Occurrence Of Gastrointestinal Symptoms Research Articles

The effect of neurotransmitters on the course of functional gastrointestinal disorders associated with emotional volitional disturbances caused by stress in children

Background. The medico-social significance of functional gastrointestinal disorders (FGID) in children is due to their prevalence and impact on the quality of life of patients. According to the biopsychosocial model, FGID are heterogeneous diseases that arise as a result of a complex interaction of biological, psychoemotional, and psychosocial factors. Objective: based on the gene­ralization of available literature data, to highlight the influence of serotonin and melatonin neurotransmitters on the course of FGIR associated with emotional volitional disturbances caused by stress in children. Materials and methods. Modern domestic and international scientific literature on the influence of serotonin and melatonin on the course of FGIR associated with emotional volitional disturbances caused by stress in children was reviewed and analyzed. To search for literary sources, the Scopus, PubMed, ResearchGate, Wiley Online Library, and Google Scholar databases were studied for 2016–2024, a total of 98 sources. Results. Modern etiopathogenetic factors for the occurrence of FGIR in children are described, with the key components of their biopsychosocial model highligh­ted. The influence of stressors on the development of mental disorders in children with FGIR, in particular emotional and volitional changes, is considered. We have demonstrated the role of serotonin and melatonin in the regulation of mood, emotions, sleep, beha­vior, anxiety, depression, etc. The importance of these neurotransmitters in the occurrence of gastrointestinal symptoms in FGIR is highlighted with modern approaches to the management of children with FGIR associated with emotional volitional disturbances caused by stress being considered. A promising therapeutic direction is identified — the use of supplements of certain neurotransmitters (in particular, serotonin and melatonin) in children with this pathology. Conclusions. The analyzed literature data demonstrate the heterogeneity of FGIR in children and the importance of stressors in their development. Neurotransmitters play a significant role in the formation of the response to stress and the course of FGIR associated with emotional volitional disturbances caused by stress in children. Data on the effectiveness of serotonin and melatonin supplementation in children with FGIR are few, so there is a need for further research on this issue in order to improve the effectiveness of treatment and the quality of life of these patients.

#279 The impact of synbiotics on the uremic toxins, inflammation, and gut microbiome of CKD patients—randomized, double-blind, placebo-controlled trial

Abstract Background and Aims The microbiome represents a complex system of microorganisms coexisting within the human body. The intestinal tract is the most densely populated region and is essential in preserving health and developing diseases such as chronic kidney disease (CKD). The relationship between the gut microbiome and the kidney is complex. CKD can significantly affect the composition of the gut microbiome, which, through the fermentation process, participates in the production of over 90 different uremic toxins with the potential to aggravate systemic inflammation, oxidative stress, and decrease renal function. Indoxyl-sulfate (IS), p-cresyl-sulfate (PCS), and trimethylamine-N-oxide (TMAO) are the most closely studied. Supplementation with pre-, pro-, or synbiotics could reduce the production and improve the intestinal clearance of uremic toxins. Assessing the efficacy and safety of this potential strategy has been the aim of our randomized, double-blind, placebo-controlled study. Method A total of 84 patients, aged over 18 years, with an estimated glomerular filtration rate (eGFR) between 15 and 45 ml/min, were randomized into two groups, the one treated with synbiotic—64 billion colonies of Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium lactis with 6.4 g of inulin in the form of capsules, and a control group treated with an identical number and appearance of capsules but with a total of 6.8 g of bioinert maltodextrin, over a period of 12 weeks. Strict control of the diet and the use of antibiotics and other probiotics was carried out. The study examined the effect of therapy on the serum level of the uremic toxins IS, PCS, and TMAO, the composition of the stool microbiome, the serum level of interleukin 6 (IL6), high-sensitivity C-reactive protein (hs-CRP), eGFR, albuminuria, degree of liver steatosis according to ultrasound elastomeric measurement, occurrence of gastrointestinal symptoms and gut transition time. The level of uremic toxins was determined using ultra-performance liquid chromatography. To determine the composition of the intestinal microbiome, we used 16s rRNA amplicon sequencing targeting the V3-V4 hypervariable region. Results The synbiotic treatment significantly reduced the levels of IS (−11% vs. 1%, p = 0.033) and PCS (−6% vs. 0%, p = 0.011) in the intervention arm. We also observed that treatment with the synbiotic significantly reduced hsCRP levels (ΔhsCRP 0 vs −29%, p = 0.03). Synbiotic treatment greatly enriched the intestinal microbiome with the genera Lactobacillus, Bifidobacterium, and Faecalibacterium by 81%, 55%, and 40%, respectively, with a reduction in the genera Ruminococcus and Enterobacterium by 35% and 40%. The use of synbiotics led to a significant reduction of liver steatosis according to the dynamics of the attenuation coefficient—ATT (ΔATT% −0.6 vs −2.3%, p = 0.33), with a decrease in the serum alanine aminotransferase—ALT (ΔALT −19% vs −28%, p = 0.035). A statistically significant shortening of the gut transition time—GTT was observed in the intervention arm (ΔGTT −5 h vs −10 h, p = 0.031), paralleled by a reduction in the intensity and prevalence of constipation symptoms. No side effects were observed. Conclusion Synbiotics could be an effective, safe, and affordable therapy that could be used to modify the intestinal microbiome of CKD patients and contribute to the reduction of the level of uremic toxins, inflammation, degree of fatty liver, shorten gut transit time and reduce the symptoms of constipation.

