Alterations in Heart Rate Variability Associated With Irritable Bowel Syndrome or Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.

INTRODUCTION: Irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) are gastrointestinal pathologies affecting large numbers of the global population and incurring significant healthcare costs. Disruptions in the gut-brain axis occurring in these conditions can lead to increased inflammation, affecting gastrointestinal and autonomic nervous system function. Heart rate variability (HRV) is commonly used to assess the state of the sympathetic and parasympathetic function of the autonomic nervous system, but it remains unclear how HRV measures are associated with gastrointestinal pathologies. Here, we conduct a systematic review of the literature comparing HRV of subjects diagnosed with IBS or IBD to HRV in healthy controls (HC). METHODS: We searched PubMed, Cochrane Library, and CINAHL (EBSCO) for eligible studies up to 2018. We included any study comparing a recognized measure of HRV between a group of patients with either IBS or IBD to a group of matched HC before any intervention. Studies were screened, and data were extracted from included articles using predefined criteria. Random effects meta-analysis was performed for each outcome, with effect size reported as the standardized mean difference. RESULTS: There were significant differences between IBD and HC in time domain HRV and significant decreases in high-frequency power measures were also noted, in both IBS and IBD compared with HC. DISCUSSION: Parasympathetic nervous system activity, represented through high-frequency power, seems to be lower in people with IBS and IBD, but conclusions are limited by the small number of studies that provide usable data, methodological heterogeneity, and high risks of bias in primary study methods and measures.

Reliability of self-reported constitutional questionnaires in Ayurveda diagnosis.

BACKGROUND: Ayurveda is one of the most ancient and widely practiced forms of medicine today, along with Traditional Chinese Medicine. It consists of determining an individual's constitution or Prakriti and current imbalance(s) through the use of multimodal approaches. Ayurveda practitioners may choose to include either a self-reported or structured interview constitutional questionnaire as part of the Prakriti assessment. Currently, there is no standardized or validated self-reported constitutional questionnaire tool employed by Ayurveda physicians or western Ayurveda educational institutions. OBJECTIVES: To examine test-retest reliability of three self-administered constitutional questionnaires at a one month interval and internal consistency of items pertaining to a single constitution. MATERIALS AND METHODS: Three constitutional questionnaires were administered online. 19 participants completed three questionnaires at two time points, one month apart. Age range was 21-62 years old with a mean age of 34. Of the 19, 5 were male and 14 female. Vata, Pitta, and Kapha scores obtained from each questionnaire were standardized to give a vector of three relative percentages, summing to 100. These percentages were further translated from numerical values to one of ten possible dosha diagnoses. RESULTS: Analysis indicated that the three questionnaires had moderately good test-retest reliability according to numerical scores, but highly variable reliability according to discrete Ayurveda diagnosis. Internal consistency pertaining to individual constitutions within one questionnaire was poor for all three primary doshas, but especially for Kapha. CONCLUSION: Further research is necessary to develop a reliable and standardized constitutional questionnaire.

Escharotic Treatment for ECC-positive CIN3 in Childbearing Years: A Case Report.

A persistent human papillomavirus (HPV) infection of a high-risk type is necessary for cervical cancer to develop. The severity of the diagnosis, together with colposcopy findings, determines the standard for treatment, and ablative or excisional options may be recommended. Escharotic treatment, together with an oral, anticarcinogenic HPV protocol and a vaginal-suppository protocol, is an alternative treatment, especially for those women of childbearing age who are concerned about the possibility of obstetrical complications associated with the use of loop electrosurgical excision (LEEP). The aim of the current case study was to observe the effect of an ablative escharotic treatment for a woman with severe dysplasia, cervical intraepithelial neoplasia grade 3 (CIN3). A 28-y-old female visited the National College of Natural Medicine clinic to obtain suggestions for alternative treatments following a satisfactory colposcopy and a biopsy revealing a high-risk HPV effect, severe dysplasia CIN3, and a positive endocervical curettage (ECC). She refused the recommended standard of care, a LEEP, because of concerns about the potential for future obstetrical complications. As an alternative, she elected to receive an escharotic treatment at a frequency of 2 treatments/wk for 5 wk. In addition to the escharotic treatment, she followed an oral protocol consisting of vitamins and botanical medicine for 1 y and she completed a 12-wk regime of vaginal suppositories following the escharotic. The authors followed her for 2 y. The woman's Papanicolaou (Pap) test at the 6-mo follow-up revealed negative cervical cytology for intraepithelial lesion or malignancy, and her follow-up ECC was negative. Liquid-based Pap results were normal, and HPV testing was negative at her 1-y follow-up. Her Pap continued to remain normal at her 2-y follow-up. For women with high-grade cervical neoplasias and positive ECCs, with satisfactory colposcopies, escharotic treatment, accompanied by oral supplementation, holds promise as an effective alternative to LEEP and other excisional procedures.

An integrative approach to interstitial cystitis.

OBJECTIVE: The aim of this study was to observe the effect of a combined pharmacologic and complementary and alternative medicine (CAM) treatment, which included biotherapeutic drainage, for a young woman with interstitial cystitis (IC). PATIENT AND METHODS: A 17-year old female patient was referred for treatment with a 2-year diagnosis of IC and dissatisfaction with her 3-month use of Elmiron. She was kept on Elmiron and prescribed additional CAM treatments, including biotherapeutic drainage, combination homeopathic medications, and asked to keep a journal. The resolution of her symptoms occurred during a 6-month period. She was followed for 2 years. RESULTS: After the first month of treatment, the patient's symptoms greatly diminished. By the end of the second month, she discontinued use of Elmiron, with the exception of one acute dose in the fourth month. By the sixth month of treatment, her symptoms had resolved. DISCUSSION: A multimodal approach integrating the use of pharmacologic and CAM treatments, including biotherapeutic drainage, holds promise as an effective treatment for IC patients.