Wheat pasture bloat dynamics, in vitro ruminal gas production, and potential bloat mitigation with condensed tannins.

PubMed

Min, B R; Pinchak, W E; Fulford, J D; Puchala, R

2005-06-01

The aim of this study was to determine the effect of winter wheat (Triticum aestivum L.) forage growth stage, forage allowance, time of day, and commercial condensed tannins (CT) on steer bloat dynamics and in vitro ruminal gas production. Twenty-six crossbreed steers (Angus x Hereford x Salers; average initial BW = 194 +/- 26 kg) were used. Wheat forage allowances were either 18 kg (high forage allowance) and 6 kg (low forage allowance) of DM/(100 kg BW.d). In each bloat observation period, fresh wheat forage samples were hand-clipped to ground level in all study pastures for nutrient and in vitro ruminal gas production analyses. In vitro ruminal gas accumulation was measured at 0, 1, 2, 3, 4, 5, 6, and 12 h. Commercial CT was added at 0, 10, 15, and 20 mg of CT/g of DM. Bloat was scored once per week on two consecutive days at 0800 and 1500 during the vegetative stage and once every 2 wk during the reproductive stage of wheat development. Mean bloat score was calculated for each steer by time of day, stage of plant growth, and forage allowance. Bloat was detected in 65.8% of the observation periods. Average bloat scores were four and 2.5 times greater (P < 0.05) in cattle grazing at a high forage allowance than at a low forage allowance in the vegetative and reproductive growth phases of wheat, respectively. Rate of gas production was greater (P < 0.001) in the vegetative stage than in the reproductive stage. Steer bloat score was positively correlated with forage CP (r = 0.22; P < 0.05) and IVDMD (r = 0.32; P < 0.05). Rate of ruminal gas production was positively correlated (P < 0.01) to forage CP (r = 0.48), NPN (r = 0.40), soluble protein (r = 0.32), and IVDMD (r = 0.47). Conversely, negative correlations were found for forage DM (r = -0.20; P < 0.05), insoluble protein (r = -0.40), NDF (r = -0.69), and forage height (r = -0.49; P < 0.01) on the rate of ruminal gas production. Addition of CT at levels greater than 10 mg of CT/g of DM decreased (P < 0.05) the rate of in vitro ruminal gas and methane gas production after 5 h of incubation. Wheat pasture bloat is a complex disorder that varies across an array of forage and environmental conditions. Condensed tannins have the potential to decrease bloat by altering ruminal gas production and soluble protein digestibility from wheat forage.

Gas and Bloating

PubMed Central

2006-01-01

Gaseous symptoms including eructation, flatulence, and bloating occur as a consequence of excess gas production, altered gas transit, or abnormal perception of normal amounts of gas within the gastrointestinal tract. There are many causes of gas and bloating including aerophagia, luminal obstructive processes, carbohydrate intolerance syndromes, small intestinal bacterial overgrowth, diseases of gut motor activity, and functional bowel disorders including irritable bowel syndrome (IBS). Because of the prominence of gaseous complaints in IBS, recent investigations have focused on new insights into pathogenesis and novel therapies of bloating. The evaluation of the patient with unexplained gas and bloating relies on careful exclusion of organic disease with further characterization of the underlying condition with directed functional testing. Treatment of gaseous symptomatology should be targeted to pathophysiologic defects whenever possible. Available therapies include lifestyle alterations, dietary modifications, enzyme preparations, adsorbents and agents which reduce surface tension, treatments that alter gut flora, and drugs that modulate gut transit. PMID:28316536

A simple technique for measurement of pressure in the tympanitic rumen of cattle.

PubMed

Turner, C B; Whyte, T D

1978-05-13

The construction and method of use of a simple device for the non-invasive measurement of intra-rumenal pressure is outlined. Results obtained from calves suffering from increased intra-rumenal pressure (bloat) are shown. The method is capable of quantifying pressures involved in bloat and could be used to augment the visual assessment of bloat scoring.

Effects of condensed tannins supplementation level on weight gain and in vitro and in vivo bloat precursors in steers grazing winter wheat.

PubMed

Min, B R; Pinchak, W E; Anderson, R C; Fulford, J D; Puchala, R

2006-09-01

Research was conducted to determine the effects of level of supplementation with quebracho condensed tannins (CT) on in vitro ruminal fluid gas production, in vivo ruminal fluid protein fractions, bloat dynamics, and ADG of steers grazing winter wheat. Two experiments were conducted to 1) enumerate the effect of ruminal fluid from steers fed quebracho CT (0, 1, and 2% CT/kg of DMI) on in vitro gas and methane production from minced fresh wheat forage; and 2) quantify the influence of CT supplementation on ruminal protein characteristics, biofilm complexes, bloat potential, and ADG of steers grazing wheat pasture. Eighteen ruminally cannulated steers (386 +/- 36 kg of BW) were randomly allocated to 1 of 3 treatments that included a control (water infusion) and 2 CT treatment levels (1 or 2% CT/kg of DMI). Treatments were administered daily (63 d) through the rumen cannula as pre-mixes with warm water (approximately 30 degrees C). Rumen contents were collected 2 h postinfusion (at 1030 to 1130) on d 0, 20, 40, 50, and 60. Bloat was visually scored daily for 5 d each wk. In Exp. 1, supplementation of CT decreased the rate of in vitro gas production in a dose-dependent response. In Exp. 2, ADG increased (P < 0.04) at both levels of CT supplementation. Mean bloat score across stage of growth and replicates decreased linearly with increasing CT supplementation; bloat scores were greater (P < 0.001) for the vegetative than for the reproductive stage of plant growth. Biofilm production and rumen fluid protein fractions varied among CT treatments and stage of growth. Addition of CT reduced the severity of bloat, principally through reducing microbial activities, biofilm production, and ruminal gas production. Quebracho CT is potentially a value-added supplement that can decrease the impacts of frothy bloat and increase BW gains in stocker cattle-wheat systems.

Effect of forage supplements on the incidence of bloat in dairy cows grazing high clover pastures.

PubMed

Phillips, C J; James, N L; Murray-Evans, J P

1996-08-17

The effect of offering forage supplements of different compositions was examined in two experiments with cows grazing high clover swards. In the first experiment strawmix supplements of high or low energy content (11 and 9 MJ metabolisable energy/kg dry matter [DM]) and high or low crude protein content (17 and 4 g/kg DM) were offered for periods of three weeks. The energy and protein contents were varied by the content of molasses and soyabean meal, respectively. The high energy, high protein supplement increased the incidence of bloat, and the low energy, high protein supplement reduced it, compared with grazing alone. Bloat was most evident in the first two weeks of each feeding period, suggesting that the cows partially adapted to the diets within three weeks. In the second experiment silage supplements reduced the incidence of bloat among cows grazing both tall and short swards. The most suitable forages to feed when there is a risk of bloat are those that are slowly fermented in the rumen but are eaten in sufficient quantity to reduce periods of rapid herbage intake.

Abdominal bloating

MedlinePlus

... Some other medicines or foods containing lactulose or sorbitol, may cause bloating. More serious disorders that may ... from foods with high levels of fructose or sorbitol. Avoid foods that can produce gas, such as ...

Severe hypoplasia of the omasal laminae in a Japanese Black steer with chronic bloat--a case report.

PubMed

Takagi, Mitsuhiro; Mukai, Shuhei; Fushimi, Yasuo; Matsushita, Kouhei; Miyoshi, Nobuaki; Yasuda, Nobuhiro; Kitajima, Hideo; Takamure, Senro; Matsushita, Toshihiko; Kitamura, Nobuo; Deguchi, Eisaburo

2007-12-01

An 11-month-old Japanese Black steer with chronic bloat underwent clinical and histological analyses. During the observation period, it showed normal appetite and fecal volume but persistent chronic bloat symptoms. Compared to controls, the steer's feces contained undigested large straws. Necropsy revealed normal rumen, reticulum, and abomasum but a small omasum. The rumen, reticulum, and abomasum mucosa was normal, with well-developed ruminal papillae. However, severe hypoplasia of the omasal laminae was observed along with hypoplasia reticular groove and ruminoreticular fold. The contents of the reticulum, omasum, and abomasums comprised undigested large sized hay particles. The omasum papillae showed no pathological abnormalities. This is a rare case of a steer with chronic bloat probably caused by severe hypoplasia of the omasal laminae.

Lactose Intolerance (For Teens)

MedlinePlus

... gut and gets broken down by bacteria, causing gas, bloating, stomach cramps, and diarrhea. Lactose intolerance is ... lactose intolerance will experience nausea, stomach cramps, bloating, gas, and diarrhea. This can be unpleasant, not to ...

Tegaserod

MedlinePlus

... to relieve pain, bloating, and constipation caused by irritable bowel syndrome (IBS; a condition that causes stomach pain, bloating, constipation, ... than prescribed by your doctor.If you have IBS with constipation, your doctor will probably tell you ...

Menopause: Medicines to Help You

MedlinePlus

... Side Effects Headaches Painful or tender breasts Vaginal spotting Stomach cramps/ Bloating Nausea and vomiting Hair loss ... Side Effects Headaches Painful or tender breasts Vaginal spotting Stomach cramps/ Bloating Nausea and vomitting Hair loss ...

Fracture mode, microstructure and temperature-dependent elastic moduli for thermoelectric composites of PbTe-PbS with SiC nanoparticle additions

NASA Astrophysics Data System (ADS)

Ni, Jennifer E.; Case, Eldon D.; Schmidt, Robert D.; Wu, Chun-I.; Hogan, Timothy P.; Trejo, Rosa M.; Lara-Curzio, Edgar; Kanatzidis, Mercouri G.

2013-12-01

Twenty-six (Pb0.95Sn0.05Te)0.92(PbS)0.08-0.055% PbI2-SiC nanoparticle (SiCnp) composite thermoelectric specimens were either hot pressed or pulsed electric current sintered (PECS). Bloating (a thermally induced increase in porosity, P, for as-densified specimens) was observed during annealing at temperatures >603 K for hot-pressed specimens and PECS-processed specimens from wet milled powders, but in contrast seven out of seven specimens densified by PECS from dry milled powders showed no observable bloating following annealing at temperatures up to 936 K. In this study, bloating in the specimens was accessed via thermal annealing induced changes in (i) porosity measured by scanning electron microscopy on fractured specimen surfaces, (ii) specimen volume and (iii) elastic moduli. The moduli were measured by resonant ultrasound spectroscopy. SiCnp additions (1-3.5 vol.%) changed the fracture mode from intergranular to transgranular, inhibited grain growth, and limited bloating in the wet milled PECS specimens. Inhibition of bloating likely occurs due to cleaning of contamination from powder particle surfaces via PECS processing which has been reported previously in the literature.

Rumen clearance rates in relation to the occurrence of alfalfa bloat in cattle. 1. Passage of water-soluble markers.

PubMed

Majak, W; Hall, J W; Rode, L M; Kalnin, C M

1986-06-01

Ruminal chlorophyll and rates of passage of two water-soluble markers were simultaneously determined in cattle with different susceptibilities to alfalfa bloat. The markers showed a slower rate of passage from the rumens of more susceptible cattle where the average half-lives for cobalt-ethylenediaminetetraacetic acid and chromium-ethylenediaminetetraacetic acid were 12 to 17 h. Average half-life of the markers was 8 h in the rumens of the less susceptible animals. In agreement, chloroplast particles in the liquid phase of rumen contents showed greater accumulation in animals susceptible to bloat, but many more observations were required to detect differences in chlorophyll among animals. This was partly due to the unhomogeneous dispersion of chloroplast fragments in the reticulorumen compared with the uniform distribution of the inert markers. Differences in rumen volumes (estimated from the quantity of marker administered and its initial concentration) were detected among animals, but these did not show a relationship to bloat susceptibility. In vitro studies indicated that alfalfa chloroplast particles were not readily degraded by rumen microorganisms. Our results support earlier conclusions on slower rates of salivation for cattle that bloat compared with those that do not.

Low quality roughages for steers grazing wheat pasture. I. Effect on weight gains and bloat.

PubMed

Mader, T L; Horn, G W; Phillips, W A; McNew, R W

1983-05-01

The effect of feeding low quality roughages (LQR) on live and carcass weight gains and the incidence and severity of bloat of stocker cattle grazed on wheat pasture was evaluated in a 3 yr study. One hundred eighty-five steer calves (172 kg mean initial weight) grazed clean-tilled wheat pasture and were either fed no LQR or had ad libitum access to wheat straw (WS) or sorghum-Sudan hay (SS). Grazing periods were (I) fall grazing, (II) winter grazing, (III) period of lush spring growth of wheat forage and (IV) period of advancing forage maturity and declining quality. Mean dry matter (DM), crude protein and acid detergent fiber (ADF) content (percentage of DM) of wheat forage averaged across years ranged, respectively, from 23.8 to 33.0, 19.8 to 26.4 and 21.5 to 27.7. Mean daily consumption (kg DM/head) of WS and SS by steers ranged from .076 to .100 and .199 to .248, respectively. Live and carcass weight gains of steers during Periods I through III (i.e., the usual wheat pasture grazing period) were not influenced (P greater than .05) by treatments. Carcass weight gains were about 74% of live weight gains. Bloat was observed only during the last 2 wk of Period III of the first year. The incidence (steer days of bloat) and severity (bloat score) of control, WS- and SS-fed steers were 9.5 and 1.2, .5 and .5 and 2.0 and 1.0, and were not different (P greater than .05) among treatments. Intake of WS and SS [g/body weight (BW).75kg] during Periods I to III was, respectively, only about 5 and 12% of roughage intakes (i.e., 37.5 g/BW.75kg) reported in the literature to "effectively control" or aid the prevention of bloat. It seems unlikely that LQR consumed to amounts similar to those of this study would control bloat of stocker cattle on wheat pasture.

The Influence of Sulfur on Dephosphorization Kinetics Between Bloated Metal Droplets and Slag Containing FeO

NASA Astrophysics Data System (ADS)

Gu, Kezhuan; Dogan, Neslihan; Coley, Kenneth S.

2017-10-01

The bloating behavior of metal droplets and the dephosphorization behavior of bloated droplets at 1853 K (1580 °C) were investigated using X-ray fluoroscopy coupled with constant volume pressure change measurements and chemical analysis of quenched samples. The effect of sulfur content on dephosphorization kinetics was studied during the decarburization period. The slag foamed during the reaction forming a foamy layer over a dense layer. After a short incubation period, the droplets became bloated due to internal decarburization. The bloated droplets floated from the dense slag into the foamy slag. The behavioral changes are directly related to the effect of sulfur on the incubation time for swelling. The dephosphorization reaction was very fast; droplets with low sulfur contents experienced phosphorus reversion shortly after entering the foamy slag, while those with higher sulfur content took a longer time to swell and went through reversion before they entered the foam. The dephosphorization rate and maximum phosphorus partition were higher at lower CO evolution rates because the dynamic interfacial oxygen potential increased with the decreasing oxygen consumption rate. The rate controlling step for dephosphorization was initially a combination of mass transport in both the metal and the slag. As the iron oxide in the slag was depleted, the rate control shifted to mass transport in slag.

Effects of baseline abdominal pain and bloating on response to lubiprostone in patients with irritable bowel syndrome with constipation.

PubMed

Chang, L; Chey, W D; Drossman, D; Losch-Beridon, T; Wang, M; Lichtlen, P; Mareya, S

2016-11-01

Lubiprostone (8 μg b.d.) received US Food and Drug Administration (FDA) approval in 2008 for the treatment of constipation-predominant irritable bowel syndrome (IBS-C) in women aged ≥18 years. In 2012, the FDA issued new guidance for IBS-C clinical trials, recommending a composite endpoint incorporating both abdominal pain and stool frequency. In a post hoc analysis, similar criteria were applied to data from two pivotal, phase 3, double-blind, randomised trials of lubiprostone in patients with IBS-C. Included patients had a baseline spontaneous bowel movement (SBM) frequency <3/week and abdominal pain or bloating ratings ≥1.36 on a 5-point scale [0 (absent) to 4 (very severe)]. Responders (composite endpoint) had a mean pain reduction ≥30% compared with baseline, and an increase from baseline of ≥1 SBM/week for ≥6 of the 12 treatment weeks. Lubiprostone effects on abdominal pain alone were also evaluated, as were bloating alone and in a composite endpoint with stool frequency. In pooled data, 325 patients received lubiprostone and 180 received placebo. Rates of response were higher with lubiprostone vs. placebo for the composite endpoint of improved pain and stool frequency (26.3% vs. 15.3%, respectively; P = 0.008) and the composite endpoint of improved bloating and stool frequency (23.8% vs. 12.6%, respectively; P = 0.012). Response rates were also higher with lubiprostone vs. placebo for abdominal pain alone (P = 0.005) and bloating alone (P = 0.012). Lubiprostone was significantly more effective than placebo in improving abdominal pain or bloating, and also in composite endpoints that included stool frequency. © 2016 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.

Pitch Fractionation.

DTIC Science & Technology

1981-12-15

The solvent fractions were obtained by sequential Soxhlet extraction with solvents such as hexane, cyclohexane, toluene, and pyridine. The most severe...Continued) *.AISYRACT (Continued) fraction increased, the pyrolysis yield and bloating increased, and the msicrostructure of the coke became finer...28 8. Coking Yield and Bloating Behavior of Fractionation Sequence AG 162-4

21 CFR 520.1840 - Poloxalene.

Code of Federal Regulations, 2011 CFR

2011-04-01

... section. (c) [Reserved] (d) Conditions of use. (1) For treatment of legume (alfalfa, clover) bloat in... animals over 500 pounds of body weight. (2) For control of legume (alfalfa, clover) bloat in cattle... poloxalene) per 100 lbs. of body weight per day. (3) For prevention of legume (alfalfa, clover) and wheat...

21 CFR 520.1840 - Poloxalene.

Code of Federal Regulations, 2010 CFR

2010-04-01

... section. (c) [Reserved] (d) Conditions of use. (1) For treatment of legume (alfalfa, clover) bloat in... animals over 500 pounds of body weight. (2) For control of legume (alfalfa, clover) bloat in cattle... poloxalene) per 100 lbs. of body weight per day. (3) For prevention of legume (alfalfa, clover) and wheat...

Health and performance of calves with forestomach-bypass fed milk replacer.

PubMed

McKinstry, D M; Cason, J L; Albert, T F; Sass, B

1976-02-01

Ten male Holstein calves were placed in groups of two calves each on similarity of age. On calf in each group was subjected to forestomach-bypass surgery at about 1 mo of age. Fortified commercial milk replacer with added minerals and vitamins was fed as the sole diet. The calves were housed indoors on slatted platforms. Weight gain was determined biweekly. Feed intake was determined daily. Necropsies were performed upon termination of the study. Recurrent ruminal bloat, fever, and anorexia of varying degrees and combinations occurred in four of the calves with forestomach bypass. Two of these calves showed slow weight gain. One of the four calves died following acute bloat while the other three calves were sacrificed following repeated episodes of bloat. The time of termination varied between 3 and 10 mo. One calf with forestomach bypass and all control calves appeared healthy throughout the experiment. Necropsies indicated that the ruminal bloat, seen in most of the forestomach-bypass calves, could be attributed to the back-flow of ingesta via the omasal-abomasal orifice. This ingesta appeared to produce gas which became trapped in the bypassed rumen.

In vitro bacterial growth and in vivo ruminal microbiota populations associated with bloat in steers grazing wheat forage.

PubMed

Min, B R; Pinchak, W E; Anderson, R C; Hume, M E

2006-10-01

The role of ruminal bacteria in the frothy bloat complex common to cattle grazing winter wheat has not been previously determined. Two experiments, one in vitro and another in vivo, were designed to elucidate the effects of fresh wheat forage on bacterial growth, biofilm complexes, rumen fermentation end products, rumen bacterial diversity, and bloat potential. In Exp. 1, 6 strains of ruminal bacteria (Streptococcus bovis strain 26, Prevotella ruminicola strain 23, Eubacterium ruminantium B1C23, Ruminococcus albus SY3, Fibrobacter succinogenes ssp. S85, and Ruminococcus flavefaciens C94) were used in vitro to determine the effect of soluble plant protein from winter wheat forage on specific bacterial growth rate, biofilm complexes, VFA, and ruminal H2 and CH4 in mono or coculture with Methanobrevibacter smithii. The specific growth rate in plant protein medium containing soluble plant protein (3.27% nitrogen) was measured during a 24-h incubation at 39 degrees C in Hungate tubes under a CO2 gas phase. A monoculture of M. smithii was grown similarly, except under H2:CO2 (1:1), in a basal methanogen growth medium supplemented likewise with soluble plant protein. In Exp. 2, 6 ruminally cannulated steers grazing wheat forage were used to evaluate the influence of bloat on the production of biofilm complexes, ruminal microbial biodiversity patterns, and ruminal fluid protein fractions. In Exp. 1, cultures of R. albus (P < 0.01) and R. flavefaciens (P < 0.05) produced the most H2 among strains and resulted in greater (P < 0.01) CH4 production when cocultured with M. smithii than other coculture combinations. Cultures of S. bovis and E. ruminantium + M. smithii produced the most biofilm mass among strains. In Exp. 2, when diets changed from bermudagrass hay to wheat forage, biofilm production increased (P < 0.01). Biofilm production, concentrations of whole ruminal content (P < 0.01), and cheesecloth filtrate protein fractions (P < 0.05) in the ruminal fluid were greater on d 50 for bloated than for nonbloated steers when grazing wheat forage. The molecular analysis of the 16S rDNA showed that 2 different ruminal microbiota populations developed between bloated and nonbloated animals grazing wheat forage. Bloat in cattle grazing wheat pastures may be caused by increased production of biofilm, resulting from a diet-influenced switch in the rumen bacterial population.

A scanning electron microscopy study of the invasion of leaflets of a bloat-safe and a bloat-causing legume by rumen microorganisms.

PubMed

Fay, J P; Cheng, K J; Hanna, M R; Howarth, R E; Costerton, J W

1981-04-01

A newly developed technique using ruthenium red to detect foci of bacterial digestion in mounts of whole leaflets that had been incubated with rumen bacteria was used to compare the digestion of alfalfa, a bloat-causing legume, and sainfoin, a bloat-safe legume. When whole leaflets were suspended in an artificial rumen medium and inoculated with rumen bacteria, massive bacterial adhesion and proliferation were noted at the stomata of alfalfa leaflets after 6 h of incubation, whereas only a few isolated bacteria adhered near the stomata of sainfoin leaflets After 22 h of incubation, the epidermal layers of alfalfa leaflets had peeled away in many areas, revealing an extensive bacterial invasion of the underlying mesophyll tissue in which large bacterial microcolonies had formed in intercellular spaces, and in intracellular spaces in several areas where plant cell walls had broken down. After 22 h of incubation, the surface of sainfoin leaflets resembled that of alfalfa leaflets at 6 h, with bacterial microcolonies adhering to the area surrounding the stomata, but without sloughing of the epidermis. Uninoculated control leaflets of both species showed no surface alteration but part of their normal bacterial flora had proliferated to form microcolonies on the surface after 22 h incubation. Dry matter loss due to leaching or bacterial digestion when whole leaflets of legumes were suspended in an artificial rumen medium, alone or with rumen bacteria, was significantly higher in the bloat-causing group. Values of leaching and of bacterial digestion were positively correlated. We conclude that reported differences in plant anatomy, and in cell wall chemistry, produce distinct rates or organic nutrient release from legume leaflets, and that these same differences produce an equally distinct susceptibility of leaflets to bacterial invasion, plant cell rupture, and the consequent release of intracellular plant components. The rate of release of organic nutrients from legume leaflets may be important in the etiology of foamy pasture bloat. This technique of in vitro digestion of whole leaflets followed by ruthenium red staining shows some promise of providing a rapid and qualitative test to distinguish, within a species, cultivars that may differ in their bloat-related characteristics.

Elderly ailment.(LEADERSHIP LITE)

ERIC Educational Resources Information Center

School Administrator, 2005

2005-01-01

A 1"-grader entered the health room at Wayside Elementary School in Potomac, Md., with an odd complaint."I feel bloated," the boy reported to Diane Arkin, a health aide.Arkin, trying to keep a straight face, asked the 6-year-old, "What does bloated feel like?"He thought for a second. "It feels like I'm 51 ."(Source: Bulletin, Montgomery County,…

21 CFR 558.465 - Poloxalene free-choice liquid Type C feed.

Code of Federal Regulations, 2011 CFR

2011-04-01

... use. (1) For control of legume (alfalfa, clover) and wheat pasture bloat in cattle, use 7.5 grams of... of Type C feed per 100 pounds of body weight daily for adequate protection. (2) For control of legume (alfalfa, clover) bloat in cattle grazing of prebloom legumes, use 10.00 grams of poloxalene per pound of...

21 CFR 558.465 - Poloxalene free-choice liquid Type C feed.

Code of Federal Regulations, 2010 CFR

2010-04-01

... use. (1) For control of legume (alfalfa, clover) and wheat pasture bloat in cattle, use 7.5 grams of... of Type C feed per 100 pounds of body weight daily for adequate protection. (2) For control of legume (alfalfa, clover) bloat in cattle grazing of prebloom legumes, use 10.00 grams of poloxalene per pound of...

Putrefactive rigor: apparent rigor mortis due to gas distension.

PubMed

Gill, James R; Landi, Kristen

2011-09-01

Artifacts due to decomposition may cause confusion for the initial death investigator, leading to an incorrect suspicion of foul play. Putrefaction is a microorganism-driven process that results in foul odor, skin discoloration, purge, and bloating. Various decompositional gases including methane, hydrogen sulfide, carbon dioxide, and hydrogen will cause the body to bloat. We describe 3 instances of putrefactive gas distension (bloating) that produced the appearance of inappropriate rigor, so-called putrefactive rigor. These gases may distend the body to an extent that the extremities extend and lose contact with their underlying support surface. The medicolegal investigator must recognize that this is not true rigor mortis and the body was not necessarily moved after death for this gravity-defying position to occur.

Breath tests and irritable bowel syndrome

PubMed Central

Rana, Satya Vati; Malik, Aastha

2014-01-01

Breath tests are non-invasive tests and can detect H2 and CH4 gases which are produced by bacterial fermentation of unabsorbed intestinal carbohydrate and are excreted in the breath. These tests are used in the diagnosis of carbohydrate malabsorption, small intestinal bacterial overgrowth, and for measuring the orocecal transit time. Malabsorption of carbohydrates is a key trigger of irritable bowel syndrome (IBS)-type symptoms such as diarrhea and/or constipation, bloating, excess flatulence, headaches and lack of energy. Abdominal bloating is a common nonspecific symptom which can negatively impact quality of life. It may reflect dietary imbalance, such as excess fiber intake, or may be a manifestation of IBS. However, bloating may also represent small intestinal bacterial overgrowth. Patients with persistent symptoms of abdominal bloating and distension despite dietary interventions should be referred for H2 breath testing to determine the presence or absence of bacterial overgrowth. If bacterial overgrowth is identified, patients are typically treated with antibiotics. Evaluation of IBS generally includes testing of other disorders that cause similar symptoms. Carbohydrate malabsorption (lactose, fructose, sorbitol) can cause abdominal fullness, bloating, nausea, abdominal pain, flatulence, and diarrhea, which are similar to the symptoms of IBS. However, it is unclear if these digestive disorders contribute to or cause the symptoms of IBS. Research studies show that a proper diagnosis and effective dietary intervention significantly reduces the severity and frequency of gastrointestinal symptoms in IBS. Thus, diagnosis of malabsorption of these carbohydrates in IBS using a breath test is very important to guide the clinician in the proper treatment of IBS patients. PMID:24976698

Mechanisms of postprandial abdominal bloating and distension in functional dyspepsia.

PubMed

Burri, Emanuel; Barba, Elizabeth; Huaman, Jose Walter; Cisternas, Daniel; Accarino, Anna; Soldevilla, Alfredo; Malagelada, Juan-R; Azpiroz, Fernando

2014-03-01

Patients with irritable bowel syndrome and abdominal bloating exhibit abnormal responses of the abdominal wall to colonic gas loads. We hypothesised that in patients with postprandial bloating, ingestion of a meal triggers comparable abdominal wall dyssynergia. Our aim was to characterise abdominal accommodation to a meal in patients with postprandial bloating. A test meal (0.8 kcal/ml nutrients plus 27 g/litre polyethylenglycol 4000) was administered at 50 ml/min as long as tolerated in 10 patients with postprandial bloating (fulfilling Rome III criteria for postprandial distress syndrome) and 12 healthy subjects, while electromyographic (EMG) responses of the anterior wall (upper and lower rectus, external and internal oblique via bipolar surface electrodes) and the diaphragm (via six ring electrodes over an oesophageal tube in the hiatus) were measured. Means +/- SD were calculated. Healthy subjects tolerated a meal volume of 913±308 ml; normal abdominal wall accommodation to the meal consisted of diaphragmatic relaxation (EMG activity decreased by 15±6%) and a compensatory contraction (25±9% increase) of the upper abdominal wall muscles (upper rectus and external oblique), with no changes in the lower anterior muscles (lower rectus and internal oblique). Patients tolerated lower volume loads (604±310 ml; p=0.030 vs healthy subjects) and developed a paradoxical response, that is, diaphragmatic contraction (14±3% EMG increment; p<0.01 vs healthy subjects) and upper anterior wall relaxation (9±4% inhibition; p<0.01 vs healthy subjects). In functional dyspepsia, postprandial abdominal distension is produced by an abnormal viscerosomatic response to meal ingestion that alters normal abdominal accommodation.

