Long-lasting dyspeptic symptoms - another consequence of the COVID-19 pandemic?

Introduction: It is known that the virus SARS-CoV-2 can attack the gastrointestinal (GI) tract and induce gastroenteritis. This can trigger a wide variety of disorders of gut-brain interaction (DGBIs) or functional gastrointestinal disorders (FGIDs), including post-infectious dyspepsia, which remains underestimated. Aim: To estimate the prevalence of dyspeptic symptoms following COVID-19, immediately after discharge and 3, 6, and 9 months after hospitalization. Material and methods: A prospective, single-centre evaluation of questions regarding functional dyspepsia (FD) as assessed by the Gastroduodenal Module of ROME IV Diagnostic Questionnaire for Adult FGIDs among 320 patients who had had COVID-19. Results: The FD ROME IV criteria were met at the respective time-points by 0.0% (0), 4.8% (12), 3.2% (8), and 3.2% (8) of cases. However, the presence of GI symptoms that suggested FD but did not meet the timeframe ROME IV criteria for FD were found in 9.6% (24), 23.5% (59), 20.7% (52), and 20.7% (52) of cases, respectively. Conclusions: The presence and persistence of gastrointestinal dyspeptic symptoms following COVID-19 is a significant problem. The timeframe of the Rome IV criteria may underestimate the number of patients with persistent dyspeptic symptoms following COVID-19 disease.

Autoimmune Pancreatitis in Patients with Inflammatory Bowel Disease: A Real-World Multicentre Collaborative ECCO CONFER Study.

BACKGROUND: Autoimmune pancreatitis [AIP] is rarely associated with inflammatory bowel disease [IBD]. The long-term outcomes of AIP and IBD in patients with coexisting AIP-IBD and predictors of complicated AIP course have rarely been reported. METHODS: An ECCO COllaborative Network For Exceptionally Rare case reports project [ECCO-CONFER] collected cases of AIP diagnosed in patients with IBD. Complicated AIP was defined as a composite of endocrine and/or exocrine pancreatic insufficiency, and/or pancreatic cancer. We explored factors associated with complicated AIP in IBD. RESULTS: We included 96 patients [53% males, 79% ulcerative colitis, 72% type 2 AIP, age at AIP diagnosis 35 ±â€…16 years]. The majority of Crohn's disease [CD] cases [78%] had colonic/ileocolonic involvement. In 59%, IBD preceded AIP diagnosis, whereas 18% were diagnosed simultaneously. Advanced therapy to control IBD was used in 61% and 17% underwent IBD-related surgery. In total, 82% of patients were treated with steroids for AIP, the majority of whom [91%] responded to a single course of treatment. During a mean follow-up of 7 years, AIP complications occurred in 25/96 [26%] individuals. In a multivariate model, older age at AIP diagnosis was associated with a complicated AIP course (odds ratio [OR] = 1.05, p = 0.008), whereas family history of IBD [OR = 0.1, p = 0.03], and CD diagnosis [OR = 0.2, p = 0.04] decreased the risk of AIP complications. No IBD- or AIP-related deaths occurred. CONCLUSIONS: In this large international cohort of patients with concomitant AIP-IBD, most patients have type 2 AIP and colonic IBD. AIP course is relatively benign and long-term outcomes are favourable, but one-quarter develop pancreatic complications. Age, familial history of IBD, and CD may predict uncomplicated AIP course.

Impact of photoperiod and functional clock on male diapause in cryptochrome and pdf mutants in the linden bug Pyrrhocoris apterus.

Numerous insect species living in temperate regions survive adverse conditions, such as winter, in a state of developmental arrest. The most reliable cue for anticipating seasonal changes is the day-to-night ratio, the photoperiod. The molecular mechanism of the photoperiodic timer in insects is mostly unclear. Multiple pieces of evidence suggest the involvement of circadian clock genes, however, their role might be independent of their well-established role in the daily oscillation of the circadian clock. Furthermore, reproductive diapause is preferentially studied in females, whereas males are usually used for circadian clock research. Given the idiosyncrasies of male and female physiology, we decided to test male reproductive diapause in a strongly photoperiodic species, the linden bug Pyrrhocoris apterus. The data indicate that reproduction is not under circadian control, whereas the photoperiod strongly determines males' mating capacity. Clock mutants in pigment dispersing factor and cryptochrome-m genes are reproductive even in short photoperiod. Thus, we provide additional evidence of the participation of circadian clock genes in the photoperiodic time measurement in insects.

