[Functional gastrointestinal disorders].
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Abdominal Pain↗
Biomedical subjects
B Adam
Publications and source records attributed to B Adam.
[Functional dyspepsia - diagnosis of desperation?].
Dyspepsia comprises a broad spectrum of predominantly upper abdominal symptoms, such as pain, indigestion, nausea, early satiety and bloating. While these symptoms are highly prevalent, in less than 50% of patients presenting with dyspepsia, structural lesions or biochemical abnormalities are found that explain the symptoms when routine clinical tests are used. In patients without structural lesions the diagnosis of functional dyspepsia is justified. Exclusion of life-threatening disorders as the cause of symptoms and reassurance of the patient as well as proper explanation of the diagnosis and its underlying disease mechanisms (i.e. symptoms are due to a sensitive gut) is crucial and can be considered as an essential element of treatment. Since there is a remarkable comorbidity of anxiety and depression, psychosomatic interventions might be necessary in selected patients. Based on controlled clinical trials few drugs, such as proton pump inhibitors, prokinetics, tricyclic antidepressants, simethicone and selected herbal preparations have been found to be effective for treatment of functional dyspepsia. Effects of H. pylori eradication, even though strongly advocated, are most likely due to undiagnosed peptic ulcer disease in a very small group of patients. While there is currently no therapy that cures functional dyspepsia, the therapeutic target is to control symptoms.
Clinical Trials as Topic↗
[Maintaining remission of ulcerative colitis with the probiotic Escherichia Coli Nissle 1917 is as effective as with standard mesalazine].
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Adult↗
Validation of the gastrointestinal symptom score for the assessment of symptoms in patients with functional dyspepsia.
AIM: To validate the gastrointestinal symptom score as an outcome measure for functional dyspepsia. METHODS: In focus groups, 10 dyspepsia-specific items including nausea, sickness, vomiting, bloating, abdominal cramps, early satiety, acidic eructation/heartburn, loss of appetite, retrosternal discomfort, epigastric pain/upper abdominal pain were identified. Ninety-five patients with functional dyspepsia and 56 healthy controls were recruited and responsiveness evaluated by analysing gastrointestinal symptom score data from 357 patients from previous placebo-controlled trials. Gastrointestinal symptom score response data were correlated with the patient's global assessments of efficacy. Convergent validity was assessed by correlating the gastrointestinal symptom score with the results obtained by the Nepean Dyspepsia Index. RESULTS: Sensitivity: In patients and healthy controls gastrointestinal symptom score yielded consistently different scores (all P < 0.0001). TEST-RETEST RELIABILITY: Gastrointestinal symptom score determined at the two time points were significantly correlated (r-values ranging from 0.842 to 0.901). CONVERGENCE VALIDITY: Gastrointestinal symptom score of both rating groups were significantly correlated with the symptom-specific component of the Nepean Dyspepsia Index (r-vales ranging from 0.666 to 0.764, P < 0.01). RESPONSIVENESS: Responses of gastrointestinal symptom score during treatment were different for patients with a global self assessment as responders compared with non-responders (all P < 0.0055). CONCLUSION: The gastrointestinal symptom score is a valid and reliable instrument to assess symptom intensities in patients with functional dyspepsia.
Aged↗
[Irritable bowel syndrome].
Patients with irritable bowel syndrome (IBS) are highly prevalent among subjects seeking medical attention at the general practitioner or specialist level. While IBS lacks any disease associated excess mortality, this disorders is relevant to the affected subjects due to the considerable burden with regard to the symptoms and an impaired quality of life. Furthermore, this disease has a substantial impact on society due to the economical consequences. In recent years substantial progress has been achieved regarding our pathophysiological understanding. However, as usual, there has been a substantial delay between the discovery of disease mechanisms and its translation into improved patient care. For diagnosing IBS standardized criteria have been established (i. e. Rome II- or the DGVS-criteria). Regarding treatment, life style advice such as avoidance of specific nutrients that precipitate or aggravate or the "little psychotherapy" (addressing patients concerns and anxiety regarding the symptoms) are considered essential. However, the overall response rate is disappointing. Evidence-based pharmacological interventions include herbal preparations, spasmolytics, low dose tricyclic antidepressants and 5-HT-3-receptor antagonists and 5-HT-4-receptor agonists. At present no cure for patients with IBS exists. Thus, all currently available treatments target palliation of symptoms. This, however, may change in the future.
Abdominal Pain↗
Effect of E. coli Nissle 1917 on post-inflammatory visceral sensory function in a rat model.
