Persistent Gastrointestinal Symptoms Research Articles

Gastrointestinal symptoms in autistic children during Covid-19 lockdown: A qualitative study of family experience

BackgroundAutistic individuals face barriers to healthcare access and premature mortality. There is an increased prevalence of gastrointestinal (GI) disorders in autistic children compared to not-autistic children. There is a complex interplay between these GI symptoms and various aspects of behaviour, sleep, and mental health in autistic children. Lockdowns during the Covid-19 pandemic changed the delivery of healthcare for all patient groups, and it is particularly important to understand the effects of this on vulnerable groups. In this qualitative study we document the family experiences associated with managing persistent GI symptoms in autistic children and access to related healthcare for these children during Covid-19 lockdowns and restrictions. MethodWe conducted semi-structured interviews with 12 parents of autistic children and subjected data from these interviews to qualitative analysis. ResultsTwo themes emerged (i) Covid-19 lockdowns and restrictions changed the children’s reported GI symptoms in a non-uniform manner; and (ii) parents were divided on the appropriateness of telemedicine services for their child. Some parents reported an increase in their child’s anxiety level that was linked to worsening of GI symptoms. Those parents who reported a reduction in their child’s social anxiety during lockdown related this to improved GI symptoms. Parents reported advantages and disadvantages of both in-person and telemedicine consultations, and they were split on their preferences for these appointment types. ConclusionsTelemedicine is preferred by some but not all families of autistic children. Clinicians should consider the interplay between anxiety and GI symptoms in autistic children when assessing and treating GI symptoms.

Effect of concurrent infection of Helicobacter pylori with Toxoplasma gondii infection on gastric pathology

BackgroundToxoplasma gondii (T. gondii) and Helicobacter pylori (H. pylori) are among the most prevalent foodborne parasitic and bacterial infections worldwide. However, the concurrent impact of coinfection on gastric pathology has yet to be studied in depth. The effect of coinfection generally either adds a synergetic or antagonistic impact; we aimed in the current work to assess the impact of T. gondii coinfection on the progression of H. pylori-associated gastric pathology and reporting H. pylori virulent strains. The study was conducted on 82 patients complaining of persistent gastrointestinal symptoms with failed treatment response and prone to endoscopy. They were subjected to stool examination to detect H. pylori antigen, serological screening for latent toxoplasmosis, endoscopy, histopathological examination, and molecular detection of H. pylori virulence strains in gastric biopsies. Out of the 82 patients, 62 patients were positive for H. pylori antigen in stool and 55 patients confirmed positivity by histopathology; out of them, 37 patients had isolated Vac As1 variants, 11 patients had combined Vac As1 and Cag A variants, and 7 patients had combined Vac As1, Cag A and VacAs2 variants. Patients with the combined two or three variances showed significantly deteriorated histopathological features than patients with a single Vac As1 variant (P < 0.05). Latent toxoplasmosis was positive among 35/82 patients. Combined H. pylori and Toxoplasma gondii infection had significantly marked inflammation than patients with isolated infection (P < 0.05). Conclusion: Screening for toxoplasmosis among H. pylori-infected patients is recommended as it is considered a potential risk factor for gastric inflammation severity. H. pylori gastric inflammation may be heightened by Toxoplasma coinfection.

Review article: A practical approach to persistent gastrointestinal symptoms in inflammatory bowel disease in remission.

Persistent gastrointestinal symptoms are prevalent in adult patients with inflammatory bowel disease (IBD), even when endoscopic remission is reached. These symptoms can have profound negative effects on the quality of life of affected patients and can be difficult to treat. They may be caused by IBD-related complications or comorbid disorders, but they can also be explained by irritable bowel syndrome (IBS)-like symptoms. To provide a practical step-by-step guide to diagnose and treat persistent gastrointestinal symptoms in patients with IBD in remission via a personalised approach. We scrutinised relevant literature on causes, diagnostics and treatment of persistent gastrointestinal symptoms (abdominal pain or discomfort, bloating, abdominal distension, diarrhoea, constipation and faecal incontinence) in patients with IBD in remission. A graphical practical guide for several steps in diagnosing, identifying potential triggers and adequate treatment of persistent gastrointestinal symptoms in IBD in remission is provided based on supporting literature. The first part of this review focuses on the diagnostic and treatment approaches for potential IBD-related complications and comorbidities. The second part describes the approach to IBS-like symptoms in IBD in remission. Persistent gastrointestinal symptoms in IBD in remission can be traced back to potential pathophysiological mechanisms in individual patients and can be treated adequately. For both IBD-related complications and comorbidities and IBS-like symptoms in IBD in remission, pharmacological, dietary, lifestyle or psychological treatments can be effective. A systematic and personalised approach is required to reduce the burden for patients, healthcare systems, and society.