Associations between various markers of intestinal barrier and immune function after a high-intensity exercise challenge.

Strenuous exercise can result in disruption of intestinal barrier function and occurrence of gastrointestinal symptoms. The aim of this exploratory study was to elucidate systemic effects of increased intestinal permeability after high-intensity exercise. Forty-one endurance-trained subjects performed a 60-min treadmill run at 80% VO2max. Small intestinal permeability was measured as urinary excretion ratio of lactulose/rhamnose (L/R). Blood, saliva and feces were analyzed for gut barrier and immune-related biomarkers. The exercise challenge increased several markers of intestinal barrier disruption, immune function and oxidative stress. We found a negative correlation between L/R ratio and uric acid (r = -0.480), as well as a positive correlation between the L/R ratio and fecal chromogranin A in male participants (r = 0.555). No significant correlations were found between any of the markers and gastrointestinal symptoms, however, perceived exertion correlated with the combination of IL-6, IL-10 and salivary cortisol (r = 0.492). The lack of correlation between intestinal permeability and gastrointestinal symptoms could be due to minor symptoms experienced in lab settings compared to real-life competitions. The correlation between L/R ratio and uric acid might imply a barrier-protective effect of uric acid, and inflammatory processes due to strenuous exercise seem to play an important role regarding physical exhaustion.

Ramadan fasting following laparoscopic sleeve gastrectomy: a prospective online survey cohort study in Egypt.

This study aims to explore the feasibility and implications of Ramadan fasting for patients who have undergone laparoscopic sleeve gastrectomy (LSG), assessing impacts on hydration, nutrient intake, weight management, and gastrointestinal symptoms. A prospective online survey was conducted among 218 LSG patients and 83 control individuals with obesity who had not undergone surgery. Participants were surveyed before and after Ramadan, providing data on fasting practices, hunger and satiety levels, fluid and nutrient intake, and the occurrence of gastrointestinal symptoms. Statistical analysis was used to compare outcomes between fasting and non-fasting periods and between LSG patients and control participants. A total of 70.2% of LSG patients completed the entire month of Ramadan fasting, with a significant correlation found between the duration post-surgery and the ability to fast. Fasting LSG patients reported decreased hunger, increased satiety, and significant reductions in fluid and nutrient intake during Ramadan. Weight loss was reported in 90.8% of fasting patients, with an average total weight loss of 7.2%. Gastrointestinal symptoms were mild and manageable. The majority of LSG patients can successfully fast during Ramadan with appropriate precautions, including adequate fluid and protein intake. The study highlights the need for patient education and tailored nutritional guidance to ensure safe and effective fasting post-LSG. In order to fast for the entire month, patients may be advised to consider postponing surgery for a few months after Ramadan, avoid overeating during non-fasting hours, and ensure sufficient fluid consumption and protein intake during fasting.

Characteristics and related factors of waterborne and foodborne infectious disease outbreaks before and after the onset of the COVID-19 pandemic (2017-2021) in the Republic of Korea: a descriptive study.

The incidence of waterborne and foodborne infectious diseases (WFIDs) continues to increase annually, attracting significant global attention. This study examined trends in WFID outbreaks in the Republic of Korea over the 5-year period before and during the coronavirus disease 2019 (COVID-19) pandemic and provided foundational data to establish measures for the prevention and control of WFID outbreaks. We analyzed 2,541 WFID outbreaks from 2017 to 2021 (42,805 cases) that were reported through the Integrated Disease Surveillance System of the Korea Disease Control and Prevention Agency. Outbreaks were defined as the occurrence of gastrointestinal symptoms in ≥2 individuals within a group with temporal and regional epidemiological associations. The related factors associated with WFID outbreaks during the observation period were statistically analyzed. The total number of WFID outbreaks significantly decreased in 2020 during the COVID-19 pandemic and increased to the pre-pandemic level in 2021. Different patterns were observed for each pathogen. The incidence of Salmonella outbreaks more than doubled, while norovirus outbreaks decreased significantly. WFID outbreaks in the Republic of Korea showed different patterns before and during the COVID-19 pandemic, influenced by infection control measures and changes in dietary consumption patterns. Outbreaks of some diseases increased, but the infection control measures applied during the pandemic resulted in a significant decrease in the overall number of WFID outbreaks. This highlights the importance of strengthening the management strategies for outbreak prevention through hygiene inspections, long-term monitoring, education, and promotion by conducting multidimensional analyses to understand the complex related factors.

