[Thyroid dysfunction in patients with small intestinal bacterial overgrowth]. / Ocena czynnosci tarczycy u osób z zespolem przerostu bakteryjnego jelita cienkiego.

Small intestinal bacterial overgrowth (SIBO), similarly as thyroid diseases, is characterized by chronic diarrhea or constipation, but it is not known whether there is a causal relationship between these disorders. AIM: The aim of the study was to assess thyroid function indices in different clinical forms of SIBO. MATERIALS AND METHODS: The study was performed in 34 patients with diarrhea predominant SIBO (group I), 30 with constipation predominant SIBO (group II) and 30 clinically healthy subjects (control group - K). Small intestinal bacterial overgrowth was assessed with lactulose hydrogen breath test (LHBT) using the breath-hydrogen analyzer (Gastrolyser, Bedfont). Serum thyrotropin (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) levels were determined by immunochemical method (ELFA) and anti-thyroid peroxidase (ATPO) protein level by immunoenzymatic method (ELISA). RESULTS: LHBT value was respectively in groups: K - 8,5 ± 2,9 ppm, I - 66,9 ± 16,9 ppm, II- 62,0 ± 15,5 ppm (p <0,001). The levels of hormones were similar in group K and I, whereas in group II differentiated: FSH 2,5 ± 0,7 vs. 3,8 ± 1,8 mU/L (p <0,05), FT3- 5,1 ± 1,2 vs. 3,7 ± 1,0 mU/L (p <0,05), FT4 - 14,1 ± 2,5 vs. 9,4 mU/L (p <0,01). In both groups of patients the levels of ATPO were statistically significantly higher than in the control group - respectively: K - 6,3 ± 3,1 IU/ml , I - 39,9 ± 23,4 IU/ml (p < 0,001), II - 94,1 ± 56,3 IU/ml (p <0,001). CONCLUSIONS: Thyroid function may be impaired in patients with small intestinal bacterial overgrowth which should be taken into account in the diagnostic and therapeutic management of the diseases of these organs.

[The number of intraepithelial lymphocytes in digestive tract in patients with IgG-dependent intolerance of cereal products]. / Liczba limfocytów sródnablonkowych w przewodzie pokarmowym u osób z IgG-zalezna nietolerancja pokarmowa.

Abnormal reaction of food antigens cause a variety disorders of gastrointestinal tract. It is not clear why exactly the same products provoke diarrhea or constipation. AIM: The aim of this study was to assess the number of intraepithelial lymphocytes (IEL) in different parts of gastrointestinal tract in patients with specific IgG antibodies against wheat and secale products. MATERIALS AND METHODS: The study was performed in 36 healthy subjects(group I) and in 70 patients with diarrhea predominant (group II, n=38) or with constipation (group III, n=32). The level of specific IgG antibodies in blood were determined using Food Detective tests (Cambridge Diagnostics). The biopsy material obtained from duodenum, jejunum as well as from right and left colon was used for routine hematoxylin-eosin staining. RESULTS: In group II compared to control group the number of IEL was statistical higher in all part of gastrointestinal tract. Furthermore, in 9 patients (23.6%) in duodenum exceed 30/100 enterocytes, and in colon mucosa exceed 25/100 (21.0%) enterocytes. In patients with constipation (group III) the number of IEL was similar to healthy subjects. CONCLUSIONS: Food intolerance of cereal products may cause immuneinflammatory changes in digestive tract comparable to celiakia and lymphocytic colitis.

[Efficacy of sulpiride and itopride in the treatment of functional dyspepsia in women with emotional and eating disorders]. / Ocena skutecznosci sulpirydu i itoprydu w leczeniu dyspepsji czynnosciowej u kobiet z zaburzeniami emocji i laknienia.

