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1.
Medicine (Baltimore) ; 100(41): e27541, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34731154

RESUMO

ABSTRACT: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that affects specific groups of people. The relationship between breakfast consumption frequency and the risk of IBS is unclear. This study aimed to investigate the association between breakfast consumption frequency and the risk of IBS among Chinese female college students.In this cross-sectional study (n = 706) conducted in October 2018, the frequency of breakfast consumption was categorized as 0 to 3 times/week, 4 to 6 times/week, or daily. IBS was diagnosed according to the Rome III criteria and was based on the presence of abdominal pain or discomfort for at least 3 months during the previous 6 months, with at least 2 or more of the following conditions: changes in frequency or form of stool and/or decrease in pain after defecation. We adjusted for confounding factors, including age, only child (yes or no), parents' educational levels (senior high school or below, college, or postgraduate), parents' marital status (married, widowed, or divorced), smoking status (smoker or nonsmoker), drinking status (drinker or nondrinker), body mass index, and depressive symptoms. A multiple logistic regression analysis was performed to determine the relationship between breakfast frequency and the risk of IBS.Among 706 participants, 23.7% were the only child in their family, and the proportion of parents divorced or widowed was 18.5%. The proportion of fathers and mothers with high school education or above was 93.3% and 96.3%, respectively. The prevalence of IBS among the participants was 17.3% (122/706). Multivariate logistic regressions analysis showed that breakfast consumption frequency is negatively associated with the risk of IBS after adjusting for confounding factors. The odds ratios (95% confidence intervals) for IBS in the breakfast frequency category of 0 to 3 times/week, 4 to 6 times/week, and daily were 1.00 (reference), 0.96 (0.58, 1.60), and 0.45 (0.26, 0.78), respectively (P = .002).Our data revealed that regular breakfast consumption is associated with a lower risk of IBS among Chinese college students. Future cohort and/or interventional studies should be conducted to further explore the association between breakfast consumption frequency and IBS.


Assuntos
Dor Abdominal/diagnóstico , Desjejum/etnologia , Economia/tendências , Gastroenteropatias/fisiopatologia , Síndrome do Intestino Irritável/epidemiologia , Dor Abdominal/etiologia , Adolescente , Grupo com Ancestrais do Continente Asiático/etnologia , Índice de Massa Corporal , Estudos Transversais , Depressão/epidemiologia , Ingestão de Líquidos , Escolaridade , Feminino , Humanos , Síndrome do Intestino Irritável/diagnóstico , Estado Civil , Pais , Prevalência , Fatores de Risco , Fumar/epidemiologia , Estudantes , Universidades/estatística & dados numéricos , Adulto Jovem
2.
Nutrients ; 13(10)2021 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-34684506

RESUMO

Functional gastrointestinal disorders (FGIDs) are characterized by abdominal pain, bloating and bowel disturbances. FGID therapy is primarily symptomatic, including treatment with herbal remedies. Flower extract of Tilia tomentosa Moench (TtM) is occasionally used as an anti-spasmodic in popular medicine. Since its effect on intestinal response is unknown, we evaluated the influence of TtM extract on small intestine contractility. Ileal preparations from C57BL/6J mice were mounted in organ baths to assess changes in muscle tension, following addition of TtM extract (0.5-36 µg/mL) or a vehicle (ethanol). Changes in contractile response to receptor- and non-receptor-mediated stimuli were assessed in ileal preparations pretreated with 12 µg/mL TtM. Alterations in the enteric nervous system neuroglial network were analyzed by confocal immunofluorescence. Increasing addition of TtM induced a marked relaxation in ileal specimens compared to the vehicle. Pretreatment with TtM affected cholinergic and tachykininergic neuromuscular contractions as well as K+-induced smooth muscle depolarization. Following incubation with TtM, a significant reduction in non-adrenergic non-cholinergic-mediated relaxation sensitive to Nω-Nitro-L-arginine methyl ester hydrochloride (pan-nitric oxide synthase inhibitor) was found. In vitro incubation of intestinal specimens with TtM did not affect the myenteric plexus neuroglial network. Our findings show that TtM-induced intestinal relaxation is mediated by nitric oxide pathways, providing a pharmacological basis for the use of TtM in FGIDs.


Assuntos
Intestino Delgado/efeitos dos fármacos , Contração Muscular/efeitos dos fármacos , Músculo Liso/efeitos dos fármacos , Extratos Vegetais/farmacologia , Tilia , Animais , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/fisiopatologia , Íleo/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL
3.
Mil Med Res ; 8(1): 50, 2021 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-34503577

RESUMO

By its nature, Gulf war illness (GWI) is multisymptomatic and affects several organ systems in the body. Along with other symptoms, veterans who suffer from GWI commonly report chronic gastrointestinal issues such as constipation, pain, indigestion, etc. However, until recently, most attention has been focused on neurological disturbances such as cognitive impairments, chronic fatigue, and chronic pain among affected veterans. With such high prevalence of gastrointestinal problems among Gulf war (GW) veterans, it is surprising that there is little research to investigate the mechanisms behind these issues. This review summarizes all the available works on the mechanisms behind gastrointestinal problems in GWI that have been published to date in various databases. Generally, these studies, which were done in rodent models, in vitro and human cohorts propose that an altered microbiome, a reactive enteric nervous system or a leaky gut among other possible mechanisms are the major drivers of gastrointestinal problems reported in GWI. This review aims to draw attention to the gastrointestinal tract as an important player in GWI disease pathology and a potential therapeutic target.


