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Gastrointestinal Symptoms (gastrointestinal + symptom)

Distribution by Scientific Domains

Medical Sciences	96%
2 Other Domains	4%

Distribution within Medical Sciences

Gastroenterology & Hepatology	35%
Pediatrics	7%
Gastroenterology	5%
Dermatology	4%
Allergy & Clinical Immunology	3%
Anesthesia & Pain Management	2%
18 Other Subdomains	25%

Kinds of Gastrointestinal Symptoms

lower gastrointestinal symptom

upper gastrointestinal symptom

Selected Abstracts

Associations Between Helicobacter pylori Infection, Co-Morbid Infections, Gastrointestinal Symptoms, and Circulating Cytokines in African Children

HELICOBACTER, Issue 2 2010
Sarah Cherian
Abstract Background:, Refugee children have complex medical needs and often have multiple infections. The relationship between infection, gastrointestinal symptoms, and systemic inflammation is poorly understood. We investigated these parameters in refugee children with a high prevalence of Helicobacter pylori, helminth, and malaria infection. Materials and Methods:, African refugee children were recruited at resettlement health screening. Data were collected on demography, gastrointestinal symptoms, co-morbid infection, and serum for peripheral cytokine levels. Helicobacter pylori infection was diagnosed by a fecal-based immunoassay. Results:, Data from 163 children were analyzed, of which 84.0% were positive for H. pylori. Infected children were significantly older (9.2 years ± 3.7 vs 7.1 years ± 3.9, p = .01). Half the cohort (84/163, 51.5%) described gastrointestinal symptoms but these were not strongly associated with co-morbid infections. Helicobacter pylori -infected children had significantly lower circulating log-interleukin-8 (IL-8) (odds ratio 0.61, 95% confidence interval (CI) 0.40, 0.94, p = .025). Helminth infections were common (75/163, 46%) and associated with elevated log-IL-5 (,: 0.42, 95% CI 0.077, 0.76). Children with malaria (15/163, 9.2%) had elevated log-tumor necrosis factor-, (TNF,) and log-IL-10 (,: 0.67, 95% CI 0.34, 1.0 and ,: 1.3, 95% CI 0.67, 1.9, respectively). IL-10 : IL-12 ratios were increased in H. pylori- infected children with malaria or helminth infections. Symptoms were generally not associated with levels of circulating peripheral cytokines irrespective of co-morbid infection diagnosis. Conclusions:, There is a high prevalence of asymptomatic H. pylori infection in recently resettled African refugee children. Gastrointestinal symptoms were not predictive of H. pylori nor of helminth infections. Serum cytokines, particularly IL-5, IL-10, and TNF,, were significantly elevated in children with malaria and helminth infections but not in those with H. pylori infection. [source]

Comparative effects of levosulpiride and cisapride on gastric emptying and symptoms in patients with functional dyspepsia and gastroparesis

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2000
C. Mansi
Background: The efficacy of several prokinetic drugs on dyspeptic symptoms and on gastric emptying rates are well-established in patients with functional dyspepsia, but formal studies comparing different prokinetic drugs are lacking. Aim: To compare the effects of chronic oral administration of cisapride and levosulpiride in patients with functional dyspepsia and delayed gastric emptying. Methods: In a double-blind crossover comparison, the effects of a 4-week administration of levosulpiride (25 mg t.d.s.) and cisapride (10 mg t.d.s.) on the gastric emptying rate and on symptoms were evaluated in 30 dyspeptic patients with functional gastroparesis. At the beginning of the study and after levosulpiride or cisapride treatment, the gastric emptying time of a standard meal was measured by 13C-octanoic acid breath test. Gastrointestinal symptom scores were also evaluated. Results: The efficacy of levosulpiride was similar to that of cisapride in significantly shortening (P < 0.001) the t1/2 of gastric emptying. No significant differences were observed between the two treatments with regards to improvements in total symptom scores. However, levosulpiride was significantly more effective (P < 0.01) than cisapride in improving the impact of symptoms on the patients' every-day activities and in improving individual symptoms such as nausea, vomiting and early postprandial satiety. Conclusion: The efficacy of levosulpiride and cisapride in reducing gastric emptying times with no relevant side-effects is similar. The impact of symptoms on patients' everyday activities and the improvement of some symptoms such as nausea, vomiting and early satiety was more evident with levosulpiride than cisapride. [source]

Efficacy and Tolerability of the Ketogenic Diet According to Lipid:Nonlipid Ratios,Comparison of 3:1 with 4:1 Diet

