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1.
Curr Opin Gastroenterol ; 38(3): 299-306, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35645022

RESUMO

PURPOSE OF REVIEW: Small bowel dysmotility is common in the context of neurological disorders. Overlooking it can have an adverse impact on patient's quality of life and neurological outcomes. This review focuses on describing the mechanisms and effects of enteric dysmotility in neurological patients and providing treatment options. RECENT FINDINGS: Small bowel dysmotility is prevalent among neurological patients. The definition and diagnosis of small bowel dysmotility is a challenge; however, up to two-thirds of neurological patients may experience associated symptoms. Small bowel dysmotility can affect the absorption of nutrients and medication, impacts on social and professional function and can result in malnutrition and its associated morbidity and mortality. SUMMARY: Small bowel dysmotility due to a neuropathy can result from acute or chronic disorders in the central and peripheral nervous system and includes the cerebral cortex, brain stem, spinal cord, parasympathetic (vagus) and sympathetic nerves and the myenteric and submucosal plexuses of the intestine. Generalized muscle disorders can also cause an enteral myopathy. Generally, the disorders may be degenerative or inflammatory. Both enteric neuropathy and myopathy may cause symptoms of abdominal pain, nausea/vomiting, bloating, constipation or diarrhoea and can cause malnutrition. The symptoms need to be addressed in order of importance to the patient and malnutrition prevented or treated.


Assuntos
Gastroenteropatias , Desnutrição , Doenças do Sistema Nervoso , Gastroenteropatias/diagnóstico , Gastroenteropatias/etiologia , Motilidade Gastrointestinal/fisiologia , Humanos , Desnutrição/complicações , Qualidade de Vida
2.
Nutrients ; 14(11)2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35684135

RESUMO

BACKGROUND: The increased intake of FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyol) rich foods has been suggested as a possible trigger of functional gastrointestinal disorders (FGIDs). Despite the high FODMAP content, the Mediterranean diet (MD) appears to have beneficial effects on health. Our aim was to evaluate whether the prevalence of FGIDs in different Mediterranean countries may be influenced by FODMAP consumption and adherence to the MD. METHODS: A school-based, cross-sectional, multicenter study was performed in six countries in the Mediterranean area: Croatia, Greece, Israel, Italy, Macedonia, and Serbia. Subjects 4-18 years were examined in relation to their eating habits and the presence of FGIDs, using Rome IV criteria, 3-day food diaries and Mediterranean Diet Quality Index in Children and Adolescents (KIDMED) questionnaires. RESULTS: We enrolled 1972 subjects between 4 and 9 years old (Group A), and 2450 subjects between 10 and 18 years old (Group B). The overall prevalence of FGIDs was 16% in Group A and 26% in Group B. FODMAP intake was significantly different among countries for both age groups. In both groups, no significant association was found between FGIDs and FODMAPs. Adherence to the MD in all countries was intermediate, except for Serbia, where it was low. In both groups, we found a statistically significant association between FGIDs and the KIDMED score (Group A: OR = 0.83, p < 0.001; Group B: OR = 0.93, p = 0.005). Moreover, a significant association was found between the KIDMED score and functional constipation (Group A: OR = 0.89, p = 0.008; Group B: OR = 0.93, p = 0.010) and postprandial distress syndrome (Group A: OR = 0.86, p = 0.027; Group B: OR = 0.88, p = 0.004). CONCLUSIONS: Our data suggest that the prevalence of FGIDs in the Mediterranean area is not related to FODMAP consumption, whereas adherence to the MD seems to have a protective effect.


Assuntos
Dieta Mediterrânea , Gastroenteropatias , Síndrome do Intestino Irritável , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Dieta , Dissacarídeos , Fermentação , Gastroenteropatias/epidemiologia , Gastroenteropatias/etiologia , Humanos , Monossacarídeos , Oligossacarídeos , Sérvia/epidemiologia
3.
Clin Nutr ESPEN ; 49: 92-102, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35623881

