Ghrelin Gene Polymorphisms in Irritable Bowel Syndrome.

INTRODUCTION/OBJECTIVE: Irritable bowel syndrome (IBS) is a bowel disorder characterized by pain accompanying defecation or altered bowel habits, divided into diarrhea-predominant, constipation-predominant, and alternating subtypes, whose pathogenesis is considered to include disordered bowel motility. The hormone ghrelin is a growth hormone secretagogue which furthermore affects gastrointestinal motility. We study the association between its genetic polymorphisms and the risk for IBS. METHODS: IBS patients meeting the Rome III criteria and controls similar in age and gender were recruited. Whole blood samples were used for genotyping via polymerase chain reaction and restriction fragment length polymorphism for the polymorphisms rs34911341, rs696217, and rs2075356. RESULTS: Participants included 142 patients and 209 controls. The rs696217 GG genotype frequency was higher in patients (78.87%) compared to controls (55.5%). The rs696217 GT genotype was significantly less frequent among patients than in controls (OR 0.31, 95% CI 0.19-0.52), as was the T allele (OR 0.43, 95% CI 0.28-0.66). No significant differences in genotype distribution were found for the rs34911341 and rs2075356 polymorphisms between patients and controls. The genotype frequencies did not significantly differ between IBS subtype groups for any of the polymorphisms studied. CONCLUSIONS: The GG and GT genotypes of the rs696217 polymorphism, as well as the G-allele, demonstrate significant association with IBS susceptibility, while the T allele appears to bear a protective effect. Ghrelin's polymorphisms are plausibly involved in IBS pathogenesis, but do not correlate with any distinct IBS subtype.

Contribution of ghrelin to functional gastrointestinal disorders' pathogenesis.

Functional gastrointestinal disorders (FGID) are heterogeneous disorders with a variety of clinical manifestations, primarily defined by signs and symptoms rather than a definite underlying cause. Their pathophysiology remains obscure and, although it is expected to differ according to the specific FGID, disruptions in the brain-gut axis are now thought to be a common denominator in their pathogenesis. The hormone ghrelin is an important component of this axis, exerting a wide repertoire of physiological actions, including regulation of gastrointestinal motility and protection of mucosal tissue. Ghrelin's gene shows genetic polymorphism, while its protein product undergoes complex regulation and metabolism in the human body. Numerous studies have studied ghrelin's relation to the emergence of FGIDs, its potential value as an index of disease severity and as a predictive marker for symptom relief during attempted treatment. Despite the mixed results currently available in scientific literature, the plethora of statistically significant findings shows that disruptions in ghrelin genetics and expression are plausibly related to FGID pathogenesis. The aim of this paper is to review current literature studying these associations, in an effort to uncover certain patterns of alterations in both genetics and expression, which could delineate its true contribution to FGID emergence, either as a causative agent or as a pathogenetic intermediate.

A Case of Lymphangioma of the Anal Canal.

Lymphangiomas are unusual benign malformations, which can often be misdiagnosed due to their relatively mild and nonspecific symptomatology. Their appearance in the anal canal is extremely rare. Correct diagnosis is necessary for formulating appropriate management. We present the case of a 42-year-old man, with a medical history of ulcerative colitis and mild symptomatology, who was diagnosed with lymphangioma of the anal canal after undergoing a colonoscopy.

Optimized sedation improves colonoscopy quality long-term.

Background. Quality monitoring and improvement is prerequisite for efficient colonoscopy. Aim. To assess the effects of increased sedation administration on colonoscopy performance. Materials and Methods. During Era 1 we prospectively measured four colonoscopy quality indicators: sedation administration, colonoscopy completion rate, adenoma detection rate, and early complications rate in three cohorts: cohort A: intention for total colonoscopy cases; cohort B: cohort A excluding bowel obstruction cases; cohort C: CRC screening-surveillance cases within cohort B. We identified deficiencies and implemented our plan to optimize sedation. We prospectively evaluated its effects in both short- (Era 2) and long-term period (Era 3). Results. We identified that sedation administration and colonoscopy completion rates were below recommended standards. After sedation optimization its use rate increased significantly (38.1% to 55.8% to 69.5%) and colonoscopy completion rate increased from 88.3% to 90.6% to 96.4% in cohort B and from 93.2% to 95.3% to 98.3% in cohort C, in Eras 1, 2, and 3, respectively. Adenoma detection rate increased in cohort C (25.9% to 30.6% to 35%) and early complications rate decreased from 3.4% to 1.9% to 0.3%. Most endoscopists increased significantly their completion rate and this was preserved long-term. Conclusion. Increased sedation administration results in long-lasting improvement of colonoscopy quality indicators.

Quality of small bowel preparation for video-capsule endoscopy. Prospective comparison of two different preparations.