EPILEPSIA, Issue 4 2007
Joo Hee Seo
Summary:,Purpose: The ketogenic diet (KD) has been considered a highly potent antiepileptic treatment for intractable childhood epilepsy. In this study, we compared the antiepileptic efficacy and diet tolerability of two different diets with lipid:nonlipid ratios of 3:1 and 4:1. Methods: Seventy-six patients with refractory childhood epilepsy were randomly placed into two groups and were started on KD diets with nonlipid:lipid ratios of either 3:1 or 4:1. Antiepileptic efficacy and diet tolerability were evaluated 3 months after initiating the diet. Patients showing seizure-free outcome with the 4:1 diet were changed to the 3:1 diet, and those without a seizure-free outcome on the 3:1 diet were changed to the 4:1 diet, for three more months, after which time their progress was monitored. Results: (1) Antiepileptic efficacy was higher for the 4:1 than the 3:1 diet (p < 0.05). Twenty-two (55.0%) of 40 patients on the 4:1 diet and 11 (30.5%) of 36 patients on the 3:1 diet became seizure free. Seizure reduction of over 90% was observed in 2 (5.0%) patients on the 4:1 diet, and 2 (5.6%) on the 3:1 diet. (2) Dietary tolerability was better for the 3:1 than the 4:1 diet. Gastrointestinal symptoms were observed in 5 (13.9%) patients with the 3:1 diet and 14 (35.0%) patients with the 4:1 diet (p < 0.05). (3) For seizure-free patients who started on the 4:1 diet, antiepileptic efficacy was maintained after changing to the 3:1 diet, while 10 (83.3%) of 12 patients who were not seizure free with the 3:1 diet showed increased seizure reduction after changing to the 4:1 diet. (4) Complications from the KD and laboratory data were not significantly different between the two groups. Conclusions: The 4:1 KD showed greater antiepileptic efficacy than the 3:1 diet with higher seizure-free outcome. In most cases, seizure free outcome was maintained even after changing the ratio to 3:1. Dietary tolerability was better in the 3:1 diet than the 4:1 with less frequent gastrointestinal symptoms. [source]

Associations Between Helicobacter pylori Infection, Co-Morbid Infections, Gastrointestinal Symptoms, and Circulating Cytokines in African Children

Gastrointestinal symptoms in intensive care patients

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009
A. REINTAM
Background: Gastrointestinal (GI) problems are not uniformly assessed in intensive care unit (ICU) patients and respective data in available literature are insufficient. We aimed to describe the prevalence, risk factors and importance of different GI symptoms. Methods: We prospectively studied all patients hospitalized to the General ICU of Tartu University Hospital in 2004,2007. Results: Of 1374 patients, 62 were excluded due to missing data. Seven hundred and seventy-five (59.1%) patients had at least one GI symptom at least during 1 day of their stay, while 475 (36.2%) suffered from more than one symptom. Absent or abnormal bowel sounds were documented in 542 patients (41.3%), vomiting/regurgitation in 501 (38.2%), high gastric aspirate volume in 298 (22.7%), diarrhoea in 184 (14.0%), bowel distension in 139 (10.6%) and GI bleeding in 97 (7.4%) patients during their ICU stay. Absent or abnormal bowel sounds and GI bleeding were associated with significantly higher mortality. The number of simultaneous GI symptoms was an independent risk factor for ICU mortality. The ICU length of stay and mortality of patients who had two or more GI symptoms simultaneously were significantly higher than in patients with a maximum of one GI symptom. Conclusion:, GI symptoms occur frequently in ICU patients. Absence of bowel sounds and GI bleeding are associated with impaired outcome. Prevalence of GI symptoms at the first day in ICU predicts the mortality of the patients. [source]

Indications of ,atopic bowel' in patients with self-reported food hypersensitivity

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2010
K. LILLESTØL
Aliment Pharmacol Ther,31, 1112,1122 Summary Background, An association between atopic disease and gastrointestinal complaints has been suggested. Aim, To explore the association between atopic disease, gastrointestinal symptoms, and possible gastrointestinal manifestations of atopic disease in patients with self-reported food hypersensitivity. Methods, Symptoms, skin prick tests, serum markers of allergy and intestinal permeability were recorded in 71 adult patients. Eosinophils, tryptase- and IgE-positive cells were counted in duodenal biopsies. Results, Sixty-six (93%) patients had irritable bowel syndrome (IBS) and 43 (61%) had atopic disease, predominantly rhinoconjunctivitis. All 43 were sensitized to inhalant allergens, 29 (41%) to food allergens, but food challenges were negative. Serum total IgE and duodenal IgE-positive cell counts were significantly correlated (P < 0.0001) and both were significantly higher in atopic than in non-atopic patients (P < 0.0001 and P = 0.003 respectively). IgE-positive cells appeared to be ,armed' mast cells. Intestinal permeability was significantly elevated in atopic compared with non-atopic patients (P = 0.02). Gastrointestinal symptoms and numbers of tryptase-positive mast cells and eosinophils did not differ between groups. Conclusions, Patients with self-reported food hypersensitivity had a high prevalence of IBS and atopic disease. Atopic patients had increased intestinal permeability and density of IgE-bearing cells compared with non-atopic patients, but gastrointestinal symptoms did not differ between groups. [source]

Comparison of breath testing with fructose and high fructose corn syrups in health and IBS

