25.1%; NS), less faecal weight (263 versus 303 g/day; NS), and a lower gastrointestinal complaints score (5.3 versus 3.1; P less than 0.05) compared with the treatment with enprostil. One patient dropped out during the treatment period with enprostil because of very severe diarrhoea and abdominal discomfort. We conclude from this study that adjunct therapy with ranitidine has significantly less side effects and may give a better reduction of faecal fat excretion and daily faecal weight in CF.