RESUMO

BACKGROUND & AIMS: The term enteral feeding intolerance (FI) is frequently used in clinical practice and the literature, yet there is no standardised definition. FI is often quoted as a reason for failure to meet enteral nutrition (EN) targets but the lack of a consensus definition precludes accurate estimates of prevalence, predictors and clinical outcomes associated with FI. A systematic review was performed of studies in adult critical care patients to evaluate the definitions, relative risk, predictors and clinical outcomes of FI and to propose a uniform definition. METHODS: Database searches were completed in MEDLINE Ovid, Embase, CINAHL, PsycINFO, Google Scholar, NHS Evidence, Scopus and Web of Science. The search was performed in January and February 2021. Studies were included if they had an interventional, observational cohort or case-control study design and contained a definition of FI in critically ill adults. The following data were extracted from each included article: 1) study design; 2) study objective; 3) inclusion criteria; 4) population and setting; 5) sample size; 6) definition of FI; 7) prevalence of FI; 8) predictors of FI; 9) clinical outcome measures associated with FI. Studies were grouped based on the symptoms used to define FI with random effects meta-analysis. RESULTS: 89 unique studies containing a definition of FI were identified. Studies were categorised according to definition of FI into 3 groups: 1) Gastric residual volume (GRV) and/or gastrointestinal (GI) symptoms (n = 74); 2) Ability to achieve EN target (n = 5); 3) Composite definitions (n = 10). Meta-analysis showed a relative risk of FI of 0.55 [95% CI 0.45, 0.68] (p < 0.00001). The most frequently reported predictors of FI were use of vasoactive drugs, sedation or use of muscle relaxants, intra-abdominal pressure and APACHE II score. CONCLUSIONS: FI is inconsistently defined in the literature but is reportedly common amongst critically ill adults. FI is most frequently defined by the presence of raised GRV and GI symptoms. However, studies show GRV to correlate poorly with delayed gastric emptying and this review demonstrated no correlation between GRV threshold and prevalence of FI. A standardised definition of FI is essential for future research and clinical practice. We propose a definition of FI including a failure to reach EN targets in addition to presence of GI symptoms. PROTOCOL REGISTRATION: PROSPERO number CRD42020211879. Registered 29th September 2020.


Assuntos
Estado Terminal , Gastroenteropatias , Adulto , Estudos de Casos e Controles , Cuidados Críticos/métodos , Estado Terminal/epidemiologia , Nutrição Enteral/métodos , Gastroenteropatias/etiologia , Humanos , Recém-Nascido , Prevalência
4.
Radiographics ; 42(3): 759-777, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35452341

RESUMO

There is a wide spectrum of hereditary and acquired immunodeficiency disorders that are characterized by specific abnormalities involving a plethora of humoral, cellular, and phagocytic immunologic pathways. These include distinctive primary immunodeficiency syndromes due to characteristic genetic defects and secondary immunodeficiency syndromes, such as AIDS from HIV infection and therapy-related immunosuppression in patients with cancers or a solid organ or stem cell transplant. The gut mucosa and gut-associated lymphoid tissue (the largest lymphoid organ in the body), along with diverse commensal microbiota, play complex and critical roles in development and modulation of the immune system. Thus, myriad gastrointestinal (GI) symptoms are common in immunocompromised patients and may be due to inflammatory conditions (graft versus host disease, neutropenic enterocolitis, or HIV-related proctocolitis), opportunistic infections (viral, bacterial, fungal, or protozoal), or malignancies (Kaposi sarcoma, lymphoma, posttransplant lymphoproliferative disorder, or anal cancer). GI tract involvement in immunodeficient patients contributes to significant morbidity and mortality. Along with endoscopy and histopathologic evaluation, imaging plays an integral role in detection, localization, characterization, and distinction of GI tract manifestations of various immunodeficiency syndromes and their complications. Select disorders demonstrate characteristic findings at fluoroscopy, CT, US, and MRI that permit timely and accurate diagnosis. While neutropenic enterocolitis affects the terminal ileum and right colon and occurs in patients receiving chemotherapy for hematologic malignancies, Kaposi sarcoma commonly manifests as bull's-eye lesions in the stomach and duodenum. Imaging is invaluable in treatment follow-up and long-term surveillance as well. Online supplemental material is available for this article. ©RSNA, 2022.


