Number Of Gastrointestinal Symptoms Research Articles

A69 EXPANDED ROLE OF THE DIETITIAN IN THE CLINICAL MANAGEMENT OF PATIENTS WITH CELIAC DISEASE

Abstract Background The only available treatment for Celiac Disease (CeD) is adhering to a strict gluten-free diet (GFD). However, a GFD has been associated with multiple nutrient imbalance and deficiencies, which are often under-recognized and remain untreated. Aims To identify the reasons for referral to a registered dietitian (RD) and RD-recommended dietary interventions for patients with CeD attending a specialised Adult Celiac Disease Clinic. Methods We conducted a retrospective chart review using nutrition assessment forms completed by the RD between November 2021 and May 2022. CeD diagnosis was performed through specific serology (anti-tissue transglutaminase IgA and anti-deamidated gliadin peptide IgG) and confirmed by duodenal biopsies demonstrating villous atrophy. We collected data on demographics, diagnosis date, nutritional status (BMI), micronutrients measured in serum, gastrointestinal (GI) symptoms, reason for consult, and the recommendations made by the RD. Data was collected in RedCap (v. 11.1, 2021, US) and expressed as both a proportion and Median (IQR). Results A total of 136 visits from 102 patients were included in the analysis. Of them, 77 were female (75.5%) with a mean age of 40.3 yrs (+/- 16.0). The median year of CeD diagnosis was 4 (IQR= 6) from 2002-2022. Patients reported various symptoms including bloating (50.9%), abdominal pain (34.3%), and constipation (23.5%). 56% of patients were overweight or obese (BMI ampersand:003E25), and 4.9% were undernourished (BMIampersand:003C18). The most common nutrient deficiencies were ferritin below 30 ng/mL (58.8%), zinc below 9.4 µmol/L (23.5%), and suboptimal levels of vitamin D (38.2%). The most common reasons for referral to the RD were to assess GFD adherence (44.1%), dietary management of GI symptoms (30.4%) and nutritional optimization (24.5%). We identified 18 different interventions recommended by the RD, the most common being how to prevent gluten cross-contamination (58.8%), tips for dining out (43.1%), GF diet education (32.4%), and increasing fibre intake (30.4%). The most common reasons for follow up visits (n=34) included dietary management of GI symptoms (60.9%) and GFD adherence (43.5%). Conclusions Patients with CeD face multiple nutritional challenges associated with following a GFD, and a number of GI symptoms. Although the GFD is the only available treatment, this review identifies the need for multiple individualized dietary interventions, which require and encourage the inclusion of a specialized RD to ensure personalized, effective care and support in the management of CeD. Funding Agencies None

Questionnaire-based analysis of autism spectrum disorders and gastrointestinal symptoms in children and adolescents: a systematic review and meta-analysis.

Gastrointestinal (GI) symptoms are frequently experienced by children with autism spectrum disorder (ASD), and these symptoms cause difficulties for these children and their families. However, studies of GI symptom prevalence differ significantly. This meta-analysis aimed to analyze the prevalence of GI symptoms in children with ASD. PubMed, Scopus, Web of Science, EMBASE were electronically searched to collect all literature on gastrointestinal symptoms of children with ASD collected through questionnaires or scales from January 2012 to May 2021. Four researchers independently scanned the literature and extracted information on general characteristics. First author name, year of publication, geographical location, type of study, sample sizes of ASD and control (if any) children, sex and average age, number of GI cases, number of GI symptoms, GI assessment tools (gastrointestinal symptoms scale), autism diagnosis methods, and other necessary data were collected and analyzed using Stata V16. The questionnaires included the Rome, 6-GSI, GIQ, GSRS, GSIQ, ADI-R, PedsQL-GI, parent-report, GI-related, and self-administered questionnaires. Compared with typically developing (TD) children, the odds ratio for In children with ASD with at least one GI symptom was 3.64, and the total prevalence was 55%. The cumulative prevalence rates of various symptoms were summarized, showing that 37% of children with ASD had constipation, 21% had abdominal pain, 19% had diarrhea, 8% had vomiting, and 23% had abdominal distension. The results of this meta-analysis on GI symptoms in ASD show that patients with ASD are more likely to develop symptoms than TD children. The prevalence of GI symptoms in In children with ASD was 55%. www.crd.york.ac.uk/PROSPERO, identifier, #CRD42017080579.

