Lower Gastrointestinal Diseases Research Articles

Maternal Smoking Around Birth Is a Risk Factor for Gastrointestinal Diseases in Offspring: A Mendelian Randomization Study.

The effect of maternal smoking around birth (MSAB) on gastrointestinal (GI) diseases in the offspring is still not fully understood. We conducted a rigorous Mendelian randomization (MR) study to examine the association between MSAB and 24 GI diseases in offspring. Single nucleotide polymorphisms (SNPs) associated with MSAB were obtained from a recent study. SNPs of GI diseases were all from the FinnGen project. We performed two-sample MR analyses (TSMR) using three methods, predominantly the inverse variance weighting (IVW) method. We performed sensitivity analyses and false discovery rate (FDR) to confirm the accuracy and robustness of the results. Genetically determined MSAB significantly influenced offspring GI diseases according to the IVW method (OR 1.251; 95% CI 1.111-1.408; P = 2.111e-04; PFDR = 5.278e-03). We then found that genetic predisposition to MSAB was significantly associated with an increased risk of 5 of 24 GI diseases, including three upper GI diseases (esophageal ulcer, gastroduodenal ulcer, and its subtype gastroduodenal ulcer) and two lower GI diseases (inflammatory bowel disease (IBD) and its subtype, ulcerative colitis (UC)) in offspring. This comprehensive TSMR analysis demonstrated that genetically predicted MSAB is a risk factor for GI disorders, including IBD, UC, and peptic ulcer, in offspring. Individuals whose mothers smoked during pregnancy are subject to increased health surveillance for GI diseases. And we need more research to explore the mediating mechanisms involved.

The Causal Effects between Mood Swings and Gastrointestinal Diseases: A Mendelian Randomization Study.

Numerous studies have examined the links between mental disorders such as depression and bipolar disorder, and gastrointestinal (GI) diseases. However, few studies have investigated the link between mood swings and GI diseases. Given the impact of mood swings on various conditions and the growing comprehension of the gut-brain axis, this study aims to explore their causal relationship using Mendelian randomization (MR) methods. Single-nucleotide polymorphisms (SNPs) associated with mood swings were obtained from a recent study. SNPs associated with GI diseases were identified from the FinnGen project. We conducted two-sample bidirectional MR analyses using three methods, primarily the inverse variance weighting (IVW) method. Furthermore, we performed sensitivity analyses and false discovery rate (FDR) analysis to validate the accuracy and robustness of the results. Bidirectional MR analysis revealed significant causal effects between mood swings and GI diseases according to the IVW method (odds ratio (OR): 1.213; 95% confidence interval (CI): 1.118-1.316; P = 3.490e-6; P FDR = 8.730e-5). Mood swings were linked to an increased risk for 11 of 24 diseases, including five upper GI diseases (gastroesophageal reflux disease (GERD), acute gastritis, gastroduodenal ulcer, duodenal ulcer, and functional dyspepsia), two lower GI diseases (diverticular disease of the intestine and irritable bowel syndrome (IBS)) and four hepatobiliary and pancreatic diseases (nonalcoholic fatty liver disease (NAFLD), chronic pancreatitis, acute pancreatitis, and pancreatic cancer). Inverse MR analysis showed no causal relationship between 24 GI diseases and mood swings. This comprehensive MR analysis suggests that genetically predicted mood swings may be a risk factor in the development of GI diseases. Interventions for mood swings may help to treat GI diseases.

Causal relationship between gut microbiota and gastrointestinal diseases: a mendelian randomization study