Effects of serial and acute enteric-coated sodium bicarbonate supplementation on anaerobic performance, physiological profile, and metabolomics in healthy young men.

BackgroundPrevious studies have reported that sodium bicarbonate ingestion may enhance high-intensity exercise performance and cause severe gastrointestinal distress. However, enteric-coated sodium bicarbonate may reduce gastrointestinal symptoms of sodium bicarbonate after oral administration. This remains to be confirmed. This study aimed to verify the effects of serial and acute enteric-coated sodium bicarbonate supplementation on anaerobic performance, physiological profile, and metabolomics in healthy young men.MethodsHealthy young males (n = 12) ingested 0.2 g/kg body mass of enteric-coated sodium bicarbonate (ES) in serial enteric-coated sodium bicarbonate (SES, continuous ES supplementation for 5 days) and acute enteric-coated sodium bicarbonate (AES, acute ES supplementation before exercise) or a placebo (PL) in a randomized crossover design. After each supplement protocol, the participants completed four Wingate anaerobic tests (WAT). The first three Wingate tests (testing anaerobic capacity) were performed with a 5-min passive recovery between each. After the third Wingate test, participants were required to complete a 50-min recovery followed by a fourth WAT test (testing the recovery of anaerobic capacity after 50-min intervals). Blood lactate (BLA), heart rate (HR), and ratings of perceived exertion (RPE) were measured in all conditions during the test, as was the subjective gastrointestinal–symptoms assessment questionnaire (GSAQ). Mean power (MP) and peak power (PP) were recorded after four WATs. Urine samples were collected before the test and 50 min after the 3rd WAT.ResultsSerial enteric-coated sodium bicarbonate supplementation improved anaerobic capacity in the third bout of WATs, as observed based on an increase in mean power (SES vs. PL (613 ± 57 vs. 542 ± 64 W), P = 0.024) and peak power (SES vs. PL (1,071 ± 149 vs. 905 ± 150 W), P = 0.016). Acute ES supplementation did not affect anaerobic capacity. The occurrence of gastrointestinal symptoms after enteric-coated sodium bicarbonate supplementation was minimal and no difference compared to placebo in the current study. In particular, serial enteric-coated sodium bicarbonate supplementation had no gastrointestinal side effects before the test. The AES and SES groups had a trivial effect on blood lactate compared to the PLA group. There was no significant difference in HR and RPE among the three groups. Based on targeted metabolomics analysis, the 50 min after the third WAT, the levels of lactate (P < 0.001), L-Malic acid (P < 0.05), and oxaloacetate (P < 0.05) were significantly higher in the SES group than in the PL group. Compared with the AES group, the levels of lactate and fumarate in the SES group were significantly increased (P < 0.05).ConclusionsOur study indicates that serial enteric-coated sodium bicarbonate supplementation positively improves anaerobic performance among healthy young men. However, acute ingestion of enteric-coated sodium bicarbonate did not improve anaerobic exercise performance. Either with serial or acute supplementation doses, enteric-coated sodium bicarbonate produced fewer gastrointestinal symptoms and no difference compared to placebo, especially with no gastrointestinal side effects after serial supplementation. Serial and acute supplementation of enteric-coated sodium bicarbonate might tend to promote lactate clearance. Furthermore, serial enteric-coated sodium bicarbonate ingestion may cause changes in the metabolism of lactate, L-Malic acid, oxaloacetate, and fumarate 50 min after exercise, which presumably may promote the tricarboxylic acid cycle and lactate clearance.

Post-infectious irritable bowel syndrome: renaissance time?

Postinfectious irritable bowel syndrome (PI–IBS) is a distinct phenotype of the disease. The occurrence of gastrointestinal symptoms in PI–IBS is in direct chronological connection with an episode of acute intestinal infection. Previously the problem was considered as the outcome of parasitic, protozoal or bacterial infection. The global spread of a novel coronavirus infection (COVID-19) and increase in the number of new cases of IBS in the population suggests a renaissance of PI–IBS and makes us look at this problem again. This article summarizes and presents modern information on the possible mechanisms of development of PI–IBS, including in persons who have undergone COVID-19.

