Occurrence Of Gastrointestinal Symptoms Research Articles

Gastrointestinal complications and their relationship with functional performance in stroke survivors

Background: Gastrointestinal (GI) complications can retard or limit a patient's rehabilitation and functional recovery. Thus, if not recognized and prevented early, they can be a significant determinant of morbidity and mortality in patients with stroke. Objective: The study was designed to determine the frequencies of GI symptoms in stroke survivors and to evaluate their relationships with functional performance. Methodology: Consecutive patients with diagnosis of stroke in medical wards and neurology clinic at the Aminu Kano Teaching Hospital and apparently healthy age and sex matched volunteers were recruited. A structured, pre-tested, close-ended questionnaire inquiring about common GI symptoms and demographic and stroke characteristics such as type, number and hemispheric side of stroke was administered in each case and control. Functional performance was assessed using the Barthel index. Results: A total of 150 patients and 150 control subjects were recruited for the study. The mean age of the patients was 58.1 ± 13 and that of the control subjects was 58.0 ± 12 and the difference was not statistically significant (P = 0.9846). There were 113 (80.7%) ischemic stroke and 27 (19.3%) hemorrhagic stroke. The most common GI symptoms were constipation (16.7%), dysphagia (12.1%) and masticatory difficulty (10.0%). There was no statistically significant difference in the occurrence of GI symptoms with respect to side of stroke. Constipation, dysphagia, masticatory difficulty, incomplete evacuation, abdominal pain, malnutrition, vomiting, bloating were found to be associated with low functional performance. Conclusion: Constipation, dysphagia and masticatory difficulty were the most common GI complications. They appear to be independent of the side or type of stroke, but are associated with low functional performance of the stroke survivors.

Effects of saxagliptin added to sub-maximal doses of metformin compared with uptitration of metformin in type 2 diabetes: the PROMPT study

Objective:The PROMPT study compared efficacy and tolerability of two treatment intensification strategies: adding saxagliptin or uptitrating metformin monotherapy, in patients with type 2 diabetes (T2D) and inadequate glycaemic control on a sub-maximal metformin dose.Research design and methods:In this double-blind, 24-week study, metformin-tolerant patients with T2D on metformin monotherapy were randomised to receive fixed-dose metformin 1500 mg/day, plus either add-on saxagliptin 5 mg/day (SAXA-MET) or a two-step metformin uptitration (MET-UP) to a maximum dose (2500 mg/day).Clinical trial registration:NCT01006590.Main outcome measures:Primary: absolute change from baseline in glycated haemoglobin A1c (HbA1c) (Week 24). Secondary: proportion of patients achieving a therapeutic glycaemic response (Week 24); change from baseline in fasting plasma glucose (Week 24); safety and tolerability. Exploratory analyses comprised three patient-related questionnaires, including the validated 5-dimension Digestive Health Status Index (DHSI).Results:A total of 286 patients were randomised: (SAXA-MET: 147; MET-UP: 139). Baseline mean (SD) HbA1c: 7.71 (0.85; SAXA-MET); 7.80 (0.82; MET-UP). Adjusted mean reductions from baseline in HbA1c (Week 24): −0.47% (SAXA-MET); −0.38% (MET-UP); mean (95% CI) difference in treatment effect, −0.10% (−0.26, 0.07); p = 0.260. The proportion of patients (95% CI) achieving a therapeutic glycaemic response (HbA1c < 7%): 43.8% (34.8, 49.6) (SAXA-MET) vs. 35.0% (29.0, 43.8) (MET-UP). Of the five DHSI domains, mean (95% CI) differences were observed for diarrhoea-predominant score (+0.8 [−2.5, 4.0] vs. +7.9 [4.6, 11.2]) and dysmotility score (−0.5 [−2.0, 1.0] vs. +1.9 [0.3, 3.4]), (SAXA-MET and MET-UP, respectively). The most common adverse event was diarrhoea: 6.1% (SAXA-MET) vs. 12.2% (MET-UP).Conclusions:In metformin-tolerant patients with T2D (inadequately controlled on sub-maximal metformin monotherapy), saxagliptin was well tolerated. Although HbA1c reduction was not significantly different between treatment groups, the lower occurrence of gastrointestinal symptoms in the SAXA-MET group suggests that saxagliptin add-on treatment may be a suitable alternative treatment strategy to metformin uptitration.