Frosted Branch Angiitis Associated with COVID-19-related Multisystem Inflammatory Syndrome in Children

Purpose: To report a case of frosted branch angiitis associated with COVID-19-related multisystem inflammatory syndrome in children (MIS-C).Case summary: An 8-year-old boy was referred to the ophthalmology clinic with decreased visual acuity in his right eye. The initial best-corrected visual acuity (BCVA) was 20/63 in the right eye and 20/32 in the left eye. Upon fundus examination, bilateral frosted branch-like vascular sheathing and retinal hemorrhage were observed. Optical coherence tomography (OCT) demonstrated macular edema. Fluorescein angiography revealed late staining and leakage of affected retinal vessels. The patient exhibited persistent fever, rash, and gastrointestinal symptoms, accompanied by an increase in inflammatory markers in laboratory tests. Testing for SARS-CoV-2 immunoglobulin G (IgG) was positive, although there was no evidence of any other autoimmune diseases or viral infections. The patient was diagnosed with frosted branch angiitis associated with MIS-C. Treatment included systemic steroids and 1% prednisolone eye drops. After 2 weeks, the BCVA improved to 20/20 in both eyes, and all clinical signs resolved without recurrence.Conclusions: In patients with frosted branch angiitis without any other apparent cause, the possibility of MIS-C should be considered. Testing for COVID-19 infection is recommended.

Celiac disease symptom profiles and their relationship to gluten-free diet adherence, mental health, and quality of life

BackgroundA subgroup of adults with celiac disease experience persistent gastrointestinal and extraintestinal symptoms, which vary between individuals and the cause(s) for which are often unclear.MethodsThe present observational study sought to elucidate patterns of persistent symptoms and the relationship between those patterns and gluten-free diet adherence, psychiatric symptoms, and various aspects of quality of life (QOL) in an online sample of adults with celiac disease. U.S. adults with self-reported, biopsy-confirmed celiac disease (N = 523; Mage = 40.3 years; 88% women; 93.5% White) voluntarily completed questionnaires as part of the iCureCeliac® research network: (a) Celiac Symptoms Index (CSI) for physical symptoms and subjective health; (b) Celiac Dietary Adherence Test for gluten-free diet adherence; (c) PROMIS-29, SF-36, and Celiac Disease Quality of Life Survey for psychiatric symptoms and QOL. Symptom profiles were derived using latent profile analysis and profile differences were examined using auxiliary analyses.ResultsLatent profile analysis of CSI items determined a four-profile solution fit best. Profiles were characterized by: (1) little to no symptoms and excellent subjective health (37% of sample); (2) infrequent symptoms and good subjective health (33%); (3) occasional symptoms and fair to poor subjective health (24%); (4) frequent to constant symptoms and fair to poor subjective health (6%). Profiles 2 and 3 reported moderate overall symptomology though Profile 2 reported relatively greater extraintestinal symptoms and Profile 3 reported relatively greater gastrointestinal symptoms, physical pain, and worse subjective health. Profiles differed on anxiety and depression symptoms, limitations due to physical and emotional health, social functioning, and sleep, but not clinical characteristics, gluten-free diet adherence, or QOL. Despite Profile 3’s moderate symptom burden and low subjective health as reported on the CSI, Profile 3 reported the lowest psychiatric symptoms and highest quality of life on standardized measures.ConclusionsAdults with celiac disease reported variable patterns of persistent symptoms, symptom severity, and subjective health. Lack of profile differences in gluten-free diet adherence suggests that adjunctive dietary or medical assessment and intervention may be warranted. Lower persistent symptom burden did not necessarily translate to better mental health and QOL, suggesting that behavioral intervention may be helpful even for those with lower celiac symptom burden.