UNLABELLED: Functional dyspepsia is often accompanied by emotional disturbances, especially in postmenopausal women. Impaired homeostasis of the dopaminergic system maybe one of the common pathogenetic factors. The aim of the study was to assess the effect of drugs which block dopamine D2 receptors on psychosomatic condition in postmenopausal women. MATERIAL AND METHODS: The study was conducted in a group of 60 women, aged 53-61 years, with postprandial distress syndrome (PDS) that met the Rome Criteria III. The severity of dyspeptic symptoms was determined statistically using a 10-point Visual Analogue Scale (VAS). The emotional state was estimated with the Hamilton Anxiety Rating Scale (HARS) and the Beck Depression Inventory (BDI), whereas the body mass index (BMI) was the indicator of the nutritional status. Sulpiride (2 x 50 mg) was administered to 30 women for 16 weeks and itopride (2 x 50 mg) to 30 others. RESULTS: After sulpiride and itopride treatment equal decrease of dyspeptic symptoms was observed, respectively from 9.08 to 4.76 pts and from 9.02 to 4.64 pts. Significant reduction in the level of anxiety (p < 0.001) and depression (p < 0.01) was obtained in both groups, slightly higher after sulpiride. However, no significant change in BMI was found. CONCLUSIONS: Sulpiride and itopride are effective in the treatment of dyspepsia in the form of postprandial distress syndrome. These drugs in the several-month treatment have no significant effect on body weight.

Influence of melatonin on symptoms of irritable bowel syndrome in postmenopausal women.

INTRODUCTION: Melatonin (MEL) exerts beneficial effects on the gut partly by myorelaxative properties upon the smooth muscle. Its secretion decreases with age, particularly in postmenopausal women. This study was aimed at evaluating the effect of MEL on the symptoms of irritable bowel syndrome (IBS) in this group of patients. MATERIAL AND METHODS: The investigations were carried out in 80 postmenopausal women, aged 48-65 years, divided into two equal groups, diagnosed according to Rome Criteria III: i.e. patients with IBS with constipation predominant (IBS-C), and patients with IBS with diarrhoea predominant (IBS-D). The control group (C) included healthy women aged 46-65 years. In all subjects, 6-sulfatoxymelatonin (6-HMS) concentration urine was measured using ELISA assay. Patients in both groups over the course of six months were given melatonin (at a dose of 3 mg fasting and 5 mg at bedtime) or a placebo (double blind trial). Disease activity was evaluated after two, four and six months, using a ten-point scale to assess the main somatic symptoms: visceral pain, abdominal bloating, etc. RESULTS: The amounts of 6-HMS urine excretion (µg/24 h) were: C 11.4 ± 3.0, IBS-C 10.2 ± 3.2, IBS-D 14.0 ± 6.3 (p 〈 0.05). Correlation between values of symptoms score and contrary excretion of 6-HMS: IBS-C r = -0.714, IBS-D r = 0.409. After six months in the IBS-C group, the intensity of visceral pain and abdominal bloating had decreased in 70% of patients (p 〈 0.01) and constipation in 50% of patients (p 〈 0.05). Beneficial changes in the IBS-D group were noted in 45% of patients, but this was not better compared to the placebo. CONCLUSIONS: Melatonin can be used as part of the treatment of IBS, particularly in patients with constipation-predominant IBS.

[Evaluation of the influence of tianeptine on the psychosomatic status of patients with ulcerative colitis in remission]. / Ocena wplywu tianeptyny na stan psychosomatyczny.

UNLABELLED: In order to maintain ulcerative colitis (UC) in remission, chronic use of aminosalicylates is recommended. All patients have a fear of the recurrence of symptoms, which makes their mental state and quality of life worse. Because of this a number of patients are recommended to use different sorts of anxiolytic drugs and antidepressants. AIM OF THE STUDY: Evaluation of the influence of tianeptine (selective serotonin reuptake enhancer) on the mental and somatic status in the group of patients. MATERIAL AND METHOD: The research was conducted in two groups of thirty patients, with benign form of ulcerative colitis in remission, aged 24-46 years. Patients, during a period of 12 months, were given aminosalicylates in a daily doses 2 x 1.0 g and tianeptine in a doses 3 x 12.5 mg (group I) or placebo (group II). During the treatment every three months anxiety (Hamilton Anxiety Rating Scale-HARS), depression (Back Depression Inventory-BDI), The Mayo Clinic Disease Activity Index (MCDAI), hemoglobin and C-reactive protein (CRP) level were evaluated. RESULTS: After 12 months in a group of patients who took tianeptine decrease in anxiety (from 20.35 +/- 4.03 to 12.65 +/- 3.78 points) and depression (from 19.95 +/- 4.49 points to 9.60 +/- 2.76 points) was obtained; difference compared with placebo was statistically significant (p < 0.01). At the same time significant decrease compared with placebo (p < 0.05) of disease activity index (respectively 3.05 +/- 1.36 and 4.65 +/- 1.69), insignificantly lower level of CRP (7.00 5.65 and 9.41 +/- 10.12) and higher level of hemoglobin (11.93 +/- 0.83 and 11.0 +/- 0.70) was observed. CONCLUSIONS: Tianeptine has a positive influence on mental and somatic status of patients with UC. Results give the support for tianeptine apllication in UC as adjuvant drug.