Autonomic and sensory symptoms and signs in incident, untreated Parkinson's disease: Frequent but mild

Although nonmotor symptoms are increasingly recognized as key features in Parkinson's disease (PD), the occurrence and severity of autonomic and sensory symptoms in patients with very early and untreated PD are poorly documented. Two hundred seven patients with newly diagnosed, untreated PD and 175 controls from the population-based Norwegian ParkWest study were included. Postural blood pressure and olfactory function were measured and eight autonomic and sensory symptoms assessed using interview-based rating scales. Autonomic and sensory symptoms were more frequent in patients compared with controls (mean number of symptoms 2.9 vs. 1.1; P < 0.001) and in the postural instability and gait difficulty motor-subtype vs. tremor dominant subtype (mean 3.3 vs. 2.5; P = 0.008). In the patient group, reduced olfaction (59%), urinary problems (47%), increased saliva or drooling (42%), constipation (39%), and sensory complaints (34%) were the most frequent symptoms. Daily activities were not affected by these symptoms in 58% of the patients, and the influence on daily activities was rated as "mild" or less for all of these symptoms in 90%. A higher Hoehn and Yahr stage was associated with a higher number of autonomic and sensory symptoms and with the occurrence of gastrointestinal symptoms. Autonomic and sensory symptoms are common in patients with untreated, early PD although the severity of these symptoms is mild, with little or no influence on daily activities. The high prevalence of increased saliva or drooling close to the time of diagnosis is noteworthy and not described earlier.

The Effect of Different Recall Periods on Estimates of Acute Gastroenteritis in the United States, FoodNet Population Survey 2006–2007

A number of countries have estimated the prevalence of acute gastroenteritis by asking survey respondents to recall past episodes of diarrhea; however, the recall period used varies between studies. We conducted a survey to examine the effects of 7-day and 1-month recall periods on the estimated annual episodes of acute gastroenteritis. Further, we examine whether asking first about illness in the previous 7 days affects a person's response to a 1-month recall period. The Foodborne Diseases Active Surveillance Network (FoodNet) conducted a population-based telephone survey that included asking respondents about the occurrence of gastrointestinal symptoms. From February through April 2007, we randomly split respondents into two groups to examine effect of recall periods and question order. One group was first asked about symptoms in the 7 days before interview and then asked about symptoms in the month before interview. The other group was asked only about symptoms in the month before interview. Overall, the monthly prevalence of acute diarrheal illness (≥3 loose stools in 24-hours, lasting >1 day, or restricting daily activities) was 7.7%. This proportion was consistent among the respondents who were first asked about a 7-day recall period (n=1436) and those asked only about symptoms in the past month (n=2132). Extrapolation from the reported 7-day prevalence of 3.1% to an annual rate of 1.6 episodes per person, however, was almost twice the rate of episodes estimated when extrapolating from the month recall period. Similar findings were found with acute gastroenteritis (acute diarrheal illness or vomiting without respiratory symptoms). First asking respondents about a 7-day recall period did not affect the prevalence of acute gastroenteritis reported for a 1-month recall period. Recall period length did, however, have a major impact on estimates of acute gastroenteritis. Retrospective studies using different recall periods may not be comparable.

Abdominal angiostrongyliasis caused by Angiostrongylus cantonensis: A possible cause of eosinophilic infiltration in human digestive tract

We report the pathological findings of a serologically proven case of Angiostrongylus cantonensis presenting with localized peritonitis followed by eosinophilic meningoencephalitis. The neurological involvement developed 3 days after the occurrence of gastrointestinal symptoms. Similarly to the life cycle in rats, it takes about 2 or 3 days for the larvae to reach the nervous system. The pathological section of the sigmoid colon showed focal eosinophilic infiltration with serosal vessel invasion. In the case reported here, we describe a new possible cause of eosinophilic infiltration in the human digestive tract.