Gastrointestinal symptoms in COVID-19.

SARS-CoV-2 infection manifests mainly by involving the respiratory system. Due to the presence of abdominal symptoms, the digestive system is clearly involved in the expression, transmission, and possible pathogenesis of COVID-19. There are many theories regarding the development of abdominal symptoms, including angiotensin 2 receptor, cytokine storm, and disturbances of the intestinal microbiome. This paper provides an overview of the most important meta-analyses and publications on gastrointestinal symptoms and the gut microbiome in COVID-19.

Risk Factors for Osteoporosis among Patients with Inflammatory Bowel Disease-Do We Already Know Everything?

INTRODUCTION: There are many known risk factors for osteoporosis (OST) among patients with inflammatory bowel disease (IBD), one of which is physical activity. MATERIAL AND METHODS: The aim of the study is to assess the frequency and risk factors of OST among 232 patients with IBD compared to a group of 199 patients without IBD. The participants underwent dual-energy X-ray absorptiometry, laboratory tests, and completed a questionnaire about their physical activity. RESULTS: It was found that 7.3% of IBD patients suffered from OST. Male gender, ulcerative colitis, extensive inflammation in the intestine, exacerbation of disease, rare physical activity, other forms of physical activity, past fractures, lower levels of osteocalcin, and higher levels of C-terminal telopeptide of type 1 collagen were risk factors for OST. As many as 70.6% of OST patients were rarely physically active. CONCLUSIONS: OST is a common problem in IBD patients. OST risk factors differ significantly between the general population and those with IBD. Modifiable factors can be influenced by patients and by physicians. The key to OST prophylaxis may be regular physical activity, which should be recommended in clinical remission. It may also prove valuable to use markers of bone turnover in diagnostics, which may enable decisions regarding therapy.

Selected Aspects of Nutrition in the Prevention and Treatment of Inflammatory Bowel Disease.

Inflammatory bowel disease has become a global health problem at the turn of the 21st century. The pathogenesis of this disorder has not been fully explained. In addition to non-modifiable genetic factors, a number of modifiable factors such as diet or gut microbiota have been identified. In this paper, the authors focus on the role of nutrition in the prevention of inflammatory bowel disease as well as on the available options to induce disease remission by means of dietary interventions such as exclusive and partial enteral nutrition in Crohn's disease, the efficacy of which is reported to be comparable to that of steroid therapy. Diet is also important in patients with inflammatory bowel disease in the remission stage, during which some patients report irritable bowel disease-like symptoms. In these patients, the effectiveness of diets restricting the intake of oligo-, di-, monosaccharides, and polyols is reported.

Low-FODMAP Diet for the Management of Irritable Bowel Syndrome in Remission of IBD.

Approximately 30% of patients with quiescent inflammatory bowel disease (IBD) meet the diagnostic criteria for irritable bowel syndrome (IBS). The aim of this study was to evaluate the effectiveness of a low-FODMAP diet in patients who meet the diagnostic criteria for IBS whilst in IBD remission. A total of 200 patients in remission of IBD were included in the study. Sixty-five of these patients (32.5%) were diagnosed with IBS according to the R4DQ. On the patients who met the IBS diagnostic criteria, anthropometric measurements, laboratory tests and lactulose hydrogen breath tests were performed. A low-FODMAP diet was introduced for 6 weeks. Of the 59 patients with IBS diagnosed at baseline for whom data were collected at the end of follow-up, after the low-FODMAP intervention IBS-like symptoms were not present in 66.1% (n = 39) (95% CI (53.4%; 76.9%)). The difference between the two groups (with SIBO at baseline (33 of 48 patients) and without SIBO at baseline (6 of 11 patients)) in the low-FODMAP diet's effectiveness was not statistically significant (p = 0.586). The low-FODMAP diet improved the gut symptoms of flatulence and diarrhea. It had no effect on the occurrence of constipation. In IBD patients in remission who meet the IBS criteria, the dietary intervention of a low-FODMAP diet is effective for a reduction in IBS-like symptoms, regardless of the coexistence of bacterial overgrowth.

