Prevalence Of Gastrointestinal Symptoms Research Articles

Efficacy and Safety of Mizoribine Combined With Tacrolimus in Living Donor Kidney Transplant Recipients: 3-Year Results by a Chinese Single Center Study

BackgroundMizoribine (MZR) was effective and safe for living Chinese donor kidney transplantation (LDKT) on tacrolimus-based treatment 1 year after transplantation. We investigated whether MZR was effective and safe for LDKT on tacrolimus-based treatment with long follow-up periods. MethodsWe compared 22 LDKT recipients who were administered MZR, tacrolimus, and corticosteroids with a control group (n = 20) treated with mycophenolate mofetil (MMF), tacrolimus, and corticosteroids. Primary efficacy endpoints were 3-year patient survival, 3-year graft survival, and acute rejection (AR) rate within 3 years after transplantation. ResultsThe 3-year patient and graft survival rates for the MZR and MMF groups were 100%. The AR rate after transplantation was 18.2% for the MZR group and 10.0% for the MMF group; the difference was not significant (P = .665). There was no significant difference in serum creatinine levels, glomerular filtration rates (eGFR), serum urate levels, blood urea nitrogen, and cystatin C levels 12, 24, and 36 months after transplantation. No significant differences in the CD3, CD4, CD8, CD4/CD8, and CD45 were observed between the 2 groups 12, 24, and 36 months after transplantation. There were no significant differences in adverse events among the MZR or the MMF group, whereas the prevalence of gastrointestinal symptoms were significantly lower in the MZR treatment group (P = .003), especially acid reflux (P = .007). Compared with the MMF group, the MZR group should lighten the burden on patients. ConclusionMZR with tacrolimus and corticosteroids provides satisfactory immunosuppression and higher safety for Chinese LDKT over a 3-year follow-up.

Gastrointestinal symptoms before and after laparoscopic Roux-en-Y gastric bypass: a longitudinal assessment

BackgroundRoux-en-Y gastric bypass (RYGB) is an effective treatment for morbid obesity, but many patients have increased gastrointestinal symptoms. ObjectivesTo evaluate gastrointestinal symptoms and food intolerance before and after RYGB over time in a large cohort of morbidly obese patients. SettingA high-volume bariatric center of excellence. MethodsA prospective cohort study was performed in patients who underwent RYGB between September 2014 and July 2015, with 2-year follow-up. Consecutive patients screened for bariatric surgery answered the Gastrointestinal Symptom Rating Scale (GSRS) and a food intolerance questionnaire before RYGB and 2 years after surgery. The prevalence of gastrointestinal symptoms before and after surgery and the association between patient characteristics and postoperative gastrointestinal symptoms were assessed. ResultsFollow-up was 86.2% (n = 168) for patients undergoing primary RYGB and 93.3% (n = 28) for revisional RYGB. The total mean GSRS score increased from 1.69 to 2.31 after surgery (P < .001), as did 13 of 16 of the individual scores. Preoperative GSRS score is associated with postoperative symptom severity (B = .343, P < .001). Food intolerance was present in 16.1% of patients before primary RYGB, increasing to 69.6% after surgery (P < .001). Patients who underwent revisional RYGB had a symptom severity and prevalence of food intolerance comparable with that among patients with primary RYGB, even though they had more symptoms before revisional surgery. ConclusionsTwo years after surgery, patients who underwent primary RYGB have increased gastrointestinal symptoms and food intolerance compared with the preoperative state. It is important that clinicians are aware of this and inform patients before surgery.