Rapidly measured indicators of recreational water quality are predictive of swimming-associated gastrointestinal illness.

Standard methods to measure recreational water quality require at least 24 hr to obtain results, making it impossible to assess the quality of water within a single day. Methods to measure recreational water quality in ≤ 2 hr have been developed. Application of rapid methods could give considerably more accurate and timely assessments of recreational water quality. We conducted a prospective study of beachgoers at two Great Lakes beaches to examine the association between recreational water quality, obtained using rapid methods, and gastrointestinal (GI) illness after swimming. Beachgoers were asked about swimming and other beach activities and 10–12 days later were asked about the occurrence of GI symptoms. We tested water samples for Enterococcus and Bacteroides species using the quantitative polymerase chain reaction (PCR) method. We observed significant trends between increased GI illness and Enterococcus at the Lake Michigan beach and a positive trend for Enterococcus at the Lake Erie beach. The association remained significant for Enterococcus when the two beaches were combined. We observed a positive trend for Bacteroides at the Lake Erie beach, but no trend was observed at the Lake Michigan beach. Enterococcus samples collected at 0800 hr were predictive of GI illness that day. The association between Enterococcus and illness strengthened as time spent swimming in the water increased. This is the first study to show that water quality measured by rapid methods can predict swimming-associated health effects.

EARLY GASTROINTESTINAL SYMPTOMS and SUBSEQUENT RECURRENT ABDOMINAL PAIN OF CHILDHOOD

Introduction Little is known of the precursors and natural history of childhood recurrent abdominal pain (RAP) and its relationship to early gastrointestinal (GI) function. This study determines the prevalence of common GI problems in childhood and assesses the relationship of RAP at age eight to prior GI function and symptoms. Methods The Raine Study enrolled 2979 women by the eighteenth week of pregnancy in a prospective cohort that has been followed to age eight with extensive data collection every 1 to 2 years. The prevalence of GI symptoms and problems in this population was determined and the relationship of these to the reporting of RAP at age eight was analysed. Results Two thousand eight hundred and sixty infants were assessed at birth, and 2162 of 2620 potentially still available were followed to year 8. One hundred and forty-two children (6.6%) experienced RAP at age eight (9.3% of girls, 5.3% of boys, P = 0.009). Only 16% of these children experienced pain more frequently than several times per week. The occurrence of GI symptoms and function at various ages up to eight have been defined. Seventy five percent of children at all ages defaecated between twice a day and once every second day. The proportion with infrequent defaecation increased with age. Ten per cent of 5-year old had been treated for constipation and 12% had difficulties with faecal soiling. The risk of RAP for early GI symptoms is shown in the table. Symptom/feature Prevalence (%) Odds ratio 95% CI * P < 0.05, ** P < 0.001. Infantile colic 28.7 4.23 3.6–5.0* GOReflux 0–4 months 29 1.23 0.84–1.80 GOReflux 5–12 months 12.8 1.16 0.70–1.91 Frequent stools year 1 17.2 0.70 0.42–1.17 Frequent stools year 2 5.9 1.0 0.43–2.34 Infrequent stools year 2 1.6 4.19 1.57–11.16* Infrequent stools year 8 2.9 4.12 2.17–7.8** Soiling year 5 11.8 1.38 0.28–6.79 Conclusions 1 RAP at age 8 is associated with infrequent defaecation at ages 2 and 8. 2 RAP at age 8 is associated with infantile colic This may reflect underlying sensitivity to gastrointestinal distension and contraction. or reflect parental anxiety. 3 RAP is not associated with frequent stools, GOReflux or with disorders of defaecation.

Workshop: physiology and tolerance of LDCs.

Although it is accepted that consumption of low-digestible carbohydrates (LDCs) can have undesirable gastrointestinal effects in some individuals, few tolerance studies are comparable in terms of symptom definition or the methodology adopted. This workshop considered the main gastrointestinal symptoms that can occur following consumption of LDCs and if current symptom definitions were wholly appropriate. The study protocols that should be adopted to investigate the gastrointestinal (GI) tolerance of LDCs were discussed and what affects tolerance, such as host factors and types of LDC ingested. The workshop debated if the occurrence of GI symptoms following consumption of LDCs outweighed their perceived functional benefits.