Gastrointestinal symptoms in patients with coronavirus disease 2019 (COVID-19) - friend or foe?

Introduction: Gastrointestinal (GI) symptoms can be considered as a manifestation of coronavirus disease 2019 (COVID-19). Aim: Our study analysed GI symptoms depending on their occurrence, and their possible causes and impact on the course of COVID-19. Material and methods: A retrospective, single-centre assessment of the frequency, risk factors, and impact of GI symptoms in 441 patients with COVID-19. Results: A statistically significant reduction in the length of stay (LOS) (15 days vs. 17 days; p = 0.04), intensive care unit admission (ICU) (16.9% vs. 26.8%; p = 0.02), and need for mechanical ventilation (14.1% vs. 23.4%; p = 0.02) in the group who had experienced GI symptoms before hospitalization was noticed. For comparison, patients who developed GI symptoms during hospitalization had statistically significantly longer LOS (21 days vs. 15 days; p = 0.0001), were more frequently admitted to the ICU (38.1% vs. 18.6%; p = 0.0003), and had a higher need for mechanical ventilation (32.7% vs. 16.2%; p < 0.001). Risk factors for GI symptoms during hospitalization in COVID-19 patients included age, Clostridioides difficile infection, and receiving certain treatment (antibiotics and lopinavir + ritonavir). Conclusions: The GI symptoms that developed before admission to hospital correlated with reduced severity of the course of COVID-19. However, in the group of patients who developed GI symptoms during hospitalization, attention should be paid to concomitant treatment. The use of antibiotics should be limited because they are associated with the deterioration of the course of COVID-19; one of the reasons might be changes in the intestinal microbiome.

Irritable bowel syndrome following COVID-19: an underestimated consequence of SARS-CoV-2 infection.

INTRODUCTION: Gastrointestinal (GI) symptoms are a common manifestation of COVID­19. OBJECTIVES: We aimed to investigate whether GI symptoms persist in patients previously infected with SARS­CoV­2 in the form of post­infection irritable bowel syndrome (PI­IBS). PATIENTS AND METHODS: A prospective, single­center evaluation of questions regarding IBS was conducted using the Rome IV Adult Diagnostic Questionnaire among 257 patients previously hospitalized for COVID­19. RESULTS: GI symptoms (abdominal pain with diarrhea or constipation) were reported at the following time points: at discharge from the hospital, and after 3 and 6 months of follow­up. GI symptoms not meeting the full Rome IV diagnostic criteria for IBS due to too short symptom duration were reported by 28 individuals (10.6%) at hospital discharge, 58 (22.3%) after 3 months, and 70 (26.9%) after 6 months. The full Rome IV criteria for IBS were not met at discharge by any of the participants, but they were met after 3 and 6 months of follow­up in 14 (5.4%) and 15 individuals (5.8%), respectively. CONCLUSION: Persistent GI symptoms following COVID­19 are frequent and deserve significant and growing attention of gastroenterologists and other health care practitioners. The Rome IV criteria may be too strict to address the full spectrum of GI symptoms following COVID­19.

Reply to van Lingen et al. Comment on "Szczubelek et al. Effectiveness of Crohn's Disease Exclusion Diet for Induction of Remission in Crohn's Disease Adult Patients. Nutrients 2021, 13, 4112".

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The effectiveness of microencapsulated sodium butyrate at reducing symptoms in patients with irritable bowel syndrome.

Aim: The aim of the study was to assess the effectiveness of a patented preparation of sodium butyrate in the triglyceride matrix at reducing clinical symptoms and improving quality of life in patients with irritable bowel syndrome (IBS). Material and methods: In this prospective multicenter clinical trial, we observed a total of 3000 non-hospitalized patients with confirmed IBS who were treated with sodium butyrate in a triglyceride matrix at a dosage of 150 mg twice a day for 12 weeks. The primary outcome was to evaluate the efficacy of sodium butyrate at reducing the severity of clinical symptoms and improving quality of life in patients with IBS. Results: A total of 2990 complete surveys were collected. A statistically significant improvement in severity of abdominal pain was noticed (p < 0.001). Moreover, flatulence, diarrhea, constipation, urgent pressure for bowel movements, nausea, and vomiting decreased significantly (p < 0.001). Most of the respondents (93.90%) declared that they would continue the therapy and 88.9% would recommend using sodium butyrate to other IBS patients. Conclusions: Sodium butyrate in the triglyceride matrix, as a postbiotic substance, may be effective in relieving the symptoms of IBS by modifying the intestinal microbiota.

