Prevalence Of Gastrointestinal Disorders Research Articles

Irritable Bowel Syndrome: A Review for General Pediatricians.

Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits. The bothersome and chronic nature of IBS symptoms negatively affects patients' activity level and quality of life, imparting an economic burden on the patient, the family, and the health care system. Research is still trying to elicit a clear pathophysiologic mechanism for IBS, and its clinical presentation and manifestations vary from patient to patient. The importance of a comprehensive history and physical examination cannot be emphasized enough in the diagnosis of IBS, as to date there are no specific laboratory studies that will confirm the diagnosis. There is currently no cure for IBS, and treatments range from a broad range of medications, to cognitive-behavioral therapy, to hyponotherapy. This review highlights recent advances in research on the epidemiology, pathophysiology, clinical manifestations, evaluation, and management of IBS.

Irritable bowel syndrome among nurses working in King Abdulaziz University Hospital, Jeddah, Saudi Arabia

BackgroundIrritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder that can cause disability and economic burden. Nurses are a vital part of the medical team and their well-being is an important issue. Yet, few studies have been done concerning IBS among nurses.ObjectivesTo determine the prevalence, severity, and predictors of IBS among nurses working at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.Materials and methodsA cross-sectional study was conducted among 229 nurses who fulfilled the eligibility criteria. They were selected by stratified random sampling during 2014–2015. A validated, confidential, self-administered data collection sheet was used for collection of personal and sociodemographic data. Rome III Criteria, IBS Severity Scoring System (IBS-SSS), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI) were included. Both descriptive and inferential statistics were done. A multiple logistic regression analysis was done to determine the predictors of IBS.ResultsThe prevalence of IBS among nurses was 14.4%, and IBS-Mixed type was the commonest variety (54.5%). Positive family history of IBS, working in outpatient clinics, having day shift, poor sleep quality, and high anxiety and depression scale scores were significantly associated with IBS. After controlling for confounding factors in regression analysis, the predictors of IBS were food hypersensitivity (aOR=4.52; 95% CI: 1.80−11.33), morbid anxiety (aOR=4.34; 95% CI: 1.49–12.67), and positive family history of IBS (aOR=3.38; 95% CI: 1.12–13.23).ConclusionThe prevalence of IBS was 14.4%. Food hypersensitivity, morbid anxiety, and family history were the predictors of IBS. Screening and management of IBS, food hypersensitivity, and psychological problems among nurses are recommended.

English

Irritable bowel syndrome (IBS) is considered as a prevalent gastrointestinal disorder which is characterized by some non-specific symptoms, such as altered bowel habits and abdominal pain. There is no recognized organic pathology associated with IBS. The prevalence of IBS is different in different communities. Its etiology remains uncertain or obscure, perhaps multifactorial. The predestined objective was the determination of prevalence, associated factors and impact of IBS on medical student studying in Prince Sattam bin Abdulaziz University. A cross-sectional study was carried out among male medical students enrolled in Prince Sattam bin Abdulaziz University during the academic year 2013 to 2014. All male medical students of second to sixth year were invited for participation in the study by filling study questionnaire. A validated, reliable, confidential, and self-administered questionnaire was used for data collection. Rome III Criteria was used for the diagnosis of irritable bowed syndrome. The IBS prevalence was 21% with profiles characterized by constipation (20.0%), diarrhea (34.3%), and other alternating symptoms (45.7%). Students who having history of chronic health problems were about three times more prone to develop IBS (OR=2.93). Those reported having stress was at 2.63 times more risk to develop IBS. Those having food hypersensitivity as compared to others were more liable to develop IBS (OR=3.29). IBS was not significantly associated with academic performance. IBS prevailed among medical students. Thus, screening of these students for psychological problems, IBS and stress management strategies are recommended for these students. Key words: Bowel habits, irritable bowel syndrome (IBS), medical students, prevalence, work absenteeism.

The genetic epidemiology of diverticulosis and diverticular disease: Emerging evidence.

