Gastrointestinal manifestations on impaired quality of life in systemic sclerosis.

OBJECTIVE: To analyze the impact of gastrointestinal manifestations on quality of life in patients with systemic sclerosis (SSc) and to provide clinical evidence for their early treatment and health-related management. METHODS: Altogether 65 patients admitted to the Peking Union Medical College Hospital selected from a disease cohort and 127 matched controls were enrolled. A self-assessment questionnaire was completed by all participants. Each participant completed scleroderma gastrointestinal tract 1.0 (SSC-GIT 1.0) questionnaire (including reflux or indigestion, diarrhea, constipation, distention, emotional well-being, and social functioning). Autoimmune antibodies were tested in SSc patients. RESULTS: Among these SSc cases, gastrointestinal manifestations were seen in 84.6%. Reflux/indigestion and diarrhea were more common in SSc patients than in the control group (67.7% vs 27.8%; 27.7% vs 10.2%, P < 0.05). SSc patients had a significantly higher percentage of abnormal social functioning than the control group (33.8% vs 3.9%, P < 0.05). SSc patients with abnormal social functioning and abnormal emotional well-being had worse distention, diarrhea, and constipation statuses. Patients with reflux or indigestion and diarrhea had lower anti-Scl-70 level than those without (both P < 0.05). Patients with distention had higher levels of anti-RNP and anti-SSA than those without distention (both P < 0.05). Patients with diarrhea had higher levels of anti-RNP than those without diarrhea (P = 0.014). CONCLUSIONS: Gastrointestinal involvement is frequent in SSc, with reflux or indigestion as the most common symptom. The impaired quality of life in patients with SSc indicates that early and active management should be considered.

Réplica a: "Evaluación y tratamiento de la anemia de forma previa a la cirugía: un reto por mejorar" / Reply to: Evaluation and treatment of anemia prior to surgery: A challenge to improve

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[Exercise Therapy in German Medical Rehabilitation - an Analysis based on Quantitative Routine Data]. / Bewegungstherapeutische Versorgung in der medizinischen Rehabilitation der Rentenversicherung ­ eine Analyse auf Basis quantitativer Routinedaten.

AIM OF THIS STUDY: This study describes the quantitative importance of exercise therapy in German medical rehabilitation based on 2014 routine data of the German Pension Insurance. It also shows changes in comparison with data from 2007. METHODS: Data from 710012 rehabilitation discharge letters comprising 83677802 treatments from central indications in medical rehabilitation were analysed descriptively. RESULTS: Overall 35.4% of treatments could be classified as exercise therapy. Total and relative duration, percentage of individual treatment and kind of exercise treatment varied between indications in 2007 as well as in 2014. There were also differences between sexes, age groups and settings. CONCLUSION: During the period examined the high importance of exercise therapy in German medical rehabilitation has increased. The results point at a meaningful concept behind the composition of exercise therapy taking indications and disease related factors into account.

International spinal cord injury bowel function basic data set (Version 2.0).

STUDY DESIGN: International expert working group. OBJECTIVES: To revise the International Spinal Cord Injury (SCI) Bowel Function Basic Data Set as a standardized format for the collecting and reporting of a minimal amount of information on bowel function in clinical practice and research. SETTING: Working group appointed by the American Spinal injury association (ASIA) and the International Spinal Cord Society (ISCoS). METHODS: The draft prepared by the working group was reviewed by the International SCI Data Set Committee and later by members of the ISCoS Executive and Scientific Committees and the ASIA board. The revised data set was posted on the ASIA and ISCoS websites for 1 month to allow further comments and suggestions. Changes resulting from a Delphi process among experts in children with SCI were included. Members of ISCoS Executive and Scientific Committees and the ASIA board made a final review and approved the data set. RESULTS: The International SCI Bowel Function Basic Data Set (Version 2.0) consists of the following 16 items: date of data collection, gastrointestinal and anal sphincter dysfunction unrelated to SCI, surgical procedures on the gastrointestinal tract, defecation method and bowel-care procedures, average time required for defecation, frequency of defecation, uneasiness, headache or perspiration during defecation, digital stimulation or evacuation of the anorectum, frequency of fecal incontinence, flatus incontinence, need to wear pad or plug, oral laxatives and prokinetics, anti-diarrheal agents, perianal problems, abdominal pain and discomfort and the neurogenic bowel dysfunction score. CONCLUSION: The International SCI Bowel Function Basic Data Set (Version 2.0) has been developed.

