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BACKGROUND AND AIMS: The Rome Foundation Global Epidemiology Study (RFGES) assessed the prevalence, burden, and associated factors of Disorders of Gut-Brain Interaction (DGBI) in 33 countries around the world. Achieving worldwide sampling necessitated use of two different surveying methods: In-person household interviews (9 countries) and Internet surveys (26 countries). Two countries, China and Turkey, were surveyed with both methods. This paper examines the differences in the survey results with the two methods, as well as likely reasons for those differences. METHODS: The two RFGES survey methods are described in detail, and differences in DGBI findings summarized for household versus Internet surveys globally, and in more detail for China and Turkey. Logistic regression analysis was used to elucidate factors contributing to these differences. RESULTS: Overall, DGBI were only half as prevalent when assessed with household vs Internet surveys. Similar patterns of methodology-related DGBI differences were seen within both China and Turkey, but prevalence differences between the survey methods were dramatically larger in Turkey. No clear reasons for outcome differences by survey method were identified, although greater relative reduction in bowel and anorectal versus upper gastrointestinal disorders when household versus Internet surveying was used suggests an inhibiting influence of social sensitivity. CONCLUSIONS: The findings strongly indicate that besides affecting data quality, manpower needs and data collection time and costs, the choice of survey method is a substantial determinant of symptom reporting and DGBI prevalence outcomes. This has important implications for future DGBI research and epidemiological research more broadly.
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Gastroenteropatias , Humanos , Cidade de Roma , Inquéritos e Questionários , China/epidemiologia , TurquiaRESUMO
BACKGROUND: Using data from the Rome Foundation Global Epidemiology Study examining prevalence of disorders of gut-brain interaction (DGBI) in 33 countries, this study explored the prevalence of all 22 disorders in Canada. It examined differences related to geography and sociodemographic factors, health impact and compared these findings to other countries. METHODS: The Rome Foundation survey was conducted through the Internet, targeting 2000 Canadian participants. The survey used the validated ROME IV diagnostic questionnaire to identify the 22 DGBI and an in-depth supplemental questionnaire that included quality assurance techniques. KEY RESULTS: There were 2029 respondents with a mean age of 48 years and 50% females. Diagnostic criteria for at least one of the 22 DGBI were met by 41.3%, similar to other countries. Functional constipation, functional diarrhea, and unspecified functional bowel disorders were most common. Irritable bowel syndrome prevalence was 4.2% using Rome IV and 10.1% using ROME III criteria. DGBI were associated with poorer quality of life and increased psychological symptom scores. Prevalence of DGBI ranged from 48% in Quebec to 36% in British Columbia. Prescription pain medication was reported by 17% with DGBI compared to 9% without DGBI and correlated negatively with mental health and physical well-being. Quebecers and francophones were in limited number but reported higher DGBI prevalence and symptom severity compared to others. CONCLUSIONS & INFERENCES: A large proportion of Canadians suffer from DGBI which seriously impact their well-being. Findings highlight the need for further research and education, including understanding whether significant regional and cultural differences contribute to DGBI.
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Síndrome do Intestino Irritável , Qualidade de Vida , Feminino , Humanos , Pessoa de Meia-Idade , Masculino , Cidade de Roma , Canadá/epidemiologia , Síndrome do Intestino Irritável/diagnóstico , Inquéritos e Questionários , Estudos Epidemiológicos , Encéfalo , PrevalênciaRESUMO
BACKGROUND & AIMS: Although functional gastrointestinal disorders (FGIDs), now called disorders of gut-brain interaction, have major economic effects on health care systems and adversely affect quality of life, little is known about their global prevalence and distribution. We investigated the prevalence of and factors associated with 22 FGIDs, in 33 countries on 6 continents. METHODS: Data were collected via the Internet in 24 countries, personal interviews in 7 countries, and both in 2 countries, using the Rome IV diagnostic questionnaire, Rome III irritable bowel syndrome questions, and 80 items to identify variables associated with FGIDs. Data collection methods differed for Internet and household groups, so data analyses were conducted and reported separately. RESULTS: Among the 73,076 adult respondents (49.5% women), diagnostic criteria were met for at least 1 FGID by 40.3% persons who completed the Internet surveys (95% confidence interval [CI], 39.9-40.7) and 20.7% of persons who completed the household surveys (95% CI, 20.2-21.3). FGIDs were more prevalent among women than men, based on responses to the Internet survey (odds ratio, 1.7; 95% CI, 1.6-1.7) and household survey (odds ratio, 1.3; 95% CI, 1.3-1.4). FGIDs were associated with lower quality of life and more frequent doctor visits. Proportions of subjects with irritable bowel syndrome were lower when the Rome IV criteria were used, compared with the Rome III criteria, in the Internet survey (4.1% vs 10.1%) and household survey (1.5% vs 3.5%). CONCLUSIONS: In a large-scale multinational study, we found that more than 40% of persons worldwide have FGIDs, which affect quality of life and health care use. Although the absolute prevalence was higher among Internet respondents, similar trends and relative distributions were found in people who completed Internet vs personal interviews.
