Non-gastrointestinal Symptoms Research Articles

Irritable Bowel Syndrome in Veterans with Gulf War Illness Evaluated at VA's War-Related Illness and Injury Study Center.

Excess rates of Gulf War illness (GWI) and irritable bowel syndrome (IBS), two chronic multisymptom illnesses, have long been documented among nearly 700,000 veterans who served in the 1990-1991 Persian Gulf War. We sought to report the prevalence, characteristics, and association of GWI and IBS decades after the war in a clinical cohort of deployed Gulf War veterans (GWVs) who were evaluated at the Department of Veterans Affairs' War Related Illness and Injury Study Center (WRIISC) for unexplained chronic symptoms. We analyzed data gathered from clinical intake questionnaires of deployed GWVs who were evaluated at WRIISC clinics between 2008 and 2020. We applied Centers for Disease Control (CDC) criteria to determine the prevalence of severe GWI. IBS was identified using Rome IV diagnostic criteria (current IBS) and veterans' self-reported "history of physician-diagnosed IBS." We examined associations between IBS and GWI using bivariate analyses and multivariable logistic regression. Among the N = 578 GWVs evaluated by the WRIISC, severe GWI (71.8%), history of physician-diagnosed IBS (50.3%) and current IBS (42.2%) were all highly prevalent. Nearly half of GWVs with severe GWI met Rome criteria for IBS (45.8%), and over half reported a history of physician-diagnosed IBS (56.1%). In multivariable models, severe GWI was significantly associated both with current IBS (adjusted odds ratio (aOR): 1.68, 95% CI: 1.11, 2.54) and with veteran-reported history of physician-diagnosed IBS (aOR: 2.15, 95% CI: 1.43, 2.23). IBS with diarrhea (IBS-D) was the most common subtype among GWVs with current IBS (61.1%). However, IBS-mixed affected a significantly greater proportion of veterans with severe GWI, compared to veterans who did not have severe GWI (P = .03). More than 20 years after the Persian Gulf War, our findings indicate a high degree of comorbidity between severe GWI and IBS among deployed GWVs seeking care for unexplained illnesses. Our results suggest GWVs with GWI should be screened for IBS for which evidence-based treatments are available and could potentially reduce symptom burden. Conversely, symptoms of IBS should trigger additional evaluation for non-gastrointestinal symptoms in deployed Gulf War veterans to identify possible GWI and ensure a comprehensive approach to care.

Gastrointestinal syndrome encountered during a train voyage to high altitudes: A 14-day survey of 69 passengers in China

BackgroundThe diagnosis and evaluation of the severity of acute mountain sickness (AMS) continue to be problematic due to a lack of consensus on the inclusion of symptoms in a scoring system. Recent investigations highlight the significance of gastrointestinal symptoms in identifying this condition. However, the specific gastrointestinal symptoms associated with AMS have not been thoroughly elucidated in previous studies, and the underlying risk factors remain inadequately comprehended. MethodsThis study aimed to investigate the characteristics, trends, and risk factors related to gastrointestinal symptoms encountered during train travel to high altitude. A total of 69 passengers, specifically all with medical backgrounds, were surveyed 6 times over a period of 14 days. ResultsThe daily incidence of abdominal discomfort was higher than non-gastrointestinal symptoms within 14 days. Gastrointestinal symptoms demonstrated a greater prevalence, longer duration, and increased risk compared to non-gastrointestinal symptoms, such as headaches. The symptoms of abdominal distension and bowel sound hyperaction were found to be prevalent and persistent among patients diagnosed with AMS, exhibiting a high incidence rate. Gender, age, body mass index (BMI), smoking habits, and alcohol consumption were identified as risk factors associated with the occurrence and duration of gastrointestinal symptoms. ConclusionThis study suggests that gastrointestinal symptoms are more common and persistent when traveling to the plateau by train. These symptoms should be taken into consideration in the further diagnosis and prevention of AMS. Therefore, this study provides a significant theoretical foundation for the prevention and treatment of AMS.

