O papel dos diários intestinais na consulta de gastrenterologia / The role of bowel diaries in a "real-life" setting

ABSTRACT Background Despite the potential advantages of patients' self-recordings of bowel habits in lower digestive disorders, few studies evaluate the relevance of clinical information obtained through bowel diaries in clinical practice. Objective The main objective of this study was to evaluate the role of bowel diaries as an auxiliary diagnostic tool in lower gastrointestinal disorders consultations. Methods In this cross-sectional study, at the end of their gastroenterology consultation, patients were questioned about their bowel habits and gastrointestinal symptoms. The bowel diary was then filled by the patients at home for 2 weeks. The data collected from the clinical interview and from the bowel diaries were analyzed. Results Fifty-three patients participated in the study. Patients underestimated the number of their bowel movements (BM) in the interviews compared with the bowel diaries (P=0.007). There was a poor agreement between stool consistencies described in the interviews and recorded in the diaries (k=0.281). Patients overestimated their straining during evacuation in the interviews compared with the diaries (P=0.012). Regarding the subgroups' analysis, patients with proctological disorders described less BM in their interviews (P=0.033). Straining during evacuation was higher in the interviews of patients without proctological disorders (P=0.028) and in the interviews of more educated patients (P=0.028). Conclusion Overall, there were discrepancies between the clinical interview and the bowel diary regarding the number of BM, the stool consistency and straining. Bowel diaries are therefore a relevant instrument as a complement to the clinical interview to objectify patients' complaints and treat functional gastrointestinal disorders more adequately.

RESUMO Contexto: Apesar das potenciais vantagens do diário intestinal como complemento à entrevista clínica, raros estudos avaliam a relevância da informação clínica obtida a partir de diários intestinais na prática clínica. Objetivo Os principais objetivos deste estudo foram avaliar o papel do diário intestinal como ferramenta diagnóstica numa consulta dedicada a patologia digestiva baixa. Métodos Foi realizado um estudo transversal, num período de 3 meses, em que no final das consultas os pacientes foram entrevistados relativamente a dados demográficos, antecedentes clínicos e hábitos e sintomas intestinais. Em seguida, foi solicitado o auto-preenchimento de um diário intestinal durante 2 semanas. Foram comparadas as respostas obtidas na entrevista clínica com os registos dos diários intestinais. Resultados: Cinquenta e três pacientes participaram no estudo. A frequência de evacuações reportada nas entrevistas clínicas e nos diários intestinais dos pacientes foi significativamente diferente (P=0,007). Verificou-se apenas uma concordância mínima entre a consistência das fezes descrita nas entrevistas e registada nos diários (κ=0,281). Em relação ao esforço evacuatório os pacientes sobrestimaram o seu esforço ao evacuar nas entrevistas (P=0,012). Adicionalmente, verificou-se que pacientes com doenças proctológicas descreveram menos evacuações nas suas entrevistas (P=0,033). A descrição do esforço durante a evacuação foi superestimada nas entrevistas de pacientes sem distúrbios proctológicos (P=0,028) e de pacientes com um nível mais elevado de educação (P=0,028). Conclusão: Globalmente verificaram-se discrepâncias entre a entrevista clínica e o diário intestinal dos pacientes em relação ao número de dejeções, à consistência das fezes e ao esforço evacuatório. Assim, esta ferramenta revelou-se uma potencial mais-valia na prática clínica diária, permitindo objetivar as queixas e consequentemente tratar os pacientes de forma mais adequada.

Clinical practice, knowledge and attitudes of oncology nurses to the management of gastrointestinal symptoms in cancer chemotherapy and the correlation research of medical and nursing cooperation / 中国实用护理杂志

Objective:To investigate the current situation of clinical practice of cancer chemotherapy-related gastrointestinal symptoms (CGIS) management among oncology nurses in Ningxia, and to explore the correlation between CGIS management and nurses′ knowledge and attitude and medical and nursing cooperation, so as to provide evidence for improving the clinical practice of cancer patients CGIS management among oncology nurses in Ningxia.Methods:This was a cross-sectional study. From January 25 to 31, 2021, the general data questionnaire and the questionnaire of clinical practice of CGIS management for cancer patients were used to survey 289 nurses in oncology department in Ningxia.Results:The scores of medical and nursing cooperation, CGIS knowledge, attitude, and CGIS management clinical practice activities of nurses in oncology department were (24.94 ± 3.20), (20.19 ± 3.82), (52.19 ± 6.17) and (129.93 ± 36.33) points, respectively. Among the scores of CGIS management clinical practice activities, gastrointestinal symptoms evaluation dimension scored the lowest, and the highest was CGIS health education dimension. There was a significant positive correlation between the scores of clinical practice of CGIS management of cancer patients and the scores of knowledge and attitude of oncology nurses ( r values were 0.225-0.293, all P<0.05). Conclusions:The clinical practice of cancer patients′CGIS management by oncology nurses needs to be improved, especially the evaluation of cancer patients′CGIS by oncology nurses. Nursing managers should formulate the activity guide of CGIS management clinical practice as soon as possible, strengthen the training of nurses′ relevant knowledge, and provide nurses with appropriate evaluation tools to improve the clinical practice of CGIS management.