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Gastroenteropatias/epidemiologia , Saúde Global , Adolescente , Adulto , Distribuição por Idade , Idoso , Feminino , Gastroenteropatias/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Proctocolectomy with IPAA is considered curative for ulcerative colitis. However, signs of Crohn's disease can develop postoperatively in some cases. OBJECTIVE: Our aim was to document the postoperative diagnosis of Crohn's disease, to identify potential preoperative predictive factors, and to review the evolution of patients on treatment. DESIGN: This is a retrospective cohort study. SETTINGS: This study was conducted at a tertiary care center in Montreal, Canada. PATIENTS: A total of 301 patients underwent an IPAA for ulcerative colitis between 1985 and 2014. MAIN OUTCOME MEASURES: The primary outcome was the cumulative incidence of the postoperative diagnosis of Crohn's disease. RESULTS: During a median follow-up of 68 months, Crohn's disease was diagnosed at a median time of 77 months (8-270) in 38 patients (12.6%). The cumulative incidence of Crohn's disease was 7.5% at 5 years postoperatively and gradually increased to 17.7% and 33.0% at 10 and 20 years. The following predictive factors for Crohn's disease were observed on univariate analysis: current tobacco smoking at surgery (HR 3.56 (95% CI, 1.54-8.22)), suspicion of indeterminate colitis (HR 3.50 (95% CI, 1.69-7.24)), presence of mouth ulcers before surgery (HR 2.16 (95% CI, 1.03-4.53)), and age at diagnosis of ulcerative colitis (HR 0.94 (95% CI, 0.90-0.97)). Suspicion of indeterminate colitis (HR 3.18 (95% CI 1.46-6.93); p = 0.004) and age at diagnosis (HR 0.95 (95% CI, 0.91-0.99); p = 0.018) remained statistically significant on multivariate analysis. Postoperative inflammatory disease was controlled by medical therapy in most patients. Removal of the pouch was necessary in 16% of patients with Crohn's disease. LIMITATIONS: This was a retrospective single-center study. CONCLUSIONS: Diagnosis of Crohn's disease can occur at a distance from surgery with an increasing cumulative incidence over time. Preoperative predictive factors are few and should not determine candidacy for surgery. Therapeutic options are identical to those available for treatment of typical Crohn's disease and allow a favorable evolution in most patients. See Video Abstract at http://links.lww.com/DCR/B372. BROTE DE CROHN DESPUS DE UNA PROCTOCOLECTOMA CON ANASTOMOSIS DE RESERVORIO LEOANAL EN CASOS DE COLITIS ULCEROSA: ANTECEDENTES:La proctocolectomía con reservorio ileo-anal se considera curativa para la colitis ulcerosa. Sin embargo, signos de enfermedad de Crohn pueden desarrollarse después de la operación en algunos casos.OBJETIVO:Nuestro objetivo fue documentar el diagnóstico postoperatorio de la enfermedad de Crohn, identificar posibles factores predictivos preoperatorios y revisar la evolución de los pacientes con tratamiento.DISEÑO:Estudio retrospectivo de cohortes.AJUSTES:Centro de atención terciaria en Montreal, Canadá.PACIENTES:301 pacientes portadores de un reservorio íleo-anal realizados por colitis ulcerosa entre 1985 y 2014.PRINCIPALES MEDIDAS DE RESULTADO:Acumulación de la incidencia en el diagnóstico postoperatorio de enfermedad de Crohn.RESULTADOS:Durante una media de 68 meses de seguimiento, la enfermedad de Crohn fué diagnosticada en un tiempo medio de 77 meses (8-270) en 38 pacientes (12,6%). La acumulación de incidencia de la enfermedad de Crohn fue del 7,5% a los 5 años después de la operación y aumentó gradualmente a 17,7 y 33,0% a los 10 y 20 años. Los siguientes factores predictivos para la enfermedad de Crohn se observaron