Patterns of endoscopy during COVID-19 pandemic: a global survey of interventional inflammatory bowel disease practice

Background/Aims@#Performance of diagnostic or therapeutic endoscopic procedures in inflammatory bowel disease (IBD) patients can be challenging during a viral pandemic; the main concerns being the safety and protection of patients and health care providers (HCP). The aim of this study is to identify endoscopic practice patterns and outcomes of IBD and coronavirus disease 19 (COVID-19) with a worldwide survey of HCP. @*Methods@#The 20-item survey questionnaire was sent to physician members of the American Society for Gastrointestinal Endoscopy Special Interest Group in Interventional IBD, Chinese IBD Society Endoscopy Interest Group, and the China Crohn’s and Colitis Foundation. @*Results@#A total of 141 respondents submitted valid responses. Nighty-five respondents (67.9%) reported that at least 25% of their scheduled emergent endoscopic procedures were canceled or postponed during the pandemic. Fifty-six respondents (40.0%) have performed emergent endoscopy during the pandemic. A few respondents (9/140, 6.4%) estimated that more than 25% of their patients had worsened disease due to delayed or canceled emergent endoscopy procedures. More than 80% of respondents believed that personal protective equipment (PPE) for the endoscopy team, room sterilization, and pre-procedure screening of patients for COVID-19 were necessary. Out of 140 respondents, 16 (11.4%) reported that several of their patients had COVID-19. Eight clinicians (5.7%) reported that they or their endoscopy colleagues developed work-related COVID-19. @*Conclusions@#Cancellation of elective and emergent endoscopy in IBD care during the pandemic was common. Few respondents reported that their patients’ disease conditions worsened due to the cancellation of the endoscopy procedure. Most respondents voiced the need for proper PPE during the procedure regardless of patients’ COVID-19 status and screening the patients for COVID-19.

Patterns of endoscopy during COVID-19 pandemic: a global survey of interventional inflammatory bowel disease practice

Background/Aims@#Performance of diagnostic or therapeutic endoscopic procedures in inflammatory bowel disease (IBD) patients can be challenging during a viral pandemic; the main concerns being the safety and protection of patients and health care providers (HCP). The aim of this study is to identify endoscopic practice patterns and outcomes of IBD and coronavirus disease 19 (COVID-19) with a worldwide survey of HCP. @*Methods@#The 20-item survey questionnaire was sent to physician members of the American Society for Gastrointestinal Endoscopy Special Interest Group in Interventional IBD, Chinese IBD Society Endoscopy Interest Group, and the China Crohn’s and Colitis Foundation. @*Results@#A total of 141 respondents submitted valid responses. Nighty-five respondents (67.9%) reported that at least 25% of their scheduled emergent endoscopic procedures were canceled or postponed during the pandemic. Fifty-six respondents (40.0%) have performed emergent endoscopy during the pandemic. A few respondents (9/140, 6.4%) estimated that more than 25% of their patients had worsened disease due to delayed or canceled emergent endoscopy procedures. More than 80% of respondents believed that personal protective equipment (PPE) for the endoscopy team, room sterilization, and pre-procedure screening of patients for COVID-19 were necessary. Out of 140 respondents, 16 (11.4%) reported that several of their patients had COVID-19. Eight clinicians (5.7%) reported that they or their endoscopy colleagues developed work-related COVID-19. @*Conclusions@#Cancellation of elective and emergent endoscopy in IBD care during the pandemic was common. Few respondents reported that their patients’ disease conditions worsened due to the cancellation of the endoscopy procedure. Most respondents voiced the need for proper PPE during the procedure regardless of patients’ COVID-19 status and screening the patients for COVID-19.

Glycopeptide and daptomycin susceptibility trends among clinical isolates of methicillin-resistant Staphylococcus aureus in a tertiary care center in North India

