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Safe Natural Remedies to Help Soothe Your Little One's Constipation Z Living (blog) Full coverage View the full article
Pubmed-Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis.
Related Articles Effect of Antidepressants and Psychological Therapies in Irritable Bowel Syndrome: An Updated Systematic Review and Meta-analysis. Am J Gastroenterol. 2018 Sep 03;: Authors: Ford AC, Lacy BE, Harris LA, Quigley EM, Moayyedi P Abstract OBJECTIVES: Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that is thought to be due to a disorder of brain-gut function. Drugs acting centrally, such as antidepressants, and psychological therapies may, therefore, be effective. METHODS: We updated a previous systematic review and meta-analysis of randomized controlled trials (RCTs). MEDLINE, EMBASE, PsychINFO, and the Cochrane Controlled Trials Register were searched (up to July 2017). Trials recruiting adults with IBS, which compared antidepressants versus placebo, or psychological therapies versus control therapy or "usual management" were eligible. Dichotomous symptom data were pooled to obtain a relative risk (RR) of remaining symptomatic after therapy, with a 95% confidence interval (CI). RESULTS: The search strategy identified 5316 citations. Fifty-three RCTs, reported in 51 separate articles, were eligible for inclusion: 17 compared antidepressants with placebo, 35 compared psychological therapies with control therapy or "usual management", and one compared both psychological therapy and antidepressants with placebo. Four of the trials of psychological therapies, and one of the RCTs of antidepressants, were identified since our previous meta-analysis. The RR of IBS symptoms not improving with antidepressants versus placebo was 0.66 (95% CI 0.57-0.76), with similar treatment effects for both tricyclic antidepressants and SSRIs, although with heterogeneity between RCTs of the latter (I2 = 49%, P = 0.07). The RR of symptoms not improving with psychological therapies was 0.69 (95% CI 0.62-0.76). Cognitive behavioral therapy, relaxation therapy, multi-component psychological therapy, hypnotherapy, and dynamic psychotherapy were all beneficial when data from two or more RCTs were pooled. There was significant heterogeneity between studies (I2 = 69%, P < 0.001) and significant funnel plot asymmetry. There were also issues regarding trial design, including lack of blinding. CONCLUSIONS: Antidepressants are efficacious in reducing symptoms in IBS patients. Psychological therapies also appear to be effective treatments for IBS, although there are limitations in the quality of the evidence, and treatment effects may be overestimated as a result. PMID: 30177784 [PubMed - as supplied by publisher] View the full article
Pubmed-Sleep Disturbance and Its Association with Gastrointestinal Symptoms/Diseases and Psychological Comorbidity.
Sleep Disturbance and Its Association with Gastrointestinal Symptoms/Diseases and Psychological Comorbidity. Digestion. 2018 Sep 04;:1-8 Authors: Lei WY, Chang WC, Wong MW, Hung JS, Wen SH, Yi CH, Liu TT, Chen JH, Hsu CS, Hsieh TC, Chen CL Abstract BACKGROUND/AIMS: We aimed to investigate gastrointestinal symptoms, clinical characteristics, and psychological factors in subjects with and without sleep disturbance (SD) in a health screening cohort. METHODS: We enrolled 2,752 consecutive subjects during their health checkups. All participants underwent an evaluation with questionnaires. Demographic characteristics and biochemical data were recorded. SD was confirmed when Pittsburgh Sleep Quality Index score was greater than 5. RESULTS: Among the study population (n = 2,674), 956 (36%) individuals had SD. SD was associated with female gender, older age, lower level of education, higher systolic blood pressure, higher serum high-density lipoprotein levels and higher prevalence of functional dyspepsia and irritable bowel syndrome (IBS). SD subjects also had more depression, more anxiety, more severe gastrointestinal reflux disease symptoms and higher prevalence of non-erosive reflux disease (NERD; p < 0.001). SD was -independently associated with female gender (OR 1.75, p < 0.001), older age (OR 1.03, p < 0.001), NERD (OR 1.88, p = 0.004), IBS (OR 1.51, p = 0.043), and depression (OR 1.16, p < 0.001) by multivariate analysis. CONCLUSIONS: Future studies will be needed to clarify the interrelationships among SD, psychological stress, and functional gastrointestinal disorders. PMID: 30179863 [PubMed - as supplied by publisher] View the full article