Frecuencia de autoanticuerpos y síntomas sugestivos de enfermedad gastrointestinal en un grupo de pacientes con psoriasis

IntroductionPsoriasis is a chronic disease associated with multiple comorbidities including inflammatory intestinal disease. There are no previous studies in Colombia regarding the relationship of gastrointestinal symptoms in patients with psoriasis. ObjectiveTo determine the frequency of symptoms and autoantibodies suggestive of gastrointestinal disease in patients with psoriasis, and to compare the results with healthy controls, as well as their relationship with disease activity. Materials and methodsCross-sectional study with an analytical component, including a questionnaire on symptoms and serum analysis of antibodies suggestive of gastrointestinal disease in cases and controls. ResultsThe analysis included 84 individuals, separated into groups of 44 cases and 40 controls. Mild psoriasis was observed in 64% of cases, and the remaining 36% had moderate to severe psoriasis. Topical treatments were given to 71% of cases, with another 16% using oral treatments, and 14% received biological treatment. The main symptoms of gastrointestinal disease were, abdominal distention (45%), constipation (39%), and fatigue (34%). A comparison showed a higher prevalence of gastrointestinal symptoms in cases vs. controls, and fatigue was statistically significant (P=.04). Only the antinuclear autoantibodies in the serum analysis were statistically significant (0 vs. 43%; P=.01). ConclusionsThe prevalence of symptoms and autoantibodies suggestive of gastrointestinal disease in patients with psoriasis is considered important, even although there are no significant differences when compared with healthy controls. Some patients with gastrointestinal symptoms had positive autoantibodies. This suggests that an adequate clinical follow-up should be carried out. Dermatologists have a decisive role in the integral management of patients.

Frequency of autoantibodies and symptoms suggestive of gastrointestinal disease in a group of patients with psoriasis

IntroductionPsoriasis is a chronic disease associated with multiple comorbidities including inflammatory intestinal disease. There are no previous studies in Colombia regarding the relationship of gastrointestinal symptoms in patients with psoriasis. ObjectiveTo determine the frequency of symptoms and autoantibodies suggestive of gastrointestinal disease in patients with psoriasis, and to compare the results with healthy controls, as well as their relationship with disease activity. Materials and methodsCross-sectional study with an analytical component, including a questionnaire on symptoms and serum analysis of antibodies suggestive of gastrointestinal disease in cases and controls. ResultsThe analysis included 84 individuals, separated into groups of 44 cases and 40 controls. Mild psoriasis was observed in 64% of cases, and the remaining 36% had moderate to severe psoriasis. Topical treatments were given to 71% of cases, with another 16% using oral treatments, and 14% received biological treatment. The main symptoms of gastrointestinal disease were, abdominal distention (45%), constipation (39%), and fatigue (34%). A comparison showed a higher prevalence of gastrointestinal symptoms in cases vs. controls, and fatigue was statistically significant (p=0.04). Only the antinuclear autoantibodies in the serum analysis were statistically significant (0 vs. 43%; p=0.01). ConclusionsThe prevalence of symptoms and autoantibodies suggestive of gastrointestinal disease in patients with psoriasis is considered important, even although there are no significant differences when compared with healthy controls. Some patients with gastrointestinal symptoms had positive autoantibodies. This suggests that an adequate clinical follow-up should be carried out. Dermatologists have a decisive role in the integral management of patients.

The Effect of Marijuana and Opiate Use on Prevalence of Gastrointestinal Symptoms: A Population-Based Analysis of Internet Search Trends

The Effect of Marijuana and Opiate Use on Prevalence of Gastrointestinal Symptoms: A Population-Based Analysis of Internet Search Trends

Gastrointestinal Symptoms in Marfan Syndrome and Hypermobile Ehlers-Danlos Syndrome.