Anticuerpos antitransglutaminasa tisular en pacientes con síntomas gastrointestinales

Introducción: La enfermedad celiaca es una enteropatía mediada por la respuesta inmune, que ha sido crecientemente reconocida como una enfermedad común, que afecta tanto a la población infantil, como a la adulta. La serología es un componente clave de la detección y diagnóstico de la celiaquía. Objetivo: Evaluar la utilidad diagnóstica de los anticuerpos antitransglutaminasa tisular en individuos con síntomas gastrointestinales crónicos. Métodos: En un estudio de corte se determinaron los anticuerpos anti-transglutaminasa tisular IgA/G en 87 pacientes adultos y pediátricos con indicación médica de anticuerpos de celiaquía. Los anti- transglutaminasa tisular IgA/G se realizaron por el ensayo inmunoadsorbente ligado a enzima y por el ensayo multiplex de inmunoblot. Se aplicó la prueba U de Mann-Whitney y se calculó el coeficiente de concordancia kappa. Resultados: La seroprevalencia de los anti-transglutaminasa tisular IgG/IgA resultó de 8,05 % (7/87) por el ensayo inmunoenzimático. Los resultados cualitativos del ensayo inmunoenzimático y del inmunoblot para los anti- transglutaminasa tisular fueron concordantes con un coeficiente kappa de 0,407 (p=0,004). La distribución de la concentración de los anticuerpos anti-TGt IgA/G obtenidos por el ensayo inmunoenzimático respecto a los resultados negativos y positivos del inmunoblot no fue significativa (p=0,08). Los pacientes con presencia de anti-transglutaminasa tisular IgA/G por el ensayo inmunoenzimático obtuvieron el diagnóstico definitivo de enfermedad celiaca confirmado por biopsia duodenal. Conclusiones: Se confirmó la utilidad de la detección de los anticuerpos anti-transglutaminasa tisular IgA/G por el ensayo inmunoenzimático como primer paso diagnóstico de la enfermedad celíaca en pacientes con síntomas gastrointestinales.

Introduction: Celiac disease is an immune-mediated enteropathy that has been increasingly recognized as a common disease, affecting both the pediatric and adult population. Serology is a key component of the detection and diagnosis of celiac disease. Objective: To evaluate the diagnostic usefulness of anti-tissue transglutaminase antibodies in individuals with chronic gastrointestinal symptoms. Methods: In a cutoff study, anti-tissue transglutaminase IgA/G antibodies were determined in 87 adult and pediatric patients with medical indication for celiac disease antibodies. Anti-tissue transglutaminase IgA/G was performed by enzyme-linked immunoadsorbent assay and multiplex immunoblot assay. Mann-Whitney U test was applied and kappa correspondence coefficient was calculated. Results: The seroprevalence of anti-tissue transglutaminase IgG/IgA was 8.05 % (7/87) by enzyme-linked immunosorbent assay. The qualitative results of the enzyme-linked immunosorbent assay and immunoblot for anti-tissue transglutaminase were consistent with a kappa coefficient of 0.407 (p=0.004). The distribution of the concentration of anti-TGt IgA/G antibodies obtained by enzyme-linked immunosorbent assay with respect to negative and positive immunoblot results was not significant (p=0.08). Patients with presence of anti-tissue transglutaminase IgA/G by enzyme-linked immunosorbent assay obtained the definitive diagnosis of celiac disease confirmed by duodenal biopsy. Conclusions: The usefulness of detection of anti-tissue transglutaminase IgA/G antibodies by enzyme-linked immunosorbent assay as a first diagnostic step of celiac disease in patients with gastrointestinal symptoms was confirmed.

Comparison of high-resolution manometry parameters among type II diabetes patients and normal volunteers

Background: Gastrointestinal (GI) autonomic neuropathy and reflux esophagitis are common in chronic diabetics. To gauge the adequacy of peristalsis, high-resolution esophageal manometry is considered as a reliable test. Aim and Objective: To compare the GI symptoms and high-resolution manometry parameters between type II diabetes patients and normal volunteers. Materials and Methods: This comparative study was conducted on 35 known type II diabetes mellitus patients (hemoglobin A1c [HbA1c] levels ?6.5%) and 35 normal volunteers between the age group of 35 and 70 years. Sociodemographic details, drug history, disease duration, and GI symptoms were elicited among the study participants. HbA1c and High-resolution manometry were measured for all the participants. Results: The frequency of epigastric pain (31.48%), heartburn (34.28%), pharyngeal irritation (31.43%), and loose stools (37.14%) were significantly higher in the diabetics. Significant difference (P < 0.05) was observed in mean basal expiratory pressure (MBEP) and mean basal inspiratory pressure (MBIP) values between diabetics and controls. There was a positive significant correlation between esophagogastric junction contractile integral and MBIP (r = 0.557), MBEP (r = 0.583), Median Integrated Relaxation pressure (r = 0.410). Conclusion: Hyperglycaemia seems to be an independent risk factor for gastroesophageal reflux disease (GERD). Obesity significantly increments the occurrence of GERD in diabetics. Strict adherence to preventive measures such as weight reduction, diet management, glycaemic control will have a great impact on the occurrence of GERD in diabetics.

Focusing on new research and clinical management of gastrointestinal symptoms in Parkinson′s disease / 中华神经科杂志

Gastrointestinal symptoms are common nonmotor symptoms of Parkinson′s disease, which are related closely to occurrence and progress of Parkinson′s disease, as well as throughout its whole process. For example, constipation can be an important symptom in prodromal stage of Parkinson′s disease, and gastroparesis would weaken the effect of drug by interfering pharmacokinetics. However, insufficient attention has been paid to the gastrointestinal symptoms of Parkinson′s disease presently, and there are few effective treatments, which compromise the quality of patients′ life greatly. The intervention focus on gut-brain axis, microbiota and gastrointestinal barrier may play a positive role in improving gastrointestinal symptoms and delaying the process of Parkinson′s disease.