en el análisis univariado: tabaquismo activo al momento de la cirugía (cociente de riesgo (HR) 3.56 (intervalo de confianza del 95% (IC) 1.54-8.22)), sospecha de colitis indeterminada (HR 3.50 (IC del 95% 1.69-7.24)), presencia de úlceras en la boca antes de la cirugía (HR 2.16 (IC 95% 1.03-4.53)) y edad al diagnóstico de colitis ulcerosa (HR 0.94 (IC 95% 0.90-0.97)). La sospecha de colitis indeterminada (HR 3.18 (IC 95% 1.46-6.93), p = 0.004) y la edad al momento del diagnóstico (HR 0.95 (IC 95% 0.91-0.99), p = 0.018) permanecieron estadísticamente significativos en el análisis multivariado. La reacción inflamatoria intestinal postoperatoria fue controlada con tratamiento médico en la mayoría de los pacientes. El retiro del reservorio íleo-anal fue necesario en 16% de los pacientes con enfermedad de Crohn.LIMITACIONES:Estudio retrospectivo de centro único.CONCLUSIONES:El diagnóstico de la enfermedad de Crohn puede ocurrir a distancia de la cirugía con la acumulación de incidencia creciente con el tiempo. Los factores predictivos preo-peratorios son pocos y no pueden determinar la candidatura para la cirugía. Las opciones terapéuticas son idénticas a las disponibles para el tratamiento de la enfermedad de Crohn típica y permiten una evolución favorable en la mayoría de los pacientes. Consulte Video Resumen en http://links.lww.com/DCR/B372. (Traducción-Dr. Xavier Delgadillo).
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Colite Ulcerativa/cirurgia , Doença de Crohn/etiologia , Complicações Pós-Operatórias , Proctocolectomia Restauradora , Adolescente , Adulto , Idoso , Doença de Crohn/diagnóstico , Doença de Crohn/epidemiologia , Doença de Crohn/terapia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
Cronkhite-Canada syndrome is a rare syndrome consisting of extensive gastrointestinal polyposis and ectodermal changes including cutaneous hyperpigmentation, alopecia, and onychodystrophy. We report the case of a 45-year-old Caucasian male patient who failed multiple treatments over 2 years including steroids, azathioprine, adalimumab, and cyclosporine. He had recurrent and prolonged hospitalizations because of diarrhea, abdominal pain, weight loss, and malnutrition. Sirolimus was initiated with a significant clinical and endoscopic benefit apparent within, respectively, 2 and 8 weeks. An ongoing remission was achieved and maintained for over 6 months after prednisone tapering. We review the current evidence on treatment of Cronkhite-Canada syndrome and suggest the incorporation of sirolimus in that algorithm.
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In recent years the diagnosis of Zollinger-Ellison syndrome (ZES) has become increasingly controversial with several new approaches and criteria proposed, differing from the classical biochemical criterion of inappropriate hypergastrinemia (i.e., hypergastrinemia in the presence of hyperchlorhydria) (Table 1). These changes have come about because of the difficulty and potential dangers of stopping proton pump inhibitors (PPIs) for gastric acid analysis; the recognition than many of the current assays used to assess gastrin concentrations are unreliable; the development of sensitive imaging modalities that detect neuroendocrine tumors (NETs) including an increasing number of the primary gastrinomas; the increased use of percutaneous or endoscopic ultrasound (EUS)-directed biopsies/cytology and the general lack of availability of acid secretory testing. In this article we will discuss the basis for these controversies, review the proposed changes in diagnostic approaches and make recommendations for supporting the diagnosis of ZES in the modern era.