Probiotic bacteria Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07 versus placebo for the symptoms of bloating in patients with functional bowel disorders: a double-blind study.

PubMed

Ringel-Kulka, Tamar; Palsson, Olafur S; Maier, Danielle; Carroll, Ian; Galanko, Joseph A; Leyer, Gregory; Ringel, Yehuda

2011-07-01

Recent data suggest a role for the intestinal microbiota in the pathogenesis of functional bowel disorders (FBDs). Probiotic studies in FBDs generated inconsistent results suggesting a strain-specific and product-specific effect. To investigate the clinical efficacy of Lactobacillus acidophilus NCFM (L-NCFM) and Bifidobacterium lactis Bi-07 (B-LBi07) in nonconstipation FBDs. A double-blind, placebo-control clinical trial of the probiotic bacterias L-NCFM and B-LBi07 twice a day (2×10(11) CFU/d) versus placebo over 8 weeks. Primary endpoints were global relief of gastrointestinal symptoms and satisfaction with treatment. Secondary endpoints were change in symptoms severity, well-being, and quality of life. Microbiological effect was assessed by quantitative real time polymerase chain reaction on fecal samples. Sixty patients (probiotic, n=31; placebo, n=29), 72% females, 84% whites, mean age 37 years. Abdominal bloating improved in the probiotics compared with the placebo group at 4 weeks (4.10 vs 6.17, P=0.009; change in bloating severity P=0.02) and 8 weeks (4.26 vs 5.84, P=0.06; change in bloating severity P<0.01). Analyses on the irritable bowel syndrome subgroup (n=33) showed similar results. L-NCFM and B-LBi07 twice a day improve symptoms of bloating in patients with FBDs. These data supports the role of intestinal bacteria in the pathophysiology of FBD and the role for probiotic bacteria in the management of these disorders.

Effects of plant tannins supplementation on animal response and in vivo ruminal bacterial populations associated with bloat in heifers grazing wheat forage

USDA-ARS?s Scientific Manuscript database

Research was conducted to determine the effects of sources of tannins on in vitro ruminal gas and foam production, in vivo ruminal bacterial populations, bloat dynamics and ADG of heifers grazing wheat forage. Two experiments were conducted to 1) enumerate the effect of tannins supplementation on bi...

Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation (IBS-C): a large population-based Internet survey in Japan.

PubMed

Kanazawa, Motoyori; Miwa, Hiroto; Nakagawa, Ayako; Kosako, Masanori; Akiho, Hiraku; Fukudo, Shin

2016-01-01

Abdominal bloating is a common symptom in patients with irritable bowel syndrome with constipation (IBS-C). However, it is not included among the required items in the Rome III diagnostic criteria for IBS. Little is known about an impact of abdominal bloating seen in patients with IBS-C. Using a large population-based sample, the aim of the present study was to investigate what is the most bothersome symptom in subjects with IBS-C. An Internet survey of 30,000 adults drawn from the general public throughout Japan was conducted to identify subtypes of IBS using the Rome III diagnostic questionnaire. Consecutively, the screened subjects with IBS-C and the same number of age- and sex-matched non-IBS subjects who were randomly selected as controls were asked to answer a questionnaire on the degree of anxiety they experienced in their daily lives, thoughts about bowel habit, and their dominant gastrointestinal symptoms together with exacerbation factors (for IBS-C only). The screening survey showed that the prevalence of overall IBS was 16.5 % (female 17.4 %, male 15.5 %) and that 2.8 % met the criteria for IBS-C, 4.5 % for IBS with diarrhea (IBS-D) and 8.2 % for mixed IBS (IBS-M). Seven hundred and fifty-nine of 835 (90.9 %) subjects with IBS-C and 746 of 830 (89.9 %) control subjects completed the consecutive questionnaire. IBS-C subjects felt a higher degree of anxiety in their daily lives (p < 0.01) and considered bowel habit to be an indicator of health (p < 0.01) to a greater extent than control subjects. In IBS-C, the degree of anxiety was significantly associated with abdominal discomfort (p < 0.01), pain (p < 0.01) and bloating (p = 0.02), but not with the frequency of bowel habit (p > 0.1). Abdominal bloating was the most bothersome symptom (27.5 %), which was more likely to occur after a meal (52.2 %), at work/school (29.2 %) and during times of stress (26.8 %). Only 4.5 % of IBS-C subjects reported abdominal pain as the 'most bothersome' symptom. A large population-based Internet survey suggests that abdominal bloating has a great impact on the daily lives of subjects diagnosed with IBS-C. Not only bowel movement/abdominal pain but also abdominal bloating should be evaluated in patients with IBS-C.

The role of fermentable carbohydrates and beverages in the symptomatology of functional gastrointestinal disease.

PubMed

Moding, Magnus; Ohlsson, Bodil

2017-11-01

The pathophysiology behind functional gastrointestinal disease (FGID) has not been defined, but an intestinal accumulation of fermentable short-chain carbohydrates (FODMAPs) is thought to be involved. A restricted coffee intake is recommended. The aim was to investigate if symptoms of FGID were associated with intake of certain foods (including FODMAPs), as well as beverages (including coffee and tea). Data were used from participants, age range 45-75 years, who had answered the EpiHealth questionnaire about their background factors, health status and intake of food and beverages. After exclusion of organic bowel diseases, 16,840 participants remained. The impact of food and beverages on functional abdominal pain, functional bloating, functional constipation and functional diarrhea were examined by adjusted binary logistic regression. Wholemeal bread (Swedish cracker) (OR: 1.361; 95% CI: 1.001-1.851) and white bread (low fiber content) (OR: 1.527; 95% CI: 1.075-2.169) were associated with constipation, whereas soft wholemeal bread (high fiber content) was associated with diarrhea (OR: 1.601; 95% CI: 1.040-2.463). Cheese was associated with bloating (OR: 1.460; 95% CI: 1.004-2.123). A high tea intake was associated with abdominal pain (p for trend =.003), bloating (p for trend = .039) and diarrhea (p for trend <.001), whereas coffee intake was associated with a decreased risk of abdominal pain (p for trend = .002) and bloating (p for trend = .007). High soda intake associated with abdominal pain and bloating and juice with diarrhea. There are weak associations between intake of grain and dairy products and FGID symptoms. Tea is associated with increased risks, whereas coffee is associated with lower risks, of FGID symptoms.

A randomized double-blind placebo-controlled clinical trial on efficacy and safety of association of simethicone and Bacillus coagulans (Colinox®) in patients with irritable bowel syndrome.

PubMed

Urgesi, R; Casale, C; Pistelli, R; Rapaccini, G L; de Vitis, I

2014-01-01

Irritable bowel syndrome (IBS) is a chronic gastrointestinal (GI) disorder that affects 15-20% of the Western population. There are currently few therapeutic options available for the treatment of IBS. The aim of this study is to evaluate the efficacy and the safety of a medical device containing a combination of Simethicone and Bacillus coagulans in the treatment of IBS. This is a monocentric double-blind, placebo-controlled parallel group clinical trial. Adult subjects suffering from IBS as defined by Rome III criteria were enrolled. Bloating, discomfort, abdominal pain were assessed as primary end point. Subjects received the active treatment or placebo 3 time a day after each meal for 4 weeks of study period. Subjects were submitted to visit at Day 0 (T1), at Days 14 (T2) and 29 (T3). Fifty-two patients were included into the study. Intragroup analysis showed a significant reduction of the bloating, discomfort and pain in Colinox® group (CG) compared to placebo group (PG). Between group analysis confirmed, at T1-T3, significant differences between CG and PG in bloating and discomfort. Simethicone is an inert antifoaming able to reduce bloating, abdominal discomfort. Literature offers increasing evidence linking alterations in the gastrointestinal microbiota and IBS and it is well known that probiotics are important to restore the native gut microbiota. The Colinox medical device is specifically targeted against most intrusive symptom of IBS (bloating) and it is also able to counteract the most accredited ethiopathogenetic factor in IBS (alterations of intestinal microbiota). This is the first randomized double-blind placebo-controlled clinical trial demonstrating the efficacy and safety of a combination of simethicone and Bacillus coagulans in treatment of IBS.

Identifying and individuating cognitive systems: a task-based distributed cognition alternative to agent-based extended cognition.

PubMed

Davies, Jim; Michaelian, Kourken

2016-08-01

This article argues for a task-based approach to identifying and individuating cognitive systems. The agent-based extended cognition approach faces a problem of cognitive bloat and has difficulty accommodating both sub-individual cognitive systems ("scaling down") and some supra-individual cognitive systems ("scaling up"). The standard distributed cognition approach can accommodate a wider variety of supra-individual systems but likewise has difficulties with sub-individual systems and faces the problem of cognitive bloat. We develop a task-based variant of distributed cognition designed to scale up and down smoothly while providing a principled means of avoiding cognitive bloat. The advantages of the task-based approach are illustrated by means of two parallel case studies: re-representation in the human visual system and in a biomedical engineering laboratory.

Gas and Bloating-Controlling Emissions: A Case-Based Review for the Primary Care Provider.

PubMed

Cotter, Thomas G; Gurney, Mark; Loftus, Conor G

2016-08-01

The evaluation of the patient with gas and bloating can be complex and the treatment extremely challenging. In this article, a simplified approach to the history and relevant physical examination is presented and applied in a case-oriented manner, suitable for application in the primary care setting. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

[Abdominal bloating: an up-to-date].

PubMed

Ducrotté, P

2009-10-01

Bloating is a common symptom, especially in women. In the clinical practice, it remains a therapeutic challenge. Since recently, its pathophysiology is better understood: an impaired transit of gas (particularly in the small bowel) or a visceral hypersensitivity leading to the induction of an abdominal discomfort despite a normal volume of gas are two of the main causes, far more frequent than an excessive production of gas. Moreover, bloating can be related to abnormal viscera-somatic reflexes promoting both an abdomino-phrenic dyssynergia and the relaxation of the muscles of the abdominal wall. From a therapeutic point of view, the efficacy of the gas absorbants remains to be more documented. Besides the treatment of a constipation and the avoidance of nutrients either highly fermentable or rich in fructose, other therapeutic options include prokinetics and drugs acting on visceral sensitivity. Probiotics are another promising option. In some centers, a non pharmacological therapeutic approach, mainly based on hypnosis, is discussed.

Abdomino-phrenic dyssynergia in patients with abdominal bloating and distension.

PubMed

Villoria, Albert; Azpiroz, Fernando; Burri, Emanuel; Cisternas, Daniel; Soldevilla, Alfredo; Malagelada, Juan-R

2011-05-01

The abdomen normally accommodates intra-abdominal volume increments. Patients complaining of abdominal distension exhibit abnormal accommodation of colonic gas loads (defective contraction and excessive protrusion of the anterior wall). However, abdominal imaging demonstrated diaphragmatic descent during spontaneous episodes of bloating in patients with functional gut disorders. We aimed to establish the role of the diaphragm in abdominal distension. In 20 patients complaining of abdominal bloating and 15 healthy subjects, we increased the volume of the abdominal cavity with a colonic gas load, while measuring abdominal girth and electromyographic activity of the anterior abdominal muscles and of the diaphragm. In healthy subjects, the colonic gas load increased girth, relaxed the diaphragm, and increased anterior wall tone. With the same gas load, patients developed significantly more abdominal distension; this was associated with paradoxical contraction of the diaphragm and relaxation of the internal oblique muscle. In this experimental provocation model, abnormal accommodation of the diaphragm is involved in abdominal distension.

Dietary potassium-sodium imbalance as a factor in the aetiology of primary ruminal tympany in dairy cows.

PubMed

Turner, M A

1981-12-01

Results of an investigation into the chemical composition of pasture herbage on twelve New Zealand dairy farms, with contrasting incidences of primary ruminal tympany (bloat), are presented. The data suggest that dietary K;Na ratio may be an important factor in the aetiology of bloat; a factor that does not seem to have been recognised in the past. Other supportive evidence for this hypothesis is briefly discussed.

The Living Dead: Bacterial Community Structure of a Cadaver at the Onset and End of the Bloat Stage of Decomposition

PubMed Central

Hyde, Embriette R.; Haarmann, Daniel P.; Lynne, Aaron M.; Bucheli, Sibyl R.; Petrosino, Joseph F.

2013-01-01

Human decomposition is a mosaic system with an intimate association between biotic and abiotic factors. Despite the integral role of bacteria in the decomposition process, few studies have catalogued bacterial biodiversity for terrestrial scenarios. To explore the microbiome of decomposition, two cadavers were placed at the Southeast Texas Applied Forensic Science facility and allowed to decompose under natural conditions. The bloat stage of decomposition, a stage easily identified in taphonomy and readily attributed to microbial physiology, was targeted. Each cadaver was sampled at two time points, at the onset and end of the bloat stage, from various body sites including internal locations. Bacterial samples were analyzed by pyrosequencing of the 16S rRNA gene. Our data show a shift from aerobic bacteria to anaerobic bacteria in all body sites sampled and demonstrate variation in community structure between bodies, between sample sites within a body, and between initial and end points of the bloat stage within a sample site. These data are best not viewed as points of comparison but rather additive data sets. While some species recovered are the same as those observed in culture-based studies, many are novel. Our results are preliminary and add to a larger emerging data set; a more comprehensive study is needed to further dissect the role of bacteria in human decomposition. PMID:24204941

Effects of Daikenchuto on Abdominal Bloating Accompanied by Chronic Constipation: A Prospective, Single-Center Randomized Open Trial.

PubMed

Yuki, Mika; Komazawa, Yoshinori; Kobayashi, Yoshiya; Kusunoki, Maho; Takahashi, Yoshiko; Nakashima, Sayaka; Uno, Goichi; Ikuma, Isao; Shizuku, Toshihiro; Kinoshita, Yoshikazu

2015-12-01

Daikenchuto (DKT), a traditional Japanese herbal medicine, is widely used for treatment of gastrointestinal disorders. We evaluated the efficacy and safety of DKT for abdominal bloating in patients with chronic constipation. To evaluate the efficacy and safety of DKT for the treatment of abdominal bloating. After discontinuing as-needed use of laxatives, 10 patients received oral DKT for 14 days (15 g/d). To evaluate small intestinal bacteria overgrowth (SIBO), a glucose breath test was performed before and after treatment with DKT. Before beginning the treatment, 4 patients (40%) had a diagnosis of SIBO based on a positive glucose breath test result. In both the SIBO and non-SIBO groups, bowel movement frequency and stool form remained unchanged after DKT treatment. For all patients, median total Gastrointestinal Symptoms Rating Scale score and the median Gastrointestinal Symptoms Rating Scale indigestion and constipation subscales were significantly decreased, whereas the median visual analog score for decreased abdominal bloating was significantly increased. Improvements of those symptoms were the same in both the SIBO and non-SIBO groups, indicating that DKT does not have effects on small intestine bacteria. No serious side effects were reported. DKT treatment improved quality of life for patients with chronic constipation regardless of the presence of SIBO and showed no effects on small intestine bacteria. UMIN Clinical Trial Registry identifier: UMIN000008070.

The living dead: bacterial community structure of a cadaver at the onset and end of the bloat stage of decomposition.

PubMed

Hyde, Embriette R; Haarmann, Daniel P; Lynne, Aaron M; Bucheli, Sibyl R; Petrosino, Joseph F

2013-01-01

Human decomposition is a mosaic system with an intimate association between biotic and abiotic factors. Despite the integral role of bacteria in the decomposition process, few studies have catalogued bacterial biodiversity for terrestrial scenarios. To explore the microbiome of decomposition, two cadavers were placed at the Southeast Texas Applied Forensic Science facility and allowed to decompose under natural conditions. The bloat stage of decomposition, a stage easily identified in taphonomy and readily attributed to microbial physiology, was targeted. Each cadaver was sampled at two time points, at the onset and end of the bloat stage, from various body sites including internal locations. Bacterial samples were analyzed by pyrosequencing of the 16S rRNA gene. Our data show a shift from aerobic bacteria to anaerobic bacteria in all body sites sampled and demonstrate variation in community structure between bodies, between sample sites within a body, and between initial and end points of the bloat stage within a sample site. These data are best not viewed as points of comparison but rather additive data sets. While some species recovered are the same as those observed in culture-based studies, many are novel. Our results are preliminary and add to a larger emerging data set; a more comprehensive study is needed to further dissect the role of bacteria in human decomposition.

Evaluating symptom outcomes in gastroparesis clinical trials: validity and responsiveness of the Gastroparesis Cardinal Symptom Index-Daily Diary (GCSI-DD).

PubMed

Revicki, D A; Camilleri, M; Kuo, B; Szarka, L A; McCormack, J; Parkman, H P

2012-05-01

Patient-reported symptom scales are needed to evaluate treatments for gastroparesis. The Gastroparesis Cardinal Symptom Index-Daily Diary (GCSI-DD) was developed to assess daily symptoms of gastroparesis. This study evaluated the validity and responsiveness of the GCSI-DD in patients with gastroparesis. Symptomatic patients were started with a new treatment for gastroparesis. Patients completed the GCSI-DD each evening during a baseline week and for 8 weeks of treatment. Responders were defined based on patient and clinician global rating of change. Minimal important differences (MID) were estimated based on baseline to 4 week changes in symptoms scores for small improvements. Of 69 patients participating, 46 had idiopathic, 19 diabetic, and four postfundoplication gastroparesis. Excellent test-retest reliability was seen for GCSI-DD scores, and there were significant correlations between GCSI-DD scores and clinician ratings of symptom severity. Responders to treatment reported improvements in nausea [effect size (ES) = 0.42, P < 0.001], postprandial fullness, ES = 0.83, P < 0.001), bloating (ES = 0.34, P < 0.001), early satiety (ES = 0.53, P < 0.001), but lower responses for upper abdominal pain (ES = 0.29), and vomiting (ES = 0.22; P = 0.119). MIDs were 0.55 for nausea, 0.97 for excessive fullness, 0.63 for bloating, 0.77 for postprandial fullness, and 0.30 for abdominal pain. A composite score of four symptoms (Composite-1; nausea, bloating, excessive fullness, postprandial fullness) had ES of 0.61 and MID of 0.73. Composite-2 score (nausea, early satiety, bloating, abdominal pain) had a lower ES of 0.47. Symptoms of early satiety, nausea, postprandial fullness, and bloating were responsive to treatment for gastroparesis. A composite of these symptoms also demonstrates validity and responsiveness to treatment for gastroparesis, and may represent an acceptable endpoint for evaluating the effectiveness of medical treatments in clinical trials for gastroparesis. © 2012 Blackwell Publishing Ltd.

Development of porous ceramsite from construction and demolition waste.

PubMed

Wang, Chuan; Wu, Jian-Zhi; Zhang, Fu-Shen

2013-01-01

The disposal of construction and demolition (C&D) waste has become a serious problem in China due to the rapid increase of Chinese construction industry in recent years. In the present study, typical C&D waste was employed for ceramsite fabrication so as to find a new way for its effective recycling. A novel process was developed for manufacturing high-quality porous ceramsite according to the special chemical composition and properties of C&D waste. Most importantly, a unique bloating agent was developed for the porous structure formation since it was difficult to obtain a suitable porous structure using traditional bloating agents. The effects of processing parameters such as sintering temperature, heating rate and soaking time were investigated, and the bloating mechanism for ceramsite was discussed. The C&D waste ceramsite (CDWC), with high-intensity, low density and homogeneous mechanical properties, was much more suitable for application in the construction field. This study provides a practical process for efficient recycling of the rapidly increasing quantities of C&D waste.

Terrestrial laser scanning and a degenerated cylinder model to determine gross morphological change of cadavers under conditions of natural decomposition.

PubMed

Zhang, Xiao; Glennie, Craig L; Bucheli, Sibyl R; Lindgren, Natalie K; Lynne, Aaron M

2014-08-01

Decomposition can be a highly variable process with stages that are difficult to quantify. Using high accuracy terrestrial laser scanning a repeated three-dimensional (3D) documentation of volumetric changes of a human body during early decomposition is recorded. To determine temporal volumetric variations as well as 3D distribution of the changed locations in the body over time, this paper introduces the use of multiple degenerated cylinder models to provide a reasonable approximation of body parts against which 3D change can be measured and visualized. An iterative closest point algorithm is used for 3D registration, and a method for determining volumetric change is presented. Comparison of the laser scanning estimates of volumetric change shows good agreement with repeated in-situ measurements of abdomen and limb circumference that were taken diurnally. The 3D visualizations of volumetric changes demonstrate that bloat is a process with a beginning, middle, and end rather than a state of presence or absence. Additionally, the 3D visualizations show conclusively that cadaver bloat is not isolated to the abdominal cavity, but also occurs in the limbs. Detailed quantification of the bloat stage of decay has the potential to alter how the beginning and end of bloat are determined by researchers and can provide further insight into the effects of the ecosystem on decomposition. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Digestive functional symptoms among commercial pilots in relation to diet, insomnia, and lifestyle factors.

PubMed

Lindgren, Torsten; Runeson, Roma; Wahlstedt, Kurt; Wieslander, Gunilla; Dammström, Bo-Göran; Norbäck, Dan

2012-09-01

The aim of our study was to identify associations between digestive symptoms among pilots and diet, insomnia, and lifestyle factors. A standardized questionnaire was mailed to all Stockholm pilots on duty in a Swedish airline company: 354 pilots and 564 office workers from the same company participated. Associations were analyzed by multiple logistic regressions with mutual adjustment. Of the pilots, 9.9% reported poor appetite, 15.2% heartburn, 12.4% diarrhea, 62.1% bloating, 9.3% constipation, and 14.4% epigastralgia. Pilots reported more bloating and poor appetite compared with office workers. The prevalence of insomnia was 70.6% among pilots and 63.1% among office workers. Among pilots, insomnia was related to poor appetite, heartburn, diarrhea, bloating, constipation, and epigastralgia. There were no associations between insomnia and digestive symptoms among office workers. Among pilots, higher body mass index (BMI) was related to heartburn and smokers more often suffered from constipation. Frequent milk consumption was associated with heartburn and less constipation; female pilots suffered from more constipation. The number of years as an active pilot was negatively associated with epigastralgia and bloating. Insomnia and some digestive symptoms were more common among pilots than office workers. In addition to insomnia, BMI, smoking, female gender, and milk consumption were associated with some digestive symptoms. The strong association between insomnia and digestive symptoms among pilots, but not among office workers, suggests a stress component related to this occupation.

[A balloon probe for the treatment of recurrent bloat in calves and young cattle].

PubMed

Doll, K

1989-01-01

For the treatment of recurrent bloat a soft-rubber balloon tube which is inserted through the nose into the rumen and can stay there for several days was developed. The inflated balloon ensures a floating of the tip of the tube in the dorsal gas cap above the rumen contents. The tube can also be used as a prophylactic measure to avoid excessive ruminal gas accumulation in recumbent patients during surgery. This report describes the experiences with this balloon tube gathered in 23 clinical patients.

A Note on the Flora and Fauna in the Rumen of Steers Fed a Feedlot Bloat-provoking Ration and the Effect of Penicillin

PubMed Central

Bryant, M. P.; Robinson, I. M.; Lindahl, Ivan L.

1961-01-01

A study was made of the predominant culturable bacteria and ciliate protozoa present in the rumen of two steers that were regularly bloating on a pelleted ratio containing 22% alfalfa meal, 16% soybean oil meal, 61% barley, and 1% common salt. The ruminal microorganisms in the two animals differed as indicated by a high total culture count of bacteria, an almost complete absence of ciliate protozoa, a low pH, and a difference in the proportions of presumptively identified predominant bacterial groups in one animal (steer 26) as compared with the other (steer 32). The first exposure of the animals to procaine penicillin (75 or 150 mg per day on 2 successive days) resulted in an abnormal ruminal flora 31 hr after the first treatment as indicated by drastic drops in total and cellulolytic bacterial counts and a change in the proportions of predominant bacterial groups. The animals refused feed for 32 to 48 hr after the first treatment. After feed consumption resumed, further treatment with 75 mg penicillin on 4 successive days did not appear to greatly alter the flora and did not result in feed refusal in animal 32. In animal 26, amounts of penicillin progressing from 50 to 200 mg per day did not result in feed refusals and observations on rumen ingesta samples during this period indicated a decrease in total bacterial count, a great increase in numbers of ciliate protozoa, a higher pH, and a change in the proportions of predominant bacterial groups so that the ruminal picture was much more similar to that of animal 32 than to its own during the pre-penicillin period. Bloat was not relieved except during the period of feed refusal. The results indicate that the ruminal flora rapidly adapts to penicillin and that bloat of the feedlot type can occur in animals with widely differing numbers and kinds of bacteria and protozoa. Feedlot bloat does not appear to be correlated with the occurrence or numbers of any of the individual predominant groups of bacteria cultured. PMID:13874139

A note on the flora and fauna in the rumen of steers fed a feedlot bloat-provoking ration and the effect of penicillin.

PubMed

BRYANT, M P; ROBINSON, I M; LINDAHL, I L

1961-11-01

A study was made of the predominant culturable bacteria and ciliate protozoa present in the rumen of two steers that were regularly bloating on a pelleted ratio containing 22% alfalfa meal, 16% soybean oil meal, 61% barley, and 1% common salt. The ruminal microorganisms in the two animals differed as indicated by a high total culture count of bacteria, an almost complete absence of ciliate protozoa, a low pH, and a difference in the proportions of presumptively identified predominant bacterial groups in one animal (steer 26) as compared with the other (steer 32). The first exposure of the animals to procaine penicillin (75 or 150 mg per day on 2 successive days) resulted in an abnormal ruminal flora 31 hr after the first treatment as indicated by drastic drops in total and cellulolytic bacterial counts and a change in the proportions of predominant bacterial groups. The animals refused feed for 32 to 48 hr after the first treatment. After feed consumption resumed, further treatment with 75 mg penicillin on 4 successive days did not appear to greatly alter the flora and did not result in feed refusal in animal 32. In animal 26, amounts of penicillin progressing from 50 to 200 mg per day did not result in feed refusals and observations on rumen ingesta samples during this period indicated a decrease in total bacterial count, a great increase in numbers of ciliate protozoa, a higher pH, and a change in the proportions of predominant bacterial groups so that the ruminal picture was much more similar to that of animal 32 than to its own during the pre-penicillin period. Bloat was not relieved except during the period of feed refusal. The results indicate that the ruminal flora rapidly adapts to penicillin and that bloat of the feedlot type can occur in animals with widely differing numbers and kinds of bacteria and protozoa. Feedlot bloat does not appear to be correlated with the occurrence or numbers of any of the individual predominant groups of bacteria cultured.

Diagnosis and Management of Rumen Acidosis and Bloat in Feedlots.

PubMed

Meyer, Nathan F; Bryant, Tony C

2017-11-01

Ruminal acidosis and ruminal bloat represent the most common digestive disorders in feedlot cattle. Ruminants are uniquely adapted to digest and metabolize a large range of feedstuffs. Although cattle have the ability to handle various feedstuffs, disorders associated with altered ruminal fermentation can occur. Proper ruminal microorganism adaptation and a consistent substrate (ration) help prevent digestive disorders. Feed bunk management, sufficient ration fiber, consistent feed milling, and appropriate response to abnormal weather are additional factors important in prevention of digestive disorders. When digestive disorders are suspected, timely diagnosis is imperative. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of alcohol ethoxylate and pluronic detergents on the development of pasture bloat in cattle and sheep.

PubMed

Stanford, K; Wang, Y; Berg, B P; Majak, W; McCartney, D H; Baron, V; McAllister, T A

2001-01-01

A series of studies was conducted to determine the efficacy and possible modes of action of a water-soluble mixture of alcohol ethoxylate and pluronic detergents (AEPD; Blocare 4511, ANCARE, Auckland, NZ) in preventing pasture bloat in ruminants grazing or fed freshly harvested alfalfa. Ten cannulated Suffolk wethers were offered freshly harvested alfalfa; five were given a daily intraruminal dose of 40 ml of 50% AEPD (vol/vol) 1 h before feeding, and five (controls) were dosed with water. Viscosity of ruminal fluid was reduced (P < 0.001) in AEPD-treated wethers, relative to the controls, for the first 2 h after feeding but not at 4 h after feeding and beyond. Treatment with AEPD did not affect dry matter (DM) intake, digestibility of DM, acid detergent fiber, or neutral detergent fiber, or N digestion and retention, implying that AEPD likely would not affect milk production. In a crossover grazing study, five of the wethers were given AEPD in drinking water (0.1%, vol/vol); treatment with AEPD was 100% effective for preventing bloat in sheep grazing early-bloom alfalfa for 4 h daily. Replicate grazing studies were conducted with cattle in Lethbridge, AB; Lacombe, AB; and Kamloops, BC. Treated animals received AEPD in the water (0.06%, vol/vol) and grazed vegetative alfalfa for 6 h daily. As it did with sheep, AEPD treatment effectively precluded the bloat observed in control animals. Consequently, AEPD may be a valuable tool for alfalfa pasture-based dairy production although further study is required to develop an integrated model for optimal administration under a variety of climatic conditions.

Functional disorders of the stomach

NASA Technical Reports Server (NTRS)

Koch, K. L.; Stern, R. M.