OBJECTIVE: Visceral hyperalgesia (VH) plays a key role for the manifestation of functional gastrointestinal (GI) disorders. In a subgroup of patients, the initial manifestation is preceded by GI inflammation. Recent studies have demonstrated an improvement of inflammation and symptoms during treatment with Escherichia coli Nissle 1917 (EcN). AIM: We aimed to characterize the effects of EcN on visceral sensitivity in a rat model of post-inflammatory VH. METHODS: Male Lewis rats underwent colorectal instillation of trinitrobenzenesulphonic acid (TNBS) plus an equal amount of ethanol (test group) or physiological saline solution (control group). After 28, 35 and 42 days, standardized colorectal distensions were performed and the visceromotor reflex (VMR) of abdominal wall muscles was quantified by electromyographic recording. From day 28 onwards, EcN was administered in drinking water. RESULTS: After TNBS, a significant increase of VMR was observed compared with saline controls over all study days. Administration of EcN reduced the TNBS-induced hyperalgesia [EcN: 863+/-125 microV vs placebo: 1258+/-157 microV (P<0.05)] at day 35, while there were no significant alterations at any other study day. CONCLUSION: The EcN administration caused a significant reduction of VH. Whether EcN might play a role in the treatment of post-infectious functional bowel disorders remains to be investigated in further studies.
Animals↗
Susceptibility genes and functional gastrointestinal disorders.
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Gastrointestinal Diseases↗
Long-term effects of transient chemically induced colitis on the visceromotor response to mechanical colorectal distension.
Acute gastrointestinal infections with transient mucosal inflammation frequently precede the onset of functional GI disorders with altered visceral sensory function. We hypothesized that an acute inflammation of the mucosa is linked to long-lasting alterations of afferent visceral pathways. Utilizing abdominal wall electromyography, we tested the visceromotor response to tonic rectal distension (60 mm Hg/3 min) in fasted, conscious, male Lewis rats (n = 40) with a barostat device before and 2, 4, 15, and 17 weeks after rectal instillation of saline or trinitrobenzenesulfonic acid plus ethanol. Tissue samples from paired controls were obtained to assess histologic tissue alterations. Inflammatory changes were present up to 2 weeks after acid/ethanol instillation but not after saline instillation. Compared to baseline measurements, the visceromotor response to colorectal distension increased significantly and reached a maximum 17 weeks (P < 0.001) after induction of colitis, while it decreased in control experiments (P < 0.05). In conclusion, these data suggest that an acute inflammation has long-term effects on somatosensory functioning.
Animals↗
Review article: the patient with gastro-oesophageal reflux disease--lifestyle advice and medication.
Gastro-oesophageal reflux disease (GERD) is a highly prevalent disorder in all Western countries. Interestingly, prevalence rates appear to be increasing in these countries, with a remarkable increase of GERD-related lethal and nonlethal complications. However, these complications are rare on a global scale. This review aims to summarize the current concepts of genetic, lifestyle and environmental factors that need to be considered whilst caring for patients with these disorders. GERD is defined by the augmented exposure of oesophageal mucosa to acidic content, and is associated with specific symptoms or mucosal lesions. A number of factors may contribute to the manifestation of GERD. Although recent studies emphasize the role of genetic factors, there are many other risk factors that play a pivotal role in the development of GERD and GERD complications. Some nutritional factors are believed to aggravate acidic reflux either by delaying gastric emptying or diminishing the pressure of the lower oesophageal sphincters. Patients are often advised to sleep with their heads elevated, but this advice is not easy to follow and has not been proven effective with regard to long-term outcome. Other lifestyle modifications include changes to the patient's diet, which are important but not frequently sufficient. Thus, medication is usually necessary for symptom control. Proton pump inhibitors are now mainstream treatment for the reduction of acid secretion in patients with severe manifestations and 4-week healing rates are approaching 90%.
Cytochrome P-450 Enzyme System↗
Serum interleukin-6, procalcitonin and C-reactive protein levels in subjects with active Behçet's disease.
BACKGROUND: Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and cytokines, including serum interleukin (IL)-6, IL-8 and IL-10, and tumour necrosis factor-alpha (TNF-alpha) have been proposed as disease activity markers in Behçet's disease (BD), although studies have shown conflicting results for IL-6. Serum procalcitonin (PCT) levels in active BD have not yet been investigated. OBJECTIVE: The aim of the present study was to determine the reliability of serum IL-6 and PCT levels as well as CRP as biological markers for activity of BD. METHODS: Serum PCT, IL-6 and CRP protein levels were measured in patients with active BD (n = 15) and in healthy control subjects (n = 15). IL-6 and PCT levels were measured in serum by chemiluminescent assay. In addition, a nephelometric method was used to analyse CRP concentrations in serum. RESULTS: Serum CRP and IL-6 values were significantly higher in the subjects with active disease than in the healthy controls (P < 0.05), but there was no significant difference in the levels of PCT in the two groups. CONCLUSION: The results of our study suggest that serum CRP and IL-6 levels are elevated in patients with active BD, but that serum PCT values are not elevated in these patients.