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BACKGROUND: Over the last decade, biologics have gained an important place for the treatment of moderate to severe inflammatory bowel disease (IBD), and many randomized control trials have evaluated their efficacy. AIM: The goal of this review is to analyze the results of these trials and to highlight the evidence and indications emerging from these studies for their implementation in the management of IBD patients. METHODS: A PubMed search was realized to screen high-quality clinical trials studying biologic agents currently available in clinics for the treatment of IBD. Words used were: "infliximab," "adalimumab," "certolizumab," "golimumab," "natalizumab," "vedolizumab," "ustekinumab," "azathioprine," "methotrexate," "Crohn's disease," and "ulcerative colitis." RESULTS: In Crohn's disease, studies supporting induction and maintenance therapies were documented for infliximab, adalimumab, certolizumab, natalizumab, vedolizumab, and ustekinumab. Infliximab, adalimumab, and certolizumab have evidences for fistulizing Crohn's disease and only infliximab and adalimumab have evidences for mucosal healing. In ulcerative colitis, studies supporting induction, maintenance, and mucosal healing were found with infliximab, adalimumab, golimumab, and vedolizumab. Only infliximab was associated with evidences for combination therapy with thiopurine and acute severe colitis in ulcerative colitis. CONCLUSION: Management with biologics in IBD patients is well validated by high-quality clinical trials.
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BACKGROUND: Although esophageal hypomotility is prevalent in obese patients, its cause remains unknown. Leptin, a hormone derived from adipose tissue, may be involved in this phenomenon because it has been shown to decrease gastric and intestinal motility in animals. It has been hypothesized that elevated plasma leptin concentration is a risk factor for esophageal dysmotility in obese patients. OBJECTIVE: To determine whether plasma leptin concentrations are higher in obese patients with esophageal hypomotility than in obese patients with a normal motility profile. METHOD: Fasting plasma leptin concentration (assessed by radioimmuoassay) was measured in all patients who were included in a study protocol investigating esophageal manometry before bariatric surgery. The patients completed standardized surveys regarding epidemiological data, upper gastrointestinal symptoms, medical history and medication(s). Basal levels of leptin, as well as corrected leptin scores adjusted for sex and body mass index, were compared in patients with and without esophageal dysmotility. RESULTS: Nine patients without dysmotility and eight with dysmotility were included. Both groups were comparable with regard to age (42±9 versus 38±9 years), sex (78% versus 75% women) and body mass index (49±10 kg/m2 versus 42±7 kg/m2). There were no significant differences regarding medication(s) and comorbidities between the two groups. When compared with normal predicted values, the corrected leptin scores were 30% higher in patients with dysmotility than in the control group with normal motility (P≤0.05). CONLCUSION: Obese patients with esophageal dysmotility exhibited elevated plasma leptin concentrations, suggesting a role for leptin in promoting esophageal hypomotility.
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Transtornos da Motilidade Esofágica/sangue , Leptina/sangue , Obesidade/sangue , Adulto , Estudos de Casos e Controles , Transtornos da Motilidade Esofágica/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicaçõesRESUMO
UNLABELLED: Patients with irritable bowel syndrome (IBS) are affected by chronic abdominal pain and show decreased pain inhibition. Moreover, they exhibit differences in brain morphology compared with healthy volunteers. The aim of this study was to examine whether decreased pain inhibition is associated with altered brain morphology in IBS patients. Structural magnetic resonance imaging scans were acquired in 14 female patients with diarrhea-predominant IBS and 14 controls. Pain and anxiety modulation were characterized using electrical stimulation of the sural nerve and heterotopic noxious counterstimulation. IBS patients reported decreased pain inhibition (P = .02) as well as increased shock anxiety, pain catastrophizing, depressive symptoms, and trait anxiety (P's ≤ .05). IBS patients also showed a thicker right posterior insula (pINS), associated with longer IBS duration (r = .67, P = .02). In addition, thicker right lateral orbitofrontal cortex was strongly associated with less pain inhibition in both IBS patients (r = .70, P = .02) and controls (r = .68, P = .01). Results are consistent with the role of the insula in interoception and pain and suggest that IBS may induce thickening of the pINS. Reduced pain inhibition may further involve a modification of the regulatory influence of the orbitofrontal cortex on pain-related processes. PERSPECTIVE: This study investigated the brain morphology of IBS patients. IBS patients showed thicker right pINS, associated with longer disease duration but not with psychological symptoms. This suggests that IBS induces thickening of pINS, which may contribute to its pathophysiology, consistent with the role of the pINS in interoception and pain.