Assuntos
Gastroenteropatias/etiologia , Síndrome do Golfo Pérsico/complicações , Sistema Nervoso Entérico/efeitos dos fármacos , Sistema Nervoso Entérico/fisiopatologia , Gastroenteropatias/fisiopatologia , Microbioma Gastrointestinal/imunologia , Microbioma Gastrointestinal/fisiologia , Humanos , Síndrome do Golfo Pérsico/fisiopatologia , Veteranos/estatística & dados numéricos
4.
Nutrients ; 13(6)2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34205445

RESUMO

In the last decade, the role of nutritional management in pediatric gastrointestinal diseases has gained increasing popularity. Disease-specific diets have been introduced as conventional treatments by international guidelines. Patients tend to more willingly accept food-based therapies than drugs because of their relatively "harmless" nature. Apart from a diet's therapeutic role, nutritional support is crucial in maintaining growth and improving clinical outcomes in pediatric patients. Despite the absence of classical "side effects", however, it should be emphasized that any dietary modification might have negative consequences on children's growth and development. Hence, expert supervision is always advised, in order to support adequate nutritional requirements. Unfortunately, the media provide an inaccurate perception of the role of diet for gastrointestinal diseases, leading to misconceptions by patients or their caregivers that tends to overestimate the beneficial role of diets and underestimate the potential adverse effects. Moreover, not only patients, but also healthcare professionals, have a number of misconceptions about the nutritional benefits of diet modification on gastrointestinal diseases. The aim of this review is to highlight the role of diet in pediatric gastrointestinal diseases, to detect misconceptions and to give a practical guide for physicians on the basis of current scientific evidence.


Assuntos
Gastroenteropatias/dietoterapia , Terapia Nutricional , Dor Abdominal , Animais , Bovinos , Criança , Pré-Escolar , Dieta , Enterite/dietoterapia , Enterite/fisiopatologia , Eosinofilia/dietoterapia , Eosinofilia/fisiopatologia , Hipersensibilidade Alimentar , Gastrite/dietoterapia , Gastrite/fisiopatologia , Gastroenteropatias/fisiopatologia , Microbioma Gastrointestinal/fisiologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Recém-Nascido , Doenças Inflamatórias Intestinais/dietoterapia , Doenças Inflamatórias Intestinais/fisiopatologia , Leite/efeitos adversos , Leite/imunologia , Necessidades Nutricionais , Guias de Prática Clínica como Assunto , Probióticos
5.
PLoS One ; 16(7): e0254280, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34237102

RESUMO

BACKGROUND AND AIM: Psychological stress has been shown to increase intestinal permeability and is associated with the development of gastrointestinal disorders. This study aimed to investigate skydiving as an alternative model to analyse the effect of acute psychological stress on intestinal barrier function. MATERIALS AND METHODS: Twenty healthy subjects participated in a tandem skydive followed by a negative control visit, of which 19 (9 females and 10 males, 25.9 ± 3.7 years) were included in the study. Intestinal permeability was assessed by a multi-sugar urinary recovery test. Sucrose recovery and lactulose/rhamnose ratio in 0-5h urine indicated gastroduodenal and small intestinal permeability, respectively, and sucralose/erythritol ratio in 5-24h urine indicated colonic permeability. Blood samples were taken to assess markers associated with barrier function. This study has been registered at ClinicalTrials.gov (NCT03644979) on August 23, 2018. RESULTS: Skydiving resulted in a significant increase in salivary cortisol levels directly after skydiving compared to the control visit. Cortisol levels were still increased two hours after landing, while cortisol levels before skydiving were not significantly different from the baseline at the control visit. Skydiving did not induce a significant increase in gastroduodenal, small intestinal or colonic permeability. There was also no significant increase in plasma intestinal and liver fatty acid-binding proteins, suggesting no damage to the enterocytes. DISCUSSION: These results show that the acute intense psychological stress induced by skydiving does not affect intestinal permeability in healthy subjects. Future models aiming to investigate the effect of stress on human intestinal barrier function should consider a more sustained exposure to the psychological stressor.