[The modern applications of radon therapy for the medical rehabilitation of the patients].

Radon therapy is one of the methods of physiobalneotherapy the mechanism of action of which is believed to consist of the influence of the small radiation doses of radon and its daughter products on the nervous, vascular, and immune apparatuses of the skin and mucosal membranes that eventually enhances the protective and adaptive potential of the body and thereby its ability to resist pathological impacts. At present, the high effectiveness of radon therapy is universally recognized and this method is widely applied for the combined treatment of various diseases in different fields of medicine. These include (1) diseases of the musculoskeletal system and locomotor disorders in the patients presenting with recurrent rheumatic fever, reactive arthritis, ankylosing spondylitis, post-traumatic osteoarthrosis and knee joint synovitis, the sympathico-tonic course of vegetative dystonia associated with connective tissue dysplasia, etc.; (2) neurological disorders in the patients presenting with cervical dorsopathy, neurological manifedstations of degenerative lesions of the cervical and lumbar spine, etc.; (3) cardiological disorders in the patients presenting with hypertensive disease, coronary heart disease, atherosclerosis of different localization, etc.; (4) gastrointestinal disorders in the patients presenting with gastric and duodenal ulcers, irritated bowel syndrome, etc.; (5) gynecological problems in the patients presenting with primary and secondary dysmenorrhea, genital endometriosis, uterine myoma, dysregulated reproductive function, polycystic ovary - syndrome, polycystic ovary syndrome and ovulatory disorders of proinflammatory origin, etc.

Abdominothoracic mechanisms of functional abdominal distension and correction by biofeedback.

BACKGROUND & AIMS: In patients with functional gut disorders, abdominal distension has been associated with descent of the diaphragm and protrusion of the anterior abdominal wall. We investigated mechanisms of abdominal distension in these patients. METHODS: We performed a prospective study of 45 patients (42 women, 24-71 years old) with functional intestinal disorders (27 with irritable bowel syndrome with constipation, 15 with functional bloating, and 3 with irritable bowel syndrome with alternating bowel habits) and discrete episodes of visible abdominal distension. Subjects were assessed by abdominothoracic computed tomography (n = 39) and electromyography (EMG) of the abdominothoracic wall (n = 32) during basal conditions (without abdominal distension) and during episodes of severe abdominal distension. Fifteen patients received a median of 2 sessions (range, 1-3 sessions) of EMG-guided, respiratory-targeted biofeedback treatment; 11 received 1 control session before treatment. RESULTS: Episodes of abdominal distension were associated with diaphragm contraction (19% ± 3% increase in EMG score and 12 ± 2 mm descent; P < .001 vs basal values) and intercostal contraction (14% ± 3% increase in EMG scores and 6 ± 1 mm increase in thoracic antero-posterior diameter; P < .001 vs basal values). They were also associated with increases in lung volume (501 ± 93 mL; P < .001 vs basal value) and anterior abdominal wall protrusion (32 ± 3 mm increase in girth; P < .001 vs basal). Biofeedback treatment, but not control sessions, reduced the activity of the intercostal muscles (by 19% ± 2%) and the diaphragm (by 18% ± 4%), activated the internal oblique muscles (by 52% ± 13%), and reduced girth (by 25 ± 3 mm) (P ≤ .009 vs pretreatment for all). CONCLUSIONS: In patients with functional gut disorders, abdominal distension is a behavioral response that involves activity of the abdominothoracic wall. This distension can be reduced with EMG-guided, respiratory-targeted biofeedback therapy.