Increased vancomycin minimum inhibitory concentration [MIC] levels in Staphylococcus aureus and their association with vancomycin treatment failure are well-known problems. Few studies have recognized progressive increases in glycopeptide MIC levels for S. aureus strains in recent years. This study determined glycopeptide and daptomycin susceptibility among methicillin resistant S. aureus [MRSA] strains. A total of 776 clinical isolates of MRSA recovered from 2009 to 2012 were studied for glycopeptide and daptomycin susceptibility using the E-test method. The vancomycin MIC geometric mean [GM] of the MRSA isolates was 0.923, 0.944, 1.134 and 1.294 mg/L in the years 2009, 2010, 2011 and 2012, respectively, and the trend significantly increased over the years [P< 0.0001]. Similarly, the teicoplanin MIC GM was 1.47, 1.49, 1.8 and 2.04 mg/L in the years from 2009 to 2012, respectively [P< 0.0001]. MIC shifts were not found for daptomycin [P> 0.232]. A significant increase in the MIC for glycopeptides was observed among the clinicalA. MRSA isolates at our center over a 4-year period. However, the daptomycin MIC did not increase in the observed MRSA isolates

Prevalence of Household-level Food Insecurity and Its Determinants in an Urban Resettlement Colony in North India.

An adequate food intake, in terms of quantity and quality, is a key to healthy life. Malnutrition is the most serious consequence of food insecurity and has a multitude of health and economic implications. India has the world’s largest population living in slums, and these have largely been underserved areas. The State of Food Insecurity in the World (2012) estimates that India is home to more than 217 million undernourished people. Various studies have been conducted to assess food insecurity at the global level; however, the literature is limited as far as India is concerned. The present study was conducted with the objective of documenting the prevalence of food insecurity at the household level and the factors determining its existence in an urban slum population of northern India. This cross-sectional study was conducted in an urban resettlement colony of South Delhi, India. A pre-designed, pre-tested, semi-structured questionnaire was used for collecting socioeconomic details and information regarding dietary practices. Food insecurity was assessed using Household Food Insecurity Access Scale (HFIAS). Logistic regression analysis was performed to determine the factors associated with food insecurity. A total of 250 women were interviewed through house-to-house survey. Majority of the households were having a nuclear family (61.6%), with mean familysize being 5.5 (SD±2.5) and the mean monthly household income being INR 9,784 (SD±631). Nearly half (53.3%) of the mean monthly household income was spent on food. The study found that a total of 77.2% households were food-insecure, with 49.2% households being mildly food-insecure, 18.8% of the households being moderately food-insecure, and 9.2% of the households being severely food-insecure. Higher education of the women handling food (OR 0.37, 95% CI 0.15-0.92; p≤0.03) and number of earning members in the household (OR 0.68, 95% CI 0.48-0.98; p≤0.04) were associated with lesser chance/odds of being food-insecure. The study demonstrated a high prevalence of food insecurity in the marginalized section of the urban society. The Government of India needs to adopt urgent measures to combat this problem.

Profile of Patients Attending an Animal Bite Management Clinic in Rural Pondicherry, India.

Aims: In India, annual incidence of animal bite is estimated as 1.7 per 100 population and that of human rabies as 1.7 per 1,00,000 population. Since rabies is universally fatal it requires prevention through timely management by wound care, Anti-Rabies Vaccine (ARV) and rabies immunoglobulin. Study Design: Retrospective record review. Place and Duration of Study: Animal Bite Management (ABM) clinic of a Primary Health Centre in rural Pondicherry, south India, between January and December, 2011. Methodology: This study is a secondary analysis of data collected at an Animal Bite Management (ABM) clinic in a primary health centre in rural Pondicherry. The study population was mainly rural and agrarian. All victims of animal bite, who sought treatment from the ABM clinic between January and December, 2011 were included. Wound washing and administration of ARV through intramuscular route was provided for all victims. Data on factors like age, gender, place of residence, biting animal was collected. Means and proportions were calculated. Chi square test for categorical and t-test for continuous variables were applied. Results: A total of 767 victims sought treatment from ABM clinic. The mean age was 29 years (1 to 84 years). Mean distance of travel to ABM clinic was 2.1 km. About a third of all cases occurred during summer (March to May). Majority of victims were bitten by dog (85%) followed by cat (9%) and monkey (6%). Only 61.7%, 32.2%, 0.8% and 0% turned up for day 3, day 7, day 14 and day 28 doses of ARV schedule. Of those who came, only 70% came on due day. There was no statistically significant difference in treatment seeking based on gender and distance from ABM clinic. Conclusion: The high dropout rate for Day 3 and subsequent doses of the ARV and the delayed administration of Day 3 and Day 7 are worrying facts because only a full and timely ARV course will provide complete protection against rabies. Aims: In India, annual incidence of animal bite is estimated as 1.7 per 100 population and that of human rabies as 1.7 per 1,00,000 population. Since rabies is universally fatal it requires prevention through timely management by wound care, Anti-Rabies Vaccine (ARV) and rabies immunoglobulin. Study Design: Retrospective record review. Place and Duration of Study: Animal Bite Management (ABM) clinic of a Primary Health Centre in rural Pondicherry, south India, between January and December, 2011. Methodology: This study is a secondary analysis of data collected at an Animal Bite Management (ABM) clinic in a primary health centre in rural Pondicherry. The study population was mainly rural and agrarian. All victims of animal bite, who sought treatment from the ABM clinic between January and December, 2011 were included. Wound washing and administration of ARV through intramuscular route was provided for all victims. Data on factors like age, gender, place of residence, biting animal was collected. Means and proportions were calculated. Chi square test for categorical and t-test for continuous variables were applied. Results: A total of 767 victims sought treatment from ABM clinic. The mean age was 29 years (1 to 84 years). Mean distance of travel to ABM clinic was 2.1 km. About a third of all cases occurred during summer (March to May). Majority of victims were bitten by dog (85%) followed by cat (9%) and monkey (6%). Only 61.7%, 32.2%, 0.8% and 0% turned up for day 3, day 7, day 14 and day 28 doses of ARV schedule. Of those who came, only 70% came on due day. There was no statistically significant difference in treatment seeking based on gender and distance from ABM clinic. Conclusion: The high dropout rate for Day 3 and subsequent doses of the ARV and the delayed administration of Day 3 and Day 7 are worrying facts because only a full and timely ARV course will provide complete protection against rabies.