Clinical analysis of 86 cases of acute fatty liver of pregnancy

Objective: To investigate the clinical characteristics and maternal and fetal prognosis of pregnant women with acute fatty liver of pregnancy (AFLP). Methods: The clinical data of 86 AFLP pregnant women admitted to the Third Affiliated Hospital of Guangzhou Medical University from September 2017 to August 2022 were collected, and their general data, clinical characteristics, laboratory tests and maternal and fetal outcomes were retrospectively analyzed. Results: (1) General information: the age of the 86 pregnant women with AFLP was (30.8±5.4) years, and the body mass index was (21.0±2.5) kg/m2. There were 50 primiparas (58.1%, 50/86) and 36 multiparas (41.9%, 36/86). There were 64 singleton pregnancies (74.4%, 64/86) and 22 twin pregnancies (25.6%, 22/86). (2) Clinical characteristics: the main complaints of AFLP pregnant women were gastrointestinal symptoms, including epigastric pain (68.6%, 59/86), nausea (47.7%, 41/86), anorexia (46.5%, 40/86), vomiting (39.5%, 34/86). The main non-gastrointestinal symptoms were jaundice of skin and/or scleral (54.7%, 47/86), edema (38.4%, 33/86), fatigue (19.8%, 17/86), bleeding tendency (16.3%, 14/86), polydipsia or polyuria (14.0%, 12/86), skin itching (8.1%, 7/86), and 17.4% (15/86) AFLP pregnant women had no obvious symptoms. (3) Laboratory tests: the incidence of liver and kidney dysfunction and abnormal coagulation function in AFLP pregnant women was high, and the levels of blood ammonia, lactate dehydrogenase and lactic acid were increased, and the levels of hemoglobin, platelet and albumin decreased. However, only 24 cases (27.9%, 24/86) of AFLP pregnant women showed fatty liver by imageology examination. (4) Pregnancy outcomes: ① AFLP pregnant women had a high incidence of pregnancy complications, mainly including renal insufficiency (95.3%, 82/86), preterm birth (46.5%, 40/86), hypertensive disorders in pregnancy (30.2%, 26/86), gestational diabetes mellitus (36.0%, 31/86), fetal distress (24.4%, 21/86), pulmonary infection (23.3%, 20/86), disseminated intravascular coagulation (16.3%, 14/86), multiple organ dysfunction syndrome (16.3%, 14/86), hepatic encephalopathy (9.3%, 8/86), and intrauterine fetal death (2.3%, 2/86). ② Treatment and outcome of AFLP pregnant women: the intensive care unit transfer rate of AFLP pregnant women was 66.3% (57/86). 82 cases were improved and discharged after treatment, 2 cases were transferred to other hospitals for follow-up treatment, and 2 cases (2.3%, 2/86) died. ③ Neonatal outcomes: except for 2 cases of intrauterine death, a total of 106 neonates were delivered, including 39 cases (36.8%, 39/106) of neonatal asphyxia, 63 cases (59.4%, 63/106) of neonatal intensive care unit admission, and 3 cases (2.8%, 3/106) of neonatal death. Conclusions: AFLP is a severe obstetric complication, which is harmful to mother and fetus. In the process of clinical diagnosis and treatment, attention should be paid to the clinical manifestations and laboratory tests of pregnant women, early diagnosis and active treatment, so as to improve maternal and fetal outcomes.

SP7.8 Qualitative exploration of gastrointestinal recovery following surgical admission: Phase I of the PRO-diGI study

Abstract Background Patients admitted to hospital for abdominal surgery often experience gastrointestinal dysfunction. Recovery of gastrointestinal function is poorly measured and only briefly assessed by clinicians. There is a need for a patient reported outcome measure to assess gastrointestinal recovery. The first stage of development requires qualitative methodology to identify key concepts. Methods Adult patients admitted to hospital for major gastrointestinal, urological, or gynaecological surgery, in an emergency or elective setting were eligible to participate. Patients treated non-operatively for small bowel obstruction were also eligible. Interviews were conducted by telephone, audio-recorded and transcribed. Interviews were coded and analysed in the NVivo software by two researchers and reviewed by lay members of the steering group. Interviews continued until saturation was reached. Ethical approval was gained prior to interviews (21/WA/0231). Results Twenty-nine interviews were completed (17 male, median age 64) across three specialties (20 gastrointestinal, 6 gynaecological, 3 urological). Two overarching themes of ‘general recovery’ and ‘gastrointestinal symptoms’ were identified. General recovery included 3 themes of; ‘life impact’, ‘mental impact’ including anxiety, and ‘physical impact’ including fatigue. Gastrointestinal symptoms included 3 themes of; ‘abdominal symptoms’ such as pain, ‘diet and appetite’, and ‘expulsory function’ such as stool frequency. A total of 18 gastrointestinal symptoms were identified during patient recovery – many of which lasted several weeks following discharge. Discussion This study highlights a broad range of gastrointestinal and non-gastrointestinal symptoms experienced by patients during their gastrointestinal recovery. Patients remain symptomatic following discharge. Clinicians should consider assessing recovery thoroughly at discharge and follow up.