BackgroundRecent research increasingly highlights a strong correlation between gut microbiota and the risk of gastrointestinal diseases. However, whether this relationship is causal or merely coincidental remains uncertain. To address this, a Mendelian randomization (MR) analysis was undertaken to explore the connections between gut microbiota and prevalent gastrointestinal diseases.MethodsGenome-wide association study (GWAS) summary statistics for gut microbiota, encompassing a diverse range of 211 taxa (131 genera, 35 families, 20 orders, 16 classes, and 9 phyla), were sourced from the comprehensive MiBioGen study. Genetic associations with 22 gastrointestinal diseases were gathered from the UK Biobank, FinnGen study, and various extensive GWAS studies. MR analysis was meticulously conducted to assess the causal relationship between genetically predicted gut microbiota and these gastrointestinal diseases. To validate the reliability of our findings, sensitivity analyses and tests for heterogeneity were systematically performed.ResultsThe MR analysis yielded significant evidence for 251 causal relationships between genetically predicted gut microbiota and the risk of gastrointestinal diseases. This included 98 associations with upper gastrointestinal diseases, 81 with lower gastrointestinal diseases, 54 with hepatobiliary diseases, and 18 with pancreatic diseases. Notably, these associations were particularly evident in taxa belonging to the genera Ruminococcus and Eubacterium. Further sensitivity analyses reinforced the robustness of these results.ConclusionsThe findings of this study indicate a potential genetic predisposition linking gut microbiota to gastrointestinal diseases. These insights pave the way for designing future clinical trials focusing on microbiome-related interventions, including the use of microbiome-dependent metabolites, to potentially treat or manage gastrointestinal diseases and their associated risk factors.

Revolutionizing gut health: exploring the role of gut microbiota and the potential of microbiome-based therapies in lower gastrointestinal diseases

The gut microbiota comprises a collection of microorganisms residing in the human digestive system, including bacteria, viruses, and fungi. These microbes have critical roles in food breakdown, immune system regulation, and the production of essential nutrients. Several lower gastrointestinal (GI) diseases, including inflammatory bowel disease, irritable bowel syndrome, and colorectal cancer, have been associated with dysbiosis, which refers to an imbalance in the gut microbiota. Additionally, the gut microbiome and its microbial compounds affect disease development and the host’s immune response. Alterations in the gut-brain axis microbiome are also implicated in lower GI diseases. Therefore, microbiome-based therapies that regulate the gut microbiota (e.g., fecal microbiota transplantation and probiotics) are essential for the prevention and treatment of these diseases. This review aims to highlight the significance of gut microbiota and microbiome-based therapies in managing lower GI diseases.

Spectrum of Colonoscopy in Children: A Tertiary Centre Experience from Bangladesh

Background: Pediatric colonoscopy is a safe, sensitive and crucial tool for diagnosing as well as treating children with lower gastrointestinal diseases. In resource-limited countries like Bangladesh, the practice of pediatric colonoscopy remains rudimentary, lacking in trained professionals and appropriate instrumentation.
 Objectives: The aim of the study was to find out the indications, common colonoscopic findings along with histopathologic evaluation and immediate post procedure complications of colonoscopy in children.
 Methods: This was a retrospective study; the records of all the patients whose age was less than 18 years and who underwent colonoscopy from January 2017 to December 2021 were studied.
 Results: Among the total of 196 children (8.23±4.12), the most common indications were lower gastrointestinal bleeding (LGIB) in 107 (54.6%) patients followed by chronic diarrhea in 33 (16.8%), recurrent abdominal pain (RAP) in 16 (8.2%), follow up Inflammatory bowel diseases (IBD) in 14 (7.1%), chronic constipation, weight loss, recurrent oral ulcer, intestinal tuberculosis (TB) and melena. The most common pathologic findings were polyps in 81 (61.4%) children followed by non-specific colitis in 19 (14.4%), IBD in 17 (12.9%) and infectious colitis in 09 (6.8%) cases. Minor adverse events occurred in only 2.0% of children.
 Conclusion: The commonest indication for pediatric colonoscopy was LGIB and the most common findings were colonic polyps. Pediatric colonoscopy is safe and effective diagnostic as well as therapeutic option for lower GI diseases.
 DS (Child) H J 2021; 38(1): 8-16

WEO Newsletter.

WEO Newsletter.