Objective Marfan syndrome (MS) is a multisystem disorder caused by a mutation in FBN1 gene. It shares some phenotypic features with hypermobile Ehlers-Danlos syndrome (EDS) such as joint hypermobility. EDS is a group of inherited heterogenous multisystem disorders characterized by skin hyperextensibility, atrophic scarring, joint hypermobility, and generalized tissue fragility. Hypermobile EDS (hEDS) is thought to be the most common type. Recent studies have suggested an association between connective tissue hypermobility and functional gastrointestinal disorders (FGDs). The aim of this study is to determine the prevalence of gastrointestinal symptoms in patients with Marfan syndrome and hypermobile EDS. Method Patients with a diagnosis of either MS or hEDS attending cardiology or rheumatology outpatients at our hospital were asked to complete SF36 RAND and Rome IV Diagnostic questionnaires. Questionnaires were also completed by patients who are members of Marfan Association UK. The same questionnaires were also completed by age- and gender-matched controls attending fracture clinic without existing diagnoses of MS or hEDS. Results Data were collected from 45 MS patients (12 males and 33 females, age range 19–41 years, mean 28 years) and 45 hEDS patients (6 males and 39 females, age range 18–32 years, mean 24 years). None had a previous organic gastrointestinal diagnosis. The control group was matched for age and sex (18 males and 72 females, age range 18–45, mean 29 years). Both MS and hEDS groups showed a higher prevalence of abdominal symptoms compared to the control group; however, the hEDS group not only showed a higher prevalence but more frequent and severe symptoms meeting Rome IV criteria for diagnosis of FGIDs. Nearly half of the hEDS patients met the criteria for more than one FGID. The hEDS group also scored lower on quality of life (QOL) scores in comparison to either of the other groups with a mean score of 48.6 as compared to 54.2 in the Marfan group and 78.6 in the control group. Conclusion FGIDs are reported in both Marfan syndrome and hypermobile Ehlers-Danlos syndrome but appear to be more common and severe in hEDS. These patients score lower on quality of life scores as well despite hypermobility being a common feature of both conditions. Further work is needed to understand the impact of connective tissue disorders on gastrointestinal symptoms.

Prevalence of Gastro Intestinal symptoms and its determinants among rural population of Kancheepuram district, Tamil Nadu,India

Background: Water is the most common yet the most precious resource on earth without which there would be no life on earth .The most predominant water borne disease is diarrhoea of which 88% is attributed to unsafe water supply, inadequate sanitation and hygiene. Diarrhoea causes 4% of deaths worldwide. Objective: To measure the prevalence of Gastro Intestinal (GI) problems and its determinants in rural area of Kancheepuram district, Tamil Nadu. Materials and methods: A community based cross sectional study was conducted in the rural area of Chunampet, Kancheepuram district. The study area includes ten villages, out of which 2 villages were selected. The study was conducted on January 2014. Sample size was calculated as 1200. Data was collected using questionnaire containing details on socio demographic profile, drinking water, and details of family members with Gastro intestinal symptoms. Results &amp; Conclusion: During the last 3 months, 11.8% (58) of the houses had GI problems. 55.7% households use pipe water for drinking purpose, 64.4% household members don’t consume chlorinated water, 59.3% household members don’t consume boiled water and 68.7% households don’t have proper latrine facility. The study showed that the reported GI problems were high among the houses who consume water which is neither boiled nor chlorinated and don’t wash their hands before eating ,which were the most likely risk factors for acquiring GI illness.

Prevalence, Severity and Potential Nutritional Causes of Gastrointestinal Symptoms during a Marathon in Recreational Runners.

The purpose of the present study was to investigate the prevalence of gastrointestinal symptoms (GIS) amongst recreational runners during a marathon race, and potential nutritional factors that may contribute. Recreational runners of the 2017 Liverpool (n = 66) and Dublin (n = 30) marathons were recruited. GIS were reported post-marathon and we considered GIS in the 7 days prior to the marathon and during the marathon using the Gastrointestinal Symptom Rating Scale (GSRS). Nutritional intake was recorded using food diaries for the day before the race, morning of the race, and during the race; 43% of participants reported moderate (≥4) GIS in the 7 days prior to the marathon and 27% reported moderate symptoms during the marathon with most common symptoms being flatulence (16%) during training, and nausea (8%) during the marathon race. Correlations between all nutritional intake and GIS were not statistically significant (p > 0.05). There were significant correlations between total GIS score (r = 0.510, p < 0.001), upper GIS score (r = 0.346, p = 0.001) and lower GIS score (r = 0.483, p < 0.001) in training and during the marathon. There appears to be a modest prevalence of GIS in recreational runners, in the week prior to a marathon and during marathon running, although there was no association with nutritional intake before or during the race.