Formation of a conceptual framework during the development of a patient-reported outcome measure for early gastrointestinal recovery: phase I of the PRO-diGi study.

Patients admitted to hospital for abdominal surgery often experience gastrointestinal dysfunction. Many studies have reported outcomes following gastrointestinal dysfunction, yet there is no unified definition of recovery or a validated patient-reported outcome measure (PROM). The first stage of PROM development requires formation of a conceptual framework to identify key themes to patients. The aim of this study was to utilize semistructured interviews to identify core themes and concepts relevant to patients to facilitate development of a conceptual framework. Adult patients admitted to hospital for major gastrointestinal, urological or gynaecological surgery, in an emergency or elective setting, were eligible to participate. Patients treated nonoperatively for small bowel obstruction were also eligible. Interviews were conducted by telephone, audio-recorded, transcribed, coded and analysed using NVivo software by two researchers and reviewed by lay members of the steering group. Interviews continued until data saturation was reached. Ethical approval was gained prior to interviews (21/WA/0231). Twenty nine interviews were completed (17 men, median age 64 years) across three specialties (20 gastrointestinal, six gynaecological, three urological). Two overarching themes of 'general recovery' and 'gastrointestinal symptoms' were identified. General recovery included three themes: 'life impact', 'mental impact', including anxiety, and 'physical impact', including fatigue. Gastrointestinal symptoms included three themes: 'abdominal symptoms' such as pain, 'diet and appetite' and 'expulsory function', such as stool frequency. A total of 18 gastrointestinal symptoms were identified during patient recovery-many of which lasted several weeks following discharge. This study reports a range of gastrointestinal and nongastrointestinal symptoms experienced by patients during early gastrointestinal recovery. Identified symptoms have been synthesized into a conceptual framework to enable development of a definitive PROM for early gastrointestinal recovery.

Overactive bladder syndrome symptoms in youth with abdominal pain-associated disorders of gut–brain interaction

The purpose of the current study was to assess the frequency of overactive bladder syndrome (OBS) symptoms and their relationship to gastrointestinal symptoms in youth with abdominal pain-associated disorders of gut–brain interaction (AP-DGBI). This is a retrospective study of 226 youth diagnosed with an AP-DGBI. As part of standard care, all patients completed a symptom questionnaire regarding gastrointestinal and non-gastrointestinal symptoms including increased urinary frequency, nighttime urination, and urinary urgency. Overall, 54% of patients reported at least one OBS symptom. Increased frequency of urination was reported by 19%, urinary urgency by 34%, and nighttime urination by 36%. Increased frequency of urination and urinary urgency were associated with a change in stool form, a change in stool frequency, and in those fulfilling criteria for IBS. Increased frequency of urination was reported more frequently in those reporting predominantly loose stools (33% vs. 12%). Urinary symptoms are common in youth with AP-DGBI. Increased urinary frequency and urinary urgency are specifically associated with IBS, with increased urinary frequency being primarily associated with diarrhea predominant IBS. Further studies are needed to determine the impact of OBS on AP-DGBI severity and quality of life, and whether they impact DGBI treatment.

The Efficacy of a Diet Low in Fermentable Oligo-, Di-, Monosaccharides, and Polyols in Irritable Bowel Syndrome Compared to Its "Real-world" Effectiveness: Protocol for a Systematic Review.