Poland syndrome.

Poland’s syndrome is a rare congenital condition, characterized by the absence of the sternal or breastbone portion of the pectoralis major muscle, which may be associated with the absence of nearby musculoskeletal structures. We hereby report an 8‑year‑old boy with typical features of Poland syndrome, the first documented case from Uttar Pradesh, India.

APE1/Ref-1 as an emerging therapeutic target for various human diseases: phytochemical modulation of its functions

Apurinic/apyrimidinic endonuclease 1 (APE1) is a multifunctional enzyme involved in the base excision repair (BER) pathway, which repairs oxidative base damage caused by endogenous and exogenous agents. APE1 acts as a reductive activator of many transcription factors (TFs) and has also been named redox effector factor 1, Ref-1. For example, APE1 activates activator protein-1, nuclear factor kappa B, hypoxia-inducible factor 1alpha, paired box gene 8, signal transducer activator of transcription 3 and p53, which are involved in apoptosis, inflammation, angiogenesis and survival pathways. APE1/Ref-1 maintains cellular homeostasis (redox) via the activation of TFs that regulate various physiological processes and that crosstalk with redox balancing agents (for example, thioredoxin, catalase and superoxide dismutase) by controlling levels of reactive oxygen and nitrogen species. The efficiency of APE1/Ref-1's function(s) depends on pairwise interaction with participant protein(s), the functions regulated by APE1/Ref-1 include the BER pathway, TFs, energy metabolism, cytoskeletal elements and stress-dependent responses. Thus, APE1/Ref-1 acts as a 'hub-protein' that controls pathways that are important for cell survival. In this review, we will discuss APE1/Ref-1's versatile nature in various human etiologies, including neurodegeneration, cancer, cardiovascular and other diseases that have been linked with alterations in the expression, subcellular localization and activities of APE/Ref-1. APE1/Ref-1 can be targeted for therapeutic intervention using natural plant products that modulate the expression and functions of APE1/Ref-1. In addition, studies focusing on translational applications based on APE1/Ref-1-mediated therapeutic interventions are discussed.

Conflictos de intereses en revistas médicas / Conflicts of interest in medical journals

Las revistas médicas son una fuente de información de gran importancia para los profesionales en medicina, para los pacientes y para los encargados de diseñar las políticas. Por lo tanto, es crucial que toda información y publicaciones en dichas revistas sean confiables y fidedignas. Está claro que los conflictos de intereses (CDI) pueden lastimar la credibilidad de una publicación y/o de una revista y tener consecuencias de largo alcance, socavando la confianza de los lectores de dichas publicaciones médicas. Este editorial pretende abordar algunos temas importantes relacionados con el CDI en revistas médicas. Específicamente se hará referencia a la definición y tipos de CDI, así como a las prácticas recomendadas para resolver tales conflictos.