Prolonged Gastrointestinal Manifestations After Recovery From COVID-19

Acute enteric infections are well known to result in long-term gastrointestinal (GI) disorders. Although COVID-19 is principally a respiratory illness, it demonstrates significant GI tropism, possibly predisposing to prolonged gut manifestations. We aimed to examine the long-term GI impact of hospitalization with COVID-19. Nested within a large-scale observational cohort study of patients hospitalized with COVID-19 across North America, we performed a follow-up survey of 530 survivors 12-18 months later to assess for persistent GI symptoms and their severity, and for the development of disorders of gut-brain interaction (DGBIs). Eligible patients were identified at the study site level and surveyed electronically. The survey instrument included the Rome IV Diagnostic Questionnaire for DGBI, a rating scale of 24 COVID-related symptoms, the Gastrointestinal Symptoms Rating Scale, and the Impact of Events-Revised trauma symptom questionnaire (a measure of posttraumatic stress associated with the illness experience). A regression analysis was performed to explore the factors associated with GI symptom severity at follow-up. Of the 530 invited patients, 116 responded (52.6% females; mean age, 55.2 years), and 73 of those (60.3%) met criteria for 1 or more Rome IV DGBI at follow-up, higher than the prevalence in the US general population (P < .0001). Among patients who experienced COVID-related GI symptoms during the index hospitalization (abdominal pain, nausea, vomiting, or diarrhea), 42.1% retained at least 1 of these symptoms at follow-up; in comparison, 89.8% of respondents retained any (GI or non-GI) COVID-related symptom. The number of moderate or severe GI symptoms experienced during the initial COVID-19 illness by self-report correlated with the development of DGBI and severity of GI symptoms at follow-up. Posttraumatic stress disorder (Impact of Events-Revised score ≥33) related to the COVID-19 illness experience was identified in 41.4% of respondents and those individuals had higher DGBI prevalence and GI symptom severity. Regression analysis revealed that higher psychological trauma score (Impact of Events-Revised) was the strongest predictor of GI symptom severity at follow-up. In this follow-up survey of patients 12-18 months after hospitalization with COVID-19, there was a high prevalence of DGBIs and persistent GI symptoms. Prolonged GI manifestations were associated with the severity of GI symptoms during hospitalization and with the degree of psychological trauma related to the illness experience.

The breadth of the neutralizing antibody response to original SARS-CoV-2 infection is linked to the presence of Long COVID symptoms.

The associations between longitudinal dynamics and the breadth of SARS-CoV-2 neutralizing antibody (nAb) response with various Long COVID phenotypes before vaccination are not known. The capacity of antibodies to cross-neutralize a variety of viral variants may be associated with ongoing pathology and persistent symptoms. We measured longitudinal neutralizing and cross-neutralizing antibody responses to pre- and post-SARS-CoV-2 Omicron variants in participants infected early in the COVID-19 pandemic, before widespread rollout of SARS-CoV-2 vaccines. Cross-sectional regression models adjusted for clinical covariates and longitudinal mixed-effects models were used to determine the impact of the breadth and rate of decay of neutralizing responses on the development of Long COVID symptoms, as well as Long COVID phenotypes. We identified several novel relationships between SARS-CoV-2 antibody neutralization and the presence of Long COVID symptoms. Specifically, we show that, although nAb responses to the original, infecting strain of SARS-CoV-2 were not associated with Long COVID in cross-sectional analyses, cross-neutralization ID50 levels to the Omicron BA.5 variant approximately 4 months following acute infection was independently and significantly associated with greater odds of Long COVID and with persistent gastrointestinal and neurological symptoms. Longitudinal modeling demonstrated significant associations in the overall levels and rates of decay of neutralization capacity with Long COVID phenotypes. A higher proportion of participants had antibodies capable of neutralizing Omicron BA.5 compared with BA.1 or XBB.1.5 variants. Our findings suggest that relationships between various immune responses and Long COVID are likely complex but may involve the breadth of antibody neutralization responses.

Systematic analysis of liver failure accompanied with hemophagocytic syndrome in adults

Objective: To retrospectively analyze literature reports and summarize the clinical characteristics of liver failure in patients accompanied with adult hemophagocytic syndrome (HPS). Methods: The Wanfang, CNKI, VIP, PubMed, and Ovid databases were searched for relevant literature on liver failure patients accompanied with adult HPS published from January 1980 to May 2022. The final included literature was systematically reviewed after screening. Results: There were a total of 77 liver failure cases accompanied with adult HPS, with an average age of (41.8 ± 12.5) years. The most common clinical manifestations of these cases were persistent high fever, fatigue, gastrointestinal symptoms, and severe jaundice. The imaging changes were not specific, and the most common was hepatosplenomegaly. Laboratory examination showed a significant increase in serum total bilirubin, lactate dehydrogenase, triglycerides, and soluble interleukin-2 receptor levels, as well as serum ferritin, while there was a decrease in prothrombin activity, natural killer cell activity, and hemocytopenia of two or more lineages in peripheral blood. Myelogram examination showed hemophagocytosis. Adult HPS secondary to infection was more likely to be accompanied with liver failure (55.8%), with an overall case fatality rate of 84.4%. Conclusion: Patients with liver failure accompanied with adult HPS have an extremely high mortality rate and a poor prognosis. Early diagnosis and treatment are the keys to improving the prognosis.