Irritable bowel syndrome (IBS) is associated with various gastrointestinal and nongastrointestinal symptoms and reduced quality of life. A diet low in fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) is one therapeutic option for IBS. Although the efficacy of the low FODMAP diet has been reported in several systematic reviews, the efficacy-effectiveness gap of the low FODMAP diet has not yet been assessed. This systematic review aims to compare the efficacy of the low FODMAP diet from efficacy randomized controlled trials (RCTs) with the effectiveness of studies conducted in "real-world" settings. RCTs, prospective and retrospective cohort studies, and retrospective audits assessing the low FODMAP diet in adults with IBS will be searched in 4 databases: Embase, MEDLINE, CENTRAL, and CINAHL. Two independent reviewers will perform study selection, data extraction, and risk of bias assessment and assess selected quality aspects from the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) protocol. Outcomes assessed are stool frequency, stool consistency, abdominal pain, overall symptom scores, adequate symptom relief, IBS-specific quality of life, and diet adherence. Data will be summarized with forest plots without summary statistics, tables, and narrative descriptions. The search, title and abstract screening, and full-text screening were completed in March 2021, and an updated search was done in May 2022. As of May 2023, data analysis is almost finished, and manuscript writing is in progress. Submission of the manuscript is expected by July 2023. The findings of this systematic review will compare the efficacy of the low FODMAP diet for IBS found in RCTs to the diet's real-world effectiveness. PROSPERO CRD42021278952; https://tinyurl.com/32jk43ev. DERR1-10.2196/41399.

Molecular Identification of Blastocystis hominis Isolates in Patients with Autoimmune Diseases

Background: Blastocystis hominis (B. hominis) is a ubiquitous parasite that has spread worldwide and is commonly present in human stool specimens. It was hypothesized that infection with B. hominis plays a role in the pathogenesis of autoimmune diseases in humans. The aim of this study is to test this hypothesis by investigating patients with autoimmune diseases. Patients with various types of autoimmune diseases with gastrointestinal symptoms were enrolled in this study as cases (n = 72) along with nongastrointestinal symptom patients as controls (n = 58). All participants in this study were subjected to history taking and were investigated for B. hominis infection via wet-mount microscopic stool examinations, staining with trichrome stain, and molecular-based tests applied to their fecal samples. Blood samples were also tested for complete blood counts. B. hominis were identified with specific PCR more in cases (12/72; 16.6%) than in controls (3/58; 5.2%), with a significant difference (p < 0.05). Significant decreases in white blood cell counts were demonstrated in systemic lupus erythematosus (SLE) and ulcerative colitis (UC) patients infected with B. hominis when compared to patients with nongastrointestinal symptoms (p-value < 0.05).

Prevalence of Undiagnosed Acute Hepatic Porphyria in Cyclic Vomiting Syndrome and Overlap in Clinical Symptoms.

Acute hepatic porphyria (AHP) presents with nausea and vomiting and can mimic cyclic vomiting syndrome (CVS). The prevalence of AHP in CVS and overlap in clinical symptomatology is not known. We thus sought to determine the prevalence of pathogenic variants for AHP and characterize symptom overlap between CVS and AHP. We conducted a cross-sectional study of 234 CVS patients using Rome criteria. Patients were eligible for AHP genetic testing if they had recurrent episodes of severe, diffuse abdominal pain with ≥ 2 of the following-peripheral nervous system (muscle weakness/aching, numbness, tingling), central nervous system (confusion, anxiety, seizures, hallucinations), autonomic nervous system (hyponatremia, tachycardia, hypertension, constipation) symptoms, red/brownish urine, or blistering skin lesions on sun-exposed areas. A family history of AHP or elevated urinary porphobilinogen (PBG)/aminolaevulinic acid (ALA) were also criteria for genetic testing and was performed using a 4-gene panel. Mean age was 38.7 ± 14.5years, 180 (76.9%) were female and 200 (85.5%) were Caucasian. During a CVS attack, 173 (92%) reported abdominal pain, 166 (87.2%) had peripheral nervous system, 164 (86.8%) had central nervous system and 173 (92) % had autonomic symptoms. Ninety-one eligible patients completed genetic testing. None were positive for AHP but two had variants of uncertain significance (VUS) in the HMBS gene. There is a high prevalence of non-gastrointestinal symptoms in CVS, like AHP, which is important for clinicians to recognize. AHP was not detected in this study and larger studies are warranted to ascertain its prevalence.