Favipiravir Induced Acute Pancreatitis in a COVID-19 Patient

There are a number of gastrointestinal symptoms and complications of COVID-19. Asymptomatic increase in pancreatic enzymes and rarely symptomatic pancreatitis are observed in this disease. This article describes a 37-year-old male suffering from mildly symptomatic COVID-19 infection, who received tablet favipiravir for his management. His condition was improving, when he developed acute pancreatitis, diagnosed clinically, biochemically and also with help of abdominal ultrasound. When he developed this, all typical symptoms of COVID-19 were improved. As a result, role of favipiravir in the development of this pancreatitis was suspected.
 J MEDICINE JAN 2021; 22 (1) : 69-71

Melatonin as a potential therapeutic molecule against COVID-19 associated gastrointestinal complications: An unrevealed link

Outbreak of the novel coronavirus disease (COVID-19) was first reported in Wuhan, Hubei province of China, in early December 2019 which was later declared as a pandemic by World Health Organization (WHO) in March 2020. The International Committee on Taxonomy of Viruses has termed this novel coronavirus as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). According to the report of WHO on 29th April, 2020, 3018681 confirmed cases along with 207973 deaths have been documented globally. COVID-19 was originally reported as a lethal lung disease with fever and cough as the most common symptoms; however, the increasing number of gastrointestinal symptoms, such as diarrhoea, vomiting and abdominal pain in patients have clearly suggested that gastrointestinal tract (GIT) may also serve as a potential route for SARS-CoV-2 infection. To identify the effective therapies on this pandemic is urgent. Keeping this in mind, we realize that melatonin is a potent antioxidant, anti-inflammatory and immunomodulatory molecule and it has been used in diverse diseases and pathophysiological conditions, including respiratory disease and viral infections. Importantly, melatonin specific receptors and its endogenously synthetic machinery are distributed throughout the mammalian gastrointestinal system. Therefore, the therapeutic potentiality of melatonin in SARS-CoV-2 associated digestive symptoms cannot be ignored. In this review, we focus on the clinical implications of melatonin on the digestive complications associated with SARS-CoV-2 infection.

Mast cell-nerve interactions correlate with bloating and abdominal pain severity in patients with non-celiac gluten / wheat sensitivity.

Gastrointestinal (GI) and extra-GI symptoms/manifestations represent key clinical features of patients with non-celiac gluten/wheat sensitivity (NCG/WS). This study aimed to investigate neuro-immune (focusing on mast cells, MCs) interactions in the duodenal submucosa of patients with NCG/WS. Submucosal whole mounts from duodenal biopsies of 34 patients with self-reported NCG/WS, 28 with celiac disease (CD), 13 with functional dyspepsia (FD), and 24 healthy controls (HC) were analyzed by immunohistochemistry. Quantitative data on neuronal and MCs density and the percentage of MCs in close vicinity to nerves were obtained, and correlations among neurons, MC density and MC-nerve distance (D), and symptoms were assessed in the three groups. The number of submucosal neurons was not different among groups. In NCG/WS, MC density was not different from HC, while it was slightly increased vs. CD (P=.07) and significantly decreased vs. FD (P<.05). The percentage of MCs close to nerves (D<15µm) was similarly increased in all three pathological groups vs. HC (P<.001). In NCG/WS, MC infiltration correlated with bloating (P=.001) and abdominal pain severity (P=.03) and the percentage of MCs in proximity to neurons correlated with the number of GI symptoms (D<5µm; P=.05), bloating and abdominal pain severity (D<15um; P=.01). Submucosal MC infiltration and the close (within 15µm) MC-to-nerve proximity in the duodenum of NCG/WS patients are features providing a histopathological basis to better understand GI symptoms in this condition.

Gastrointestinal failure affects outcome of intensive care

PurposeGoal of this study was to describe incidence and outcome of gastrointestinal failure (GIF) in ICU patients, evaluate its additive role to SOFA score in mortality prediction and describe GIF according to etiology. Materials and methodsA retrospective study with prospective data collection was conducted in mixed adult ICU patients admitted 2004–2015. GIF was considered present if ≥3 of following 6 symptoms occurred in 1 day: maximum gastric residual volume ≥ 500 mL; absent bowel sounds; vomiting or regurgitation; diarrhea; suspected or radiologically confirmed bowel distension; gastrointestinal bleeding. Division into primary (gastrointestinal pathology causing GIF) and secondary (due to other conditions) GIF was made based on origin of syndrome. ResultsGIF developed in 413 (10.4%) of 3959 patients. Primary GIF occurred in 61.3% and secondary GIF in 38.7% of patients. Development of GIF was associated with longer mechanical ventilation, ICU stay and higher ICU, 30-day and 90-day mortality. Outcomes of patients with primary and secondary GIF were similar. All SOFA sub-scores and number of gastrointestinal symptoms on admission day independently predicted 90-day mortality. ConclusionsGastrointestinal failure, independent of origin, is associated with worse ICU outcome. Similar to other organ failures included in SOFA score, GIF independently predicts mortality.