Diverticular disease (DD) is one of the most prevalent gastrointestinal disorders. The pathogenesis of diverticulosis and DD is controversially discussed. Current studies call the traditional concept of a fibre-deficient diet causing the development of diverticula into question. Data from two recent twin studies have provided conclusive evidence for a strong genetic component to diverticulosis. Although genomewide association studies have provided new insights into the polygenic architecture of human diseases, genomic research in diverticulosis and DD has just been started. This is an astonishing fact given the high morbidity and mortality of the disease, as well as the substantial economic burden on health care systems. For this review, we provide an update of the molecular pathobiology and summarise recent evidence supporting the hypothesis that distinct, yet unidentified genetic variants contribute to the development of diverticulosis and DD.

Two-Year Outcomes Post-Transoral Incisionless Fundoplication for Gastroesophageal Reflux Disease

Introduction: GERD is one of the most prevalent gastrointestinal disorders in the United States. Transoral incisionless fundoplication (TIF) has emerged as an endoscopic treatment for a subset of patients with chronic gastroesophageal reflux disease (GERD) who do not obtain adequate symptom relief with PPI's. Long-term comparison to Nissen fundoplication and proton pump inhibitor therapy deserves further evaluation. Methods: We used the Optum healthcare database to determine overall resource utilization including costs for hospitalizations, outpatient visits and PPI therapy. Standardized costs were used for inpatient and outpatient visits and pharmacologic therapy. We used the Charlson co-morbidity index (CCI) to estimate patient co-morbidities. Standard CPT codes were used for Nissen. Since there was no CPT code for TIF, we verified cases by review of hospital records. Combined Nissen+hiatal hernia repair (HHR) were excluded, but cases involving TIF+HHR were included. We collected outcomes over a 2-year period post-therapy. 3-way ANOVA testing was performed. Results: The cohort consisted of a total of 13,293 patients of whom 10,486 were on high-dose PPI therapy, 2,734 underwent Nissen, and 73 patients had the TIF procedure. The mean CCI scores scores were higher for the PPI cohort (1.4±0.02 for PPI, 0.95±1.4 for Nissen and 0.86±0.13 for TIF, p=0.00). Table 1 demonstrates utilization of medication and outpatient visits pre- and post-therapy. At two years post-TIF, healthcare utilization and total health care costs were decreased for the TIF cohort. There were no differences comparing TIF and Nissen cohorts. As shown in Table 2 and Figure 1, median costs increased during the 1st year post-index when the endoscopic or surgical therapy was performed (median cost $9,031 for the PPI cohort per patient compared to $29,151 for the Nissen cohort and $26,196 for the TIF patients). These healthcare costs were normalized based on U.S. geographic region and procedure/treatment type. During the 2nd year, these costs were significantly decreased for the TIF cohort. Limitations of the analysis include the short time period post-TIF and small number of patients with available follow-up information.Figure 1Table 1: Record of Median Utilization Pre and Post-ProcedureTable 2: Median Costs at 24 Months Per CohortConclusion: At two years post-therapy, total costs decreased overall for the TIF cohort and healthcare utilization was reduced. The outcomes post-TIF appear to be comparable to those post-Nissen.Figure 2