Efficacy and tolerability of dopamine agonists in a parkinsonian population.

A clinical retrospective study was carried out in a population of 366 Parkinson's disease (PD) outpatients, to analyse the efficacy and tolerability of nonergoline and ergoline dopamine agonist (DA), in monotherapy or in combination with L-dopa. Safety was comparable in both groups except for higher occurrence of gastrointestinal symptoms in ergoline group and somnolence in nonergoline group. No significant difference concerning efficacy and tolerability was found during DA monotherapy. Mean age at PD onset was slightly higher in patients withdrawing DA monotherapy for adverse events comparing to patients who needed the addition of L-dopa (60.36 +/- 7.53 versus 54.88 +/- 10.75; p<0.05), suggesting that older age at the onset of the disease increases the risk for adverse events during DA monotherapy. The follow-up of the remaining patients still in monotherapy with DA will allow a better evaluation of these aspects.

Gastrointestinal symptoms in patients with asthma

AIMSMinor gastrointestinal abnormalities have been reported in children with asthma, but the prevalence of gastrointestinal symptoms in these children has not been studied.METHODS75 children with bronchial asthma and an age...

Gastrointestinal symptoms during long-distance walking.

Gastrointestinal (GI) symptoms are common during prolonged intense exercise. To examine whether GI symptoms are also common during prolonged exercise of lower intensity, we obtained data on incidence, duration, and severity of GI symptoms during four consecutive days walking with a total distance of 203 km for men and 164 km for women. The research population consisted of 79 men and 76 women, aged 30-49 yr, who responded to a questionnaire and a diary concerning anthropometric data, activity pattern, dietary intake, and GI symptoms. The results show that 24% of the subjects experienced one or more symptoms. Nausea, headache, and flatulence were the most frequent symptoms. Nine subjects dropped out during the race, two of whom indicated that they stopped as a result of one or more GI symptoms. Logistic regression analysis revealed that the occurrence of GI symptoms was a significant exercise-limiting factor. Univariate analysis showed that incidence and duration of GI symptoms were significantly related to the subjects' experience (number of prior participations to the event), body weight loss during walking, and several components of the diet before and during the event. A significant relationship between GI symptoms and age, gender, training status, and walking speed could not be found. We conclude that GI symptoms during long-distance walking can impair exercise performance, although these symptoms occur less frequently and are less severe in comparison with prolonged intense exercise.

Review article: olestra and its gastrointestinal safety.

Olestra is a fat substitute made from sucrose and vegetable oil. Olestra is neither digested nor absorbed, and therefore adds no calories or fat to the diet. Because the gut is the only organ that is exposed to olestra, the potential for olestra to affect gastrointestinal structure and function, and the absorption of nutrients from the gut, has been investigated. Histological evaluations performed after long-term feeding studies have shown no indications that olestra causes injury to the gastrointestinal mucosa. Olestra is not metabolized by the colonic microflora, and has no meaningful effects on the metabolic function of these organisms. Studies of gastrointestinal transit have shown that the consumption of olestra with food does not affect gastric emptying, or small or large bowel transit times. Olestra does not affect the absorption of macronutrients, water-soluble vitamins or minerals. It causes a dose-responsive decrease in the availability of the fat-soluble vitamins A, D, E and K; however, this potentially adverse effect is offset by the addition of vitamins to olestra-containing foods. Olestra has no consistent effect on the amount of total bile acids excreted in the faeces, and therefore probably has no significant effect on bile acid absorption. The occurrence of gastrointestinal symptoms, including diarrhoea, loose stools, gas and abdominal cramping, after consumption of olestra under ordinary snacking conditions is comparable to that following consumption of triglyceride-containing snacks.