1990-01-01

Gastroenterologists frequently encounter patients who report vague epigastric discomforts or sensations of fullness, bloating, and distention in the upper abdomen. The discomfort is neither burning in character nor severe in intensity; there is no nocturnal pain. The epigastric location of discomfort and lack of radiation may help to exclude biliary tract and pancreatic diseases. Nausea may be present, but there is little or no vomiting. After these patients ingest liquids or solid foods, the symptoms of easy filling or early satiety and increasing discomfort and nausea are almost always present. The patient may only report "indigestion," but a specific chief complaint, such as pain, discomfort, nausea, or bloating may be elicited with further inquiries. Solid foods usually provoke more symptoms than do liquids. Symptoms of early satiety, nausea, bloating, and abdominal discomfort may culminate in the vomiting of undigested food. These vague upper gastrointestinal (GI) symptoms have been termed "dyspepsia." When peptic diseases of the stomach are excluded, the symptom complex has been called "nonulcer" dyspepsia, a vague syndrome with symptoms attributed to stomach dysfunction. Nonulcer dyspepsia has been reviewed recently. Such symptoms, commonly attributed to a "functional" disorder, are very common in clinical practice, with an incidence of 30% of patients. In this review, we will discuss an approach to the evaluation and treatment of patients with symptoms of nausea, early satiety, bloating, and vague epigastric discomfort--dyspeptic symptoms associated with functional stomach disorders. We will review the anatomy and motility of the stomach and suggest potential neuromuscular malfunctions of the stomach that may result in epigastric symptoms. The potential role of stress and other brain-gut interactions, which may underlie these symptoms, will also be reviewed.

Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome.

PubMed

Ducrotté, Philippe; Sawant, Prabha; Jayanthi, Venkataraman

2012-08-14

To assess the symptomatic efficacy of Lactobacillus plantarum 299v (L. plantarum 299v) (DSM 9843) for the relief of abdominal symptoms in a large subset of irritable bowel syndrome (IBS) patients fulfilling the Rome III criteria. In this double blind, placebo-controlled, parallel-designed study, subjects were randomized to daily receive either one capsule of L. plantarum 299v (DSM 9843) or placebo for 4 wk. Frequency and intensity of abdominal pain, bloating and feeling of incomplete rectal emptying were assessed weekly on a visual analogue scale while stool frequency was calculated. Two hundred and fourteen IBS patients were recruited. After 4 wk, both pain severity (0.68 + 0.53 vs 0.92 + 0.57, P < 0.05) and daily frequency (1.01 + 0.77 vs 1.71 + 0.93, P < 0.05) were lower with L. plantarum 299v (DSM 9843) than with placebo. Similar results were obtained for bloating. At week 4, 78.1 % of the patients scored the L. plantarum 299v (DSM 9843) symptomatic effect as excellent or good vs only 8.1 % for placebo (P < 0.01). A 4-wk treatment with L. plantarum 299v (DSM 9843) provided effective symptom relief, particularly of abdominal pain and bloating, in IBS patients fulfilling the Rome III criteria.

Dicyclomine

MedlinePlus

... tract by blocking the activity of a certain natural substance in the body. ... dry mouth upset stomach vomiting constipation stomach pain gas or bloating loss of appetite dizziness tingling headache ...

Linaclotide

MedlinePlus

Linaclotide is used in adults to treat irritable bowel syndrome with constipation (IBS-C; a condition that causes stomach pain or cramps, bloating, and infrequent or difficult passage of stools) and chronic idiopathic ...

Reflux symptoms and side effects among patients with gastroesophageal reflux disease at baseline, during treatment with PPIs, and after Nissen fundoplication.

PubMed

Rantanen, Tuomo; Kiljander, Toni; Salminen, Paulina; Ranta, Arto; Oksala, Niku; Kellokumpu, Ilmo

2013-06-01

There are no prospective studies available on the behavior of extraesophageal and esophageal symptoms and treatment-related side effects in patients without effective antireflux medication, receiving the most effective antireflux medication, and after laparoscopic fundoplication. Extraesophageal and esophageal reflux symptoms and treatment-related side effects were assessed in 60 patients while they were on no effective antireflux medication (three-week washout period), after three month of treatment with double-dose esomeprazole, and 3 months after laparoscopic Nissen fundoplication. Esophageal and extraesophageal reflux symptoms, rectal flatulence, and bloating were analyzed with the visual analog scale. In addition, dysphagia, rectal flatulence, and bloating were recorded as none, mild, moderate, or severe. Both extraesophageal and esophageal reflux symptoms decreased after treatment with esomeprazole and were further reduced after fundoplication. Dysphagia and flatulence did not increase from baseline after surgery. Bloating decreased both after treatment with esomeprazole and after fundoplication. In contrast, dysphagia and increased flatus were found more often after surgery than during treatment with esomeprazole. Dysphagia and rectal flatulence were less common during treatment with esomeprazole than at baseline or after surgery. Both extraesophageal and esophageal reflux symptoms decreased after treatment with esomeprazole and were reduced further after fundoplication. Any treatment-related side effect was not increased after surgery when compared to baseline. However, compared to esomeprazole there was more dysphagia and flatulence after fundoplication.

Clinical trial: Lactobacillus plantarum 299v (DSM 9843) improves symptoms of irritable bowel syndrome

PubMed Central

Ducrotté, Philippe; Sawant, Prabha; Jayanthi, Venkataraman

2012-01-01

AIM: To assess the symptomatic efficacy of Lactobacillus plantarum 299v (L. plantarum 299v) (DSM 9843) for the relief of abdominal symptoms in a large subset of irritable bowel syndrome (IBS) patients fulfilling the Rome III criteria. METHODS: In this double blind, placebo-controlled, parallel-designed study, subjects were randomized to daily receive either one capsule of L. plantarum 299v (DSM 9843) or placebo for 4 wk. Frequency and intensity of abdominal pain, bloating and feeling of incomplete rectal emptying were assessed weekly on a visual analogue scale while stool frequency was calculated. RESULTS: Two hundred and fourteen IBS patients were recruited. After 4 wk, both pain severity (0.68 + 0.53 vs 0.92 + 0.57, P < 0.05) and daily frequency (1.01 + 0.77 vs 1.71 + 0.93, P < 0.05) were lower with L. plantarum 299v (DSM 9843) than with placebo. Similar results were obtained for bloating. At week 4, 78.1 % of the patients scored the L. plantarum 299v (DSM 9843) symptomatic effect as excellent or good vs only 8.1 % for placebo (P < 0.01). CONCLUSION: A 4-wk treatment with L. plantarum 299v (DSM 9843) provided effective symptom relief, particularly of abdominal pain and bloating, in IBS patients fulfilling the Rome III criteria. PMID:22912552

Hiccups

MedlinePlus

... a hiccup is a quick closing of your vocal cords. This is what causes the "hic" sound ... or excited A bloated stomach Certain medicines Abdominal surgery Metabolic disorders Central nervous system disorders Hiccups usually ...

Fiber

MedlinePlus

... short period of time can cause intestinal gas ( flatulence ), bloating , and abdominal cramps . This problem often goes ... 213. National Research Council. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and ...

Gastroparesis

MedlinePlus

... hours the contractile responses while the subject is fasting and eating are observed and recorded. The manometry ... Hepatitis C Inflammatory Bowel Disease Irritable Bowel Syndrome Obesity Digestive Health Topics Abdominal Pain Syndrome Belching, Bloating, ...

Lubiprostone

MedlinePlus

Lubiprostone is used to relieve stomach pain, bloating, and straining and produce softer and more frequent bowel ... not caused by a disease or a medication). Lubiprostone is also used to treat irritable bowel syndrome ...

Simethicone

MedlinePlus

Simethicone is used to treat the symptoms of gas such as uncomfortable or painful pressure, fullness, and bloating.This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

Side Effects: Constipation

Cancer.gov

Cancer treatment can cause constipation. Symptoms include hard stools, stomach cramps, bloating, and nausea. Causes also include pain medicine, diet changes, dehydration, and being less active. Prevention and treatment of constipation is explained.

Indigestion (For Teens)

MedlinePlus

... belly nausea bloating uncontrollable burping heartburn When to Go to the Doctor Usually, indigestion only happens once ... Don't eat a huge meal and immediately go to sports practice. Try to eat at least ...

ERCP

MedlinePlus

... dye, or drug used during the procedure Bleeding Hole (perforation) of the bowel Inflammation of the pancreas ( ... or severe bloating Bleeding from the rectum or black stools Fever above 100°F (37.8°C) ...

Medications (for IBS)

MedlinePlus Videos and Cool Tools

... natural." It might come in a pill, a liquid, or a food product. When you take something ... That Cause Cramping and Diarrhea Foods that Cause Gas and Bloating Dietary Fiber 12 Week Elimination Diet ...

Eosinophilic Disorders Glossary

MedlinePlus

... and related foods may lead to bloating from fermentation of a certain carbohydrate that is high in ... and is fermented by bacteria. Byproducts of the fermentation process cause symptoms, including gas, diarrhea, nausea, and ...

Belching, Bloating and Flatulence

MedlinePlus

... Examples of such food are bran, cabbage, cauliflower, broccoli, and beans. This can result in excess flatulence ... as soda and beer. Foods such as cauliflower, broccoli, cabbage, beans, and bran should be avoided. Milk ...

Alosetron

MedlinePlus

... urgent need to have bowel movements caused by irritable bowel syndrome (IBS; a condition that causes stomach pain, bloating, constipation, ... alosetron and call your doctor.Alosetron may control IBS but will not cure it. If alosetron helps ...

Clinical response in Mexican patients with irritable bowel syndrome treated with a low diet low in fermentable carbohydrates (FODMAP).

PubMed

Pérez y López, N; Torres-López, E; Zamarripa-Dorsey, F

2015-01-01

The low FODMAP diet eliminates carbohydrates and fermentable alcohols because they are not absorbed by the intestine, but are fermented by the microbiota, causing bloating and flatulence. To evaluate the clinical response to the low FODMAP diet in patients with the different clinical subtypes of irritable bowel syndrome (IBS). Patients attended to at the Gastroenterology Department in 2014 that were diagnosed with IBS based on the Rome III criteria were included in the study. They were managed with a low FODMAP diet for 21 days and their response to the symptoms of abdominal pain, bloating, flatulence, and stool form pre and post-diet were evaluated through the visual analogue scale, Bristol scale, and patient overall satisfaction. The results were analyzed by means, 95% CI, and the Student's t test. Of the 31 patients included in the study, 87% were women and the mean age was 46.48 years. Distribution was: IBS-C 64.5%, IBS-D 22.6%, and IBS-M 12.9%. The score for pain was 6.0 (95% CI 5.04-6.96) and the post-diet score was 2.77 (95% CI 1.60-3.95) (P<.001). The score for bloating was 7.10 (95% CI 6.13-8.06) and the post-diet score was 4.19 (95% CI 2.95-5.44) (P<.001). The score for flatulence was 5.94 (95% CI 4.79-7.08) and the post-diet score was 3.06 (IC95% 1.99-4.14) (P<.001). The pre-diet Bristol Scale result was 3.68 (95% CI 3.14-4.22) and the post-diet result was 4.10 (95% CI 3.66-4.54) (P=.1). The satisfaction percentage was 70.9%. In this first study on a Mexican population with IBS, there was significant improvement of the main symptoms, including pain, bloating, and flatulence after treatment with a low FODMAP diet. Copyright © 2015 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.

Rumen distension and contraction influence feed preference by sheep.

PubMed

Villalba, J J; Provenza, F D; Stott, R

2009-01-01

Distension of the rumen limits feed intake by livestock. Ruminal dysfunctions due to bloat, which causes distension by accumulation of excessive gas within the rumen, also reduce feeding. We hypothesized that excessive levels of rumen distension cause feed aversions and that preference increases for feeds eaten in association with recovery from bloat. To test these hypotheses, we determined whether 12 commercial crossbred lambs (average initial BW of 43 +/- 2 kg) could associate ingestion of specific feeds with the consequences of increased intraruminal pressure and its subsidence. Six of the lambs were fitted with rumen cannulas and offered ground alfalfa for 30 min after a rubber balloon was inserted into the rumen of each animal and distended with air to volumes of 1.8, 2.5, or 4.5 L. Subsequently, balloons were deflated and alfalfa was offered again for a second period of 30 min. Feed intake was not affected when the balloon was not distended (P = 0.45 to 0.93), but distension reduced feed intake (P < 0.001) in direct proportion to the magnitude of distension at all 3 volumes (R(2) = 0.70). Relief from distension promoted a compensatory increase in feed intake (P = 0.006). During conditioning to determine if lambs acquired a preference for a feed associated with recovery from distension, fistulated lambs were offered novel feeds: wheat bran (group 1; n = 3) and beet pulp (group 2; n = 3), and the balloon was distended for 30 min. Feeds were then switched and the balloons were deflated (recovery). Control lambs (n = 6) received the same feeding protocol without the balloons. Lambs formed strong aversions to feeds associated with distension and preferred feeds associated with recovery (P = 0.001 to P = 0.10). No preferences or avoidances were observed in control lambs conditioned without rumen distension (P = 0.17 to P = 0.87). Thus, rumen distension and recovery from distension induced feed aversions and preferences, respectively, which may be critical in learning avoidance of bloat-inducing plants and preferences for plants and supplements that relieve the incidence of bloat.

Weight gain - unintentional

MedlinePlus

... Cushing syndrome Underactive thyroid, or low thyroid (hypothyroidism) Polycystic ovary syndrome Menopause Pregnancy Bloating, or swelling due to a buildup of fluid in the tissues can cause weight gain. This may be due to menstruation, heart ...

Air swallowing as a tic.

PubMed

Weil, Rimona S; Cavanna, Andrea E; Willoughby, John M T; Robertson, Mary M

2008-11-01

The authors present a patient with Gilles de la Tourette syndrome who developed abdominal distension and bloating due to air swallowing. We suggest that this air swallowing may have been due to a tic.

Ileus

MedlinePlus

... are abdominal bloating caused by a buildup of gas and liquids, nausea, vomiting, severe constipation, loss of appetite, and ... rare, but if it occurs, the buildup of gas and liquid caused by ileus must be relieved. Usually, a ...

Mesenteric venous thrombosis

MedlinePlus

... after eating and over time Bloating Diarrhea Fever Gastrointestinal bleeding Vomiting and nausea ... to treat MVT when there is no associated bleeding. In some cases, ... (an opening from the colon into the skin) may be needed.

Confusing or Ambiguous Upper Gut Symptoms

MedlinePlus

... esophageal sphincter. This is called gastroesophageal reflux – the fundamental abnormality underlying GERD. Unlike vomiting, the regurgitated material ... Belching Bloating and Distension Chronic Pain Medications Self-management Other Management Techniques 8-step Approach to Chronic ...

Common Disorders of the Pancreas

MedlinePlus

... way to confirm the diagnosis of pancreatic disease. Acute Pancreatitis Acute pancreatitis is a sudden attack causing inflammation of ... severe and last several days. Other symptoms of acute pancreatitis include nausea, vomiting, diarrhea, bloating, and fever. ...

Anatomic Problems of the Lower GI Tract

MedlinePlus

... then changes waste from liquid to a solid matter called stool. Stool passes from the colon to ... include abdominal tenderness, swelling, or bloating bloody or dark-red stools constipation—a condition in which a ...

Effects of a combination of hinokitiol (β-thujaplicin) and an organic acid mixture on ruminal fermentation in heifers fed a high-grain diet.

PubMed

Ishii, Junichiro; Omura, Hiroshi; Mitsui, Tadao; Eguchi, Norichika; Ueno, Takashi; Goto, Hisaya; Ito, Hiroshi

2012-01-01

This study evaluated the effects of hinokitiol (a natural antibacterial compound extracted from Thujopsis dolabrata var. hondai) and an organic acid mixture (citrate content 50%) on ruminal fermentation. Antibacterial properties were examined by measuring minimal inhibitory concentration. Hinokitiol at 1.56µg/mL or an organic acid mixture at 1600µg/mL inhibited Streptococcus bovis growth. The combination of 0.78µg/mL hinokitiol and 200µg/mL of an organic acid mixture also inhibited S. bovis growth. Both hinokitiol and the hinokitiol and an organic acid mixture combination showed strong antibacterial properties on Gram-positive bacteria such as S. bovis, but relatively weak antibacterial activities on Gram-negative bacteria such as Megasphaera elsdenii. Three ruminally cannulated heifers were fed a bloat-producing diet containing barley, pelleted alfalfa meal, soybean meal and salt without long-cut roughage to investigate the ruminal characteristics in vivo. Feeding to heifers a bloat-producing diet containing 7.8mg/kg hinokitiol and 0.2% of an organic acid mixture significantly decreased the increase in stable ingesta volume. Hinokitiol or an organic acid mixture did not affect ruminal volatile fatty acids, protozoa and bacteria. These results suggest that a combination of hinokitiol and an organic acid mixture might reduce frothy bloat in cattle fed high-grain diets. © 2011 The Authors. Animal Science Journal © 2011 Japanese Society of Animal Science.

Epidemiology of uninvestigated gastrointestinal symptoms in adolescents: a population-based study applying the Rome II questionnaire.

PubMed

Sohrabi, Sahand; Nouraie, Mehdi; Khademi, Hooman; Baghizadeh, Somayyeh; Nasseri-Moghaddam, Siavosh; Malekzadeh, Reza

2010-07-01

: Gastrointestinal (GI) disorders in early life contribute to a lower quality of life and more persistent GI symptoms during the rest of life. Epidemiologic data on adolescence GI disorders are scarce. We aimed to perform a population-based study to assess the prevalence of GI symptoms in adolescents and their relation to sex, age, and socioeconomic status. : A multistage random sample of Tehran middle and high school students (ages 14-19 years) was selected. A validated Persian version of the Rome II questionnaire was used to measure the frequency of different GI disorders as well as demographic socioeconomic variables. : A total of 1436 participants were enrolled in the study, 736 (51.3%) of whom were men. Mean (SD) age was 16.9 (1.8) years. The frequency of at least 1 GI symptom was 32.4%. The 4 most prevalent GI symptoms were bloating (16.9%), heartburn (4.9%), incontinence (4.3%), and irritable bowel syndrome (4.1%). Bloating, irritable bowel syndrome, and proctalgia fugax were significantly more common in girls (P < 0.05). Incontinence was significantly more prevalent in lower socioeconomic status levels (P = 0.01). In logistic regression, age was a risk factor for abdominal bloating and dysphagea and a protective factor for incontinence. : Our study indicates that GI symptoms are common among adolescents. Girls are more prone to these disorders. Special psychological and medical interventions are necessary for high-risk groups.

Irritable Bowel Syndrome

MedlinePlus

Irritable bowel syndrome (IBS) is a problem that affects the large intestine. It can cause abdominal cramping, bloating, and a change in bowel ... go back and forth between the two. Although IBS can cause a great deal of discomfort, it ...

Laparoscopic Surgery

MedlinePlus

... Main ACG Site ACG Patients Home / Digestive Health Topic / Laparoscopic Surgery Laparoscopic Surgery Basics Overview What is laparoscopic surgery? ... with your doctor whether some type of laparoscopic surgery is most suitable for your ... Topics Abdominal Pain Syndrome Belching, Bloating, and Flatulence Common ...

Survey of Chemical Compounds Tested In Vitro against Rumen Protozoa for Possible Control of Bloat

PubMed Central

Willard, F. L.; Kodras, Rudolph

1967-01-01

Over 170 chemical agents were screened for antiprotozoal action in bovine ruminal fluid. Compounds were tested at 0.1 and 0.05% concentrations. Tested compounds included inorganic compounds, antibiotics, biocides, neuromuscular agents, arsenicals, plant and animal hormones, antimalarials, surface-active agents, anthelmintics, and many others. The most active compounds were cupric sulfate, nickel sulfate, nitrofurazone, hydrogen peroxide, dodecyl sodium sulfate, pelargonic acid, iodoacetic acid, 1-diethylaminoethylamino-4-methylthiaxanthrone, sodium arsanilate, sodium arsenate, bismuth glycolyl arsanilate, 1-β-hydroxyethyl-2-methyl-5-nitroimidazole, and p-nitroaniline. Copper ion was not particularly effective against entodinia; nickel ion had no effect on holotrichs. Hydrogen peroxide and iodoacetic acid were effective at a concentration of 0.005%. Anionic surface-active agents were very effective, especially long-chain sulfates and phosphates. These antiprotozoal agents warrant further in vivo studies for possible use in treating or curing bloat in ruminants. PMID:6077407

Survey of chemical compounds tested in vitro against rumen protozoa for possible control of bloat.

PubMed

Willard, F L; Kodras, R

1967-09-01

Over 170 chemical agents were screened for antiprotozoal action in bovine ruminal fluid. Compounds were tested at 0.1 and 0.05% concentrations. Tested compounds included inorganic compounds, antibiotics, biocides, neuromuscular agents, arsenicals, plant and animal hormones, antimalarials, surface-active agents, anthelmintics, and many others. The most active compounds were cupric sulfate, nickel sulfate, nitrofurazone, hydrogen peroxide, dodecyl sodium sulfate, pelargonic acid, iodoacetic acid, 1-diethylaminoethylamino-4-methylthiaxanthrone, sodium arsanilate, sodium arsenate, bismuth glycolyl arsanilate, 1-beta-hydroxyethyl-2-methyl-5-nitroimidazole, and p-nitroaniline. Copper ion was not particularly effective against entodinia; nickel ion had no effect on holotrichs. Hydrogen peroxide and iodoacetic acid were effective at a concentration of 0.005%. Anionic surface-active agents were very effective, especially long-chain sulfates and phosphates. These antiprotozoal agents warrant further in vivo studies for possible use in treating or curing bloat in ruminants.

Randomized controlled trial of probiotics after colonoscopy.

PubMed

D'Souza, Basil; Slack, Timothy; Wong, Shing W; Lam, Francis; Muhlmann, Mark; Koestenbauer, Jakob; Dark, Jonathan; Newstead, Graham

2017-09-01

Up to 20% of patients have ongoing abdominal symptoms at day 2 and beyond following colonoscopy. It was hypothesized that some of these symptoms are related to alterations in gut microbiota secondary to bowel preparation and would improve with probiotics compared with placebo. Patients were given either a probiotic or placebo capsule in the days following colonoscopy. Colonoscopy was performed with air insufflation. The probiotic capsule contained the strains Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07. Patients recorded their symptoms at 1 h, 1, 2, 4, 7 and 14 days post colonoscopy and returned results once their symptoms had resolved. The primary outcomes used were the length of days to resolution of bloating, abdominal pain and altered bowel function post colonoscopy. A total of 320 patients were randomized. After loss to follow-up and withdrawal, 133 patients were analysed in the probiotic group and 126 in the placebo group. Patients having probiotic had a lower number of pain days following colonoscopy, 1.99 versus 2.78 days (P < 0.033). There was no significant difference in bloating or return to normal bowel habit days (P = 0.139 and 0.265 respectively). Subgroup analysis revealed that patients with pre-existing abdominal pain benefited from probiotics in number of pain days, 2.16 versus 4.08 (P = 0.0498). Our study has shown a significant reduction in the duration of pain days post colonoscopy in patients taking probiotic compared with placebo. No significant effect was seen in terms of return to normal bowel function or bloating post colonoscopy. © 2015 Royal Australasian College of Surgeons.

Ruminal motility of stocker cattle grazed on winter wheat pasture.

PubMed

Horn, G W; Frost, D F

1982-10-01

A 2-yr study was conducted to determine whether bloat of stocker cattle grazing winter wheat pasture is a primary bloat or a secondary bloat as a result of reduced ruminal motility. Amplitude (mm Hg) and frequency of ruminal contractions (contractions/min) of steers were measured before and after the steers were placed on wheat pasture, and at about weekly intervals during the pasture grazing periods. Implantable pressure transducers and water-filled balloon cannulas were used to measure ruminal motility. During the first year, amplitude of contractions increased (P less than .005) during grazing of wheat pasture (i.e., 20.5 vs 6.7 and 21.6 vs 12.9, respectively, for steers with implanted pressure transducers and water-filled balloon cannulas). Frequency of ruminal contractions of steers on wheat pasture was not decreased (P greater than .05). In the second year, amplitudes of ruminal contractions of steers on wheat pasture ranged from 11.0 to 33.5, and were either similar or greater (P less than .05) than the mean for the pre- and post-wheat pasture period (16.5). Frequencies of ruminal contractions that ranged from 1.66 to 1.80 were observed on four dates during the pasture grazing period, and were decreased (P less than .05) as compared with the mean for the pre- and post-wheat pasture period (2.43). However, the reduced frequencies were not accompanied by reduced (P greater than .05) amplitude x frequency of contractions. The data indicate that ruminal motility is not decreased in stocker cattle grazing winter wheat pasture.

Effect of antispasmodic agents, alone or in combination, in the treatment of Irritable Bowel Syndrome: systematic review and meta-analysis.

PubMed

Martínez-Vázquez, M A; Vázquez-Elizondo, G; González-González, J A; Gutiérrez-Udave, R; Maldonado-Garza, H J; Bosques-Padilla, F J

2012-01-01

Irritable bowel syndrome (IBS) is characterized by recurrent abdominal pain, bloating, and changes in bowel habit. To determine the clinical effectiveness of the antispasmodic agents available in Mexico for the treatment of IBS. We carried out a systematic review and meta-analysis of randomized controlled clinical trials on antispasmodic agents for IBS treatment. Clinical trials identified from January 1960 to May 2011 were searched for in MEDLINE, the Cochrane Library, and in the ClinicalTrials.gov registry. Treatment response was evaluated by global improvement of symptoms or abdominal pain, abdominal distention/bloating, and frequency of adverse events. The effect of antispasmodics vs placebo was expressed in OR and 95% CI. Twenty-seven studies were identified, 23 of which fulfilled inclusion criteria. The studied agents were pinaverium bromide, mebeverine, otilonium, trimebutine, alverine, hyoscine, alverine/simethicone, pinaverium/simethicone, fenoverine, and dicyclomine. A total of 2585 patients were included in the meta-analysis. Global improvement was 1.55 (CI 95%: 1.33 to 1.83). Otilonium and the alverine/simethicone combination produced significant values in global improvement while the pinaverium/simethicone combination showed improvement in bloating. As for pain, 2394 patients were included with an OR of 1.52 (IC 95%: 1.28 a 1.80), favoring antispasmodics. Antispasmodics were more effective than placebo in IBS, without any significant adverse events. The addition of simethicone improved the properties of the antispasmodic agents, as seen with the alverine/simethicone and pinaverium/simethicone combinations. Copyright © 2011 Asociación Mexicana de Gastroenterología. Published by Elsevier España. All rights reserved.

Randomised clinical trial: mixed soluble/insoluble fibre vs. psyllium for chronic constipation.

PubMed

Erdogan, A; Rao, S S C; Thiruvaiyaru, D; Lee, Y Y; Coss Adame, E; Valestin, J; O'Banion, M

2016-07-01

Fibre supplements are useful, but whether a plum-derived mixed fibre that contains both soluble and insoluble fibre improves constipation is unknown. To investigate the efficacy and tolerability of mixed soluble/insoluble fibre vs. psyllium in a randomized double-blind controlled trial. Constipated patients (Rome III) received mixed fibre or psyllium, 5 g b.d., for 4 weeks. Daily symptoms and stool habit were assessed using stool diary. Subjects with ≥1 complete spontaneous bowel movement/week above baseline for ≥2/4 weeks were considered responders. Secondary outcome measures included stool consistency, bowel satisfaction, straining, gas, bloating, taste, dissolvability and quality of life (QoL). Seventy-two subjects (mixed fibre = 40; psyllium = 32) were enrolled and two from psyllium group withdrew. The mean complete spontaneous bowel movement/week increased with both mixed fibre (P < 0.0001) and psyllium (P = 0.0002) without group difference. There were 30 (75%) responders with mixed fibre and 24 (75%) with psyllium (P = 0.9). Stool consistency increased (P = 0.04), straining (P = 0.006) and bloating scores decreased (P = 0.02) without group differences. Significantly more patients reported improvement in flatulence (53% vs. 25%, P = 0.01) and felt that mixed fibre dissolved better (P = 0.02) compared to psyllium. QoL improved (P = 0.0125) with both treatments without group differences. Mixed fibre and psyllium were equally efficacious in improving constipation and QoL. Mixed fibre was more effective in relieving flatulence, bloating and dissolved better. Mixed fibre is effective and well tolerated. © 2016 John Wiley & Sons Ltd.

Lactobacillus paracasei F19 versus placebo for the prevention of proton pump inhibitor-induced bowel symptoms: a randomized clinical trial.

PubMed

Compare, Debora; Rocco, Alba; Sgamato, Costantino; Coccoli, Pietro; Campo, Salvatore Maria Antonio; Nazionale, Immacolata; Larussa, Tiziana; Luzza, Francesco; Chiodini, Paolo; Nardone, Gerardo

2015-04-01

Proton pump inhibitors may foster intestinal dysbiosis and related bowel symptoms. To evaluate the effect of Lactobacillus paracasei F19 on bowel symptom onset in patients on long-term proton pump inhibitors. In this randomized, double-blind, placebo-controlled study, patients with typical gastroesophageal reflux disease symptoms receiving pantoprazole 40 mg/d for six months were randomly assigned to receive: (A) Lactobacillus paracasei F19 bid for three days/week for six months; (B) placebo bid for three days/week for six months; (C) Lactobacillus paracasei F19 bid for three days/week for three months and placebo bid for three days/week for the following three months; (D) placebo bid for three days/week for three months and Lactobacillus paracasei F19 bid for three days/week for the following three months. Bloating, flatulence, abdominal pain and bowel habit were assessed monthly. 100/312 patients were enrolled. In the parallel groups, the treatment-by-time interaction affected bloating (p = 0.015), while Lactobacillus paracasei F19 treatment alone affected flatulence (p = 0.011). Moreover, the treatment-by-time interaction significantly affected the mean score of bloating (p = 0.01) and flatulence (p < 0.0001), the mean stool form (p = 0.03) and mean stool frequency/week (p = 0.016). Analysis of the cross-over groups, limited to the first three months because of carry-over effect, confirmed these results. Lactobacillus paracasei F19 supplementation prevents bowel symptom onset in patients on long-term proton pump inhibitors. Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

The low FODMAP diet improves gastrointestinal symptoms in patients with irritable bowel syndrome: a prospective study.