Assuntos
Colo/fisiopatologia , Mucosa Intestinal/fisiopatologia , Intestino Delgado/fisiopatologia , Estresse Psicológico/fisiopatologia , Estresse Psicológico/psicologia , Adulto , Colo/metabolismo , Proteínas de Ligação a Ácido Graxo/metabolismo , Feminino , Gastroenteropatias/metabolismo , Gastroenteropatias/fisiopatologia , Gastroenteropatias/psicologia , Humanos , Hidrocortisona/metabolismo , Mucosa Intestinal/metabolismo , Intestino Delgado/metabolismo , Lactulose/metabolismo , Masculino , Permeabilidade , Ramnose/metabolismo , Estresse Psicológico/metabolismo
6.
J Psychosom Res ; 148: 110561, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34217956

RESUMO

OBJECTIVE: The COVID-19 pandemic has had a significant impact on mental health across the globe. People living with a chronic gastrointestinal (GI) disorder might be particularly at risk of mental health complications given higher rates of comorbid anxiety and depression compared to the healthy population. As GI disorders affect up to 40% of the population worldwide, this international collaborative study seeks to evaluate the extent of the impact of the COVID-19 pandemic on GI symptoms specifically and more generally on the well-being of those living with chronic GI conditions. METHODS: A longitudinal survey with three time points (baseline, 6-month, and 12-month) will be conducted online. Adult participants with GI disorders from multiple countries will be recruited via patient associations, social media advertising, utilizing snowball sampling. Participants will be invited to complete a battery of questionnaires including demographic and health parameters, and measures of gastrointestinal symptoms, fear of COVID-19, perceived impact of COVID-19, illness perceptions, coping, depression, anxiety, stress, catastrophizing, and quality of life, using validated measures where available. Statistical analyses will include univariate descriptive models, multivariate models utilizing regression, mediation, and moderation, and latent growth models. CONCLUSIONS: This project may present novel information to the field of psychogastroenterology and may provide crucial information regarding the areas of impact for individuals with GI disorders during and following the pandemic. Further, this information can guide healthcare providers and patient associations on how to target support related to the pandemic mental health sequelae for these patients.


Assuntos
COVID-19/epidemiologia , Gastroenteropatias/epidemiologia , Gastroenteropatias/psicologia , Inquéritos Epidemiológicos , Cooperação Internacional , Projetos de Pesquisa , Ansiedade/epidemiologia , Depressão/epidemiologia , Gastroenteropatias/fisiopatologia , Humanos , Estudos Longitudinais , Pandemias , Qualidade de Vida , Reprodutibilidade dos Testes , Estresse Psicológico/epidemiologia
7.
J Int Soc Sports Nutr ; 18(1): 36, 2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001168

RESUMO

BACKGROUND: Elite athletes may suffer from impaired immune function and gastro-intestinal (GI) symptoms, which may affect their health and may impede their performance. These symptoms may be reduced by multi-strain probiotic supplementation. Therefore, the aim of the current study is to examine the effects of probiotic supplementation on aerobic fitness characteristics, inflammatory markers and incidence and severity of GI symptoms in elite cyclists. METHODS: Twenty-seven male cyclists, ranked elite or category 1 level competitions, were randomly assigned to a multi-strain probiotic-supplemented group (E, n = 11) or placebo group (C, n = 16). All participants visited the laboratory at the beginning of the study and following 90 d of supplementation/placebo. Prior to testing, all participants completed a GI symptoms questionnaire and underwent physical and medical examination, and anthropometric measurements. Venous blood was drawn for inflammatory markers analysis. The cyclists then underwent maximal oxygen consumption (VO2max) test and time-to-fatigue (TTF) test at 85 % of maximal power, 3 h following the VO2max test. All testing procedures were repeated after 90 d of probiotic / placebo treatment (double blind design). RESULTS: Lower incidence of nausea, belching, and vomiting (P < 0.05) at rest, and decreased incidence of GI symptoms during training were found in E group vs. C Group, respectively (∆GI -0.27 ± 0.47 % vs. 0.08 ± 0.29 %, P = 0.03), no significant changes were observed in the incidence of total overall GI symptoms (∆GI -5.6 ± 14.7 % vs. 2.6 ± 11.6 %, P = 0.602) Mean rate of perceived exertion (RPE) values during the TTF were lower in E group (∆RPE: -0.3 ± 0.9 vs. 0.8 ± 1.5, P = 0.04). No significant changes were measured between and within groups in VO2max and TTF values, mean levels of C-reactive protein (CRP), IL-6-and tumor necrosis factor alpha (TNFα) values following treatment. CONCLUSIONS: Probiotics supplementation may have beneficial effects on GI symptoms in elite cyclists. Future studies, using higher doses and during different training seasons, might help understanding the effects of probiotic supplementation on elite athletes' health and performance. TRIAL REGISTRATION: NIH clinicaltrial.gov #NCT02756221 Registered 25 April 2016.