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Córtex Cerebral/patologia , Síndrome do Intestino Irritável/patologia , Síndrome do Intestino Irritável/psicologia , Dor/patologia , Dor/psicologia , Córtex Pré-Frontal/patologia , Dor Abdominal/etiologia , Dor Abdominal/psicologia , Adulto , Ansiedade/psicologia , Catastrofização/psicologia , Depressão/psicologia , Estimulação Elétrica , Eletrochoque , Feminino , Humanos , Imageamento por Ressonância Magnética , Percepção da Dor , Limiar da Dor/psicologia , Curva ROC , Córtex Somatossensorial/patologiaRESUMO
BACKGROUND: Gastrin measurements are performed primarily for the diagnosis of gastrin-producing tumors, gastrinomas, which cause the Zollinger-Ellison syndrome (ZES). Gastrin circulates as several bioactive peptides, however, and the peptide pattern in gastrinoma patients often deviates from normal. Therefore, it is necessary to measure all forms of gastrin. CONTENT: Only immunoassays are useful for measurement of gastrin in plasma. The original assays were RIAs developed in research laboratories that used antibodies directed against the C terminus of gastrin peptides. Because the C-terminal tetrapeptide amide sequence constitutes the active site of gastrin peptides, these assays were well suited for gastrinoma diagnosis. More recently, however, most clinical chemistry laboratories have switched to commercial kits. Because of recent cases of kit-measured normogastrinemia in patients with ZES symptoms, the diagnostic sensitivity and analytical specificity of the available kits have been examined. The results show that gastrin kits frequently measure falsely low concentrations because they measure only a single gastrin form. Falsely high concentrations were also encountered, owing to overreactivity with O-sulfated gastrins or plasma proteins. Thus, more than half of the gastrin kits on the market are unsuited for diagnostics. SUMMARY: Gastrinomas are neuroendocrine tumors, some of which become malignant. A delay in diagnosis leads to fulminant ZES, with major, even lethal, complications. Consequently, it is necessary that the diagnostic sensitivity of gastrin kits be adequate. This diagnostic sensitivity requires antibodies that bind the C-terminal epitope of bioactive gastrins without the influence of O-sulfation.
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Biomarcadores Tumorais/sangue , Gastrinoma/diagnóstico , Gastrinas/sangue , Sequência de Aminoácidos , Especificidade de Anticorpos , Gastrinoma/complicações , Gastrinoma/patologia , Gastrinas/química , Gastrinas/imunologia , Humanos , Imunoensaio/métodos , Dados de Sequência Molecular , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade , Síndrome de Zollinger-Ellison/diagnóstico , Síndrome de Zollinger-Ellison/etiologia , Síndrome de Zollinger-Ellison/patologiaRESUMO
BACKGROUND & AIMS: Patients with Zollinger-Ellison syndrome (ZES) are treated by proton pump inhibitors (PPIs) to protect them from severe and potentially lethal peptic complications related to massive gastric acid hypersecretion. We report here on the dangerous consequences of interrupting PPI therapy. METHODS: We describe 2 ZES patients in whom interruption of PPI treatment for diagnostic evaluation generated severe health complications. RESULTS: Less than 48 hours after stopping PPIs, patient 1 developed multiple strictures of the esophagus caused by massive vomiting of gastric acid, and patient 2 presented with severe abdominal pain with intestinal microperforation from duodenal ulcers. Because of persistent gastrin stimulatory drive and because of the abolition of reflex protective defense mechanisms against gastric acid hypersecretion during PPI treatment, patients with ZES under PPI therapy are exposed to severe peptic complications when facing rebound acid secretion at the interruption of their antisecretory treatment. CONCLUSIONS: PPI treatment interruption has dangerous consequences, and PPI therapy always should be maintained in patients known or suspected of ZES. Diagnostic evaluations should be performed under PPI protection.