The Predictive Value of the Hydrogen Breath Test in the Diagnosis of Fructose Malabsorption. Digestion. 2018 Sep 04;:1-8 Authors: Helwig U, Koch AK, Koppka N, Holtmann S, Langhorst J Abstract BACKGROUND: Fructose malabsorption is commonly diagnosed by the hydrogen fructose (H2) breath test. However, the mechanisms behind fructose malabsorption in humans are not well understood and the clinical relevance of this test is considered controversial. Hence, the main aim of this study is to evaluate the predictive value of the H2 breath test. METHODS: Regarding exclusion criteria, the study enrolled 562 consecutive patients, enlisted to a gastroenterology clinic between 2009 and 2011 for testing malabsorption. In the final data analysis, 246 patients were included. Ecotrophologists used 3 categories to rate dietary success: complete response, partial response and no response to the diet. They also rated the occurrence of abdominal pain, diarrhoea and bloating during the H2 breath test. Ordinal regression analysis using SPSS was performed to evaluate whether H2 breath test results - measured as the maximum H2 level, the maximum increase in H2, and the area under the curve (AUC) - predicted dietary success or failure. Correlation analyses were applied to test whether symptoms of fructose malabsorption correlated with the H2 breath test measures. Finally, we evaluated whether cut-off-values of 40 or 60 parts per million (ppm) serve better than the test measure of 20 ppm to diagnose fructose malabsorption. RESULTS: When a fructose-free diet was administered it was found that 103 patients (41.9%) were complete responders, 116 (47.2%) were partial responders and 27 (11%) were non-responders. The H2 breath test with the 20 ppm cut-off-value, that is, the maximum H2 level, the maximum increase in H2, and the AUC did not predict dietary response (all 95% CI ns). This was also the case when using 40 or 60 ppm as cut-off-values (all 95% CI ns). Abdominal pain during the test correlated significantly with the AUC. Diarrhoea and bloating correlated significantly with the AUC, the maximum H2 level and the maximum increase in H2 (p < 0.05). CONCLUSIONS: The H2 breath test produced no predictive value for the fructose-free diet outcomes; its value as a predictive test is therefore questionable. However, the symptoms of fructose malabsorption correlated significantly with the H2 breath test measures, and this is an indication that there is at least a degree of validity of the H2 breath test beyond the simple detection or exclusion of fructose malabsorption. PMID: 30179874 [PubMed - as supplied by publisher] View the full article
Twitter-RT @NIH_NCCIH: Pain affects patients physically and emotionally. NCCIH’s #HopeThroughResearch series will focus on researchers as they shar…
RT @NIH_NCCIH: Pain affects patients physically and emotionally. NCCIH’s #HopeThroughResearch series will focus on researchers as they shar… (RSS generated with FetchRss) View the full article
Twitter-In case you missed it...Why a GI #Dietitian Adds Value to a GI Practice https://t.co/DJyHd4PT1u
In case you missed it...Why a GI #Dietitian Adds Value to a GI Practice http://bit.ly/2uOjeOp (RSS generated with FetchRss) View the full article
Twitter-#FODMAPs: Overview of the Emerging Science - Today's Dietitian Magazine https://t.co/AQzBEK8KdE
#FODMAPs: Overview of the Emerging Science - Today's Dietitian Magazine http://www.todaysdietitian.com/newarchives/0518p14.shtml#.W4voZrWHopc.twitter (RSS generated with FetchRss) View the full article
Twitter-Budgeting on the #lowFODMAP diet? Stick to frozen vegetables & berries - generally much cheaper than fresh varieties & just as nutritious! https://t.co/n01pEw75xN
Budgeting on the #lowFODMAP diet? Stick to frozen vegetables & berries - generally much cheaper than fresh varieties & just as nutritious! (RSS generated with FetchRss) View the full article
RT @alex_ford12399: Very important editorial from LGH https://twitter.com/LancetGastroHep/status/1035906517638307841 (RSS generated with FetchRss) View the full article
Pubmed-Epidemiological and genomic characterization of community-acquired Clostridium difficile infections.