Assuntos
Desempenho Atlético/fisiologia , Ciclismo/fisiologia , Suplementos Nutricionais , Gastroenteropatias/prevenção & controle , Inflamação/prevenção & controle , Probióticos/administração & dosagem , Adulto , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Método Duplo-Cego , Gastroenteropatias/fisiopatologia , Humanos , Inflamação/fisiopatologia , Interleucina-6/sangue , Masculino , Fadiga Muscular , Consumo de Oxigênio , Condicionamento Físico Humano/fisiologia , Fator de Necrose Tumoral alfa/sangue , Adulto Jovem
8.
Nurs Clin North Am ; 56(2): 311-323, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34023124

RESUMO

Sleep deficiency in children is a public health concern, and it is highly comorbid in pediatric chronic pain conditions. Children may be particularly vulnerable to the deleterious effects of sleep deficiency, because comorbid sleep deficiency in chronic pain may further exacerbate already existent symptoms of pain, anxiety, depressions, daytime function, and increase health care use. Sleep deficiency is modifiable and integrating human-centered approaches into the development of sleep interventions is a pragmatic approach to partner with parents and children to provide them with the knowledge, motivation, and skills for setting and achieving goals, adapting to setbacks, and problem solving.


Assuntos
Dor Crônica/complicações , Transtornos do Sono-Vigília/etiologia , Anemia Falciforme/complicações , Anemia Falciforme/fisiopatologia , Artrite Juvenil/complicações , Artrite Juvenil/fisiopatologia , Dor Crônica/psicologia , Gastroenteropatias/complicações , Gastroenteropatias/fisiopatologia , Cefaleia/complicações , Cefaleia/fisiopatologia , Humanos , Pediatria/métodos , Pediatria/tendências , Transtornos do Sono-Vigília/fisiopatologia , Inquéritos e Questionários
9.
Mayo Clin Proc ; 96(4): 1071-1089, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33814075

RESUMO

Functional gastrointestinal (GI) disorders (FGIDs) result from central and peripheral mechanisms, cause chronic remitting-relapsing symptoms, and are associated with comorbid conditions and impaired quality of life. This article reviews sex- and gender-based differences in the prevalence, pathophysiologic factors, clinical characteristics, and management of functional dyspepsia (FD) and irritable bowel syndrome (IBS) that together affect approximately 1 in 4 people in the United States. These conditions are more common in women. Among patients with IBS, women are more likely to have severe symptoms and coexistent anxiety or depression; constipation or bloating and diarrhea are more common in women and men, respectively, perhaps partly because defecatory disorders, which cause constipation, are more common in women. Current concepts suggest that biological disturbances (eg, persistent mucosal inflammation after acute gastroenteritis) interact with other environmental factors (eg, abuse) and psychological stressors, which influence the brain and gut to alter GI tract motility or sensation, thereby causing symptoms. By comparison to a considerable understanding of sex-based differences in the pathogenesis of visceral hypersensitivity in animal models, we know less about the contribution of these differences to FGID in humans. Slow gastric emptying and colon transit are more common in healthy women than in men, but effects of gonadal hormones on colon transit are less important than in rodents. Although increased visceral sensation partly explains symptoms, the effects of sex on visceral sensation, colonic permeability, and the gut microbiome are less prominent in humans than rodents. Whether sex or gender affects response to medications or behavioral therapy in FD or IBS is unclear because most patients in these studies are women.


Assuntos
Gastroenteropatias/diagnóstico , Gastroenteropatias/fisiopatologia , Gastroenteropatias/terapia , Índice de Gravidade de Doença , Fatores Sexuais , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estados Unidos/epidemiologia
10.
Molecules ; 26(7)2021 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-33917379

RESUMO

Polyphenols are classified as an organic chemical with phenolic units that display an array of biological functions. However, polyphenols have very low bioavailability and stability, which make polyphenols a less bioactive compound. Many researchers have indicated that several factors might affect the efficiency and the metabolism (biotransformation) of various polyphenols, which include the gut microbiota, structure, and physical properties as well as its interactions with other dietary nutrients (macromolecules). Hence, this mini-review covers the two-way interaction between polyphenols and gut microbiota (interplay) and how polyphenols are metabolized (biotransformation) to produce various polyphenolic metabolites. Moreover, the protective effects of numerous polyphenols and their metabolites against various gastrointestinal disorders/diseases including gastritis, gastric cancer, colorectal cancer, inflammatory bowel disease (IBD) like ulcerative colitis (UC), Crohn's disease (CD), and irritable bowel syndrome (IBS) like celiac disease (CED) are discussed. For this review, the authors chose only a few popular polyphenols (green tea polyphenol, curcumin, resveratrol, quercetin), and a discussion of their proposed mechanism underpinning the gastroprotection was elaborated with a special focus on clinical evidence. Overall, this contribution would help the general population and science community to identify a potent polyphenol with strong antioxidant, anti-inflammatory, anti-cancer, prebiotic, and immunomodulatory properties to combat various gut-related diseases or disorders (complementary therapy) along with modified lifestyle pattern and standard gastroprotective drugs. However, the data from clinical trials are much limited and hence many large-scale clinical trials should be performed (with different form/metabolites and dose) to confirm the gastroprotective activity of the above-mentioned polyphenols and their metabolites before recommendation.