Assuntos
Síndrome de Imunodeficiência Adquirida , Enterocolite Neutropênica , Gastroenteropatias , Neoplasias Gastrointestinais , Infecções por HIV , Sarcoma de Kaposi , Síndrome de Imunodeficiência Adquirida/complicações , Duodeno , Enterocolite Neutropênica/complicações , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/etiologia , Neoplasias Gastrointestinais/patologia , Infecções por HIV/complicações , Humanos , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/etiologia , Sarcoma de Kaposi/patologia
5.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 34(2): 113-120, 2022 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-35387714

RESUMO

Acute gastrointestinal dysfunction is a common and important complication of sepsis. As no exiting formal definition and classification of gastrointestinal dysfunction, most of the treatment strategies for gastrointestinal dysfunction are not based on clinical evidence, but on their own clinical experience. Experts of traditional Chinese medicine, integrated traditional Chinese and Western medicine and Western medicine from various disciplines in Shanghai are organized by the Shanghai Society of Integrated Traditional Chinese and Western Medicine and the Emergency Department Branch of Shanghai Physicians Association. After repeated discussion, literature search and formulation of the outline, we developed consensus on gastrointestinal dysfunction secondary to sepsis with integrating Traditional Chinese Medicine and Western medicine by consulting extensively on clinical experts in the fields of emergency medicine, gastroenterology, general surgery, infectious medicine and traditional Chinese medicine, and holding several expert forums and consultation meetings. This clinical expert consensus focused on acute gastrointestinal injury (AGI) classification and inducer of sepsis. In this consensus, the common symptoms, diagnosis, classifications, treatment strategies and suggestions of acute gastrointestinal injury or dysfunction secondary to sepsis were explored from the aspect of both Traditional Chinese Medicine and Western medicine.


Assuntos
Gastroenteropatias , Sepse , China , Consenso , Gastroenteropatias/etiologia , Gastroenteropatias/terapia , Humanos , Medicina Tradicional Chinesa , Sepse/complicações , Sepse/terapia
6.
Ann Card Anaesth ; 25(2): 178-181, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35417964

RESUMO

Background: Perioperative trans-esophageal echocardiography ('TEE') is widely used for the assessment of anatomy/repair of congenital cardiac defects. It is recognised that there are risks associated with its use. Aims: We wished, by means of a contemporaneous prospective national audit over a six-month period, to establish what proportion of TEE studies in children are complicated by major upper gastrointestinal or upper aerodigestive tract trauma. Methods: After obtaining appropriate local institutional ethics committee approval, a national prospective audit of the rate and severity of gastrointestinal complications of trans-esophageal echocardiography studies in anaesthetised adult cardiology and cardiac surgical patients was conducted by the Association of Cardiothoracic Anaesthesia and Critical Care in the United Kingdom and Ireland during the twelve months of 2017. During the second six months of the audit, the Congenital Cardiac Anaesthesia Network (an organisation including anaesthetists with a paediatric cardiac anaesthetic practice in all the United Kingdom cardiac surgical centres) prospectively audited the incidence of such complications of TEE studies in children. Results: A total of 1,059 studies were included in this six-month paediatric audit. There were no reports of the specified major complication. Statistical Analysis: The zero incidence of the major complication is consistent with a worst possible incidence of five per thousand TEE examinations. Conclusions: Such potentially reassuring information could be included in discussions with patients or families about the risk of trans-esophageal studies in children.


Assuntos
Anestesia em Procedimentos Cardíacos , Procedimentos Cirúrgicos Cardíacos , Gastroenteropatias , Cardiopatias Congênitas , Adulto , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Ecocardiografia Transesofagiana/efeitos adversos , Gastroenteropatias/diagnóstico por imagem , Gastroenteropatias/epidemiologia , Gastroenteropatias/etiologia , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Humanos
7.
Transpl Immunol ; 72: 101590, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35346826

RESUMO

BACKGROUND: Lung transplantation is the only effective way to treat end-stage lung disease. Severe gastrointestinal complications are common after lung transplantation and are associated with increased mortality. Early identification and active intervention are necessary to avoid treatment delays. Abdominal massage belongs to the category of external treatment of traditional Chinese medicine (TCM), which is often used in the treatment of internal diseases. It has an excellent effect in treating stomachache, bloating, anorexia, and constipation. CASE PRESENTATION: The patient developed gastrointestinal dysfunction 16 days after lung transplantation. Through the implementation of abdominal massage intervention, symptoms were significantly relieved, weight gain occurred, and the curative effect was good. CONCLUSION: Abdominal massage can relieve gastrointestinal symptoms and promote the recovery of gastrointestinal function after lung transplantation and has good curative effects. This method is worth promoting in patients who have had lung transplantation.