Multi-Class Classification of Gastrointestinal Diseases using Deep Learning Techniques

Objective: Currently, gastrointestinal problems claim the lives of about two million individuals every year throughout the world. Video endoscopy is one of the most important tools for detecting gastrointestinal diseases (GD). However, it has the disadvantage of producing a huge quantity of images that should be analysed by medical professionals, which demands more time. This makes manual diagnosis challenging, encouraging research into computer-assisted methods for accurately identifying all of the produced images in a short amount of time. The goal of this research is to develop anArtificial intelligence technique to classify the different diseases in gastrointenstine. Materials and Methods: In developing a framework for classifying gastrointestinal diseases, the proposed methodology is unique. VGG-19 and ResNet-50, two deep learning networks, were used to evaluate their ability to recognise a dataset of lower GD. To validate the proposed models, a Kvasir dataset of 3500 images was employed, comprising 500 images from each of the seven classes. Results: ResNet-50 had the greatest validation accuracy of 96.81%, recall of 95.28%, precision of 95%, and 94.85% of F1 score, whereas VGG-19 had the highest validation accuracy of 94.21%, recall of 94%, precision of 94.28%, and 94% of F1 score. Conclusions: The Convolutional neural network (CNN) was used to extract shape, colour, and texture features. Softmax assists in the classification of seven types of GD by passing these features into fully connected layers. Two models performed equally well and yielded promising results.

Smoking, alcohol consumption, and 24 gastrointestinal diseases: Mendelian randomization analysis.

Whether the positive associations of smoking and alcohol consumption with gastrointestinal diseases are causal is uncertain. We conducted this Mendelian randomization (MR) to comprehensively examine associations of smoking and alcohol consumption with common gastrointestinal diseases. Genetic variants associated with smoking initiation and alcohol consumption at the genome-wide significance level were selected as instrumental variables. Genetic associations with 24 gastrointestinal diseases were obtained from the UK Biobank, FinnGen study, and other large consortia. Univariable and multivariable MR analyses were conducted to estimate the overall and independent MR associations after mutual adjustment for genetic liability to smoking and alcohol consumption. Genetic predisposition to smoking initiation was associated with increased risk of 20 of 24 gastrointestinal diseases, including 7 upper gastrointestinal diseases (gastroesophageal reflux, esophageal cancer, gastric ulcer, duodenal ulcer, acute gastritis, chronic gastritis, and gastric cancer), 4 lower gastrointestinal diseases (irritable bowel syndrome, diverticular disease, Crohn's disease, and ulcerative colitis), 8 hepatobiliary and pancreatic diseases (non-alcoholic fatty liver disease, alcoholic liver disease, cirrhosis, liver cancer, cholecystitis, cholelithiasis, and acute and chronic pancreatitis), and acute appendicitis. Fifteen out of 20 associations persisted after adjusting for genetically predicted alcohol consumption. Genetically predicted higher alcohol consumption was associated with increased risk of duodenal ulcer, alcoholic liver disease, cirrhosis, and chronic pancreatitis; however, the association for duodenal ulcer did not remain statistically significant after adjustment for genetic predisposition to smoking initiation. This study provides MR evidence supporting causal associations of smoking with a broad range of gastrointestinal diseases, whereas alcohol consumption was associated with only a few gastrointestinal diseases. The Natural Science Fund for Distinguished Young Scholars of Zhejiang Province; National Natural Science Foundation of China; Key Project of Research and Development Plan of Hunan Province; the Swedish Heart Lung Foundation; the Swedish Research Council; the Swedish Cancer Society.

Treatment with COLchicine in hospitalized patients affected by COVID-19: The COLVID-19 trial