Adult↗
Distribution of hydrophobic residues is crucial for the fusogenic properties of the Ebola virus GP2 fusion peptide.
The lipid-destabilizing properties of the N-terminal domain of the GP2 of Ebola virus were investigated. Our results suggest that the domain of Ebola virus needed for fusion is shorter than that previously reported. The fusogenic properties of this domain are related to its oblique orientation at the lipid/water interface owing to an asymmetric distribution of the hydrophobic residues when helical.
Amino Acids↗
[Avoidance of injuries to migrating fish by hydropower and water intake plants].
Every year numerous downstream migrating fish are lethally injured by hydro power plants and inlet works. Especially the katadromous Eel (Anguilla anguilla) and anadromous species like Atlantic Salmon (Salmo salar), which have to migrate downstream into the ocean for closing their life cycle, are highly endangered. Due to their specific migratory behavioral pattern, size and morphology conventional protection techniques, like screens do not properly keep them out from getting into the power plant intakes. Despite of the relevance of this problem for ecology and fishing, there are no protection and downstream migration facilities in Europe available, which can efficiently avoid the damage of all species and sizes of downstream migrating fish. Nevertheless according to protect the fish populations it's necessary to use consequently fish protection and downstream migration facilities, i.e. mechanical barrieres or alternative techniques like early warning systems as a prerequisit for a fish-friendly operational management of hydro power plants.
Anguilla↗
Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial.
BACKGROUND: This study aimed to assess the efficacy of artichoke leaf extract (ALE) in the treatment of patients with functional dyspepsia (FD). METHODS: In a double-blind, randomized controlled trial (RCT), 247 patients with functional dyspepsia were recruited and treated with either a commercial ALE preparation (2 x 320 mg plant extract t.d.s.) or a placebo. The primary efficacy variable was the sum score of the patient's weekly rating of the overall change in dyspeptic symptoms (four-point scale). Secondary variables were the scores of each dyspeptic symptom and the quality of life (QOL) as assessed by the Nepean Dyspepsia Index (NDI). RESULTS: Two hundred and forty-seven patients were enrolled, and data from 244 patients (129 active treatment, 115 placebo) were suitable for inclusion in the statistical analysis (intention-to-treat). The overall symptom improvement over the 6 weeks of treatment was significantly greater with ALE than with the placebo (8.3 +/- 4.6, vs. 6.7 +/- 4.8, P < 0.01). Similarly, patients treated with ALE showed significantly greater improvement in the global quality-of-life scores (NDI) compared with the placebo-treated patients (- 41.1 +/- 47.6 vs. - 24.8 +/- 35.6, P < 0.01). CONCLUSION: The ALE preparation tested was significantly better than the placebo in alleviating symptoms and improving the disease-specific quality of life in patients with functional dyspepsia.
Adolescent↗
Effects of a fixed combination of peppermint oil and caraway oil on symptoms and quality of life in patients suffering from functional dyspepsia.
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Drug Therapy, Combination↗
Evidence for a genetic association between monoamine oxidase A and restless legs syndrome.
BACKGROUND: Impairment in the central dopaminergic system has been consistently suggested as an etiologic factor in restless legs syndrome (RLS). OBJECTIVE: To investigate a possible role for the MAOA and MAOB genes in RLS using a population-based association study. METHODS: In addition to a dinucleotide repeat located within the second intron of the MAOB gene, a functional variable number of tandem repeat (VNTR) polymorphism recently identified in the MAOA gene promoter region was examined, using 96 extensively characterized patients and 200 control subjects matched for ethnic background. The relationship between variation at these loci and several clinical features was also considered. RESULTS: Pertaining to the MAOA gene, females with the high activity allele had a greater risk (OR: 2.0; 95% CI: 1.06 to 3.77) of being affected with RLS than females carrying the low activity alleles. The authors did not observe this association among the male subjects (OR: 0.98; 95% CI: 0.31 to 3.14). Interestingly, females carrying the high transcription alleles showed a longer sleep onset latency (U = 163.5; p = 0.015) and exhibited a higher movement index during the Suggested Immobilization Test (Student's t-test = -2.02; p = 0.048). No differences were observed regarding the MAOB gene in our sample. CONCLUSIONS: The high activity allele of the MAOA gene may represent a modifying factor involved in the severity of RLS manifestations in females.