Risk factors for prolonged length of stay after colorectal surgery / Fatores de risco para prolongamento do tempo de permanencia apos cirurgia colorretal

OBJECTIVE: Colorectal surgeons often struggle to explain to administrators/payers reasons for prolonged length of stay (LOS). This study aim was to identify factors associated with increased LOS after colorectal surgery. DESIGN: The study population included patients from the 2007 American-College-of-Surgeons-National-Surgical-Quality-Improvement-Program (ACS-NSQIP) database undergoing ileocolic resection, segmental colectomy, or anterior resection. The study population was divided into normal (below 75th percentile) and prolonged LOS (above the 75th percentile). A multivariate analysis was performed using prolonged LOS as dependent variable and ACS-NSQIP variables as predictive variables. P-value < 0.01 was considered significant. RESULTS: 12,269 patients with a median LOS of 6 (inter-quartile range 4-9) days were included. There were 2,617 (21.3%) patients with prolonged LOS (median 15 days, inter-quartile range 13-22). 1,308 (50%) were female, and the median age was 69 (inter-quartile range 57-79) years. Risk factors for prolonged LOS were male gender, congestive heart failure, weight loss, Crohn's disease, preoperative albumin < 3.5 g/dL and hematocrit < 47%, baseline sepsis, ASA class ≥ 3, open surgery, surgical time ≥ 190 min min, postoperative pneumonia, failure to wean from mechanical ventilation, deep venous thrombosis, urinary-tract infection, systemic sepsis, surgical site infection and reoperation within 30-days from the primary surgery. CONCLUSION: Multiple factors are associated with increased LOS after colorectal surgery. Our results are useful for surgeons to explain prolonged LOS to administrators/payers who are critical of this metric. (AU)

OBJETIVO: Os cirurgiões proctologistas muitas vezes enfrentam dificuldades para explicar aos administradores/contribuintes as razões para o prolongamento do tempo de internação hospitalar (TIH). O objetivo deste estudo foi identificar os fatores associados ao aumento do TIH após cirurgia colorretal. MÉTODO: A população do estudo incluiu pacientes que constam do banco de dados do American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) no ano de 2007 e que foram submetidos à ressecção ileocólica, colectomia segmentar ou ressecção anterior. A população do estudo foi dividida em normal (abaixo do percentil 75) e TIH prolongado (acima do percentil 75). A análise multivariada foi realizada usando o TIH prolongado como variável dependente e as variáveis do ACS-NSQIP como preditivas. Um valor de p < 0,01 foi considerado significativo. RESULTADOS: No total, 12.269 pacientes com um TIH mediano de 6 dias (intervalo interquartil, 4-9) foram incluídos. Havia 2.617 pacientes (21,3%) com TIH prolongado (mediana, 15 dias; intervalo interquartil, 13-22). A idade média dos pacientes era de 69 anos (intervalo interquartil, 57-79) e 1.308 (50%) eram do sexo feminino. Os fatores de risco para TIH prolongado foram sexo masculino, insuficiência cardíaca congestiva, perda de peso, doença de Crohn, albumina < 3,5 g/dL e hematócrito < 47% no pré-operatório, sepse basal, classe ASA ≥ 3, cirurgia aberta, tempo cirúrgico ≥ 190 minutos, pneumonia no pós-operatório, falha no desmame da ventilação mecânica, trombose venosa profunda, infecção do trato urinário, sepse sistêmica, infecção do sítio cirúrgico e reoperação dentro de 30 dias da cirurgia primária. CONCLUSÃO: Vários fatores estão associados ao aumento do TIH após a cirurgia colorretal. Nossos resultados são úteis para que os cirurgiões possam explicar os TIH prolongados aos administradores/contribuintes que são críticos dessa métrica. (AU)

Awareness of medical students in a medical college in Mangalore, Karnataka, India concerning infection prevention practices