PubMed

de Roest, R H; Dobbs, B R; Chapman, B A; Batman, B; O'Brien, L A; Leeper, J A; Hebblethwaite, C R; Gearry, R B

2013-09-01

Current treatment for irritable bowel syndrome (IBS) is suboptimal. Fermentable oligo-, di-, mono-saccharides and polyols (FODMAPs) may trigger gastrointestinal symptoms in IBS patients. Our aim was to determine whether a low FODMAP diet improves symptoms in IBS patients. Irritable bowel syndrome patients, who had performed hydrogen/methane breath testing for fructose and lactose malabsorption and had received dietary advice regarding the low FODMAP diet, were included. The effect of low FODMAP diet was prospectively evaluated using a symptom questionnaire. Furthermore, questions about adherence and satisfaction with symptom improvement, dietary advice and diet were assessed. Ninety patients with a mean follow up of 15.7 months were studied. Most symptoms including abdominal pain, bloating, flatulence and diarrhoea significantly improved (p < 0.001 for all). 75.6%, 37.8% and 13.3% of patients had fructose, lactose malabsorption or small intestinal bacterial overgrowth respectively. Fructose malabsorption was significantly associated with symptom improvement (abdominal pain odds ratio (OR) 7.09 [95% confidence interval (CI) 2.01-25.0], bloating OR 8.71 (95% CI 2.76-27.5), flatulence OR 7.64 (95% CI 2.53-23.0) and diarrhoea OR 3.39 (95% CI 1.17-9.78), p < 0.029 for all). Most patients (75.6%) were adherent to the diet, which was associated with symptom improvement (abdominal pain, bloating, flatulence and diarrhoea all significantly associated with adherence, r > 0.27, p < 0.011). Most patients (72.1%) were satisfied with their symptoms. The low FODMAP diet shows efficacy for IBS patients. The current strategy of breath testing and dietary advice provides a good basis to understand and adhere to the diet. © 2013 John Wiley & Sons Ltd.

Gastrointestinal symptoms in spinal cord injury: relationships with level of injury and psychologic factors.

PubMed

Ng, Clinton; Prott, Gillian; Rutkowski, Susan; Li, Yueming; Hansen, Ross; Kellow, John; Malcolm, Allison

2005-08-01

Previous surveys of gastrointestinal symptoms after spinal cord injury have not used validated questionnaires and have not focused on the full spectrum of such symptoms and their relationship to factors, such as level of spinal cord injury and psychologic dysfunction. This study was designed to detail the spectrum and prevalence of gastrointestinal symptoms in spinal cord injury and to determine clinical and psychologic factors associated with such symptoms. Established spinal cord injury patients (>12 months) randomly selected from a spinal cord injury database completed the following three questionnaires: 1) Rome II Integrative Questionnaire, 2) Hospital Anxiety and Depression Scale, and 3) Burwood Bowel Dysfunction after spinal cord injury. A total of 110 patients participated. The prevalence of abdominal bloating and constipation were 22 and 46 percent, respectively. Bloating was associated with cervical (odds ratio = 9.5) and lumbar (odds ratio = 12.1) level but not with thoracic level of injury. Constipation was associated with a higher level of injury (cervical odds ratio = 5.6 vs. lumbar) but not with psychologic factors. In contrast, abdominal pain (33 percent) and fecal incontinence (41 percent) were associated with higher levels of anxiety (odds ratio = 6.8, and odds ratio = 2.4) but not with the level of injury. There is a high prevalence and wide spectrum of gastrointestinal symptoms in spinal cord injury. Abdominal bloating and constipation are primarily related to specific spinal cord levels of injury, whereas abdominal pain and fecal incontinence are primarily associated with higher levels of anxiety. Based on our findings, further physiologic and psychologic research studies in spinal cord injury patients should lead to more rational management strategies for the common gastrointestinal symptoms in spinal cord injury.

Randomised clinical trial: rifaximin versus placebo for the treatment of functional dyspepsia.

PubMed

Tan, V P Y; Liu, K S H; Lam, F Y F; Hung, I F N; Yuen, M F; Leung, W K

2017-03-01

Gut dysbiosis may contribute to pain and bloating in patients with functional gastrointestinal disease. To determine if treatment with rifaximin would improve the symptoms of functional dyspepsia in Chinese patients in a double-blinded, randomised, placebo-controlled trial. Consecutive subjects with a diagnosis of functional dyspepsia as per the Rome III criteria were randomised to receive rifaximin 400 mg or placebo, all taken three times daily for 2 weeks. The investigators and study subjects were blinded to the treatment allocation. Subjects were followed up for 8 weeks. The primary end point was adequate relief of global dyspeptic symptoms (GDS). Secondary endpoints were relief of individual dyspeptic symptoms. Eighty-six subjects were recruited. At week 8, there were significantly more subjects in the rifaximin than in the placebo group who experienced adequate relief of GDS (78% vs. 52%, P = 0.02). A trend favouring rifaximin group was also noted in the preceding 4 weeks. Rifaximin was also superior to placebo in providing adequate relief of belching and post-prandial fullness/bloating (PPF) in subjects at week 4. Subgroup analysis revealed that female subjects had more significant response to rifaximin treatment (adequate relief of GDS at week 4: 76% vs. 42%, P = 0.006; week 8: 79% vs. 47%, P = 0.008), as well as improvements in their belching and PPF at week 4. The incidences of adverse effects were similar in both groups. Treatment with 2 weeks of rifaximin led to adequate relief of global dyspeptic symptoms, belching and post-prandial fullness/bloating in subjects with functional dyspepsia. The difference was more marked in females. (clinicaltrials.org NCT01643083). © 2017 John Wiley & Sons Ltd.

Physical inactivity during leisure time and irregular meals are associated with functional gastrointestinal complaints in middle-aged and elder subjects.

PubMed

Ohlsson, Bodil; Manjer, Jonas

2016-11-01

Few studies have examined how lifestyle factors affect functional gastrointestinal disorders. The aim of this study was to see if leisure time physical inactivity, dietary habits or body mass index (BMI) were associated with increased risk of functional abdominal pain, functional bloating, functional constipation or functional diarrhea. This study was based on a questionnaire as part of the Swedish EpiHealth study. The cohort included 16,840 subjects between 45 and 75 years of age. Subjects with organic gastrointestinal diseases were excluded. Gastrointestinal symptoms were defined as functional abdominal pain, functional bloating, functional constipation and functional diarrhea. A meal (breakfast, lunch and dinner) was considered irregular if not taken every day. The impact of leisure time physical activity, dietary habits and BMI on functional symptoms were examined by logistic regression, adjusted for age, gender, socio-economy, smoking and alcohol habits. Higher the degree of physical activity, lower the risk for all kind of gastrointestinal complaints (p ≤ 0.001). Intakes of lunch more seldom or never versus every day were associated with diarrhea (OR: 1.592; 95% CI: 1.046-2.422). Irregular breakfast habits tended to associate with bloating (OR: 1.366; 95% CI 0.995-1.874). BMI was not significantly associated with gastrointestinal complaints, but BMI ≥25 kg/m(2) tended to reduce risk of constipation compared with BMI <25 kg/m(2). Physical inactivity during leisure time shows independent associations with all functional gastrointestinal symptoms, whereas irregular dietary habits mainly associates with functional diarrhea. Higher degree of physical activity is associated with corresponding risk reductions of symptoms.

Lubiprostone Is Effective in the Treatment of Chronic Idiopathic Constipation and Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

PubMed

Li, Fan; Fu, Tao; Tong, Wei-Dong; Liu, Bao-Hua; Li, Chun-Xue; Gao, Yu; Wu, Jin-Song; Wang, Xiang-Feng; Zhang, An-Ping

2016-04-01

To evaluate the efficacy and safety of lubiprostone in the treatment of chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C). We performed a literature search of the MEDLINE, Cochrane, Google Scholar, and ClinicalTrials.gov databases (from January 1, 2005, through January 31, 2015). Relevant studies meeting the inclusion criteria were manually searched by 2 independent reviewers. Efficacy outcomes evaluated at 1 week, 1 month, and 3 months of intervention were weekly frequency of spontaneous bowel movements, severity of constipation, consistency of stools, degree of abdominal pain/discomfort, degree of straining, and abdominal bloating. Of 246 studies identified, data from 9 trials comprising 1468 patients (63.6%) in the lubiprostone group and 841 (36.4%) in the placebo group were analyzed. We found that lubiprostone treatment significantly improved the severity of constipation, stool consistency, abdominal pain, degree of straining, and abdominal bloating at 1 week (P≤.03) and 1 month (P≤.004), except for abdominal pain at 1 month, which was similar to that when treated with placebo (P=.21). At 3 months, except for abdominal bloating (P=.03), there was no difference between lubiprostone and placebo groups in all other outcomes (P≥.05). Adverse effects such as nausea, vomiting, and diarrhea were common (incidence rate, 2.4%-75%); however, the incidence of serious adverse effects was low (<5%) and was mostly unrelated to lubiprostone treatment. Lubiprostone is a safe and efficacious drug for the treatment of chronic idiopathic constipation and irritable bowel syndrome with constipation, with limited adverse effects in 3 months of follow-up. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

[A Randomized Controlled Clinical Trial for Electroacupuncture Treatment of Post-surgical Gastrointestinal Dysfunction in Patients Undergoing Laparotomy].

PubMed

Pan, Hui; Li, Jia; Zhao, Yu; Li, Ning

2016-10-25

To evaluate the clinical efficacy of electroacupuncture (EA) stimulation of Zusanli (ST 36) and Neiguan (PC 6) in the treatment of persistent postoperative gastrointestinal dysfunction in patients undergoing laparotomy. A total of 60 laparotomy patients were enlisted in the present study and were randomly divided into conventional treatment group (control) and EA group ( n =30 in each group). Patients of the EA group were treated by conventional treatment and EA stimulation (2 Hz, 1-10 mA) of bilateral ST 36 and PC 6 for 30 min, once daily for 5 days, and patients of the control group treated by conventional treatment (pre- and post-surgical fasting, measures for gastrointestinal decompression, electrolyte stabilization, parenteral nutrition support, and anti-infection in necessity, etc). The first postoperative flatus and defecation time, postoperative hospital stays,abdominal bloating grading (0-4 points, i.e. Likert scale), and adverse events were recorded and evaluated. After the treatment, the first postoperative flatus and defecation time, and hospital stay time and abdominal bloating scores from the 2 nd to the 5 th day post-surgery in the EA group were significantly lower than those of the control group ( P <0.05). The abdominal bloating scores of the two groups were gradually and obviously decreased from the 2 nd day on in comparison with pre-treatment ( P <0.05). Of the two 30 cases in the control and EA groups, 5 and 14 were cured in their clinical symptoms, 15 and 13 experienced marked improvement, 7 and 3 were effective, 2 and 0 invalid, with the effective rates being 66.7% and 90.0%, respectively. EA is effective in improving persistent postoperative gastrointestinal dysfunction in cancer patients undergoing laparotomy.

[The diet low in fermentable carbohydrates short chain and polyols improves symptoms in patients with functional gastrointestinal disorders in Spain].

PubMed

Huamán, José Wálter; Felip, Ana; Guedea, Elena; Jansana, Marta; Videla, Sebastián; Saperas, Esteban

2015-03-01

Successful treatment of patients with irritable bowel syndrome (IBS) often remains elusive. Recent studies in Australia, the United Kingdom and New Zealand have suggested the efficacy of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) in the management of these patients. The aims of this study were to determine whether a diet low in FODMAPs improves symptoms in patients with functional gastrointestinal disorders (FGID) in Spain and to analyze the predictors of a good response. A prospective study was carried out in consecutive patients with FGID type IBS and functioanl abdominal bloating. At inclusion all patients underwent an assessment through a baseline demographic questionnaire of symptoms of anxiety and depression and quality of life. A hydrogen breath test with lactose and fructose was performed and a low FODMAPs diet was indicated for 2 months by expert dietitians. These tests were taken as a reference. A positive response was defined as an improvement of at least 5 points out of a possible 10 in the symptom questionnaire. We included 30 patients (24 women, 39 [12] years). The response to the low FODMAPs diet was positive in controlling overall symptoms and specific symptoms such as functioanl abdominal bloating, abdominal pain, diarrhea, flatulence, nausea and fatigue in more than 70% of patients (P<.05). By contrast, constipation was controlled in only 48% of patients (P>.05). Adherence to the diet was good in 87% of patients and was a predictor of positive response in the univariate analysis. A diet low in FODMAPs is associated with symptom improvement in patients with IBS and functioanl abdominal bloating. Adherence to the diet was a determining factor. Copyright © 2014 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.

Aerophagia: excessive air swallowing demonstrated by esophageal impedance monitoring.

PubMed

Hemmink, Gerrit J M; Weusten, Bas L A M; Bredenoord, Albert J; Timmer, Robin; Smout, André J P M

2009-10-01

Patients with aerophagia suffer from the presence of an excessive volume of intestinal gas, which is thought to result from excessive air ingestion. However, this has not been shown thus far. The aim of this study was therefore to assess swallowing and air swallowing frequencies in patients with suspected aerophagia. Ambulatory 24-hour pH-impedance monitoring was performed in patients in whom excessive amounts of intestinal gas were visualized on plain abdominal radiograms. All patients had symptoms of bloating, abdominal distention, flatulence, or excessive belching. Reflux parameters and the number of swallows and air swallows were assessed. The most common symptoms were bloating, abdominal distention, and constipation. Only 3 patients reported excessive belching and 1 patient reported flatulence as their predominant symptom. During the 24-hour measurement, patients showed high incidences of air swallows (521 +/- 63) and gastric belches (126 +/- 37). Patients had normal swallowing frequency (741 +/- 71). This study presents objective parameters that confirm the existence of excessive air swallowing or aerophagia using esophageal impedance monitoring.

Defining and diagnosing irritable bowel syndrome.

PubMed

Schuster, M M

2001-07-01

Approximately 20% of the general population has irritable bowel syndrome (IBS). Although the majority of these individuals do not consult a physician, IBS accounts for 25% of visits to a gastroenterologist and up to 12% of visits to a primary care physician. Consequently, the direct and indirect costs associated with IBS are estimated at $8 billion annually. IBS symptoms, with no apparent structural pathology, include altered bowel habits, abdominal pain/discomfort, and bloating. The Rome II criteria, a standardized guideline for the diagnosis of IBS, contains in its definition abdominal pain or discomfort associated with altered bowel habits. Bloating may often be present. Three patient subgroups are defined according to the predominant bowel symptom: constipation, diarrhea, or alternating constipation and diarrhea. Hematology, fecal occult blood test, flexible sigmoidoscopy, and lactose intolerance evaluations are recommended for all patients demonstrating symptoms of IBS. When indicated, tests are recommended to rule out bacterial or parasitic infections, pelvic floor muscle dyssynergia, colonic inertia, peptic ulcer, or inflammatory bowel disease.

How Many Administrators Are Too Many?

ERIC Educational Resources Information Center

Rogers, Jenny

2013-01-01

For years, faculty members have pointed to the sluggish growth in the number of tenured professors and complained that university payrolls are filled with too many administrators. This, they maintain, adds unnecessary costs and takes the focus away from teaching and learning. But whether such "administrative bloat" is really occurring and how much…

Deepening Corporate Integrity in the Nigerian University System

ERIC Educational Resources Information Center

Ejiogu, Aloy; Onyene, Virgy

2008-01-01

The quest and agitation for the enthronement of corporate integrity in the nation's universities by the stakeholders have become almost hysterical given the often alleged, sometimes proven, cases of mal-administration, fund embezzlement and or misappropriation, over bloated or even fake invoicing, unbridled favoritism, sexual harassment, bribery,…

High forage quality helps maintain resilience to gastrointestinal parasites in sheep and goats

USDA-ARS?s Scientific Manuscript database

Condensed tannins (CT) in browse and forage plants can have positive or negative effects on livestock health and performance, depending on the type and concentration of CT present in the diet. Historically, bloating in ruminants was reduced or eliminated when grazing legumes that contained CT. Con...

Why Does College Cost So Much?

ERIC Educational Resources Information Center

Archibald, Robert B.; Feldman, David H.

2010-01-01

Much of what is written about colleges and universities ties rapidly rising tuition to dysfunctional behavior in the academy. Common targets of dysfunction include prestige games among universities, gold plated amenities, and bloated administration. This book offers a different view. To explain rising college cost, the authors place the higher…

Net Survey: "Top Ten Mistakes" in Academic Web Design.

ERIC Educational Resources Information Center

Petrik, Paula

2000-01-01

Highlights the top ten mistakes in academic Web design: (1) bloated graphics; (2) scaling images; (3) dense text; (4) lack of contrast; (5) font size; (6) looping animations; (7) courseware authoring software; (8) scrolling/long pages; (9) excessive download; and (10) the nothing site. Includes resources. (CMK)

The Cost of Chaos in the Curriculum. Perspectives on Higher Education

ERIC Educational Resources Information Center

Capaldi Phillips, Elizabeth D.; Poliakoff, Michael B.

2015-01-01

ACTA's report "The Cost of Chaos in the Curriculum" reveals that the vast array of course choices given to college students is a cause of exploding costs and poor academic outcomes. And a bloated undergraduate curriculum is particularly detrimental to the success of students from lower socioeconomic backgrounds. The report documents how…

Education or Reputation? A Look at America's Top-Ranked Liberal Arts Colleges

ERIC Educational Resources Information Center

Poliakoff, Michael; Alacbay, Armand

2014-01-01

ACTA [American Council of Trustees and Alumni] today released a report that examines the country's most prestigious liberal arts colleges. Despite endowments soaring as high as $1.8 billion, nearly all institutions increased tuition during the Great Recession to finance bloated administrative spending, with many college presidents enjoying…

A Wealth of Data, and Nobody in Charge

ERIC Educational Resources Information Center

Guernsey, Lisa

2008-01-01

Colleges capture a slew of highly sensitive information on everyone on campus. While chief privacy officer has become a recognized title in the corporate world, higher education seems slow to pick up on the trend--a reluctance that could represent either head-in-the-sand thinking or fiscally prudent avoidance of bureaucratic bloat. This article…

Behavioral Treatment of Chronic Belching Due to Aerophagia in a Normal Adult

ERIC Educational Resources Information Center

Cigrang, Jeffrey A.; Hunter, Christine M.; Peterson, Alan L.

2006-01-01

Aerophagia, or excessive air swallowing, is a potential cause of belching, flatulence, bloating, and abdominal pain and may contribute to a worsening of gastrointestinal (GI) disorders. A limited number of published reports of aerophagia treatment indicate that behavioral methods may be of benefit. A case report is presented describing the…

What Is Celiac Disease? How Do I Live with It?

ERIC Educational Resources Information Center

Blaska, Joan

2007-01-01

Celiac disease, also known as celiac sprue, is a hereditary, autoimmune disease that causes a sensitivity to gluten, which is a protein found in wheat, rye, and barley. The key symptoms of celiac disease are diarrhea, constipation, gas, bloating, backaches, stomachaches, nausea, anemia, fatigue, osteoporosis, stunted growth in children, and weight…

Current Economic Issues in Employee Benefits. Background Paper No. 39.

ERIC Educational Resources Information Center

Woodbury, Stephen A.

A multitude of public policy issues currently surround the tax treatment of employee benefits, particularly since the tax-favored status of employer contributions to pensions and health insurance has been blamed for a shrinking tax base that has exacerbated the federal budget deficit, an inefficient and bloated health-care sector, overinsurance by…

Extending our knowledge of fermentable, short-chain carbohydrates for managing gastrointestinal symptoms.

PubMed

Barrett, Jacqueline S

2013-06-01

The Monash University low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet is now accepted as an effective strategy for managing symptoms of irritable bowel syndrome (IBS) in Australia, with interest expanding across the world. These poorly absorbed, short-chain carbohydrates have been shown to induce IBS symptoms of diarrhea, bloating, abdominal pain, and flatus due to their poor absorption, osmotic activity, and rapid fermentation. Four clinical trials have been published to date, all with significant symptomatic response to the low FODMAP diet. Up to 86% of patients with IBS have achieved relief of overall gastrointestinal symptoms and, more specifically, bloating, flatus, abdominal pain, and altered bowel habit from the approach. This review provides an overview of the low FODMAP diet and summarizes the research to date, emerging concepts, and limitations. FODMAPs are known to be beneficial to bowel health; the importance of this and how this should be considered in the clinical management of IBS is also discussed. A clinical management flowchart is provided to assist nutrition professionals in the use of this approach.

Clinical diseases of the rumen: a physiologist's view.

PubMed

Leek, B F

1983-07-02

An interpretation of many of the classical signs of ruminal dysfunction is possible by extrapolation from the results of research in rumen physiology. Correlation of motility and ruminal fluid characteristics will often provide a means of establishing the degree, the duration and the differential diagnosis of the dysfunction detected. In the case of disorders of ruminal motility, general anaesthesia and diseases at any sites which produce pain or fever can inhibit the hindbrain reflex centres responsible for evoking primary and secondary cycle contractions of the reticulorumen. Simple indigestion/rumen impaction, vagus indigestion and hypocalcaemic milk fever cause ruminal stasis, probably because they relax the reticuloruminal smooth muscle and hence decrease the reflexly excitable sensory inputs from tension receptors. Grain engorgement/ruminal acidosis and extreme bloat are likely to excite other sensory receptors (epithelial receptors), which reflexly inhibit cyclical motility. Bloat occurs when eructation is inadequate either because the oesophagus is obstructed or because cardiac opening is reflexly inhibited by the presence of ruminal fluid rather than gas at the cardia in conditions of subnormal motility or of leguminous frothing.

Quality of life and antireflux medication use following laparoscopic Nissen fundoplication.

PubMed

Bloomston, M; Zervos, E; Gonzalez, R; Albrink, M; Rosemurgy, A

1998-06-01

With the advent of minimally invasive techniques, the surgical treatment of gastroesophageal reflux disease has received renewed interest. The efficacy of laparoscopic Nissen fundoplication in eliminating reflux has been documented. This study was undertaken to determine changes in quality of life and cost of antireflux medications after laparoscopic Nissen fundoplication. One hundred patients undergoing laparoscopic Nissen fundoplication between 1992 and 1997 completed questionnaires assessing changes in pre- and postoperative cost and number of antireflux medications, reflux symptoms, and quality of life. The average number of antireflux medications was significantly reduced (1.8 versus 0.3, P < 0.0001) as was the average monthly cost ($170 versus $30, P < 0.0001). Patients reported significant (P < 0.05) symptomatic improvement in postprandial heartburn, nocturnal heartburn, postprandial nausea, postprandial vomiting, dysphagia, and gas/bloating. Patients in this series noted fewer symptoms and used fewer antireflux medications at less cost after laparoscopic Nissen fundoplication. Symptoms commonly thought of as complications of fundoplication (vomiting, dysphagia, gas/bloating) were less common after fundoplication. This report documents the efficacy of laparoscopic fundoplication in improving quality of life and reducing use and cost of antireflux medications.

Carbon dioxide insufflation during colonoscopy in deeply sedated patients

PubMed Central

Singh, Rajvinder; Neo, Eu Nice; Nordeen, Nazree; Shanmuganathan, Ganesananthan; Ashby, Angelie; Drummond, Sharon; Nind, Garry; Murphy, Elizabeth; Luck, Andrew; Tucker, Graeme; Tam, William

2012-01-01

AIM: To compare the impact of carbon dioxide (CO2) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy. METHODS: Patients referred for colonoscopy were randomized to receive either CO2 or air insufflation during the procedure. Both the colonoscopist and patient were blinded to the type of gas used. During the procedure, insertion and withdrawal times, caecal intubation rates, total sedation given and capnography readings were recorded. The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale (VAS) (0-3). Patients then graded their level of discomfort and abdominal bloating using a similar VAS. Complications during and after the procedure were recorded. RESULTS: A total of 142 patients were randomized with 72 in the air arm and 70 in the CO2 arm. Mean age between the two study groups were similar. Insertion time to the caecum was quicker in the CO2 group at 7.3 min vs 9.9 min with air (P = 0.0083). The average withdrawal times were not significantly different between the two groups. Caecal intubation rates were 94.4% and 100% in the air and CO2 groups respectively (P = 0.012). The level of discomfort assessed by the nurse was 0.69 (air) and 0.39 (CO2) (P = 0.0155) and by the patient 0.82 (air) and 0.46 (CO2) (P = 0.0228). The level of abdominal bloating was 0.97 (air) and 0.36 (CO2) (P = 0.001). Capnography readings trended to be higher in the CO2 group at the commencement, caecal intubation, and conclusion of the procedure, even though this was not significantly different when compared to readings obtained during air insufflation. There were no complications in both arms. CONCLUSION: CO2 insufflation during colonoscopy is more efficacious than air, allowing quicker and better cecal intubation rates. Abdominal discomfort and bloating were significantly less with CO2 insufflation. PMID:22783048

A randomised clinical trial (RCT) of a symbiotic mixture in patients with irritable bowel syndrome (IBS): effects on symptoms, colonic transit and quality of life.

PubMed

Cappello, Carmelina; Tremolaterra, Fabrizio; Pascariello, Annalisa; Ciacci, Carolina; Iovino, Paola

2013-03-01

The aim of this study is to test in a double-blinded, randomised placebo-controlled study the effects of a commercially available multi-strain symbiotic mixture on symptoms, colonic transit and quality of life in irritable bowel syndrome (IBS) patients who meet Rome III criteria. There is only one other double-blinded RCT on a single-strain symbiotic mixture in IBS. This is a double-blinded, randomised placebo-controlled study of a symbiotic mixture (Probinul, 5 g bid) over 4 weeks after 2 weeks of run-in. The primary endpoints were global satisfactory relief of abdominal flatulence and bloating. Responders were patients who reported at least 50 % of the weeks of treatment with global satisfactory relief. The secondary endpoints were change in abdominal bloating, flatulence, pain and urgency by a 100-mm visual analog scale, stool frequency and bowel functions on validated adjectival scales (Bristol Scale and sense of incomplete evacuation). Pre- and post-treatment colonic transit time (Metcalf) and quality of life (SF-36) were assessed. Sixty-four IBS patients (symbiotic n = 32, 64 % females, mean age 38.7 ± 12.6 years) were studied. This symbiotic mixture reduced flatulence over a 4-week period of treatment (repeated-measures analysis of covariance, p < 0.05). Proportions of responders were not significantly different between groups. At the end of the treatment, a longer rectosigmoid transit time and a significant improvement in most SF-36 scores were observed in the symbiotic group. This symbiotic mixture has shown a beneficial effect in decreasing the severity of flatulence in IBS patients, a lack of adverse events and a good side-effect profile; however, it failed to achieve an improvement in global satisfactory relief of abdominal flatulence and bloating. Further studies are warranted.

Carbon dioxide insufflation during colonoscopy in deeply sedated patients.

PubMed

Singh, Rajvinder; Neo, Eu Nice; Nordeen, Nazree; Shanmuganathan, Ganesananthan; Ashby, Angelie; Drummond, Sharon; Nind, Garry; Murphy, Elizabeth; Luck, Andrew; Tucker, Graeme; Tam, William

2012-07-07

To compare the impact of carbon dioxide (CO₂) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy. Patients referred for colonoscopy were randomized to receive either CO₂ or air insufflation during the procedure. Both the colonoscopist and patient were blinded to the type of gas used. During the procedure, insertion and withdrawal times, caecal intubation rates, total sedation given and capnography readings were recorded. The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale (VAS) (0-3). Patients then graded their level of discomfort and abdominal bloating using a similar VAS. Complications during and after the procedure were recorded. A total of 142 patients were randomized with 72 in the air arm and 70 in the CO₂ arm. Mean age between the two study groups were similar. Insertion time to the caecum was quicker in the CO₂ group at 7.3 min vs 9.9 min with air (P = 0.0083). The average withdrawal times were not significantly different between the two groups. Caecal intubation rates were 94.4% and 100% in the air and CO₂ groups respectively (P = 0.012). The level of discomfort assessed by the nurse was 0.69 (air) and 0.39 (CO₂) (P = 0.0155) and by the patient 0.82 (air) and 0.46 (CO₂) (P = 0.0228). The level of abdominal bloating was 0.97 (air) and 0.36 (CO₂) (P = 0.001). Capnography readings trended to be higher in the CO₂ group at the commencement, caecal intubation, and conclusion of the procedure, even though this was not significantly different when compared to readings obtained during air insufflation. There were no complications in both arms. CO₂ insufflation during colonoscopy is more efficacious than air, allowing quicker and better cecal intubation rates. Abdominal discomfort and bloating were significantly less with CO₂ insufflation.

Apyretic gastrointestinal disorders due to giardiasis contracted in Morocco

PubMed Central

Meunier, Yann A.; Hole, Michael K.

2011-01-01

We present the case of a 32-year-old French man who presented with morning nausea, bloating, frequent flatulence, burping, occasional pyrosis, and alternating diarrhea and constipation two weeks after a trip to Morocco. The diagnosis was established by a parasitological stool exam that revealed cysts of Giardia lamblia. He was successfully treated with tinidazole. PMID:24765301

Waist-High and Knee-Deep: Humane Learning beyond Polemics and Precincts

ERIC Educational Resources Information Center

Higgins, Chris

2015-01-01

In this essay, Chris Higgins sets out to disentangle the tradition of humane learning from contemporary distinctions and debates. The first section demonstrates how a bloated and incoherent "humanism" now functions primarily as a talisman or a target, that is, as a prompt to choose sides. It closes with the image of Doris Salcedo's…

"Animal House" at 30: O Bluto, Where Art Thou?

