Capsaicin-Sensitive Vagal Afferent Nerve-Mediated Interoceptive Signals in the Esophagus.

Heartburn and non-cardiac chest pain are the predominant symptoms in many esophageal disorders, such as gastroesophageal reflux disease (GERD), non-erosive reflux disease (NERD), functional heartburn and chest pain, and eosinophilic esophagitis (EoE). At present, neuronal mechanisms underlying the process of interoceptive signals in the esophagus are still less clear. Noxious stimuli can activate a subpopulation of primary afferent neurons at their nerve terminals in the esophagus. The evoked action potentials are transmitted through both the spinal and vagal pathways to their central terminals, which synapse with the neurons in the central nervous system to induce esophageal nociception. Over the last few decades, progress has been made in our understanding on the peripheral and central neuronal mechanisms of esophageal nociception. In this review, we focus on the roles of capsaicin-sensitive vagal primary afferent nodose and jugular C-fiber neurons in processing nociceptive signals in the esophagus. We briefly compare their distinctive phenotypic features and functional responses to mechanical and chemical stimulations in the esophagus. Then, we summarize activation and/or sensitization effects of acid, inflammatory cells (eosinophils and mast cells), and mediators (ATP, 5-HT, bradykinin, adenosine, S1P) on these two nociceptive C-fiber subtypes. Lastly, we discuss the potential roles of capsaicin-sensitive esophageal afferent nerves in processing esophageal sensation and nociception. A better knowledge of the mechanism of nociceptive signal processes in primary afferent nerves in the esophagus will help to develop novel treatment approaches to relieve esophageal nociceptive symptoms, especially those that are refractory to proton pump inhibitors.

Symptoms and dietary practices of irritable bowel syndrome patients compared to controls: results of a USA national survey.

BACKGROUND: Little is known regarding the dietary behaviors and epidemiology of irritable bowel syndrome (IBS) patients in the USA. METHODS: This was an IRB-approved cross-sectional survey conducted via a secured online server (SurveyMonkey®). A representative sample of the US population was queried regarding demographics, gastrointestinal (GI) symptoms, treatments and dietary practices. Of 1718 respondents, 161 reported IBS. These were compared to 1116 subjects reporting no GI diagnosis (controls). RESULTS: Overall, 9% reported a diagnosis of IBS. When compared to controls, IBS patients were more likely over 45 years (P<0.001) and female (P<0.001). IBS patients more frequently noted abdominal pain, constipation, diarrhea, gas/bloating and GERD/heartburn (all P<0.001) than controls. Regarding therapeutic measures, IBS patients were more likely to cite food avoidance, over-the-counter remedies, probiotics, consultation with doctor/dietitian, and prescriptions (all P<0.001). However, they were less likely to believe their strategies were effective. While the majority of subjects believed food contributed to their symptoms, those with IBS listed more dietary triggers. IBS patients were more likely to follow a dietary 'plan' with 21% citing lactose-free, 17% gluten-free and 9% low-FODMAP (all P<0.001). Nevertheless, 47% with IBS denied following any dietary plans. A minority, (24%), of IBS patients was aware of the low-FODMAP diet. CONCLUSIONS: In this US survey, IBS was reported by 9% of the population, most often females over 45 years. IBS patients were more likely to implement therapeutic strategies and cite food triggers, yet few were aware of the low-FODMAP diet. Outreach programs could improve awareness of this substantiated intervention.

Gastrointestinal symptom improvement from fiber, STW 5, peppermint oil, and probiotics use-Results from an online survey.