Effectiveness of Crohn's Disease Exclusion Diet for Induction of Remission in Crohn's Disease Adult Patients.

Exclusive enteral nutrition (EEN) is a first-line treatment in active, mild to moderate Crohn's disease (CD) in children. The Crohn's disease exclusion diet (CDED), which avoids products known to have a pro-inflammatory effect on the intestinal mucosa, presents similar effectiveness to EEN for inducing remission in the paediatric population. The aim of the study was to evaluate the effectiveness of the CDED in inducing remission in adult patients. Between March 2020 and May 2021, 32 patients in a gastroenterology outpatient centre were treated according to the assumptions of the CDED. The patients were seen at baseline, at week 6, and at week 12 of the study. During the visits, anthropometric measurements and laboratory tests were performed, Crohn's disease activity index (CDAI) was calculated, and the Inflammatory Bowel Disease Questionnaire (IBDQ) was completed. The study included a total of 32 participants, 18 women (56.3%) and 14 men (43.7%). Clinical remission was obtained in 76.7% patients after 6 weeks and in 82.1% after 12 weeks of therapy. Calprotectin levels were significantly lower in the second follow-up compared with baseline (p = 0.021). The CDED is an effective therapy for inducing remission in the adult CD population.

Biosimilar infliximab versus originator in Crohn's disease anti-TNF-α naïve and non-naïve patients.

INTRODUCTION: Data comparing response to originator and biosimilar infliximab in anti-TNF-α naïve and non-naïve Crohn's disease patients is limited. AIM: To assess the efficacy, safety, and tolerability of a biosimilar infliximab in comparison to the originator drug in anti-TNF-α naïve and non-naïve Crohn's disease patients. Data comparing response in those two groups of patients are limited. MATERIAL AND METHODS: This retrospective single-centre study enrolled 168 adult Crohn's disease patients treated for 1 year with infliximab originator or biosimilar. Assessment included achievement of clinical remission (during induction and maintenance therapy and follow-up period - 24 months) and occurrence of adverse events. RESULTS: Forty-seven patients taking infliximab and 68 on biosimilar were anti-TNF-α naïve. There were no differences in clinical remission rate between naïve and non-naïve patients after 1 year of treatment (infliximab - 80.9% and 73.1%, respectively; biosimilar - 79.4% and 74.1%, respectively). The relapse rate during the follow-up period was higher in anti-TNF-α non-naïve patients (p < 0.001) with no significant differences between two groups. Adverse events were more common in anti-TNF-α non-naïve patients with no difference between infliximab and biosimilar groups (13.3% vs. 17.6%, respectively). The infliximab group of anti-TNF-α naïve patients had a higher rate of adverse events compared to the biosimilar (8.1% vs. 1.9%), but it did not reach statistical significance. CONCLUSIONS: This is a study comparing anti-TNF-α naïve and non-naïve patients with Crohn's disease. Relapse rate during follow-up was significantly higher in anti-TNF-α non-naïve patients, but with no significant differences between originator and biosimilar.

The Use of Virtual Reality to Reduce Stress among Inflammatory Bowel Disease Patients Treated with Vedolizumab.

