A 1 year course of starch- and sucrose-reduced diet used by irritable bowel syndrome patients with diarrhoea and the effect of genetic variants.

Background: Irritable bowel syndrome is a heterogeneous syndrome and it is difficult to find an effective treatment. Previously, a starch- and sucrose-reduced diet (SSRD) demonstrated promising short-term outcomes. It was proposed that genetic variants in the sucrose-isomaltase gene might influence this success. Our aim in this work was to extend the follow-up study to 1 year and to analyse the effect of the genetic variants of genes involved in starch and sucrose metabolism. Methods: IBS-SSS questionnaire, IBS-QoL questionnaire and questionnaires about adherence, difficulty and food assessment were sent to 34 patients after 6 months and 1 year after the end of the dietary intervention. In addition, 11 genes involved in sucrose and starch metabolism were sequenced. Results: Twenty-three participants responded to the 6 months follow-up and 16 to the 1 year follow-up. IBS-SSS total value increased 59.71% in the 6 months follow-up compared with the end of the intervention (p = 0.0018), and 55.39% in the 1 year follow-up (p = 0.0166); while IBS-QoL score decreased 24.09% (p = 0.0002) and 18.07% (p = 0.0022), respectively. The adherence decreased by 29.11% (p = 4.8 × 10-5) and 27.21% (p = 0.0054), respectively. In addition, carriers of pathogenic variants on the SI gene showed a slightly better performance than non-carriers. Finally, the participants showed less satisfaction over time with 18 allowed foods in the diet. Conclusion: Over time the SSRD is difficult to follow and the genotype might affect the performance of the diet. Since this diet could be a promising therapeutic option, a larger cohort needs to be analysed to validate the results and to compare it with other diets.

The effect of starch- and sucrose-reduced diet accompanied by nutritional and culinary recommendations on the symptoms of irritable bowel syndrome patients with diarrhoea.

Background: Irritable bowel syndrome (IBS) is a common gastrointestinal condition which entails a high burden in the quality of life (QoL) of patients. Nutritional interventions have been proposed to alleviate symptoms, since still no effective treatments exist for IBS. Objectives: Our aim is to analyse the feasibility of the use of starch- and sucrose-reduced diet (SSRD). Design: In this study, we used a SSRD accompanied by nutritional and culinary recommendations to measure the effects in IBS patients with diarrhoea. Methods: In all, 34 participants completed a 4-week nutritional intervention based on SSRD. Symptoms, QoL and dietary habits were assessed by several questionnaires that were completed at the beginning, daily, after 2 weeks, at the end, and after 2 months. Results: 85.29% of the participants reached the primary endpoint [reduction of 50 points or more in IBS-symptom severity scale (SSS)], and 58.82% the secondary endpoint (reduction of 50% or more in IBS-SSS). The relief of symptoms and improvement of the QoL were significant after 2 weeks of intervention, at the end and after 2 months. Dietary habits were consistent with the diet and high adherence was achieved. Conclusions: SSRD and individualized nutritional and culinary guidance improved symptoms and QoL of IBS patients with diarrhoea, with a high adherence.

Incidence and evolution of foreign body impaction in the upper gastrointestinal tract and its relationship with eosionophilic oesophagitis / Incidencia y evolución de las impactaciones por cuerpos extraños en el tracto digestivo superior y su relación con la esofagitis eosinofílica

Background: Foreign body impaction is a frequent indication of urgent endoscopy. One of the reasons for impaction is eosinophilic oesophagitis (EE). To analyze characteristics of oesophageal foreign body impactions and their relationship with eosinophilic oesophagitis.Methods: In this retrospective study, urgent endoscopies in a tertiary care centre were analyzed. We included all urgent endoscopies due to bolus and foreign body impactions performed between September 1st 2018 and September 1st 2020. We reviewed clinical data of all patients who were diagnosed with EE and compared it to impactions that were due to other motives. The mean follow-up time was 18.7 months.Results: 693 urgent endoscopy procedures were performed. 239 (34%) of these were due to foreign body ingestion. Mean age of the patients was 63 years old and 135 (63%) were men. EE was diagnosed in 36 (17%) patients. The factors associated with EE were age, to be younger than 50 years (OR, 7.3; 95% CI, 1.1–48.4; p=0.04), asthma/rhinitis/atopic dermatitis (OR, 8.9; 95% CI, 2.3–35.3; p=0.002), findings in the endoscopy as trachealization (OR, 9.7; 95% CI, 1.3–70.9; p=0.03) and psychotropic/calcium channel blocker drugs (OR, 0.09; 95% CI, 0.009–0.9; p=0.04). 15 (7%) patients died. In 6 of them death was impaction-related. None patients with EE died.Conclusions: Foreign body impaction in the upper gastrointestinal tract due to EE is a frequent cause of urgent endoscopy. Being under 50 years of age, having asthma/rhinitis/atopic dermatitis, trachealization on the oesophagus and not taking psychotropic/calcium channel blocker drugs are factors associated with the diagnosis of EE. Mortality in the follow-up of patients without EE is important.(AU)