NEUROGASTROENTEROLOGY & MOTILITY, Issue 5 2008
S. M. Skoog
Abstract, Although incomplete fructose absorption has been implicated to cause gastrointestinal symptoms, foods containing high fructose corn syrup (HFCS) contain glucose. Glucose increases fructose absorption in healthy subjects. Our hypothesis was that fructose intolerance is less prevalent after HFCS consumption compared to fructose alone in healthy subjects and irritable bowel syndrome (IBS). Breath hydrogen levels and gastrointestinal symptoms were assessed after 40 g of fructose (12% solution) prepared either in water or as HFCS, administered in double-blind randomized order on 2 days in 20 healthy subjects and 30 patients with IBS. Gastrointestinal symptoms were recorded on 100-mm Visual Analogue Scales. Breath hydrogen excretion was more frequently abnormal (P < 0.01) after fructose (68%) than HFCS (26%) in controls and patients. Fructose intolerance (i.e. abnormal breath test and symptoms) was more prevalent after fructose than HFCS in healthy subjects (25%vs 0%, P = 0.002) and patients (40%vs 7%, P = 0.062). Scores for several symptoms (e.g. bloating r = 0.35) were correlated (P , 0.01) to peak breath hydrogen excretion after fructose but not HFCS; in the fructose group, this association did not differ between healthy subjects and patients. Symptoms were not significantly different after fructose compared to HFCS. Fructose intolerance is more prevalent with fructose alone than with HFCS in health and in IBS. The prevalence of fructose intolerance is not significantly different between health and IBS. Current methods for identifying fructose intolerance should be modified to more closely reproduce fructose ingestion in daily life. [source]

Gastrointestinal symptoms in adolescents with type 1 diabetes

PEDIATRIC DIABETES, Issue 4 2010
Maria Lodefalk
Lodefalk M, Åman J. Gastrointestinal symptoms in adolescents with type 1 diabetes. Objective: To compare the prevalence of gastrointestinal (GI) symptoms in adolescents with and without type 1 diabetes (T1DM) and to relate the symptoms in patients to demographic, socioeconomic, diabetes-specific variables, and food habits. Method: In a population-based, cross-sectional setting, 173 adolescents with T1DM and 160 matched controls completed a questionnaire. Moreover, 13 patients and 1 control were excluded due to having a GI disorder. Results: Moreover, 75% of patients and 77% of controls reported at least one GI symptom (ns). More girls than boys reported symptoms. Reflux episodes were more prevalent in patients with poorer socioeconomic status. Poor appetite, loss of weight, an uncomfortable feeling of fullness, swallowing difficulties, and nausea were more prevalent in patients smoking daily compared with patients not smoking daily. Vomiting was more prevalent in patients with duration of diabetes >7 yr, and patients with reflux episodes had higher glycated hemoglobin (HbA1c). Belching and early satiety were more prevalent in patients with an irregular meal pattern. Conclusions: GI symptoms in adolescents are common, but the prevalence is not increased in those with T1DM. GI symptoms in adolescents with T1DM are associated with female sex, poorer socioeconomic status, daily cigarette smoking, longer duration of diabetes, poorer metabolic control, and an irregular meal pattern. [source]

Differences in clinical features between influenza A H1N1, A H3N2, and B in adult patients

RESPIROLOGY, Issue 2 2003
Masahide KAJI
Objective: The differences in clinical features between influenza A H1N1, A H3N2, and B in the past three influenza seasons were examined. Methodology: Patients with respiratory symptoms who consulted Kurume University Medical Center, Department of Internal Medicine, Kurume, Fukuoka, Japan, from January to March in 1999, 2000, and 2001 were included. Based on virological and serological findings, the influenza patients were divided into the above three groups for comparison of symptoms and laboratory data. Results: Patients (n = 196) included 54 with influenza A H1N1, 98 with A H3N2, and 44 with B. Mean ages in the groups were 33 ± 8.4 years, 41 ± 15.2 years, and 29 ± 9.8 years (influenza B patients tended to be younger). Fever was much greater in the A H3N2 group (38.6 ± 0.46°C) than in the A H1N1 or B groups. This was also true for laboratory indices of viral infection. Gastrointestinal symptoms such as nausea, epigastralgia, and diarrhoea were prominent in influenza B. Myalgia was common in all groups. Conclusions: Influenza A H3N2 infection was more severe than A H1N1 or B in terms of fever, leukopenia, and C-reactive protein. Myalgia and other symptoms such as fever, headache, general malaise and sore throat were equally frequent in influenza A H3N2, A H1N1, and B infections. Gastrointestinal symptoms were more common in influenza B. [source]

Relevance of gastrointestinal symptoms in endometriosis

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009
Paulette MAROUN
Background: Endometriosis commonly presents with a range of symptoms none of which are particularly specific for the condition, often resulting in misdiagnosis or delay in diagnosis. Aim: To investigate gastrointestinal symptoms in women with endometriosis and compare their frequency with that of the classical gynaecological symptoms. Methods: Systematic exploration of symptoms in a consecutive series of 355 women undergoing operative laparoscopy for suspected endometriosis. Results: Endometriosis was confirmed by histology in 290 women (84.5%). Bowel lesions were present in only 7.6%. Ninety per cent of women had gastrointestinal symptoms, of which bloating was the most common (82.8%), but 71.3% also had other bowel symptoms. All gastrointestinal symptoms were similarly predictive of histologically confirmed endometriosis. Seventy-six women (21.4%) had previously been diagnosed with irritable bowel syndrome and 79% of them had endometriosis confirmed. Conclusion: Gastrointestinal symptoms are nearly as common as gynaecological symptoms in women with endometriosis and do not necessarily reflect bowel involvement. [source]

