Significant Differences In Gastrointestinal Symptoms Research Articles

Helicobacter pylori in gastrointestinal manifestation of systemic sclerosis.

To study the prevalence of Helicobacter pylori in systemic sclerosis patients and its gastrointestinal manifestations in comparison with Helicobacter pylori-negative systemic sclerosis patients. Systemic sclerosis gastrointestinal outcome post Helicobacter pylori eradication was evaluated. In total, 70 systemic sclerosis patients and 70 age-, gender- and race-matched healthy controls had their urea breath test done. Gastrointestinal manifestations in systemic sclerosis were assessed using University of California at Los Angeles 2.0 and Leeds Dyspepsia Questionnaire questionnaires. Systemic sclerosis patients with confirmed Helicobacter pylori infection were given standard Helicobacter pylori eradication therapy. Urea breath test was repeated 6 weeks posteradication therapy with their gastrointestinal symptoms reassessed. The prevalence of Helicobacter pylori was low in both systemic sclerosis patients (10%) and healthy controls (2.9%). There was no significant difference in gastrointestinal symptoms between Helicobacter pylori-positive and Helicobacter pylori-negative systemic sclerosis patients. However, the Helicobacter pylori-positive patients reported higher median severity scores for the gastrointestinal symptoms of reflux (0.5 vs 0.35), abdominal distension (1.5 vs 0.75) and social functioning impairment score (0.5 vs 0.16) using the University of California at Los Angeles 2.0 score. The Helicobacter pylori-positive patients also indicated increased upper abdominal pain (3.0 vs 0.0), regurgitation (2.0 vs 0.0) and burping (3.0 vs 0.0), observed from the Leeds Dyspepsia Questionnaire scores. Gastrointestinal outcomes post-Helicobacter pylori eradication showed either an improvement or complete resolution of symptoms. Gastrointestinal symptoms in systemic sclerosis patients are unlikely to be caused by Helicobacter pylori in the recent years in our cohort of patients. No significant difference in gastrointestinal symptoms was seen between Helicobacter pylori-positive and Helicobacter pylori-negative systemic sclerosis patients. Helicobacter pylori can be readily tested by urea breath test to look for present infection.

Gastrointestinal Symptoms and Dopamine Transporter Asymmetry in Early Parkinson's Disease.

BackgroundThe neurophysiological correlates of gastrointestinal symptoms (GISs) in Parkinson's disease (PD) are not well understood. It has been proposed that in patients with a gastrointestinal origin of PD dopaminergic neurodegeneration would be more symmetric.ObjectivesThe aim is to assess the associations between GISs and asymmetry of nigrostriatal dopaminergic neurodegeneration in PD.MethodsNinety PD patients were assessed using motor and GIS scales and 123I‐FP‐CIT SPECT. We calculated the asymmetry index and the predominant side of motor symptoms and dopamine transporter (DAT) imaging defect and assessed their association with GISs.ResultsThere were no significant differences in GISs between symmetric and asymmetric dopaminergic defect. Left predominant defect was related to more GIS and higher constipation scores.ConclusionsGISs were associated with left predominant reduction in putaminal DAT binding but not asymmetry per se. It remains open whether left‐sided DAT deficit is related to more pronounced GI involvement or symptom perception in PD. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson Movement Disorder Society.

Gastrointestinal motility evaluation in children with orthostatic intolerance: Mayo Clinic experience.