Severe HepatitisE virus infection in a patient with rheumatoid arthritis treated with baricitinib

Es wurde ein Patient mit rheumatoider Arthritis (RA) vorgestellt, der unter der Therapie mit dem Januskinase-1/2-Inhibitor Baricitinib eine Infektion mit dem Hepatitis-E-Virus (HEV) entwickelte. Unser Patient hatte bei seiner vierteljährlichen Routineuntersuchung deutlich erhöhte Transaminasen bei einer unauffälligen körperlichen Untersuchung. Es fanden sich Antikörper der IgM- und IgG-Klasse gegen HEV und ein erhöhtes C‑reaktives Protein (CRP) sowie HEV-RNA mittels Real-Time-PCR, was auf eine frische HEV-Infektion hinwies. Baricitinib wurde sofort abgesetzt. Die ausführliche Anamnese ergab, dass der Patient Tage vor der Konsultation Rindertartar verzehrt hatte, ohne dass gastrointestinale Symptome oder Fieber aufgetreten waren. Im weiteren Verlauf erholte sich der Patient vollständig, und die Leberfunktionstests und das CRP normalisierten sich innerhalb von 3 Monaten. Baricitinib wurde daraufhin wieder eingenommen. Bisher wurden nur wenige Daten zu HEV-Infektionen bei RA-Patienten, die mit JAK-Inhibitoren behandelt wurden, publiziert.

Gastrointestinal Symptoms are Quantitatively and Biologically Associated with COVID-19 Severity

Background: Gastrointestinal (GI) symptoms have been reported variously in patients with coronavirus disease 2019 (COVID-19). However, whether GI symptoms are associated with critical illness remain inconclusive.Methods: We performed a large-scale meta-analysis to comprehensively quantify the prevalence of various GI symptoms and their associations with COVID-19 severity. Single-cell transcriptome and SARS-CoV-2 pseudovirus infection assay were performed to elucidate potential mechanisms. A total of 55 studies encompassing 14,361 cases were included in this meta-analysis.Findings: We found that anorexia was the most common GI symptom in COVID-19 patients with a pooled prevalence of 19.93%. Patients with GI symptoms of abdominal pain, anorexia, and diarrhea have 2.78, 2.05, and 1.25 times risks to develop COVID-19 severity, respectively. Notably, male patients with GI symptoms were more susceptible to severe COVID-19 than females with risk increased by 47%. The proportion of angiotensin-covering enzyme II (ACE2)-positive cells in intestinal epithelial cells was the highest compared with that in other GI organs. Biologically, elevated expression of ACE2 in intestinal epithelial cells could promote SARS-CoV-2 colonization in accordance with the occurrence of GI symptoms in the clinical course of COVID-19.Interpretation: Timely recognition of COVID-19 patients with GI symptoms in the early stage of infection may reduce the risk of developing severe illness.Funding: None to declare. Declaration of Interest: None to declare.

Gastrointestinal Symptoms Are Associated with the Increased Risk of Progression from Non-Severe to Severe Illness in COVID-19 Patients: A Multicenter, Retrospective Study

Background: The involvement of gastrointestinal (GI) symptoms in the progression of COVID-19 patients has not been illustrated, with the association between GI symptoms and severity of illness remaining controversial. The present study aimed to evaluate the association between GI symptoms and the illness progression, severity, and prognosis of COVID-19 patients. Design: This retrospective study recruited 1024 consecutive patients with laboratory-confirmed COVID-19 from three hospitals in Wuhan. The severity of illness was classified as non-severe and severe for analyses. The primary outcome was the association between GI symptoms and the progression from non-severe to severe illness (PNTS) in COVID-19 patients. Results: Of the 934 COVID-19 patients (mean age 59.3 years; 43.7% males), the prevalence of overall and specific GI symptoms at/prior to admission were 59.9% and 13.0%, respectively. Patients with GI symptoms were associated with increased risk of fever (56.1% vs. 48.1%; P=0.02), increased IL-6 (18.2% vs. 11.7%; P=0.04), ground-glass opacity (56.8% vs. 43.1%; PConclusion: The occurrence of GI symptoms is proved to be the independent risk factor for PNTS, which might be a crucial indicator in the early prevention of illness deterioration.Funding Statement: National Key R&D Program of China (2018YFC1313103), and National Natural Science Foundation of China (Grant No. 81670473 and 81873546), "Shu Guang" project of Shanghai Municipal Education Commission and Shanghai Education Development Foundation (No. 19SG30).Declaration of Interests: There is no conflict of interests for each authorEthics Approval Statement: This study was approved by the Ethics Committee of the Changhai hospitals. The requirement for informed patient consent was waived by the ethics committee due to the retrospective design and as the data analyzed were considered as a part of a continuing investigation of a public health emergency of international concern by the National Health Commission (NHC) of the People's Republic of China.