A rare complex mutation in FMF gene; genetics and treatment decisions in Familial Mediterranean Fever patients

Introduction: FMF is an autosomal-recessive autoinflammatory disease characterized by episodic, self-limiting attacks characterized by fever, abdominal pain, pleurisy, arthritis and erysipelas-like-erythema. Systemic amyloidosis is the most severe manifestation of the disease. Case: 3 year old patient for evaluation of FMF who was referred because of gastrointestinal symptoms and a paternal family history of FMF. He had a number of gastrointestinal symptoms as an infant up to the age of 8 months, since the age of 1 year the patient had had 2 episodes each lasting 2 months, during which he would be sick every week with fever and severe abdominal pain and vomiting. The patient met the criteria for FMF based on the criteria from the Sheba medical center of Tel Hashomer in Israel. The patient was determined to have rare heterozygous complex mutation with E148Q-P369S-R408Q in cis state. Testing of his parents revealed that he had inherited all of the mutations from his mother despite the paternal familial history of FMF. Since amyloidosis is rare in Ashkenazi families and due to absence of mutations liked with high risk of amyloidosis, it was determined that he did not need chronic colchicine therapy. To best of our knowledge this is the third reported case of FMF with this gene complex and the first reported case in a patient of Shephardic and Ashkenazi Jewish ancestry. Conclusion: E148Q, P369S and R408Q when present separately are associated with a mild phenotype and incomplete penetrance, but when present together in cis form on same allele may lead to increased penetrance and clinical disease.

Endocannabinoid-related compounds in gastrointestinal diseases.

The endocannabinoid system (ECS) is an endogenous signalling pathway involved in the control of several gastrointestinal (GI) functions at both peripheral and central levels. In recent years, it has become apparent that the ECS is pivotal in the regulation of GI motility, secretion and sensitivity, but endocannabinoids (ECs) are also involved in the regulation of intestinal inflammation and mucosal barrier permeability, suggesting their role in the pathophysiology of both functional and organic GI disorders. Genetic studies in patients with irritable bowel syndrome (IBS) or inflammatory bowel disease have indeed shown significant associations with polymorphisms or mutation in genes encoding for cannabinoid receptor or enzyme responsible for their catabolism, respectively. Furthermore, ongoing clinical trials are testing EC agonists/antagonists in the achievement of symptomatic relief from a number of GI symptoms. Despite this evidence, there is a lack of supportive RCTs and relevant data in human beings, and hence, the possible therapeutic application of these compounds is raising ethical, political and economic concerns. More recently, the identification of several EC‐like compounds able to modulate ECS function without the typical central side effects of cannabino‐mimetics has paved the way for emerging peripherally acting drugs. This review summarizes the possible mechanisms linking the ECS to GI disorders and describes the most recent advances in the manipulation of the ECS in the treatment of GI diseases.

The influence of continuous blood purification on the intra-abdominal pressure and the gastrointestinal dysfunction of intra-abdominal hypertension

Objective To study the influence of continuous blood purification(CBP) on the intra-abdominal pressure(IAP) and the gastrointestinal dysfunction of intra-abdominal hypertension(IAH). Methods 80 patients with IAH were selected and divided into observation group and control group(n=40) according to random number table method.The observation group was given 3d CBP therapy.The control group was given conventional treatment.The mean arterial pressure(MAP), IAP and abdominal perfusion pressure(APP) were detected.The number of gastrointestinal symptoms was observed, sequential organ failure score(SOFA score) was used to assess the organ function of the two groups before and after treatment. Results The MAP, IAP, APP, SOFA score of the two groups before treatment had no statistically significant differences(P>0.05). The MAP of the two groups after treatment[(88.46±8.93)mmHg vs.(87.76±8.04)mmHg]had no statistically significant difference(P>0.05). The IAP[(9.02±1.06)mmHg]and SOFA score[(1.32±0.45)]of the observation group after treatment were significantly lower, the APP [(85.34±7.59)mmHg] was obviously higher than before treatment and the control group[(19.54±4.23)mmHg, (5.24±2.05)points, (70.76±6.43)mmHg], the differences were statistically significant(t=3.575, 2.855, 3.274, 3.563, 3.114, 3.782, all P 0.05). The number of gastrointestinal symptoms of the observation group after treatment [(6.54±2.24)times] was obviously lower than before treatment and the control group [(15.45±4.43)times], the difference was statistically significant(t=3.022, P 0.05). Conclusion CBP could significantly reduce the IPA of the patients with IAH, raise the APP, improve gastrointestinal perfusion, reduce gastrointestinal symptoms, has positive significance to improve the gastrointestinal dysfunction. Key words: Hemofiltration; Pressure; Gastrointestinal motility