ObjectiveTo evaluate whether the addition of colchicine to standard of care (SOC) results in better outcomes in hospitalized patients with COVID-19. DesignThis interventional, multicenter, randomized, phase 2 study, evaluated colchicine 1.5 mg/day added to SOC in hospitalized COVID-19 patients (COLVID-19 trial) and 227 patients were recruited. The primary outcome was the rate of critical disease in 30 days defined as need of mechanical ventilation, intensive care unit (ICU), or death. Results152 non-anti-SARS-CoV-2-vaccinated patients (colchicine vs controls: 77vs75, mean age 69.1±13.1 vs 67.9±15 years, 39% vs 33.3% females, respectively) were analyzed. There was no difference in co-primary end-points between patients treated with colchicine compared to controls (mechanical ventilation 5.2% vs 4%, ICU 1.3% vs 5.3%, death 9.1% vs 6.7%, overall 11 (14.3%) vs 10 (13.3%) patients, P=ns, respectively). Mean time to discharge was similar (colchicine vs controls 14.1±10.4 vs 14.7±8.1 days). Older age (>60 years, P=0.025), P/F<275 mmHg (P=0.005), AST>40 U/L (P<0.001), pre-existent heart (P=0.02), lung (P=0.003), upper-gastrointestinal (P=0.014), lower-gastrointestinal diseases (P=0.009) and cancer (P=0.008) were predictive of achieving the primary outcome. Diarrhoea (9.1% vs 0%, p=0.0031) and increased levels of AST at 6 days (76.9±91.8 vs 33.5±20.7 U/l, P=0.016) were more frequent in the colchicine group. ConclusionColchicine did not reduce the rate and the time to the critical stage. Colchicine was relatively safe although adverse hepatic effects require caution. We confirm that older (>60 years) patients with comorbidities are characterized by worse outcome.

The interactions between traditional Chinese medicine and gut microbiota: Global research status and trends.

BackgroundThere is a crosstalk between traditional Chinese medicine (TCM) and gut microbiota (GM), many articles have studied and discussed the relationship between the two. The purpose of this study is to use bibliometric analysis to explore the research status and development trends of the TCM/GM research, identify and analyze the highly cited papers relating to the TCM/GM.MethodsA literature search regarding TCM/GM publications from 2004 to 2021 was undertaken on August 13, 2022. The main information (full record and cited references) of publications was extracted from the Science Citation Index Expanded (SCI-E) of Web of Science Core Collection (WoSCC). The Bibliometrix of R package, CiteSpace and VOSviewer were used for bibliometric analysis.ResultsA total of 830 papers were included. The publication years of papers were from 2004 to 2021. The number of papers had increased rapidly since 2018. China had the most publications and made most contributions to this field. Nanjing University of Chinese Medicine and Beijing University of Chinese Medicine were in the leading productive position in TCM/GM research, Chinese Academy of Chinese Medical Sciences had the highest total citations (TC). Duan Jin-ao from Nanjing University of Chinese Medicine had the largest number of publications, and Tong Xiao-lin from China Academy of Chinese Medical Sciences had the most TC. The Journal of Ethnopharmacology had the most published papers and the most TC. The main themes in TCM/GM included the role of GM in TCM treatment of glucolipid metabolism diseases and lower gastrointestinal diseases; the mechanism of interactions between GM and TCM to treat diseases; the links between TCM/GM and metabolism; and the relationship between GM and oral bioavailability of TCM.ConclusionThis study gained insight into the research status, hotspots and trends of global TCM/GM research, identified the most cited articles in TCM/GM and analyzed their characteristics, which may inform clinical researchers and practitioners’ future directions.

The Macro- and Micro-Mechanics of the Colon and Rectum I: Experimental Evidence.

Many lower gastrointestinal diseases are associated with altered mechanical movement and deformation of the large intestine, i.e., the colon and rectum. The leading reason for patients’ visits to gastrointestinal clinics is visceral pain, which is reliably evoked by mechanical distension rather than non-mechanical stimuli such as inflammation or heating. The macroscopic biomechanics of the large intestine were characterized by mechanical tests and the microscopic by imaging the load-bearing constituents, i.e., intestinal collagen and muscle fibers. Regions with high mechanical stresses in the large intestine (submucosa and muscularis propria) coincide with locations of submucosal and myenteric neural plexuses, indicating a functional interaction between intestinal structural biomechanics and enteric neurons. In this review, we systematically summarized experimental evidence on the macro- and micro-scale biomechanics of the colon and rectum in both health and disease. We reviewed the heterogeneous mechanical properties of the colon and rectum and surveyed the imaging methods applied to characterize collagen fibers in the intestinal wall. We also discussed the presence of extrinsic and intrinsic neural tissues within different layers of the colon and rectum. This review provides a foundation for further advancements in intestinal biomechanics by synergistically studying the interplay between tissue biomechanics and enteric neurons.