Transtorno do Espectro Autista (TEA) e hipersensibilidade alimentar: perfil nutricional e prevalência de sintomas gastrointestinais

Objetivo: caracterizar o perfil nutricional e identificar a ocorrência de sintomas gastrointestinais na presença de hipersensibilidade alimentar, de crianças e adolescentes atendidos em um centro de referência no sul do Brasil. Método: estudo transversal realizado por meio da aplicação de questionário em um centro educacional para portadores do transtorno do espectro autista, na cidade de Pelotas, RS. Foram coletados dados sociodemográficos, bem como dados antropométricos e informações sobre dietas de exclusão, acompanhamento nutricional e sintomas gastrointestinais dos participantes. Resultados: Participaram do estudo 12 indivíduos, dos quais a maioria era do sexo masculino (75%), criança (91,6%) e da cor branca (91,6%). Metade dos participantes estava com excesso de peso (25% sobrepeso e 25% obesidade), além daqueles que já apresentavam risco de sobrepeso (16,7%), enquanto somente 33,3% estavam eutróficos. Dentre as dietas de exclusão, as mais prevalentes foram lactose (75%), caseína (25%) e glúten (25%), sendo que a maioria (75%) dos alunos não fazia acompanhamento nutricional. Avaliando presença de sintomas gastrointestinais, flatulência (33,3%) foi o mais relatado. Conclusão: destaca-se a importância de um suporte nutricional adequado para este público, uma vez que a maioria da amostra está com risco ou excesso de peso, além da presença de hipersensibilidade alimentar. Deve-se ter atenção no manejo de dietas de exclusão e estratégias para lidar com os sintomas gastrointestinais presentes, uma vez que sua eficácia ainda não possui comprovação científica para todos os casos.

Acute gastric injury after ingestion of substrate with hyperosmolar glucose and benzoate inversely related with small intestinal bacterial overgrowth.

The occurrence of gastrointestinal symptoms and the presence of small intestinal bacterial overgrowth (SIBO) could be determined after ingestion of substrate with highly concentrated glucose for glucose breath test (GBT), after which endoscopic images for acute gastric injury have not been clarified. The aims of this study were to investigate the prevalence and relationship of acute gastric injury with SIBO after GBT. A cohort of 235 patients with functional gastrointestinal symptoms undergoing breath test with 50 g glucose solution, immediately followed by upper endoscopy were surveyed. The acute gastric injury in endoscopic images and the GBT for hydrogen (H2) or methane (CH4) were assessed. The prevalence of acute gastric injury was 28.1% (66/235) after GBT. There were significant differences in GBT positivity (+) with and without gastric injury (25.8% vs 40.8%, p=0.03). In subtypes, GBT (H2) + was significantly lower in group with gastric injury than in the group without. No differences were seen in GBT (CH4) + between two groups. On multivariate analysis, the subtype of GBT (H2) + (Odds ratio (OR)=0.42; 95% Confidence interval (CI)=0.20-0.90; p=0.03) inversely and female (OR=2.11; 95% CI=1.11-4.00; p=0.02) were significantly related with gastric injury. Whereas gastric injury was the only independent related factor for GBT + inversely (OR=0.51; 95% CI=0.27-0.97; p=0.04). Highly concentrated glucose might provoke acute gastric injury, which could predict the absence of SIBO.

Gastrointestinal symptoms and digestive comorbidities in an Italian cohort of patients with COVID-19.