Gut microbiota signature in children with autism spectrum disorder who suffered from chronic gastrointestinal symptoms

BackgroundChildren diagnosed with autism spectrum disorder (ASD) frequently suffer from persistent gastrointestinal symptoms, such as constipation and diarrhea. Various studies have highlighted differences in gut microbiota composition between individuals with ASD and healthy controls of similar ages. However, it’s essential to recognize that these disparities may be influenced by cultural practices, dietary habits, and environmental factors.MethodsIn this study, we collected fecal samples from both children diagnosed with ASD (n = 42) and healthy individuals (n = 41) residing in the southeastern coastal region of China. Subsequently, 16 S rRNA gene sequencing and advanced bioinformatics analyses were conducted to investigate the distinctive features of gut microbial communities within each group.ResultsThe ASD group consisted of 28 males and 14 females, with a median age of 5.8 years, while the control group included 25 males and 16 females, with a median age of 6.8 years. Among the 83 sequenced fecal samples, a total of 1031 operational taxonomic units (OTUs) were identified. These included 122 unique OTUs specific to the control group and 285 unique OTUs specific to the ASD group. Analyses of α-diversity and β-diversity unveiled significant differences in the abundance and composition of gut microbiota between the two groups. It was found that the dominant bacterial taxa in healthy individuals were UBA1819, Flavonifractor, and Bradyrhizobium. In contrast, the ASD group exhibited a prevalence of Streptococcus, Ruminococcus, and Ruminiclostridium. Further analysis using Kyoto Encyclopedia of Genes and Genomes (KEGG) and Clusters of Orthologous Groups (COG) showed significant differences in the metabolic functionalities of the gut microbiota between the two groups. Notably, the metabolic pathway related to alpha-linolenic acid (ALA) in the gut microbiota of the ASD group was notably diminished compared to the control group. Conversely, the ASD group demonstrated significantly elevated levels of metabolic pathways involving uncharacterized conserved proteins, aminoglycoside phosphotransferase, and inorganic pyrophosphatase compared to the control group.ConclusionsOverall, these results confirm that there are significant differences in the gut microbiota structure between children with ASD and healthy controls in the southeast coastal region of China. This underscores the critical significance of delving into clinical interventions capable of mitigating the gastrointestinal and psychological symptoms encountered by children with ASD. A particularly encouraging path for such interventions lies in the realm of fecal microbiota transplantation, a prospect that merits deeper inquiry.

Usefulness of self-assessment of gastrointestinal symptoms: a web-based study in Anhui, China.

Gastrointestinal symptoms (GISs) are highly prevalent worldwide caused by a combination of biopsychosocial factors. Given the complex nature coupled with ineffective communication of diagnosis by physicians, patients with intimate GISs often feel stigmatized which in turn can inhibit their ability to express their thoughts and feelings adequately and lead to either over or underreport of their symptoms. And selective service seeking for and reporting of GISs have direct bearing on the stage of disease at presentation, and consequently, on the overall prognosis. The study aimed to investigate the usefulness of a web-based self-assessment of GISs as a supplementary means to cope with potential over/under reporting during routine consultations. The study used data about GISs collected using a novel web-based self-assessment tool (n=475) and that from non-participative observation of doctor-patient consultations (n=447) and household survey (n=10552) in Anhui, China. The data analysis focused primarily on description of composition of respondents and occurrence rates of GISs by socio-demographics and by methods and settings of symptom solicitation. Chi-square power tests were used, when necessary, to compare the differences in the occurrence rates between relevant groups and the significance level of the two-sided test was set at α<0.05. Both the average occurrence rates of upper and lower GISs derived from the web-based self-assessment were higher than that from the observation, being 20.9% vs 14.2% (p<0.001) and 12.9% vs 10.8% (p=0.02) respectively. The differences in six out of the nine upper GISs and three out of the eleven lower GISs studied were tested with statistical significance (p<0.05), and all these symptoms witnessed higher self-assessed than observed frequency rates. For upper GISs, the self-assessed versus observed differences ranged from 17.1% for bloating to 100% for bad mood after meal; while for lower GISs, the differences ranged from -50.5% for hematochezia/melena to 100% for uncontrollable stool. Stomachache, regurgitation, and dysphagia displayed higher occurrence rates among participants of the self-assessment than those of the household survey, being 20% vs 13%, 14% vs 11% and 3% vs 2% respectively; while the opposite was observed for constipation (5% vs 11%), hematochezia or melena (4% vs 5%) and anorexia (4% vs 5%). All the differences in the self-assessed occurrence rates of specific persistent GISs between socio-graphic groups were tested non-significant (P>0.05); while the same rate of any of the six persistent GISs studied among the respondents aged 51-60 was statistically higher than that among other age groups (P=0.03). The web-based self-assessment tool piloted in this study is useful and acceptable. It helps in soliciting more comprehensive GISs, especially symptoms with concerns about stigmatization, privacy, shame etc. Further studies are needed to integrate the web-based self-assessment with routine consultations and evaluate its efficacy.