Adult↗
Breast milk leptin: its relationship to maternal and infant adiposity.
BACKGROUND AND AIMS: Leptin, the product of the obese gene (ob), is synthesized by adipose tissue and contributes to the regulation of energy homeostasis and food intake. Recently, immunoreactive leptin was reported to be present in human milk. The objective was to determine if there was a relation between breast milk leptin concentrations and adiposity in exclusively breast-fed infants. METHODS: Fifty healthy, exclusively breast-fed infants beyond neonatal period, and their mothers were included into the study. Infants whose weight-for-length was above the 90th percentile were defined as obese (n=17), and non-obese if the weight for length between 20-90th percentile (n=33). Anthropometric measurements of infants and mothers were also made and breast milk samples were analyzed for leptin. RESULTS: There was no significant difference between breast milk leptin concentrations of obese and non-obese infants' mothers. Breast milk leptin concentrations were significantly correlated with mothers' body mass index when all subjects analyzed. There was no significant correlation between breast milk leptin concentrations and body mass index of infants. CONCLUSIONS: Leptin concentrations of human milk are not different in the mothers of obese and non-obese infants. These findings suggests that milk-borne leptin has no significant effect on adiposity during infancy.
Adipose Tissue↗
Asthma management and perceptions in rural South Africa.
BACKGROUND: Many First World countries have endeavored to measure the impact of asthma on individuals with asthma and, in addition to this quality of life evaluation, have attempted to define the quality of care for this common chronic illness. OBJECTIVE: The primary objective of this research probe was to assist the National Asthma Program in South Africa with the formulation and delivery of its outreach program to rural asthmatic patients. METHODS: A discussion/questionnaire document was compiled by Partners in Research from established literature. All interviews were conducted in either the clinics, hospitals, or respondents' homes. Both adult asthmatic patients and parents of pediatric asthmatic patients were interviewed. Interviewing took place at seven rural health clinics across South Africa. Each interview included extensive demographic details, questions on asthma definition, symptoms and symptom triggers, family history, age at diagnosis, frequency of symptoms, and treatment. RESULTS: Thirty-five adult asthmatic patients and 27 parents of pediatric asthmatic patients were interviewed. Of the adults, 40% reported wheezing at least once a week (despite diagnosis and treatment) and 19% of children reported similar symptom exacerbations. Fifty-one percent of adults and 56% of children were awakened at least once a week by cough or wheeze. Quality of life measurement reflected that, on average, 37% of responders were frightened during an acute asthma attack, and 68% of parents reported fearing the death of their asthmatic children. Fifty-one percent of adults and 33% of children had been hospitalized at least once for asthma. Although respondents claimed regular training in use of inhaler device, only 43% of adults completed each step correctly. CONCLUSIONS: There is a great deal of fear and ignorance surrounding asthma and, therefore, there is a real need for a greater level of patient education even in the rural areas of South Africa. In rural South Africa, attention should be paid to nurses, because they play a greater role than doctors in management and education of asthma.
Adolescent↗
Diurnal variation of abdominal motor responses to colorectal distension and plasma cortisol levels in rats.
Most patients with functional bowel disorders complain of daytime symptoms while they remain asymptomatic at night. As symptoms are associated with heightened visceral sensitivity, we hypothesized that circadian fluctuations of the visceral sensory function occur. At four different timepoints (06.00, 12.00, 18.00 and 24.00 h), colorectal distensions (CRD) were performed in fasting conscious male Lewis rats using a balloon catheter and a barostat device. The abdominal wall contractions (behavioural pain response) were assessed during colorectal distension by abdominal wall electromyography (EMG). Plasma levels for endogenous cortisol were determined simultaneously at these timepoints. EMG responses to CRD were significantly (P < 0.05) higher at midnight and in the early morning. Plasma cortisol levels peaked in the evening. In night-active Lewis rats, the behavioural pain response to noxious visceral stimulation is augmented at night and fluctuations of visceral sensitivity are accompanied by circadian changes of plasma concentrations of endogenous cortisol. We conclude that there are marked circadian fluctuations in visceral sensory functions. Thresholds are low during time periods of normal behavioural activity. These findings suggest that fluctuation of the sensory functions may be linked to the circadian variability of symptoms in patients with functional GI disorders.
Abdomen↗