Antecedentes: La impactación por cuerpos extraños es una indicación frecuente de endoscopia urgente. Una de las causas de impactación es la esofagitis eosinofílica. Nuestro objetivo es analizar las características de las impactaciones por cuerpos extraños en el esófago y su relación con la esofagitis eosinofílica.Métodos: En este estudio retrospectivo, se analizan todas las endoscopias urgentes realizadas por impactación de alimentos y cuerpos extraños en un hospital terciario entre el 1 de septiembre de 2018 y el 1 de septiembre de 2020. Se analizan las características clínicas de los pacientes diagnosticados de esofagitis eosinofílica y se comparan con las impactaciones debidas a otros motivos. El seguimiento medio fue de 18,7 meses.Resultados: Se realizaron 693 procedimientos de endoscopia urgentes; de ellos, 239 (34%) fueron por impactación por cuerpos extraños. La edad media fue de 63 años y 135 (63%) eran hombres; 36 (17%) de todos los pacientes con impactación fueron diagnosticados de esofagitis eosinofílica. Los factores asociados a ella fueron la edad, ser menor de 50 años (OR 7,3; IC 95%: 1,1-48,4; p=0,04), el antecedente de asma y/o rinitis y/o dermatitis atópica (OR 8,9; IC 95%: 2,3-35,3; p=0,002), los hallazgos endoscópicos como traquealización (OR 9,7; IC 95%: 1,3-70,9; p=0,03) y el consumo de fármacos psicotrópicos o antagonistas del calcio (OR 0,09; IC 95%: 0,009-0,9; p=0,04). Fallecieron 15 (7%) pacientes, todos sin esofagitis eosinofílica y en 6 el fallecimiento se relacionó con las impactaciones.Conclusiones:La impactación por cuerpos extraños en el tubo digestivo por esofagitis eosinofílica es una entidad frecuente en los servicios de endoscopia de urgencia.(AU)

Incidence and evolution of foreign body impaction in the upper gastrointestinal tract and its relationship with eosionophilic oesophagitis.

BACKGROUND: Foreign body impaction is a frequent indication of urgent endoscopy. One of the reasons for impaction is eosinophilic oesophagitis (EE). To analyze characteristics of oesophageal foreign body impactions and their relationship with eosinophilic oesophagitis. METHODS: In this retrospective study, urgent endoscopies in a tertiary care centre were analyzed. We included all urgent endoscopies due to bolus and foreign body impactions performed between September 1st 2018 and September 1st 2020. We reviewed clinical data of all patients who were diagnosed with EE and compared it to impactions that were due to other motives. The mean follow-up time was 18.7 months. RESULTS: 693 urgent endoscopy procedures were performed. 239 (34%) of these were due to foreign body ingestion. Mean age of the patients was 63 years old and 135 (63%) were men. EE was diagnosed in 36 (17%) patients. The factors associated with EE were age, to be younger than 50 years (OR, 7.3; 95% CI, 1.1-48.4; p=0.04), asthma/rhinitis/atopic dermatitis (OR, 8.9; 95% CI, 2.3-35.3; p=0.002), findings in the endoscopy as trachealization (OR, 9.7; 95% CI, 1.3-70.9; p=0.03) and psychotropic/calcium channel blocker drugs (OR, 0.09; 95% CI, 0.009-0.9; p=0.04). 15 (7%) patients died. In 6 of them death was impaction-related. None patients with EE died. CONCLUSIONS: Foreign body impaction in the upper gastrointestinal tract due to EE is a frequent cause of urgent endoscopy. Being under 50 years of age, having asthma/rhinitis/atopic dermatitis, trachealization on the oesophagus and not taking psychotropic/calcium channel blocker drugs are factors associated with the diagnosis of EE. Mortality in the follow-up of patients without EE is important.