Clinical presentation patterns of patients with coeliac disease in Gaza Strip: a cross-sectional descriptive study

BackgroundCoeliac disease is an autoimmune disease of the small intestine precipitated by the ingestion of gluten in genetically susceptible individuals. Clinical presentation of patients with coeliac disease patients varies depending on age and has been associated with other autoimmune conditions. In the Gaza strip, the patterns of clinical presentations and associations have not been reported. We aimed to assess these factors. MethodsThis cross-sectional descriptive study was done in July, 2015. We administered a structured questionnaire to all patients who were diagnosed as having coeliac disease and were registered at Ard El Insan Association, a Palestinian charitable society that provides preventive and therapeutic services, family guidance, and health education to patients with nutritional diseases through clinics in the Gaza Strip. The questionnaire focused on the presenting symptoms, coexisting diseases, and the diet of each patient. Patients provided verbal consent for their data to be used in this study. We used SPSS Statistics version 23.0 for data management and descriptive statistical analysis. Findings55 patients aged 2–40 years were included in our study with a mean age of 20 (SD 11·7) years. 23 (42%) patients were younger than 18 years. 19 (34%) were boys or men and 36 (66%) were girls or women. The mean age of the first presentation with gastrointestinal complaints was 10 (SD 9) years, whereas the mean age of diagnosis was 16 (10) years. The most common presenting symptoms were anorexia (76%), abdominal distention (73%), and diarrhoea (73%). In addition, 78% of patients had poor weight gain, 71% had iron deficiency anaemia, 40% had arthralgia, and 33% had short stature and had experienced delayed puberty. 18 (33%) patients had a family history of coeliac disease. The proportion of patients who had other autoimmune diseases was 23%, with the most frequent being urticaria (9%), type 1 diabetes (4%), asthma (4%), alopecia (4%), and thyroiditis (2%). 44 (80%) patients adhered to therapeutic diets. The mean level of haemoglobin at diagnosis was 10·0 (SD 1·7) g/L, but at the latest visit was 11·6 (1·2) g/L. InterpretationOur findings suggest that coeliac disease occurs notably more frequently in girls and women than in boys and men in Gaza Strip and that diagnosis can take 5–6 years after the first gastrointestinal complaint. On the other hand, a substantial number of patients presented with non-gastrointestinal symptoms. Therefore, an awareness of the broad spectrum of presentations of coeliac disease is necessary to avoid delays in diagnosis. FundingNone.

Significance of digestive symptoms after COVID-19 vaccination: A retrospective single-center study

ObjectiveThere is insufficient research on digestive symptoms and outcomes following coronavirus disease (COVID-19) vaccination. We aimed to investigate digestive symptoms and related complications among South Koreans who were administered COVID-19 vaccines. MethodsForty-six patients (men: 22, women: 24) with a median age of 68 years (interquartile range:55.5, 73.8 years) who experienced digestive symptoms following COVID-19 vaccination between March 1 and July 30, 2021, were included. This retrospective single-center study collected information on clinical symptoms, laboratory tests, imaging results, comorbidities, complications, treatment type, and prognosis. ResultsThirty-three (71.7%), nine (19.6%), and three (6.5%) patients were administered AZD1222 (AstraZeneca), BNT162b2 (Pfizer/BioNTech), and JNJ-78436735 (Johnson and Johnson) vaccines, respectively. Patients were classified with mild (25 patients, 54.3%), moderate (five patients, 10.9%), and severe (16 patients, 34.8%) based on disease severity. Digestive symptoms included abdominal pain, diarrhea, dyspepsia, and nausea, which usually developed within 1 day (78.3%) following the first vaccination. In total, 14 (30.4%) patients experienced only gastrointestinal symptoms, whereas 32 (69.6%) experienced non-gastrointestinal symptoms. Complications included enterocolitis (76%), acute kidney injury (9%), anaphylactoid reaction (2%), and duodenal perforation (2%). ConclusionsCOVID-19 vaccines caused digestive symptoms and other complications that ranged from mild to severe. While further validation is required, our results suggest that monitoring digestive symptoms following COVID-19 vaccination can help detect rather severe complications that require medical intervention.