Orthostatic intolerance (OI) and autonomic dysfunction (AD) are common in adolescents and young adults. Patients experience multisystem symptoms including gastrointestinal (GI), postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), or only symptoms of OI (SOI) without significant findings on 70-degree head-up tilt testing (HUT). We hypothesize that patients with POTS, OH, and SOI show differences in GI symptoms and motility test and that heart rate (HR) changes on HUT predict severity of GI dysmotility. From medical records of patients (<18years) with OI, we collected demographics, presenting symptoms, GI manifestations, and GI motility testing. Data were compared between the 3 groups (POTS, OH, and SOI). We assessed changes in HR on HUT with changes on GI motility evaluation. Two hundred twenty-nine patients were included (73% females). Abdominal pain (65%), nausea (49%), vomiting (18%), and constipation (24%) were the most common GI symptoms. In patients who had motility evaluation, there were 27% (53/193) with delayed gastric emptying (GE) at 4hours, 35% (32/92) with delayed colonic transit (CT), 55% (17/31) with reduced gastric accommodation (GA), and 75% (21/28) with dyssynergic defecation (DD). Among 100 POTS, 34 OH, and 95 SOI patients, no significant differences in GI symptoms or motility tests were identified and HR changes on HUT were not associated with changes on motility tests. GI symptoms are frequent in adolescents with OI and are associated with delayed GE, reduced GA, delayed CT, and presence of DD.

Prebiotic UG1601 mitigates constipation-related events in association with gut microbiota: A randomized placebo-controlled intervention study.

BACKGROUNDConstipation is a common functional gastrointestinal disorder and its etiology is multifactorial. Growing evidence suggests that intestinal dysbiosis is associated with the development of constipation. Prebiotics are subjected to bacterial fermentation in the gut to produce short-chain fatty acids (SCFAs), which can help relieve constipation symptoms. The prebiotic UG1601 consists of inulin, lactitol, and aloe vera gel, which are known laxatives, but randomized, controlled clinical trials that examine the effects of this supplement on gut microbiota composition are lacking.AIMTo assess the efficacy of the prebiotic UG1601 in suppressing constipation-related adverse events in subjects with mild constipation.METHODSAdults with a stool frequency of less than thrice a week were randomized to receive either prebiotics or a placebo supplement for 4 wk. All participants provided their fecal and blood samples at baseline and at the end of intervention. Gastrointestinal symptoms and stool frequency were evaluated. The concentrations of serum endotoxemia markers and fecal SCFAs were determined. The relative abundance of SCFA-producing bacteria and the gut microbial community in the responders and non-responders in the prebiotics supplementation group were evaluated.RESULTSThere were no significant differences in gastrointestinal symptoms between groups, although the prebiotic group showed greater symptom improvement. However, after prebiotic usage, serum cluster of differentiation (CD) 14 and lipopolysaccharide (LPS) concentrations were significantly decreased (CD14, P = 0.012; LPS, P < 0.001). The change in LPS concentration was significantly larger in the prebiotic group than in the placebo group (P < 0.001). Fecal SCFAs concentrations did not differ between groups, while the relative abundance of Roseburia hominis, a major butyrate producer, was significantly increased in the prebiotic group (P = 0.045). The abundances of the phylum Firmicutes and the family Lachnospiraceae (phylum Firmicutes, class Clostridia) (P = 0.009) were decreased in the responders within the prebiotic group. In addition, the proportions of the phylum Firmicutes, the class Clostridia, and the order Clostridiales were inversely correlated with several fecal SCFAs (P < 0.05).CONCLUSIONAlterations in gut microbiota composition, including a decrease in the phylum Firmicutes and an increase in butyrate-producing bacteria, following prebiotic UG1601 supplementation might help alleviate symptom scores and endotoxemia.

Postprandial Glucose and Insulin Response to a Cookie with or Without Added RS4 Wheat Starch After 3 Days of Pre-Feeding: A Double Blind, Randomized, Controlled Clinical Trial (P08-081-19)