The Coronavirus Disease 2019 (COVID-19) pandemic mainly involves respiratory symptoms, though gastrointestinal (GI) symptoms are increasingly being recognized. In this context, the presence of comorbidities appears to be associated with adverse outcomes. However, the role of digestive manifestations is not yet well defined. The primary aim of this study was to assess the prevalence of GI symptoms and digestive comorbidities in a cohort of patients with COVID-19 compared to controls. The secondary aim was to determine the association of GI-symptoms and digestive comorbidities with clinical outcomes. Inpatients with COVID-19 and controls with similar symptoms and/or radiological findings were enrolled. Symptoms at admission and throughout hospitalization were collected as they were comorbidities. The measured clinical outcomes were mortality, intensive care unit admission and cumulative endpoint. A total of 105 patients were included: 34 with COVID-19 and 71 controls. At admission, the prevalence of GI symptoms among COVID-19 patients was 8.8%. During hospitalization, the frequency of GI symptoms was higher in patients with COVID-19 than in controls (p=0.004). Among patients with COVID-19, the mortality and a cumulative endpoint rates of those with GI symptoms were both lower than for those without GI symptoms (p=0.016 and p=0.000, respectively). Finally, we found digestive comorbidities to be associated with a milder course of COVID-19 (p=0.039 for cumulative endpoint). Our results highlighted the non-negligible frequency of GI symptoms in patients with COVID-19, partly attributable to the therapies implemented. In addition, the presence of GI symptoms and digestive comorbidities is associated with better outcomes. Most likely, digestive comorbidities do not hinder the host's immune response against SARS-COV-2, and the occurrence of GI symptoms might be linked to a faster reduction of the viral load via the faecal route.

The rise of one anastomosis gastric bypass: insights from surgeons and dietitians.

One anastomosis gastric bypass/Mini Gastric Bypass (OAGB/MGB) is an emerging bariatric surgery (BS) technique. We evaluated and compared attitudes of bariatric surgeons and dietitians towards the considerations for choosing BS-type ("Decision-making"), the contributing factors to the rise of OAGB/MGB in Israel ("OAGB/MGB-rise") and notions regarding the occurrence of gastrointestinal (GI) symptoms and nutritional deficiencies following OAGB/MGB. Anonymous online surveys were distributed. The participants were asked to rate by a 10-point Likert scale (0 = not at all; 100 = very much/often) their attitudes towards "Decision-making", "OAGB/MGB-rise" and occurrence of GI symptoms and nutritional deficiencies following OAGB/MGB. For "Decision-making" and "OAGB/MGB-rise", items were considered prioritized where ≥ 50% of the group considered them as 'very-important' (rating ≥ 80). Data on age, sex, years-in-practice and main workplace were also collected. A total of 106 professionals participated in the survey (42 surgeons; 64 dietitians). The respective mean age, years-in-practice and sex were 52.3 ± 8.7 vs. 42.3 ± 9.0years, 21.0 ± 10.8 vs. 15.5 ± 9.2years and 85.7% vs. 3.1% males. The inter-observer agreement for prioritized items related to "Decision-making" was fair (Kappa = 0.250; P = 0.257) and both groups prioritized patient's BMI, comorbidities and compliance. The inter-observer agreement for prioritized items related to "OAGB/MGB-rise" was moderate (Kappa = 0.550; P = 0.099) and both groups prioritized ease of performance, shorter operation duration and failure of former restrictive BS. Surgeons reported lower occurrence of nutritional deficiencies and GI symptoms as adverse effects of OAGB/MGB (P ≤ 0.033). The study highlights the views of bariatric surgeons and dietitians concerning factors that underpin the rise of OABG/MGB in Israel and possible rates of GI symptoms and nutritional deficiencies associated with this modality.

Familial intestinal degenerative neuropathy with chronic intestinal pseudo-obstruction linked to a gene locus with duplication in chromosome 9

Background: Intestinal degenerative neuropathy without extra-intestinal involvement occurs as familial forms (FIDN) but the genetics behind is unknown. We studied a Swedish family with autosomal dominant disease and several cases of chronic intestinal pseudo-obstruction (CIP).Methods: We included 33 members of a family sharing a male ancestor. Chronic intestinal symptoms including diarrhoea occurred in 11, four had severe CIP. DNA was analysed with SNP-microarray (Affymetrix), linkage (Allegro Software) and gene dosage (CNAG 3.0).Results: Genetic linkage was found to the short arm of Ch9 to a 9.7 Mb region with 45 protein-coding genes, 22 of which were duplicated (1.2 Mb duplication) (dup(9)(p21.3) with breaking point in the FOCAD-gene. Lod score for the region was 3.4. Fourteen subjects were duplication carriers including all 11 subjects having severe chronic symptoms/CIP. Nineteen subjects had no duplication. The occurrence of gastrointestinal symptoms in the family was strongly linked to duplication carrier-ship (p = .0005). The two branches of the family had separate maternal ancestors (A and B). Including the previous generation, severe disease (overt CIP and/or death from intestinal failure) was assessed to occur in 100% (5/5) of duplication carriers in branch A and in 21% (3/14) in branch B (p = .005). In branch B the onset of symptoms was later (median 38 vs. 24 yrs) and three duplication carriers were symptom-free.Conclusions: In this family with autosomal dominant hereditary intestinal neuropathy, the disorder is linked to a 9.7 Mb region in Ch9 including a 1.2 Mb duplication. There is a significant difference in disease expressivity between family branches, seemingly related to separate maternal ancestors.