Number of Gastrointestinal Symptoms is a Useful Means of Identifying Patients with Cancer for Dysphagia.

Dysphagia is a symptom suggestive of severe underlying pathology, although its causes include organic and non-organic disorders. The epidemiology of dysphagia is, however, poorly understood. We evaluated the prevalence of dysphagia in outpatients in Japan, measured the proportion ultimately found to have an organic cause, and recorded the nature of their symptoms and the underlying disorder. Of 5362 consecutive outpatients attending the Digestive Center at our hospital between June 1, 2010 and December 31, 2012, 186 patients (3.5%) had dysphagia with a frequency score of ≥5 out of 6. The most common diagnosis was cancer (34 patients, 18.3%), followed by gastroesophageal reflux disease (24 patients, 12.9%). An esophageal motility disorder was diagnosed in 21 patients (11.3%); the causes in the remaining 107 patients (57.5%) were miscellaneous. Multivariable analysis identified the following predictors of cancer: age≥54years, weight loss, being a drinker of alcohol, and ≤2 gastrointestinal symptoms. Our findings can be used to inform the prioritization of referrals from primary care for investigation and treatment for patients with cancer for dysphagia.

SAT0330 Juvenile Onset Raynaud's Predicts Good Survival in the Canadian Scleroderma Research Group Cohort

BackgroundJuvenile onset systemic sclerosis is thought to have distinct features compared to adult onset systemic sclerosis (SSc). There is currently little data on patients with juvenile onset of Raynaud's phenomenon...

Sleep disturbances in systemic sclerosis: evidence for the role of gastrointestinal symptoms, pain and pruritus

SSc is a rare autoimmune CTD characterized by thickening and fibrosis of skin and internal organs. There is significant mortality and no cure. Sleep disturbance has been identified as an important contributor to poor quality of life. The objective was to investigate socio-demographic and medical factors potentially associated with sleep disturbance in SSc. The sample consisted of patients from the Canadian Scleroderma Research Group's (CSRG) 15-centre, pan-Canadian Registry assessed with the 8-item Patient-Reported Outcome Measurement Information System (PROMIS) sleep disturbance scale short form, version 1.0. Pearson's correlations were used to assess bivariate association of socio-demographic and medical variables with PROMIS sleep scores. The independent association of PROMIS sleep disturbance scores and factors previously identified as associated with sleep disturbance in the general population, in SSc and other rheumatic diseases, was assessed using multiple linear regression. Among 397 patients in the study (88% female, mean age 57.5 years), 25% (n = 98) had diffuse cutaneous SSc. Mean duration since onset of non-RP symptoms was 10.6 years. Number of gastrointestinal symptoms (standardized regression coefficient β = 0.19, P = 0.001), pain severity (β = 0.21, P < 0.001) and pruritus severity (β = 0.13, P = 0.024) were independently associated with more severe sleep disturbance. Gastrointestinal symptoms, pain and pruritus were associated with sleep disturbance in SSc. Additional research is needed on sleep in SSc so that well-informed sleep interventions can be developed and tested.