ObjectivesResearch on the effect of resistant starch on postprandial glucose levels has mainly focused on the attenuation achieved by substituting it for the available carbohydrate (avCarb), few studies have looked at the effect on glucose levels when the resistant starch is added to avCarb. The objective of this study was therefore to investigate the acute effect on postprandial glycemia and insulinemia of a cross-linked RS4 wheat starch (Fibersym® RW) in a test cookie compared to a control cookie matched for available carbohydrate after a 3-day habituation period. MethodsThis study used a double blind, randomized, cross-over design. Nineteen healthy subjects were screened of which 16 were eligible and randomized into the study. A total of 15 subjects completed the study (5M:10F; 32 ± 11y; 24.9 ± 2.5 kg/m2; BP 112/70 mmHg). After 3-day pre-feeding of Control (dietary fiber 1.6 g/d) or Fibersym sugar snap cookies (dietary fiber 29 g/d), the subjects, after an overnight fast, consumed either the respective Control or Fibersym cookie, both meals contained 40 g avCarb. Blood samples were collected over 2 h. Gastrointestinal (GI) symptoms were recorded during the pre-feeding period and during the postprandial visit. Subjective appetite scores were measured at the same time points when blood samples were collected. ResultsThe 90-min blood glucose incremental area under the curve (IAUC) was statistically significantly lower after ingesting the Fibersym cookie (71.9 ± 8.5 mmolxmin/L) compared to the Control cookie (86.7 ± 9.3 mmolxmin/L) (P < 0.02). In addition, the peak glucose concentrations at 30 and 45 min after consumption of the Fibersym cookie was significantly lower than the Control cookie (P < 0.05). Insulin levels at 90-min (P < 0.016) and the 2-h (P < 0.02) insulin IAUC’s were significantly lower after consumption of the Fibersym cookie compared to the Control cookie. There were no significant differences in GI symptoms over the 3-day pre-feeding period and during the 2 h postprandial visit between the two cookies and neither did the appetite scores differ significantly. ConclusionsThe cross-linked RS4 wheat starch, Fibersym, when formulated into a cookie, is well tolerated and attenuates blood glucose and insulin levels in healthy subjects compared to a Control cookie containing the same amount of available carbohydrate. Funding SourcesMGP Ingredients, Inc.

A Systematic Review of the Role of Prebiotics and Probiotics in Autism Spectrum Disorders.

Background: Autism spectrum disorder (ASD) is a complex developmental condition typically characterized by deficits in social and communicative behaviors as well as repetitive patterns of behaviors. Despite its prevalence (affecting 0.1% to 1.8% of the global population), the pathogenesis of ASD remains incompletely understood. Patients with ASD are reported to have more frequent gastrointestinal (GI) complaints. There is some anecdotal evidence that probiotics are able to alleviate GI symptoms as well as improve behavioral issues in children with ASD. However, systematic reviews of the effect of prebiotics/probiotics on ASD and its associated symptoms are lacking. Methods: Using the keywords (prebiotics OR probiotics OR microbiota OR gut) AND (autism OR social OR ASD), a systematic literature search was conducted on PubMed, EMBASE, Medline, Clinicaltrials.gov and Google Scholar databases. The inclusion criteria were original clinical trials, published in English between the period 1st January 1988 and 1st February 2019. Results: A total of eight clinical trials were systematically reviewed. Two clinical trials examined the use of prebiotic and/or diet exclusion while six involved the use of probiotic supplementation in children with ASD. Most of these were prospective, open-label studies. Prebiotics only improved certain GI symptoms; however, when combined with an exclusion diet (gluten and casein free) showed a significant reduction in anti-sociability scores. As for probiotics, there is limited evidence to support the role of probiotics in alleviating the GI or behavioral symptoms in children with ASD. The two available double-blind, randomized, placebo-controlled trials found no significant difference in GI symptoms and behavior. Conclusion: Despite promising preclinical findings, prebiotics and probiotics have demonstrated an overall limited efficacy in the management of GI or behavioral symptoms in children with ASD. In addition, there was no standardized probiotics regimen, with multiple different strains and concentrations of probiotics, and variable duration of treatments.

Interventions for reducing inflammation in familial Mediterranean fever.

Interventions for reducing inflammation in familial Mediterranean fever.

Pilot Study: Comparison of Sourdough Wheat Bread and Yeast-Fermented Wheat Bread in Individuals with Wheat Sensitivity and Irritable Bowel Syndrome.