Effect of serotonin 1A agonist tandospirone on depression symptoms in senile patients with dementia

HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 4 2002
Yutaka Masuda
Abstract The treatment of depression in senile patients with dementia is difficult with the drugs used formerly. The effects of a new anxiolytic drug, tandospirone, were investigated on depression symptoms in nine senile patients with dementia using Hamilton Depression Rating Scale (HAM-D) items. Tandospirone improved the symptoms, especially the depressive mood, agitation and anxiety, although a slight gastrointestinal symptom was found in one patient. The findings in the present study may suggest that tandospirone is a useful and comparatively safe drug for depression symptoms in senile patients with dementia. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Recurrent abdominal pain, food allergy and endoscopy

ACTA PAEDIATRICA, Issue 1 2001
Steffen Husby
Gastrointestinal food allergy, a well-recognized clinical entity, has a wide spectrum of clinical features, including cutaneous, respiratory and gastrointestinal symptoms and objective abnormalities. The gastrointestinal alterations in food allergy have been described throughout the gastrointestinal tract. Recurrent abdominal pain (RAP) is a common complaint in school-age children. The findings among children with RAP of an underlying food allergy associated with mucosal pathology of the foregut may support a causal relationship between food allergy and RAP. Further studies are needed to elucidate whether well-documented food allergy (based on double-blind placebo-controlled food challenges) is a major cause of RAP. [source]

Prevalence of autoimmune diseases in islet transplant candidates with severe hypoglycaemia and glycaemic lability: previously undiagnosed coeliac and autoimmune thyroid disease is identified by screening

DIABETIC MEDICINE, Issue 2 2007
M. Walter
Abstract Aims, Autoimmune diseases such as Addison's or coeliac disease can contribute to hypoglycaemia or malabsorption and are more common in Type 1 diabetes (T1DM). This brief report describes the prevalence of known and newly detected autoimmune disease in clinical islet transplant candidates with longstanding T1DM and severe hypoglycaemia and/or glycaemic lability who are routinely screened for coexisting autoimmune disease. Methods, One hundred and twenty-four C-peptide negative T1DM subjects [77 (62%) female, mean age 44 ± 9 years, diabetes duration 28 ± 11 years, body mass index 24.9 ± 3.5 kg/m2] with indications for clinical islet transplantation at the University of Alberta were screened for autoimmune disease by history and measurement of anti-transglutaminase antibodies (positive > 10 U/ml), 09.00 h cortisol (followed by adrenocorticotrophic hormone-stimulation if < 495 nmol/l) and thyroid-stimulating hormone to determine the prevalence of coeliac disease, Addison's disease and autoimmune thyroid disease, respectively. Results, Forty per cent of subjects had one or more coexisting autoimmune disease. The prevalence of autoimmune disease was 35%, coeliac disease 8% and Addison's disease 1.6%. In 11 individuals (9%), one or more autoimmune disease were newly detected (seven coeliac disease and five thyroid disease). Seven of 10 cases of coeliac disease were newly detected. A gluten-free diet in individuals with newly diagnosed coeliac disease reduced gastrointestinal symptoms, but indications for clinical islet cell transplantation persisted. Conclusions, Coexisting autoimmune disease is common in candidates for clinical islet cell transplantation. Screening in this group identified a substantial number of previously unrecognized cases. Clinicians should consider the presence of autoimmune disease even in the absence of classical symptoms. [source]

Gastric emptying in diabetes: clinical significance and treatment

DIABETIC MEDICINE, Issue 3 2002
M. Horowitz
Abstract The outcome of recent studies has led to redefinition of concepts relating to the prevalence, pathogenesis and clinical significance of disordered gastric emptying in patients with diabetes mellitus. The use of scintigraphic techniques has established that gastric emptying is abnormally slow in approx. 30,50% of outpatients with long-standing Type 1 or Type 2 diabetes, although the magnitude of this delay is modest in many cases. Upper gastrointestinal symptoms occur frequently and affect quality of life adversely in patients with diabetes, although the relationship between symptoms and the rate of gastric emptying is weak. Acute changes in blood glucose concentration affect both gastric motor function and upper gastrointestinal symptoms. Gastric emptying is slower during hyperglycaemia when compared with euglycaemia and accelerated during hypoglycaemia. The blood glucose concentration may influence the response to prokinetic drugs. Conversely, the rate of gastric emptying is a major determinant of post-prandial glycaemic excursions in healthy subjects, as well as in Type 1 and Type 2 patients. A number of therapies currently in development are designed to improve post-prandial glycaemic control by modulating the rate of delivery of nutrients to the small intestine. [source]