[Gastrin secretion in patients with functional dyspepsia]. / Wydzielanie gastryny u osób z dyspepsja czynnosciowa.

UNLABELLED: The pathogenesis of functional dyspepsia is very complicated and its etiology is still not clear. One of the supposed pathophysiological mechanisms are disturbences of gastric acid secretion and gastric motility. Recently, it has been recognized, that in the pathogenesis of above disturbances may play a role enterohormones, like gastrin. AIM: To establish if in patients with functional dyspepsia the level of gastrin concentration changes and wheather it correlates with type and grade of symptom's intensity. MATERIAL AND METHODS: The study included 50 subjects between of 20 to 54 years with diagnosed functional dyspepsia (according to the Rome III Criteria). The study group was divided into two subgroups: group I--25 subjects with Epigastric Pain Syndrome--EPS and group II--25 subjects with Postprandial Distress Syndrome--PDS. Control group comprised 20 healthy subjects (without any clinical or morphological symptoms of digestive tract disease). In each patient due to gastrointestinal tract organic disease exclusion the gastroscopy, histological examination of gastric mucosa, ultrasonography of abdomen and laboratory tests were performed. H. pylori infection was detected using fast urea test (CLO-test), confirmed by histopathological examination (stained Giemsa method) and non-invasive urea breath test (UBT-13C) using mass spectrophotometer FANci 2 (Fisher Analyser Instrumente GmbH). In each patient the level of gastrin concentration in blood serum, in fasting state, was determined, based on ELISA method considering the length of the weave lamda=430 nm. The study group was also divided into 3 subgroups, using 10-points scale of symptom's intensity: --grade 1--mild (1-3 points); --grade 2--moderate (4-6 points); --grade 3--severe (7-10 points). RESULTS: The concentration of gastrin in blood serum in healthy subjects was 2.4 +/- 1.23 pmol/L. In patients with functional dyspepsia was significantly higher; in patients with Epigastric Pain Syndrome--7.51 +/- 2.46 pmol/L (p < 0.05), in patients with Postprandial Distress Syndrome - 6,92 +/- 2.18 pmol/L (p < 0.05). There were no significant differences in dependence on pain's intensity in EPS--the concentrations in subgroups 1, 2 and 3 were: 7.36 +/- 1.4 pmol/L, 7.53 +/- 2.43 pmol/L and 7.64 +/- 2.55 pmol/L. The gastrin concentration in PDS in dependence on symptom's intensity in subgroup 1 was 6.34 +/- 1.2 pmol/L, in subgroups 2 and 3 were higher: 6.99 +/- 2.31 pmol/L and 7.42 +/- 2.2 pmol/L, but the differences were not statistically significant. In patients with functional dyspepsia, infected with H. pylori the gastrin concentration was significantly higher and was 15.28 +/- 5.3 pmol/L (p < 0.05). There were no significant differences in dependence on type of dyspepsia. CONCLUSIONS: The gastrin concentration in blood serum in fasting state in patients with functional dyspepsia is higher than in control subjects, both in patients with Epigastric Pain Syndrome--EPS as well as with Postprandial Distress Syndrome--PDS. The grade of symptom's intensity does not correlate with increase of gastrin concentration.