ERIC Educational Resources Information Center

Hoover, Eric

2008-01-01

A gentleman does not steal horses, spit food across the table, or pee on peoples' shoes. By that definition, John "Bluto" Blutarsky is not a gentleman, but something more extraordinary. The fictional antihero of "National Lampoon's Animal House," Bluto is a slovenly symbol of irreverence, a bloated personification of the id. Bored by the past and…

Yale Study: African-American Women Report More Menopause Symptoms than White Women

ERIC Educational Resources Information Center

Black Issues in Higher Education, 2005

2005-01-01

A study of African-American women in menopause shows that while they experience many of the same symptoms as White women, they report more vasomotor symptoms such as dizziness and bloating, according to a study by a Yale School of Nursing researcher. The women reported symptoms common among White women in menopause--hot flashes, irregular…

Instructional Investment or Administrative Bloat: The Effects of Charter System Conversion on Resource Allocations and Staffing Patterns

ERIC Educational Resources Information Center

Kramer, Dennis A., II; Lane, Megan; Tanner, Melvin

2017-01-01

Despite the growing call for local autonomy and flexibility, few scholars have examined the role of school district-level flexibility on resource allocation and staffing patterns. Leveraging the charter system law within the State of Georgia, we utilize a generalized difference-in-differences approach to estimate the impact of flexibility of…

The Role of Proanthocyanidins Complex in Structure and Nutrition Interaction in Alfalfa Forage

PubMed Central

Jonker, Arjan; Yu, Peiqiang

2016-01-01

Alfalfa (Medicago sativa L.) is one of the main forages grown in the world. Alfalfa is a winter hardy, drought tolerant, N-fixing legume with a good longevity, high yield, high nutrient levels, high digestibility, unique structural to non-structural components ratio, high dry matter intake, and high animal productivity per hectare. However, its main limitation is its excessively rapid initial rate of protein degradation in the rumen, which results in pasture bloat and inefficient use of protein with consequent excessive excretions of nitrogen into the environment. Proanthocyanidins are secondary plant metabolites that can bind with protein and thereby reduce the rate and extent of ruminal protein degradation. However, these secondary metabolites do not accumulate in alfalfa. This review aims to firstly describe the events involved in the rapid release of protein from alfalfa and its effect on ruminant nutrition, environmental pollution, and pasture bloat; secondly, to describe occurrence, structure, functions and benefits of moderate amounts of proanthocyanidin; and finally, to describe the development of alfalfa which accumulates moderate amounts of proanthocyanidins. The emphasis of this review focuses on the role of proanthocyanidins compounds in structure and nutrition interaction in ruminant livestock systems. PMID:27223279

The Role of Proanthocyanidins Complex in Structure and Nutrition Interaction in Alfalfa Forage.

PubMed

Jonker, Arjan; Yu, Peiqiang

2016-05-23

Alfalfa (Medicago sativa L.) is one of the main forages grown in the world. Alfalfa is a winter hardy, drought tolerant, N-fixing legume with a good longevity, high yield, high nutrient levels, high digestibility, unique structural to non-structural components ratio, high dry matter intake, and high animal productivity per hectare. However, its main limitation is its excessively rapid initial rate of protein degradation in the rumen, which results in pasture bloat and inefficient use of protein with consequent excessive excretions of nitrogen into the environment. Proanthocyanidins are secondary plant metabolites that can bind with protein and thereby reduce the rate and extent of ruminal protein degradation. However, these secondary metabolites do not accumulate in alfalfa. This review aims to firstly describe the events involved in the rapid release of protein from alfalfa and its effect on ruminant nutrition, environmental pollution, and pasture bloat; secondly, to describe occurrence, structure, functions and benefits of moderate amounts of proanthocyanidin; and finally, to describe the development of alfalfa which accumulates moderate amounts of proanthocyanidins. The emphasis of this review focuses on the role of proanthocyanidins compounds in structure and nutrition interaction in ruminant livestock systems.

Anismus: a marker of multi-site functional disorders?

PubMed

Bouchoucha, Michel; Devroede, Ghislain; Arsac, Michel

2004-07-01

This study was undertaken to assess the clinical significance of anismus in patients who complain of constipation. Thirty control subjects and 93 consecutive patients complaining of functional constipation took part in the study. Colonic transit time study and anorectal manometry were performed. Questions about depression and urinary and sexual diseases were added to a questionnaire based on the Rome II criteria, and visual analog scales about four items (constipation, diarrhoea, abdominal bloating and abdominal pain). Constipated patients have lower threshold sensation volume, lower constant sensation volume, and lower maximum tolerable volume than controls. Thirty-seven patients (40%) were found to have anismus, based on anorectal manometry. No significant difference was found between constipated patients with anismus and constipated patients without anismus, using anorectal manometry. Constipated patients had longer colorectal transit time than controls, but neither total nor segmental colonic transit time was correlated with the presence or absence of anismus. In patients with anismus, a higher frequency of oesophageal symptoms, dysmotility-like dyspepsia, aerophagia, functional bowel disorders, functional abdominal pain, soiling, and dyschezia was found. In addition, a higher frequency of urinary complaints, sexual complaints, and depression was found. Anismus was associated with increased awareness of constipation, abdominal bloating, and abdominal pain, but not with diarrhoea.

Surgery of the Forestomach.

PubMed

Lozier, Joseph W; Niehaus, Andrew J

2016-11-01

Indications for rumen surgery include rumen tympany (bloat), toxic plant ingestion, to provide enteral nutrition, to perform elective cannula placement, and to access other forestomach compartments (reticulum/omasum). The rumen is a highly contaminated viscus and special care should be taken to avoid peritoneal contamination from rumen contents. Diseases causing forestomach dysfunction and surgical procedures on the forestomach compartments are discussed here. Copyright © 2016 Elsevier Inc. All rights reserved.

Building Community Power for Better Schools: An Evaluation of the Parent and Youth Education Policy Collaborative, 2001-2003

ERIC Educational Resources Information Center

Keleher, Terry; Morita, Josina

2004-01-01

School reform in Chicago, the third largest school district in the country, has been a major public concern for decades. In the 1970s and 1980s, the Chicago Public Schools (CPS) suffered through financial crises, a bloated bureaucracy, and repeated teacher strikes, as academic achievement plummeted and dropout rates soared. In 1987, U.S. Secretary…

The Expanding Universe: Dark Energy

ERIC Educational Resources Information Center

Lincoln, Don; Nord, Brian

2014-01-01

As is true of a far more famous story, it all began a long time ago, in a galaxy far, far away. It even involved a binary star system. A small star, called a white dwarf, had become a burned out husk of its former self and it turned to gorging on hydrogen and helium from its bloated red giant neighbor. The transferred gas reignited the fires of…

Development of lightweight aggregates from stone cutting sludge, plastic wastes and sepiolite rejections for agricultural and environmental purposes.

PubMed

Moreno-Maroto, José Manuel; González-Corrochano, Beatriz; Alonso-Azcárate, Jacinto; Rodríguez, Luis; Acosta, Anselmo

2017-09-15

Three different wastes have been assessed for lightweight aggregate (LWA) manufacturing: granite and marble sludge (COR), sepiolite rejections (SEP) and polyethylene-hexene thermoplastics (P). A preliminary study of the physical and chemical properties of the raw materials was carried out to design proper batches. It was mixed 10% SEP with 90% COR to confer plasticity, and in turn, 0, 2.5, 5 and 10% (w/w) of P was added to check its suitability as a bloating agent. The mixtures were milled, kneaded with water, extruded, shaped into pellets, oven-dried and finally fired at 1100, 1125 and 1150 °C for 4, 8 and 16 min. The main technological properties of the aggregates related to bloating, density, porosity, loss on ignition, water absorption and compressive strength were measured. Scanning Electron Microscopy was used to study the microstructure of some LWAs. 23 out of 29 types of aggregate were lightweight, although neither bloating effect was observed, nor the typical cellular structure comprised of shell and core with relatively large pores was obtained, but a structure consisting of micropores and microchannels. The increase of temperature and time of firing involved a greater sintering, which in turn was translated into higher shrinkage, density and compressive strength values, but less porosity and water absorption. The addition of P did not involve any improvement, indeed it caused a significant decrease in compressive strength. The LWA sintered without P at the minimum time (4 min) and temperature of firing (1100 °C) was selected to assess its water suction capability. The results pointed out that this LWA could be suitable in hydroponics and/or water filtration systems, even better than the commercial LWA Arlita G3. A new and most environment-friendly perspective in LWA industry arises from here, promoting LWA production at relative low temperatures (prior to significant sintering occurs) and using non-plastic silty wastes instead of clays as major components. Copyright © 2017 Elsevier Ltd. All rights reserved.

Response of irritable bowel syndrome with constipation patients administered a combined quebracho/conker tree/M. balsamea Willd extract.

PubMed

Brown, Kenneth; Scott-Hoy, Brandi; Jennings, Linda W

2016-08-06

The aim of this case series was to retrospectively examine the symptom response of irritable bowel syndrome with constipation (IBS-C) patients administered an herbal extract in a real-world setting. Twenty-four IBS-C patients in a community office practice were provided a combination over-the-counter dietary supplement composed of quebracho (150 mg), conker tree (470 mg) and M. balsamea Willd (0.2 mL) extracts (Atrantil™) and chose to take the formulation for a minimum of 2 wk in an attempt to manage their symptoms. Patient responses to the supplement were assessed by visual analogue scale (VAS) for abdominal pain, constipation and bloating at baseline and at 2 wk as part of standard-of-care. Patient scores from VAS assessments recorded in medical chart data were retrospectively compiled and assessed for the effects of the combined extract on symptoms. Sign tests were used to compare changes from baseline to 2 wk of taking the extract. Significance was defined as P < 0.05. Twenty-one of 24 patients (88%) responded to the dietary supplement as measured by individual improvements in VAS scores for abdominal pain, bloating and constipation symptoms comparing scores prior to administration of the extract against those reported after 2 wk. There were also significant improvements in individual as well as mean VAS scores after 2 wk of administration of the combined extract compared to baseline for abdominal pain [8.0 (6.5, 9.0) vs 2.0 (1.0, 3.0), P < 0.001], bloating [8.0 (7.0, 9.0) vs 1.0 (1.0, 2.0), P < 0.001] and constipation [6.0 (3.0, 8.0) vs 2.0 (1.0, 3.0), P < 0.001], respectively. In addition, 21 of 24 patients expressed improved quality of life while taking the formulation. There were no reported side effects to administration of the dietary supplement in this practice population suggesting excellent tolerance of the formulation. This pilot retrospective analysis of symptom scores from patients before and after consuming a quebracho/conker tree/M. balsamea Willd extract may support the formulation's use in IBS-C.

Response of irritable bowel syndrome with constipation patients administered a combined quebracho/conker tree/M. balsamea Willd extract

PubMed Central

Brown, Kenneth; Scott-Hoy, Brandi; Jennings, Linda W

2016-01-01

The aim of this case series was to retrospectively examine the symptom response of irritable bowel syndrome with constipation (IBS-C) patients administered an herbal extract in a real-world setting. Twenty-four IBS-C patients in a community office practice were provided a combination over-the-counter dietary supplement composed of quebracho (150 mg), conker tree (470 mg) and M. balsamea Willd (0.2 mL) extracts (Atrantil™) and chose to take the formulation for a minimum of 2 wk in an attempt to manage their symptoms. Patient responses to the supplement were assessed by visual analogue scale (VAS) for abdominal pain, constipation and bloating at baseline and at 2 wk as part of standard-of-care. Patient scores from VAS assessments recorded in medical chart data were retrospectively compiled and assessed for the effects of the combined extract on symptoms. Sign tests were used to compare changes from baseline to 2 wk of taking the extract. Significance was defined as P < 0.05. Twenty-one of 24 patients (88%) responded to the dietary supplement as measured by individual improvements in VAS scores for abdominal pain, bloating and constipation symptoms comparing scores prior to administration of the extract against those reported after 2 wk. There were also significant improvements in individual as well as mean VAS scores after 2 wk of administration of the combined extract compared to baseline for abdominal pain [8.0 (6.5, 9.0) vs 2.0 (1.0, 3.0), P < 0.001], bloating [8.0 (7.0, 9.0) vs 1.0 (1.0, 2.0), P < 0.001] and constipation [6.0 (3.0, 8.0) vs 2.0 (1.0, 3.0), P < 0.001], respectively. In addition, 21 of 24 patients expressed improved quality of life while taking the formulation. There were no reported side effects to administration of the dietary supplement in this practice population suggesting excellent tolerance of the formulation. This pilot retrospective analysis of symptom scores from patients before and after consuming a quebracho/conker tree/M. balsamea Willd extract may support the formulation’s use in IBS-C. PMID:27602249

Strategic Retrenchment and Renewal in the American Experience

DTIC Science & Technology

2014-08-01

during his presidency. Less well examined are Hoover’s own differences with the traditional Republican heritage of laissez - faire and his subsequent...values and ideas about government’s role in society, and one that discomfited the older laissez - faire elite, such as President Coolidge and Secretary...positive map to the middle course between the tyranny and bloated bureaucracy of statism and the injustices of laissez - faire capitalism. Yet, as with

Lesson Plan: An Agenda for Change in American Higher Education. The William G. Bowen Memorial Series in Higher Education

ERIC Educational Resources Information Center

Bowen, William G.; McPherson, Michael S.

2016-01-01

American higher education faces some serious problems--but they are not the ones most people think. In this brief and accessible book, two leading experts show that many so-called crises--from the idea that typical students are drowning in debt to the belief that tuition increases are being driven by administrative bloat--are exaggerated or simply…

Effect of processing sorghum grain on dairy calf performance.

PubMed

Abdelgadir, I E; Morrill, J L

1995-09-01

Two trials evaluated the effect of sorghum grain processing on dairy calf performance. In trial 1, Holstein calves (n = 76; .5 to 8 wk of age) were fed one of three calf starters that contained either raw, roasted (exit temperature of 135 degrees C), or conglomerated sorghum grain. The conglomeration process consisted of grinding the grain, adding water, pelleting the mixture, and then roasting it. Raw and roasted sorghum grains were ground through a 3.2-mm screen and then included in complete pelleted starters; conglomerated sorghum grain pellets were mixed with the other pelleted ingredients of the starter. Processing did not enhance calf performance or affect selected ruminal and blood metabolites. In trial 2, roasted and conglomerated sorghum grains were ground through a 3.2-mm screen, and each was included in a pelleted starter fed for ad libitum intake to Holstein calves (n = 48) from .5 to 8 wk of age. Calf performance was not affected by method of grain processing, and ruminal and blood metabolites were similar; however, 22% of calves on the conglomerated sorghum grain starter bloated during the postweaning period, which probably resulted in reduced feed intake from wk 6 to 8. Measures to prevent bloat may be necessary to realize a potential benefit of conglomerating sorghum grain for calves.

Effect of Levan Supplement in Orange Juice on Weight, Gastrointestinal Symptoms and Metabolic Profile of Healthy Subjects: Results of an 8-Week Clinical Trial

PubMed Central

Niv, Eva; Shapira, Yami; Akiva, Ira; Rokhkind, Evgenia; Naor, Etty; Arbiv, Mira; Vaisman, Nachum

2012-01-01

Levan is a commonly used dietary fiber of the fructans group. Its impact on health remains undetermined. This double blind controlled study aimed to investigate the effect of 8 weeks’ daily consumption of 500 mL of natural orange juice enriched with 11.25 g of levan compared to the same amount of natural orange juice without levan on weight, gastrointestinal symptoms and metabolic profiles of 48 healthy volunteers. The statistical analyses compared between- and within-group findings at baseline, 4 weeks and study closure. The compared parameters were: weight, blood pressure, blood laboratory tests, daily number of defecations, scores of stool consistency, abdominal pain, bloating, gas, dyspepsia, vomiting and heartburn. Despite a higher fiber level recorded in the study group, there was no significant difference in the effect of the two kinds of juices on the studied parameters. Both juices decreased systolic and diastolic pressures, increased sodium level (within normal range), stool number, and bloating scores, and decreased gas scores. In conclusion, levan itself had no effect on weight, gastrointestinal symptoms or metabolic profile of healthy volunteers. Its possible effect on obese, hypertensive or hyperlipidemic patients should be investigated in further studies. PMID:22852055

Frequency of functional bowel disorders among healthy volunteers in Mexico City.

PubMed

Schmulson, Max; Ortíz, Orianna; Santiago-Lomeli, Mariana; Gutiérrez-Reyes, Gabriela; Gutiérrez-Ruiz, María Concepción; Robles-Díaz, Guillermo; Morgan, Douglas

2006-01-01

The frequency of functional bowel disorders (FBD) in Mexico using the Rome II criteria is unknown. The Rome II Modular Questionnaire (RII-MQ) was translated into Spanish in coordination with the Rome Committee and their Latin American program. Volunteers were recruited by advertisement in Mexico City, and administered the RII-MQ. The study population consisted of 324 healthy volunteers, with a mean age of 35.7; 66% were female. The most prevalent disorders were heartburn 35%, irritable bowel syndrome (IBS) 35%, functional bloating 21%, proctalgia fugax 21%, and functional constipation 19%. Based on gender, IBS-C was 4 times more frequent in females than males (19 vs. 4.6%) and functional bloating 3 times more frequent (10 vs. 3.7%). Differences according to occupation included a higher prevalence of ulcer-like dyspepsia (p = 0.04), IBS-C (p = 0.018) and proctalgia fugax (p = 0.034) among students. This is the first study to use RII-MQ to determine the prevalence of FBD in urban Mexico. The prevalence of IBS was significant and is related to a number of factors, including the stress of living in an overpopulated city. Selection bias is likely operative. A community-based study is warranted. Copyright 2006 S. Karger AG, Basel

Osteopathic management of chronic constipation in women patients. Results of a pilot study.

PubMed

Belvaux, Aurélie; Bouchoucha, Michel; Benamouzig, Robert

2017-10-01

Constipation is a common problem in western countries. The aim of this pilot study was to determine the effectiveness of osteopathic manipulative treatment (OMT) for the treatment of constipated women with functional constipation (FC) or defeation disorders (DD). Twenty-one constipated females referred to a tertiary center were recruited. A course of OMT, weekly for four weeks, was given. Clinical questionnaire, Bristol stool form scale and patients' subjective perception of constipation, bloating and abdominal pain, were recorded. Total and segmental colonic transit time (CTT) were performed before and after OMT. Eleven patients had FC and 10 DD, as defined by Rome III criteria. After OMT, the Knowless Eccersley Scott Symptom score (P=0.020), the oro-anal transit time (P=0.002), the right (P=0.005) and left (P=0.009) CTT had decreased while the stool frequency (P=0.005) and the Bristol Stool Form scale (P=0.003) had increased. After OMT, the intensity of constipation, and the Patient assessment of constipation symptoms score did not change but a decrease of abdominal pain, bloating, quality of life score and drug use was found. This study shows OMT has potential benefit for treating functional constipation in women. Further randomised trials are required to confirm these results. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Novel Therapies in IBS-D Treatment.

PubMed

Nee, Judy; Zakari, Mohammed; Lembo, Anthony J

2015-12-01

Irritable bowel syndrome (IBS) is a common gastrointestinal disease characterized by abdominal pain and change in bowel habits. IBS diarrhea predominant (IBS-D), which is arguably the most common subset of IBS, is also associated with rectal urgency, increased frequency, abdominal bloating, and loose to watery stools. Current treatments for diarrhea include mu-opioid agonists (i.e., loperamide, lomotil) and bile acid sequestrants (i.e., cholestyramine) while treatments for abdominal pain include antispasmodics (i.e., hyoscyamine, dicyclomine) and tricyclic antidepressants (i.e., amitriptyline). There are currently 3 FDA-approved treatments for IBS-D, which have been shown to improve both abdominal pain and diarrhea. Alosetron was initially approved by FDA 2000; however, its use is now limited to women with severe IBS-D symptoms refractory to other treatment. Eluxadoline, a mixed mu-opioid agonist, and rifaximin, a broad spectrum gut specific antibiotic, were both FDA approved in 2015. Eluxadoline has been shown to relieve abdominal pain and stool consistency in appropriate candidates. While large trials already showed the efficacy of rifaximin in treating non-constipated IBS for bloating, stool consistency, and abdominal pain, the recent TARGET 3 trial demonstrates that retreatment is also effective. While these new treatments significantly expand options for patients suffering from IBS-D, there is likely to remain a need for additional safe and effective therapies.

Valorisation of different types of boron-containing wastes for the production of lightweight aggregates.

PubMed

Kavas, T; Christogerou, A; Pontikes, Y; Angelopoulos, G N

2011-01-30

Four boron-containing wastes (BW), named as Sieve (SBW), Dewatering (DBW), Thickener (TBW) and Mixture (MBW) waste, from Kirka Boron plant in west Turkey were investigated for the formation of artificial lightweight aggregates (LWA). The characterisation involved chemical, mineralogical and thermal analyses as well as testing of their bloating behaviour by means of heating microscopy. It was found that SBW and DBW present bloating behaviour whereas TBW and MBW do not. Following the above results two mixtures M1 and M2 were prepared with (in wt.%): 20 clay mixture, 40 SBW, 40 DBW and 20 clay mixture, 35 SBW, 35 DBW, 10 quartz sand, respectively. Two different firing modes were applied: (a) from room temperature till 760 °C and (b) abrupt heating at 760 °C. The obtained bulk density for M1 and M2 pellets is 1.2g/cm(3) and 0.9 g/cm(3), respectively. The analysis of microstructure with electron microscopy revealed a glassy phase matrix and an extended formation of both interconnected and isolated, closed pores. The results indicate that SBW and DBW boron-containing wastes combined with a clay mixture and quartz sand can be valorised for the manufacturing of lightweight aggregates. Copyright © 2010 Elsevier B.V. All rights reserved.

[Obstruction of the nasal passage caused by a balloon catheter in a calf].

PubMed

Rijkenhuizen, A B

1993-01-01

Decompression of the rumen as a supporting symptomatic therapy of recurrent bloat in calves and juvenile cattle is used regularly. The gas should be released for several days. This is facilitated by the use of a balloon stomach tube, which can be left in situ for up to five days. However, the use of this tube is not always without risks, which will be discussed on base of a patient.

Departmental of Clinical Investigation: Annual Research Progress Report for Fiscal Year 1992. Volume 1

DTIC Science & Technology

1993-01-01

effect of cisapride on the symptoms of unexplained upper abdominal pain, nausea, vomiting, anorexia, early satiety, bloating/ distension in patients with...for 30 minutes following eccentric exercise will less the 3 indices of delayed-onset muscle soreness (DOMS): perceived muscular soreness, reduced...post-exercise and the Talag Pain Rating Scale will be used to assess muscular soreness. Progress: No progress report was furnished by the principal

The SiO Masers of TX Camelopardalis

NASA Astrophysics Data System (ADS)

Marvel, Kevin B.; Diamond, P.; Kemball, A.

2001-06-01

Observations of evolved stars with the Very Long Baseline Array have shown that silicon monoxide masers are found just above the photospheres of these interesting objects. By observing many times over a few pulsation periods, researchers are now discovering complex motions in the extended photospheres of these bloated, old stars. We will present several dramatic "movies" of these sources and speculate on wat such observations can tell us about the physical conditions near the star.

Small Bowel Bacterial Overgrowth Associated with Persistence of Abdominal Symptoms in Children Treated with a Proton Pump Inhibitor.

PubMed

Sieczkowska, Agnieszka; Landowski, Piotr; Zagozdzon, Pawel; Kaminska, Barbara; Lifschitz, Carlos

2015-05-01

Small bowel bacterial overgrowth (SBBO) was diagnosed in 22.5% of 40 children treated for 3 months with a proton pump inhibitor (PPI). Compared with those without SBBO, children with SBBO had higher frequency of abdominal pain, bloating, eructation, and flatulence. Patients with gastrointestinal symptoms after PPI treatment should be evaluated for SBBO rather than empirically prolonging PPI therapy. Copyright © 2015 Elsevier Inc. All rights reserved.

Pathophysiology and Toxicokinetic Studies of Blue-Green Algae Intoxication in the Swine Model

DTIC Science & Technology

1986-11-21

given one hour apart in order to avoid excessive distension of the rumen . The dry weight dosage selected was similar to that which was experimentally...dehydrated. Ruminal atony and mild bloat developed. The three cows that first vent down had low pretreatment blood calcium concentrations of 6.4, 7.5 and...responsive, and weak. The rumen contraction rate slowed from one contraction per minute (predosing) to one contraction every three minutes. The

Ecology and pathogenicity of gastrointestinal Streptococcus bovis.

PubMed

Herrera, Paul; Kwon, Young Min; Ricke, Steven C

2009-01-01

Streptococcus bovis is an indigenous resident in the gastrointestinal tracts of both humans and animals. S. bovis is one of the major causes of bacterial endocarditis and has been implicated in the incidence of human colon cancer, possibly due to chronic inflammatory response at the site of intestinal colonization. Certain feeding regimens in ruminants can lead to overgrowth of S. bovis in the rumen, resulting in the over-production of lactate and capsular polysaccharide causing acute ruminal acidosis and bloat, respectively. There are multiple strategies in controlling acute lactic acidosis and bloat. The incidence of the two diseases may be controlled by strict dietary management. Gradual introduction of grain-based diets and the feeding of coarsely chopped roughage decrease the incidence of the two disease entities. Ionophores, which have been used to enhance feed conversion and growth rate in cattle, have been shown to inhibit the growth of lactic acid bacteria in the rumen. Other methods of controlling lactic acid bacteria in the ruminal environment (dietary supplementation of long-chain fatty acids, induction of passive and active immune responses to the bacteria, and the use of lytic bacteriophages) have also been investigated. It is anticipated that through continued in-depth ecological analysis of S. bovis the characteristics responsible for human and animal pathogenesis would be sufficiently identified to a point where more effective control strategies for the control of this bacteria can be developed.

Probing the low-stellar-mass domain with Kepler and APOGEE observations of eclipsing binaries

NASA Astrophysics Data System (ADS)

Prsa, Andrej; Hambleton, Kelly

2018-01-01

Observations of low-mass stars (M < 0.5 Msun) have been shown to systematically disagree with the predictions of stellar evolutionary models, where observed radii can be inflated by as much as 5-15% as compared to model predictions. One of the proposed explanations for this discrepancy that is gaining traction are stellar magnetic fields impeding the onset of convection and the subsequent bloating of the star. Here we present modeling analysis results of two benchmark eclipsing binaries, KIC 3003991 and KIC 2445134, with low mass companions (M ~ 0.2 MSun and M ~ 0.5 MSun, respectively). The models are based on Kepler photometry and APOGEE spectroscopy. APOGEE is a part of the Sloan spectroscopic survey that observes in the near-infrared, providing greater sensitivity towards fainter, red companions. We combine the binary modeling software PHOEBE with emcee, an affine invariant Markov chain Monte Carlo sampler; celerite, a Gaussian process library; and our own codes to create a modeling suite capable of modeling correlated noise, shot noise, nuisance astrophysical signals (such as spots) and the full set of eclipsing binary parameters. The results are obtained within a probabilistic framework, with robust mass and radius uncertainties ~1-4%. We overplot the derived masses, radii and temperatures over evolutionary models and note stellar size bloating w.r.t. model predictions for both systems. This work has been funded by the NSF grant #1517460.

Cumin Extract for Symptom Control in Patients with Irritable Bowel Syndrome: A Case Series

PubMed Central

Agah, Shahram; Taleb, Amir Mehdi; Moeini, Reyhane; Gorji, Narjes; Nikbakht, Hajar

2013-01-01

BACKGROUND Irritable bowel syndrome is one of the most common gastrointestinal disorders Characterized by chronic abdominal pain, altered bowel habits or changes in stool consistency. Unfortunately, no specific treatments for relieving IBS symptoms have been suggested yet. This pilot study was conducted to evaluate the efficacy of the Cumin extract, a kind of herbal used in the treatment of gastrointestinal disorders like bloating, and other symptoms of IBS. METHODS Fifty seven patients with IBS (according to the ROME II diagnostic criteria) with no nay other accompanying illness enrolled in study. Patients were advised to discontinue their other treatments during the study course, then 20 drops per day of Cumin essential oil was administered for included patients. IBS-associated symptoms including abdominal pain, nausea, painful defection, presence of mucosa in stool, changes in stool consistency and defecation frequency were evaluated using a questionnairebefore treatment, 2 and 4 weeks after beginning treatment and 2 and 4 weeks after stopping treatment. RESULTS Abdominal pain, bloating, incomplete defecation, fecal urgency and presence of mucus discharge in stool were statistically significant decreased during and after treatment with Cumin extract. Stool consistency and defecation frequency were also both statistically significant improved in patients with constipation dominant pattern of IBS. CONCLUSION Cumin extract can be effective in improving all IBS symptoms. Considering its low cost and easy availability Cumin administration in patients with IBS may have economic benefits. PMID:24829694

Tegaserod in the treatment of irritable bowel syndrome (IBS) with constipation as the prime symptom

PubMed Central

Layer, Peter; Keller, Jutta; Loeffler, Helena; Kreiss, Andreas

2007-01-01

Irritable bowel syndrome with constipation (IBS-C) as the predominant bowel symptom is a prevalent disorder, characterized by recurring abdominal pain/discomfort, bloating, and constipation, and imposes a significant socio-economic burden. Traditional treatments generally address just one of the multiple IBS symptoms. The efficacy and safety profile of tegaserod, a serotonin 5-HT4 receptor agonist, has been demonstrated in several randomized, placebo-controlled, and open-label trials. This review discusses the major clinical trials of tegaserod, which have involved 8948 IBS patients. Overall, data reveal that tegaserod is an effective treatment for IBS-C, providing statistically significant relief of overall and multiple individual IBS-C symptoms (abdominal pain/discomfort, bloating, and constipation) in both placebo-controlled and “real-life” open-label settings. Repeat treatments with tegaserod were also shown to be effective, which is noteworthy given the chronic and episodic nature of IBS. Moreover, tegaserod was associated with improvements in patients’ quality of life and work productivity. Data also indicate that tegaserod is well tolerated over the short-term (4 weeks), long-term (12 months), and repeated treatments. Diarrhea is the only adverse event consistently associated with tegaserod and was generally mild and transient. Overall, tegaserod has been demonstrated to offer effective and well-tolerated treatment of IBS-C, providing patients with meaningful symptom relief. PMID:18360619

Recycling of air pollution control residues from municipal solid waste incineration into lightweight aggregates.