Changes in symptoms and lifestyle factors in patients seeking healthcare for gastrointestinal symptoms: an 18-year follow-up study.

BACKGROUND: Gastrointestinal symptoms and lifestyle change over time. The data from this 18-year longitudinal study are intended to further elucidate the long-term natural course of functional gastrointestinal (GI) symptoms and possible influencing factors. AIM: The aim of this study was to evaluate the correlation between lifestyle factors over time by reassessing symptom profiles in patients who presented with GI symptoms in 1990. METHOD: The study population comprises a subset of individuals enrolled in the Swedish Dyspepsia Study, which commenced in 1990. In 1990, each participant in the Swedish Dyspepsia Study underwent physical assessment and completed a computer-based questionnaire on eight GI symptoms and lifestyle factors. An identical questionnaire was completed in 2008. RESULTS: In total, 137 participants, 85 women and 52 men, were included in the follow-up study. None of the symptoms increased in frequency. Four of the symptoms decreased in frequency: abdominal pain [odds ratio (OR) 2.70], flatulence (OR 4.09), nausea (OR 3.05), and acid regurgitation (OR 1.59). Significant lifestyle changes included increased BMI (P<0.0001), decreased tobacco smoking (P<0.0001), and milk drinking (P=0.0080). Increased exercise was correlated with a decrease in acid regurgitation (OR 3.05) and vomiting (OR 7.38), but an increase in diarrhea (OR 0.23) and nausea (OR 0.33). Decreased smoking was correlated with a decrease in acid regurgitation (OR 3.45) and heartburn (OR 2.91). CONCLUSION: The results indicated that the lifestyle changes in the studied population followed the same pattern as seen in the general population, and changes in lifestyle factors may have an impact on GI symptoms and may guide symptom management in the patient, all in order to reduce personal suffering and healthcare costs in the form of fewer visits to the doctor and lower numbers of drug prescriptions.

Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation.

OBJECTIVE: To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation. DESIGN: Observational study. SETTING: Postacute rehabilitation facility. PARTICIPANTS: Patients (N=2754) aged ≥65 years admitted over a 4-year period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement. RESULTS: Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16-1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01-1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31-1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15-1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19-23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13-2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67-2.93; P<.001, respectively). CONCLUSIONS: Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome.

[Use of the prokinetic domperidine in patients in the early postoperative period].

The work focuses on the comparison of influence of domperidone and metoclopramide on rehabilitation of motor-evacuation function of stomach and small intestine in 82 patients with post-surgical flatulent distention. For group 1 (n=50) - metoclopramide was administered intravenously from the 1st postoperative day, 10 mg 3 times a day. For group 2 (n=32) - domperidone was used from the 1st postoperative day (motilium suspension), 20 ml 4 times a day. The results of gastrointestinal tract capacity rehabilitation were evaluated using the data of peripheral electrogastroenterography, enteral balance, a complex of radial diagnostics methods. Application of domperidone in patients with post-surgical flatulent distention resulted in quicker gastrointestinal tract motor resolution.

Lower gastrointestinal symptoms and quality of life in patients with systemic sclerosis: a population-based study.

OBJECTIVE: To investigate the frequency and nature of bowel symptoms in a population-based cohort of patients with systemic sclerosis (SSc), compared with healthy controls, and to relate these symptoms to health-related quality of life (HR-QOL). METHOD: Seventy-nine SSc patients and 158 matched controls answered a validated questionnaire on gastrointestinal (GI) symptoms and Medical Outcomes Study Short Form Health Survey (SF-36). Modified Miller Score, a composite score measuring faecal incontinence, was computed. RESULTS: Abnormal stool consistency, bloating, a feeling of incomplete evacuation, faecal incontinence and rectal bleeding were more frequently reported by SSc patients than controls. The ability for anorectal discrimination, and deferring defecation was diminished in SSc patients. Bowel function affected general well being in 30% of patients and social life in 20%. Patients had lower SF-36 scores, that is, worse HR-QOL than controls. Modified Miller Score did not correlate to the SF-36 scores in patients, but other lower GI symptoms, especially abdominal pain and bloating, were associated with diminished HR-QOL. CONCLUSION: Lower GI symptoms, including faecal incontinence, are more common in patients with SSc than in healthy controls and are of consequence to the individual patient's life. The lower prevalence of anorectal discrimination in the SSc patients suggests a neuronal defect in these patients. Increased awareness of these symptoms might stimulate a search for new diagnostic and therapeutic strategies.