SPLENIC RUPTURE FOLLOWING ROUTINE COLONOSCOPY

DIGESTIVE ENDOSCOPY, Issue 4 2010
Tabraze Rasul
Splenic rupture is a life-threatening condition characterized by internal hemorrhage, often difficult to diagnose. Colonoscopy is a gold standard routine diagnostic test to investigate patients with gastrointestinal symptoms as well as to those on the screening program for colorectal cancer. Splenic injury is seldomly discussed during consent for colonoscopy, as opposed to colonic perforation, as its prevalence accounts for less than 0.1%. A 66-year-old Caucasian woman with no history of collagen disorder was electively admitted for routine colonoscopy for surveillance of adenoma. She was admitted following the procedure for re-dosing of warfarin, which was stopped prior to the colonoscopy. The patient was found collapsed on the ward the following day with clinical shock and anemia. Computed tomography demonstrated grade 4 splenic rupture. Immediate blood transfusion and splenectomy was required. Splenic rupture following routine colonoscopy is extremely rare. Awareness of it on this occasion saved the patient's life. Despite it being a rare association, the seriousness warrants inclusion in all information leaflets concerning colonoscopy and during its consent. [source]

Validation of the Mayo Dysphagia Questionnaire

DISEASES OF THE ESOPHAGUS, Issue 3 2007
A. B. M. Grudell
SUMMARY., While multiple instruments characterize upper gastrointestinal symptoms, a validated instrument devoted to the measurement of a spectrum of esophageal dysphagia attributes is not available. Therefore, we constructed and validated the Mayo Dysphagia Questionnaire (MDQ). The 27 items of the MDQ underwent content validity, feasibility, concurrent validity, reproducibility, internal consistency, and construct validity testing. To assess content validity, five esophageal subspecialty gastroenterologists reviewed the items to ensure inclusion of pertinent domains. Feasibility testing was done with eight outpatients who refined problematic items. To assess concurrent validity, 70 patient responses on the MDQ were compared to responses gathered in a structured patient-physician interview. A separate group of 70 outpatients completed the MDQ twice to assess the reproducibility of each item. A total of 148 patients participated in the validation process (78 [53%] men; mean age 62). On average, the MDQ took 6 minutes to complete. A single item (odynophagia) tested poorly with a kappa value of < 0.4. Otherwise, the majority of concurrent validity kappa values were in the good to excellent range with a mean of 0.63 (95% CI 0.22,0.89). The majority of reproducibility kappa values were also in the good to excellent range with a median kappa value of 0.76 (interquartile range: 0.67,0.81). Cronbach's alpha values were excellent in the range of 0.86,0.88. Spearman rank correlation coefficients to assess construct validity were also excellent in the range of 0.87,0.98. Thus, the MDQ is a concise instrument that demonstrates overall excellent concurrent validity, reproducibility, internal consistency, and construct validity for the features of esophageal dysphagia. [source]

Whole stomach with antro-pyloric nerve preservation as an esophageal substitute: an original technique

DISEASES OF THE ESOPHAGUS, Issue 2 2004
J.-M. Collard
SUMMARY., The paper describes an original technique of gastric tailoring in which the two-thirds of the lesser curvature proximal to the crow's foot are denuded flush with the gastric wall, leaving both nerves of Latarjet and the hepatic branches of the left vagus nerve intact. Maintenance of the vagal supply to the antro-pyloric segment in two patients resulted in the presence of peristaltic contractions sweeping over the antrum on simple observation of the antral wall at the end of the procedure and on both upper G-I series and intragastric manometry tracings 6 weeks postoperatively. Gastric exposure to bile on 24-h gastric bile monitoring was normal 6 weeks after the operation. Neither patient had any gastrointestinal symptoms with the exception of early sensations of postprandial fullness when overeating. [source]

Psychological and emotional aspects of gastroesophageal reflux disease

DISEASES OF THE ESOPHAGUS, Issue 3 2002
T. Kamolz
SUMMARY. A synergy exists between the psychological and physiological aspects of esophageal and other gastrointestinal symptoms. Based on a biopsychosocial model of disease, several multidisciplinary concepts of interventions in gastrointestinal disorders have been evaluated. The role of psychological factors in gastroesophageal reflux disease (GERD) has been under study. This article reviews psychological and emotional factors influencing GERD symptoms and treatment. [source]

Surveillance of Infectious Disease Occurrences in the Community: An Analysis of Symptom Presentation in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 7 2003
Joe Suyama MD
Objectives: To determine the effectiveness of a simulated emergency department (ED)-based surveillance system to detect infectious disease (ID) occurrences in the community. Methods: Medical records of patients presenting to an urban ED between January 1, 1999, and December 31, 2000, were retrospectively reviewed for ICD-9 codes related to ID symptomatology. ICD-9 codes, categorized into viral, gastrointestinal, skin, fever, central nervous system (CNS), or pulmonary symptom clusters, were correlated with reportable infectious diseases identified by the local health department (HD). These reportable infectious diseases are designated class A diseases (CADs) by the Ohio Department of Health. Cross-correlation functions (CCFs) tested the temporal relationship between ED symptom presentation and HD identification of CADs. The 95% confidence interval for lack of trend correlation was 0.0 ± 0.074; thus CCFs > 0.074 were considered significant for trend correlation. Further cross-correlation analysis was performed after chronic and non-community-acquirable infectious diseases were removed from the HD database as a model for bioterrorism surveillance. Results: Fifteen thousand five hundred sixty-nine ED patients and 6,489 HD patients were identified. Six thousand two hundred eight occurrences of true CADs were identified. Only 87 (1.33%) HD cases were processed on weekends. During the study period, increased ED symptom presentation preceded increased HD identification of respective CADs by 24 hours for all symptom clusters combined (CCF = 0.112), gastrointestinal symptoms (CCF = 0.084), pulmonary symptoms (CCF = 0.110), and CNS symptoms (CCF = 0.125). The bioterrorism surveillance model revealed increased ED symptom presentation continued to precede increased HD identification of the respective CADs by 24 hours for all symptom clusters combined (CCF = 0.080), pulmonary symptoms (CCF = 0.100), and CNS symptoms (CCF = 0.120). Conclusions: Surveillance of ED symptom presentation has the potential to identify clinically important ID occurrences in the community 24 hours prior to HD identification. Lack of weekend HD data collection suggests that the ED is a more appropriate setting for real-time ID surveillance. [source]