Pharmacokinetics of Para-Aminosalicylic Acid and Its 2 Major Metabolites: A Potential Relationship to the Development of Gastrointestinal Intolerance.

Para-aminosalicylic acid (PAS), often the last drug remaining for treatment of drug-resistant tuberculosis, is notorious for causing gastrointestinal intolerance; however, the cause of PAS intolerance is uncertain. The objective of this study was to assess relationships between peak concentrations of PAS administered as a granular slow-release enteric coated formulation, and its metabolites acetyl-PAS and glycine-PAS, and intolerance. PAS and its metabolites were measured in 29 adult patients with drug-resistant tuberculosis at Brooklyn Hospital, Cape Town, randomized to receive granular slow-release enteric-coated PAS 4 g twice daily or 8 g once daily for 1 week, followed by the alternative regimen. Concentrations of PAS and its metabolites were determined by liquid chromatography and tandem mass spectrometry, and a visual analogue scale evaluated intolerance. Spearman's correlation test assessed the relationship between maximum plasma concentrations (Cmax ) and intolerance scores. A large interindividual variability was observed for the PAS Cmax (40.42-68.55 mg/L) following 4 g twice daily; (62.69-102.41 mg/L) for 8 g once daily and a similar wide Cmax range found for the metabolites acetyl-PAS and glycine-PAS. Twenty-six patients reported at least 1 intolerance episode, but most visual analogue scale scores clustered around 0. Significant inverse associations were found between acetyl-PAS Cmax and bloating (rho = -0.448; P = .025) and diarrhea (rho = -0.407; P = .044) for the twice-daily regimen and a similar inverse association found for glycine-PAS and diarrhea (rho = -0.412; P = .041). Plasma concentrations of the metabolites did not correlate with the occurrence of gastrointestinal symptoms, but higher metabolite concentrations correlated with lower intolerance scores; slow metabolism of PAS and its continued presence in the intestinal tract may be the main cause of intolerance.

Clinical evaluation of two different protein content formulas fed to full-term healthy infants: a randomized controlled trial

BackgroundA high early protein intake is associated with rapid postnatal weight gain and altered body composition. We aimed to evaluate the safety of a low-protein formula in healthy full-term infants.MethodsA randomized controlled trial was conducted. A total of 118 infants were randomized to receive two different protein content formulas (formula A or formula B (protein content: 1.2 vs. 1.7 g/100 mL, respectively)) for the first 4 months of life. Anthropometry and body composition by air displacement plethysmography were assessed at enrolment and at two and 4 months. The reference group comprised 50 healthy, exclusively breastfed, full-term infants.ResultsWeight gain (g/day) throughout the study was similar between the formula groups (32.5 ± 6.1 vs. 32.8 ± 6.8) and in the reference group (30.4 ± 5.4). The formula groups showed similar body composition but a different fat-free mass content from breastfed infants at two and 4 months. However, the formula A group showed a fat-free mass increase more similar to that of the breastfed infants. The occurrence of gastrointestinal symptoms or adverse events was similar between the formula groups.ConclusionsFeeding a low-protein content formula appears to be safe and to promote adequate growth, although determination of the long-term effect on body composition requires further study.Trial registrationThe present study was retrospectively registered in ClinicalTrials.gov (trial number: NCT03035721 on January 18, 2017).

No effect of adding dairy lipids or long chain polyunsaturated fatty acids on formula tolerance and growth in full term infants: a randomized controlled trial

BackgroundWhen breastfeeding is not possible, infants are fed formulas in which lipids are usually of plant origin. However, the use of dairy fat in combination with plant oils enables a lipid profile in formula closer to breast milk in terms of fatty acid composition, triglyceride structure and cholesterol content. The objectives of this study were to investigate the impact on growth and gastrointestinal tolerance of a formula containing a mix of dairy lipids and plant oils in healthy infants.MethodsThis study was a monocentric, double-blind, controlled, randomized trial. Healthy term infants aged less than 3 weeks whose mothers did not breastfeed were randomly allocated to formula containing either: a mix of plant oils and dairy fat (D), only plant oils (P) or plant oils supplemented with long-chain polyunsaturated fatty acids (PDHA). Breastfed infants were included in a reference group (BF). Anthropometric parameters and body composition were measured after 2 and 4 months. Gastrointestinal tolerance was evaluated during 2 day-periods after 1 and 3 months thanks to descriptive parameters reported by parents. Nonrandomized BF infants were not included in the statistical analysis.ResultsEighty eight formula-fed and 29 BF infants were enrolled. Gains of weight, recumbent length, cranial circumference and fat mass were similar between the 3 formula-fed groups at 2 and 4 months and close to those of BF. Z-scores for weight, recumbent length and cranial circumference in all groups were within normal ranges for growth standards. No significant differences were noted among the 3 formula groups in gastrointestinal parameters (stool frequency/consistency/color), occurrence of gastrointestinal symptoms (abdominal pain, flatulence, regurgitation) or infant’s behavior.ConclusionsA formula containing a mix of dairy lipids and plant oils enables a normal growth in healthy newborns. This formula is well tolerated and does not lead to abnormal gastrointestinal symptoms. Consequently, reintroduction of dairy lipids could represent an interesting strategy to improve lipid quality in infant formulas.Trial registrationClinicalTrials.gov Identifier NCT01611649, retrospectively registered on May 25, 2012.