Tezacaftor/Ivacaftor therapy has negligible effects on the cystic fibrosis gut microbiome.

People with cystic fibrosis (pwCF) experience a range of persistent gastrointestinal symptoms throughout life. There is evidence indicating interaction between the microbiota and gut pathophysiology in CF. However, there is a paucity of knowledge on the potential effects of CF transmembrane conductance regulator (CFTR) modulator therapies on the gut microbiome. In a pilot study, we investigated the impact of Tezacaftor/Ivacaftor dual combination CFTR modulator therapy on the gut microbiota and metabolomic functioning in pwCF. Fecal samples from 12 pwCF taken at baseline and following placebo or Tezacaftor/Ivacaftor administration were subjected to microbiota sequencing and to targeted metabolomics to assess the short-chain fatty acid (SCFA) composition. Ten healthy matched controls were included as a comparison. Inflammatory calprotectin levels and patient symptoms were also investigated. No significant differences were observed in overall gut microbiota characteristics between any of the study stages, extended also across intestinal inflammation, gut symptoms, and SCFA-targeted metabolomics. However, microbiota and SCFA metabolomic compositions, in pwCF, were significantly different from controls in all study treatment stages. CFTR modulator therapy with Tezacaftor/Ivacaftor had negligible effects on both the gut microbiota and SCFA composition across the course of the study and did not alter toward compositions observed in healthy controls. Future longitudinal CFTR modulator studies will investigate more effective CFTR modulators and should use prolonged sampling periods, to determine whether longer-term changes occur in the CF gut microbiome. IMPORTANCE People with cystic fibrosis (pwCF) experience persistent gastrointestinal (GI) symptoms throughout life. The research question "how can we relieve gastrointestinal symptoms, such as stomach pain, bloating, and nausea?" remains a top priority for clinical research in CF. While CF transmembrane conductance regulator (CFTR) modulator therapies are understood to correct underlying issues of CF disease and increasing the numbers of pwCF are now receiving some form of CFTR modulator treatment. It is not known how these therapies affect the gut microbiome or GI system. In this pilot study, we investigated, for the first time, effects of the dual combination CFTR modulator medicine, Tezacaftor/Ivacaftor. We found it had negligible effects on patient GI symptoms, intestinal inflammation, or gut microbiome composition and functioning. Our findings are important as they fill important knowledge gaps on the relative effectiveness of these widely used treatments. We are now investigating triple combination CFTR modulators with prolonged sampling periods.

A scientometric analysis of the relationship between functional dyspepsia and anxiety