Assuntos
Gastroenteropatias/tratamento farmacológico , Polifenóis/uso terapêutico , Substâncias Protetoras/uso terapêutico , Estômago/patologia , Animais , Gastroenteropatias/microbiologia , Gastroenteropatias/fisiopatologia , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Metaboloma/efeitos dos fármacos , Polifenóis/química , Polifenóis/farmacologia , Estômago/efeitos dos fármacos
11.
Nat Rev Gastroenterol Hepatol ; 18(8): 571-587, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33731961

RESUMO

One of the most transformative developments in neurogastroenterology is the realization that many functions normally attributed to enteric neurons involve interactions with enteric glial cells: a large population of peripheral neuroglia associated with enteric neurons throughout the gastrointestinal tract. The notion that glial cells function solely as passive support cells has been refuted by compelling evidence that demonstrates that enteric glia are important homeostatic cells of the intestine. Active signalling mechanisms between enteric glia and neurons modulate gastrointestinal reflexes and, in certain circumstances, function to drive neuroinflammatory processes that lead to long-term dysfunction. Bidirectional communication between enteric glia and immune cells contributes to gastrointestinal immune homeostasis, and crosstalk between enteric glia and cancer stem cells regulates tumorigenesis. These neuromodulatory and immunomodulatory roles place enteric glia in a unique position to regulate diverse gastrointestinal disease processes. In this Review, we discuss current concepts regarding enteric glial development, heterogeneity and functional roles in gastrointestinal pathophysiology and pathophysiology, with a focus on interactions with neurons and immune cells. We also present a working model to differentiate glial states based on normal function and disease-induced dysfunctions.


Assuntos
Sistema Nervoso Entérico/fisiologia , Gastroenteropatias/fisiopatologia , Neuroglia/fisiologia , Animais , Sistema Nervoso Entérico/citologia , Gastroenteropatias/tratamento farmacológico , Motilidade Gastrointestinal/fisiologia , Homeostase , Humanos , Neuroglia/citologia , Transdução de Sinais
12.
Neurogastroenterol Motil ; 33(3): e14104, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33591607

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with gastrointestinal and hepatic manifestation in up to one fifth of patients. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiologic agent of COVID-19, infects gastrointestinal epithelial cells expressing angiotensin-converting enzyme 2 (ACE2) receptors triggering a cascade of events leading to mucosal and systemic inflammation. Symptomatic patients display changes in gut microbiota composition and function which may contribute to intestinal barrier dysfunction and immune activation. Evidence suggests that SARS-CoV-2 infection and related mucosal inflammation impact on the function of the enteric nervous system and the activation of sensory fibers conveying information to the central nervous system, which, may at least in part, contribute symptom generation such as vomiting and diarrhea described in COVID-19. Liver and pancreas dysfunctions have also been described as non-respiratory complications of COVID-19 and add further emphasis to the common view of SARS-CoV-2 infection as a systemic disease with multiorgan involvement. PURPOSE: The aim of this review was to highlight the current knowledge on the pathophysiology of gastrointestinal SARS-CoV-2 infection, including the crosstalk with the gut microbiota, the fecal-oral route of virus transmission, and the potential interaction of the virus with the enteric nervous system. We also review the current available data on gastrointestinal and liver manifestations, management, and outcomes of patients with COVID-19.


Assuntos
COVID-19/complicações , COVID-19/fisiopatologia , Gastroenteropatias/etiologia , Gastroenteropatias/fisiopatologia , Microbioma Gastrointestinal/fisiologia , Trato Gastrointestinal/fisiopatologia , Animais , Diarreia/etiologia , Diarreia/fisiopatologia , Diarreia/virologia , Disbiose/etiologia , Disbiose/fisiopatologia , Disbiose/virologia , Sistema Nervoso Entérico/fisiopatologia , Sistema Nervoso Entérico/virologia , Gastroenteropatias/virologia , Trato Gastrointestinal/virologia , Humanos , Hepatopatias/etiologia , Hepatopatias/fisiopatologia , Hepatopatias/virologia , Pancreatopatias/etiologia , Pancreatopatias/fisiopatologia , Pancreatopatias/virologia
13.
Pediatr Infect Dis J ; 40(3): e113-e115, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33565816

RESUMO

Multisystem inflammatory syndrome in children (MIS-C) is an emerging entity during the coronavirus disease 2019 pandemic. Medium- and large-vessel changes are present in MIS-C; however, microcirculatory impairment has not been documented. We report a case of MIS-C in a toddler that presented with persistent fever, gastrointestinal symptoms and rash. Nailfold videocapillaroscopy was abnormal, suggesting microcirculatory disease in the setting of MIS-C.