Internet-based assessment of bowel symptoms and quality of life.

(Table is included in full-text article). Internet-based questionnaires will, no doubt, continue to gain popularity. Internet presents an attractive medium for the researcher to collect large amounts of data with relatively little effort. The questionnaires can be available to respondents all over the world, 24 h a day, with very little labor involved. The questionnaires can be electronically scored immediately upon completion. Results can then be stored in an analyzable form or be used instantly to redirect the respondent to follow-up questionnaires. Nonetheless, good questionnaire design and psychometric principles still apply. This is true even when porting a valid paper and pencil test to the Internet. In addition, technical and logistical issues in web-based testing can affect the reliability and validity of the questionnaires. Researchers are cautioned to follow good questionnaire development practices and consider the unique problems of Internet-based instruments.

Internet-based assessment of bowel symptoms and quality of life.

OBJECTIVES: We wished to determine the value of an open-access internet questionnaire for assessment of upper and lower gastrointestinal symptoms and health-related quality of life. METHODS: Between January 2002 and June 2005, a symptom scale for upper gastrointestinal and lower gastrointestinal symptoms was placed on a genuine website (www.gesundheits-umfrage.de) and linked to the website of the German irritable bowel syndrome patient group (www.Reizdarmselbsthilfe.de). Patients were asked to report gastrointestinal symptoms that had occurred during the last month. Patients who finished this symptoms questionnaire and acknowledged more than two of a total of eight upper gastrointestinal symptoms and/or more than two of 16 lower gastrointestinal symptoms were immediately offered the assessment of their health-related quality of life by a validated general quality of life scale--the patient general well-being inventory--a 22-item scale with six subscales (anxiety, depression, general well-being, self-control, health, and vitality) and a global scale. Total patient general well-being inventory scores and subscale values were correlated to upper gastrointestinal and lower gastrointestinal symptom scores including the Rome I definition of the irritable bowel syndrome, and to social variables. RESULTS: Five thousand two hundred and fifty-six individuals completed symptom assessment. Out of these, 4431 had three or more upper gastrointestinal symptoms, the mean number of upper gastrointestinal symptoms reported was 3.2+/-2.0; 4456 had three or more lower gastrointestinal symptoms (mean: 10.3+/-3.3), and 3187 met the Rome I criteria for irritable bowel syndrome. A total of 3316 individuals completed the patient general well-being inventory assessment (1156 men, 2160 women, mean age: 37.7+/-12.3 years). Upper gastrointestinal, lower gastrointestinal, and total symptom score were higher in women than in men (P < 0.001), and significantly correlated to the global quality of life assessment. Family status affected the symptom scores (higher in singles) and quality of life scores (lower in people living in partnership for health, but higher for vitality and depression). Age correlated negatively with upper gastrointestinal, lower gastrointestinal, and with total symptom scores as well as with some patient general well-being inventory scores. CONCLUSION: Symptom and quality of life assessment using an open internet questionnaire is feasible and generates data which are, in large, comparable to those from other sources of assessment, despite the fact that the population addressed is, on average, moderately younger than previously studied cohorts.

Prevalence and socioeconomic impact of upper gastrointestinal disorders in the United States: results of the US Upper Gastrointestinal Study.