Related Articles Epidemiological and genomic characterization of community-acquired Clostridium difficile infections. BMC Infect Dis. 2018 Aug 31;18(1):443 Authors: Thornton CS, Rubin JE, Greninger AL, Peirano G, Chiu CY, Pillai DR Abstract BACKGROUND: Clostridium difficile infection (CDI) is a major cause of morbidity and mortality in North America and Europe. The aim of this study was to identify epidemiologically-confirmed cases of community-acquired (CA)-CDI in a large North American urban center and analyze isolates using multiple genetic and phenotypic methods. METHODS: Seventy-eight patients testing positive for C. difficile from outpatient clinics were further investigated by telephone questionnaire. CA-CDI isolates were characterized by antibiotic susceptibility, pulsed-field gel electrophoresis and whole genome sequencing. CA-CDI was defined as testing positive greater than 12 weeks following discharge or no previous hospital admission in conjunction with positive toxin stool testing. RESULTS: 51.3% (40/78) of the patients in this study were found to have bona fide CA-CDI. The majority of patients were female (71.8% vs. 28.2%) with 50-59 years of age being most common (21.8%). Common co-morbidities included ulcerative colitis (1/40; 2.5%), Crohn's disease (3/40; 7.5%), celiac disease (2/40; 5.0%) and irritable bowel syndrome (8/40; 20.0%). However, of 40 patients with CA-CDI, 9 (29.0%) had been hospitalized between 3 and 6 months prior and 31 (77.5%) between 6 and 12 months prior. The hypervirulent North American Pulostype (NAP) 1-like (9/40; 22.5%) strain was the most commonly identified pulsotype. Whole genome sequencing of CA-CDI isolates confirmed that NAP 1-like pulsotypes are commonplace in CA-CDI. From a therapeutic perspective, there was universal susceptibility to metronidazole and vancomycin. CONCLUSIONS: All CA-CDI cases had some history of hospitalization if the definition were modified to health care facility exposure in the last 12 months and is supported by the genomic analysis. This raises the possibility that even CA-CDI may have nosocomial origins. PMID: 30170546 [PubMed - in process] View the full article
Pubmed-Long-Term Gastrointestinal Consequences are Frequent Following Sporadic Acute Infectious Diarrhea in a Tropical Country: A Prospective Cohort Study.