(1) Background: The use of virtual reality (VR) in improving patient comfort related to medical procedures in oncology patients raised the question of whether similar benefits could be obtained by patients with inflammatory bowel disease (IBD). (2) Methods: In this prospective, randomized, controlled, single-center clinical trial, a total of 90 patients with IBD treated with vedolizumab were enrolled and randomized in a 1:1 allocation to either the VR immersion group or the routine-treated group. The primary outcome was to evaluate whether VR could decrease stress and anxiety related to a medical procedure. The secondary outcome was to assess the safety of the VR. (3) Results: A statistically significant improvement in well-being and psychological comfort (p = 0.046), feeling of relaxation (p = 0.046), sense of influence on the treatment process (p < 0.001), improved perception of the way the drug works (p < 0.001), improved positive attitude while waiting for the next administration of the drug (p = 0.026), and increased motivation for treatment (p = 0.026) was noticed in the intervention group. There were no statistically significant differences in the incidence of complications in the intervention and control groups. (4) Conclusions: The use of VR had a positive effect on the reduction of stress associated with vedolizumab treatment and could improve compliance.

Clostridioides difficile infection in coronavirus disease 2019 (COVID-19): an underestimated problem?

INTRODUCTION: The use of antibiotics and possibility of microbiota disruption during the coronavirus disease 2019 (COVID­19) pandemic have raised questions about the incidence of Clostridioides difficile infection (CDI). OBJECTIVES: This study aimed to assess the frequency of and risk factors for CDI in patients with COVID­19. PATIENTS AND METHODS: We conducted a retrospective, single­center evaluation study on the frequency of and risk factors for CDI in patients with COVID­19 and in the prepandemic era. The analysis included 441 patients with severe acute respiratory syndrome coronavirus 2 (SARS­CoV­2) infection and 2961 pa­ tients hospitalized before the pandemic. RESULTS: A significant increase in the incidence of CDI was noted during the COVID­19 pandemic compared with the prepandemic period: 10.9% versus 2.6%, P <0.001. Risk factors for CDI in patients with COVID­19 included: age, length of hospital stay, occurrence of diarrhea during hospitalization, use of antibiotics other than azithromycin, and coexistence of nervous system disease or chronic kidney disease-all of these factos had a weak association with CDI development. The multivariable logistic regression model indicated other unassessed variables that had an impact on the CDI incidence rate. CONCLUSIONS: We observed a higher incidence of CDI in patients with COVID­19. Antibiotic therapy was a relevant risk factor for CDI, although its effect was weak. Other drugs used during the pandemic were not found to have an impact on disease development. Possible causes of CDI may include fecal microbiota disruption by SARS­CoV­2 infection, but further research is needed to validate this hypothesis.

Light and Temperature Synchronizes Locomotor Activity in the Linden Bug, Pyrrhocoris apterus.

Circadian clocks are synchronized with the external environment by light and temperature. The effect of these cues on behavior is well-characterized in Drosophila, however, little is known about synchronization in non-model insect species. Therefore, we explored entrainment of locomotor activity by light and temperature in the linden bug Pyrrhocoris apterus (Heteroptera), an insect species with a strong seasonal response (reproductive diapause), which is triggered by both photoperiod and thermoperiod. Our results show that either light or temperature cycles are strong factors entraining P. apterus locomotor activity. Pyrrhocoris is able to be partially synchronized by cycles with temperature amplitude as small as 3°C and more than 50% of bugs is synchronized by 5°C steps. If conflicting zeitgebers are provided, light is the stronger signal. Linden bugs lack light-sensitive (Drosophila-like) cryptochrome. Notably, a high percentage of bugs is rhythmic even in constant light (LL) at intensity ∼400 lux, a condition which induces 100% arrhythmicity in Drosophila. However, the rhythmicity of bugs is still reduced in LL conditions, whereas rhythmicity remains unaffected in constant dark (DD). Interestingly, a similar phenomenon is observed after temperature cycles entrainment. Bugs released to constant thermophase and DD display weak rhythmicity, whereas strong rhythmicity is observed in bugs released to constant cryophase and DD. Our study describes the daily and circadian behavior of the linden bug as a response to photoperiodic and thermoperiodic entraining cues. Although the molecular mechanism of the circadian clock entrainment in the linden bug is virtually unknown, our study contributes to the knowledge of the insect circadian clock features beyond Drosophila research.

The introduction of the IBD Disk in Poland - a new tool for assessing disability in patients with inflammatory bowel disease.