PubMed

Quina, Margarida J; Bordado, João M; Quinta-Ferreira, Rosa M

2014-02-01

This work focuses on the assessment of technological properties and on the leaching behavior of lightweight aggregates (LWA) produced by incorporating different quantities of air pollution control (APC) residues from municipal solid waste (MSW) incineration. Currently this hazardous waste has been mostly landfilled after stabilization/solidification. The LWA were produced by pelletizing natural clay, APC residues as-received from incineration plant, or after a washing treatment, a small amount of oil and water. The pellets were fired in a laboratory chamber furnace over calcium carbonate. The main technological properties of the LWA were evaluated, mainly concerning morphology, bulk and particle densities, compressive strength, bloating index, water adsorption and porosity. Given that APC residues do not own expansive (bloating) properties, the incorporation into LWA is only possible in moderate quantities, such as 3% as received or 5% after pre-washing treatment. The leaching behavior of heavy metals from sintered LWA using water or acid solutions was investigated, and despite the low acid neutralization capacity of the synthetic aggregates, the released quantities were low over a wide pH range. In conclusion, after a washing pre-treatment and if the percentage of incorporation is low, these residues may be incorporated into LWA. However, the recycling of APC residues from MSW incineration into LWA does not revealed any technical advantage. Copyright © 2013 Elsevier Ltd. All rights reserved.

Dose response of PEG 3350 for the treatment of childhood fecal impaction.

PubMed

Youssef, Nader N; Peters, John M; Henderson, Wendy; Shultz-Peters, Sandra; Lockhart, Danielle K; Di Lorenzo, Carlo

2002-09-01

To investigate the efficacy and safety of polyethylene glycol (PEG) 3350 in the treatment of childhood fecal impaction. This was a prospective, double-blind, parallel, randomized study of 4 doses of PEG 3350; 0.25 g/kg per day, 0.5 g/kg per day, 1 g/kg per day, 1.5 g/kg per day, given for 3 days in children with constipation for >3 months and evidence of fecal impaction. Forty patients completed the study (27 boys, median age 7.5, range 3.3-13.1 years). Disimpaction occurred in 75% of children, with a significant difference between the two higher doses and the lower doses (95% vs 55%, P <.005). All groups had an increased number of bowel movements during the 5-day study versus baseline, respectively: 6.5 versus 1.1 (P <.005), 8.0 versus 1.3 (P <.005), 10.9 versus 1.7 (P <.005), and 12.3 versus 1.4 (P <.005). Adverse effects included nausea (5%), vomiting (5%), bloating (18%), cramping (5%), and diarrhea (13%). Diarrhea and bloating were more prevalent (P <.02) in the higher-dose than in the lower-dose group. No clinically significant changes in electrolytes were noted. The 3-day administration of PEG 3350 is safe and effective in the treatment of childhood fecal impaction at doses of 1 and 1.5 g/kg per day.

Environmental Impact Research Program: White Clover (Trifolium repens). Section 7.3.5, US Army Corps of Engineers Wildlife Resources Management Manual.

DTIC Science & Technology

1986-07-01

types where they are common (Kohn and Mooty 1971). Rumen analyses of white-tailed deer in Montana showed that forbs comprised 80% of summer samples...frequency of occurrence in deer rumens collected from January through March in the Northern Black Hills. Bluegrass- white clover meadows are also...CAUTIONS AND LIMITATIONS White clover, like most legumes, occasionally causes bloat in animals, particularly cattle and sheep that have overfilled

Symptoms of Functional Intestinal Disorders Are Common in Patients with Celiac Disease Following Transition to a Gluten-Free Diet.

PubMed

Silvester, Jocelyn A; Graff, Lesley A; Rigaux, Lisa; Bernstein, Charles N; Leffler, Daniel A; Kelly, Ciarán P; Walker, John R; Duerksen, Donald R

2017-09-01

Celiac disease and functional intestinal disorders may overlap, yet the natural history of functional symptoms in patients with celiac disease is unknown. To investigate the prevalence of irritable bowel syndrome (IBS), functional dyspepsia (FD), and functional bloating (FB) symptoms among patients with celiac disease at diagnosis and during the first year of a gluten-free diet. Adults with a new diagnosis of celiac disease were surveyed at baseline, 6 months and 1 year using standardized measures for intestinal symptoms [Rome III diagnostic questionnaire and celiac symptom index (CSI)] and gluten-free diet adherence [gluten-free eating assessment tool (GF-EAT) and celiac diet adherence test]. At diagnosis, two-thirds fulfilled Rome III diagnostic questionnaire symptom criteria for IBS (52%), functional dyspepsia (27%), and/or functional bloating (9%). One year post-diagnosis, there was high adherence to a gluten-free diet as 93% reported gluten exposure less than once per month on the GF-EAT and only 8% had ongoing celiac disease symptoms (CSI score >45). The rates of those meeting IBS (22%) and functional dyspepsia (8%) symptom criteria both decreased significantly on a gluten-free diet. The prevalence of functional symptoms (any of IBS, FD or FB) at 1 year was 47%. Long-term follow-up of patients with celiac disease is necessary because many patients with celiac disease who are adherent to a gluten-free diet have persistent gastrointestinal symptoms.

Double-blind placebo-controlled study of mesalamine in post-infective irritable bowel syndrome--a pilot study.

PubMed

Tuteja, Ashok K; Fang, John C; Al-Suqi, Manal; Stoddard, Gregory J; Hale, Devon C

2012-10-01

Post-infective irritable bowel syndrome (PI-IBS) is characterized by continuing symptoms of irritable bowel syndrome, typically diarrhea-predominant, following an episode of acute gastroenteritis. There is often an increase in sub-epithelial inflammatory and neuroendocrine cells on colonic mucosal biopsy. Mesalamine is an anti-inflammatory agent, effective in the treatment of inflammatory bowel disease. The goal of this study was to compare mesalamine to placebo on symptoms and quality-of-life (QOL) in PI-IBS. Twenty patients who developed diarrhea-predominant IBS after gastroenteritis were randomized to receive mesalamine (Asacol®) 1.6 gm b.i.d. or placebo for 12 weeks in a double-blind placebo-controlled study. QOL was assessed using the IBS-QOL questionnaire. Stool frequency, stool consistency, urgency, severity of abdominal pain, severity of bloating, and global-improvement scale were recorded in daily diaries for 7 days at baseline and every 4 weeks. Data were analyzed by comparing the change from baseline to last follow-up. One patient withdrew after randomization; data were incomplete in two patients. Thus, data were analyzed from 17 patients (11 men and 6 women, median age: 27 years, range 22-45 years). Mesalamine was not associated with significant improvement in global symptoms, abdominal pain, bloating, stool urgency, frequency, or consistency (all p ≥ 0.11) or QOL (p ≥ 0.16). There was no significant improvement in global symptoms or overall QOL with mesalamine in patients with PI-IBS.

A comparative study of the decomposition of pig carcasses in a methyl methacrylate box and open air conditions.

PubMed

Li, Liangliang; Wang, Jiangfeng; Wang, Yu

2016-08-01

Analysis of the process of decomposition is essential in establishing the postmortem interval. However, despite the fact that insects are important players in body decomposition, their exact function within the decay process is still unclear. There is also limited knowledge as to how the decomposition process occurs in the absence of insects. In the present study, we compared the decomposition of a pig carcass in open air with that of one placed in a methyl methacrylate box to prevent insect contact. The pig carcass in the methyl methacrylate box was in the fresh stage for 1 day, the bloated stage from 2 d to 11 d, and underwent deflated decay from 12 d. In contrast, the pig carcass in open air went through the fresh, bloated, active decay and post-decay stages; and 22.3 h (0.93 d), 62.47 h (2.60 d), 123.63 h (5.15 d) and 246.5 h (10.27 d) following the start of the experiment respectively, prior to entering the skeletonization stage. A large amount of soft tissue were remained on the pig carcass in the methyl methacrylate box on 26 d, while only scattered bones remained on the pig carcass in open air. The results indicate that insects greatly accelerate the decomposition process. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

[The effect of lifestyle modification on chronic constipation].

PubMed

Borre, Mette; Qvist, Niels; Raahave, Dennis; Worsøe, Jonas; Ærthøj, Jørgen Peter; Christensen, Peter; Krogh, Klaus

2015-04-06

First-line treatment of constipation includes dietary fibre, fluid and exercise. The evidence for these recommendations is, however, scarce. Increased intake of fibre will reduce colonic transit time and improve the frequency and consistency of stools in 50% of patients. Bloating and flatulence are common side effects to highly fermentable fibres. Daily intake of 2 l of water enhances the positive effects of fibre and 30 min. exercise per day also alleviates symptoms. Conservative treatment is usually insufficient and should be supplemented with laxatives or motility enhancing drugs.

Surgical Management of Colonic Inertia

PubMed Central

McCoy, Jacob A.; Beck, David E.

2012-01-01

For the select small number of constipated patients that cannot be managed medically, surgical options should be considered. Increases in our knowledge of colorectal physiology and experience have fostered improvements in patient evaluation and surgical management. Currently, patients with refractory colonic inertia are offered total abdominal colectomy and ileorectal anastomosis, often with laparoscopic techniques. With proper patient selection, the results have been excellent for resolving the frequency and quality of bowel movements. However, symptoms such as bloating and abdominal pain, which may be related to irritable bowel syndrome rather than the colonic inertia, may persist. PMID:23449085

Effect of fructose-reduced diet in patients with irritable bowel syndrome, and its correlation to a standard fructose breath test.

PubMed

Berg, Leif Kyrre; Fagerli, Erik; Martinussen, Marit; Myhre, Arnt-Otto; Florholmen, Jon; Goll, Rasmus

2013-08-01

To perform a validation of dairy registrations for use as diagnostic tool in IBS and fructose malabsorption (FM). To investigate the precision of the fructose breath test (FBT) as compared with symptom score reduction on fructose-reduced diet (FRD) in a cohort of patients with Rome II defined irritable bowel syndrome (IBS). IBS patients diagnosed according to the Rome II criteria and with no organic gastrointestinal disease were enrolled. The patients were randomized in an open study design with a 2 week run-in on IBS diet, followed by 4 weeks w/wo additional FRD. FBT was performed in all patients. Dairy registrations of stool frequency and consistency as well as abdominal pain/discomfort and bloating on a visual analog scale (VAS) were performed during the whole study. A total of 182 subjects performed the study according to protocol (88 FRD, 94 controls). The VAS symptom registration performed well in validation procedures, whereas stool data showed less impressive characteristics. FRD improved symptom scores (abdominal pain/discomfort and bloating) significantly whereas no changes were observed in the control group. The effect of FRD on the stool frequency was modest but no effect was observed on the stool consistency. The FBT did not discriminate between patients with and without effect of FRD, and even in the group with a negative FBT significant improvement of symptom scores was observed. VAS measures yield reliable symptom evaluation in dairy registrations of IBS. FRD improves symptom scores in IBS patients independent of results from the FBT.

Gas-related symptoms after antireflux surgery.

PubMed

Kessing, Boudewijn F; Broeders, Joris A J L; Vinke, Nikki; Schijven, Marlies P; Hazebroek, Eric J; Broeders, Ivo A M J; Bredenoord, Albert J; Smout, André J P M

2013-10-01

Gas-related symptoms such as bloating, flatulence, and impaired ability to belch are frequent after antireflux surgery, but it is not known how these symptoms affect patient satisfaction with the procedure or what determines the severity of these complaints. We aimed to assess the impact of gas-related symptoms on patient-perceived success of surgery and to determine whether the severity of gas-related complaints after antireflux surgery is associated with objectively measured abnormalities. Fifty-two patients were studied at a median of 27 months after antireflux surgery. The influence of gas-related symptoms on their quality of life and satisfaction with surgical outcome was assessed. The rates of air swallows and gastric and supragastric belches before and after surgery were assessed using impedance measurements. Bloating and flatulence were associated with a decreased quality of life and less satisfaction with surgical outcome. Notably, 9 % of the patients would not opt for surgery again due to gas-related symptoms. Antireflux surgery decreased the total number of gastric belches but did not affect the number of air swallows. The severity of gas-related symptoms was not associated with an increased number of preoperative air swallows and/or belches or a larger postoperative decrease in the number of gastric belches. Gas-related symptoms are associated with less satisfaction with surgical outcome. The severity of gas-related symptoms is not determined by the number of preoperative air swallows or a more severe impairment of the ability to belch after surgery. Preoperative predictors of postoperative gas-related symptoms therefore could not be identified.

Indications for and factors relating to outcome after rumenotomy or rumenostomy in cattle: 95 cases (1999-2011).

PubMed

Hartnack, Amanda K; Niehaus, Andrew J; Rousseau, Marjolaine; Pentecost, Rebecca L; Miesner, Matt D; Anderson, David E

2015-09-15

To evaluate indications for and factors relating to outcome after rumenotomy or rumenostomy in cattle. Retrospective case series. 95 cattle that underwent rumenotomy or rumenostomy. Medical records for 95 cattle that underwent either rumenostomy or rumenotomy at 2 veterinary teaching hospitals in 1999 through 2011 were analyzed. Reasons for the procedures were noted. Long-term outcome was determined during telephone interviews with owners. 42 (44%) bovids underwent rumenostomy and 53 (56%) bovids underwent rumenotomy. Among the 42 animals undergoing rumenostomy, 18 (43%) had rumen cannulas placed during elective procedures. Other indications for rumenostomy included ruminal tympany (bloat [n = 20]), esophageal obstruction (choke [1]), grain overload (1), and provision of access for administration of enteral nutrition (2). Indications for rumenotomy included traumatic reticuloperitonitis (n = 31), bloat (9), foreign body (6), choke (5), and other (2). Long-term follow-up data were available for 31 of 42 (74%) bovids that underwent rumenostomy. Of those 31 animals, 17 (55%) were still in the herd, 4 (13%) had been culled, and 10 (32%) had died or were euthanized. Long-term follow-up data were available for 38 of 53 (72%) bovids that underwent rumenotomy. Of those 38 animals, 13 (34%) were still in the herd, 14 (37%) had been culled, and 11 (29%) had died or been euthanized. Results indicated that rumenotomy and rumenostomy can be effective in treating or relieving complications secondary to forestomach disorders in cattle. Bovids undergoing rumen surgery had a favorable prognosis for survival and a fair prognosis for potential return to production.

Herbal Remedies for Functional Dyspepsia and Traditional Iranian Medicine Perspective

PubMed Central

Babaeian, Mahmoud; Naseri, Mohsen; Kamalinejad, Mohammad; Ghaffari, Farzaneh; Emadi, Fatemeh; Feizi, Awat; Hosseini Yekta, Nafiseh; Adibi, Peyman

2015-01-01

Context: Functional dyspepsia (FD) is a functional gastro-intestinal disorder with high prevalence. Among various treatment options, treatment by complementary and alternative medicines especially herbal remedies also practiced. Traditional Iranian medicine (TIM), a valuable resource of valid applied studies of ancient Iranian scholars, recommends numerous medicinal plants to treat dyspepsia symptoms. In this study, through investigation of TIM references, we aimed to identify medicinal plants for treatment of digestion insufficiency. Evidence Acquisition: In this qualitative study, dyspepsia symptoms including fullness, early satiety, bloating, nausea, and belching were checked under reliable sources of traditional medicine. Then medicinal plants recommended for the treatment of the symptoms were extracted from the books. Likewise, for investigating the pharmacological properties of medicinal plants used for the relieving of dyspepsia symptoms, electronic databases such as PubMed, Scopus, Google Scholar and some Iranian databases like SID and IranMedex were employed. Results: The study yielded 105 plants from 37 families which could treat various dyspepsia symptoms; fifty-seven plants, mainly from Apiaceae, Lamiaceae, Amaryllidaceae and Zingiberaceae had digestive effects. In this research, based on the information in TIM reference texts, we obtained 58 plants effective for bloating, 40 for nausea, 37 for appetite loss and 7 for belching. In human clinical trials conducted on medicinal plants effective for FD symptoms, 7 single plants were used. Conclusions: Finding the medicinal plants effective on digestion insufficiency based on TIM could suggest a better strategy for the relieving of dyspepsia symptoms. Traditional Iranian medicine prescribes medicinal plants based on each patient’s personal characteristics and practices multiple target therapies. PMID:26734483

Herbal Remedies for Functional Dyspepsia and Traditional Iranian Medicine Perspective.

PubMed

Babaeian, Mahmoud; Naseri, Mohsen; Kamalinejad, Mohammad; Ghaffari, Farzaneh; Emadi, Fatemeh; Feizi, Awat; Hosseini Yekta, Nafiseh; Adibi, Peyman

2015-11-01

Functional dyspepsia (FD) is a functional gastro-intestinal disorder with high prevalence. Among various treatment options, treatment by complementary and alternative medicines especially herbal remedies also practiced. Traditional Iranian medicine (TIM), a valuable resource of valid applied studies of ancient Iranian scholars, recommends numerous medicinal plants to treat dyspepsia symptoms. In this study, through investigation of TIM references, we aimed to identify medicinal plants for treatment of digestion insufficiency. In this qualitative study, dyspepsia symptoms including fullness, early satiety, bloating, nausea, and belching were checked under reliable sources of traditional medicine. Then medicinal plants recommended for the treatment of the symptoms were extracted from the books. Likewise, for investigating the pharmacological properties of medicinal plants used for the relieving of dyspepsia symptoms, electronic databases such as PubMed, Scopus, Google Scholar and some Iranian databases like SID and IranMedex were employed. The study yielded 105 plants from 37 families which could treat various dyspepsia symptoms; fifty-seven plants, mainly from Apiaceae, Lamiaceae, Amaryllidaceae and Zingiberaceae had digestive effects. In this research, based on the information in TIM reference texts, we obtained 58 plants effective for bloating, 40 for nausea, 37 for appetite loss and 7 for belching. In human clinical trials conducted on medicinal plants effective for FD symptoms, 7 single plants were used. Finding the medicinal plants effective on digestion insufficiency based on TIM could suggest a better strategy for the relieving of dyspepsia symptoms. Traditional Iranian medicine prescribes medicinal plants based on each patient's personal characteristics and practices multiple target therapies.

Symptoms Associated with Dietary Fiber Supplementation over Time in Individuals with Fecal Incontinence

PubMed Central

Bliss, Donna Z.; Savik, Kay; Jung, Hans-Joachim G.; Whitebird, Robin; Lowry, Ann

2011-01-01

Background Knowledge about adverse symptoms over time from fiber supplementation is lacking. Purpose To compare the severity of adverse gastrointestinal (GI) symptoms during supplementation with dietary fiber or placebo over time in adults with fecal incontinence. Secondary aims were to determine the relationship between symptom severity and emotional upset and their association with study attrition and reducing fiber dose. Methods Subjects (N=189, 77% female, 92% white, (age = 58 years, SD = 14) with fecal incontinence were randomly assigned to placebo or a supplement of 16g total dietary fiber/day from one of three sources: gum arabic, psyllium, or carboxymethylcellulose. They reported GI symptoms daily during baseline (14 days), incremental fiber dosing (6 days), and two segments of steady full fiber dose (32 days total). Results Severity of symptoms in all groups was minimal. Adjusting for study segment and day, a greater feeling of fullness in the psyllium group was the only symptom that differed from symptoms in the placebo group. Odds of having greater severity of flatus, belching, fullness, and bloating were 1.2–2.0 times greater in the steady dose segment compared to baseline. There was a positive association between symptom severity and emotional upset. Subjects with a greater feeling of fullness or bloating or higher scores for total symptom severity or emotional upset were more likely to withdraw from the study sooner or reduce fiber dose. Conclusions Persons with fecal incontinence experience a variety of GI symptoms over time. Symptom severity and emotional upset appear to influence fiber tolerance and study attrition. Supplements seemed well tolerated. PMID:21543963

Direct-to-consumer and physician promotion of tegaserod correlated with physician visits, diagnoses, and prescriptions.

PubMed

Dorn, Spencer D; Farley, Joel F; Hansen, Richard A; Shah, Nilay D; Sandler, Robert S

2009-08-01

Direct-to-consumer advertisement (DTCA) and physician promotion of drugs can influence patient and physician behaviors. We sought to determine the relationship between promotion of tegaserod and the number of office visits for abdominal pain, constipation, and bloating; diagnoses of irritable bowel syndrome (IBS); and tegaserod prescriptions. We used an Integrated Promotional Services database to estimate tegaserod DTCA and promotion expenditures; the National Ambulatory/Hospital Medical Care Surveys (1997-2005) to estimate the number of ambulatory care visits for abdominal pain, constipation, and bloating and diagnoses of IBS; and IMS Health's National Prescription Audit Plus (Fairfield, CT) to estimate the number of prescriptions. We constructed segmented and multivariate regression models to analyze the data. In the 3 months immediately following the start of tegaserod DTCA, there was a significant increase in physician visits (by 1 million; 95% confidence interval [CI], 0.5-1.6 million) and IBS diagnoses (by 397,025; 95% CI, 3909-790,141). Subsequently, the trend of visits and IBS diagnoses was reduced. In multivariate analyses that examined the overall relationship of promotion with visits, diagnoses, and prescriptions, only the relationship between physician promotion and tegaserod prescribing was significant; every $1 million spent on physician promotion resulted in an additional 4108 prescriptions (95% CI, 2526-5691). The initial DTCA of tegaserod was associated with a significant, immediate increase in physician visits and IBS diagnoses. This trend reversed and, in multivariate models, neither DTCA nor physician promotion correlated with visits or diagnoses. Physician promotion (although not DTCA) correlated with tegaserod prescription volume.

Direct to consumer and physician promotion of tegaserod correlated with physician visits, diagnoses, and prescriptions

PubMed Central

Dorn, Spencer D.; Farley, Joel F.; Hansen, Richard A.; D. Shah, Nilay; Sandler, Robert S.

2009-01-01

Background & Aims Direct to consumer advertisement (DTCA) and physician promotion of drugs can influence patient and physician behaviors. We sought to determine the relationship between promotion of tegaserod and the number of office visits for abdominal pain, constipation, and bloating; diagnoses of irritable bowel syndrome (IBS); and tegaserod prescriptions. Methods We used an Integrated Promotional Services database to estimate tegaserod DTCA and promotion expenditures, The National Ambulatory/Hospital Medical Care Surveys (1997–2005) to estimate the number of ambulatory care visits for abdominal pain, constipation, and bloating and diagnoses of IBS, and IMS Health's National Prescription Audit Plus to estimate the number of prescriptions. We constructed segmented and multivariate regression models to analyze the data. Results In the 3 months immediately following the start of tegaserod DTCA, there was a significant increase in physician visits (by 1 million; 95% CI 0.5–1.6 million) and IBS diagnoses (by 397,025; 95% CI 3,909–790,141). Subsequently, the trend of visits and IBS diagnoses reduced. In multivariate analyses that examined the overall relationship of promotion with visits, diagnoses, and prescriptions, only the relationship between physician promotion and tegaserod prescribing was significant; every $1 million spent on physician promotion resulted in an additional 4,108 prescriptions (95% CI: 2,526–5,691). Conclusions The initial DTCA of tegaserod was associated with a significant, immediate increase in physician visits and IBS diagnoses. This trend reversed and in multivariate models, neither DTCA nor physician promotion correlated with visits or diagnoses. Physician promotion (though not DTCA) correlated with tegaserod prescription volume. PMID:19445943

Diagnostic challenges of celiac disease in a young child: A case report and a review of the literature.

PubMed

Mărginean, Cristina Oana; Meliţ, Lorena Elena; Stefănuţ Săsăran, Vlăduţ; Mărginean, Cristian Dan; Mărginean, Maria Oana

2018-06-01

Celiac disease is a chronic, immune-mediated, multiorgan disorder that affects susceptible individuals, and it is triggered by gluten and other prolamins. We present the case of a 1-year-old male child, with a history of idiopathic pericardial effusion, admitted in our clinic for severe abdominal bloating, irritability, loss of appetite and intermittent diarrheic stools. The clinical findings were: influenced general status, irritability, distended abdomen, and diffuse abdominal tenderness. The initial laboratory tests revealed anemia, leukocytosis, increased inflammatory biomarkers, high levels of transaminases, and hypoalbuminemia. The stool culture identified an enterocolitis with enteropathogenic Escherichia coli (E. coli). We initiated antibiotic treatment, substitution therapy with human albumin and probiotics with initial favorable evolution, but after 1 month, the patient was re-admitted for the persistence of intermittent diarrheic stools and abdominal bloating, when we established the diagnosis of cow's milk protein allergy. We initiated diary-free diet. Unfortunately, the patient was re-admitted after another 8 months, presenting the same clinical and laboratory findings as during the initial admission. We repeated the serology for celiac disease and we performed an upper gastrointestinal endoscopy with duodenal biopsies, which established the diagnosis of celiac disease. After 1 month of gluten-free diet, the patient's evolution improved considerably. Enterocolitis with E. coli could be considered as trigger for CD in our case. The diagnosis of CD in small children can be hindered by an insufficient gluten-exposure, and can lead to a delay in the diagnosis as in the case presented above.

Symptom Profiles in Patients With Irritable Bowel Syndrome or Functional Abdominal Pain Compared With Healthy Controls.

PubMed

Varni, James W; Shulman, Robert J; Self, Mariella M; Nurko, Samuel; Saps, Miguel; Saeed, Shehzad A; Bendo, Cristiane B; Patel, Ashish S; Dark, Chelsea Vaughan; Zacur, George M; Pohl, John F

2015-09-01

Patient-reported outcome (PRO) measures of gastrointestinal symptoms are recommended to determine treatment effects for irritable bowel syndrome (IBS) and functional abdominal pain (FAP). Study objectives were to compare the symptom profiles of pediatric patients with IBS or FAP with healthy controls and with each other using the PedsQL Gastrointestinal Symptoms and Gastrointestinal Worry Scales, and to establish clinical interpretability of PRO scale scores through identification of minimal important difference (MID) scores. Gastrointestinal Symptoms and Worry Scales were completed in a 9-site study by 154 pediatric patients and 161 parents (162 families; IBS n = 46, FAP n = 119). Gastrointestinal Symptoms Scales measuring stomach pain, stomach discomfort when eating, food and drink limits, trouble swallowing, heartburn and reflux, nausea and vomiting, gas and bloating, constipation, blood in poop, and diarrhea were administered along with Gastrointestinal Worry Scales. A matched sample of 447 families with healthy children completed the scales. Gastrointestinal Symptoms and Worry Scales distinguished between patients with IBS or FAP compared with healthy controls (P < 0.001), with larger effect sizes (>1.50) for symptoms indicative of IBS or FAP, demonstrating a broad multidimensional gastrointestinal symptom profile and clinical interpretability with MID scores for individual PRO scales. Patients with IBS manifested more symptoms of constipation, gas and bloating, and diarrhea than patients with FAP. Patients with IBS or FAP manifested a broad gastrointestinal symptom profile compared with healthy controls with large differences, indicating the critical need for more effective interventions to bring patient functioning within the range of healthy functioning.

Targeted therapies for diarrhea-predominant irritable bowel syndrome

PubMed Central

Olden, Kevin W

2012-01-01

Irritable bowel syndrome (IBS) causes gastrointestinal symptoms such as abdominal pain, bloating, and bowel pattern abnormalities, which compromise patients’ daily functioning. Common therapies address one or two IBS symptoms, while others offer wider symptom control, presumably by targeting pathophysiologic mechanisms of IBS. The aim of this targeted literature review was to capture clinical trial reports of agents receiving the highest recommendation (Grade 1) for treatment of IBS from the 2009 American College of Gastroenterology IBS Task Force, with an emphasis on diarrhea-predominant IBS. Literature searches in PubMed captured articles detailing randomized placebo-controlled trials in IBS/diarrhea-predominant IBS for agents receiving Grade I (strong) 2009 American College of Gastroenterology IBS Task Force recommendations: tricyclic antidepressants, nonabsorbable antibiotics, and the 5-HT3 receptor antagonist alosetron. Studies specific for constipation-predominant IBS were excluded. Tricyclic antidepressants appear to improve global IBS symptoms but have variable effects on abdominal pain and uncertain tolerability; effects on stool consistency, frequency, and urgency were not adequately assessed. Nonabsorbable antibiotics show positive effects on global symptoms, abdominal pain, bloating, and stool consistency but may be most efficacious in patients with altered intestinal microbiota. Alosetron improves global symptoms and abdominal pain and normalizes bowel irregularities, including stool frequency, consistency, and fecal urgency. Both the nonabsorbable antibiotic rifaximin and the 5-HT3 receptor antagonist alosetron improve quality of life. Targeted therapies provide more complete relief of IBS symptoms than conventional agents. Familiarization with the quantity and quality of evidence of effectiveness can facilitate more individualized treatment plans for patients with this heterogeneous disorder. PMID:22754282

Feeding, evaluating, and controlling rumen function.