The Prevalence of Gastrointestinal Symptoms Depends on Disease Duration and Gastrointestinal Tract Region in Patients with Type 2 Diabetes

Background/Aims: We aimed to unravel how symptoms related to gastrointestinal (GI) dysfunction impair quality of life (QoL) in patients with diabetes mellitus (DM). Methods: We enrolled 134 outpatients with type 2 DM and 16 non-DM. In DM patients, mean age was 64.7 years, mean body mass index (BMI) 24.7 kg/m2, mean glycated hemoglobin (HbA1c) 7.1%, and mean DM duration 13.7 years. In non-DM, mean age was 66.6 years and mean BMI was 25.2 kg/m2. GI symptom-related QoL was determined using the Izumo scale, based on five factors, i.e., heartburn, gastralgia, postprandial fullness, constipation and diarrhea. The sum of scores obtained for the three questions in each domain was calculated, and subjects with a score of 5 or higher were considered to be symptomatic with impaired QoL. JMP Clinical version 5.0 was used for all statistical analyses. Results: In DM patients, constipation was much greater than non-DM, diarrhea was somewhat higher, other symptoms did not increase significantly. In DM, lower abdominal symptoms were found to be more frequent than those affecting the upper abdomen. Diabetic duration and medications showed associations with GI symptoms. We identified differences in peak prevalences of the five symptoms. Gastralgia and total GI symptoms peaked at a diabetes duration of 15-19 years. Heartburn and postprandial fullness tended to increase with disease duration. Constipation and diarrhea showed bimodal peaks, with the first early and the second late in the disease course. Finally, GI symptoms showed clustering that reflected the region of the GI tract affected, i.e., constipation and diarrhea had similar frequencies. Conclusions: Our study highlights the importance of questioning patients about QoL impairment due to abdominal symptoms, especially in the early and the late periods of diabetes. The heterogeneous nature of the underlying GI symptoms, including medication usage, should be taken into consideration when managing patients with T2DM. Disclosure M. Fujishiro: Research Support; Self; Johnson &amp; Johnson Services, Inc. A. Kushiyama: Research Support; Self; Teijin Pharma Limited, Sanwa Kagaku Kenkyusho Co., Ltd., Kowa Pharmaceutical Co., Ltd, StaGen. Consultant; Self; RIZAP. H. Yamazaki: None. T. Yamamotoya: None. T. Kikuchi: None. H. Sakoda: None. R. Suzuki: Research Support; Self; Daiichi Sankyo Company, Limited, Kyowa Hakko Kirin Co., Ltd.. Other Relationship; Self; MSD K.K., Novo Nordisk Pharma Ltd., Daiichi Sankyo Company, Limited, Eli Lilly Japan K.K. T. Kadowaki: Consultant; Self; Novo Nordisk A/S, AstraZeneca, Merck Sharp &amp; Dohme Corp.. Research Support; Self; Kissei Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Sanofi, Kyowa Hakko Kirin Co., Ltd., Novo Nordisk A/S, Astellas Pharma, Daiichi Sankyo Company, Limited, Takeda, Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Merck Sharp &amp; Dohme Corp., Nippon Boehringer Ingelheim Co. Ltd.. Speaker's Bureau; Self; Astellas Pharma, AstraZeneca, Merck Sharp &amp; Dohme Corp., Ono Pharmaceutical Co., Ltd., Takeda, Eli Lilly and Company, Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk A/S.

Gastric Emptying Impacts the Timing of Meal Glucose Peak in Subjects With Uncomplicated Type 1 Diabetes.