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Estenose Esofágica/diagnóstico , Perfuração Intestinal/diagnóstico , Inibidores da Bomba de Prótons/administração & dosagem , Suspensão de Tratamento , Síndrome de Zollinger-Ellison/complicações , Síndrome de Zollinger-Ellison/tratamento farmacológico , Estenose Esofágica/patologia , Humanos , Perfuração Intestinal/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND & AIMS: Zollinger-Ellison syndrome (ZES) is characterized by hypersecretion of gastric acid, severe peptic ulcerations in the upper small intestine, and diarrhea. It is usually diagnosed by measuring increased levels of gastrin in plasma. METHODS: We examined the accuracy of commercial kits to measure gastrin (7 radioimmunoassays and 5 enzyme-linked immunosorbent assays), using plasma from 40 patients suspected or known to have ZES. Each sample was analyzed using the 12 kits and a reference assay that measures bioactive gastrin in plasma, irrespective of size and amino acid derivatization. Known concentrations of peptides with identical sequences to circulating gastrins were also assessed by all assays. Molecular patterns in plasma from patients with ZES were examined by chromatography and monitored by kits that measure false-low or false-high concentrations of gastrin. RESULTS: Failure to diagnose gastrinomas has serious consequences. Four kits found false-low concentrations of gastrin in 20% to 80% of the patients. Specificity assessment showed that the antibodies used in these kits bound only gastrin-17. Three kits found false-high concentrations of gastrin, because the reagents had increased reactions to sulfated gastrins or to unspecific factors in plasma. Thus, only 5 of 12 kits tested accurately measure plasma concentrations of gastrin. CONCLUSIONS: Seven of 12 tested commercial kits inaccurately measure plasma concentrations of gastrin; these assays used antibodies with inappropriate specificity that were insufficiently validated. Misdiagnosis of gastrinoma based on lack of specificity of assays for gastrin results in ineffective or inappropriate therapy for patients with ZES.
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Gastrinas/sangue , Síndrome de Zollinger-Ellison/sangue , Adulto , Idoso , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radioimunoensaio , Reprodutibilidade dos Testes , Adulto Jovem , Síndrome de Zollinger-Ellison/diagnósticoRESUMO
The mechanisms of chronic pain in irritable bowel syndrome (IBS) have been widely investigated but remain unclear. The present study investigated the relation between visceral hypersensitivity, cutaneous thermal sensitivity, and central pain mechanisms. Rectal sensitivity was assessed with a barostat, and forearm and calf sensitivity with a contact thermode. Central mechanisms were assessed by counterirritation using sustained cold-pain to the hand and painful electric shocks to the ankle. Psychological symptoms were also assessed, using questionnaires. Female volunteers with diarrhea-predominant IBS (n=27) and healthy controls (n=25) participated in the study. IBS patients had lower rectal and calf pain thresholds compared to controls (p's<0.05). IBS patients also reported more pain than controls for rectal distensions, and heat pain on the calf and forearm (all p's<0.001). Cold-pain inhibited shock-pain in controls but not IBS patients (controls: -13.5+/-5.3 vs IBS: +1.9+/-10.5; p<0.01). In addition, visceral hypersensitivity was significantly correlated to cutaneous thermal hypersensitivity and pain inhibition deficits, although effects were only weak and moderate, respectively. Furthermore, covariance analyses indicated that psychological factors accounted for group differences in visceral hypersensitivity and pain inhibition deficits. In conclusion, this study confirms the relation between altered pain inhibition processes and widespread hypersensitivity in IBS. The present results also suggests that psychological symptoms and altered pain processing in IBS patients may reflect at least in part, common underlying mechanisms.
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Hipersensibilidade/fisiopatologia , Síndrome do Intestino Irritável/fisiopatologia , Inibição Neural/fisiologia , Limiar da Dor/fisiologia , Dor/fisiopatologia , Vísceras/fisiopatologia , Adulto , Vias Aferentes/fisiopatologia , Análise de Variância , Tornozelo/inervação , Eletromiografia/métodos , Feminino , Humanos , Hiperalgesia/fisiopatologia , Síndrome do Intestino Irritável/psicologia , Dor/psicologia , Medição da Dor/métodos , Estimulação Física , Estatística como Assunto , Inquéritos e Questionários , Vísceras/inervaçãoRESUMO
Ghrelin is a 28 amino-acid peptide discovered in 1999. It is synthesized mainly in endocrine cells of the gastric mucosa and secreted into the blood. Physiological contributions of the peptide in human include probably regulation of growth hormone and of appetite. Ghrelin can also influence the gastrointestinal system, mostly by stimulating the contractility of the proximal gut. Whether ghrelin is a significant regulator of the digestive physiology remains to be shown. Whether ghrelin agonist agents could be useful prokinetic drugs in human medicine is currently under exploration.