Many patients suspect wheat as being a major trigger of their irritable bowel syndrome (IBS) symptoms. Our aim was to evaluate whether sourdough wheat bread baked without baking improvers and using a long dough fermentation time (>12 h), would result in lower quantities of alpha-amylase/trypsin inhibitors (ATIs) and Fermentable, Oligo-, Di-, Mono-saccharides and Polyols (FODMAPs), and would be better tolerated than yeast-fermented wheat bread for subjects with IBS who have a poor subjective tolerance to wheat. The study was conducted as a randomised double-blind controlled 7-day study (n = 26). Tetrameric ATI structures were unravelled in both breads vs. baking flour, but the overall reduction in ATIs to their monomeric form was higher in the sourdough bread group. Sourdough bread was also lower in FODMAPs. However, no significant differences in gastrointestinal symptoms and markers of low-grade inflammation were found between the study breads. There were significantly more feelings of tiredness, joint symptoms, and decreased alertness when the participants ate the sourdough bread (p ≤ 0.03), but these results should be interpreted with caution. Our novel finding was that sourdough baking reduces the quantities of both ATIs and FODMAPs found in wheat. Nonetheless, the sourdough bread was not tolerated better than the yeast-fermented bread.

Síntomas somáticos en preadolescentes de 10 a 12 años con sobrepeso u obesidad

Resumen Introducción. Numerosos estudios han relacionado la obesidad y el sobrepeso con síntomas físicos, psicológicos y sociales, pero son escasos los trabajos que examinan la presencia de síntomas somáticos en niños con exceso de peso. Objetivo. Conocer si existen diferencias en la manifestación de síntomas somáticos en preadolescentes de 10 a 12 años en función de su categoría ponderal (normopeso y sobrepeso/obesidad), así como en otras variables relacionadas con la enfermedad (veces en el último mes que han estado enfermos, que han acudido al médico o que han faltado a clase por estar enfermos y existencia de enfermedades en los miembros de su familia). Método. Se trata de un estudio transversal de casos y controles en el que participaron 668 preadolescentes, de los que 301 presentaban normopeso y 367 exceso de peso (obesidad o sobrepeso). Los participantes completaron el Children’s Somatization Inventory que examina la presencia de síntomas gastrointestinales, pseudoneurológicos y dolor. Para el análisis de los datos se llevó a cabo un análisis multivariado de la varianza. Resultados. No se hallaron diferencias significativas en función de la categoría ponderal en la manifestación de síntomas somáticos. Las diferencias fueron significativas únicamente en función del sexo, presentando las niñas más síntomas gastrointestinales que los niños (F [1,666] = 8.71; p = .003). Al examinar la sintomatología en cada subgrupo, se hallaron diferencias entre los niños con normopeso y obesidad/sobrepeso, mostrando estos últimos más falta de energía o cansancio (χ2 = 5.35; p &lt; .05), dificultad para respirar (χ2 = 7.51; p &lt; .01), convulsiones (χ2 = 4.12; p &lt; .05) y mala digestión (χ2 = 4.89; p &lt; .05). Además, fue mayor el porcentaje de niños con normopeso que no tiene ningún familiar enfermo respecto a los que presentaron obesidad o sobrepeso (χ2 = 2.47; p &lt; .01). Discusión y conclusión. En su conjunto, los resultados confirman la necesidad de valorar de forma exhaustiva y multidisciplinar la sintomatología física y psicológica de los niños y niñas obesos y con sobrepeso, para poder ofrecer una intervención exitosa, no sólo centrada en la reducción de peso, sino en la mejora de su calidad de vida.

Gluten and casein supplementation does not increase symptoms in children with autism spectrum disorder.

A gluten- and casein-free diet is often given to children with autism spectrum disorder (ASD). We aimed to determine the effect of gluten and casein supplementation on maladaptive behaviour, gastrointestinal symptom severity and intestinal fatty acids binding protein (I-FABP) excretion in children with ASD. A randomised, controlled, double-blind trial was performed on 74 children with ASD with severe maladaptive behaviour and increased urinary I-FABP. Subjects were randomised to receive gluten-casein or a placebo for seven days. We evaluated maladaptive behaviour before and after supplementation, using I-FABP excretion, the approach withdrawal problem composite subtest of the Pervasive Developmental Disorder Behavior Inventory and the Gastrointestinal Symptom Severity Index. The mean approach withdrawal problem composite score was significantly higher before supplementation than after, both in the placebo and in the gluten-casein group. However, the mean difference was not significant and may have been caused by additional therapy. There was no significant difference in gastrointestinal symptoms and urinary I-FABP excretion. Administrating gluten-casein to children with ASD for one week did not increase maladaptive behaviour, gastrointestinal symptom severity or urinary I-FABP excretion. The effect of prolonged administration or other mechanisms of enterocyte damage in ASD should be explored.