Health-related quality of life is not impaired in children with undetected as well as diagnosed celiac disease: a large population based cross-sectional study.

BackgroundKnowledge regarding the health-related quality of life (HRQoL) of children with celiac disease remains limited and inconclusive. We investigated the HRQoL of three groups of 12-year-olds with: i) undetected celiac disease ii) clinically diagnosed celiac disease, and iii) without celiac disease.MethodsA school-based cross-sectional multicenter screening study invited 18 325 children, whereof 68% consented to participate. Participants provided a blood sample, which was later analyzed for anti-tissue-tranglutaminase antibodies, and alongside filled in a questionnaire. When anti-tissue-tranglutaminase antibodies were elevated, a small intestinal biopsy verified the screening-detected celiac disease diagnosis. Self-reported HRQoL was measured using Kidscreen, a generic 52 items instrument with proven reliability and validity. Scores were linearly transformed into a 0–100 scale with higher values indicating better HRQoL. Mean values with standard deviations (mean ± SD) were compared, and uni- and multivariate logistic regression models tested the odds of a low HRQoL among children with undetected or diagnosed celiac disease, respectively.ResultsChildren with undetected celiac disease (n = 238) reported similar HRQoL as children without celiac disease (n = 12 037) (83.0 ± 11.0 vs. 82.5 ± 11.3, P = 0.51), and also similar HRQoL (82.2 ± 12.2, P = 0.28) to that of children with diagnosed celiac disease (n = 90), of whom 92% were adherent to treatment. Having undetected celiac disease did not increase the odds of low overall HRQoL, independent of sex, area of residence, study year and occurrence of gastrointestinal symptoms (adjusted odds ratio 0.77, 95% CI 0.54-1.10). Comparable results were seen for diagnosed celiac disease cases (adjusted odds ratio 1.11, 95% CI 0.67-1.85).ConclusionChildren with undetected celiac disease reported comparable HRQoL as their peers with diagnosed celiac disease, and those without celiac disease, when reporting prior to receiving the diagnosis through screening. Thus, children with celiac disease, both untreated and diagnosed, perceive their HRQoL as unimpaired by their disease.

Gastrointestinal symptoms before and during menses in healthy women

BackgroundLittle is known as to the extent gastrointestinal (GI) complaints are reported by women around menses. We aimed to describe GI symptoms that occurred premenstrually and during menses in healthy women, and to specifically assess the relationship of emotional symptoms to GI symptoms around menses.MethodsWe recruited healthy, premenopausal adult women with no indication of GI, gynecologic, or psychiatric disease who were attending an outpatient gynecology clinic for well-woman care. They completed a survey that queried menstrual histories and the presence of GI and emotional symptoms. We compared the prevalence of primary GI symptoms (abdominal pain, diarrhea, constipation, nausea, vomiting), as well as pelvic pain and bloating, in the 5 days preceding menses and during menses, and assessed whether emotional symptoms or other factors were associated with the occurrence of GI symptoms.ResultsOf 156 respondents, 73% experienced at least one of the primary GI symptoms either pre- or during menses, with abdominal pain (58% pre; 55% during) and diarrhea (24% pre; 28% during) being the most common. Those experiencing any emotional symptoms versus those without were more likely to report multiple (2 or more) primary GI symptoms, both premenstrually (depressed p = 0.006; anxiety p = 0.014) and during menses (depressed p < 0.001; anxiety p = 0.008). Fatigue was also very common (53% pre; 49% during), and was significantly associated with multiple GI symptoms in both menstrual cycle phases (pre p < 0.001; during p = 0.01).ConclusionsEmotional symptoms occurring in conjunction with GI symptoms are common perimenstrually, and as such may reflect shared underlying processes that intersect brain, gut, and hormonal pathways.