Diabetes mellitus is associated with gastrointestinal (GI) motility dysfunction, ranging from delayed to accelerated gastric emptying (GE). To evaluate GE in patients with type 1 diabetes mellitus (T1DM) without chronic complications and to investigate its relation with postprandial glucose and GI hormone responses. Cross-sectional study. Forty-two patients with T1DM free of chronic complications referred to Federico II University and 31 healthy controls similar for age, sex, and body mass index. GE was assessed by using the 13C-octanoate breath test with a standardized solid meal. During the meal, plasma glucose, ghrelin, and glucagon-like peptide 1 (GLP-1) responses were assessed, and GI symptoms were evaluated by a specific questionnaire. Patients with T1DM showed a significantly slower GE half-emptying time (GE t1/2) (113 ± 34 minutes) than did controls (89 ± 17 minutes; P < 0.001). Thirty-six percent of T1DM showed a delayed GE (t1/2 > 120 minutes), whereas all controls showed a normal GE. When patients with T1DM were stratified according to GE t1/2, postmeal glucose response was significantly different between those with delayed and those with normal GE (P = 0.013). In particular, patients with T1DM and delayed GE showed a significantly longer mean time to peak glucose than did patients with normal GE (P = 0.004). In addition, GE t1/2 was an independent predictor of the time to peak glucose (β = 0.329; P = 0.025). GLP-1 and ghrelin responses to the test meal, as well as the prevalence of GI symptoms, were similar between patients with T1DM and controls and between patients with T1DM with normal GE and those with delayed GE. Delayed GE time is associated with a longer time to peak glucose. GE evaluation could be useful for individualizing the timing of preprandial insulin bolus in patients with T1DM.

Connecting Our Gut Feeling and How Our Gut Feels: The Role of Well-being Attributes in Irritable Bowel Syndrome.

Background/AimsThere is a close relationship between the mind and gut in the pathogenesis of functional bowel disorders. Common psychological disturbances such as depression and anxiety are not uncommon in those with irritable bowel syndrome (IBS). There is little research investigating the role of positive psychology and gastrointestinal (GI) conditions. In this pilot study we investigated the well-being attributes in those with and without IBS.MethodsWe used an anonymous online survey and recruited 416 study subjects using social media as the main method of recruitment. We gathered demographic information, GI symptoms, history of mental health issues such as anxiety and depression, assessed several well-being attributes, and finally assessed subjective well-being. We hypothesized that those with GI symptoms and IBS have lower scores in their well-being attributes compared to healthy controls.ResultsWe observed that a history of anxiety and depression is significantly associated with GI symptoms and IBS. In addition, sense of subjective well-being and several well-being attributes are negatively associated with GI symptoms and/or IBS. Of interest, the household income showed a negative correlation with the prevalence of GI symptoms and IBS.ConclusionsSubjective well-being, and several well-being attributes that contribute to the sense of overall contentment, are negatively associated with GI symptoms and IBS. The link between subjective well-being, and GI symptoms and IBS are independent of anxiety and depression. Well-being attributes and sense of subjective well-being may be a contributory factor in clinical expression of GI symptoms or IBS consistent with the biopsychosocial model of the disease.

Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review.

Gastrointestinal symptoms are among the most common complaints in patients with postural tachycardia syndrome (POTS). In some cases, they dominate the clinical presentation and cause substantial disabilities, including significant weight loss and malnutrition, that require the use of invasive treatment to support caloric intake. Multiple cross-sectional studies have reported a high prevalence of gastrointestinal symptoms in POTS patients with connective tissue diseases, such as Ehlers-Danlos, hypermobile type, and in patients with evidence of autonomic neuropathy. Previous studies that evaluated gastric motility in these patients reported a wide range of abnormalities, particularly delayed gastric emptying. The pathophysiology of gastrointestinal symptoms in POTS is likely multifactorial and probably depends on the co-morbid conditions. In patients with POTS and Ehlers-Danlos syndromes, structural and functional abnormalities in the gastrointestinal connective tissue may play a significant role, whereas in neuropathic POTS, the gastrointestinal tract motility and gut hormonal secretion may be directly impaired due to localized autonomic denervation. In patients with normal gastrointestinal motility but persistent gastrointestinal symptoms, gastrointestinal functional disorders should be considered. We performed a systematic review of the literature related to POTS and gastrointestinal symptoms have proposed possible mechanisms and discussed diagnosis and treatment approaches for delayed gastric emptying, the most common gastrointestinal abnormality reported in patients with POTS.