BACKGROUND & AIMS: This study examined the prevalence of upper gastrointestinal (GI) symptoms and symptom groupings and determined impact on disability days in a nationally representative US sample. METHODS: A telephone survey of 21,128 adults was conducted including questions about the presence of upper GI symptoms during the past 3 months. Respondents were categorized as symptomatic (ie, reported GI symptoms once per month) or asymptomatic. The survey included questions about missed work, leisure activity, or household activity days. Symptom groupings were identified by using factor analysis, and cluster analysis was used to assign respondents into distinct groups on the basis of these symptom groupings. RESULTS: The prevalence of an average of 1 or more upper GI symptoms during the past 3 months was 44.9%. The most common symptoms experienced during the past 3 months were early satiety, heartburn, and postprandial fullness. Factor analysis identified 4 symptom groupings: (1) heartburn/regurgitation; (2) nausea/vomiting; (3) bloating/abdominal pain; and (4) early satiety/loss of appetite. Five respondent clusters were identified; the largest clusters were primarily early satiety/fullness (44%) and gastroesophageal reflux disease-like symptoms (28%). Two small clusters reflected nausea and vomiting (7%) and a heterogeneous symptom profile (4%). Symptomatic respondents reported significantly more missed work, leisure, and household activity days than asymptomatic respondents (all P < .0001). CONCLUSIONS: Factor analysis separated GI symptoms into groupings reflecting gastroesophageal reflux disease and dyspepsia: early satiety, postprandial fullness, and loss of appetite; bloating and abdominal pain/discomfort; and nausea and vomiting. These upper GI symptoms were associated with significant loss of work and activity days.

[Long-term outcomes after acute vitamin D3 intoxication]. / Otdalennye posledstviia intoksikatsii vitaminom D3.

We observed 75 subjects with acute vitamin D3 intoxication (AVD3I). The clinical manifestations of this intoxication are kidneys disorders (65.0%), renal insufficiency (51.0%), gastrointestinal tract disorders (23.0%), arterial hypertension (52.0%). After this intoxication these patients are recommended prolonged rehabilitation.

[Effect of secondary prophylaxis on quality of life in gerontologic patients at the rehabilitation center for the disabled Patriotic war veterans in local sanatorium]. / Vliianie vtorichnoi profilaktiki na kachestvo zhizni gerontologicheskikh bol'nykh v usloviiakh tsentra reabilitatsii invalidov Otechestvennoi voiny na baze mestnogo sanatoriia.

AIM: To study efficacy of sanatorium treatment of aged patients with gastroenterological and locomotor diseases in the heriatric center. MATERIAL AND METHODS: 100 patients were investigated for effects of sanatorium treatment on quality of life. RESULTS: Clinical symptoms depended on the patients' age. Patients under 70 years of age had leading symptoms from gastrointestinal organs and locomotor system. These patients were most responsive to rehabilitation measures. In 70-year-olds and older patients cardiovascular and cerebral pathologies are of special importance limiting usage of physiotherapy and necessitating wider application of medicines: hypotensive, antianginal, circulation correcting, etc. The sanatorium stage of rehabilitation creates a positive emotional background in these patients. CONCLUSION: Sanatorium treatment resulted in improvement of life quality in gerontological patients.

Hardware-software co-design of portable functional gastrointestinal stimulator system.

In the recent years, functional electrical stimulation has been applied to restore impaired motility in the gastrointestinal tract. Unlike other methods of electrical stimulation of the gut, microprocessor-controlled, sequential electrical stimulation has been shown to induce peristalsis and enhance emptying in acute canine gastric and colonic models. This study aims at completing the development of a portable microprocessor-based functional stimulator system consisting of a microelectronic stimulator, patient-specific computer-based real-time software and a programming interfacing device. The ultimate goals of the design are to ensure that (1) the portable stimulator can be efficiently utilized in chronic animal experiments; and (2) the device can be further miniaturized into an implantable version. The designed portable stimulator generates four channel sequential bipolar rectangular pulse trains with programmable parameters within the stimulation requirements obtained from a previously developed computer model. Real-time simulation of colonic peristalsis and a case-specific stimulation model were implemented using patient-specific computer-based software. A chronic canine case study confirmed the feasibility of this microprocessor-controlled stimulation method for future clinical applications in humans.