Aims: Functional dyspepsia is a common disorder characterized by persistent or recurrent upper gastrointestinal tract symptoms without underlying disease or structural abnormalities that can have a significant impact on an individual's overall quality of life. Studies in the literature indicate that anxiety also plays an important role in the etiology of functional dyspepsia. Early diagnosis and treatment of the underlying anxiety disorder are important to relieve dyspeptic symptoms. In this study, the aim was to examine the studies related to functional dyspepsia and anxiety using the bibliometric method.&#x0D; Methods: Clarivate Analytics' Web of Science database was used to search for articles and reviews on functional dyspepsia and anxiety between 1980 and 2022. VOSviewer, Tableau, and IBM SPSS Statistics were used for bibliometric network visualization and statistical analyses. A regression analysis using a nonlinear exponential model was used to forecast the number of publications in the next years. Keyword network visualization maps were used to identify recent trends and relationships.&#x0D; Results: The Web of Science database included 560 articles and reviews about functional dyspepsia and anxiety between 1991 and 2023, with the top 5 research areas being Gastroenterology, Clinical Neurology, Neurosciences, Psychiatry, and General Internal Medicine. The collaborative clustering network map shows four distinct clusters based on total link strength scores, and the correlation between Gross Domestic Product (GDP) and the number of studies published suggests that countries with higher GDP tend to publish more studies. Since 2015, the amount of published materials on the topic has dramatically increased and is continuing to rise.&#x0D; Conclusion: There has been an upward trend in publications about the relationship between functional dyspepsia and anxiety since the 2010s, with the top ten countries with the greatest number of publications being mostly wealthy nations. The most cited journal on the topic was the American Journal of Gastroenterology, with 1441 total citations. Our findings suggest that this is a rapidly evolving field with a broad range of research topics.

Factors associated with long-term gastrointestinal symptoms in colorectal cancer survivors in the women's health initiatives (WHI study).

Colorectal cancer (CRC) survivors often experience long-term symptoms after cancer treatments. But gastrointestinal (GI) symptom experiences are under-investigated in CRC survivors. We described persistent GI symptoms after cancer treatments in female CRC survivors and assessed GI symptoms' risk and life-impact factors. A cross-sectional study utilized data from the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study that recruited postmenopausal women. Correlation analyses and multivariable linear regression models were used. CRC survivors after cancer treatments were included (N = 413, mean age 71.2 years old, mean time since diagnosis = 8.1 years). 81% of CRC survivors experienced persistent GI symptoms. Bloating/gas was the most prevalent (54.2%± 0.88) and severe GI symptom, followed by constipation (44.1%±1.06), diarrhea (33.4%±0.76), and abdominal/pelvic pain (28.6%±0.62). Significant risk factors for GI symptoms include time since cancer diagnosis (<5 years), advanced cancer stage, high psychological distress, poor dietary habits, and low physical activity. Fatigue and sleep disturbance were the most significant risk factors for long-term GI symptoms (β = 0.21, t = 3.557; β = 0.20, t = 3.336, respectively, Ps < .001). High severity of GI symptoms was positively associated with poor quality of life (QOL), increased daily life interferences (social and physical functions), and low body image satisfaction (Ps < .001). Women CRC survivors experience a high GI symptom burden, highlighting the need to inform policy and improve the QOL of cancer survivors. Our findings will aid in identifying those more vulnerable to symptoms, and inform future survivorship care interventions (i.e., community-based cancer symptom management) by considering multiple risk factors (e.g., psychological distress).

NON-PHARMACOLOGICAL MANAGEMENT OF FUNCTIONAL GASTROINTESTINAL DISORDERS THROUGH AYURVEDA: A REVIEW

Non-pharmacological management refers to the management without the use of medications. Gastrointestinal disorders, especially Functional Gastrointestinal Disorders (FGIDs), are common disorders characterized by persistent and recurrent gastrointestinal symptoms due to abnormal functioning of the enteric nervous system where no structural or organic pathology is identified. FGIDs are associated with motility disturbances, visceral hypersensitivity, altered mucosal and immune function, gut microbiota, etc. To fully understand the pathophysiology of FGIDs, it is important to comprehend the biopsychosocial behaviour, which focuses on understanding and treatment of the illness and the subjective sense of the patient's suffering. Globally, the most common FGIDs (irritable bowel syndrome and functional dyspepsia) alone affect 16–26% of the population. The non-pharmacological management includes reassurance, lifestyle modifications including observance of dinacharya (daily regimen), gut hygiene, ritucharya (seasonal regimen), psychotherapy, dietary interventions like intake of pathyaahara, implementing sadvritta, the ideal code of conduct, performing yoga, etc. Since gastrointestinal disorders are highly prevalent and pharmacological modalities are limited in contemporary medicine. Thus, a non-pharmacological approach can be preferred in today’s era for sustainable results. Ayurveda follows a holistic approach and has never considered an individual's physical, physiological, and psychological aspects as separate entities. Hence, the management of different diseases has been given under three modalities: daivavyapashraya, yuktivyapashraya, and satvavajaya chikitsa. Thus, in the non-pharmacological management of FGIDs, Ayurveda played a magnificent role.