OP‐23 FUNCTIONAL DYSPEPSIA IS ASSOCIATED WITH DUODENAL EOSINOPHILIA IN A PEDIATRIC COHORT

Objectives:Functional dyspepsia (FD) is a highly prevalent gastrointestinal disorder with unknown etiology. We aimed to assess the association between dyspeptic symptoms and duodenal eosinophilia in children referred for upper endoscopy.Methods:In this retrospective cohort study, all histopathology reports of normal upper endoscopies performed at a single tertiary center between 2010 and 2014 were reviewed. FD was defined as epigastric pain or discomfort for more than 2 months with no response to acid suppressants. Controls were those with non‐erosive reflux disease, dysphagia or rumination syndrome. Duodenal biopsies were analyzed by pathologists blinded to indication. Intramucosal eosinophils were counted per mm2 on haematoxylin and eosin stained digital imaged sections using Aperio eSlide Manager. Demographics, clinical variables, family history and histologic findings were compared between cases and controls.Results:In total, 36 cases and 36 non‐matched controls were identified of which 56% and 53% were female (p = 0.81). Mean (± SD) age was higher in cases compared to controls (13.6 (± 3.1) vs. 10.5 (± 4.0) years; p = .001). Dyspeptic symptoms (epigastric pain 81% and/or upper abdominal discomfort 33%) were food‐related in 69% and nocturnal in 31% of cases. Self‐reported nausea (64% vs. 17%; p < .0001), lethargy (19% vs. 0%; p = .005) and a family history of functional gastrointestinal disorders (28% vs. 3%; p = .003) were more common in cases than controls. There was a higher but not significantly different rate of atopic history (39% vs. 25%; p = .21) and psychological co‐morbidity (53% vs. 39%; p = .24) in FD cases versus controls. Duodenal intraepithelial lymphocytes per 100 enterocytes were similar in cases and controls (median (IQR) 10 (8–13) vs. 12 (8–18); p = 0.12). Duodenal eosinophil counts per mm2 were significantly increased in cases compared to controls (151 (118–207) vs. 76 (60–106); p < 0.001).Conclusions:This study confirms recent reports of duodenal eosinophilia in FD. The high rate of atopic and psychological co‐morbidity in FD suggests multi‐factorial mechanisms and may explain why current therapeutic options aimed at symptom control are largely unsatisfactory. Duodenal eosinophilia in FD should be considered a therapeutic target.

Diagnosis and Treatment of <i>Helicobacter Pylori</i> Infection

Helicobacter Pylori affects nearly half of the world’s population and is a major pathogen associated with prevalent gastrointestinal disorders, including peptic ulcer and gastric cancer. Various diagnostic methods are available to detect infection, and the choice of method depends on factors such as their accessibility, advantages and disadvantages and cost. New treatment options for eradicating H. pylori have emerged as a result of the decreased efficacy of standard triple therapy due to increasing antibiotic resistance. This work reviews the main diagnostic methods used to identify H. pylori infection and to confirm the eradication of infection. We also provide a comprehensive overview of current and emerging strategies for the treatment of H. pylori infection. Keywords: Helicobacter Pylori; Diagnosis; Therapeutics 중심 단어: 헬리코박터 파일로리; 진단; 치료

Unmet Needs in the Treatment of Gastroesophageal Reflux Disease.

Gastroesophageal reflux disease (GERD) is a highly prevalent gastrointestinal disorder. Proton pump inhibitors have profoundly revolutionized the treatment of GERD. However, several areas of unmet need persist despite marked improvements in the therapeutic management of GERD. These include the advanced grades of erosive esophagitis, nonerosive reflux disease, maintenance treatment of erosive esophagitis, refractory GERD, postprandial heartburn, atypical and extraesophageal manifestations of GERD, Barrett’s esophagus, chronic protein pump inhibitor treatment, and post-bariatric surgery GERD. Consequently, any future development of novel therapeutic modalities for GERD (medical, endoscopic, or surgical), would likely focus on the aforementioned areas of unmet need.

Molecular and cellular mechanisms of tight junction dysfunction in the irritable bowel syndrome.

The pathophysiological mechanisms of the irritable bowel syndrome (IBS), one of the most prevalent gastrointestinal disorders, are complex and have not been fully elucidated. The present study aimed to investigate the molecular and cellular mechanisms of tight junction (TJ) dysfunction in IBS. Intestinal tissues of IBS and non-IBS patients were examined to observe cellular changes by cell chemical tracer electron microscopy and transmission electron microscopy, and intestinal claudin-1 protein was detected by immunohistochemistry, western blot analysis and fluorescence quantitative polymerase chain reaction. Compared with the control group, TJ broadening and the tracer extravasation phenomenon were observed in the diarrhea-predominant IBS group, and a greater number of neuroendocrine cells and mast cells filled with high-density particles in the endocrine package pulp as well as a certain extent of vacuolization were present. The expression of claudin-1 in diarrhea-predominant IBS patients was decreased, while it was increased in constipation-predominant IBS patients. In conclusion, the results of the present study indicated that changes in cellular structure and claudin-1 levels were associated with Tjs in IBS.