Assuntos
Gastroenteropatias , Transplante de Pulmão , Massagem , Gastroenteropatias/etiologia , Gastroenteropatias/terapia , Humanos , Transplante de Pulmão/efeitos adversos
8.
J Gastrointestin Liver Dis ; 31(1): 98-106, 2022 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-35306547

RESUMO

BACKGROUND AND AIMS: Fabry disease (FD) is a rare chronic genetic disorder that presents under a paucity of symptoms. Gastrointestinal (GI) involvement is a common event and can sometimes be debilitating, but relatively often it is overlooked. We aimed to provide a systematic review of main GI symptoms in FD patients and treatment possibilities. METHODS: We completed a systematic review of literature, using the MeSH terms: "Fabry disease", "gastrointestinal", "gastrointestinal", "digestive", "manifestations", "symptoms", "clinical", "treatment", "therapy" and the supplementary concepts "enzyme replacement", "chaperone", "Migalastat", in different combinations, with defined inclusion and exclusion criteria. RESULTS: From 221 initial studies identified, through our selection process we included a final date base of 51 articles on GI signs and symptoms and their treatment. The primary GI manifestations of the disease consist of abdominal pain, bowel movement disorders or nausea and vomiting. Less frequent manifestations such as diverticular bowel disease, gastroesophageal reflux or achalasia have also been described. Main treatment options in FD are represented by enzyme replacement therapy and chaperone treatment. Patients presenting with GI symptoms unfortunately do not always respond to enzyme replacement, necessitating symptomatic relief. CONCLUSION: Fabry disease is a rare disease that often involves the GI tract, affecting patients' quality of life and burdening the healthcare system. Physicians must be aware of the multitude of manifestations in this category of patients, to promptly recognize and treat them.


Assuntos
Doença de Fabry , Gastroenteropatias , Terapia de Reposição de Enzimas , Doença de Fabry/complicações , Doença de Fabry/diagnóstico , Doença de Fabry/tratamento farmacológico , Gastroenteropatias/diagnóstico , Gastroenteropatias/etiologia , Gastroenteropatias/terapia , Humanos , Qualidade de Vida
9.
Nutrients ; 14(5)2022 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-35267949

RESUMO

Functional gastrointestinal disorders (FGIDs) refer to gastrointestinal tract issues that lack clear structural or biochemical causes. Their pathophysiology is still unclear, but gut microbiota alterations are thought to play an important role. This systematic review aimed to provide a comprehensive overview of the faecal microbiota of infants and young children with FGIDs compared to healthy controls. A systematic search and screening of the literature resulted in the inclusion of thirteen full texts. Most papers reported on infantile colic, only one studied functional constipation. Despite methodological limitations, data show alterations in microbial diversity, stability, and colonisation patterns in colicky infants compared to healthy controls. Several studies (eight) reported increases in species of (pathogenic) Proteobacteria, and some studies (six) reported a decrease in (beneficial) bacteria such as Lactobacilli and Bifidobacteria. In addition, accumulation of related metabolites, as well as low-grade inflammation, might play a role in the pathophysiology of infantile colic. Infants and toddlers with functional constipation had significantly lower levels of Lactobacilli in their stools compared to controls. Microbial dysbiosis and related changes in metabolites may be inherent to FGIDs. There is a need for more standardised methods within research of faecal microbiota in FGIDs to obtain a more comprehensive picture and understanding of infant and childhood FGIDs.


Assuntos
Gastroenteropatias , Microbioma Gastrointestinal , Microbiota , Criança , Pré-Escolar , Disbiose/complicações , Fezes , Gastroenteropatias/etiologia , Humanos , Lactente
10.
Medicine (Baltimore) ; 101(11)2022 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-35356922