Gastrointestinal and hepatobiliary manifestations of COVID-19 in children: A Review

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) is shaking the world heavily. SARS-COV-2 (COVID-19) infection has a wide variety of presentations as it affects almost every system of body. Gastrointestinal and hepatobiliary symptoms are frequently overlooked especially in children. Objectives: The purpose of this review was to discuss the gastrointestinal and hepatobiliary presentations of COVID-19 in children and compare with non-gastrointestinal presentations. Methods: This study was a narrative review. Recent available literature was searched by keywords. The most recent information from relevant articles were collected and reviewed. This write up was compiled after the review of articles from the last one and half year. Results: About 50.0% symptomatic children with COVID-19 had gastrointestinal manifestations. COVID-19 with gastrointestinal symptoms had delayed diagnosis, delayed hospitalization and worse outcome in compare with Covid-19 with non-gastrointestinal symptoms. Conclusion: Vomiting, diarrhoea, abdominal pain, anorexia, nausea are common gastrointestinal manifestations in children with COVID-19. Elevated transaminasemia is not uncommon. Bangladesh Med Res Counc Bull 2021; 47(1): 3-8

Patient perspectives on key symptoms and preferences for follow-up after upper gastro-intestinal cancer surgery

PurposeLong-lasting symptoms and reductions in quality of life are common after oesophago-gastric surgery. Post-operative follow-up has traditionally focussed on tumour recurrence and survival, but there is a growing need to also identify and treat functional sequelae to improve patients’ recovery.MethodsAn electronic survey was circulated via a British national charity for patients undergoing oesophago-gastric surgery and their families. Patients were asked about post-operative symptoms they deemed important to their quality of life, as well as satisfaction and preferences for post-operative follow-up. Differences between satisfied and dissatisfied patients with reference to follow-up were assessed.ResultsAmong 362 respondents with a median follow-up of 58 months since surgery (range 3–412), 36 different symptoms were reported as being important to recovery and quality of life after surgery, with a median of 13 symptoms per patient. Most (84%) respondents indicated satisfaction with follow-up. Satisfied patients were more likely to have received longer follow-up (5-year or longer follow-up 60% among satisfied patients vs 27% among unsatisfied, p < 0.001). These were also less likely to have seen a dietitian as part of routine follow-up (37% vs 58%, p = 0.005).ConclusionThis patient survey highlights preferences regarding follow-up after oesophago-gastrectomy. Longer follow-up and dietician involvement improved patient satisfaction. Patients reported being concerned by a large number of gastrointestinal and non-gastrointestinal symptoms, highlighting the need for multidisciplinary input and a consensus on how to manage the poly-symptomatic patient.

Predictors of Symptom-Specific Treatment Response to Dietary Interventions in Irritable Bowel Syndrome.

(1) Background: Predictors of dietary treatment response in irritable bowel syndrome (IBS) remain understudied. We aimed to investigate predictors of symptom improvement during the low FODMAP and the traditional IBS diet for four weeks. (2) Methods: Baseline measures included faecal Dysbiosis Index, food diaries with daily energy and FODMAP intake, non-gastrointestinal (GI) somatic symptoms, GI-specific anxiety, and psychological distress. Outcomes were bloating, constipation, diarrhea, and pain symptom scores treated as continuous variables in linear mixed models. (3) Results: We included 33 and 34 patients on the low FODMAP and traditional IBS diet, respectively. Less severe dysbiosis and higher energy intake predicted better pain response to both diets. Less severe dysbiosis also predicted better constipation response to both diets. More severe psychological distress predicted worse bloating response to both diets. For the different outcomes, several differential predictors were identified, indicating that baseline factors could predict better improvement in one treatment arm, but worse improvement in the other treatment arm. (4) Conclusions: Psychological, nutritional, and microbial factors predict symptom improvement when following the low FODMAP and traditional IBS diet. Findings may help individualize dietary treatment in IBS.

Comparison of laboratory characteristics of gastrointestinal symptoms and nongastrointestinal symptoms in patients infected with COVID-19: a systematic review and meta-analysis.