BACKGROUND/AIM: The best preparation for successful small bowel video-capsule endoscopy (VCE) is still unknown. The primary aim of our study was to compare sodium phosphate (PS) and polyethylene glycol (PEG) purge on the quality of small bowel preparation. METHODOLOGY: In this prospective, non-randomized, two centers study, we evaluated 47 and 48 consecutive outpatients who received PS and PEG preparations, respectively. Two independent investigators measured the proportion of small bowel transit time (SBTT) without clean mucosa. Two other investigators assessed bowel preparation independently, using a visual analogue scale (VAS). RESULTS: The proportion of SBTT without clean mucosa was similar for both preparations, in the proximal [3.8 (2.1-8.7) % vs. 4.85 (2.7-9.7) %, p = 0.24)] and in the distal half [31.9 (10.7-52.5) % vs. 22.9 (6.9-57.7) %, p = 0.48] of VCE recording. There was moderate - good correlation of VAS assessment of bowel preparation with the proportion of SBTT without clean mucosa in the proximal (r = 0.69, p < 0.001) and in the distal half (r = 0.76, p < 0.001) of the recording. The outcome measures of the studies were similar for both preparations. CONCLUSIONS: PS and PEG preparations result in similar quality of small bowel preparation and similar outcome measures of VCE studies. VAS assessment could be an alternative measure of bowel preparation in clinical practice.

Effect of sleep on excessive belching: a 24-hour impedance-pH study.

UNLABELLED: In patients with repetitive and troublesome belching an organic cause is seldom found, indicating the presence of an acquired abnormal behavior. The aim of our study was to investigate the incidence and pattern of belching during a 24-hour period. METHODS: Combined 24-hour pH and intraluminal impedance monitoring was performed in 14 patients (9 female; mean age: 43 y) with excessive belching and 10 patients (6 women, mean age 42 y; range 28 to 56) with noncardiac chest pain. Thereafter, we counted the number of belching events and differentiated the number of supragastric and gastric belches. RESULTS: During the 24-hour study, the hourly rate of belching was 38.7+/-6.0; rate of supragastric belches were significantly higher compared to gastric belches (37.7+/-6.0 vs 1.0+/-0.5, P<0.001). Patients with noncardiac chest pain showed a lower average hourly rate of belching (3.1+/-0.6, P<0.001). Dividing the recording into 2 periods (daily-upright and night-supine), there was a significant decrease in the hourly rate at night (37.8+/-6.1 vs. 0.9+/-0.5, respectively, P<0.001); mostly due to decrease in supragastric belches, where as the rate of gastric belches remained unchanged. None of the patients showed pathological acid reflux and none of the supragastric belches was associated with acid or nonacid reflux events. CONCLUSIONS: Supragastric belch is the prominent belching pattern in patients with excessive belching. Supragastric belches almost ceased at night suggesting the presence of a behavioral disorder. There were no diurnal changes in the rate of gastric belches.

PillCam Colon capsule endoscopy does not always complement incomplete colonoscopy.

BACKGROUND: There are no data on the role of PillCam Colon capsule (PCC) endoscopy for examination of the colon in incomplete colonoscopy cases. OBJECTIVE: To evaluate whether PCC endoscopy can complete colon examination after failure of conventional colonoscopy to visualize the cecum. SETTING: Three tertiary centers. STUDY DESIGN: Retrospective case series. PATIENTS: Patients who underwent PCC endoscopy after incomplete colonoscopy from January to June 2008. INTERVENTIONS: Conventional colonoscopy and PCC endoscopy. RESULTS: By using PCC, we studied 12 patients who had incomplete colonoscopy. Six patients had an obstructing tumor of the left side of the colon, and, in 6 cases, there were technical difficulties to complete colonoscopy. PCC endoscopy visualized the rectum in 1 case. The capsule did not reach the site where colonoscopy stopped in 6 of the 12 cases, ie, 3 left sited tumors and 3 with technical difficulties. Moreover, in 1 of the 3 cases in which the capsule passed the site where colonoscopy stopped, poor bowel preparation precluded the accurate examination of the colon. Four patients underwent a third colon examination (3 barium enemas and 1 virtual CT colonoscopy). There were no adverse events related to PCC endoscopy. LIMITATIONS: A retrospective study and a selected patient population. Data may not be applicable to other settings. CONCLUSION: In this retrospective case series of patients with incomplete colonoscopy, PCC endoscopy did not always satisfactorily examine the colon.

Effects of ageing on small bowel video-capsule endoscopy examination.

OBJECTIVES: The effects of ageing on small bowel video-capsule endoscopy (VCE) studies have not been studied prospectively yet. METHODS: We prospectively investigated 120 consecutive VCE studies. Patients were divided into three age groups: <40, 40-64, and > or =65 yr. Two independent investigators examined the completion of the examination and measured the VCE gastric transit time (GTT), small bowel transit time (SBTT), and the proportion of VCE SBTT without clean intestinal mucosa. They also recorded study findings. RESULTS: We examined the videos of 32 (26.7%), 36 (30%), and 52 (43.3%) patients aged under 40, 40-64, and over 64 yr, respectively. VCE completion (cecum visualized) rate was similar in the three groups (81.2%, 77.8%, and 78.8%, respectively, P= 0.96). There was no difference in GTT (P= 0.22) and in SBTT (P= 0.8) among the three age groups. Although in univariate analysis, there was a trend (P= 0.057) for higher proportion of SBTT without clean mucosa in patients over 64 yr (22.65 [12.42-32.22]%) versus patients under 40 (12.65 [4.57-30.7]%) and patients aged 40-64 yr (12.55 [6.12-31.32]%), multivariate linear regression analysis has not confirmed this difference. Older patients had significantly less erosions and normal studies, but they had more angiodysplasias (P < 0.05). All four tumors were detected in the elderly. CONCLUSIONS: Ageing does not affect the completion rate and the quality of bowel preparation for VCE. However, elderly patients have fewer normal studies and more angiodysplasias and tumors in the small bowel.