AB96. 141. Altered appetite, body weight and quality of life after curative oesophagectomy

Background: Improved oncologic outcomes in oesophageal cancer have resulted in increased survivorship, and a focus on long-term health-related quality-of-life (HR-QL). Gastrointestinal symptoms are common among patients after oesophagectomy, but data regarding the postoperative trajectory of nutrition-related symptoms and their relation to body weight loss (%BWL) and HR-QL are lacking. This study aimed to characterise the prevalence of gastrointestinal symptoms and altered appetite, and their impact on postoperative HR-QL in survivorship.

Coeliac disease and gastrointestinal symptom screening in adult first-degree relatives.

The first-degree relatives (FDRs) of patients with coeliac disease are the main risk group for disease development. The study aims to evaluate the screening strategy in FDRs with negative coeliac serology based on human leukocyte antigen (HLA) genotyping, followed by duodenal biopsy, and to analyze the prevalence of gastrointestinal symptoms and the influence of gluten intake. Adult FDRs with negative coeliac serology were invited to participate (n=205), and a total of 139 completed the study protocol. HLA genotyping, transglutaminase antibody assessment, and duodenal biopsy were performed. Symptomatology was assessed using questionnaires during the various phases of dietary modification (baseline diet, gluten-free diet, and gluten overload). The study included 139 participants (mean age, 42years; 53.2% women). HLA-DQ2/8 was positive in 78.4% of the participants (homozygous, 15.1%; heterozygous, 63.3%). Histopathological alterations were noted in 37.1% of participants who underwent duodenal biopsy (Marsh I, 32.7%; Marsh IIIa, 4.4%). At baseline, symptoms were observed in 45.7% of the participants, and the proportion decreased to 24.5% after the gluten-free diet (P<0.001). Symptoms were not associated with the presence of histological alterations or genetic risk. However, younger age (odds ratio [OR]=0.91), female sex (OR=2.9), and the presence of autoimmune disorders (OR=2.8) were independently associated with a significant symptom response to the gluten-free diet. Duodenal lymphocytosis and atrophy are frequently noted in FDRs, despite negative serological markers. In addition, gastrointestinal symptoms are commonly present and associated with gluten intake regardless of the histological pathology.

Prevalence of Gastrointestinal Symptoms in Renal Transplant Children Receiving Mofetil Mycophenolate

Prevalence of Gastrointestinal Symptoms in Renal Transplant Children Receiving Mofetil Mycophenolate

Functional Dyspepsia Symptoms Are Strongly Associated With Coeliac Disease: Results From a Population-Based Study