OBJECTIVES: Several common supplements are used by a significant number of patients affected by gastrointestinal (GI) disorders to improve symptoms and quality of life. We investigated the impact of GI symptom improvement with the use of fiber, STW 5, probiotics, and peppermint oil in relation to overall GI pain and quality of life via an online survey. DESIGN: We used a cross-sectional, descriptive, correlation design. A Qualtrics online survey was utilized to collect data from January to June 2013 through various websites. Areas evaluated included participant demographics, use of supplements, and gastrointestinal symptom severity. RESULTS: The rate of supplement use among patients with GI disorders was high (90% in past year) and consultation with healthcare providers was reported by 80%. Participants who completed the survey (n = 68) reported a strong correlation between GI symptom severity and overall quality of life (r2 = 0.8682, p < 0.001). The use of fiber improved GI symptom severity while both STW 5 and probiotics were linked to specific improvements. CONCLUSIONS: Persons with chronic GI disorders often choose the complementary use of common supplements to mitigate GI symptoms and consult with their healthcare providers frequently. The use of STW 5 and probiotics specifically is linked to overall reduction in GI symptoms and improvement of quality of life.

Dietary guideline adherence for gastroesophageal reflux disease.

BACKGROUND: Gastroesophageal reflux disease (GERD) is the most common gastrointestinal disease, and the cost of health care and lost productivity due to GERD is extremely high. Recently described side effects of long-term acid suppression have increased the interest in nonpharmacologic methods for alleviating GERD symptoms. We aimed to examine whether GERD patients follow recommended dietary guidelines, and if adherence is associated with the severity and frequency of reflux symptoms. METHODS: We conducted a population-based cross-sectional study within the Kaiser Permanente Northern California population, comparing 317 GERD patients to 182 asymptomatic population controls. All analyses adjusted for smoking and education. RESULTS: GERD patients, even those with moderate to severe symptoms or frequent symptoms, were as likely to consume tomato products and large portion meals as GERD-free controls and were even more likely to consume soft drinks and tea [odds ratio (OR) = 2.01 95% confidence interval (CI) 1.12-3.61; OR = 2.63 95% CI 1.24-5.59, respectively] and eat fried foods and high fat diet. The only reflux-triggering foods GERD patients were less likely to consume were citrus and alcohol [OR = 0.59; 95% CI: 0.35-0.97 for citrus; OR = 0.41 95% CI 0.19-0.87 for 1 + drink/day of alcohol]. The associations were similar when we excluded users of proton pump inhibitors. CONCLUSIONS: GERD patients consume many putative GERD causing foods as frequently or even more frequently than asymptomatic patients despite reporting symptoms. These findings suggest that, if dietary modification is effective in reducing GERD, substantial opportunities for nonpharmacologic interventions exist for many GERD patients.

Preventing gut dysfunction

Gastrointestinal dysfunction can be prevented by modifying our diet, drug use, lifestyle and environment. Diet modification significantly affects the symptoms of gastrointestinal tract in some individuals. Many foods will cause upset stomach and each individual has to learn this by trial and error. In the oesophagus, reflux symptoms are aggravated by a wide variety of substances including, alcohol, red wine, nicotine. The lack of fibre in our diet is thought to be responsible for the high incidence of constipation, diverticular disease and haemorrhoids seen in the western world. The availability of numerous drugs over the counter leads to a large intake of drugs by the population. The lifestyle of a patient may be important in some gastrointestinal conditions, and the environment in which our patients live may have considerable significance to their gut symptoms. Clean water and good sanitation are necessary to prevent the transmission of food-borne diseases which have a major impact on the gastrointestinal tract

[Effect of a high-protein diet on clinical and some biochemical indices of patients with torpid and latent courses of recurrent rheumatic heart disease]. / Vliianie vysokobelkovoi diety na klinicheskie i nekotorye biokhimicheskie pokazateli u bol'nykh vialo i latentno tekushchim vozvratnym revmokarditom

The effect of a protein-rich diet containing 141 g of protein on the clinical and some biochemical findings in 145 patients with a torpidly, and latently running recurrent rheumatic heart disease was studied. Pertinent observations have shown the protein-rich diet to have a very beneficial effect on the clinico-biochemical and immunological indices that are pathognomic of rheumatism with low activity and torpid course.