First Year Gastrointestinal Endoscopy Profile in Singkawang West Borneo 2017 – 2018

Background: Gastrointestinal endoscopic examination which is included in the referral system of the Badan Penyelenggara Jaminan Sosial (BPJS) has been available at St Vincentius Hospital Singkawang and already been conducted by internist since March 2017 to diagnose upper and lower gastrointestinal diseases. The gastrointestinal endoscopic examination unit serves referrals from Singkawang and its 3 surrounding districts (Sambas, Bengkayang, and Mempawah) that close to the Malaysian border. The purpose of this study is to determine the patients’ profile from Singkawang, Sambas, Bengkayang, and Mempawah Districs who underwent gastrointestinal endoscopic examination at St Vincentius Hospital from March 2017 to April 2018.Method: This is a retrospective descriptive study by using secondary data of patient’s medical records at St Vincentius Hospital Singkawang in March 2017 - April 2018. Every patient is included as a sample (total sampling). Total numbers are consisted of 308 patients including 230 esophagogastroduodenoscopies and 78 colonoscopies.Result: The results of this study showed that majority of patients were more likely to undergo esophagogastroduodenoscopy (EGD) (75%) than colonoscopy (25%). Males, age group of 51-70 years old and Malay ethnic are the groups of patients who have the most upper and lower gastrointestinal disorders. The prominent finding of esophagogastroduodenoscopy was erosive gastritis (64%), whereas internal hemorrhoids was the most common finding in colonoscopy (67%); if internal hemorrhoids was excluded, colon mass became the most common finding disorder.Conclusion: Patient were mostly male, age group between 51 – 70 years old and Malay. The most common finding in colonoscopy (67%); if internal hemorrhoids was excluded, colon mass shifted forward as the top finding disorder.

Image-Enhanced Endoscopy in Lower Gastrointestinal Diseases: Present and Future.

From dye-assisted conventional chromoendoscopy to novel virtual chromoendoscopy, image-enhanced endoscopy (IEE) is continuously evolving to meet clinical needs and improve the quality of colonoscopy. Dye-assisted chromoendoscopy using indigo carmine or crystal violet, although slightly old-fashioned, is still useful to emphasize the pit patterns of the colonic mucosa and predict the histological structures of relevant lesions. Equipment-based virtual chromoendoscopy has the advantage of being relatively easy to use. There are several types of virtual chromoendoscopy that vary depending on the manufacturer and operating principle. IEE plays distinctive roles with respect to histologic characterization of colorectal polyps and prediction of the invasion depth of colorectal cancers. In addition, the newest models of IEE have the potential to increase adenoma and polyp detection rates in screening colonoscopy.

Functional Diagnosis in Upper and Lower Gastrointestinal Diseases: Relevance for Conservative, Interdisciplinary and Surgical Therapies

Functional Diagnosis in Upper and Lower Gastrointestinal Diseases: Relevance for Conservative, Interdisciplinary and Surgical Therapies

Selected Gastroenterologic Problems in the Tropics (Peacekeeping Missions, Work)

Abstract Research shows a potential threat from external environmental factors which might be the cause of upper and lower gastrointestinal diseases in tourists, or soldiers engaged in tropical peacekeeping missions. The research includes infections which due to their spread are also present in their home countries such as Helicobacter pylori infections, viral hepatitis as well as infections which might cause symptoms of upper and lower gastrointestinal tract diseases as a result of poor sanitary and unhygienic conditions. Contact with diseases typical of the tropical climate, especially during longer stays, increases the chances of bringing some tropical diseases back to Poland, which can be problematic for the domestic health care service.