Dietary patterns and risk of gallbladder disease: a hospital-based case-control study in adult women.

Gallbladder disease is one of the most prevalent gastrointestinal disorders that may result from a complex interaction of genetic and environmental factors. This study examined the association of dietary patterns with gallstone disease among Iranian women. This case-control study was conducted in general teaching hospitals in Tehran, Iran. Participants were 101 female cases and 204 female controls aged 40-65 years who were admitted for problems other than GBD. Dietary patterns were identified using principal components analysis based on food frequency questionnaire. Compared to the control group, cases were less educated, less physically active, and consumed more total energy (p<0.02). Having ≥ 3 livebirths increased the risk of gallstone by more than 5 times, followed by having rapid weight loss, being single, having familial history of gallstone, and consuming high total energy. Two distinct dietary patterns were identified in women (healthy and unhealthy). After adjustment for several confounding variables, healthy dietary pattern was associated with a decreased risk of gallstone disease (OR=0.14, 95% CI 0.048-0.4) while unhealthy dietary pattern was associated with an increased risk (OR=3.77, 95% CI 1.52-9.36). These findings confirm that dietary pattern approach provides potentially useful and relevant information on the relationship between diet and disease. Identifying risk factors will provide an opportunity for prevention of gallbladder disease in developing countries facing an increased risk of obesity.

Health consequences of shift-work: The case of Iranian Hospital Security Personnel

Shift-work, which is an ergonomics issue in workplaces, can negatively affect workers. The security personnel of medical centers in Iran have multiple responsibilities and consequently are exposed to such unwanted situations as observing patients, disputing with patient's attendants, unwanted shift schedules, and being away from family for long periods. This study assessed health problems of Iranian hospital security personnel (shift-worker personnel) using the Survey of Shift-workers (SOS) questionnaire (Persian version). This cross-sectional study was conducted in seven medical centers (4 hospitals and 3 clinics). A total of 416 workers were surveyed: shift-workers (exposed group) (n=209) and non-shift-workers (unexposed group) (n=207). The prevalence of adverse health effects was higher in shift-workers than day-workers. The level of education and mean Body Mass Index (BMI) in shift-workers were significantly higher compared with day-workers. The prevalence of gastrointestinal disorders, cardiovascular and psychological problems were also significantly higher in shift-workers compared with day-workers. Overall, the prevalence of health problems among the security personnel of medical centers was high. Hence, it is recommended that personnel be put under periodic monitoring and receive medical counseling and treatment if there is any disorder.

Gastroprotective effect of methanolic extract of Gomphrena celosioides on indomethacin induced gastric ulcer in Wistar albino rats.

Context:Gastric ulcer is one of the most prevalent gastrointestinal disorders. A number of studies have been carried out to determine the efficacy of herbal medicines in the treatment of gastric ulcer.Objectives:The present study was undertaken to evaluate the anti-ulcerogenic activity of methanol extract of Gomphrena celosioides (GC) in male Wistar rats.Materials and Methods:The rats were divided into eight groups, methanol extract of GC was administered orally, for seven consecutive to five groups. On the 7th day, indomethacin was administered to induce gastric ulceration. Gastric secretions were collected and analyzed.Results:Animals pretreated with GC extract showed a significant reduction in ulcer score, ulcer index, gastric volume, and gastric total acidity in indomethacin-induced ulcer models in a dose dependent manner when compared to the ulcerated control group.Conclusion:The study revealed gastroprotective activity of the extract in dose-dependent manner. Methanol extract of the leaves of GC was significantly effective in protecting the gastric mucosa against indomethacin-induced ulcers at all the dose level studied.