Related Articles Long-Term Gastrointestinal Consequences are Frequent Following Sporadic Acute Infectious Diarrhea in a Tropical Country: A Prospective Cohort Study. Am J Gastroenterol. 2018 Aug 31;: Authors: Rahman MM, Ghoshal UC, Sultana S, Kibria MG, Sultana N, Khan ZA, Ahmed F, Hasan M, Ahmed T, Sarker SA Abstract BACKGROUND: Postinfection irritable bowel syndrome (PI-IBS) and functional dyspepsia (PI-FD), though reported from the temperate countries, have not been studied in the tropics; PI-malabsorption syndrome (MAS), which mimics PI-IBS, is reported from the tropics. No report till date on PI-IBS excluded PI-MAS. We studied: (i) the frequency of continuing bowel dysfunction after acute gastroenteritis (AG), (ii) its predictors, and (iii) PI-MAS among patients with PI-IBS. METHODS: 345 consecutive subjects each, with AG and age- and gender-matched healthy controls were followed up 3-monthly for 12 months using a translated-validated questionnaire and functional gastrointestinal disorders (FGIDs) were diagnosed by Rome III criteria. Symptom duration >3 months but <6 months was diagnosed as chronic bowel dysfunction (CBD) and dyspeptic symptoms, respectively. MAS was diagnosed if 2/3 tests (D-xylose H2 breath test, Sudan III-stained stool microscopy, and duodenal histology) were abnormal. Fecal microbiological studies were performed in 245/345 (71%) patients. RESULTS: AG patients more often developed PI-IBS and PI-FD than controls (16.5 vs. 2.6% and 7.4 vs. 0.6%, respectively; p<0.001). Presence of FD was a risk factor for PI-IBS and IBS for PI-FD. On multivariate analysis, dyspeptic symptoms, CBD, and weight loss were the risk factors for PI-FGIDs. The frequency of PI-IBS following Vibrio cholera and other bacterial infection was comparable. Malabsorption was present among 2/23 (9%) patients with PI-IBS. CONCLUSION: FGIDs are common after AG; dyspeptic symptoms, CBD, and weight loss were risk factors for PI-FGIDs. Vibrio cholerae infection caused PI-FGID, which was never reported. About 9 % patients fulfilling the criteria for PI-IBS had PI-MAS. PMID: 30171215 [PubMed - as supplied by publisher] View the full article
Twitter-RT @KashyapPurna: Dr. Uday Ghoshal presents data in #FNM2018 on differences in treatment response of #microbiome therapies- response to #a…
RT @KashyapPurna: Dr. Uday Ghoshal presents data in #FNM2018 on differences in treatment response of #microbiome therapies- response to #a… (RSS generated with FetchRss) View the full article
Twitter-RT @LancetGastroHep: New Editorial - Unmet needs of patients with irritable bowel syndrome (https://t.co/abx38rRYKu) and Comment - Funding…
RT @LancetGastroHep: New Editorial - Unmet needs of patients with irritable bowel syndrome (http://hubs.ly/H0dlCc70) and Comment - Funding… (RSS generated with FetchRss) View the full article
Related Articles Kluyveromyces marxianus yeast enables the production of low FODMAP whole wheat breads. Food Microbiol. 2018 Dec;76:135-145 Authors: Struyf N, Vandewiele H, Herrera-Malaver B, Verspreet J, Verstrepen KJ, Courtin CM Abstract There is evidence that a diet low in Fermentable Oligo-, Di-, Monosaccharides And Polyols (FODMAPs) alleviates symptoms in approx. 70% of the patients suffering from irritable bowel syndrome. Through fructans, wheat containing products are a major source of FODMAPs in the western diet. Although fructans are partially degraded during dough fermentation by Saccharomyces cerevisiae invertase, wheat bread contains notable fructan levels. In this study, it was shown that Kluyveromyces marxianus strain CBS6014 can degrade more than 90% of the fructans initially present in wheat whole meal during bread making, which can be attributed to its high inulinase activity. As K. marxianus CBS6014 was not able to consume maltose during fermentation, alternative sugars (sucrose) or glucose releasing enzymes (amyloglucosidase) had to be included in the bread making recipe to ensure sufficient production of CO2 and high bread quality. Five volatile flavor compounds were produced in significantly different levels when K. marxianus CBS6014 was used as starter culture compared with the conventional S. cerevisiae bakery strain. These differences were, however, not detected when sensory analysis of the crumb was performed. This study demonstrates the potential of inulinase-producing K. marxianus strains for the production of (whole meal) breads low in FODMAPs. PMID: 30166134 [PubMed - in process] View the full article
Related Articles Brain-Gut Therapies and Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2018 Jul;14(7):399 Authors: Lichtenstein GR PMID: 30166955 [PubMed] View the full article
Related Articles The Emerging Role of Brain-Gut Therapies for Irritable Bowel Syndrome. Gastroenterol Hepatol (N Y). 2018 Jul;14(7):436-438 Authors: Riehl ME PMID: 30166961 [PubMed] View the full article
Pubmed-Inflammatory Bowel Disease and Irritable Bowel Syndrome: What to Do When There Is an Overlap.