The effect of intra-abdominal hypertension on gastrointestinal function

Introduction. Intra-abdominal hypertension (IAH) is a frequent occurrence in critically ill patients. Raised intra-abdominal pressure negatively affects gastro-intestinal (GI) function and may reduce the success of enteral nutrition support, which in turn is associated with adverse clinical outcomes. Aim. To evaluate the impact of raised intra-abdominal pressure (IAP) on GI function and success of enteral nutrition support in an adult intensive care unit (ICU) population at risk of abdominal compartment syndrome (ACS). Methods. In a prospective observational study, critically ill patients in whom the IAP was monitored routinely for clinical indications were assessed for GI symptoms, methods of nutrition support and enteral feeding success on a daily basis. Results. In total, data from 17 patients for a total of 98 patient days were included in the study. The mean IAP was 14.0 mmHg (standard deviation (SD) 3.7) on admission to the ICU. There were 10 patients with grade I, 2 with grade II and 2 with grade III IAH. Seven patients (41%) developed ACS. GI symptoms were common in patients with IAH, and days of IAH correlated positively with number of GI symptoms ( r =0.85, p =0.000). Exclusive enteral feeding was possible on 32% of study days. There was a 12% incidence of enteral feeding intolerance and a 59% incidence of enteral feeding failure. Enteral feeding failure was not significantly associated with IAH ( r =0.43, p =0.08), but was associated with number of GI symptoms ( r =0.67, p =0.003). Days of IAH were positively associated with longer ICU stay ( r =0.65, p =0.005), as was prevalence of IAH combined with concurrent GI symptoms ( r =0.71, p =0.001). Days with IAH and multiple GI symptoms combined was associated with worse subsequent sequential organ failure assessment (SOFA) score ( r =0.64, p=0.005). The worst SOFA score in those who died was significantly higher than that of survivors (11.7 (SD 3.05) v. 6.86 (SD 3.2), p =0.03), and was also significantly higher in those who developed ACS than in those who did not (10.9 (SD 2.5) v. 5.5 (SD 1.1), p =0.0005). The mortality rate was 17%, and only patients who developed ACS died. Conclusion. Raised IAP was associated with poor GI function, enteral feed intolerance, prolonged hospital stay and death.

How Common Is Back Pain in Women With Gastrointestinal Problems?

This study examined the relationship between back pain and gastrointestinal (GI) symptoms in a large scale population study with consideration of possible confounding factors. Cross-sectional analysis of survey data from the Australian Longitudinal Study on Women's Health was conducted using multinomial logistic regression to model 4 frequencies of back pain in relation to number of GI symptoms (including constipation, hemorrhoids, and other bowel problems). A total of 38,050 women from 3 age cohorts were included in analysis. After adjustment for confounding factors, the number of GI symptoms was significantly associated with back pain among all age cohorts. Odds ratios for experiencing back pain "rarely," "sometimes," and "often" increased with the number of GI symptoms. Young, mid-age, and older women who experience 2 or 3 GI symptoms had adjusted odds ratios of 3.3 (2.5 to 4.4), 3.0 (2.5 to 3.7) and 2.8 (2.3 to 3.4), respectively, for "often" having back pain. This study has identified a strong association between back pain and GI symptoms in women. Possible factors that may account for this relationship include referred pain through viscerosomatic convergence, altered pain perception, increased spinal loading when straining during defecation, or reduced support of the abdominal contents and spine secondary to changes in function of the abdominal muscles.

Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery—A randomized clinical study

In acute pancreatitis, traditional treatment has been initial fasting on purpose to avoid activation of proteolytic enzymes and pancreatic enzyme secretion. The aim of the present study was to evaluate the efficacy and feasibility of immediate oral feeding as compared to traditional fasting in patients with mild acute pancreatitis. Sixty patients were randomized to the two treatment groups, fasting or immediate oral feeding. The inclusion criteria were pancreas amylase > or =3 times above normal, onset of abdominal pain within 48 h, acute physiological and chronic health evaluation (APACHE) score<8 and C-reactive protein (CRP) <150 mg/L. Outcome measures were pancreas-specific amylase, systemic inflammatory response, feasibility and length of hospital stay (LOHS). The groups were comparable with respect to age, sex, etiology, APACHE, time from onset of pain and amylase at admission. No significant differences were seen between the groups concerning levels of amylase, CRP, leukocytes, abdominal pain or number of gastrointestinal symptoms. The LOHS was significantly shorter in the oral feeding group (4 vs. 6 days; p<0.05). No signs of exacerbation of the disease process were seen in terms of significant differences between treatment groups for amylase or systemic inflammatory response. In mild acute pancreatitis, immediate oral feeding was feasible and safe and may accelerate recovery without adverse gastrointestinal events.

Comparison of symptoms of influenza A with abacavir-associated hypersensitivity reaction.