Post-infectious irritable bowel syndrome following a diagnosis of traveller's diarrhoea: a comprehensive characterization of clinical and laboratory parameters.

Prolonged or recurrent gastrointestinal symptoms may persist after acute traveller's diarrhoea (TD), even after adequate treatment of the primary cause. This study aims to describe the epidemiological, clinical and microbiological characteristics of patients with post-infectious irritable bowel syndrome (PI-IBS) after returning from tropical or subtropical areas. We conducted a retrospective study of patients presenting between 2009 and 2018 at the International Health referral centre in Barcelona with persistent gastrointestinal symptoms following a diagnosis of TD. PI-IBS was defined as the presence of persistent or recurrent gastrointestinal manifestations for at least 6 months after the diagnosis of TD, a negative stool culture for bacterial pathogens and a negative ova and parasite exam after targeted treatment. Epidemiological, clinical and microbiological variables were collected. We identified 669 travellers with a diagnosis of TD. Sixty-eight (10.2%) of these travellers, mean age 33years and 36 (52.9%) women, developed PI-IBS. The most frequently visited geographical areas were Latin America (29.4%) and the Middle East (17.6%), with a median trip duration of 30days (IQR 14-96). A microbiological diagnosis of TD was made in 32 of these 68 (47%) patients, 24 (75%) of whom had a parasitic infection, Giardia duodenalis being the most commonly detected parasite (n = 20, 83.3%). The symptoms persisted for a mean of 15months after diagnosis and treatment of TD. The multivariate analysis revealed that parasitic infections were independent risk factors for PI-IBS (OR 3.0, 95%CI 1.2-7.8). Pre-travel counselling reduced the risk of PI-IBS (OR 0.4, 95%CI 0.2-0.9). In our cohort, almost 10% of patients with travellers' diarrhoea developed persistent symptoms compatible with PI-IBS. Parasitic infections, mainly giardiasis, seem to be associated with PI-IBS.

Nutritional assessment of women with celiac disease compared to the general population

The nutritional quality of a gluten-free diet is debated because of the elimination of grains that are important sources of nutrients. The aim of this cross-sectional study was to perform a nutritional assessment in treated women with celiac disease and ongoing symptoms, and compare dietary intake with a healthy reference group (Norkost 3). Celiac disease patients with biopsy confirmed mucosal healing, but persistent gastrointestinal symptoms, were included from an ongoing clinical trial. Nutritional assessment included anthropometrics, blood samples and dietary intake obtained by two 24h recalls. Dietary intake in celiac women was compared with dietary intake in healthy women (Norkost 3). Two sample t-test was used for comparison of CeD and Norkost 3 women. Adjustment for age, BMI, education and smoking, by use of multiple linear regression analysis, did not change the results. In total, 59 women with celiac disease and 925 women that participated in Norkost 3 were included, with a mean age of 45 years in both groups. Women with celiac disease had a higher proportion of energy (E%) from fat (39 vs 34%, P<0.001) and saturated fat (15 vs 13%, P=0.01), a lower E% from protein (16 vs 18%, P=0.01) and a lower intake of dietary fiber (19 vs 22g, P=0.002) compared to Norkost 3 women. Women with celiac disease had a lower intake of bread, fruit and milk, and a higher intake of cereals and cheese compared to Norkost 3 women. The average requirement was not met for several micronutrients, but blood analysis revealed few nutritional deficiencies: two women with insufficient vitamin D status and one with insufficient folic acid status. The women with celiac disease had an unbalanced diet with a higher intake of total- and saturated fatty acids and a lower intake of fiber compared to the general population. These findings emphasizes the need for nutritional follow-up of celiac patients and development of nutrient dense gluten-free products.

The Impact of Persistent Gastrointestinal Symptoms on Completion of Oral Immunotherapy in Clinical Trials

Although oral immunotherapy (OIT) is an effective treatment option for food allergy it can be complicated by persistent gastrointestinal (GI) reactions. The impact of GI symptoms on the outcome of OIT is not known.

Intestinal obstruction due to annular pancreas in neonatal period: a case report

Annular pancreas is a rare congenital malformation characterized by a pancreatic ring surrounding the descending part of the duodenum. It occurs in 1:20,000 live births. The age of presentation depends on the severity of the intestinal obstruction. The diagnosis requires imaging studies and surgical exploration. This is the case of a 13-day-old newborn admitted to the Neonatal Intensive Care Unit of Hospital Nacional Arzobispo Loayza. He presented with gastric residuum, vomiting and intermittent abdominal distension. Given the persistent gastrointestinal symptoms despite the treatment administered, a radiological examination of the upper digestive tract with contrast dye was conducted. Signs of duodenal stenosis were found. An exploratory laparotomy showed a postoperative diagnosis of annular pancreas. Kimura’s diamond-shaped side-to-side duodenoduodenal anastomosis was performed as a definitive treatment.