PubMed

Lean, Ian J; Golder, Helen M; Hall, Mary Beth

2014-11-01

Achieving optimal rumen function requires an understanding of feeds and systems of nutritional evaluation. Key influences on optimal function include achieving good dry matter intake. The function of feeds in the rumen depends on other factors including chemical composition, rate of passage, degradation rate of the feed, availability of other substrates and cofactors, and individual animal variation. This article discusses carbohydrate, protein, and fat metabolism in the rumen, and provides practical means of evaluation of rations in the field. Conditions under which rumen function is suboptimal (ie, acidosis and bloat) are discussed, and methods for control examined. Copyright © 2014 Elsevier Inc. All rights reserved.

Toxicosis in dairy cattle exposed to poison hemlock (Conium maculatum) in hay: isolation of Conium alkaloids in plants, hay, and urine.

PubMed

Galey, F D; Holstege, D M; Fisher, E G

1992-01-01

Cattle in two herds developed signs of bloating, increased salivation and lacrimation, depression, respiratory distress, ataxia, and death after ingestion of hay that contained large amounts of poison hemlock (Conium maculatum). Twenty of 30 Angus cows and calves were affected in the first herd (2 died). In the second herd, 5 of 30 Holstein heifers were affected (1 died). The Conium alkaloids, coniine and gamma-coniceine, were quantified in the hay, the plants from the responsible hayfield, and the urine of affected animals.

Fluid therapy in calves.

PubMed

Smith, Geof W; Berchtold, Joachim

2014-07-01

Early and aggressive fluid therapy is critical in correcting the metabolic complications associated with calf diarrhea. Oral electrolyte therapy can be used with success in calves, but careful consideration should be given to the type of oral electrolyte used. Electrolyte solutions with high osmolalities can significantly slow abomasal emptying and can be a risk factor for abomasal bloat in calves. Milk should not be withheld from calves with diarrhea for more than 12 to 24 hours. Hypertonic saline and hypertonic sodium bicarbonate can be used effectively for intravenous fluid therapy on farms when intravenous catheterization is not possible. Copyright © 2014 Elsevier Inc. All rights reserved.

Laparoscopic anterior 180-degree versus nissen fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis of randomized clinical trials.

PubMed

Broeders, Joris A; Roks, David J; Ahmed Ali, Usama; Watson, David I; Baigrie, Robert J; Cao, Zhanguo; Hartmann, Jens; Maddern, Guy J

2013-05-01

To compare short- and long-term outcome after 180-degree laparoscopic anterior fundoplication (180-degree LAF) with laparoscopic Nissen fundoplication (LNF). LNF is currently the most frequently performed surgical therapy for gastroesophageal reflux disease. Alternatively, 180-degree LAF has been alleged to reduce troublesome dysphagia and gas-related symptoms, with similar reflux control. MEDLINE, EMBASE, Cochrane Library, and web of Knowledge CPCI-S were searched for randomized clinical trials comparing primary 180-degree LAF with LNF. The methodological quality was evaluated to assess bias risk. Primary outcomes were esophageal acid exposure, esophagitis, heartburn score, dilatation for dysphagia, modified Dakkak dysphagia score (0-45), and reoperation rate. Meta-analysis was conducted at 1 and 5 years. Five distinct randomized clinical trials comparing 180-degree LAF (n = 227) with LNF (n = 231) were identified. At 1 year, the Dakkak dysphagia score [2.8 vs 4.8; weighted mean difference: -2.25; 95% confidence interval (CI): -2.66 to -1.83; P < 0.001], gas bloating [11% vs 18%; relative risk (RR) 0.59; 95% CI: 0.36-0.97; P = 0.04], flatulence (14% vs 25%; RR: 0.57; 95% CI: 0.35-0.91; P = 0.02), inability to belch (19% vs 31%; RR: 0.63; 95% CI: 0.40-0.99; P = 0.05), and inability to relieve bloating (34% vs 44%; RR: 0.74; 95% CI: 0.55-0.99; P = 0.04) were lower after 180-degree LAF. Esophageal acid exposure (standardized mean difference: 0.19; 95% CI: -0.07 to 0.46; P = 0.15), esophagitis (19% vs 13%; RR: 1.42; 95% CI: 0.69-2.91; P = 0.34), heartburn score (standardized mean difference: 1.27; 95% CI:-0.36 to 2.90; P = 0.13), dilatation rate (1.4% vs 2.8%; RR: 0.60; 95% CI: 0.19-1.91; P = 0.39), reoperation rate (5.7% vs 2.8%; RR: 2.08; 95% CI: 0.80-5.41; P = 0.13), perioperative outcome, regurgitation, proton pump inhibitor (PPI) use, lower esophageal sphincter pressure, and patient satisfaction were similar after 180-degree LAF and LNF. At 5 years, the Dakkak dysphagia score, flatulence, inability to belch, and inability to relieve bloating remained lower after 180-degree LAF. The 5-year heartburn score, dilatation rate, reoperation rate, PPI use, and patient satisfaction were similar. At 1 and 5 years, dysphagia and gas-related symptoms are lower after 180-degree LAF than after LNF, and esophageal acid exposure and esophagitis are similar, with no differences in heartburn scores, patient satisfaction, dilatations, and reoperation rate. These results lend level 1a support for the use of 180-degree LAF for the surgical treatment of gastroesophageal reflux disease.

Powder processing and mechanical properties of Silver0.86Lead19Antimony telluride20 (LAST) and Lead0.95Tin0.05Tellurium - Lead sulfide 8% (Lead telluride -Lead sulfide) thermoelectric materials

NASA Astrophysics Data System (ADS)

Ni, Jennifer Elisabeth

Thermoelectric (TE) materials convert between thermal and electrical energy and when used with existing processes will increase the efficiency via waste heat recovery. Ag0.86Pb19SbTe20 (LAST) and Pb0.95Sn0.05Te - PbS 8% (PbTe-PbS) materials exhibit good thermoelectric (TE) properties and have potential applications as thermoelectric generators in waste heat recovery. However, to fully characterize the thermo-mechanical behavior of LAST and PbTe-PbS materials under in-service conditions, knowledge is needed of the mechanical and thermal properties at room and high temperature. As fracture strength is inversely proportional to the square root of grain size, cast ingots were powder processed to reduce powder particle size. Three different powder processing methods were used (1) dry milling only, (2) wet milling only, or (3) dry milling and wet milling The specimens were fabricated using hot pressing or pulsed electric current sintering (PECS) from planetary ball milled powders. In this study, elastic moduli, including Young's modulus, shear modulus, and Poisson's ratio, were measured dynamically using resonant ultrasound spectroscopy (RUS) at room temperature and as a function of temperature up to 663 K. The room temperature porosity dependence for Young's modulus followed the empirical exponential relationships common for brittle materials, with a material dependent constant bPE of 3.5 and 1.3 for LAST and PbTe-PbS, respectively. The room temperature Young's modulus for a theoretically dense specimen was 58.4 +/- 0.6 GPa and 56.2 +/- 0.4 GPa for for LAST and PbTe-PbS, respectively. For hot pressed PbTe-PbS specimens, the Vickers indentations mean hardness and fracture toughness was 1.18 + 0.09 GPa and 0.35 +/- 0.04 MPa·m 1/2. The coefficient of thermal expansion is important for understanding the mechanical response of a material to a thermal gradient or a thermal transient. For PbTe-PbS the coefficient of thermal expansion measured using dilatometry and high temperature x-ray diffraction was 21.5 x 10-6 K -1. Bloating during post-densification annealing was measured indirectly using resonant ultrasound spectroscopy and dilatometry and directly using scanning electron microscopy. Dry milled only PECS-processed PbTe-PbS specimens did not bloat during post-densification anneals up to 936 K. Hot pressed and PECS-processed specimens processed from wet milled and dry and wet milled powder bloated during densification anneals at temperatures over 603 K.

Bowel symptoms in patients that receive proton pump inhibitors. Results of a multicenter survey in Mexico.

PubMed

Schmulson, M J; Frati-Munari, A C

2018-04-17

Proton pump inhibitors (PPIs) have been associated with small intestinal bacterial overgrowth (SIBO), which increases with prolonged PPI use, and SIBO has been associated with irritable bowel syndrome (IBS). The aim of the present study was to study the prevalence of bowel symptoms in patients treated with PPIs in Mexico. Gastroenterologists in 36 cities surveyed patients treated with PPIs, utilizing an ad hoc questionnaire to determine the presence of bowel symptoms and IBS. Two hundred and fifteen physicians interviewed 1,851 patients. PPI indications were gastritis (48.8%), gastroesophageal reflux (38.5%), peptic ulcer (6.2%), and others (6.5%). A total of 77.5% of the patients received treatment for ≤6 months and 11.9% for ≥1 year. Symptoms were reported in 92.3% of the patients: abnormal bowel habits (90%), bloating (82%), abdominal pain (63%), flatulence (58%), and abdominal discomfort (53%). A total of 67.5% of the patients fit the Rome III criteria for IBS. Symptoms presented in 55.9% of the patients before PPI intake and in 44.1% of the patients after PPI use (P<.005). Constipation (63.8%) predominated in the former, and diarrhea (56.5%) in the latter (P<.0001). The treatments prescribed for managing those symptoms were antispasmodics, antibiotics, prokinetics, and antiflatulents, but patients stated greater satisfaction with antibiotics (mainly rifaximin) (P<.0001). The association of PPIs with bowel symptoms and IBS is frequent in Mexico. Diarrhea and bloating predominate, and antibiotics produce the greatest treatment satisfaction, suggesting that SIBO or dysbiosis is the cause of the PPI-related bowel symptoms. However, that remains to be confirmed. Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

Effects of long-term PPI treatment on producing bowel symptoms and SIBO.

PubMed

Compare, Debora; Pica, Loredana; Rocco, Alba; De Giorgi, Francesco; Cuomo, Rosario; Sarnelli, Giovanni; Romano, Marco; Nardone, Gerardo

2011-04-01

Gastroesophageal reflux disease (GERD), including erosive reflux disease and non-erosive reflux disease (NERD), is a chronic disease with a significant negative effect on quality of life. State-of-the-art treatment involves proton pump inhibitors (PPIs). However, relapse of symptoms occurs in the majority of the patients who require recurrent or continuous therapy. Although PPIs are well tolerated, little information is available about gastrointestinal side effects. To evaluate the effects of long-term PPI treatment on development of bowel symptoms and/or small intestinal bacterial overgrowth (SIBO). Patients with NERD not complaining of bowel symptoms were selected by upper endoscopy, 24-h pH-metry and a structured questionnaire concerning severity and frequency of bloating, flatulence, abdominal pain, diarrhoea and constipation. Patients were treated with esomeprazole 20 mg bid for 6 months. Prior to and after 8 weeks and 6 months of therapy, patients received the structured questionnaire and underwent evaluation of SIBO by glucose hydrogen breath test (GHBT). Forty-two patients with NERD were selected out of 554 eligible patients. After 8 weeks of PPI treatment, patients complained of bloating, flatulence, abdominal pain and diarrhoea in 43%, 17%, 7% and 2%, respectively. After 6 months, the incidence of bowel symptoms further increased and GHBT was found positive in 11/42 (26%) patients. By a post hoc analysis, a significant (P < 0·05) percentage of patients (8/42) met Rome III criteria for irritable bowel syndrome. Prolonged PPI treatment may produce bowel symptoms and SIBO; therefore, the strategy of step-down or on-demand PPI therapy should be encouraged in GERD. © 2010 The Authors. European Journal of Clinical Investigation © 2010 Stichting European Society for Clinical Investigation Journal Foundation.

Long-term results of laparoscopic Nissen fundoplication due to gastroesophageal reflux disease. A ten year follow-up in a low volume center.

PubMed

Kornmo, T S; Ruud, T E

2008-01-01

Laparoscopic 360 degrees nissen fundoplication has been our routine surgical procedure since 1995, in the treatment of gastroesophageal reflux disease (GERD). We have reviewed our results of patients treated with laparoscopic Nissen fundoplication (LNF) during 1995-1998. 170 patients have undergone LNF in our hospital since 1995. during the period of 1995-1998, 33 patients were treated. all patients were asked to return a structured follow-up questionnaire, using a Visick grading scale, after an average of 69 months (2003) and 117 months (2007). 29 questionnaires (90%) were answered in 2003, and 31 questionnaires (97%) were answered in 2007. one patient died at home before the first questionnaire in 2003, and is therefore not included. We present our results on LNF after an observation time of 117 months (range 99-144 months). patient satisfaction after LNF is rated as very good or good (Visick 1-2) in 93% in 2003 and 97% in 2007. 97% of the patients would recommend the same treatment to other patients with similar symptoms at ten year follow up. One patient has undergone resurgery during follow up. Daily gas bloat and flatulence is reported in 52% in 2003 and 39% in 2007, and is the most common reason for reduced satisfaction. Five patients report of reflux symptoms, one patient daily and four patients sometimes, where the first patient still uses proton pump inhibitor (PPI) daily and three patients use PPI occasionally. patient satisfaction after LNF treatment for gerd is high at long-term (10 years) follow-up. Bloating and flatulence persistently occurred to a great extent and the need for preoperative information regarding these symptoms is important.

Outcome of breath tests in adult patients with suspected small intestinal bacterial overgrowth

PubMed Central

Mattsson, Johanna; Minaya, Maria Teresa; Monegro, Milka; Lebwohl, Benjamin; Lewis, Suzanne K.; Green, Peter HR; Stenberg, Reidun

2017-01-01

Aim: The aim was to investigate breath test outcomes in patients with suspected SIBO and indicative symptoms of SIBO, diagnosed by breath testing. Background: Breath testing is used to detect small intestinal bacterial overgrowth (SIBO) by measuring hydrogen and methane produced by intestinal bacteria. Methods: This retrospective cross sectional study included 311 patients with gastrointestinal symptoms who underwent the breath test for evaluation of SIBO at Celiac Disease Center at Columbia University, New York, in 2014-2015. The patients were divided into two groups based on the physician’s choice: lactulose breath test group (72%) and glucose breath test group (28%). Among them, 38% had a history of celiac disease or non-celiac gluten sensitivity. Results: In total, 46% had a positive breath test: 18% were positive for methane, 24 % positive for hydrogen and 4% positive for both gases (p=0.014). Also, 50% had a positive lactulose breath result and 37% had a positive glucose breath result (p=0.036). The most common symptom for performing the breath test was bloating and the only clinical symptom that significantly showed a positive glucose breath test was increased gas (p=0.028). Conclusion: Lactulose breath test was more often positive than glucose breath test. Positivity for hydrogen was more common than methane. Bloating was the most frequently perceived symptom of the patients undergoing the breath test but the only statistically significant clinical symptom for a positive glucose breath test was increased gas. Furthermore, the results showed that there was no significant association between positive breath test result and gender, age, non-celiac gluten sensitivity or celiac disease. PMID:29118931

Hubble PanCET: an isothermal day-side atmosphere for the bloated gas-giant HAT-P-32Ab

NASA Astrophysics Data System (ADS)

Nikolov, N.; Sing, D. K.; Goyal, J.; Henry, G. W.; Wakeford, H. R.; Evans, T. M.; López-Morales, M.; García Muñoz, A.; Ben-Jaffel, L.; Sanz-Forcada, J.; Ballester, G. E.; Kataria, T.; Barstow, J. K.; Bourrier, V.; Buchhave, L. A.; Cohen, O.; Deming, D.; Ehrenreich, D.; Knutson, H.; Lavvas, P.; Lecavelier des Etangs, A.; Lewis, N. K.; Mandell, A. M.; Williamson, M. H.

2018-02-01

We present a thermal emission spectrum of the bloated hot Jupiter HAT-P-32Ab from a single eclipse observation made in spatial scan mode with the Wide Field Camera 3 (WFC3) aboard the Hubble Space Telescope (HST). The spectrum covers the wavelength regime from 1.123 to 1.644 μm which is binned into 14 eclipse depths measured to an averaged precision of 104 parts-per million. The spectrum is unaffected by a dilution from the close M-dwarf companion HAT-P-32B, which was fully resolved. We complemented our spectrum with literature results and performed a comparative forward and retrieval analysis with the 1D radiative-convective ATMO model. Assuming solar abundance of the planet atmosphere, we find that the measured spectrum can best be explained by the spectrum of a blackbody isothermal atmosphere with Tp = 1995 ± 17 K, but can equally well be described by a spectrum with modest thermal inversion. The retrieved spectrum suggests emission from VO at the WFC3 wavelengths and no evidence of the 1.4 μm water feature. The emission models with temperature profiles decreasing with height are rejected at a high confidence. An isothermal or inverted spectrum can imply a clear atmosphere with an absorber, a dusty cloud deck or a combination of both. We find that the planet can have continuum of values for the albedo and recirculation, ranging from high albedo and poor recirculation to low albedo and efficient recirculation. Optical spectroscopy of the planet's day-side or thermal emission phase curves can potentially resolve the current albedo with recirculation degeneracy.

A pilot study on the effect of a symbiotic mixture in irritable bowel syndrome: an open-label, partially controlled, 6-month extension of a previously published trial.

PubMed

Bucci, C; Tremolaterra, F; Gallotta, S; Fortunato, A; Cappello, C; Ciacci, C; Iovino, P

2014-04-01

In recent years, the efficacy of probiotics has received considerable attention in the treatment for irritable bowel syndrome (IBS). In this regard, a symbiotic mixture (Probinul(®)) has shown beneficial effects. The aim of this study was to extend the previously published 4-week randomized, double-blinded, placebo-controlled study of this symbiotic mixture. This is an open-label prospective, partially controlled, 6-month extension period pilot study in which patients continued to receive the symbiotic mixture (Group 1) or were switched from placebo to symbiotic mixture (Group 2) using cyclic administration (last 2 weeks/month). The primary endpoints were the overall satisfactory relief of bloating and flatulence (assessed as proportions of responders). The secondary endpoints were evaluation of the symptom severity scores (bloating, flatulence, pain and urgency) and bowel function scores (frequency, consistency and incomplete evacuation). Twenty-six IBS patients completed the 6-month extension period (13 patients in Group 1 and 13 patients in Group 2). In the per-protocol analysis, the proportions of responders across time were not significantly different in the groups but in Group 2, there was an increased percentage of responders for flatulence (p = 0.07). In addition, the score of flatulence was reduced significantly during the 6-month treatment period in Group 2 (p < 0.05), while no other significant differences were detected. Treatment with this symbiotic mixture was associated with persistence of relief from flatulence or new reduction in flatulence in the present 6-month long extension study. These results need to be more comprehensively assessed in large, long-term, randomized, placebo-controlled studies.

Lactose intolerance in Indonesian children.

PubMed

Hegar, Badriul; Widodo, Ariani

2015-01-01

"Lactose intolerance (LI)" is considered a common problem in Asians, and in many parts of the world. Its prevalence and age of manifestation varies between by Asian country, for possible genetic or cultural reasons. Studies in Indonesian children 3-15 years old (y) are available within the past two decades, using a pure lactose tolerance test. The prevalences of lactose malabsorption (LM) in pre-elementary (3-5 y), elementary (6-11 y), and junior high (12-14 y) school-children were 21.3%, 57.8%, and 73%, respectively. An increasing trend for LM prevalence was seen within the pre-elementary group, from 9.1% at 3 y to 28.6% at 5 y. The most frequent symptoms of LI in junior high school (JHS) group were abdominal pain (64.1%), abdominal distention (22.6%), nausea (15.1%), flatulence (5.7%), and diarrhea (1.9%), mostly within one hour of lactose ingestion. In children with regular and irregular milk drinking, LM occurred in 81.2% and 69.6%; LI was found in 56.2% and 52.1%, respectively. Most JHS children with dairy-associated recurrent abdominal pain (RAP) symptoms proved to be malabsorbers. Dairy products most related to RAP were milk and yogurt. LI was found in 81% of RAP children with abdominal pain most frequently, followed by nausea, bloating, diarrhea, borborygmi, and flatulence. Symp-tom onset occurred 30 minutes after lactose ingestion, especially nausea, bloating, and abdominal pain. In RAP children LI symptoms mostly found in breath hydrogen concentration>20 ppm. More LI symptoms were found in lactose malabsorbers, but symptoms were mild and generally disappeared in 7 hours, and in most by 15 hours.

Relations between passage rates of rumen fluid and particulate matter and foam production in rumen contents of cattle fed on different diets ad lib.

PubMed

Okine, E K; Mathison, G W; Hardin, R T

1989-03-01

1. A group of six cattle, three of which had a non-bloating history (group A) and had been ruminally cannulated for the previous 2 years, and three with a history of being bloat-prone (group B) and which had been ruminally cannulated only 3 months before the study, were fed ad lib. on chopped lucerne (Medicago sativa) hay, lucerne pellets, or a 100 g chopped hay and 900 g rolled barley grain/kg diet over three periods of 30 d each. Flow of rumen digesta, by reference to CoEDTA and chromium-mordanted fibres, and foam production from samples of rumen contents were measured. 2. Samples of rumen contents (50 ml) from group A produced foam heights of 150 and 60 mm, 2 and 4 h after feeding respectively, compared with 240 and 150 mm for group B (P less than 0.05). 3. The fractional passage rate of the 1-2 mm particles mordanted with Cr did not differ (P greater than 0.05) between groups. 4. The fractional outflow rates (FOR) for CoEDTA 0-2 h and 2-7 h after feed was offered were 0.205 and 0.160/h for group A and 0.093 and 0.086/h for group B respectively (P less than 0.05). 5. Rumen-fluid FOR 0-2 h and 2-7 h after provision of feed were significantly (P less than 0.05) inversely correlated (r -0.74 and -0.85 respectively) with the amount of foam produced from rumen contents at these times.

Understanding polycystic ovary syndrome from the patient perspective: a concept elicitation patient interview study.

PubMed

Martin, Mona L; Halling, Katarina; Eek, Daniel; Krohe, Meaghan; Paty, Jean

2017-08-18

The aim of this study was to explore the need for a new disease-specific patient reported outcome (PRO) measure for use in clinical trials of drugs designed to target the underlying causes of polycystic ovary syndrome (PCOS), and in the process contribute to our understanding of the symptoms and impacts that define the patient experience with PCOS. Semi-structured interviews were conducted in 20 women diagnosed with PCOS according to the Rotterdam criteria who had not menstruated in the previous month. The relative importance of PCOS symptoms and impact concepts to patients was determined by analyzing the frequency of their expression in the interview transcripts. These insights were compared to clinicians' perceptions of PCOS. Pain- and discomfort-related symptoms accounted for the highest proportion (27.6%) of the 735 patient expressions, although clinicians did not consider pain to be important to patients with PCOS. The most frequently expressed individual symptoms were cramping (70% of patients; 14.7% of concepts), irregular menstruation (95% of patients; 12.2% of concepts), facial hair growth (75% of patients; 10.6% of concepts), heavy bleeding (70% of patients; 8.8% of concepts), infertility (70% of patients; 5.4% of concepts), and bloating (60% of patients; 5.2% of concepts). Cramping, heavy bleeding, and bloating were not identified by clinicians as being important to patients with PCOS. The impacts most frequently reported by patients with PCOS related to emotional well-being (e.g. anxiety/stress) and coping behaviors (e.g. acne medication, hair removal). The only validated PCOS-specific PRO, the PCOSQ, does not capture some key PCOS symptoms and impacts expressed by patients with PCOS, most notably those related to pain and discomfort, bleeding intensity and coping behaviours. Furthermore, some key PCOS symptoms may be under-recognized in the clinic.

Glioplasticity in irritable bowel syndrome.

PubMed

Lilli, N L; Quénéhervé, L; Haddara, S; Brochard, C; Aubert, P; Rolli-Derkinderen, M; Durand, T; Naveilhan, P; Hardouin, J-B; De Giorgio, R; Barbara, G; Bruley des Varannes, S; Coron, E; Neunlist, M

2018-04-01

Growing evidence indicates a wide array of cellular remodeling in the mucosal microenvironment during irritable bowel syndrome (IBS), which possibly contributes to pathophysiology and symptom generation. Here, we investigated whether enteric glial cells (EGC) may be altered, and which factors/mechanisms lead to these changes. Colonic mucosal biopsies of IBS patients (13 IBS-Constipation [IBS-C]; 10 IBS-Diarrhea [IBS-D]; 11 IBS-Mixed [IBS-M]) and 24 healthy controls (HC) were analyzed. Expression of S100β and GFAP was measured. Cultured rat EGC were incubated with supernatants from mucosal biopsies, then proliferation and Ca 2+ response to ATP were analyzed using flow cytometry and Ca 2+ imaging. Histamine and histamine 1-receptor (H1R) involvement in the effects of supernatant upon EGC was analyzed. Compared to HC, the mucosal area immunoreactive for S100β was significantly reduced in biopsies of IBS patients, independently of the IBS subtype. IBS-C supernatants reduced EGC proliferation and IBS-D and IBS-M supernatants reduced Ca 2+ response to ATP in EGC. EGC expressed H1R and the effects of supernatant upon Ca 2+ response to ATP in EGC were blocked by pyrilamine and reproduced by histamine via H1R. IBS supernatants reduced mRNA expression of connexin-43. The S100β-stained area was negatively correlated with the frequency and intensity of pain and bloating. Changes in EGC occur in IBS, involving mucosal soluble factors. Histamine, via activation of H1R-dependent pathways, partly mediates altered Ca 2+ response to ATP in EGC. These changes may contribute to the pathophysiology and the perception of pain and bloating in patients with IBS. © 2017 John Wiley & Sons Ltd.

Postprandial Gastrointestinal Function Differs after Acute Administration of Sourdough Compared with Brewer's Yeast Bakery Products in Healthy Adults.

PubMed

Polese, Barbara; Nicolai, Emanuele; Genovese, Daniela; Verlezza, Viviana; La Sala, Carmine N; Aiello, Marco; Inglese, Marianna; Incoronato, Mariarosaria; Sarnelli, Giovanni; De Rosa, Tiziana; Schiatti, Alfio; Mondelli, Francesco; Ercolini, Danilo; Cuomo, Rosario

2018-02-01

Europeans consume large quantities of bakery products, although these are known as one of the food categories that potentially leads to postprandial symptoms (such as fullness and bloating). The aim of this study was to evaluate the effects of sourdough baked goods on gastric emptying and gastrointestinal fermentation and symptoms in healthy people. In a double-blind, randomized crossover study, 2 sourdough croissants (SCs) or 2 brewer's yeast croissants (BCs) were served as single meals to 17 healthy adults [9 women; age range: 18-40 y; body mass index range (in kg/m2): 18-24]. Gastric volume (GV) was evaluated by magnetic resonance to calculate gastric-emptying rate in the 3-h interval after croissant ingestion. A hydrogen breath test was performed to measure hydrogen production after SC and BC ingestion. Palatability and postprandial gastrointestinal symptoms (discomfort, nausea, fullness, and bloating) over a 4-h period after the meal were evaluated. The area under the curve (AUC) was used to evaluate the overall effects on all variables tested. The total GV AUC was reduced by 11% during the 3 h after the consumption of SCs compared with BCs (P = 0.02). Hydrogen production during the 4-h interval after ingestion of SCs was 30% lower than after BCs (P = 0.03). SCs were rated as being >2 times as palatable as BCs (P < 0.001). The overall severity of postprandial symptoms was 36% lower during the 4 h after intake of SCs compared with BCs (P = 0.05). Sourdough bakery products could promote better postprandial gastrointestinal function in healthy adults and be more acceptable than those prepared with brewer's yeast. This trial was registered at www.clinicaltrials.gov as NCT03207516.

Improvement of digestive complaints in women with severe colorectal endometriosis benefiting from continuous amenorrhoea triggered by triptorelin. A prospective pilot study.

PubMed

Roman, H; Saint Ghislain, M; Milles, M; Marty, N; Hennetier, C; Moatassim, S; Desnyder, E; Abo, C

2015-09-01

To assess the impact of therapeutic amenorrhoea triggered by triptorelin in the digestive complaints of women with deep endometriosis infiltrating the rectum. Prospective series of consecutive patients with deep endometriosis of the rectum enrolled over a period of 17 consecutive months. University tertiary referral center. Seventy patients. Medical therapy (triptorelin 11.25 mg and add-back therapy using estradiol) administered for 3.4±1.8months before surgery. Gastrointestinal standardised questionnaires before beginning medical treatment and the day before surgery. The most frequent digestive complaints at baseline were: defecation pain in 77.1% of patients, bloating in 60%, diarrhoea in 54.3% and constipation in 50%. The largest diameter of the rectal area infiltrated by the disease was <1cm in 12.2% of women, 1 to 2.9 cm in 34.3% and ≥3cm in 51.4%. Multiple colorectal nodules were found in 32.9%. Medical treatment led to disappearance of cyclic defecation pain in 78.6%, dyschesia in 58.3%, diarrhoea in 58.3% and bloating in 50%. Relieving digestive complaints was not significantly related to either length of triptorelin administration or size of rectal infiltration by deep endometriosis. Therapeutic amenorrhoea averaging 3 months allowed complete improvement of various cyclic digestive complaints in more than half of patients. In selected patients, continuous therapeutic amenorrhoea could compensate for the lack of complete resection of deep infiltrating endometriosis of the rectum, when this latter is likely to result in a high rate of postoperative morbidity. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Computed tomography assessment of intestinal gas volumes in functional gastrointestinal disorders.