Misconceptions and negative attitudes towards the metabolic effects of Ramadan fasting, resulting in fasting avoidance

The aim of this study was to assess public knowledge about the effects of Ramadan fasting on various aspects of health and its association with fasting decision-making. This cross-sectional study was conducted on 600 subjects. The association between fasting and participants’ knowledge and attitudes toward Ramadan fasting, anthropometric measurements, physical activity, depression, anxiety, stress, dietary intake, and prior history of diseases was evaluated. The results indicated an adverse correlation between negative attitudes towards the effects of Ramadan fasting and adherence to fasting (P<0.0001). The prevalence of gastrointestinal disorders was higher in the non-fasting group (P=0.002). No significant association was found between other investigated variables and fasting adherence. It seems that negative thinking about the effects of Ramadan fasting may be inversely associated with fasting decision-making. Therefore, evidence-based educational programs may improve public knowledge and encourage fasting among eligible people.

Prevalence and risk factors of cholelithiasis in Amol city, northern Iran: a population based study.

Cholelithiasis is one of the most prevalent gastrointestinal disorders requiring hospitalization. While different factors influence gallstone formation in patients, these factors are not the same in different societies or in different geographical locations. To evaluate the epidemiology and risk factors associated with gallstone formation in a large population group, the present survey was conducted in northern Iran. In 6143 asymptomatic subjects, the incidence of gallstone formation as well as risk factors were evaluated through a structured questionnaire, physical examination and ultrasonography study. Sample selection was based on stratified cluster systemic randomization. Of these enrolled subjects 3507 (57.1%) were male and 2636 (42.9%) were female with a mean age of 42.71 ± 17.1 years. The prevalence of gallstones was 0.80%. On multivariate analysis, the risk of gallstone disease is correlated to rural locale, diastolic hypertension, age, and TG levels. However, systolic hypertension, glucose serum levels and obesity were also significantly associated with the presence of gallstones. The present study proposes that the rate of gallstone disease in northern Iran is lower than previous studies have reported, and that most of the risk factors can be prevented by changes in lifestyle and diet.

PWE-164 A Meta-analysis Of Randomised Controlled Trials On The Effect Of Probiotics On Functional Constipation In Adults

IntroductionConstipation is a prevalent gastrointestinal disorder whose treatment remains challenging. Patient dissatisfaction with prescribed medications is common, and there is a need for alternative methods of management. Probiotics are live...

Helicobacter Pylori vacA Gene Detection in Saliva of Patients with Upper Gastrointestinal Disorders in Accra, Ghana

Helicobacter pylori play an essential role in the pathogenesis of upper gastrointestinal disorders. The diagnostic role of the bacterium thus has been a subject of intense investigations. In this study we used an immune-chromatographic method and the polymerase chain reaction (PCR) to detect H. pylori in the saliva of patients with clinically diagnosed upper gastrointestinal disorders. Thirty such patients reporting to the Korle-Bu Teaching Hospital (Accra, Ghana) for upper gastrointestinal endoscopy consented for this study. Saliva samples were collected from each subject and analysed for H. pylori antibodies using a rapid immuno-chromatographic assay and H. pylori DNA by nested PCR using specific primers. Ten (33.3%) out of the 30 samples tested positive for the saliva antibody test with the most prevalent gastrointestinal disorders among the positive subjects being peptic ulcer (60%) followed by gastritis (30%) and esophagitis (10%). Following nested PCR analysis, a 346bp fragment of the vacA (m2) gene region of H. pylori was amplified in 9 (90%) out the 10 samples that were positive by the rapid immuno-chromatographic assay. Saliva samples could serve as a reliable non-invasive alternative to detect the presence of H. pylori infection in synergy with available diagnostic methods in Ghana.

Treatment of Helicobacter pylori infection: meeting the challenge of antimicrobial resistance.