Introduction: Coeliac disease (CD) is estimated to affect up to 1 in 100 Australians. Although CD has a wide range of clinical manifestations, patients frequently present with gastrointestinal (GI) symptoms which overlap with functional GI disorders such as irritable bowel syndrome (IBS) or functional dyspepsia (FD).Patients with CD have been shown to experience persistent GI symptoms despite long term treatment with a gluten free diet. Methods: The aim of this study was to define GI symptoms reported in an Australian cohort with a doctor diagnosis of CD and compare with those not reporting CD. A total of 3825 people (mean age 58.4 years, age range 18-100 years and 47.5% males) randomly selected from the Australian population returned a mail survey (Digestive Health & Wellbeing Survey, response rate=45%) which contained questions on whether the participant had ever been told by a physician that they had CD, and GI symptom questions to establish whether they had co-existent functional GI disorders. Adherence to a gluten free diet was not assessed. Prevalence of CD, FD and IBS are reported with 95% exact confidence intervals. The difference between symptoms in CD compared with the unaffected population was tested for significance using a Pearson chi-square test. Results: The prevalence of doctor diagnosed CD was 1.17% in this cohort. Subjects with CD reported significantly higher levels of GI symptoms than unaffected individuals, including abdominal pain associated with abnormal bowel habit, diarrhoea, bloating, distention, epigastric burning and early satiety (see Table 1). There was no significant difference observed in symptoms of post-prandial fullness, nausea, constipation, abnormal stool consistency, or straining with defecation. The prevalence of FD as defined by Rome III criteria in the CD cohort was 37.5% (95% CI 22.7-54.2) compared to 13.9% (95% CI 12.8- 15.1) in the non-affected population (OR 3.7, 95% CI 1.9-7.1, p < 0.001). There was no significant difference in the prevalence of IBS in the affected compared with the non- affected cohort (30.8% versus 22.2%, p=0.2).Table: Table. Gastrointestinal symptoms reported in patients with and without coeliac disease (CD). Items reported as greater than one day per week (*) or greater than or equal to “often” (**)Conclusion: The prevalence of gastrointestinal symptoms and a diagnosis of functional dyspepsia are significantly higher in patients with a doctor diagnosis of CD than in the unaffected population.

Gastrointestinal tract disorders in the elderly.

The number and the proportion of older people in the world have both increased substantially in recent years in most countries, and the growth is projected to accelerate in the coming decades. It is thus important to gain a better understanding of the most frequent diseases in people living to advanced old age. Although the aging process has clinically significant effects on oropharyngeal and upper esophageal motility, colonic function and gastrointestinal (GI) immunity, no specific GI disease of the aged population is known. Nevertheless, the prevalence of GI symptoms and signs have increased, due to aging processes and to the superimposed effects of comorbidities and environmental exposure (medications, alcohol, tobacco). As a consequence, GI morbidity in the elderly represents an increasingly relevant burden for public health systems. This review focuses on the most frequent GI disorders of the elderly, describing their epidemiological, pathophysiological and clinical implications. The main benign diseases, symptoms or signs involving the GI tract are discussed, debating the potential role of a multidisciplinary approach when appropriate. Finally, it is highlighted that age-related physiologic changes in most systems, including the GI tract, affect diagnostic test interpretation and response to treatments, and may be difficult to differentiate from disease. This should be considered together with the fact that, with multiple coexisting diseases, there is a less consistent relationship between disease and clinical manifestations in the elderly.

Probiotics for fibromyalgia: study design for a pilot double-blind, randomized controlled trial.

Fibromyalgia syndrome (FMS) is a chronic, generalized and diffuse pain disorder accompanied by other symptoms such as emotional and cognitive deficits. The FMS patients show a high prevalence of gastrointestinal symptoms. Recently it has been found that microbes in the gut may regulate brain processes through the gut-microbiota-brain axis, modulating thus affection, motivation and higher cognitive functions. Therefore, the use of probiotics might be a new treatment that could improve the physical, psychological and cognitive state in FMS; however, no evidence about this issue is available. This paper describes the design and protocol of a double-blind, placebo-controlled and randomized pilot study. We use validated questionnaires, cognitive task through E-Prime and biological measures like urine cortisol and stool fecal samples. The trial aim is to explore the effects of eight weeks of probiotics therapy in physical (pain, impact of the FMS and quality of life), emotional (depression, and anxiety) and cognitive symptoms (attention, memory, and impulsivity) in FMS patients as compared to placebo. This pilot study is the first, to our knowledge, to evaluate the effects of probiotics in FMS. The primary hypothesis was that FMS patients will show a better performance on cognitive tasks, and an improvement in emotional and physical symptoms. These results will contribute to a better understanding in the gut-brain axis. Here we present the design and protocol of the study.