Síntomas gastrointestinales y afectación hepática en pacientes diagnosticados con COVID-19 / Gastrointestinal symptoms and liver involvement in patients diagnosed with COVID-19

Se identificó la relación entre los síntomas gastrointestinales y la afectación hepática en pacientes diagnosticados con COVID-19. El daño hepático en estos pacientes puede ser causado por el virus que infecta directamente las células hepáticas, por ello se debe prestar más atención al estado de la función hepática de los pacientes con COVID-19. Se realizó un estudio observacional, descriptivo y transversal en pacientes diagnosticados con COVID-19, pertenecientes a dos hospitales del cantón Ambato, de enero a julio de 2021. Se seleccionó una muestra no probabilística, de 125 pacientes con los siguientes criterios: no presentar afectación hepática, no estar bajo tratamiento con fármacos hepatotóxicos. Para identificar posible diferencia de medias entre los niveles de las determinaciones de TGP, TGO, GGT y LDH en los pacientes con y sin síntomas se utilizó la prueba t de Student para muestras independientes. Posteriormente, se realizó la prueba estadística Regresión logística binaria con el método Intro. La prueba de bondad de ajuste Hosmer-Lemeshow permitió evaluar el ajuste del modelo. Para todas las pruebas de hipótesis se empleó un nivel de significación del 5%(AU)

The relationship between gastrointestinal symptoms and liver involvement in patients diagnosed with COVID-19 was identified. Liver damage in these patients may be caused by the virus directly infecting liver cells, so more attention should be paid to the liver function status of COVID-19 patients. An observational, descriptive and cross-sectional study was carried out in patients diagnosed with COVID-19, belonging to two hospitals in the Ambato canton, from January to July 2021. A non-probabilistic sample of 125 patients was selected with the following criteria: no liver involvement, no treatment with hepatotoxic drugs. To identify possible mean differences between the levels of TGP, TGO, GGT and LDH determinations in patients with and without symptoms, the Student's t-test was used for independent samples. Subsequently, the binary logistic regression statistical test was performed with the Intro method. The Hosmer-Lemeshow goodness-of-fit test allowed us to evaluate the fit of the model. For all hypothesis tests, a significance level of 5% was used(AU)

Severidade dos sintomas da síndrome do intestino irritável e consumo de FODMAPs em estudantes universitários / Severity of irritable bowel syndrome symptoms and fodmaps intake in university students

ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) symptoms such as diarrhea, bloating and abdominal pain can reduce University student's productivity and learning ability. One of the possible treatments for IBS is the temporarily exclusion of foods that have a high content of short-chain fermentable carbohydrates, the fermentable, oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). OBJECTIVE: This study aimed to assess University student's intake of foods that are rich in FODMAPs, looking for possible associations with the severity of IBS symptoms. METHODS: A cross-sectional study was carried out, with undergraduate students from a private University in the city of São Paulo, Brazil, aged between 19 and 46 years old and that were enrolled in different courses and stages. Students were invited to participate and those who gave their formal consent were included in this research. A sociodemographic and lifestyle questionnaire was applied, in addition to the Gastrointestinal Symptom Rating Scale - GSRS. Students also responded a short Food Frequency Questionnaire, developed to investigate habitual FODMAPs intake of Brazilian adult population. Spearman's correlation analysis between the student's GSRS scores and the frequency of foods rich in FODMAPs intake were performed in SPSS v.21. RESULTS: Fifty-six students were interviewed, with mean age of 21.4 years old (SD=4.41), with a predominance of women (76.8%). The GSRS results showed that 58.9% of students felt minimal to moderate abdominal discomfort and 14.3% had moderately severe to very severe abdominal pain during the prior week to the interview. Besides abdominal pain, the gastrointestinal symptoms that were most reported by students were flatulence (98.2%), stomach rumbling (89.3%) and eructations (85.7%). Greater symptom severity was observed in women (P=0.004) and sedentary students (P=0.003). Regarding FODMAPs consumption, honey (P=0.04), chocolate (P=0.03) and milk table cream (P=0.001) intakes were positively correlated with the greater severity of symptoms. CONCLUSION: Although clinical diagnosis is necessary to establish IBS, 73.2% of the students presented minimal to very severe abdominal pain during the prior week. Female had sedentary students had greater severity of gastrointestinal symptoms. A low FODMAP diet, well oriented, could bring some symptoms relief to these University students.