Electrogastrographic Study of the Effect of Transcatheter Arterial Chemoembolization on Gastric Myoelectric Activity

Background: Transcatheter arterial chemoembolization (TACE) of the hepatic artery is frequently used in the treatment of inoperable hepatocellular carcinoma (HCC). TACE causes not only effective tumor tissue necrosis in patients with hepatoma but also adverse effects on extrahepatic abdominal organs. There are no published reports on the effect of TACE on the gastric myoelectric activity. In this study, using cutaneous electrogastrography (EGG), we evaluated the effect of TACE on gastric myoelectric activity in patients with HCC. Methods: A total of 27 patients (24 men and 3 women, aged 22 to 78 years) with hepatoma, admitted for TACE, were included in this study. Furthermore, 28 patients (24 men and 4 women, aged 26 to 75 years), admitted for diagnostic angiography of the liver, served as the control group. Cutaneous EGG was performed before and after TACE or angiography. Results: In the TACE group there were significant changes in dominant frequency (DF) and percentages of DF in the defined normal range, bradygastric range, and tachygastric range on post-meal EGG. On fasting EGG, only the dominant frequency and percentages of DF in the bradygastric range changed significantly. However, there was no correlation between the occurrence of nausea/vomiting and the degree of change in the EGG variables, during both fasting and postprandial states. In the control group there were no significant differences in EGG variables before and after angiography. Conclusions: TACE can affect gastric myoelectric activity in HCC patients. Nevertheless, the relationship between changes in myoelectric activity and the occurrence of gastrointestinal symptoms needs further investigation.

Effect of Cheese on Intestinal Transit Time and Other Indicators of Bowel Function in Residents of a Retirement Home

Effects of increased intake of cheese on intestinal transit time and other indicators of bowel function were studied in 21 retirement home residents (18 women and 3 men; age, 68-87 years). The study was divided into four succeeding periods: 1) 1-week basal period (usual diet); 2)3-week cheese period (extra cheese was offered as such on bread or used in cooking); 3) 3-week no-cheese period (all cheese on bread was replaced with cured meats and cold cuts, and no cheese was used in cooking); 4) 3-week follow-up period (usual diet). During the last week of each period a questionnaire was filled out on fecal frequencies, consistency of feces (soft, normal, hard), and occurrence of abdominal pain and flatulence. Use of laxative medications and therapeutic foods (prunes) was registered. Eleven of the 21 subjects collected fecal samples for the determination of fecal wet weight and intestinal transit time by means of radiopaque Sitzmark capsules. Intakes of cheese, fiber-containing foods, and fluids by these 11 subjects during meals offered in the cafeteria were recorded on a prefilled questionnaire. In spite of a 10-fold increase in the intake of cheese no change in intestinal transit time, fecal frequency, fecal wet weight, consistency of feces, and occurrence of gastrointestinal symptoms was observed. The use of laxative medication was higher during the cheese period, but no change in the combined use of laxative medication and therapeutic foods (prunes) was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Benzodiazepine Withdrawal Reaction in Two Children following Discontinuation of Sedation with Midazolam

To report the occurrence of recurrent benzodiazepine withdrawal reactions in two very young children following discontinuation of sedation with midazolam. A 15-month-old boy with apneic episodes was sedated with midazolam for 12 days with constant infusion. Half a day after discontinuation of the midazolam the boy became restless, tachycardic, and hyperpyrexic. When midazolam was readministered, all symptoms disappeared. Four days later midazolam was again discontinued and within 12 hours the same signs and symptoms reappeared. Midazolam infusion was restarted, and the signs and symptoms disappeared for the second time. After thoracotomy, a 14-day-old boy received intravenous midazolam for sedation for 29 days. Within 12 hours after discontinuation of midazolam he became restless, developed a bulging stomach secondary to aerophagia, and was vomiting. Midazolam therapy was reinstituted and continued for another 2 months by constant infusion. Thereafter, the boy was successfully weaned from artificial ventilation in 5 days under sedation with midazolam. About 12 hours after discontinuation of midazolam the boy became restless, tachycardic, again developed a bulging stomach because of aerophagia, and vomited. When the child was sedated with clorazepate by continuous infusion, the signs and symptoms disappeared. Case reports describing benzodiazepine withdrawal reaction upon discontinuation of midazolam were reviewed and compared. The symptoms observed in the children we present resemble those mentioned in the three children and two adults reported previously. Unique in the very young children in this article is the occurrence of gastrointestinal symptoms, which most likely are the result of air being swallowed secondary to severe agitation. Midazolam withdrawal reactions in adults and children, particularly in an intensive care unit, can be significant. Considerable caution must be taken with relatively long-term administration and abrupt discontinuation of midazolam.