RESUMO

RATIONALE: The gastrointestinal (GI) tract is a common target organ of graft-vs-host disease (GVHD) in hematopoietic stem cell transplantation (HSCT) patients, and GI tract GVHD is often resistant to standard treatments such as corticosteroids. Moreover, longterm use of systemic corticosteroids sometimes induces adverse events such as infection. Beclomethasone dipropionate (BDP) is a potent, topically active corticosteroid, which is metabolized to an active derivative in the intestinal mucosa. Oral BDP therapy is reportedly effective against GI tract GVHD in adult HSCT patients, but its efficacy and safety in pediatric patients remain undefined. Here, we report three pediatric and young adult cases who were treated with oral BDP. PATIENT CONCERNS: Three (6-, 7-, and 18-year-old) patients developed stage 2 to 4 lower GI tract GVHD, which was resistant to standard immunosuppressive therapies. DIAGNOSIS: Lower GI tract GVHD in these patients was histopathologically proven by endoscopic biopsy. INTERVENTIONS: Oral administration of enteric-coated capsules of BDP (3-8 mg/day) was started for the treatment of lower GI tract GVHD. OUTCOMES: With the introduction of oral BDP therapy, their GI tract symptoms promptly resolved (abdominal pain, within 3-7 days; diarrhea, within 2-3 weeks). Subsequently, systemic immunosuppressive agents such as corticosteroids and mycophenolate mofetil were successfully tapered off. During oral BDP therapy, although cytomegalovirus antigenemia and Acinetobacter Iwoffii sepsis developed in 2 cases, both were curable with conventional treatments. In a young adult case, concomitant BK virus-associated hemorrhagic cystitis resolved after oral BDP was introduced and systemic immunosuppressive agents were reduced. Transient growth restriction was observed in a pediatric case who was treated with oral BDP for approximately 300days. LESSONS: Our experiences suggest that oral BDP therapy is an effective approach for GI tract GVHD that is resistant to standard immunosuppressive therapies. Of clinical importance, our case suggests the possibility that oral BDP therapy may improve the immunosuppressive condition in GI tract GVHD patients by contributing to the reduction of systemic immunosuppressive medications as a result of prompt improvement of GI tract GVHD symptoms.


Assuntos
Gastroenteropatias , Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Beclometasona/efeitos adversos , Beclometasona/uso terapêutico , Criança , Gastroenteropatias/induzido quimicamente , Gastroenteropatias/etiologia , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/etiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Adulto Jovem
11.
Aliment Pharmacol Ther ; 55(9): 1116-1127, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35352373

RESUMO

BACKGROUND: The popularity of the gluten-free diet and sales of gluten-free products have increased immensely. AIMS: To investigate whether gluten induces gastrointestinal symptoms, measured by self-reported questionnaires, as well as mental health symptoms in adolescents from a population-based cohort. METHODS: The eligible participants (n = 273) were recruited from a population-based cohort of 1266 adolescents and had at least four different gastrointestinal symptoms. Phase one (n = 54) was a run-in phase where the participants lived gluten-free for 2 weeks. If they improved they continued to phase 2 (n = 33), a blinded randomised cross-over trial. Participants were blindly randomised either to start with 7 days of gluten, eating two granola bars containing 10 g of gluten or to 7 days on placebo, eating two granola bars without gluten, followed by the reverse and separated by a 7-day washout period. The effects of the intervention on gastrointestinal symptoms and mental health symptoms were assessed. RESULTS: In total, 54/273 participants entered the run-in phase and 35 were eligible for randomization. A total of 33 were randomised and 32 completed the trial. The median age was 20.3 (IQR 19.2-20.9) and 32/33 participants were females. Compared with a placebo, gluten did not induce gastrointestinal symptoms. The difference in the average VAS was -0.01 (95% confidence interval -2.07 to 2.05). Nor did we find a difference in the outcomes measuring mental health. CONCLUSION: Compared with placebo, adding gluten to the diet did not induce gastrointestinal symptoms or worsened mental health in adolescents recruited from a population-based cohort. The trial registration number is NCT04639921.


Assuntos
Doença Celíaca , Gastroenteropatias , Adolescente , Adulto , Estudos Cross-Over , Dieta Livre de Glúten/efeitos adversos , Método Duplo-Cego , Feminino , Gastroenteropatias/etiologia , Glutens/efeitos adversos , Humanos , Masculino , Adulto Jovem
12.
J Card Surg ; 37(4): 808-817, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35137981