RESUMO CONTEXTO: Os sintomas da síndrome do intestino irritável (SII), como diarreia, "inchaço" e dor abdominal, podem reduzir a produtividade e a capacidade de aprendizagem do estudante universitário. Um dos possíveis tratamentos para a SII é a exclusão temporária de alimentos que possuem alto teor de carboidratos fermentáveis de cadeia curta, os fermentáveis, oligossacarídeos, dissacarídeos, monossacarídeos e polióis (FODMAPs). OBJETIVO: Este estudo teve como objetivo avaliar a ingestão de alimentos ricos em FODMAPs por estudantes universitários, buscando possíveis associações com a gravidade dos sintomas da SII. MÉTODOS: Foi realizado um estudo transversal, com alunos de graduação de uma Universidade privada da cidade de São Paulo, Brasil, com idades entre 19 e 46 anos, matriculados em diferentes cursos e estágios. Os alunos foram convidados a participar e aqueles que deram seu consentimento formal foram incluídos nesta pesquisa. Foi aplicado um questionário sociodemográfico e de estilo de vida, além da Gastrointestinal Symptom Rating Scale - GSRS. Os alunos também responderam a um pequeno Questionário de Frequência Alimentar, desenvolvido para investigar o consumo habitual de FODMAPs na população adulta brasileira. A análise de correlação de Spearman entre os escores GSRS do aluno e a frequência do consumo de alimentos ricos em FODMAPS foi realizada no SPSS v.21. RESULTADOS: Foram entrevistados 56 alunos, com média de idade de 21,4 anos (DP=4,41) e predomínio do sexo feminino (76,8%). Os resultados do GSRS mostraram que 58,9% dos alunos sentiram desconforto abdominal mínimo a moderado e 14,3% tiveram dor abdominal moderadamente intensa a muito intensa durante a semana anterior à entrevista. Além das dores abdominais, os sintomas gastrointestinais mais referidos pelos estudantes foram flatulência (98,2%), roncos estomacais (89,3%) e eructações (85,7%). Maior gravidade dos sintomas foi observada em mulheres (P=0,004) e estudantes sedentários (P=0,003). Em relação ao consumo de FODMAPs, a ingestão de mel (P=0,04), chocolate (P=0,03) e creme de leite (P=0,001) se correlacionou positivamente com a maior gravidade dos sintomas. CONCLUSÃO: Embora o diagnóstico clínico seja necessário para o estabelecimento da presença da SII, 73,2% dos alunos apresentaram dor abdominal mínima a muito intensa na semana anterior ao estudo. Estudantes do sexo feminino e sedentários apresentaram maior gravidade dos sintomas gastrointestinais. Uma dieta pobre em FODMAP, bem orientada, poderia trazer algum alívio destes sintomas a estes universitários.

Relación entre el SARS-CoV-2, la microbiota intestinal y la presencia de síntomas digestivos / Relationship between SARS-CoV-2, gut microbiota and the presence of digestive symptoms

Introducción: Los síntomas gastrointestinales asociados a la COVID-19 puede afectar entre el 3 y 39 por ciento de los enfermos. Objetivo: Examinar la relación entre la infección por el virus, la microbiota intestinal y la presencia de síntomas digestivos. Métodos: Búsqueda bibliográfica en Medline, Pubmed, Scielo, LILACS y Cochrane en los últimos 6 meses de 2020 en idioma inglés y español, sobre la presencia de síntomas digestivos en enfermos de COVID-19. Resultados: El eje pulmón-intestino está conectado bidireccionalmente, por lo que los metabolitos y microbios del pulmón pueden afectar la microbiota intestinal y se justifica así, la posibilidad de que SARS-CoV-2 tenga impacto en ese ecosistema. Se ha confirmado la detección de ARN del SARS-CoV-2 en muestras de heces incluso después que los resultados de muestras respiratorias han sido negativas, lo que supone que el mecanismo fecal-oral es una posible ruta de transmisión de la enfermedad. Los síntomas gastrointestinales que se asocian a la infección por SARS-CoV-2 son: anorexia, náuseas, dolor abdominal y vómitos, este último es el síntoma más frecuente en la población pediátrica. Los pacientes que presentaron diarrea se relacionaron con una evolución desfavorable de la enfermedad, aunque aún no se confirman las hipótesis planteadas al respecto. Consideraciones finales: Se necesitan más investigaciones sobre las alteraciones de la microbiota intestinal, la potencial transmisión fecal-oral del SARS-CoV-2 y la caracterización de las manifestaciones digestivas en los enfermos de COVID-19. Son importantes las medidas de bioseguridad para la manipulación de los deshechos biológicos de los enfermos(AU)

ABSTRACT Introduction: Gastrointestinal symptoms associated with COVID-19 can affect between 3 and 39 percent of patients. Objective: Examine the relationship between infection with the virus, the gut microbiota and the presence of digestive symptoms. Methods: Bibliographic search in Medline, Pubmed, Scielo, LILACS and Cochrane in the last 6 months of 2020 in English and Spanish languages on the presence of digestive symptoms in COVID-19 patients. Results: The lung-intestinal axis is bidirectionally connected, so the metabolites and microbes of the lung can affect the gut microbiota and thus justify the possibility that SARS-CoV-2 will have an impact on that ecosystem. SARS-CoV-2 RNA detection has been confirmed in stool samples even after respiratory sample results have been negative, implying that the fecal-oral mechanism is a possible route of transmission of the disease. Gastrointestinal symptoms associated with SARS-CoV-2 infection are: anorexia, nausea, abdominal pain and vomiting, the latter is the most common symptom in the pediatric population. Patients who had diarrhea were associated with an unfavorable evolution of the disease, although the hypotheses raised in this regard are not yet confirmed. Final considerations: More research is needed on alterations of the gut microbiota, the potential fecal-oral transmission of SARS-CoV-2 and the characterization of digestive manifestations in COVID-19 patients. Biosecurity measures are important for the handling of biological waste of the patients(AU)

Gastrointestinal symptoms in coronavirus disease 2019 presentation in Saudi Arabia

Background: Coronavirus disease 2019 (COVID-19) infection has announced by the World Health Organization (WHO) as a pandemic disease in 2020. Identification and analysis of COVID-19 presentation are important for quick isolation and diagnosis. Respiratory symptoms are typically present in COVID-19 patients. Objectives: The objectives of this study were to identify of gastrointestinal (GI) symptoms and laboratory results in the initial presentation of COVID-19 patients. Materials and Methods: Our study is a retrospective study of 379 COVID-19 patients’ assessments. They were admitted into government hospitals in Kingdom of Saudi Arabia’s South and East regions through April month 2020. Results: About 14% of the patients were presented initially with GI symptoms only, in which Nausea and anorexia are the most common complain. The mean C-reactive protein, alanine aminotransferase , and aspartate aminotransferase levels were significantly elevated. Conclusion: It is crucial for physicians to be aware that COVID-19 infection could present initially with GI-related symptoms and keep appropriate attention and suspicion.