Concomitant laparoscopic cholecystectomy and laproscopic assisted splenectomy for surgical management of hereditary spherocytosis

Laparoscopic splenectomy is rapidly becoming a common treatment modality in the surgical management of hematological processes involving the spleen .Hereditary spherocytosis is the most common red blood cell membrane disorder and its diagnosis is often associated with haemolytic crisis and premature cholelithiasis .our patient 25 year old presented with cholelithiasis ,splenomegaly and anemia and because of persistent anemia and gastrointestinal symptoms the patient underwent laparoscopic cholecystectomy and splenectomy in pregnant women (1st trimaster)

S48 Health Disadvantage Is Associated With Persistent GI Symptoms in Adults With Crohn’s Disease in Endoscopic Remission

Background: While it is widely recognized that patients’ socioeconomic status and living environments play crucial roles in the management and clinical course of CD, there is a scarcity of health disparities research beyond the associations with race, ethnicity, and insurance coverage. We herein examine the relationship between the symptomatic and inflammatory burden of CD and social determinants of health (SDOH) compassing encompass neighborhood environments and community conditions, including access to education, job opportunities, transportation, and dietary resources. Methods: We performed a retrospective cohort study on adults with CD enrolled in a tertiary referral center biobank in Southern California from 2014-2021. We included patients with standardized clinical disease activity assessments (2-item patient-reported outcome [PRO-2] for abdominal pain [AP] and stool frequency [SF]; remission: AP ≤3 and SF≤1) within 7 days of an ileocolonoscopy scored by the Simple Endoscopic Score for Crohn Disease (remission <3). Health disadvantage was assessed using the California Healthy Places Index (SDOH index), a zip code-based system that ranks communities’ SDOH domains using weighted z-scores (0-100 percentile) from the most health disadvantage (low score) to the most health advantaged (high score) in 8 subdomains: economy, education, healthcare access, housing, neighborhoods, clean environment, transportation, and social environment. Multivariate regression models were created from patient/SDOH factors (dependent variable) that were statistically significant (P < 0.05) on univariate logistic regression to compare the differences between patient with and without active GI symptoms (independent variable) despite endoscopic remission. SDOH subdomains were classified as below (health disadvantage) or above the median (reference) on the SDOH Index. Results: Of the 353 ileocolonoscopies (cases) from 216 unique patients with CD, 151 cases (43%) from 108 unique patients had endoscopic remission. Health disadvantage was not associated with endoscopic disease activity (P = 0.95) with 42% (25/59) and 43% (126/294) of patients below and above the SDOH index median, respectively, were in endoscopic remission. Patients with health disadvantage (below median on the SDOH Index) were more likely to report GI symptoms despite endoscopic remission (OR 2.7, 95% CI 1.1-6.5, P = 0.03). On univariate analysis, poor economic conditions (OR 2.4, 95% CI 1.0-5.7, P = 0.04), low education attainment (OR 3.9, 95% CI 1.8-8.2, P = 0.0004), unfavorable neighborhood conditions (OR 3.1, 95% CI 1.6-6.3, P = 0.001), and poor healthcare access (OR 2.3, 95% CI 1.1-4.4, P = 0.02) were risk factors for persistent GI symptoms. Females (OR 2.8, 95% CI 1.4-5.7, P = 0.003) and smokers (OR 2.6, 95% CI 1.2-5.8, P = 0.02) also reported more persistent GI symptoms. On multivariable analysis, unfavorable neighborhood conditions (aOR 2.9, 95% CI 1.3-6.5, P = 0.01), smoking (aOR 2.6, 95% CI 1.1-6.4, P = 0.02), and female gender (aOR 2.8, 95% CI 1.3-6.5, P = 0.01) remained as risk factors for persistent GI symptoms despite endoscopic remission. Conclusion(s): Health disadvantage, specifically poor neighborhood conditions, may be non-inflammatory risk factors for persistent gastrointestinal symptoms of adults with Crohn’s disease in endoscopic remission. Further investigations into the role of social determinants of health and environmental risk factors in the clinical course and manifestation of IBD are warranted.