RESUMO

BACKGROUND: Ischemic gastrointestinal complications (IGIC) following cardiac surgery are associated with high morbidity and mortality and remain difficult to predict. We evaluated perioperative risk factors for IGIC in patients undergoing open cardiac surgery. METHODS: All patients that underwent an open cardiac surgical procedure at a tertiary academic center between 2011 and 2017 were included. The primary outcome was IGIC, defined as acute mesenteric ischemia necessitating a surgical intervention or postoperative gastrointestinal bleeding that was proven to be of ischemic etiology and necessitated blood product transfusion. A backward stepwise regression model was constructed to identify perioperative predictors of IGIC. RESULTS: Of 6862 patients who underwent cardiac surgery during the study period, 52(0.8%) developed IGIC. The highest incidence of IGIC (1.9%) was noted in patients undergoing concomitant coronary artery, valvular, and aortic procedures. The multivariable regression identified hypertension (odds ratio [OR] = 5.74), preoperative renal failure requiring dialysis (OR = 3.62), immunocompromised status (OR = 2.64), chronic lung disease (OR = 2.61), and history of heart failure (OR = 2.03) as independent predictors for postoperative IGIC. Pre- or intraoperative utilization of intra-aortic balloon pump or catheter-based assist devices (OR = 4.54), intraoperative transfusion requirement of >4 RBC units(OR = 2.47), and cardiopulmonary bypass > 180 min (OR = 2.28) were also identified as independent predictors for the development of IGIC. CONCLUSIONS: We identified preoperative and intraoperative risk factors that independently increase the risk of developing postoperative IGIC after cardiac surgery. A high index of suspicion must be maintained and any deviation from the expected recovery course in patients with the above-identified risk factors should trigger an immediate evaluation with the involvement of the acute care surgical team.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Gastroenteropatias , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Gastroenteropatias/etiologia , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
13.
Nutrients ; 14(4)2022 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-35215484

RESUMO

Adverse food reactions (AFRs) are abnormal clinical responses related to food or the ingestion of a food component, including drinks, food additives, and dietary supplements [...].


Assuntos
Hipersensibilidade Alimentar , Gastroenteropatias , Adulto , Alérgenos , Criança , Alimentos/efeitos adversos , Gastroenteropatias/etiologia , Humanos , Imunoglobulina E
14.
Ann N Y Acad Sci ; 1512(1): 98-113, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35220596

RESUMO

Epidemiological studies have shown that maternal diabetes is associated with autism spectrum disorder development, although the detailed mechanism remains unclear. We have previously found that maternal diabetes induces persistent epigenetic changes and gene suppression in neurons, subsequently triggering autism-like behavior (ALB). In this study, we investigated the potential role and effect of hematopoietic stem cells (HSCs) on maternal diabetes-mediated gastrointestinal (GI) dysfunction and ALB in a mouse model. We show in vitro that transient hyperglycemia induced persistent epigenetic changes and gene suppression of tight junction proteins. In vivo, maternal diabetes-mediated oxidative stress induced gene suppression and inflammation in both peripheral blood mononuclear cells and intestine epithelial cells, subsequently triggering GI dysfunction with increased intestinal permeability and altered microbiota compositions, as well as suppressed gene expression in neurons and subsequent ALB in offspring; HSC transplantation (HSCT) ameliorates this effect by systematically reversing maternal diabetes-mediated oxidative stress. We conclude that HSCT can ameliorate maternal diabetes-mediated GI symptoms and autism-like behavior in mouse offspring.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Diabetes Gestacional , Gastroenteropatias , Transplante de Células-Tronco Hematopoéticas , Animais , Transtorno Autístico/etiologia , Transtorno Autístico/terapia , Feminino , Gastroenteropatias/etiologia , Gastroenteropatias/terapia , Humanos , Leucócitos Mononucleares/metabolismo , Camundongos , Gravidez
16.
J Smooth Muscle Res ; 58(0): 1-10, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35173105

RESUMO

PURPOSE: Gastric dysmotility has been reported in patients with long-standing diabetes mellitus (DM). Some patients with DM are diagnosed as diabetes gastroparesis and have several upper gastrointestinal (GI) symptoms such as appetite loss and abdominal pain. This study aimed to identify the relationship between gastric motility and upper GI symptoms in patients with long-standing DM. METHOD: This study was conducted among 23 patients with DM and 15 healthy controls. All the patients with DM were receiving insulin treatment and had at least one history of incidence of diabetic nephropathy, retinopathy or neuropathy. Gastric motility was evaluated using electrogastrography (EGG) and gastric emptying using the 13C-acetic acid breath test. The most severe upper gastrointestinal symptoms were assessed in all patients. RESULTS: Compared to healthy controls, patients with long-standing DM showed a significantly lower percentage of normogastria at the postprandial state with a lower power ratio in EGG. Gastric emptying was significantly delayed in patients with DM in the overall analysis. Sixteen patients with DM (69.6%) demonstrated abnormalities in either gastric myoelectrical activity or gastric emptying. Among patients with abnormal EGG or delayed gastric emptying, 12 had some GI symptoms, compared with 3 patients with normal gastric motility. No significant correlation was observed between the gastric emptying parameters and HbA1c values. CONCLUSION: Patients with long-standing DM showed gastric dysmotility, including impaired gastric myoelectrical activity and delayed gastric emptying. Gastric dysmotility appears to be closely correlated with upper GI symptoms in patients with long-standing DM.