Gastrointestinal symptoms in pregnancy among antenatal clinic attendees in Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Northeast Nigeria

Background: Pregnant women are at increasing risk of GI symptoms such as nausea, vomiting and heartburns, most of these symptoms are as a result of the hormonal and physical changes associated with pregnancy. This study aimed to determine prevalence of gastrointestinal symptoms (GI) among pregnant women attending booking clinic at a Northeastern Nigerian Teaching Hospital.Methods: The study was a cross-sectional, questionnaire-based survey of four hundred and fifty-two pregnant women booking for antenatal care. Their sociodemographic variables as well as the presence or absence of gastrointestinal symptoms in index pregnancy were obtained at by the use of researcher-administered questionnaire. Data were analyzed and presented as frequencies and percentages. A 5% significance level (p <0.05) to test associations.Results: Two fifty-five women had heart burns (56.4%) while 235 (52.0%) had nausea in pregnancy, these were observed to be the most prevalent GI symptoms among the women. Diarrhea and hemorrhoids were the uncommon GI symptoms in the study population constituting 406 (89.5%), and 360 (79.6%) respectively. Easy fullness was noted in 39.8% of the women while vomiting was in 41.8% and constipation in 29% of the respondents. A significant association was observed (p value <0.05) between parity and development of anorexia and hemorrhoids in pregnancy (p values of 0.049 and 0.051 respectively) but not for the other symptoms.Conclusions: GI symptoms are common in pregnancy, the most prevalent symptoms are that of heart burns and nausea, while diarrhea is relatively uncommon.

Study on incidence of oesophageal carcinoma in patients undergoing upper gastrointestinal endoscopy for upper gastrointestinal symptoms in a secondary care hospital

Background: Oesophageal carcinoma is one of the leading causes of cancer related deaths worldwide and is also associated with high morbidity. Hence early diagnosis and treatment are the only effective way to improve survival and quality of life in oesophageal carcinoma patients. Early-stage oesophageal carcinoma are often asymptomatic and may also present with common upper gastrointestinal symptoms hence diagnosis of early oesophageal carcinoma is only based on detection of suspicious lesions through endoscopy and histopathological evaluation of biopsies from these suspicious lesions. The study is designed to see whether using alarming upper gastrointestinal symptoms, risk of oesophageal carcinoma in patients can be predicted.Methods: Present study comprises of 200 patients presenting with upper gastrointestinal symptoms at JSS Hospital, Chamarajanagar (both out patients and referred patients) during the period of October 2018 to December 2019, who underwent upper gastrointestinal endoscopy.Results: Out of 200 patients, 135 patients were males and 65 patients were females. According to the study, dysphagia was found to be a significant predictive factor and in contrary to the global statistics this study showed females aged more than 60 years were significantly at higher risk of developing oesophageal carcinoma.Conclusions: We recommend to do an early endoscopy for any patient presenting with upper gastrointestinal symptoms and to take multiple biopsies from any suspicious lesion especially for male gender older than 50 years and female gender older than 60 years presenting with dysphagia.

Four Cases of Upper Gastrointestinal Symptoms Successfully Treated with Ryokeijutsukanto / 日本東洋医学雑誌

Case 1 was a 28-year-old female who had epigastric discomfort and epigastralgia for three months. These symptoms were accompanied with dizziness, faintness and hot flush. Right after taking ryokeijutsukanto, her dizziness, faintness and chillness of foot disappeared with improvement of gastrointestinal symptoms after two weeks. Case 2 was a 40-year-old female who presented prolonged nausea and epigastralgia for eight months. She also complained of dizziness and strong globus sensation when taking meals. After taking ryokeijutsukanto, her appetite improved in a week and gastrointestinal symptoms improved in 3 weeks. Case 3 was a 15-year-old female whose complaints were nausea, epigastric discomfort, palpitation, dizziness and globus sensation consequent to swaying feeling after riding a roller coaster. These symptoms including nausea improved after taking ryokeijutsukanto with 3g of magnolia bark for a week. Case 4 was a 28-year-old male who presented severe appetite loss and epigastric discomfort when he got tired. He also complained of faintness. His faintness disappeared after taking ryokeijutsukanto for 2 weeks. His appetite also improved after four weeks. Clinical courses of these cases suggest that ryokeijutsukanto may be useful for the treatment of upper gastrointestinal symptoms including functional dyspepsia, i.e. fluid retention with qi-counterflow.

Effect of polydextrose-containing beverage on bowel habits and gastrointestinal symptoms of constipated subjects: a pilot study

@#Introduction: Indonesians have a low intake of dietary fibre, a key component for an increased incidence in constipation. Available data have documented the benefits of polydextrose (PDX) in healthy subjects. However, data on constipated subjects are lacking. This study aimed to investigate the effect of consuming a PDX (prebiotic) beverage on bowel habits and gastrointestinal symptoms of constipated subjects over seven days. Methods: This was a randomised, non-blinded, nonplacebo-controlled parallel design study involving 24 subjects, divided equally into two groups. Group A (active control group) consisted of 12 subjects, consuming one serving size of 6g PDX beverage. While Group B (intervention group) consisted of 12 subjects, consuming two servings of the same product, containing 12g PDX beverage. Changes in bowel habits (constipation score, stool frequency and stool consistency) and gastrointestinal symptoms (abdominal pain, bloating and flatulence) were monitored. Results: Within seven days, Group B showed 4.9% more reduction in overall constipation mean score than that of Group A. Positive improvement in gastrointestinal symptoms were reported: i.e. abdominal pain (∆M = -0.08±0.43), bloating (∆M = -0.29±0.37) and flatulence (∆M = -0.17±0.47). Majority of subjects had desirable stool frequency (87.5%, >3 defecations/week) and stool consistency (58.3%, type 4). These improvements were due to the fact that PDX provides physiological effects consistent with prebiotic fibre, which alters the gut microbiota composition during the fermentation cycle in the large intestine. Conclusion: Findings of this study suggested that daily PDX beverage consumption effectively improved bowel habits, with fewer constipated subjects reporting of gastrointestinal symptoms.