Assuntos
COVID-19/diagnóstico , Gastroenteropatias/diagnóstico , SARS-CoV-2/isolamento & purificação , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , COVID-19/fisiopatologia , COVID-19/virologia , Exantema , Febre , Gastroenteropatias/fisiopatologia , Gastroenteropatias/virologia , Humanos , Lactente , Masculino , México , Microcirculação , Angioscopia Microscópica , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/virologia
14.
J Clin Invest ; 131(4)2021 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-33586685

RESUMO

The extrinsic and autonomic nervous system intricately controls the major functions of the gastrointestinal tract through the enteric nervous system; these include motor, secretory, sensory, storage, and excretory functions. Disorders of the nervous system affecting gastrointestinal tract function manifest primarily as abnormalities in motor (rather than secretory) functions. Common gastrointestinal symptoms in neurologic disorders include sialorrhea, dysphagia, gastroparesis, intestinal pseudo-obstruction, constipation, diarrhea, and fecal incontinence. Diseases of the entire neural axis ranging from the cerebral hemispheres to the peripheral autonomic nerves can result in gastrointestinal motility disorders. The most common neurologic diseases affecting gastrointestinal function are stroke, parkinsonism, multiple sclerosis, and diabetic neuropathy. Diagnosis involves identification of the neurologic disease and its distribution, and documentation of segmental gut dysfunction, typically using noninvasive imaging, transit measurements, or intraluminal measurements of pressure activity and coordination of motility. Apart from treatment of the underlying neurologic disease, management focuses on restoration of normal hydration and nutrition and pharmacologic treatment of the gut neuromuscular disorder.


Assuntos
Neuropatias Diabéticas , Sistema Nervoso Entérico , Gastroenteropatias , Motilidade Gastrointestinal , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/tratamento farmacológico , Neuropatias Diabéticas/patologia , Neuropatias Diabéticas/fisiopatologia , Sistema Nervoso Entérico/efeitos dos fármacos , Sistema Nervoso Entérico/patologia , Sistema Nervoso Entérico/fisiopatologia , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/etiologia , Gastroenteropatias/patologia , Gastroenteropatias/fisiopatologia , Humanos
15.
Neurochem Int ; 144: 104938, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33535070

RESUMO

The localization of bacterial components and/or metabolites in the central nervous system may elicit neuroinflammation and/or neurodegeneration. Helicobacter pylori (a non-commensal symbiotic gastrointestinal pathogen) infection and its related metabolic syndrome have been implicated in the pathogenesis of gastrointestinal tract and central nervous system disorders, thus medications affecting the nervous system - gastrointestinal tract may shape the potential of Helicobacter pylori infection to trigger these pathologies. Helicobacter pylori associated metabolic syndrome, by impairing gut motility and promoting bacterial overgrowth and translocation, might lead to brain pathologies. Trimebutine maleate is a prokinetic drug that hastens gastric emptying, by inducing the release of gastrointestinal agents such as motilin and gastrin. Likewise, it appears to protect against inflammatory signal pathways, involved in inflammatory disorders including brain pathologies. Trimebutine maleate also acts as an antimicrobial agent and exerts opioid agonist effect. This study aimed to investigate a hypothesis regarding the recent advances in exploring the potential role of gastrointestinal tract microbiota dysbiosis-related metabolic syndrome and Helicobacter pylori in the pathogenesis of gastrointestinal tract and brain diseases. We hereby proposed a possible neuroprotective role for trimebutine maleate by altering the dynamics of the gut-brain axis interaction, thus suggesting an additional effect of trimebutine maleate on Helicobacter pylori eradication regimens against these pathologies.


Assuntos
Encefalopatias/tratamento farmacológico , Fármacos Gastrointestinais/uso terapêutico , Gastroenteropatias/tratamento farmacológico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Trimebutina/uso terapêutico , Encefalopatias/epidemiologia , Encefalopatias/fisiopatologia , Disbiose/tratamento farmacológico , Disbiose/epidemiologia , Disbiose/fisiopatologia , Fármacos Gastrointestinais/farmacologia , Gastroenteropatias/epidemiologia , Gastroenteropatias/fisiopatologia , Microbioma Gastrointestinal/efeitos dos fármacos , Microbioma Gastrointestinal/fisiologia , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/fisiopatologia , Helicobacter pylori/fisiologia , Humanos , Resultado do Tratamento , Trimebutina/farmacologia
16.
Neurogastroenterol Motil ; 33(5): e14092, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33550640

RESUMO

BACKGROUND: Psychological stress and anxiety, such those generated by forced quarantine, affect gastrointestinal symptoms course in patients with functional gastrointestinal disorders. Thus, our aim was to assess, in a cohort of patients regularly followed up in a devoted outpatient clinic of Southern Italy, the association between their gastrointestinal symptoms changes, stress, and anxiety reported during the Italian lockdown. METHODS: We recruited patients from the outpatient clinic of the University of Salerno, devoted to functional gastrointestinal disorders, selecting only patients for whom an evaluation was available in the last 6 months before the lockdown. Gastrointestinal symptoms were evaluated at each visit through standardized questionnaire and pooled in a database. On 45th days from the beginning of the lockdown, patients were re-assessed by phone with the same questionnaire. Anxiety and stress levels were assessed through a self-administered online questionnaire based on Generalized Anxiety Disorder 7 test and Perceived Stress Scale 10 test. KEY RESULTS: The intensity-frequency scores of several upper gastrointestinal symptoms improved (Wilcoxon test <0.05). Higher anxiety levels had a higher risk of worsening chest pain (OR 1.3 [1.1-1.7]), waterbrash (OR 1.3 [1.0-1.7]), epigastric burning (OR 1.3 [1.0-1.6]), and abdominal pain (OR 1.6 [1.0-2.3]). When compared to the interval preceding the outbreak, half of the patients declared their symptoms remained unchanged, 13.6% worsened, and 36.4% improved. CONCLUSIONS AND INFERENCES: During the COVID-19 quarantine, there was an improvement of the majority of upper gastrointestinal symptoms in our patients, and anxiety seems an important risk of worsening few of them.