Assuntos
Diabetes Mellitus , Gastroenteropatias , Gastroparesia , Esvaziamento Gástrico , Gastroenteropatias/etiologia , Gastroparesia/etiologia , Humanos , Período Pós-Prandial
17.
Biomolecules ; 12(2)2022 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-35204685

RESUMO

Among the histamine receptors, growing evidence points to the histamine H3 receptor as a pharmacological candidate to counteract the autonomic neuropathy associated with diabetes. The study aimed to evaluate the effect of PF00868087 (also known as ZPL-868), a CNS-sparing histamine H3 receptor antagonist, on the autonomic neuropathy of the intestinal tract associated with diabetes. Diabetes was induced in male BALB/c mice by a single high dose of streptozotocin (150 mg/kg). Colorectal specimens from control and diabetic mice, randomized to vehicle or PF0086087 (10, 30, 100 mg/kg/day by oral gavage for 14 days), were processed for morphological and immunohistochemical analysis. A significant overproduction of mucus in the intestinal mucosa of diabetic mice compared to the controls was observed. PF0086087 at the highest dose prevented mucin overproduction. The immunohistochemistry analysis demonstrated that diabetes causes a decrease in the inhibitory component of enteric motility, measured as the percentage of neuronal nitric oxide synthase-positive neurons (p < 0.05) and a parallel increase in the excitatory component evaluated as substance P-positive fibres (p < 0.01). PF0086087 dose-dependently prevented these pathophysiological events. In conclusion, PF0086087 may be an essential tool in preventing nitrergic dysfunction in the myenteric plexus of the distal colon and diabetes-induced gastrointestinal complications.


Assuntos
Diabetes Mellitus Experimental , Gastroenteropatias , Animais , Diabetes Mellitus Experimental/complicações , Gastroenteropatias/etiologia , Gastroenteropatias/prevenção & controle , Antagonistas dos Receptores Histamínicos/uso terapêutico , Masculino , Camundongos , Plexo Mientérico , Estreptozocina/uso terapêutico
18.
Radiat Oncol ; 17(1): 9, 2022 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-35039065

RESUMO

INTRODUCTION: Acute and late toxicity was analysed for prostate cancer patients with bilateral hip prostheses, who received fixed field intensity modulated radiotherapy (IMRT). The aims were (1) to establish whether toxicity rates differed from those of a control group with normal hips, (2) to develop a volumetric modulated arc therapy (VMAT) approach for patients with prostheses and (3) to compare doses to bladder and rectum for the control group, prostheses group and VMAT replans for the prostheses group. METHODS: Genitourinary (GU) and gastrointestinal (GI) toxicity was scored using Common Terminology Criteria for Adverse Events version 5.0. The incidence of grade 2 or worse (G2+) toxicity was compared using Fisher's exact test. Dose volume histograms (DVHs) and mean doses to organs at risk (OARs) were compared using signed rank tests. RESULTS: There were 17 patients in the prostheses group and 50 in the control group. Acute and late GU toxicity was similar. G2+ late GI toxicity incidence was 31% for the prostheses group and 14% for the control group (p = 0.14). Significant differences (p < 0.05) were seen between the OAR DVHs of the prostheses group who had IMRT and the control group for a range of intermediate doses. The rectum mean dose was significantly different (p < 0.001), but no difference was seen for the bladder mean dose (p = 0.08). CONCLUSIONS: No significant differences were seen in GU and GI toxicity incidence between patients with bilateral hip prostheses and a control group. The DVHs for bladder and rectum were significantly higher for patients with prostheses planned with IMRT. Replanning using a VMAT technique significantly reduced doses to the OARs, whilst maintaining good planning target volume coverage.