Gastrointestinal manifestations and associated health outcomes of COVID-19: a brazilian experience from the largest south american public hospital

OBJECTIVES: Brazil has rapidly developed the second-highest number of COVID-19 cases in the world. As such, proper symptom identification, including gastrointestinal manifestations, and relationship to health outcomes remains key. We aimed to assess the prevalence and impact of gastrointestinal symptoms associated with COVID-19 in a large quaternary referral center in South America. METHODS: This was a single-center cohort study in a COVID-19 specific hospital in São Paulo, Brazil. Consecutive adult patients with laboratory confirmed SARS-CoV-2 were included. Baseline patient history, presenting symptoms, laboratory results, and clinically relevant outcomes were recorded. Regression analyses were performed to determine significant predictors of the gastrointestinal manifestations of COVID-19 and hospitalization outcomes. RESULTS: Four-hundred patients with COVID-19 were included. Of these, 33.25% of patients reported ≥1 gastrointestinal symptom. Diarrhea was the most common gastrointestinal symptom (17.25%). Patients with gastrointestinal symptoms had higher rates of concomitant constitutional symptoms, notably fatigue and myalgia (p<0.05). Gastrointestinal symptoms were also more prevalent among patients on chronic immunosuppressants, ACE/ARB medications, and patient with chronic kidney disease (p<0.05). Laboratory results, length of hospitalization, ICU admission, ICU length of stay, need for mechanical ventilation, vasopressor support, and in-hospital mortality did not differ based upon gastrointestinal symptoms (p>0.05). Regression analyses showed older age [OR 1.04 (95% CI, 1.02-1.06)], male gender [OR 1.94 (95% CI, 1.12-3.36)], and immunosuppression [OR 2.60 (95% CI, 1.20-5.63)], were associated with increased mortality. CONCLUSION: Based upon this Brazilian study, gastrointestinal manifestations of COVID-19 are common but do not appear to impact clinically relevant hospitalization outcomes including the need for ICU admission, mechanical ventilation, or mortality.

Hallazgos radiológicos en pseudoobstrucción intestinal por lupus eritematoso sistémico. Reporte de un caso / Radiological findings in pseudo-intestinal obstruction due to systemic lupus erythematosus. A case report

Resumen La pseudoobstrucción intestinal (POI) es una complicación poco frecuente de lupus eritematoso sistémico (LES), y su diagnóstico suele ser un reto, especialmente al diferenciarla de otras enfermedades abdominales. El cuadro clínico de la enfermedad se debe al daño muscular, vascular y nervioso de las paredes intestinales, lo que genera hipomotilidad y datos de obstrucción. En este artículo, se reporta el caso de una mujer de 19 años con dolor abdominal, distensión abdominal y vómito, con antecedentes de trombosis de vena cava inferior y LES. La tomografía computada (TC) de abdomen mostró signos de distensión intestinal, POI, ascitis y ureterohidronefrosis derecha, lo que descartó la obstrucción evitándose una intervención quirúrgica. El manejo fue con corticoesteroides. La evolución fue buena y se decidió el egreso de la paciente. Después de 12 meses no se reportaron complicaciones. La POI por LES es de difícil diagnóstico, pero la identificación y correlación de la semiología del caso con los datos inmunológicos y de imagenología, fue decisiva en el diagnóstico diferencial con otras patologías abdominales, como la obstrucción intestinal.

Abstract The pseudo-intestinal obstruction (PIO) is an uncommon complication due to systemic lupus erythematosus (SLE) and its diagnosis can be challenging, especially when trying to differentiate it from other abdominal diseases. Clinical manifestations are caused by muscular, vascular and nervous damage of the intestinal walls, causing hypomotility and symptoms of obstruction. This paper reports the case of a 19 year-old woman who first manifested abdominal pain, abdominal distention and vomits, plus she had a history of inferior vena cava thrombosis and lupus. An abdominal computed tomography (CT) scan showed intestinal distention, PIO, ascites and right hydronephrosis, therefore the diagnosis of a real obstruction was rejected, and surgical intervention was avoided. The patient was treated with steroids. The response to the treatment was good, the patient went into remission, and was discharged from the hospital. 12 months later, no complications were reported. SLE with PIO is hard to detect, but the proper identification and correlation of the semiology of the case with the immunological and imaging data was decisive in the differential diagnosis with other abdominal diseases, such as the intestinal obstruction.