Inflammatory Bowel Disease and Irritable Bowel Syndrome: What to Do When There Is an Overlap. Inflamm Bowel Dis. 2018 Aug 29;: Authors: Kamal A, Padival R, Lashner B PMID: 30169572 [PubMed - as supplied by publisher] View the full article
Don't be conned by constipation Regina Leader-Post Full coverage View the full article
Related Articles Recent insights into the role of ChREBP in intestinal fructose absorption and metabolism. BMB Rep. 2018 Aug 30;: Authors: Lee HJ, Cha JY Abstract Fructose in the form of sucrose and high fructose corn syrup is absorbed by the intestinal transporter and mainly metabolized in the small intestine. However, excess intake of fructose overwhelms the absorptive capacity of the small intestine, leading to fructose malabsorption. Carbohydrate response element-binding protein (ChREBP) is a basic helix-loop-helix leucine zipper transcription factor that plays a key role in glycolytic and lipogenic gene expression in response to carbohydrate consumption. While ChREBP was initially identified as a glucose-responsive factor in the liver, recent evidence suggests that ChREBP is essential for fructose-induced lipogenesis and gluconeogenesis in the small intestine as well as in the liver. We recently identified that the loss of ChREBP leads to fructose intolerance via insufficient induction of genes involved in fructose transport and metabolism in the intestine. As fructose consumption is increasing and closely associated with metabolic and gastrointestinal diseases, a comprehensive understanding of cellular fructose sensing and metabolism via ChREBP may uncover new therapeutic opportunities. In this mini review, we briefly summarize recent progress in intestinal fructose metabolism, the regulation and function of ChREBP by fructose, and delineate the potential mechanisms by which excessive fructose consumption may lead to irritable bowel syndrome. PMID: 30158026 [PubMed - as supplied by publisher] View the full article
Pubmed-My tummy hurts - a case report of abdominal pain and macrocytic anemia caused by hypothyroidism.
Related Articles My tummy hurts - a case report of abdominal pain and macrocytic anemia caused by hypothyroidism. Endocrinol Diabetes Metab Case Rep. 2018;2018: Authors: Hamid K, Dayalani N, Jabbar M, Saah E Abstract A 6-year-old female presented with chronic intermittent abdominal pain for 1 year. She underwent extensive investigation, imaging and invasive procedures with multiple emergency room visits. It caused a significant distress to the patient and the family with multiple missing days at school in addition to financial burden and emotional stress the child endured. When clinical picture was combined with laboratory finding of macrocytic anemia, a diagnosis of hypothyroidism was made. Although chronic abdominal pain in pediatric population is usually due to functional causes such as irritable bowel syndrome, abdominal migraine and functional abdominal pain. Hypothyroidism can have unusual presentation including abdominal pain. The literature on abdominal pain as the main presentation of thyroid disorder is limited. Pediatricians should exclude hypothyroidism in a patient who presents with chronic abdominal pain. Contrast to its treatment, clinical presentation of hypothyroidism can be diverse and challenging, leading to a delay in diagnosis and causing significant morbidity. Learning points: Hypothyroidism can have a wide range of clinical presentations that are often nonspecific, which can cause difficulty in diagnosis.In pediatric patients presenting with chronic abdominal pain as only symptom, hypothyroidism should be considered by the pediatricians and ruled out.In pediatric population, treatment of hypothyroidism varies depending on patients' weight and age.Delay in diagnosis of hypothyroidism can cause significant morbidity and distress in pediatrics population. PMID: 30159149 [PubMed] View the full article