Healthcare-associated infections [HCAIs] are an important public health problem. It is estimated that approximately 1 out of every 20 hospitalized patients will contract an HCAI. The risk is substantial not only to patients but also to healthcare workers, who may contract deadly blood-borne infectious diseases. Hence, it is essential for healthcare professionals to have adequate knowledge regarding infection prevention practices [IPPs] to reduce the burden of these illnesses among patients seeking care. This cross-sectional study was conducted among 268 medical students at Kasturba Medical College, Mangalore. Information regarding important IPPs such as hand hygiene [HH], needle-stick injuries [NSIs], and standard precautions [SPs] was collected using a semi-structured questionnaire. The collected information was analyzed using SPSS v.11. Fisher's exact test was used to test the association between variables of interest. Overall, knowledge levels regarding HH were low in aspects such as healthcare workers' hands as sources of infection [40%] and the minimum time needed to apply hand rubs [45.7%], whereas knowledge levels were high in aspects such as indications for using HH. Regarding NSI prevention, knowledge levels were low in aspects such as activities with the highest NSI risk [56%]. However, knowledge levels were high in relation to SPs. The knowledge levels regarding infection practices were not adequate among the participants, particularly in the case of hand hygiene methods. Other important aspects, such as needle-stick injuries and use of standard precautions, were better understood, although many aspects still require improvement. These findings suggest the need to consider strengthening the training related to IPPs as a separate entity in the existing curriculum

Extensive gingival enlargement in siblings. A case report

Gingival fibromatosis is characterised by varying degrees of fibrotic gingival overgrowth that can be caused by a variety of aetiological factors. Hereditary gingival fibromatosis [HGF] is a rare genetic disorder, characterised by a slowly progressive, benign enlargement of keratinised gingiva. The condition may be found in an autosomal dominant or autosomal recessive mode of inheritance, the former being more common. It usually develops as an isolated disorder but can be one feature of a multisystem syndrome. Accordingly, HGF has been divided into two forms: non-syndromic and syndromic. The gingival enlargement can be localised or generalised, but usually involves both arches. The authors describe a case of non-syndromic generalised severe HGF, involving the maxillary and mandibular arches in two brothers. This report focuses on the diagnosis, treatment, and control of the disease. The pattern of inheritance and histopathologic characteristics are also emphasised

Abdominoperineal resection does not decrease quality of life in patients with low rectal cancer

PURPOSE: Issues related to body image and a permanent stoma after abdominoperineal resection may decrease quality of life in rectal cancer patients. However, specific problems associated with a low anastomosis may similarly affect quality of life for patients undergoing low anterior resection. The aim of this study was to compare quality of life of low rectal cancer patients after undergoing abdominoperineal resection versus low anterior resection. METHODS: Demographics, tumor and treatment characteristics, and prospectively collected preoperative quality-of-life data for patients undergoing low anterior resection or abdominoperineal resection for low rectal cancer between 1995 and 2009 were compared. Quality of life collected at specific time intervals was compared for the two groups, adjusting for age, body mass index, use of chemoradiation, and 30 days postoperative complications. The short-form-36 questionnaire was used to determine quality of life. RESULTS: The query returned 153 patients (abdominoperineal resection = 68, low anterior resection = 85) with a median follow-up of 24 (3-64) mo. The after abdominoperineal resection group had a higher mean age (63 + 12 vs. 54 + 12, p < 0.001) and more American Society of Anesthesiologists classification 3/4 patients (65 percent vs. 43 percent, p = 0.03) than low anterior resection. Other demographics, tumor stage, use of chemoradiation, overall postoperative complication rates, and quality-of-life follow-up time were not statistically different in both groups. Patients undergoing abdominoperineal resection had a lower baseline short-form-36 mental component score than those undergoing low anterior resection. However, 6 mo after surgery this difference was no longer statistically significant and essentially disappeared at 36 mo after surgery. CONCLUSION: Patients undergoing abdominoperineal resection for low rectal cancer have a similar long-term quality of life as those undergoing low anterior resection. These findings can help clinicians to better counsel patients with low rectal cancer who are being considered for abdominoperineal resection.

Spontaneous biliary perforation in infancy and childhood: clues to diagnosis.

Spontaneous perforation of extrahepatic bile duct is rare. The cause is idiopathic once trauma and choledochal cyst are ruled out. The condition presents a diagnostic dilemma. Preoperative recognition is necessary as early surgical intervention gives excellent prognosis. We report clinical observations made in three cases with acute presentations. Diagnosis is to be suspected by the presence of jaundice after an initial anicteric period of good health with biliary ascites. This is confirmed by bilious abdominal paracentesis, signs of peritonitis and absent free gas on X ray. The constellation of these three findings was constant in three patients. The presented paper highlights the same as reliable clues to diagnosis.