Assuntos
Ansiedade/psicologia , COVID-19 , Dispepsia/fisiopatologia , Gastroenteropatias/fisiopatologia , Azia/fisiopatologia , Síndrome do Intestino Irritável/fisiopatologia , Estresse Psicológico/psicologia , Dor Abdominal/fisiopatologia , Dor Abdominal/psicologia , Adulto , Dor no Peito/fisiopatologia , Dor no Peito/psicologia , Controle de Doenças Transmissíveis , Dispepsia/psicologia , Feminino , Gastroenteropatias/psicologia , Azia/psicologia , Humanos , Síndrome do Intestino Irritável/psicologia , Itália , Masculino , Pessoa de Meia-Idade , Questionário de Saúde do Paciente , Política Pública , SARS-CoV-2 , Inquéritos e Questionários
17.
Nat Rev Gastroenterol Hepatol ; 18(5): 314-334, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33510461

RESUMO

Microorganisms colonize various ecological niches in the human habitat, as they do in nature. Predominant forms of multicellular communities called biofilms colonize human tissue surfaces. The gastrointestinal tract is home to a profusion of microorganisms with intertwined, but not identical, lifestyles: as isolated planktonic cells, as biofilms and in biofilm-dispersed form. It is therefore of major importance in understanding homeostatic and altered host-microorganism interactions to consider not only the planktonic lifestyle, but also biofilms and biofilm-dispersed forms. In this Review, we discuss the natural organization of microorganisms at gastrointestinal surfaces, stratification of microbiota taxonomy, biogeographical localization and trans-kingdom interactions occurring within the biofilm habitat. We also discuss existing models used to study biofilms. We assess the contribution of the host-mucosa biofilm relationship to gut homeostasis and to diseases. In addition, we describe how host factors can shape the organization, structure and composition of mucosal biofilms, and how biofilms themselves are implicated in a variety of homeostatic and pathological processes in the gut. Future studies characterizing biofilm nature, physical properties, composition and intrinsic communication could shed new light on gut physiology and lead to potential novel therapeutic options for gastrointestinal diseases.


Assuntos
Biofilmes , Gastroenteropatias/microbiologia , Microbioma Gastrointestinal/fisiologia , Trato Gastrointestinal/microbiologia , Gastroenteropatias/patologia , Gastroenteropatias/fisiopatologia , Trato Gastrointestinal/patologia , Trato Gastrointestinal/fisiologia , Trato Gastrointestinal/fisiopatologia , Homeostase , Humanos , Membrana Mucosa/microbiologia , Membrana Mucosa/patologia , Membrana Mucosa/fisiologia , Membrana Mucosa/fisiopatologia
18.
Theranostics ; 11(1): 292-303, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33391475

RESUMO

In systemic mastocytosis (SM), the clinical features and survival vary greatly. Patient-related factors determining the outcome in SM are largely unknown. Methods: We examined the impact of sex on the clinical features, progression-free survival (PFS), and overall survival (OS) in 3403 patients with mastocytosis collected in the registry of the European Competence Network on Mastocytosis (ECNM). The impact of cytogenetic and molecular genetic aberrations on sex differences was analyzed in a subset of patients. Results: Of all patients enrolled, 55.3% were females. However, a male predominance was found in a subset of advanced SM (AdvSM) patients, namely SM with an associated hematologic neoplasm (SM-AHN, 70%; p < 0.001). Correspondingly, organomegaly (male: 23% vs. female: 13%, p = 0.007) was more, whereas skin involvement (male: 71% vs. female: 86%, p = 0.001) was less frequent in males. In all patients together, OS (p < 0.0001) was significantly inferior in males, and also within the WHO sub-categories indolent SM, aggressive SM (ASM) and SM-AHN. PFS was significantly (p = 0.0002) worse in males when all patients were grouped together; due to low numbers of events, this significance persisted only in the subcategory smoldering SM. Finally, prognostically relevant cytogenetic abnormalities (10% vs. 5%, p = 0.006) or molecular aberrations (SRSF2/ASXL1/RUNX1 profile; 63% vs. 40%, p = 0.003) were more frequently present in males. Conclusions: Male sex has a major impact on clinical features, disease progression, and survival in mastocytosis. Male patients have an inferior survival, which seems related to the fact that they more frequently develop a multi-mutated AdvSM associated with a high-risk molecular background.