Efficacy and Tolerability of the Ketogenic Diet According to Lipid:Nonlipid Ratios,Comparison of 3:1 with 4:1 Diet

Associations Between Helicobacter pylori Infection, Co-Morbid Infections, Gastrointestinal Symptoms, and Circulating Cytokines in African Children

Antimicrobial Susceptibility of Helicobacter pylori Strains in a Random Adult Swedish Population

HELICOBACTER, Issue 4 2006
Tom Storskrubb
Abstract Background and Aim:, Antimicrobial resistance in Helicobacter pylori is a growing problem and has become an important factor leading to eradication failure. Information on antimicrobial susceptibility is important for selection of an optimum treatment regimen. The resistance rate in a random population has not been studied previously. Methods:, A random Swedish population sample (n = 3000, age 20,81 years) was surveyed using a mailed validated questionnaire assessing gastrointestinal symptoms (response rate of 74%). One-third of the responders was invited, in random order, and accepted an esophagogastroduodenoscopy with biopsies for H. pylori culture and histology. Subjects were not treated for their H. pylori infection but a minimum inhibitory concentration of metronidazole, clarithromycin, amoxicillin, and tetracycline for the H. pylori isolates (n = 333) was determined by agar dilution. Prescribed antibiotic in the area was recorded. Results:, Irrespective of symptomatology, 16.2% of the isolated H. pylori strains were resistant to metronidazole, 1.5% to clarithromycin, 0% to amoxicillin, and 0.3% to tetracycline. The antibiotic consumption was low from an international perspective. Conclusion:, The resistance to the antibiotics was lower than expected from patient sample studies, especially for clarithromycin, most probably due to a restrictive prescription policy in the area. Introduction of a test-and-treat strategy in Sweden would only marginally affect the usage of clarithromycin. [source]

Encapsulating peritoneal sclerosis: Importance to the hemodialysis practitioner

HEMODIALYSIS INTERNATIONAL, Issue 4 2009
Jeffrey PERL
Abstract Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of long-term peritoneal dialysis (PD) therapy. Encapsulating peritoneal sclerosis is characterized by peritoneal membrane inflammation, followed by progressive peritoneal membrane fibrosis and intestinal encapsulation. Clinical manifestations include ascites as well as intermittent and recurrent small bowel obstruction. The prognosis of EPS is poor. The exact cause of EPS remains unknown. While the risk factors for EPS are not well elucidated, EPS is seen with increased frequency after an increased duration of PD therapy. In more than half the patients who develop EPS, the diagnosis is made after transfer to hemodialysis (HD). It is important for the HD practitioner to initiate surveillance in any patient at risk for EPS while maintaining a heightened index of suspicion for EPS in an HD patient with gastrointestinal symptoms and a history of previous PD therapy. Early diagnosis and prompt initiation of treatment is essential. Early in the course of EPS, immunosuppressive therapy remains the mainstay of treatment. Ultimately, parenteral nutritional support may be required along with surgical therapy to relieve intestinal obstruction. We report a case of EPS in an HD patient at our center highlighting the incidence, risk factors, and treatment strategies in the context of available evidence. [source]

Fecal S100A12 and fecal calprotectin as noninvasive markers for inflammatory bowel disease in children

INFLAMMATORY BOWEL DISEASES, Issue 3 2008
Marc A. Sidler MD
Abstract Background: Fecal calprotectin is a sensitive marker for gut inflammation. Recently, we have established that a related protein, S100A12, is elevated in the feces of children with inflammatory bowel disease (IBD). This may represent a specific and sensitive disease marker. The objective was to investigate the utility of fecal S100A12, in comparison to fecal calprotectin and standard inflammatory markers, as a screening marker for IBD in children with gastrointestinal symptoms. Methods: Stool samples were obtained from 61 children presenting with gastrointestinal symptoms requiring endoscopy. Fecal S100A12, calprotectin, and serum S100A12 levels were measured and correlated to final diagnosis and standard tests (ESR, CRP, platelet count, and albumin). Results: Children diagnosed with IBD (n = 31) had elevated fecal S100A12 (median 55.2 mg/kg) and calprotectin (median 1265 mg/kg) levels compared with the children without IBD (n = 30; S100A12: median 1.1 mg/kg, P < 0.0001; calprotectin: median 30.5 mg/kg; P < 0.0001). The sensitivity and specificity of fecal S100A12 (cutoff 10 mg/kg) for the detection of IBD were both 97%, whereas fecal calprotectin (cutoff 50 mg/kg) gave a sensitivity of 100% and a specificity of 67%. Conclusions: Both fecal markers were superior to the sensitivities and specificities of any standard inflammatory test. Both fecal S100A12 and calprotectin are sensitive markers of gastrointestinal inflammation, but fecal S100A12 provided exceptional specificity in distinguishing children with IBD from children without IBD. Fecal S100A12 is a simple, noninvasive test that can be used to screen and select children warranting further invasive and laborious procedures such as endoscopy for the investigation of their gastrointestinal symptoms. (Inflamm Bowel Dis 2007) [source]