Prevalence of gastrointestinal symptoms in Angelman syndrome.

Angelman syndrome (AS) is a neurogenetic disorder characterized by intellectual disability, expressive speech impairment, movement disorder, epilepsy, and a happy demeanor. Children with AS are frequently reported to be poor feeders during infancy and as having gastrointestinal issues such as constipation, reflux, and abnormal food related behaviors throughout their lifetime. To assess the prevalence of gastrointestinal disorders in individuals with AS, we retrospectively analyzed medical records of 120 individuals seen at the Angelman Syndrome Clinic at Massachusetts General Hospital and 43 individuals seen at the University of North Carolina Comprehensive Angelman Clinic. The majority of patients' medical records indicated at least one symptom of gastrointestinal dysfunction, with constipation and gastroesophageal reflux disease (GERD) the most common. Other gastrointestinal issues reported were cyclic vomiting episodes, difficulty swallowing, excessive swallowing, and eosinophilic esophagitis. Upper gastrointestinal symptoms such as GERD, swallowing difficulties, cyclic vomiting, and eosinophilic esophagitis were more common in those with deletions and uniparental disomy, likely related to the involvement of multiple genes and subsequent hypotonia. The frequency of constipation is consistent among all genetic subtypes while early feeding issues appear to mainly affect those with deletions. Caregivers and healthcare providers should be aware of the high prevalence of these issues, as proper treatment may improve not only gastrointestinal dysfunction but also sleep and behavioral issues.

Constipation in adults with neurofibromatosis type 1

BackgroundNeurofibromatosis type 1 (NF1) is an autosomal-dominant disease characterised by symptoms of the skin, eyes, nervous system and bones. A previous study indicated that constipation, large rectal diameters and prolonged colorectal transit times are common in children with NF1. The aim of the present study was to investigate and compare the prevalence of gastrointestinal symptoms in adult patients with NF1 to their unaffected relatives serving as the control group. Patients with NF1 were recruited from one of two Danish National Centres of Expertise for NF1 and their unaffected relatives were invited to participate as controls. Gastrointestinal symptoms were assessed with a web-based, self-administered, validated, Rome® III diagnostic questionnaire. Logistic regression was used to estimate the prevalence of functional dyspepsia, IBS and functional constipation in each group and the groups were compared using their odds ratios.ResultsThe response rates for patients and controls were 66.4% and 82.4%, respectively. We compared 175 patients, median age 34.2 (IQR = 20.1) and 91 of their unaffected relatives, median age 42.0 (IQR = 12). The overall likelihood of fulfilling the diagnostic criteria for functional constipation, irritable bowel syndrome or functional dyspepsia was 33.1% among patients vs. 14.3% among controls, (odds ratio (OR): 2.97; 95% CI: 1.56–5.66) and after adjustment for age and gender (OR: 3.06; 95% CI: 1.62–5.79). The likelihood of functional constipation was higher among patients (OR: 3.80; 95% CI: 1.27–11.31), and this was still true after adjustment (OR: 3.49; 95% CI: 1.14–10.64). The likelihood of irritable bowel syndrome (OR: 2.29; 95% CI: 0.98–5.33) was evident after adjustment (OR: 2.46; 95% CI: 1.10–5.47), whereas there was no difference in the likelihood of functional dyspepsia (OR: 2.35; 95% CI: 0.67–8.32) after adjustment (OR:2.25; 95% CI: 0.70–7.17).ConclusionsOverall, having symptoms usually attributed to either functional dyspepsia, IBS or functional constipation is more common in adults with NF1 compared to unaffected relatives. Of the three, the likelihood of constipation is markedly higher. The high prevalence of constipation indicates that it is not functional but part of the NF1 disorder.