In vitro antioxidant activity and scavenging effects of some new 1,3,5-triphenyl-2-pyrazolines and 3-[2"-hydroxy naphthalen-1"-YL]-1, 5-diphenyl-2-pyrazolines

A new class of potential pyrazoline derivatives had been synthesized and evaluated for their anti oxidant activities. The obtained five new 1,3,5-triphenyl-2-pyrazolines and another ten 3-[2"-hydroxynapthalen- 1"-yl]-1,5-diphenyl-2-pyrazolines were evaluated for antioxidative activities by using different reactive oxygen species [ROS] assays containing superoxide anion, hydroxyl radical, ABTS cation radical scavenging assays and inhibition of lipid peroxidation assay. The compounds exhibited more prominent effects in scavenging the free radical assays and also inhibited the lipid peroxidation. Compounds 10,13 possessing trimethoxy substitution on phenyl ring at position 5 of the 2-pyrazolines exhibited maximum activity, infact more than that of the standard drug ascorbic acid. Compounds11, 3, 4, 2 and 1 having dimethyl amino groups at position 4 of the phenyl ring at position 5 of the 2-pyrazolines also showed good activity. The present study revealed that an electron releasing group at position 4 of the phenyl ring is very much essential for all these 2-pyrazolines to show significant activity

Multi-segmental neurofibromatosis.

Neurofibromatosis (NF), one of the commonest phakomatoses, is characterized by varied clinical manifestations. Segmental NF is one of the uncommon subtypes of NF. We report a young adult presenting with asymptomatic skin lesions- neurofibromas and café-au-lait macules- over localized areas of the lower back, affecting more than one segment. None of the family members were found to have features of segmental NF. Segmental NF may be misdiagnosed as a birthmark or remain undiagnosed for long periods of time, as the patients are often asymptomatic. Moreover, the clinical features are highly variable and range from a small area of skin involvement to involvement over the entire half of the body. This variation is explained by the fact that segmental NF is thought to arise from a postzygotic NF1 gene mutation, leading to somatic mosaicism. We have also reviewed the relevant literature on this subject.

Correlation of manometric and radiographic diagnosis in esophageal motility disorders.

BACKGROUND: Radiography and manometry are complementary investigations in the diagnosis of esophageal motility disorders. In most centers, however, manometry is not available and diagnosis is based on radiography alone. AIMS: To correlate the findings on radiography in patients with esophageal motility disorders in whom a manometric diagnosis was available. METHODS: Retrospective analysis of esophageal manometry and barium contrast studies of 138 patients, done for suspected motility disorders, over a period of two years. RESULTS: Manometry was abnormal in 111 (80.4%) cases [achalasia 87, scleroderma 6, non specific esophageal motility disorders (NEMD) 13, diffuse esophageal spasm (DES) 5]. Radiology was abnormal in 106 cases; the overall radiographic sensitivity was 73.9% (achalasia 87.4%, scleroderma 83.3%, NEMD 38.5%) and the positive predictive value was 75.5% (achalasia 95%, scleroderma 100%, NEMD 29.4%). CONCLUSION: Radiography has a high sensitivity and positive predictive value in esophageal motility disorders like achalasia and scleroderma but in DES and NEMD the two investigative modalities (radiography and manometry) do not correlate well.

Total and segmental colonic transit time in non ulcer dyspepsia.

BACKGROUND: Patients with non ulcer dyspepsia (NUD) often have associated lower alimentary tract symptoms which are labelled as due to the irritable bowel syndrome. AIMS: To asymptomatic colonic dysmotility is present in patients with NUD. METHODS: We studied total and segmental colonic transit times in 25 patients with NUD (14 men age range 20-70 yr), and 25 matched normal controls (13 men; 18-50 yr), using the multiple-marker, single-film technique. Twenty markers each were administered at 0, 9 and 18 h and an abdominal film taken at 27 h. RESULTS: Total colonic transit time was shorter (median 9 h) in patients with NUD as compared to controls (median 15.8 h) p = 0.0018, with similar segmental motility pattern as in controls. There was no significant difference between the symptom subgroups of NUD. CONCLUSIONS: Patients with NUD often have altered colonic transit even in the absence of symptoms. NUD may therefore be only a subset of diffuse gastrointestinal dysmotility with predominant proximal alimentary tract symptoms, whereas the term irritable bowel syndrome is used when lower tract symptoms predominate.