Background:The Coronavirus Disease 2019 (COVID-19) pandemic poses a massive crisis to global public health. Gastrointestinal (GI) symptoms are increasingly reported in COVID-19. The characteristics of laboratory findings of COVID-19 are critical for clinical diagnosis and treatment.Objectives:The study aimed to summarize laboratory features in COVID-19 with GI symptoms and non-GI symptoms.Design:This study was a systematic review and meta-analysis. Electronic literature searches were conducted for studies that included patients infected COVID-19 with GI symptoms and non-GI symptoms. GI symptoms included diarrhea, abdominal pain, nausea and vomiting, and anorexia. This study used a random-effects model to assess pooled data.Data sources and methods:We systematically searched PubMed, Embase, Cochrane, Web of Science for studies through 31 October 2021, with no language restrictions. We used the following search terms: ‘COVID-19’ OR ‘2019-nCoV’ OR ‘SARS-CoV-2’ OR ‘coronavirus 2019’ OR ‘severe acute respiratory syndrome coronavirus 2’ OR ‘coronavirus’ OR ‘novel coronavirus’ OR ‘nCoV’ AND ‘gastrointestinal symptoms’ OR ‘digestive symptoms’ AND ‘clinical feature’ OR ‘clinical characteristics.’ Data mostly originated from Chinese and American studies.Results:Of 796 identified studies, 14 were eligible and were included in our analysis (N = 8396 participants). Meta-analysis showed that GI symptoms group had an elevated alanine aminotransferase (ALT) [pooled mean difference (MD), 4.5 U/L; 95% confidence interval, [0.45, 8.55]; p = 0.03; I2 = 87%]. No publication bias was detected by Begg’s and Egger’s regression test (p = 0.130). COVID-19 with the GI symptoms also showed a trend toward decreased white blood cell count, lymphopenia, neutrophilia, thrombocytopenia and elevated total bilirubin.Conclusion:GI symptoms are common in COVID-19. No significant differences were found in most laboratory indicators except elevated ALT.Registration:CRD42020209039 (PROSPERO).

P-OGC21 Patient perspectives on symptoms of importance and preferences for follow-up after major upper gastro-intestinal cancer surgery

Abstract Background Long-lasting symptoms and reductions in quality of life are common after oesophago-gastric surgery. Post-operative follow-up has traditionally focussed on tumour recurrence and survival, but there is a growing need to also identify and treat functional sequelae to improve patients’ recovery. Methods An electronic survey was circulated via a British national charity for patients undergoing oesophago-gastric surgery and their families. Patients were asked about post-operative symptoms they deemed important to their quality of life, as well as satisfaction and preferences for post-operative follow-up. Differences between satisfied and dissatisfied patients with reference to follow-up were assessed. Results Among 362 respondents with a median follow-up of 58 months since surgery (range 3-412), 36 different symptoms were reported as being important to recovery and quality of life after surgery, with a median 13 symptoms per patient. Most (84%) respondents indicated satisfaction with follow-up. Unsatisfied patients were more likely to have received shorter follow-up than 5 years (27% among unsatisfied patient vs. 60% among satisfied patients, p &amp;lt; 0.001and were less likely to have seen a dietitian as part of routine follow-up (37% vs. 58%, p = 0.005). Conclusions This patient survey highlights preferences with regard to follow-up after oesophago-gastrectomy. Longer follow-up and dietician involvement improved patient satisfaction. Patients reported being concerned by a large number of gastrointestinal and non-gastrointestinal symptoms, highlighting the need for multidisciplinary input and a consensus on how to manage the poly-symptomatic patient.

Atypical and typical manifestations of the hiatal hernia

: Hiatal hernias may present in variety of ways, both typical and atypical. Manifestations are dependent on the type and size of the hernia. Gastrointestinal manifestations are the most common, predominately with GERD and associated syndromes. Typical GERD presents with heartburn and regurgitation as part of a reflux syndrome. Additionally, GERD may manifest as a typical chest pain syndrome unrelated to a cardiac etiology. Hiatal hernia associated GERD may present with esophageal mucosal injury in the form of reflux esophagitis, stricture, Barrett’s esophagus, and progress to esophageal malignancy. Atypical GERD symptoms like cough, laryngitis, asthma, and dental erosions may be may exist with hiatal hernias. GERD symptoms are more often associated with type 1 hiatal hernias. Typical gastrointestinal obstructive symptoms of hiatal hernia manifest as nausea, bloating, emesis, dysphagia, early satiety, and postprandial fullness and pain in the epigastrium and chest. Less common, atypical presentations include gastric outlet obstruction, secondary gastric volvulus, intestinal obstruction and ischemia, and bleeding. These manifestations occur more frequently with paraesophageal hernias. Bleeding, ulcerations in the form of Cameron lesions, and iron deficiency anemia are additional atypical manifestations of hiatal hernia. As hiatal hernias enlarge and move more into the thorax, non-gastrointestinal symptoms become more frequent. Typical pulmonary presentations consist of dyspnea, dyspnea on exertion, and atelectasis as a result of pulmonary compression. Similarly, compression on the left atrium may explain the higher prevalence of atrial fibrillation in patients with hiatal hernia. Pulmonary fibrosis remains an atypical presentation of hiatal hernia, likely associated with the increased prevalence of GERD in hiatal hernia.