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Fármacos Gastrointestinais/uso terapêutico , Grelina/fisiologia , Grelina/uso terapêutico , Animais , Fármacos Gastrointestinais/farmacologia , Motilidade Gastrointestinal/efeitos dos fármacos , Trato Gastrointestinal/efeitos dos fármacos , Grelina/agonistas , Grelina/farmacologia , HumanosRESUMO
OBJECTIVES: This report is a preliminary comparative study of irritable bowel syndrome symptoms in eight countries, USA, Mexico, Canada, England, Italy, Israel, India, and China. We also assessed global symptom patterns and correlations and relationships to several psychosocial variables. METHODS: Two hundred and thirty-nine participants completed a bowel symptom scale composed of four symptoms, abdominal pain or discomfort, bloating, diarrhea, and constipation as well as two psychosocial questionnaires, quality of relationship and attribution of symptoms to physical or emotional factors. RESULTS: Pain score in Italy, with the least urban population, was significantly higher than six of the seven other countries whereas it was lowest in India and England. Bloating was highest in Italy and constipation was highest in Mexico, both significantly higher than five other countries. Diarrhea was higher in China than five other countries. All significance values were P<0.05. Globally, diarrhea was less common than constipation, P<0.001 and bloating significantly correlated with constipation as well with pain, P<0.05. Composite analysis of psychosocial variables and symptoms indicated that family conflict correlated directly, P<0.05, whereas family support correlated indirectly, P<0.01, with pain and bloating. Pain, bloating and diarrhea were significantly attributed to physical etiology, P<0.01, whereas only diarrhea was attributed to emotional cause, P<0.05. CONCLUSION: This study suggests that there are significant variations in irritable bowel syndrome symptoms in different geographic locations around the world. Various hypotheses that may explain our data such as cultural beliefs, gut contamination, urban and rural location, dietary practice, and psychosocial factors should be further investigated.
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Síndrome do Intestino Irritável/etnologia , Dor Abdominal/etnologia , Dor Abdominal/etiologia , Dor Abdominal/psicologia , Adulto , Atitude Frente a Saúde , Constipação Intestinal/etnologia , Constipação Intestinal/etiologia , Constipação Intestinal/psicologia , Comparação Transcultural , Diarreia/etnologia , Diarreia/etiologia , Diarreia/psicologia , Escolaridade , Feminino , Humanos , Síndrome do Intestino Irritável/etiologia , Síndrome do Intestino Irritável/psicologia , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Psicofisiologia , Saúde da População Rural/estatística & dados numéricos , Índice de Gravidade de Doença , Inquéritos e Questionários , Saúde da População Urbana/estatística & dados numéricosRESUMO
PURPOSE OF REVIEW: Motilin is a hormone produced from endocrine cells of the duodenal mucosa to help regulate motility of the digestive tract. This review discusses new findings on the potential impact of motilin in human medicine. RECENT FINDINGS: Motilin is a member of the peptide family that includes ghrelin whose cDNA also encodes a new candidate peptide, obestatin. Physiological interactions between these products will have to be explored. Pharmacological agents, agonists as well as antagonists, to motilin receptors are now emerging for clinical application. Motilin-receptor characterization, regarding its localization on nerves or muscles, as well as its biochemical mechanisms to sensitization for example, will be important steps in the design of future motilin agonists or antagonists. SUMMARY: Motilin is a fascinating hormone for the physiologist. Its interaction with the family member ghrelin and with obestatin will open new areas for basic research. Motilin-receptor agonists or antagonists could soon be part of the therapeutic arsenal of the clinician to improve digestive dysmotility.
Assuntos
Motilina/fisiologia , Motilidade Gastrointestinal/efeitos dos fármacos , Grelina/fisiologia , Humanos , Contração Muscular/fisiologia , Músculo Liso/metabolismo , Neurônios/metabolismo , Peptídeos/fisiologia , Receptores dos Hormônios Gastrointestinais/agonistas , Receptores dos Hormônios Gastrointestinais/antagonistas & inibidores , Receptores dos Hormônios Gastrointestinais/metabolismo , Receptores dos Hormônios Gastrointestinais/fisiologia , Receptores de Neuropeptídeos/agonistas , Receptores de Neuropeptídeos/antagonistas & inibidores , Receptores de Neuropeptídeos/metabolismo , Receptores de Neuropeptídeos/fisiologiaRESUMO
Patients with IBS frequently complain of medication side effects. The goals of this study were to assess the prevalence of drug intolerance as an extra GI manifestation in patients with IBS and to verify the association between drug intolerance and psychological comorbidity. Female patients followed in a tertiary care center completed questionnaires assessing the presence of drug intolerance as well as somatic and psychological extra GI conditions. IBS patients (Rome II criteria; n = 71) were compared to inflammatory bowel disease patients (IBD; n = 96) or to healthy controls (HC; n = 67). The relationship to psychological comorbidity was verified in two different paradigms: (1) by looking at the statistical correlation between drug intolerance and the psychological extra GI symptoms in our IBS patients, and (2) by comparing in a meta-analysis the side effects to placebo (the nocebo effect is presumably increased due to hypervigilance or amplification in psychological disorders) in IBS patients or in patients with comparable medical conditions included in various drug trials approved by Health Canada. Our results show that prevalence of drug intolerance was significantly more elevated in IBS (41% patients) than in HC (7%) or in IBD (27%); somatic and psychological extra GI symptoms were also markedly increased in IBS. In addition, drug intolerance in our IBS patients was significantly associated with somatic comorbidities such as fatigue or multiple symptoms (P < 0.001), but not with psychological factors such as depression, anxiety, mood instability, or sleep disorder. A meta-analysis revealed that the nocebo effect was not different in patients with IBS than in control patients. In conclusion, drug intolerance is a frequent extra GI manifestation of IBS that is not associated with psychological comorbidity; thus, a somatic origin must be explored.