Clinical characteristics and etiology analysis of 223 children undergoing colonoscopy

Objective To investigate the clinical characteristics and etiology in infants undergoing colonoscopy in order to improve the understandings of lower gastrointestinal tract diseases and their endoscopic manifestations. Methods The clinical and endoscopic data of the infants aged ≤3 years old who underwent conoloscopy at the Department of Gastroenterology, Children′s Hospital of Chongqing Medical University, from July 2010 to December 2014, were retrospectively analyzed.A total of 223 children were included, 148 male and 75 female.The age range was from 26 d to 3 years old(<6 months: 41 cases; 6-12 months: 68 cases; 1-3 years old: 114 cases). Results A total of 235 colonoscopies were performed under deep sedation by single or double manipulators.Cecal intubation was successful in 192 colonoscopies and terminal ileal intubation was completed in 29 colonoscopies, with a high success rate of 94.0%(221/235 colonoscopies). The main symptoms included hematochezia(124 cases, 55.6%), persistent/chronic diarrhea(55 cases, 24.7%), hematochezia with chronic diarrhea(22 cases, 9.5%), and others(22 cases, 9.5%). Of the 223 patients, clear diagnosis were established for 215 children(96.4%), with food protein-induced proctocolitis (FPIPC) (78/223 cases, 35.0%), colonic polyps (50/223 cases, 22.4%), colitis(29/223 cases, 13.0%), antibiotic associa-ted diarrhea (AAD) (19/223 cases, 8.5%), FPIPC with AAD (10/223 cases, 4.5%). Conclusions Colonoscopy serves as a very important tool for the accurate diagnosis of lower gastrointestinal diseases with hematochezia and/or chronic diarrhea.FPIPC and colonic polyps are the most common causes for hematochezia and/or chronic diarrhea.AAD may be another important cause of chronic diarrhea and bloody stool in infants.Moreover, ghe application of colonoscopy in combination with histopathology can also play an important role in the diagnosis of some rare diseases, such as intestinal tuberculosis, primary intestinal lymphangiectasia, Behcet′s disease and primary immunodeficiency disease. Key words: Infant; Colonoscopy; Hematochezia; Chronic diahrrhea

Remote transmission of live endoscopy over the Internet: Report from the 87th Congress of the Japan Gastroenterological Endoscopy Society.

Live demonstration of endoscopy is one of the most attractive and useful methods for education and is often organized locally in hospitals. However, problems have been apparent in terms of cost, preparation, and potential risks to patients. Our aim was to evaluate a new approach to live endoscopy whereby remote hospitals are connected by the Internet for live endoscopic demonstrations. Live endoscopy was transmitted to the Congress of the Japan Gastroenterological Endoscopic Society by 13 domestic and international hospitals. Patients with upper and lower gastrointestinal diseases and with pancreatobiliary disorders were the subjects of a live demonstration. Questionnaires were distributed to the audience and were sent to the demonstrators. Questions concerned the quality of transmitted images and sound, cost, preparations, programs, preference of style, and adverse events. Of the audience, 91.2% (249/273) answered favorably regarding the transmitted image quality and 93.8% (259/276) regarding the sound quality. All demonstrators answered favorably regarding image quality and 93% (13/14) regarding sound quality. Preparations were completed without any outsourcing at 11 sites (79%) and were evaluated as 'very easy' or 'easy' at all but one site (92.3%). Preparation cost was judged as 'very cheap' or 'cheap' at 12 sites (86%). Live endoscopy connecting multiple international centers was satisfactory in image and sound quality for both audience and demonstrators, with easy and inexpensive preparation. The remote transmission of live endoscopy from demonstrators' own hospitals was preferred to the conventional style of locally organized live endoscopy.

Common Mechanism of Pathogenesis in Gastrointestinal Diseases Implied by Consistent Efficacy of Single Chinese Medicine Formula: A PRISMA-Compliant Systematic Review and Meta-Analysis.