Functional Gastrointestinal Disorders and Associated Health Impairment in Individuals with Celiac Disease

Individuals with celiac disease (CD) can experience persisting gastrointestinal symptoms despite adhering to a gluten-free diet (GFD). This may be due to functional gastrointestinal disorders (FGIDs), although there is little data on its prevalence and associated factors. An online health questionnaire was completed by adult members of Celiac UK in October 2018. The survey included validated questions on Rome IV FGIDs, nongastrointestinal somatic symptoms, anxiety, depression, quality of life, health care use, GFD duration, and its adherence using the celiac dietary adherence test score (with a value ≤ 13 indicating optimal adherence). The prevalence of FGIDs and associated health impairment in the celiac cohort was compared against an age- and sex-matched population-based control group. Of the 863 individuals with CD (73% female; mean age, 61 years), all were taking a GFD for at least 1 year, with 96% declaring that they have been on the diet for 2 or more years (2-4 years, 20%; ≥5 years, 76%). The adherence to a GFD was deemed optimal in 61% (n= 523), with the remaining 39% (n= 340) nonadherent. Those adhering to a GFD fulfilled criteria for a FGID in approximately one-half of cases, although this was significantly lower than nonadherent subjects (51% vs 75%; odds ratio [OR], 2.0; P < .001). However, the prevalence of FGIDs in GFD-adherent subjects was significantly higher than in matched population-based controls (35%; OR, 2.0; P < .001). This was accounted for by functional bowel (46% vs 31%; OR, 1.9; P < .0001) and anorectal disorders (14.5% vs 9.3%; OR, 1.7; P= .02) but not functional esophageal (7.6% vs 6.1%; P= .36) or gastroduodenal disorders (8.7% vs 7.4%; P= .47). Finally, GFD-adherent subjects with FGIDs were significantly more likely than their counterparts without FGIDs to have abnormal levels of anxiety (5% vs 2%; OR, 2.8; P= .04), depression (7% vs 2%; OR, 3.6; P= .01), somatization (31% vs 8%; OR, 5.1; P < .0001), and reduced quality of life (P < .0001). One in 2 people with CD, despite having been on a GFD for a number of years and demonstrating optimal adherence, have ongoing symptoms compatible with a Rome IV FGID. This is 2-fold the odds of FGIDs seen in age- and sex-matched controls. The presence of FGIDs is associated with significant health impairment, including psychological comorbidity. Addressing disorders of gut-brain interaction might improve outcomes in this specific group of patients.

Coeliac disease presenting atypically: A much wider spectrum.

Atypical coeliac disease in young children is frequently missed when it presents atypically as non-gastrointestinal presentations to different specialties. There was a greater delay (54months) in establishing the diagnosis in those with atypical coeliac disease (p < 0.001). No difference was observed in the mode of delivery or duration of breast feeding, but significant difference was observed between gestational age at birth (p < 0.001). Most cases showed stunted growth and underweight. Irritability, anaemia, rickets, dermatitis herpetiformis, alopecia and intussusception were other common predictors of atypical coeliac disease. Because of a myriad spectrum of non-gastrointestinal symptoms, at any age with diverse presentation, a high index of suspicion is therefore required.

Diagnostics of Celiac disease: comprehensible solutions to a complex problem

The prevalence of the celiac disease (CeD) is increasing worldwide, which is not only due to the modern capabilities of the latest laboratory and instrumental technologies but rather with a true rise in incidence. Despite recent advances in endoscopic imaging and serological tests, the accurate diagnosis of CeD remains challenging. Since the majority of patients are “asymptomatic” from the gastrointestinal aspects they come to medical attention because of other reasons than CeD and a large number of CeD passes undiagnosed. This fact highlights the need for improved strategies in the future for the optimal detection of patients and use of clear algorithms for diagnosing CeD. The review describes the global experience in diagnosing CeD and provides «step-by-step» recommendations to help specialists in medicine not only in cases with the usual classical manifestations of CeD, but also in complex clinical variants of this disease or for patients already following a gluten-free diet. Keywords: diagnostics of celiac disease, CeD, anemia, intestinal biopsy, non-gastrointestinal symptoms, serology for celiac disease, HLA testing, gluten-free diet.