Assuntos
Gastroenteropatias/etiologia , Prótese de Quadril , Complicações Pós-Operatórias/etiologia , Neoplasias da Próstata/radioterapia , Lesões por Radiação/etiologia , Radioterapia de Intensidade Modulada/efeitos adversos , /etiologia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Gut Microbes ; 14(1): 2027852, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35090382

RESUMO

Nonspecific gastrointestinal (GI) symptoms, such as postprandial cramping pain, diarrhea, nausea and vomiting are typical symptoms for irritable bowel syndrome or inflammatory bowel disease, but may also be the first symptoms of Fabry disease (FD). This review focus on GI manifestations in FD, by providing an overview of symptoms, a proper diagnosis, an appropriate management by FD-specific and concomitant medications and lifestyle interventions. We provide comprehensive literature-based data combined with personal experience in the management of FD patients. Since FD is rare and the clinical phenotype is heterogeneous, affected patients are often misdiagnosed. Consequently, physicians should consider FD as a possible differential diagnosis when assessing unspecific GI symptoms. Improved diagnostic tools, such as a modified GI symptom assessment scale can facilitate the diagnosis of FD in patients with GI symptoms of unknown cause and thus enable the timely initiation of a disease-specific therapy. Expansive intravenous enzyme replacement therapy with α-galactosidase A or oral chaperone therapy for patients with amenable mutations improve the disease burden including GI symptoms, but a timely start of therapy is crucial for the prognosis. A special diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) or pro- and prebiotics might improve FD-typical GI symptoms. Furthermore, preliminary success was reported with the oral administration of α-galactosidase A. In addition to a timely initiation of FD-specific therapy, affected patients with GI symptoms might benefit from a FODMAP-low diet, pro- and prebiotics and/or low-cost oral substitution with AGAL to support digestion and reduce dysbiosis.


Assuntos
Doença de Fabry/complicações , Gastroenteropatias/etiologia , Animais , Terapia de Reposição de Enzimas , Doença de Fabry/dietoterapia , Doença de Fabry/metabolismo , Doença de Fabry/terapia , Gastroenteropatias/metabolismo , Gastroenteropatias/terapia , Microbioma Gastrointestinal , Trato Gastrointestinal/metabolismo , Trato Gastrointestinal/microbiologia , Humanos
20.
Eur J Gastroenterol Hepatol ; 34(3): 274-280, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-35100175

RESUMO

BACKGROUND AND OBJECTIVES: Lactose malabsorption and lactose-induced symptoms are poorly correlated, as shown by breath tests and various symptom assessment methods. Validated assessment is the key to overcome the limitations of biased symptom measurements. We characterized lactose-induced symptoms with the population-specific, validated paediatric carbohydrate perception questionnaire (pCPQ) and their correlation with the history of symptoms (HoS). METHODS: A total of 130 patients with functional gastrointestinal symptoms underwent a lactose hydrogen breath and tolerance test (LBTT) allowing for a diagnosis of malabsorption (M+) and lactose sensitivity (S+). HoS indicative of lactose-induced symptoms (abdominal pain, nausea, bloating, flatulence, diarrhoea) in the 4 weeks preceding the test was determined using a validated questionnaire. The pCPQ was used to score lactose-induced symptoms. MAIN RESULTS: The LBTT revealed 41 children (31.5%) with lactose malabsorption (M+), 56 (43.1%) with lactose sensitivity (S+) and 24 (18.5%) were M+/S+. Sensitivity correlated with HoS (P < 0.001), regardless of whether malabsorption was detectable. Malabsorption status did not correlate with HoS (NS). The odds of lactose sensitivity significantly increased when abdominal pain [odds ratio (OR) 3.5, confidence interval (CI) 1.6-7.8], nausea (OR 2.3, CI, 1.1-4.9) and flatulence (OR 3.1, CI 1.4-6.8) were reported in the 4 weeks preceding the LBTT. Symptoms after the lactose load were similar for M+/S+ and M-/S+, except for flatulence, which was more frequent in malabsorbers (P < 0.01). CONCLUSION: Our findings fit well with the emerging view of the important role of a validated symptom assessment after a lactose load. The determination of symptoms may be more relevant than malabsorption for the clinical outcomes of paediatric patients with lactose-related gastrointestinal symptoms.


Assuntos
Gastroenteropatias , Intolerância à Lactose , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Testes Respiratórios , Criança , Flatulência/etiologia , Gastroenteropatias/diagnóstico , Gastroenteropatias/etiologia , Humanos , Hidrogênio , Lactose , Intolerância à Lactose/complicações , Intolerância à Lactose/diagnóstico , Náusea , Avaliação de Sintomas
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