Micofenolato o tacrolimus comparado con ciclofosfamida en el tratamiento de nefritis lúpica: revisión sistemática y metaanálisis

ObjectiveTo perform a meta-analysis of controlled clinical trials to compare response rates of complete response and partial remission rates, as well as the adverse effects of immunosuppressive treatments, such as mycophenolate (MF) and tacrolimus, compared with cyclophosphamide (CY), for the management of lupus nephritis. Materials and methodsClinical trials were identified through MEDLINE database using PubMed, OVID and Cochrane search engines, LILACS, EMBASE, New York Academy of Medicine and conference proceedings from the ACR, EULAR, and GLADEL. Data were extracted independently by 2 reviewers. ResultsFor the comparison between MF and CY, 9 clinical trials were obtained, with a total of 812 patients, showing that MF has similar efficacy with CY in terms of complete and partial remission. There was no significant difference in gastrointestinal symptoms, leukopenia or deaths. There is less risk of menstrual abnormalities (RR: 0.38, 95% CI: 0.20-0.73), infections (RR: 0.64; 95% CI: 0.45-0.91) and less risk of hair loss (RR: 0.25, 95% CI: 0.16-0.38) in the MF group. For the comparison between tacrolimus and CY, 3 clinical trials were obtained, with a total 146 patients, showing that tacrolimus and CY have similar efficacy in complete and partial remission. In the outcome response (complete and partial remission), it was found that tacrolimus had a greater benefit than CY (RR: 1.21, 95% CI: 1.02-1.45). There was no significant difference in terms of toxicity between tacrolimus and CY. ConclusionsPatients treated with MF, tacrolimus and CY have similar rates of remission; however there is greater benefit in outcome response when comparing tacrolimus and CY. Comparing MF with CY showed a lower risk of menstrual abnormalities and reduced risk of alopecia.

Correlation of G/A -22018 single-nucleotide polymorphism with lactase activity and its usefulness in improving the diagnosis of adult-type hypolactasia among North Indian children

Adult-type hypolactasia (AtH or lactase non-persistence) is the physiological decline in lactase activity that manifests in majority of the world's population after weaning. Recently, various single-nucleotide polymorphisms (SNPs) upstream of lactase gene (LCT) have been suggested to be associated with AtH or the lactase persistent trait in different human populations. C/T -13910 SNP was found be completely associated with AtH in Finnish population, and G/A -22018 SNP was found to be strongly, but not completely, associated with AtH. The aim of this study was to correlate G/A -22018 SNP with intestinal lactase activity in North Indian children. These children were also genotyped for C/T -13910 SNP. We also examined the differences in milk consumption and milk-related clinical symptoms in children with different genotypes of G/A -22018 and C/T -13910 SNPs. Intestinal biopsies were obtained from 231 children aged 2-16years undergoing routine endoscopy for various abdominal complaints. The biopsies were assayed for lactase, sucrase, and maltase activities and genotyped for G/A -22018 and C/T -13910 SNPs using restriction fragment length polymorphism and DNA sequencing analysis. There was a significant correlation between lactase activity and different genotypes of G/A -22018 SNP. Children with G/G -22018 genotype had low lactase activity. With a reference value of<10U/g protein (lactase activity) to be indicative of AtH, the sensitivity and specificity of genetic test based on G/A -22018 SNP was 94.4 and 94.1%, respectively. Furthermore, the consumption of milk was lower in children with G/G -22018 genotype. Flatulence was the only symptom significantly more frequent among the children with G/G -22018 genotype compared to those with G/A and A/A -22018 genotypes. However, most of the children with G/G -22018 genotype seem to tolerate small amounts of milk without any significant difference in gastrointestinal symptoms from those with G/A and A/A -22018 genotypes.