Assuntos
Aberrações Cromossômicas , Mastocitose Sistêmica/genética , Fatores Sexuais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Subunidade alfa 2 de Fator de Ligação ao Core/genética , Feminino , Gastroenteropatias/fisiopatologia , Neoplasias Hematológicas/complicações , Hepatomegalia/fisiopatologia , Humanos , Lactente , Recém-Nascido , Leucemia de Mastócitos/fisiopatologia , Leucemia Mieloide Aguda/complicações , Masculino , Mastocitose Sistêmica/complicações , Mastocitose Sistêmica/mortalidade , Mastocitose Sistêmica/fisiopatologia , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/complicações , Prognóstico , Intervalo Livre de Progressão , Proteínas Proto-Oncogênicas c-kit/genética , Proteínas Repressoras/genética , Fatores de Processamento de Serina-Arginina/genética , Dermatopatias/fisiopatologia , Esplenomegalia/fisiopatologia , Taxa de Sobrevida , Adulto Jovem
19.
Can J Cardiol ; 37(4): 621-631, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33440229

RESUMO

Acute heart failure (AHF) is a complex, heterogeneous, clinical syndrome with high morbidity and mortality, incurring significant health care costs. Patients transition from home to the emergency department, the hospital, and home again and require decisions surrounding diagnosis, treatment, and prognosis at each step of the way. The purpose of this review is to examine the epidemiology, etiology, and classifications of AHF and specifically focus on practical information relevant to the clinician. We examine the mechanisms of decompensation relevant to clinical presentations-including precipitating factors, neuroendocrine interactions, and inflammation-along with how consideration of these factors may help select therapies for an individual patient. The prevalence and significance of end-organ manifestations such as renal, gastrointestinal, respiratory, and neurologic manifestations are discussed. We also highlight how the development of renal dysfunction relates to the choice of a variety of diuretics that may be useful in specific circumstances and review guideline-directed medical therapy. We discuss the practical use (and pitfalls) of a variety of evidence-based clinical scoring criteria available to risk stratify patients with AHF. Finally, evidence-based management of AHF is discussed, including both pharmacologic and nonpharmacologic therapies, including the lack of evidence for using old and new vasodilators and the recent evidence regarding initiation of newer therapies in hospital. Overall, we suggest that clinicians consider implementing the newer data in AHF and subject existing practice patterns and treatments to the same rigour as new therapies.


Assuntos
Insuficiência Cardíaca/terapia , Doença Aguda/terapia , Algoritmos , Reabilitação Cardíaca , Fármacos Cardiovasculares/uso terapêutico , Disfunção Cognitiva/fisiopatologia , Técnicas de Diagnóstico Cardiovascular , Diuréticos/uso terapêutico , Medicina Baseada em Evidências , Gastroenteropatias/fisiopatologia , Insuficiência Cardíaca/classificação , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Inflamação/fisiopatologia , Nefropatias/fisiopatologia , Ventilação não Invasiva , Sistema Renina-Angiotensina/fisiologia , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia
20.
Int J Med Sci ; 18(3): 593-603, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33437194

RESUMO

Sleep disturbances often result from inappropriate lifestyles, incorrect dietary habits, and/or digestive diseases. This clinical condition, however, has not been sufficiently explored in this area. Several studies have linked the circadian timing system to the physiology of metabolism control mechanisms, energy balance regulation, and nutrition. Sleep disturbances supposedly trigger digestive disorders or conversely represent specific clinical manifestation of gastrointestinal (GI) diseases. Poor sleep may worsen the symptoms of GI disorders, affecting the quality of life. Conversely, short sleep may influence dietary choices, as well as meal timing, and the circadian system drives temporal changes in metabolic patterns. Emerging evidence suggests that patients with inappropriate dietary habits and chronic digestive disorders often sleep less and show lower sleep efficiency, compared with healthy individuals. Sleep disturbances may thus represent a primary symptom of digestive diseases. Further controlled trials are needed to fully understand the relationship between sleep disturbances, dietary habits, and GI disorders. It may be also anticipated that the evaluation of sleep quality may prove useful to drive positive interventions and improve the quality of life in a proportion of patients. This review summarizes data linking sleep disorders with diet and a series of disease including gastro-esophageal reflux disease, peptic disease, functional gastrointestinal disorders, inflammatory bowel diseases, gut microbiota alterations, liver and pancreatic diseases, and obesity. The evidence supporting the complex interplay between sleep dysfunction, nutrition, and digestive diseases is discussed.


Assuntos
Gastroenteropatias/complicações , Doenças Negligenciadas/complicações , Transtornos Nutricionais/complicações , Transtornos do Sono-Vigília/complicações , Ritmo Circadiano/fisiologia , Digestão/fisiologia , Gastroenteropatias/fisiopatologia , Humanos , Doenças Negligenciadas/fisiopatologia , Transtornos Nutricionais/fisiopatologia , Qualidade de Vida , Sono/fisiologia , Transtornos do Sono-Vigília/fisiopatologia
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