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic disorder of the gastrointestinal tract, which can significantly deteriorate everyday functioning. We are, however, still lacking simple methods to assess the influence of IBD on patients' disability. IBD Disk is a new graphical tool that allows for a quick assessment of the influence of IBD on different aspects of everyday life. AIM: To present the adaptation process of the IBD Disk in Poland. MATERIAL AND METHODS: The Polish IBD Working Group together with the Institute of Translational Medicine in Birmingham (United Kingdom) and a professional translational agency performed a translation and re-translation of the Polish version of the IBD Disk. After full agreement was achieved, the final Polish version was accepted. In the next step, its understandability and ease of use was assessed by using a semiquantitative scale (scale from 1 to 10, where "1" means very easy to use, "10" means - very difficult to use). RESULTS: In the initial translation phase, the concordance between translation agency and experts was very high. In the re-translation phase only some stylistic and grammatical corrections were made. In the final step the general assessment of understandability of all items of the tool was high. Moreover, patients with IBD assessed the ease of use of the IBD Disk as very easy (median: 1.5 points, 95% confidence interval: 1.0-2.0). CONCLUSIONS: The Polish adaptation of IBD Disk directly reflects the original English version. Thus, it can be further used in the validation process among Polish IBD patients.

Skin and gastrointestinal symptoms in COVID-19.

INTRODUCTION: The first cases of coronavirus disease 2019 (COVID-19) were noted in December 2019 in Wuhan province, China. The World Health Organisation (WHO) announced the pandemic status on March 11, 2020. The manifestations of the disease are as follows: fever, cough, fatigue, anosmia and ageusia, dyspnoea, chest pain, muscle soreness, chills, sore throat, rhinitis, headache, gastrointestinal (GI) symptoms, and dermal lesions. AIM: To evaluate the relationship between dermal lesions and GI symptoms in a group of COVID-19 patients. MATERIAL AND METHODS: A group of 441 COVID-19 patients admitted to the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw between March 15th and June 15th, 2020. RESULTS: Of 441 patients with confirmed SARS-CoV-2 infection, 255 (58.5%) experienced gastrointestinal (GI) symptoms: lack of appetite was reported in 124 (48.6%) cases, diarrhoea was noted in 109 (42.7%), abdominal pain in 95 (37.3%), vomiting in 37 (14.5%), and nausea in 32 (12.5%) cases. Eight (1.81%) patients had dermal lesions: erythematous macular lesions (2 patients - 25%), erythematous infiltrated lesions (2; 25%), erythematous infiltrated and exfoliative lesions (3; 37.5%), erythematous papular lesions (3; 37.5%), and erythematous oedematous lesions (2; 25%). All of those patients reported gastrointestinal symptoms during the hospitalisation. CONCLUSIONS: The following study analyses possible causes of dermal lesions and their coexistence with GI symptoms. Several possible theories were taken into account, including the microbiota alterations and issue of drug-related complications.

Efficacy, tolerability, and safety of infliximab biosimilar in comparison to originator biologic and adalimumab in patients with Crohn disease.

INTRODUCTION: An infliximab biosimilar has been shown to be equivalent to originator infliximab. However, data concerning the drug's efficacy and safety in patients with Crohn disease (CD) are still limited. OBJECTIVES: The aim of the study was to assess the efficacy, tolerability, and safety of an infliximab biosimilar in the Polish population with CD in comparison to its originator biologic and adalimumab. PATIENTS AND METHODS: This was a retrospective, single­center study of 286 consecutive patients with CD. They received originator infliximab, an infliximab biosimilar, or adalimumab on the basis of the same inclusion criteria. Disease activity was estimated at baseline, after induction therapy, after 1 year of treatment, and during 12 months of follow­up. RESULTS: There were no differences in the Crohn's Disease Activity Index in patients treated with infliximab, infliximab biosimilar, or adalimumab. Clinical response, clinical remission, and glucocorticoid­free remission rates were also comparable between groups. The relapse rate was similar in groups receiving infliximab biosimilar and adalimumab (54% and 61%, respectively), with relapses occurring more often in patients receiving infliximab (83% of patients during 12­month follow­up; P <0.001). CONCLUSIONS: We showed the same efficacy and safety of the infliximab biosimilar in comparison to the originator drug and adalimumab in the Polish population, not only during induction and 1­year therapy, but also during 12­month follow­up.