Meta-analysis

To compare cyclooxygenase-2 (Cox-2) inhibitors alone with NSAIDs plus proton pump inhibitors (PPIs) in preventing gastrointestinal adverse events: upper gastrointestinal (UGI) adverse events and gastrointestinal symptoms in Osteoarthritis and Rheumatoid arthritis. PubMed, the Cochrane Library, EMBASE, ISI Web of Knowledge, Chinese Biomedical Literature Database, and reference lists of relevant papers for articles published 1990-2010.12 were searched. The related data matching standards set for this study were extracted. Statistical analyses were carried out using RevMan (5.0) software. The meta-analysis of six randomized controlled trials with a total of 6219 patients revealed that there was no difference in the UGI adverse events between Cox-2 inhibitors and nonselective NSAIDs with concurrent use of PPIs [relative risk (RR) 0.61, 95% confidence interval (CI) 0.34-1.09]. There was no significant difference in gastrointestinal symptoms (RR 1.10, 95% CI: 0.88-1.39) and the cardiovascular adverse events (RR 1.67, 95% CI: 0.78-3.59) between the two groups. Cox-2 inhibitors are no better than nonselective NSAIDs with PPIs in regard to UGI adverse events, gastrointestinal symptoms and cardiovascular adverse events in Osteoarthritis and Rheumatoid arthritis. On the basis of the current evidence and the combined wishes of the patient, clinicians should carefully consider and weigh both gastrointestinal and cardiovascular risk before selecting NSAID plus PPIs or Cox-2 inhibitors.

Comparison of Gastrointestinal Symptoms at Daily 10 Mg Versus Weekly 70 Mg Alendronate Prescription in 195 Osteoporotic Cases

Osteoporosis is defined as a reduction of bone density or the presence of a fragility fracture. One class of new antiosteoporotic drugs is the bisphosphonates. Oral bisphosphonates seems to induce serious gastrointestinal (GI) side effects in some patients. The aim of the study is to comparison the GI symptoms of Alendronate daily 10mg versus weekly 70mg administration in osteoporotic patients during 8 weeks. This is a clinical trial study that was conducted in the department of Internal Medicine, Shohada Ashayer Hospital, Khorramabad, Iran, 2002-2007. 195 osteoporotic patients selected for this study. They separated in three groups (first group: Placebo for eight weeks, 2 nd group 70 mg Alendronate at single dose per weeks for eight weeks and 3 rd group 10 mg Alendronate per day for 8 weeks). Then GI symptoms were detected for each person at different groups. The Data was analyzed with Chi-square test and ANOVA. comparison of mean of complications between groups shows that the patients in placebo group had lesser complications (P < 0.001). Comparison of each symptom between patients in 2 nd and 3 rd groups shows that only eructation had lesser frequency in first group of patients and other complications had not significant difference during 8 weeks of treatment. there is significant differences in GI symptoms between placebo and Alendronate but between Alendronate in doses of 10mg per day and 70 mg per week had not significant difference. Using of Alendronate must be cautiously because of producing severe GI disorders.

Clinical trial: gluten microchallenge with wheat‐based starch hydrolysates in coeliac disease patients – a randomized, double‐blind, placebo‐controlled study to evaluate safety

Wheat-based starch hydrolysates such as glucose syrups, dextrose and maltodextrins are found in more than 50% of European processed food. These products contain low amounts of residual gluten and it has been questioned whether they are safe for coeliac disease patients. To investigate whether coeliac disease patients can safely consume wheat-based starch hydrolysate products. This randomized, double-blind, placebo-controlled, prospective follow-up study involved 90 coeliac disease patients in remission randomized to consume glucose syrups, maltodextrins or placebo for 24 weeks. Small bowel mucosal morphology and inflammation, symptoms, coeliac serology and malabsorption laboratory data were evaluated at baseline and at the end of the study. Daily ingestion of wheat-based starch hydrolysates, glucose syrups and maltodextrins, had no deleterious effect on small-bowel mucosal villous architecture or inflammation in coeliac disease patients when compared to the placebo group. Neither were there any significant differences in gastrointestinal symptoms, serology or malabsorption parameters after 24 weeks. Wheat-based starch hydrolysates, glucose syrups and maltodextrins did not have harmful effect on coeliac disease patients. Coeliac patients can thus safely continue to consume these products.