Oro-facial granulomatosis: Crohn's disease or a new inflammatory bowel disease?

INFLAMMATORY BOWEL DISEASES, Issue 9 2005
FRCP, Jeremy Sanderson MD
Abstract Background: Oro-facial granulomatosis (OFG) is a rare chronic inflammatory disorder presenting characteristically with lip swelling but also affecting gingivae, buccal mucosa, floor of mouth, and a number of other sites in the oral cavity. Histologically, OFG resembles Crohn's disease (CD), and a number of patients with CD have oral involvement identical to OFG. However, the exact relationship between OFG and CD remains unknown. Methods: Thirty-five patients with OFG and no gut symptoms were identified from a combined oral medicine/gastroenterology clinic. All underwent a standardized assessment of the oral cavity and oral mucosal biopsy to characterize the number of sites affected and the type of inflammation involved. Hematological and biochemical parameters were also recorded. All 35 patients underwent ileocolonoscopy and biopsy to assess the presence of coexistent intestinal inflammation. Results: Ileal or colonic abnormalities were detected in 19/35 (54%) cases. From gut biopsies, granulomas were present in 13/19 cases (64%). An intestinal abnormality was significantly more likely if the age of OFG onset was less than 30 years (P = 0.01). Those with more severe oral inflammation were also more likely to have intestinal inflammation (P = 0.025), and there was also a correlation between the histologic severity of oral inflammation and the histologic severity of gut inflammation (P = 0.047). No relationship was found between any blood parameter and intestinal involvement. Conclusions: Endoscopic and histologic intestinal abnormalities are common in patients with OFG with no gastrointestinal symptoms. Younger patients with OFG are more likely to have concomitant intestinal involvement. In these patients, granulomas are more frequent in endoscopic biopsies than reported in patients with documented CD. OFG with associated intestinal inflammation may represent a separate entity in which granulomatous inflammation occurs throughout the gastrointestinal tract in response to an unknown antigen or antigens. [source]

The epidemiological aspects of irritable bowel syndrome in Southeastern Anatolia: a stratified randomised community-based study

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2005
erif Yilmaz
Summary Even though studies on the epidemiology of the irritable bowel syndrome (IBS) are increasing day by day, epidemiological data are still unknown in many regions. Our objective was to determine the IBS prevalence, factors associated with this prevalence and probable risk groups in Southeastern Anatolia. The total population in the target region is approximately 6 million. A total of 3000 people (1521 females and 1479 males) randomly selected by stratified cluster sampling were interviewed face-to-face by using a questionnaire comprising demographic features and the Rome II criteria which also included probable risk factors and questions related with Bristol scale stool form. The statistical analysis was performed by using a package program called epi info 2000. IBS prevalence was 10.2% according to the Rome II criteria in our region. Six hundred and twenty-five of 3000 subjects had gastrointestinal symptoms in the last 3 months. IBS rate was higher in women (12.4%) than in men (8.0%), and married subjects had higher IBS rates (11.6%) than singles (6.7%). Those differences were statistically significant (p = 0.000 for both). It was most common in the 35,54-year age group. No difference was observed in terms of settlement (rural/urban), age group, education and occupation. History of abortion in women increased the IBS risk by 1.8 times (p = 0.000 Crude odds ratios = 1.8 (1.3,2.6) 95% confidence intervals). Of the IBS patients, 48.1% had characteristics of diarrhoea-predominance, 38.9% constipation-predominance while 13.0% had none. There was a significant relation between dominant stool form and Bristol scale stool form. IBS prevalence is 10.2% in the first community-based study carried out in this specific subject in Southeastern Anatolia. The dominance of middle age and females remained significant. [source]

Gastric adenocarcinoma mistakenly diagnosed as an eating disorder: Case report

INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 3 2010
FRANZCP, Leit-Chin Siew MBBS
Abstract Objective: A number of organic conditions may mimic the symptoms of an eating disorder, however, gastric outlet obstruction mimicking anorexia nervosa has rarely been reported. Method: We report the case of a 51-year-old female admitted to an eating disorders unit with an initial diagnosis of anorexia nervosa. Results: The patient's upper gastrointestinal symptoms and weight loss were found to be secondary to gastric outlet obstruction from a gastric adenocarcinoma. Coincidental psychosocial stressors and past psychiatric history, among other factors, had confounded the diagnosis. Discussion: Organic causes of weight loss and upper gastrointestinal symptoms need to be fully excluded prior to making the diagnosis of an eating disorder, particularly when there are atypical features in the presentation. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010 [source]