Gastrointestinal symptoms in chronic migraine patients / 中华神经科杂志

Objective To discuss the correlation between gastrointestinal symptoms concomitant with chronic migraine and sleep disorders,anxiety and depression.Methods Self-rating Anxiety Scale (SAS),Self-rating Depression Scale (SDS),Pittsburgh Sleep Quality Index (PSQI) and Gastrointestinal Symptom Rating Scale (GSRS) were adopted to conduct comparative analysis on gastrointestinal symptoms,anxiety,depression,sleep disorders,and related risk factors in 151 chronic migraine patients who conformed to International Headache Society International Classification of Headache Diseases-Ⅱ diagnostic code and 151 healthy controls in the Third Affiliated Hospital of Qiqihar Medical University from January 2015 to December 2017.Results PSQI scores (8.46±2.54 vs 4.53±1.95,t=2.913,P＜0.05),SAS scores (53.24± 11.66 vs 39.58±8.63,t=3.112,P＜0.05),SDS scores (51.09±8.80 vs 36.11±5.74,t=3.520,P＜0.05),and GSRS scores (4.53 (3.74,5.32) vs 1.29 (0.73,1.31),Z=30.804,P＜0.05) were all higher in migraine patients than that in healthy controls,and the differences were all statistically significant.In chronic migraine patients,139 (92.05％) had one gastrointestinal symptom at least,and the overall incidence of each gastrointestinal symptom was abdominal distension (60 cases,39.74％),exhaust increase (51 cases,33.77％),and endless defecation (43 cases,28.48％),etc.,in turn.Multiple regression analysis showed that headache degree,frequency,PSQI scores,SAS scores,and SDS scores were the main risk factors of gastrointestinal symptoms concomitant with chronic migraine.GSRS scores of chronic migraine patients presented positive correlation with PSQI scores (r=0.65,P=0.000),SAS scores (r=0.42,P=0.000),and SDS scores (r=0.48,P=0.000),respectively.Conclusion Chronic migraine patients are easy to be accompanied with gastrointestinal symptoms,and headache degree and frequency,sleep disorders,depression and anxiety are the main risk factors of concomitant gastrointestinal symptoms.

Effects of acupuncture in treating insomnia due to spleen-stomach disharmony syndrome and its influence on intestinal microbiome: Study protocol for a randomized controlled trial / 中西医结合学报

BACKGROUND@#Insomnia is a common complaint that is closely related to gastrointestinal symptoms, which is consistent with the traditional Chinese medicine classical theory of "stomach disharmony leading to restless sleep." Acupuncture is an effective complementary and alternative medicine therapy to improve gastrointestinal function and restore the normal sleep-wake cycle. However, studies on the effectiveness of acupuncture for insomnia due to spleen-stomach disharmony syndrome are limited to case reports and few randomized controlled trials; deeper research on its mechanism is still lacking. This randomized controlled trial aims to assess the treatment efficacy of "harmonizing stomach to tranquilize mind" acupuncture for insomnia and its influence on the intestinal microbiome.@*METHODS/DESIGN@#This is a randomized, single-blind, parallel-group study. Sixty eligible patients with insomnia due to spleen-stomach disharmony syndrome will be randomly divided into two groups (1:1 allocation ratio). The intervention group will use "harmonizing stomach to tranquilize mind" acupuncture, and the control group will receive sham acupuncture. Participants will receive 5 acupuncture treatment sessions per week for 4 consecutive weeks. The Pittsburgh Sleep Quality Index will be used to evaluate the clinical efficacy of acupuncture treatment by making assessments at baseline, the end of treatment and the end of the follow-up. High-throughput 16S ribosomal ribonucleic acid gene sequencing will be performed to detect changes in the intestinal microbial composition before and after treatment.@*DISCUSSION@#The results of this trial are expected to confirm that "harmonizing stomach to tranquilize mind" acupuncture can effectively relieve insomnia and alter the intestinal microbiome.@*TRIAL REGISTRATION@#Chinese Clinical Trials Registry: ChiCTR1800017092.

Effect of cognitive-behavior therapy combined with mirtazapine on clinical efficacy in patients with functional dyspepsia / 中华行为医学与脑科学杂志

Objective@#To evaluate the efficacy of cognitive-behavioral therapy (CBT) combined with mirtazapine for patients with functional dyspepsia (FD).@*Methods@#Totally 121 patients with FD who met Rome Ⅳ diagnostic criteria in clinic of clinical psychiatry of a general hospital were collected.They were randomly divided into combined treatment group(n=61) and single drug group(n=60). The treatment period was 8 weeks.All patients with FD were given mirtazapine.The combined treatment group received 8 times systemic CBT treatments at the same time.Symptom checklist-90 (SCL-90) and gastrointestinal integral scale (GIS) were evaluated in all patients before and after 8-week intervention.@*Results@#After 8 weeks of intervention, the total score of SCL-90 scale, somatization, compulsion, depression, paranoia and other factors in the combined treatment group were lower than those in the single group(130.26±36.18 vs 147.95±45.55, 1.34±0.44 vs 1.51±0.5, 1.66±0.50 vs 1.90±0.66, 1.47±0.52 vs 1.69±0.63, 1.48±0.49 vs 1.70±0.61, 1.47±0.50 vs 1.73±0.68, respectively)(all P<0.05). After 8 weeks of intervention, the total score of the GIS scale in the combined treatment group (6.77±5.05 vs 9.49±5.24), vomiting (0.57±0.77 vs 0.88±0.91), spastic upper abdominal pain (0.43±0.74 vs 0.90±1.08) and post-sternal discomfort (0.57±0.89 vs 1.05±1.19) were significantly lower than that of the simple drug group after intervention(6.77±5.05 vs 9.49±5.24, 0.57±0.77 vs 0.88 ±0.91, 0.43±0.74 vs 0.90±1.08 and 0.57±0.89 vs 1.05±1.19, respectively), and the differences were statistically significant (all P<0.05).@*Conclusion@#CBT combined with mirtazapine in the treatment of FD is superior to drug therapy alone.CBT combined with mirtazapine can improve the emotional problems in the treatment of FD and further improving the digestive function.