Assuntos
Doenças Inflamatórias Intestinais/complicações , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/tratamento farmacológico , Sensibilidade Química Múltipla/etiologia , Adulto , Estudos de Casos e Controles , Comorbidade , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Doenças Inflamatórias Intestinais/psicologia , Síndrome do Intestino Irritável/psicologia , Pessoa de Meia-Idade , Sensibilidade Química Múltipla/psicologia , Inquéritos e QuestionáriosRESUMO
Multiple pregnancies are still an important cause of noninfectious abortion, stillbirth, neonatal mortality, and significant delays in reproductive performance in mares. Despite new management techniques, reduction in multiple pregnancies is an ongoing preoccupation and challenge for the equine veterinarian. The aim of the present study was to establish a twin pregnancy experimental model in the mare to study the effectiveness of a transvaginal ultrasound-guided embryonic vesicle injection. Mares in heat were inseminated and then received an embryo at day 7 of the estrous cycle. At days 14 and 30, 53.5% (n = 23) and 23% (n = 10) of the mares, respectively, were carrying twins. Twin pregnancies were reduced at day 30 by transvaginal ultrasound-guided puncture of the embryonic vesicle (control, n = 5) or by transvaginal ultrasound-guided injection (TVUEVI) of 25 mg of amikacin into the embryonic vesicle (n = 5). The TVUEVI treatment had a 40% success rate and no significant variations in progesterone and prostaglandin metabolite were observed. Even though the technique does not seem very effective, the experimental model could be useful for clinical research in embryo reduction and early embryonic loss.
Assuntos
Redução de Gravidez Multifetal/veterinária , Prenhez , Gravidez Múltipla , Ultrassonografia Pré-Natal/veterinária , Amicacina/uso terapêutico , Animais , Feminino , Idade Gestacional , Cavalos , Gravidez , Redução de Gravidez Multifetal/efeitos adversos , Redução de Gravidez Multifetal/métodos , Resultado do Tratamento , Gêmeos , Ultrassonografia Pré-Natal/métodosRESUMO
While chronic constipation (CC) has a high prevalence in primary care, there are no existing treatment recommendations to guide health care professionals. To address this, a consensus group of 10 gastroenterologists was formed to develop treatment recommendations. Although constipation may occur as a result of organic disease, the present paper addresses only the management of primary CC or constipation associated with irritable bowel syndrome. The final consensus group was assembled and the recommendations were created following the exact process outlined by the Canadian Association of Gastroenterology for the following areas: epidemiology, quality of life and threshold for treatment; definitions and diagnostic criteria; lifestyle changes; bulking agents and stool softeners; osmotic agents; prokinetics; stimulant laxatives; suppositories; enemas; other drugs; biofeedback and behavioural approaches; surgery; and probiotics. A treatment algorithm was developed by the group for CC and constipation associated with irritable bowel syndrome. Where possible, an evidence-based approach and expert opinions were used to develop the statements in areas with insufficient evidence. The nature of the underlying pathophysiology for constipation is often unclear, and it can be tricky for physicians to decide on an appropriate treatment strategy for the individual patient. The myriad of treatment options available to Canadian physicians can be confusing; thus, the main aim of the recommendations and treatment algorithm is to optimize the approach in clinical care based on available evidence.