Treatment of Helicobacter pylori (H. pylori) infection is paramount for the management of prevalent gastrointestinal disorders including peptic ulcer disease and gastric cancer. Due to the wide increase in prevalence of H. pylori resistance to antibiotics, clarithromycin-based triple therapies are not any more suitable for unconditional empiric use, and should not be recommended, unless local resistance to this antibiotic is low (< 20%). Alternative strategies have been proposed to overcome the issue of increasing clarithromycin resistance, and some of them are already implemented in clinical practice. These comprise: (1) adoption of novel, more effective, empirical treatments: bismuth quadruple, sequential, non-bismuth quadruple (concomitant), dual-concomitant (hybrid), and levofloxacin-based regimens, the latter mainly designated as second-line/rescue options; (2) perspectives for a susceptibility-guided (tailored) therapeutic approach based on culture-free molecular testing methods; and (3) adjunct use of probiotics to improve eradication rates. The present article is aimed to provide a comprehensive overview of current and emerging strategies in the treatment of H. pylori infection, focusing on the challenge of antimicrobial resistance.

Positive Predictors for GERD and therapeutic response to proton-pump inhibitors

Background: Gastroesophageal reflux disease (GERD) is one of the most prevalent gastrointestinal disorders. Most effective therapy in GERD are proton pump inhibitors (PPIs). Rates on therapeutic response are still conflicting and vary depending on reported symptoms. Aim of our study is to identify objective and subjective predictors for reliable diagnosis of GERD and response to PPI-therapy.

Linaclotide-a Novel Secretagogue in the Treatment of Irritable Bowel Syndrome with Constipation and Chronic Idiopathic Constipation

Irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) are highly prevalent gastrointestinal disorders. Traditional symptoms based therapies had somewhat limited success and efficacy in addressing the disorders. Recently, linaclotide emerged as novel peptide capable of improving abdominal symptoms in patients suffering from IBS-C and CIC. Guanylate cyclase C (GC-C) receptor a multi domain protein, found to be molecular target for linaclotide which acts by activating GC-C receptor on the apical surface of intestinal epithelial cells. Binding of linaclotide to GC-C receptor triggers the elevation of second messenger cGMP that elicits fluid secretion into intestinal cells which play a critical role in maintaining homeostasis through cystic fibrosis transmembrane conductance regulator (CFTR). Data from Phase II and III clinical trials demonstrated that linaclotide seems to produce a statistically significant increase in stool frequency, improved straining, decreased abdominal pain and discomfort.

Association between khat chewing and gastrointestinal disorders: a cross sectional study.

Khat (Catha edulis Forsk) is a psycho-stimulant substance grown in East Africa. But its adverse effects and its prevalence are not well studied. The main aim of the present study is thus to assess the association between khat chewing and GI problems among students in Ambo University. A cross-sectional study was conducted in January 2010 on 1005 Ambo University students. Study subjects were selected using systematic random sampling technique, and data were collected using self-administered questionnaire. Data analysis was made using SPSS version 16.0 for windows package. The mean age of the respondents was 20.79 ± 1.39 ranging from 18-30 years. Seven hundred twenty (71.6 %) of the study participants were males and 994 (98.9%) were in the age group of 15-24 years. The prevalence of gastritis was 580 (57.7%); constipation 235 (23.4%); hemorrhoids 54 (5.4%) and that of dental problems (carries, decay, filling and extraction) was 225 (22.4%) of all study participants. Gastrointestinal disorders were found to be higher among khat chewers, where 64(36.2%) of them had dental problems; 127(71.8%) symptoms of gastritis; 86(48.6%) constipation and 26(14.7%) hemorrhoids which demonstrated statistically significant association with p < 0.001. The prevalence of gastrointestinal disorders was found to be higher among khat chewers, indicating that khat chewing could be a predisposing factor to gastrointestinal disorders. Community-based awareness creation about the adverse effect of khat use is thus recommended.