Treatment of Vasomotor Symptoms of Menopause With Black Cohosh, Multibotanicals, Soy, Hormone Therapy, or Placebo: A Randomized Trial

Possible risks from even short-term hormone therapy have led many women to try herbs, multibotanical supplements, and dietary soy as alternative treatments for vasomotor symptoms occurring at or after menopause. The Herbal Alternatives for Menopausal Trial (HALT) was a 12-month double-blind, randomized, controlled study assessing the effectiveness and safety of three naturopathic measures as compared to hormone therapy and placebo in 351 women 45 to 55 years of age who were either in late menopausal transmission (52%) or postmenopausal (48%). The participants had at least two vasomotor symptoms each day. Five interventions were compared: 160 mg of black cohosh daily; a multibotanical containing 200 mg of black cohosh daily and nine other ingredients; the multibotanical plus dietary soy counseling; 0.625 mg daily of conjugated equine estrogen, with or without 2.5 mg daily of medroxyprogesterone acetate; and placebo. The rate and intensity of vasomotor symptoms were scored from 1 (mild) to 3 (severe), and the Wiklund Vasomotor Symptom Subscale was used to assess symptoms after 3, 6, and 12 months. At baseline, the women in this study averaged 6.5 vasomotor symptoms daily and symptom intensity averaged 1.8 on the 1-to-3 scale. The number of symptoms per day as well as Wiklund scores decreased in the first 3 months in all groups. No significant differences in either the number of daily symptoms or their intensity was found between the herbal interventions and placebo at 3, 6, or 12 months, with the exception of more intense symptoms at 12 months with the multibotanical plus soy intervention than in the placebo group. Negative findings also were obtained when hot flashes and night sweats were analyzed separately. At no time did Wiklund scores differ significantly between the herbal intervention and placebo groups. In contrast, differences favoring hormone therapy over placebo were significant at all follow-up intervals. Women taking hormone therapy experienced more breast pain and menstrual disorders than did placebo recipients, but there were no significant differences in gastrointestinal symptoms, nausea and vomiting, fatigue, malaise, or headache. Adherence to assigned treatment averaged 86% during the 12-month follow-up period. In view of the urgent need for safe ways of relieving vasomotor symptoms in perimenopausal and menopausal women, it is unfortunate that these results fail to support the use of black cohosh-alone or as part of a multibotanical product-to control these symptoms.

Gastric Electrical Activity and Gastric Emptying in Preterm Newborns Fed Standard and Hydrolysate Formulas

ABSTRACTBackgroundBecause infant formulas containing hydrolyzed cow milk protein are used to reduce feeding intolerance and to improve gastric emptying, the effect on gastrointestinal motility of a hydrolysate formula was compared with that of a standard preterm formula.MethodsThirty‐six preterm newborns with a gestational age of 32.2 ± 2.3 weeks were assigned randomly to standard formula or hydrolyzed formula. Cutaneous electrogastrography and ultrasound examination of gastric emptying were performed simultaneously to evaluate gastrointestinal motility before and after the test meal. All recording sessions were performed 1 week after infants had reached full enteral feeding.ResultsNo significant difference in gastrointestinal symptoms was noted in the newborns fed the different formulas. In particular, regurgitation and vomiting were observed in 78% versus 64% of preterm newborns after standard and hydrolyzed formula, respectively (Fisher exact test, not significant). No differences were found in terms of gastric electrical activity and gastric emptying time between the two groups.ConclusionsIt seems unnecessary to use hydrolysate formulas to improve motility in preterm infants.