Gastrointestinal Symptoms in Middle-Aged Diabetic Patients

Occurrence of gastrointestinal symptoms was investigated in a questionnaire-based survey of 89 randomly selected patients with insulin-dependent diabetes mellitus, 481 patients with noninsulin-dependent diabetes mellitus, and 635 nondiabetic control subjects. The prevalences of upper gastrointestinal symptoms, abdominal pain, diarrhea, and constipation were similar in diabetic patients and control subjects. Women with noninsulin-dependent diabetes mellitus had a significantly higher and women with insulin-dependent diabetes mellitus a significantly lower prevalence of gallstone disease than control women (29%, 5%, and 19%, respectively). We conclude that the occurrence and spectrum of gastrointestinal symptoms in middle-aged subjects with insulin- and noninsulin-dependent diabetes mellitus do not differ from those of the general population.

An Outbreak of Toxic Encephalopathy Caused by Eating Mussels Contaminated with Domoic Acid

In Canada in late 1987 there was an outbreak of an acute illness characterized by gastrointestinal symptoms and unusual neurologic abnormalities among persons who had eaten cultivated mussels. Health departments in Canada solicited reports of this newly recognized illness. A case was defined as the occurrence of gastrointestinal symptoms within 24 hours or of neurologic symptoms within 48 hours of the ingestion of mussels. From the more than 250 reports received, 107 patients met the case definition. The most common symptoms were vomiting (in 76 percent of the patients), abdominal cramps (50 percent), diarrhea (42 percent), headache, often described as incapacitating (43 percent), and loss of short-term memory (25 percent). Nineteen patients were hospitalized, of whom 12 required intensive care because of seizures, coma, profuse respiratory secretions, or unstable blood pressure. Male sex and increasing age were associated independently with the risks of hospitalization and memory loss. Three patients died. Mussels associated with this illness were traced to cultivation beds in three river estuaries on the eastern coast of Prince Edward Island. Domoic acid, which can act as an excitatory neurotransmitter, was identified in mussels left uneaten by the patients and in mussels sampled from these estuaries. The source of the domoic acid appears to have been a form of marine vegetation, Nitzschia pungens, also identified in these waters in late 1987. The contaminated mussels from Prince Edward Island were removed from the market, and no new cases have occurred since December 1987. We conclude that the cause of this outbreak of a novel and severe intoxication was the ingestion of mussels contaminated by domoic acid, a potent excitatory neurotransmitter.

A Perspective on Milk Intolerance

Lactose-intolerance is defined as the occurrence of gastrointestinal symptoms after ingestion of a test dose of lactose, usually 50 g in aqueous solution. The amount of lactose in an 8-oz. glass of milk (i.e., that amount normally considered a serving when making dietary recommendations) is only 12 g and is present in a mixture of proteins, fats, salts, vitamins and water. Unfortunately, many people, both in the scientific and health communities, believe lactose-intolerance implies intolerance to milk because of its lactose content. The result has been unwarranted recommendations to reduce or restrict milk consumption for people who may be lactose-intolerant but able to tolerate a normal serving of milk. This may mean an unnecessary loss of milk's important nutrients. Milk has long been recognized as a valuable food in feeding programs directed at overcoming protein-calorie malnutrition and maintaining a nutritionally balanced diet for all people. Milk is a major supplier of three nutrients — calcium, riboflavin and vitamin A — which are commonly found lacking in the American diet. For those people who are truly milk-intolerant, suitable alternatives include cultured dairy products (such as some yogurts), and cheeses, the recommendation to consume smaller quantities of milk more frequently throughout the day, and lactose-hydrolyzed milk. Possible beneficial effects of milk containing bacterial cultures such as Lactobacillus acidophilus also are being studied.