Differentiation between abacavir hypersensitivity and viral respiratory infections is problematic. Fifteen cases of abacavir hypersensitivity were matched to 30 controls with culture proven influenza A with no abacavir exposure. Rash was associated with hypersensitivity (odds ratio [OR] = 13.1, P = 0.02) as was the presence of nausea (OR = 30, P < 0.001), vomiting (OR = 17.1, P = 0.001) or diarrhoea (OR = 22, P < 0.001). The number of gastrointestinal symptoms was also predictive of hypersensitivity reaction (P < 0.001). Respiratory symptoms (cough, sore throat, or dyspnoea) were not associated with abacavir hypersensitivity (OR = 0.08, P = 0.001). Multivariate analysis confirmed the following associations for abacavir hypersensitivity: the number of gastrointestinal symptoms (OR = 8.6, P = 0.0032), cough (OR = 0.039, P = 0.02) and rash (OR = 16.9, P = 0.07). Abacavir hypersensitivity is strongly associated with gastrointestinal (GI) symptoms. Cough without GI symptoms is associated with influenza.

Psychological distress is linked to gastrointestinal symptoms in diabetes mellitus.

Gastrointestinal (GI) symptoms are common in patients with long-standing diabetes mellitus, but the pathogenesis is controversial. We aimed to determine if GI symptoms are linked to psychological distress in diabetes. A consecutive sample of outpatients with diabetes mellitus (n = 209) and a random sample of community diabetics (n = 892) completed a validated questionnaire measuring GI symptoms, the Hospital Anxiety and Depression (HAD) Scale for anxiety and depression, and the Eysenck short neuroticism scale. Overall, 42% reported one or more GI symptoms: bloating, abdominal pain, loose stools, and urgency were most common. The mean HAD and neuroticism scores were significantly higher for most GI symptoms (11 of 14, all p < 0.05), and a dose-response relationship was observed. GI symptoms were, in general, approximately twice as frequent in cases with anxiety or depression (HAD > or = 11). Anxiety, depression, and neuroticism were each independently associated with the number of GI symptoms, adjusting for age, gender, duration and type of diabetes, and self-reported glycemic control. Increased levels of state anxiety and depression and neuroticism are associated with upper and lower GI symptoms in diabetes mellitus. It is uncertain whether psychological distress is causally linked to symptoms, or whether GI symptoms per se increase levels of anxiety and depression.

Psychological distress is linked to gastrointestinal symptoms in diabetes mellitus

OBJECTIVE: Gastrointestinal (GI) symptoms are common in patients with long-standing diabetes mellitus, but the pathogenesis is controversial. We aimed to determine if GI symptoms are linked to psychological distress in diabetes. METHODS: A consecutive sample of outpatients with diabetes mellitus (n = 209) and a random sample of community diabetics (n = 892) completed a validated questionnaire measuring GI symptoms, the Hospital Anxiety and Depression (HAD) Scale for anxiety and depression, and the Eysenck short neuroticism scale. RESULTS: Overall, 42% reported one or more GI symptoms: bloating, abdominal pain, loose stools, and urgency were most common. The mean HAD and neuroticism scores were significantly higher for most GI symptoms (11 of 14, all p < 0.05), and a dose–response relationship was observed. GI symptoms were, in general, approximately twice as frequent in cases with anxiety or depression (HAD ≥ 11). Anxiety, depression, and neuroticism were each independently associated with the number of GI symptoms, adjusting for age, gender, duration and type of diabetes, and self-reported glycemic control. CONCLUSIONS: Increased levels of state anxiety and depression and neuroticism are associated with upper and lower GI symptoms in diabetes mellitus. It is uncertain whether psychological distress is causally linked to symptoms, or whether GI symptoms per se increase levels of anxiety and depression.

Acquired motility disorders in childhood.

Acquired motility disorders in childhood cause a number of gastrointestinal symptoms - principally, recurrent vomiting, abdominal pain and distension, constipation and loose stools. Gastrointestinal motility disorders result from disturbances of the control mechanisms of gut motor activity, which may be produced by organic disease involving enteric nerves and muscle, perturbation of the humoral environment of the nerves and muscle, and altered central nervous system input. In children, both congenital and acquired disease processes may produce these pathogenetic mechanisms, resulting in syndromes that vary in severity from chronic intestinal pseudo-obstruction to the irritable bowel syndrome.

7 Motility disorders in childhood

Motility disorders are very common in childhood, causing a number of gastrointestinal symptoms: recurrent vomiting, abdominal pain and distension, constipation and obstipation, and loose stools. The disorders result from disturbances of gut motor control mechanisms caused by either intrinsic disease of nerve and muscle, central nervous system dysfunction or perturbation of the humoral environment in which they operate. Intrinsic gut motor disease and central nervous system disorder are most usually congenital in origin, and alterations of the humoral environment acquired. Irritable bowel syndrome occurs in children as well as adults and is multifactorial in origin, with an interplay of psychogenic and organic disorders.