Distribution trends of colorectal adenoma and cancer: A colonoscopy database analysis of 11 025 Chinese patients

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 10 2010
Yu Bai
Abstract Background and Aim:, A left-to-right shift of colorectal cancer (CRC) has been reported in Western studies. However, few Asian studies have investigated the anatomic distribution of colorectal adenoma and CRC. We aimed to describe the time trends in the distribution of colorectal adenoma and CRC in a Chinese population. Methods:, A colonoscopy database was reviewed, and all consecutive patients with lower gastrointestinal symptoms who underwent colonoscopy from 1998 to 2009 were identified. Data, including patients' sex, age, symptoms, and the number and anatomic locations of colorectal adenoma and CRC, were documented. Results:, A total of 11 025 patients were included in the final analysis; 1012 and 363 patients were diagnosed with colorectal adenoma and CRC, respectively. Overall, there were more distal than proximal adenomas (54.4% vs 37.9%), and the proportion of proximal adenomas remained stable from 1998,2006 to 2007,2009 (38.2% vs 37.6%). Similarly, there were more distal than proximal CRC (56.5% vs 42.4%), and the proportion of proximal CRC declined from 45.8% in 1998,2006 to 38.4% in 2007,2009. Colorectal adenoma and CRC were equally distributed among both sexes. For elderly patients (> 50 years), there was a non-significant trend towards more proximal adenoma and CRC. Conclusions:, The present study suggests no distal-to-proximal shift of colorectal adenoma and CRC among the Chinese population in Shanghai over the past 12 years. The distribution pattern of colorectal adenoma and CRC of Chinese patients is different from that of Western patients, who had more colorectal lesions located in the distal part. [source]

Psychological comorbidity and complexity of gastrointestinal symptoms in clinically diagnosed irritable bowel syndrome patients

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7pt1 2008
Antonina Mikocka-Walus
Abstract Background and Aim:, The prevalence of psychological disorders is high in patients with irritable bowel syndrome (IBS) but their role in symptom reporting is uncertain. It is thus interesting whether the number of functional gastrointestinal disorders (FGID) determines the load of psychological comorbidity. The Rome III criteria have not been used to evaluate such a relationship as yet. Moreover, not many studies have examined the sensitivity of the Rome III criteria in detecting IBS. Our aims were therefore: (i) to determine whether those IBS participants with more FGID had a tendency to greater psychological comorbidity than those with fewer FGID; and (ii) to assess the performance of the Rome III criteria in detecting IBS versus the diagnosis of the gastroenterologist. Methods:, A cross-sectional survey of 32 consecutive outpatients with clinically diagnosed IBS was performed. The Hospital Anxiety and Depression Scale (HADS), the Short Form 12 Health Survey (SF-12), and the Rome III criteria questionnaire (BDQ-6) were administered. Multiple linear regression was conducted to detect associations among FGID, anxiety, depression and quality of life. Results:, Overall, 50% of participants were anxious and 12% were depressed. Forty-four percent of participants had >two FGID; however, the number of FGID did not correlate with scores for anxiety, depression or quality of life. Amazingly, only 50% (CI: 33,67) of participants clinically diagnosed with IBS met Rome III criteria for IBS. Conclusion:, Contrary to our expectations, a greater load of FGID did not correlate with a greater load of psychological comorbidity. Surprisingly, the Rome III criteria detected only 50% of clinical cases of IBS. [source]

CLINICAL COURSE and RELAPSE RATE IN INTESTINAL BEHCET'S DISEASE

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2001
TI Kim
Behçet's disease is a multisystemic recurrent inflammatory disease. Gastrointestinal tract involvement in Behçet's disease has been identified throughout the alimentary tract and causes diverse symptoms. Various treatment have been utilized to induce or maintain remission. However, little is known about clinical course and prognosis in Behçet's disease with intestinal involvement. The aims of this study were to evaluate the clinical course and relapse rate in intestinal Behçet's disease and to investigate factors that may affect relapse. Methods, Clinical course and characteristics, including demographic parameters, gastrointestinal symptoms as well as systemic manifestations, laboratory data, endoscopic findings, and treatment strategies for the induction of remission, of 97 patients (49 male, 48 female) with intestinal Behçet's disease were retrospectively reviewed. Cumulative relapse free rate and factors related with relapse were analysed by Kaplan,Meier method and log,rank test, respectively. Results, The median duration of the relapse free period was 7 months (ranges from 1 to 171 months). One, two, and five year relapse free rates were 41.2, 29.7 and 10.2%, respectively. Sex, clinical subtype of Behçet's disease, symptom and laboratory data at onset, colonoscopic findings, such as distribution of lesions as well as number, size, depth, and shape of ulcer, and initial treatment (medical vs. surgical) did not affect relapse rate. However, large ulcers (> 20 mm) and young age at onset (< 37 years old) were factors significantly related with higher relapse rate (P < 0.05, log,rank test). Conclusion, High relapse rate in intestinal Behçet's disease was identified. Age at onset and size of the ulcer are factors related with long-term prognosis of intestinal Behçet's disease. [source]