Gastrointestinal (GI) disorders often manifest similar symptoms with overlapping clinical diagnosis and unmet medical needs. Traditional Chinese medicine (TCM) has history-proven benefits for GI diseases; albeit language barrier prevents Western readers from accessing the original reports in Chinese. The TCM formula Si-Ni-San (SNS) consists of 4 herbs targeting on homeostatic disturbances characterized by "reflux" and "irritable" problems. Here we used SNS as a therapeutic tool to explore the common mechanisms of pathogenesis in non-neoplastic GI diseases.Data sources from PUBMED, Chinese National Knowledge Infrastructure, and Wanfang databases were searched for clinical trials. Comparisons were SNS as intervention and Western conventional medicine as control, which treat patients with upper GI disorders (gastroesophageal reflux disease, peptic ulcer, chronic gastritis, duodenogastric reflux), lower GI diseases (irritable bowel syndrome, ulcerative colitis), and functional dyspepsia. Participants and studies in accordance with the Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement were eligible. We used the Jadad scale to assess methodological qualities, the fixed or random-effect model to evaluate therapeutic efficacy, and the funnel plots to explore publication bias. Outcome was clinical efficacy defined by symptom relief with normal GI endoscopy, radiology, and pathology.We included 83 studies involving 7762 participants: 1708 versus 1397 of the upper GI disorders in 34 studies, 901 versus 768 of the lower GI diseases in 19 studies, 1641 versus 1348 of functional dyspepsia in 30 studies, and 328 versus 287 of relapse rate in 8 studies. Six studies had a Jadad score >2 points and the rest were <2 points. Pooled data showed significant efficacy of SNS for the upper GI disorders (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 3.09-4.92), lower GI diseases (OR = 4.91, 95% CI = 3.71-6.51), and functional dyspepsia (N = 2989; OR = 3.94, 95% CI = 3.17-4.90). The relapse rate was 12.9% for SNS, significantly <46.5% for conventional therapies (OR = 0.16, 95% CI = 0.11-0.25).The consistent efficacy of the single TCM formula implicates common mechanisms of pathogenesis in GI disorders.

Non-invasive volatile organic compound analysis from exhaled breath for the diagnosis of gastroesophageal cancer.

TPS225 Background: The work carried out in our laboratory using Selective Ion Flow-Tube Mass Spectrometry (SIFT-MS) analysis of volatile organic compounds (VOCs) in exhaled breath has identified compounds that can differentiate gastro-esophageal cancer from non-cancer patients. A model has been developed based on 220 patients with upper gastrointestinal pathology (81 cancer, 88 positive control and 51 patients with endoscopically normal gastrointestinal tract). Methods: Clinical trial registry number: 14/LO/1136. Study 1: Refinement of VOC exhaled breath model. Exhaled breath from 120 patients undergoing diagnostic lower endoscopy for the investigation of gastrointestinal symptoms will be used to refine the existing model by studying the influence of lower gastrointestinal diseases and in particular colorectal cancer, upon VOC analysis. To date 94 patients have been recruited. Study 2: Blinded validation multi-centre study for the use of exhaled Breath SIFT-MS analysis to predict gastro-esophageal cancer. This study will be conducted across four centers and will utilize SIFT-MS exhaled breath analysis, for comparison of predicted cancer risk based upon the VOC exhaled breath model compared to endoscopic findings and histology biopsies in order to determine the overall diagnostic accuracy for this non-invasive test. Sample Size – Based upon a prevalence of cancer of 50% in the study population and maintaining a sensitivity and specificity of 80% for the diagnostic model derived from our previous research, the sample size estimated is 325 patients. Inclusion criteria:Patients with upper gastrointestinal symptoms attending for endoscopy or surgery. Exclusion criteria: Patients with a documented active infection or liver disease. Statistical methods: Comparison of predicted cancer risk and actual OGD findings or histology from endoscopic biopsies will then be made, and the overall diagnostic accuracy (sensitivity, specificity, positive and negative predictive value, ROC curve analysis) for this non-invasive diagnostic investigation will be determined. Deliverables: The diagnostic accuracy of the exhaled breath test for the prediction of oesophago-gastric cancer. Clinical trial information: 14/LO/1136.

Ethnic variations in five lower gastrointestinal diseases: Scottish Health and Ethnicity Linkage Study

ObjectivesOur objective was to augment the limited evidence mainly from local, clinical studies of ethnic differences in gastrointestinal disorders. Our question was: are there ethnic variations in hospitalisation/death for lower...