Relationships of superior mesenteric artery hemodynamic indexes with lower gastrointestinal tract symptoms scales in patients with type 2 diabetes / 中国实用内科杂志

OBJECTIVE: To study the association between superior mesenteric artery hemodynamic indexes and scores of lower gastrointestinal symptoms rating scales(LGSRS) in patients with type 2 diabetic mellitus. METHODS: Totally 142 inpatients with type 2 diabetes with average age of 58.76±12.32 yrs were enrolled, who were treated from August 2016 to March 2018. The history, gender, age,course and BMI were recorded, and fasting blood glucose(FBG), glycosylated hemoglobin(HbA1c), 2-hour postprandial blood glucose(PBG), total cholesterol(TC), triglyceride(TG), urine ACR and LGSRS were determined. Ultrasonic scanning of mesenteric artery was performed for hemodynamic indexes, including artery inner diameter(ID), peak systolic velocity(PSV), end-diastolic velocity(EDV), and resistance index(RI)at starting part,first level branch, and second level branch from root of the superior mesenteric artery(SMA).Patients were divided into 2 groups according to their LGSRS, 74 patients with LGSRS≥6 were in positive group, and 68 patients with LGSRS0.05), but the age and DD were significantly higher in positive group than in control group(P0.05). 3. There were no significant difference between positive group and control group in ID at starting part and first level branch of SMA, while ID at second level branch was significantly increased in positive group compared with control group [(3.83±0.85)mm vs.(3.53±0.90)mm, P<0.05)].4. RI at first(0.816±0.059 vs 0.842±0.063,P<0.05) and second level branch(0.813±0.076 vs 0.845±0.073, P<0.05) and PSV at first level branch[(110.89±46.89)cm/s vs(95.72±36.59)cm/s,P<0.05] were significantly high in positive group; there were no difference in other hemodynamic indexes between the groups. 5.Adjusted by age,DD,glycemic and lipidemic profile,Logistic regression showed that ID at first(RR=2.092,95%CI 1.080-4.050,P=0.029) and second level branch(RR=0.491,95%CI 0.252-0.955,P=0.36) and EDV at second level branch(RR=0.897,95%CI 0.824-0.976,P=0.012) were independent factors influencing LGSRS(P<0.05). CONCLUSION: Ultrosonic hemodynamic abnormalities in the superior mesenteric artery might be important factor in development of lower gastrointestinal tract symptoms in patients with type 2 diabetes.

Factores de riesgo asociados al diagnóstico de alergia al huevo IgE mediada en Pediatría

Introducción: La prevalencia de alergias alimentarias se ha incrementado, lo que representa un problema de salud pública. Las guías alimentarias recomendaban retrasar la introducción de alimentos de manera a prevenir alergias alimentarias sin real evidencia. Objetivos: Describir el perfil clínico del paciente pediátrico que acude a consulta con el diagnóstico de alergia al huevo. Materiales y métodos: Estudio de observacional retrospectivo descriptivo de. Ingresaron al estudio pacientes con sospecha de alergia al huevo que tuvieron estudio de RAST. Se estudio datos demográficos, lactancia materna, inicio de alimentación solida incluyendo el huevo, presencia de manisfestaciones de alergia. Se realizo comparación entre los grupo con RAST positivo y aquellos con resultados negativo. Los datos fueron procesados en Microsoft Excell y se utilizó variables descriptivas. Resultados: ingresaron 156 pacientes ,58 en cada grupo con prueba positiva y negativa. Los pacientes alérgicos al huevo se presentaron con un predominio de sexo masculino, con antecedentes personales de atopia, peso y tallas normales, duración de la lactancia materna promedio de 10,5 meses, introducción de sólidos a los 5,7 meses, edad de ingesta de huevo a los 9,2 meses, similar al grupo con test negativo. Los síntomas predominantes fueron los gastrointestinales Como manifestación de atopia concomitante tuvieron mayor porcentaje de Alergia a las proteínas de leche de vaca y dermatitis atópica en comparación con el grupo con test negativo. Conclusiones: No hubo diferencias demograficas ni de habitos alimentarios entre los grupos con RAST postivo y negativo Hubo concomitancia de otras manisfestaciones de alergia en el grupo RAST postivo.

Introduction: The prevalence of food allergies has increased, representing a public health problem. Current dietary guidelines recommend delaying the introduction of food in order to prevent food allergies, but supporting evidence for this is lacking. Objectives: To describe the clinical profile of pediatric patients presenting with a diagnosis of egg allergy. Materials and methods: This was a descriptive, retrospective, observational study. We included patients with a suspected egg allergy who had a RAST study. We evaluated demographic data, breastfeeding, introduction of solid foods, including egg, and the presence of allergy manifestations. A comparison was made between the groups with positive RAST and those with negative results. The data was processed in Microsoft Excel and descriptive variables were used. Results: 156 patients were included in the study, 58 in each group with positive and negative tests. Egg-allergic patients were predominantly male, with a personal history of atopy, normal weight and size, an average breastfeeding duration of 10.5 months, introduction of solids at 5.7 months, age of intake of egg at 9.2 months, which was similar to the group with negative testing. The predominant symptoms were gastrointestinal. Concomitant atopy manifestations included a higher percentage of cow's milk protein allergy and atopic dermatitis compared to the group with a negative testing. Conclusions: There were no demographic or dietary differences between the groups with positive and negative RAST. There was concomitance of other allergic manifestations in the positive RAST group.