PubMed

Mc Williams, Sebastian R; Mc Laughlin, Patrick D; O'Connor, Owen J; Desmond, Alan N; Ní Laoíre, Aine; Shanahan, Fergus; Quigley, Eamonn Mm; Maher, Michael M

2012-10-01

Many patients with functional gastrointestinal disorders (FGIDs) rank sensations of bloating and distension among their most debilitating symptoms. Previous studies that have examined intestinal gas volume (IGV) in patients with FGIDs have employed a variety of invasive and imaging techniques. These studies are limited by small numbers and have shown conflicting results. The aim of our study was to estimate, using CT of the abdomen and pelvis (CTAP), IGV in patients attending FGID clinic and to compare IGV in patients with and without FGID. All CTAP (n = 312) performed on patients (n = 207) attending a specialized FGID clinic over 10-year period were included in this study. Patients were classified into one of 3 groups according to the established clinical grading system, as organic gastrointestinal disorder (OGID, ie, patients with an organic non-functional disorder, n = 84), FGID (n = 36) or organic and functional gastrointestinal disorder (OFGID, ie, patients with an organic and a functional disorder, n = 87). Two independent readers blinded to the diagnostic group calculated IGV using threshold based 3D region growing with OsiriX. Median IGVs for the FGID, OGID, and OFGID groups were 197.6, 220.6 and 155.0 mL, respectively. Stepwise linear regression revealed age at study, gender, and calculated body mass index to predict the log IGV with an r(2) of 0.116, and P < 0.001. There was a significant positive correlation between age and IGV in OGID (Spearman's = 0.253, P = 0.02) but this correlation was non-significant in the other groups. Although bloating is a classic symptom in FGID patients, IGV may not be increased compared with OGID and OFGID patients.

A preliminary study on the decomposition and dipteran associated with exposed carcasses in an oil palm plantation in Bandar Baharu, Kedah, Malaysia.

PubMed

Azwandi, A; Abu Hassan, A

2009-04-01

This study was carried out in an oil palm plantation in Bandar Baharu, Kedah using monkey carcasses and focuses in documenting the decomposition and dipteran colonization sequences in 50 days. This is the first study of Diptera associated with the exploitation of carcasses conducted in the north of peninsular Malaysia during the dry and wet seasons thereat. During the process of decomposition in both seasons, five phases of decay were recognized namely fresh, bloated, active decay, advance decay and dry remain. In this decomposition study, biomass loss of carcass occurred rapidly during the fresh to active decay stage due to the colonization and feeding activity of the Diptera larvae. The duration of the fresh and bloated stages of decay were the same in wet and dry seasons but later stages of decay were markedly shorter during the wet season. Twenty one species of adult Diptera were identified colonizing carcasses in the study period. Among the flies from the family Calliphoridae, Chrysomya megacephala Fabricius and Chrysomya nigripes Aubertin were recognized as the earliest arrivals on the first day of exposure. Adult Ch. nigripes was abundant for approximately two weeks after placement of the carcasses. By comparing the percentages of adults collected during the study period, the calliphorids abundance in percentages in wet season was 50.83%, but in dry season, the abundance was only about 35.2%. In contrast, the percentage of Sphaeroceridae in wet season was only 3.33%, but in the dry season, the abundance was 20.8%. Dipteran in family Phoridae, Piophilidae, Sepsidae, Drosophilidae and Dolichopodidae colonized the carcasses for a long period of time and were categorized as long term colonizers.

Efficacy and safety of lubiprostone in patients with chronic constipation.

PubMed

Barish, Charles F; Drossman, Douglas; Johanson, John F; Ueno, Ryuji

2010-04-01

The aim of this study is to assess the efficacy and safety of lubiprostone in adults with chronic constipation. This multicenter, parallel-group trial enrolled 237 patients with chronic constipation and randomized them to 4 weeks of double-blind treatment with oral lubiprostone 24 mcg or placebo twice daily. The primary efficacy endpoint was the number of spontaneous bowel movements (SBMs) after 1 week of treatment. Secondary evaluations included SBMs at weeks 2, 3, and 4; percentage of patients with a SBM within 24 h of first study dose; stool consistency; degree of straining; constipation severity; abdominal bloating and discomfort; global treatment effectiveness; and safety assessments. Lubiprostone-treated patients experienced greater mean numbers of SBMs at week 1 compared with placebo (5.89 versus 3.99, P = 0.0001), with significantly greater percentages having SBMs within 24 h of the first dose (61.3% versus 31.4%, P < 0.0001). At each assessment, SBM frequency and percentages of full responders (> or =4 SBM per week) were significantly greater among lubiprostone-treated patients compared with placebo (P < or = 0.0171). Lubiprostone-treated patients reported significant improvements in stool consistency, straining, and constipation severity at all weeks, and in abdominal bloating at week 1. Patient assessments of treatment effectiveness were significantly greater with lubiprostone compared with placebo at all weeks (P < 0.0004). Gastrointestinal-related disorders were the most common adverse events in both treatment groups. In patients with chronic constipation, lubiprostone produced a bowel movement in the majority of individuals within 24 h of initial dosing, with sustained improvement in frequency as well as other constipation symptoms over 4 weeks of treatment.

Efficacy of Bacillus coagulans Unique IS2 in treatment of irritable bowel syndrome in children: a double blind, randomised placebo controlled study.

PubMed

Sudha, M Ratna; Jayanthi, N; Aasin, M; Dhanashri, R D; Anirudh, T

2018-06-15

The efficacy of the probiotic strain, Bacillus coagulans Unique IS2 in the treatment of Irritable Bowel Syndrome (IBS) was evaluated in children. A total of 141 children of either sex in the age group 4-12 years, diagnosed with IBS according to the Rome III criteria, participated in the double-blind randomised controlled trial. Children received either B. coagulans Unique IS2 chewable tablets or placebo once daily for eight weeks followed by a two week follow-up period. Reduction in pain intensity as well as other symptoms associated with Irritable Bowel Syndrome like abdominal discomfort, bloating, distension, sense of incomplete evacuation, straining at stool, urgency of bowel movement, passage of gas and mucus, and bowel habit satisfaction were assessed. B. coagulans Unique IS2 treated group showed a greater reduction in pain scores as evaluated by a weekly pain intensity scale. There was a significant reduction (P<0.0001) in pain intensity in the probiotic treated group (7.6±0.98) as compared to the placebo group (4.2±1.41) by the end of the treatment period (8 weeks). There was also a significant improvement in stool consistency as well as reduction in abdominal discomfort, bloating, staining, urgency, incomplete evacuation and passage of gas. Bowel habit satisfaction and global assessment of relief was also observed in the B. coagulans Unique IS2 treated group as compared to the placebo group. This study demonstrates the efficacy of B. coagulans Unique IS2 in reducing the symptoms of Irritable Bowel Syndrome in children in the age group of 4-12 years.

Pros and Cons While Looking Through an Asian Window on the Rome IV Criteria for Irritable Bowel Syndrome: Pros.

PubMed

Ghoshal, Uday C

2017-07-30

A decade after Rome III, in 2016, Rome IV criteria were published. There are major differences between Rome IV and the earlier iteration, some of which are in line with Asian viewpoints. The clinical applicability of the Rome IV criteria of irritable bowel syndrome (IBS) in Asian perspective is reviewed here. Instead of considering functional gastrointestinal disorders (FGIDs) to be largely psychogenic, Rome IV suggested the importance of the gut over brain ("disorders of gut-brain interaction" not "brain-gut interaction"). The word "functional" is underplayed. Multi-dimensional clinical profile attempts to recognize micro-organic nature, like slow colon transit and fecal evacuation disorders in constipation and dietary intolerance including that of lactose and fructose, bile acid malabsorption, non-celiac wheat sensitivity, small intestinal bacterial overgrowth, and gastrointestinal infection in diarrhea. Overlap between different FGIDs has been recognized as Rome IV suggests these to be a spectrum rather than discrete disorders. Bloating, common in Asia, received attention, though less. Sub-typing of IBS may be more clinician-friendly now as the patient-reported stool form may be used than a diary. However, a few issues, peculiar to Asia, need consideration; Rome IV, like Rome III, suggests that Bristol type I-II stool to denote constipation though Asian experts include type III as well. Work-up for physiological factors should be given greater importance. Language issue is important. Bloating, common in IBS, should be listed in the criteria. Threshold values for symptoms in Rome IV criteria are based on Western data. Post-infectious malabsorption (tropical sprue) should be excluded to diagnose post-infectious IBS, particularly in Asia.

Quality of Life Comparing Dor and Toupet After Heller Myotomy for Achalasia

PubMed Central

Tomasko, Jonathan M.; Augustin, Toms; Tran, Tung T.; Haluck, Randy S.; Rogers, Ann M.

2014-01-01

Background: Laparoscopic Heller cardiomyotomy (LHC) is standard therapy for achalasia. Traditionally, an antireflux procedure has accompanied the myotomy. This study was undertaken to compare quality-of-life outcomes between patients undergoing myotomy with Toupet versus Dor fundoplication. In addition, we investigated overall patient satisfaction after LHC in the treatment of achalasia. Methods: One hundred thirty-five patients who underwent LHC over a 13-year period were identified for inclusion. Symptoms queried included dysphagia, heartburn, and bloating using the Gastroesophageal Reflux Disease–Health-Related Quality of Life Scale and a second published scale for the assessment of gastroesophageal reflux disease and dysphagia symptoms. The patients' overall satisfaction after surgery was also rated. Data were compared on the basis of type of fundoplication. Symptom scores were analyzed using chi-square tests and Fisher's exact tests. Results: Sixty-three patients completed the survey (47%). There were no perioperative deaths or reoperations. The mean length of stay was 2.8 days. The mean operative time for LHC with Toupet fundoplication was 137.3 ± 30.91 minutes and for LHC with Dor fundoplication was 111.5 ± 32.44 minutes (P = .006). There was no difference with respect to the incidence or severity of postoperative heartburn, dysphagia, or bloating. Overall satisfaction with Toupet fundoplication was 87.5% and with Dor fundoplication was 93.8% (P > .999). Conclusions: LHC with either Toupet or Dor fundoplication gave excellent patient satisfaction. Postoperative symptoms of heartburn and dysphagia were equivalent when comparing LHC with either antireflux procedure. Dor and Toupet fundoplication were found to have equivalent outcomes in the short term. We prefer Dor to Toupet fundoplication because of its decreased need for extensive dissection and better mucosal protection. PMID:25392612

Short-term outcomes using magnetic sphincter augmentation versus Nissen fundoplication for medically resistant gastroesophageal reflux disease.

PubMed

Louie, Brian E; Farivar, Alexander S; Shultz, Dale; Brennan, Christina; Vallières, Eric; Aye, Ralph W

2014-08-01

In 2012 the United States Food and Drug Administration approved implantation of a magnetic sphincter to augment the native reflux barrier based on single-series data. We sought to compare our initial experience with magnetic sphincter augmentation (MSA) with laparoscopic Nissen fundoplication (LNF). A retrospective case-control study was performed of consecutive patients undergoing either procedure who had chronic gastrointestinal esophageal disease (GERD) and a hiatal hernia of less than 3 cm. Sixty-six patients underwent operations (34 MSA and 32 LNF). The groups were similar in reflux characteristics and hernia size. Operative time was longer for LNF (118 vs 73 min) and resulted in 1 return to the operating room and 1 readmission. Preoperative symptoms were abolished in both groups. At 6 months or longer postoperatively, scores on the Gastroesophageal Reflux Disease Health Related Quality of Life scale improved from 20.6 to 5.0 for MSA vs 22.8 to 5.1 for LNF. Postoperative DeMeester scores (14.2 vs 5.1, p=0.0001) and the percentage of time pH was less than 4 (4.6 vs 1.1; p=0.0001) were normalized in both groups but statistically different. MSA resulted in improved gassy and bloated feelings (1.32 vs 2.36; p=0.59) and enabled belching in 67% compared with none of the LNFs. MSA results in similar objective control of GERD, symptom resolution, and improved quality of life compared with LNF. MSA seems to restore a more physiologic sphincter that allows physiologic reflux, facilitates belching, and creates less bloating and flatulence. This device has the potential to allow individualized treatment of patients with GERD and increase the surgical treatment of GERD. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Quality of life comparing dor and toupet after heller myotomy for achalasia.

PubMed

Tomasko, Jonathan M; Augustin, Toms; Tran, Tung T; Haluck, Randy S; Rogers, Ann M; Lyn-Sue, Jerome R

2014-01-01

Laparoscopic Heller cardiomyotomy (LHC) is standard therapy for achalasia. Traditionally, an antireflux procedure has accompanied the myotomy. This study was undertaken to compare quality-of-life outcomes between patients undergoing myotomy with Toupet versus Dor fundoplication. In addition, we investigated overall patient satisfaction after LHC in the treatment of achalasia. One hundred thirty-five patients who underwent LHC over a 13-year period were identified for inclusion. Symptoms queried included dysphagia, heartburn, and bloating using the Gastroesophageal Reflux Disease-Health-Related Quality of Life Scale and a second published scale for the assessment of gastroesophageal reflux disease and dysphagia symptoms. The patients' overall satisfaction after surgery was also rated. Data were compared on the basis of type of fundoplication. Symptom scores were analyzed using chi-square tests and Fisher's exact tests. Sixty-three patients completed the survey (47%). There were no perioperative deaths or reoperations. The mean length of stay was 2.8 days. The mean operative time for LHC with Toupet fundoplication was 137.3±30.91 minutes and for LHC with Dor fundoplication was 111.5±32.44 minutes (P=.006). There was no difference with respect to the incidence or severity of postoperative heartburn, dysphagia, or bloating. Overall satisfaction with Toupet fundoplication was 87.5% and with Dor fundoplication was 93.8% (P>.999). LHC with either Toupet or Dor fundoplication gave excellent patient satisfaction. Postoperative symptoms of heartburn and dysphagia were equivalent when comparing LHC with either antireflux procedure. Dor and Toupet fundoplication were found to have equivalent outcomes in the short term. We prefer Dor to Toupet fundoplication because of its decreased need for extensive dissection and better mucosal protection.

Relief of Menstrual Symptoms and Migraine with a Single-Tablet Formulation of Sumatriptan and Naproxen Sodium

PubMed Central

Ballard, Jeanne; Diamond, Michael P.; Mannix, Lisa K.; Derosier, Frederick J.; Lener, Shelly E.; Krishen, Alok; McDonald, Susan A.

2014-01-01

Abstract Background: Dysmenorrhea and menstrual migraine may share a common pathogenic pathway. Both appear to be mediated, in part, by an excess of prostaglandin production that occurs during menstruation. Methods: Data were pooled from two replicate randomized controlled trials of 621 adult menstrual migraineurs with dysmenorrhea who treated migraine with sumatriptan-naproxen or placebo. Along with headache symptoms, nonpain menstrual symptoms (bloating, fatigue, and irritability) and menstrual pain symptoms (abdominal and back pain) were recorded at the time periods of 30 minutes and 1, 2, 4, and 4–24 hours. Relief of menstrual symptoms was compared using a Cochran-Mantel-Haenszel test. Logistic regression was used to determine the odds of a headache response with increasing numbers of moderate to severe dymenorrheic symptoms. Results: Sumatriptan-naproxen was superior to placebo for relief of tiredness, irritability, and abdominal pain at the time periods of 2, 4, and 4–24 hours (p≤0.023); back pain at the time periods of 4 and 4–24 hours (p≤0.023); and bloating at 4–24 hours endpoint (p=0.01). The odds ratios (ORs) of attaining migraine pain freedom for 2 hours and for sustained 2–24 hours decreased as moderate to severe dysmenorrhea symptoms increased with sumatriptan-naproxen versus placebo. Conclusions: Treatment with sumatriptan-naproxen may provide relief of menstrual symptoms and migraine in female migraineurs with dysmenorrhea. The presence of moderate to severe dysmenorrhea symptoms is associated with decreased response rates for menstrual migraine, suggesting that the co-occurrence of these disorders may negatively impact the results of migraine-abortive therapy. PMID:24579886

Symptomatic improvement with gluten restriction in irritable bowel syndrome: a prospective, randomized, double blinded placebo controlled trial

PubMed Central

Pawar, Sunil V; Gambhire, Pravir A; Jain, Samit S; Surude, Ravindra G; Shah, Vinaya B; Contractor, Qais Q; Rathi, Pravin M

2016-01-01

Background/Aims The existence of non-celiac gluten sensitivity has been debated. Indeed, the intestinal and extra-intestinal symptoms of many patients with irritable bowel syndrome (IBS) but without celiac disease or wheat allergy have been shown to improve on a gluten-free diet. Therefore, this study set out to evaluate the effects of gluten on IBS symptoms. Methods We performed a double-blind randomized placebo-controlled rechallenge trial in a tertiary care hospital with IBS patients who fulfilled the Rome III criteria. Patients with celiac disease and wheat allergy were appropriately excluded. The participants were administered a gluten-free diet for 4 weeks and were asked to complete a symptom-based questionnaire to assess their overall symptoms, abdominal pain, bloating, wind, and tiredness on the visual analog scale (0-100) at the baseline and every week thereafter. The participants who showed improvement were randomly assigned to one of two groups to receive either a placebo (gluten-free breads) or gluten (whole cereal breads) as a rechallenge for the next 4 weeks. Results In line with the protocol analysis, 60 patients completed the study. The overall symptom score on the visual analog scale was significantly different between the two groups (P<0.05). Moreover, the patients in the gluten intervention group scored significantly higher in terms of abdominal pain, bloating, and tiredness (P<0.05), and their symptoms worsened within 1 week of the rechallenge. Conclusions A gluten diet may worsen the symptoms of IBS patients. Therefore, some form of gluten sensitivity other than celiac disease exists in some of them, and patients with IBS may benefit from gluten restrictions. PMID:27799885

Painful or Mild-Pain Constipation? A Clinically Useful Alternative to Classification as Irritable Bowel Syndrome with Constipation Versus Functional Constipation.

PubMed

Bouchoucha, Michel; Devroede, Ghislain; Mary, Florence; Bon, Cyriaque; Bejou, Bakhtiar; Benamouzig, Robert

2018-02-28

Abdominal pain is not used to characterize constipated patients. This study aimed to compare clinical, psychological, and physiological features in patients with IBS-constipation (IBS-C) with those in patients with functional constipation (FC) according to the intensity of abdominal pain. All patients filled a standard Rome III questionnaire. In addition, they indicated the intensity of constipation, diarrhea, bloating, and abdominal pain on a 10-point Likert scale, and their stool form with the Bristol Stool Form Scale. Anxiety and depression were assessed with the Beck Depression Inventory and the State-Trait Anxiety Inventory. Physiological evaluation included anorectal manometry and total and segmental colonic transit time. A total of 546 consecutive patients, 245 with IBS-C and 301 with FC, were included. Painful constipation (PFC) was found by cluster analysis and subsequently defined as having a value over four on the Likert scale for abdominal pain. PFC was found in 67% of IBS-C patients and in 22% of FC patients. PFC patients have digestive disorders with greater frequency and report higher levels of constipation and bloating, despite similar stool form. They have higher scores of depression, state and trait anxiety, and shorter terminal transit time than mild-pain constipated patients. Compared to IBS-C patients, PFC patients report higher levels of abdominal pain (P < 0.001). Psychological and physiological parameters were similar in PFC and IBS-C patients. Painful constipation and mild-pain constipation could be an alternative way to identify constipated patients than using the diagnosis of IBS-C and FC for clinical evaluation and drug studies.

Randomized double blind placebo-controlled trial of Saccharomyces cerevisiae CNCM I-3856 in irritable bowel syndrome: improvement in abdominal pain and bloating in those with predominant constipation.

PubMed

Spiller, Robin; Pélerin, Fanny; Cayzeele Decherf, Amélie; Maudet, Corinne; Housez, Béatrice; Cazaubiel, Murielle; Jüsten, Peter

2016-06-01

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by recurrent abdominal pain and/or discomfort. Probiotics have been reported to benefit IBS symptoms but the level of benefit remains quite unclear. This study was designed to assess the benefit of Saccharomyces cerevisiae I-3856 on IBS symptoms. A randomized, double blind, placebo-controlled trial has been performed in 379 subjects with diagnosed IBS. Subjects were randomly supplemented with the probiotics (1000 mg) or placebo for 12 weeks. Questionnaires (gastrointestinal symptoms, stools, wellbeing, and quality of life) were completed. Primary endpoint was percentage of responders defined as having a 50% decrease in the weekly average "intestinal pain/discomfort score" for at least 4 out of the last 8 weeks of the study. There was no overall benefit of S. cerevisiae I-3856 on IBS symptoms and wellbeing in the study population. Moreover, S. cerevisiae I-3856 was not statistically significant predictor of the responder status of the subjects (p > 0.05). Planned subgroup analyses showed significant effect in the IBS-C subjects: improvement of gastrointestinal symptoms was significantly higher in active group, compared to placebo, on abdominal pain/discomfort and bloating throughout the study and at the end of the supplementation. In this study, S. cerevisiae I-3856 at the dose of 1000 mg per day does not improve intestinal pain and discomfort in general IBS patients. However, it seems to have an effect in the subgroup with constipation which needs further studies to confirm (NCT01613456 in ClinicalTrials.gov registry).

Homeopathic treatment of premenstrual syndrome: a case series.

PubMed

Danno, Karine; Colas, Aurélie; Terzan, Laurence; Bordet, Marie-France

2013-01-01

Observational, prospective study to describe the homeopathic management of premenstrual syndrome (PMS) by a group of French physicians. Women with PMS for >3 months were prescribed individualized homeopathic treatment. The intensity of 10 clinical symptoms of PMS was scored individually at inclusion and at a 3-6 month follow-up visit: absent = 0, mild = 1, moderate = 2, severe = 3. Total symptom score (range: 0-30) was calculated and compared for each patient at inclusion and at follow-up. PMS impact on daily activities (quality of life, QoL) was compared at inclusion and follow-up as: none, mild, moderate, severe, very severe. Twenty-three women were prescribed homeopathic treatment only (mean age: 39.7 years). Folliculinum (87%) was the most frequently prescribed homeopathic medicine followed by Lachesis mutus (52.2%). The most common PMS symptoms (moderate or severe) at inclusion were: irritability, aggression and tension (87%), mastodynia (78.2%) and weight gain and abdominal bloating (73.9%); and the most common symptoms at follow-up were: irritability, aggression and tension (39.1%), weight gain and abdominal bloating (26.1%) and mastodynia (17.4%). Mean global score for symptom intensity was 13.7 at inclusion and 6.3 at follow-up. The mean decrease in score (7.4) was statistically significant (p < 0.0001). Twenty-one women reported that their QoL also improved significantly (91.3%; p < 0.0001). Homeopathic treatment was well tolerated and seemed to have a positive impact on PMS symptoms. Folliculinum was the most frequent homeopathic medicine prescribed. There appears to be scope for a properly designed, randomized, placebo-controlled trial to investigate the efficacy of individual homeopathic medicines in PMS. Copyright © 2012 The Faculty of Homeopathy. Published by Elsevier Ltd. All rights reserved.

Efficacy of morning-only 4 liter sulfa free polyethylene glycol vs 2 liter polyethylene glycol with ascorbic acid for afternoon colonoscopy

PubMed Central

Rivas, John M; Perez, Alejandro; Hernandez, Marlow; Schneider, Alison; Castro, Fernando J

2014-01-01

AIM: To compare the bowel cleansing efficacy of same day ingestion of 4-L sulfa-free polyethylene glycol (4-L SF-PEG) vs 2-L polyethylene glycol solution with ascorbic acid (2-L PEG + Asc) in patients undergoing afternoon colonoscopy. METHODS: 206 patients (mean age 56.7 years, 61% male) undergoing outpatient screening or surveillance colonoscopies were prospectively randomized to receive either 4-L SF-PEG (n = 104) or 2-L PEG + Asc solution (n = 102). Colonoscopies were performed by two blinded endoscopists. Bowel preparation was graded using the Ottawa scale. Each participant completed a satisfaction and side effect survey. RESULTS: There was no difference in patient demographics amongst groups. 4-L SF-PEG resulted in better Ottawa scores compared to 2-L PEG + Asc, 4.2 vs 4.9 (P = 0.0186); left colon: 1.33 vs 1.57 respectively (P = 0.0224), right colon: 1.38 vs 1.63 respectively (P = 0.0097). No difference in Ottawa scores was found for the mid colon or amount of fluid. Patient satisfaction was similar for both arms but those assigned to 4-L SF-PEG reported less bloating: 23.1% vs 11.5% (P = 0.0235). Overall polyp detection, adenomatous polyp and advanced adenoma detection rates were similar between the two groups. CONCLUSION: Morning only 4-L SF-PEG provided superior cleansing with less bloating as compared to 2-L PEG + Asc bowel preparation for afternoon colonoscopy. Thus, future studies evaluating efficacy of morning only preparation for afternoon colonoscopy should use 4-L SF-PEG as the standard comparator. PMID:25132784

Efficacy and tolerability of linaclotide in the treatment of irritable bowel syndrome with constipation in a real‑world setting - results from a German noninterventional study.

PubMed

Andresen, Viola; Miehlke, Stephan; Beck, Elmar; Wiseman, Gwen; Layer, Peter

2018-05-09

 Linaclotide is a minimally absorbed peptide guanylate cyclase-C agonist approved for the treatment of irritable bowel syndrome with constipation (IBS-C). This study assessed the efficacy and tolerability of linaclotide in IBS-C in routine clinical practice in Germany.  This was a 52-week, noninterventional study of linaclotide in patients aged ≥ 18 years with moderate to severe IBS-C. Severity of abdominal pain and bloating and frequency of bowel movements were assessed over 5 study visits. Treatment-related adverse events were recorded.  The study enrolled 375 patients; the mean observation duration was 4.4 months. Linaclotide marketing was halted during the study period for economic reasons, accounting for low patient numbers and short observation duration. Linaclotide significantly reduced mean (standard deviation [SD]) scores between treatment start (visit 1) and study end (visit 5) for abdominal pain intensity (visit 1: 4.87 [2.63] vs. visit 5: 2.40 [2.20], p < 0.0001), mean [SD] bloating intensity (visit 1: 5.30 [2.70] vs. visit 5: 2.86 [2.34], p < 0.0001), and increased mean [SD] bowel movement frequency (visit 1: 2.71 [1.80] vs. 4.38 [1.86], p < 0.0001). Diarrhea, occurring in 5.1 % of patients, was the most common adverse event.  Linaclotide is effective in improving the major symptoms of IBS-C and demonstrates a favorable safety profile in the real-world environment of routine clinical practice. DRKS (www.drks.de/): DRKS00005088. © Georg Thieme Verlag KG Stuttgart · New York.

Release of bacterial alkaline phosphatase in the rumen of cattle fed a feedlot bloat-provoking diet or a hay diet.

PubMed

Cheng, K J; Hironaka, R; Costerton, J W

1976-05-01

Alkaline phosphatase (APase) was present in the bovine rumen in both cell-free and cell-associated states and levels of the enzyme varied with dietary regime. Reaction product deposition showed that the enzyme was associated with the mixed bacterial population. No enzyme was observed to be associated with protozoa. Trace activity of APase was also detected in the saliva. The presence of large amounts of APase in cell-free rumen fluid of cattle fed fine concentrate feed is believed to be due, in part, to the breakage of bacterial cells that occurs in the rumen.

Irritable bowel syndrome.

PubMed

Malone, Michael A

2011-09-01

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that leads to crampy pain, gassiness, bloating, and changes in bowel habits in the absence of any currently identifiable organic disorder. Patients with IBS may be classified by their predominant bowel habit: diarrhea-predominant, constipation-predominant, or IBS with alternating bowel movements. IBS is often associated with stress or anxiety. Although IBS can be frustrating and concerning to patients with this disorder, it does not cause permanent harm to the intestines and does not lead to a serious disease such as cancer. Although treatments exist for its symptoms, there is no known cure. Copyright © 2011 Elsevier Inc. All rights reserved.

Diverticular disease: A therapeutic overview

PubMed Central

Tursi, Antonio

2010-01-01

Formation of colonic diverticula, via herniation of the colonic wall, is responsible for the development of diverticulosis. When diverticulosis becomes symptomatic, it becomes diverticular disease. Diverticular disease is common in Western and industrialized countries, and it is associated with numerous abdominal symptoms (including pain, bloating, nausea, diarrhea, and constipation). Standard medical therapies with antibiotics are currently recommended for patients affected by diverticular disease. However, changing concepts on the pathophysiology of the disease suggest that diverticular disease may share many of the hallmarks of inflammatory bowel diseases. On this basis, the addition of therapies using mesalazine and probiotics may enhance treatment efficacy by shortening the course of the disease and preventing recurrences. PMID:21577292

[Hiatal hernia and reflux disease--long-term results following fundoplication and consequences in therapeutic failures].

PubMed

Ackermann, C; Margreth, L; Muller, C; Harder, F

1987-01-01

10 to 20 years (median 15.1 years) after fundoplication for primary reflux disease 257 patients were questioned about their symptoms. Data of 163 patients could be analyzed. 21.4% of the patients have persistent or recurrent reflux symptoms, about half of them (9.8%) need medical treatment. Adverse side-effects of the fundoplication are frequent: dysphagia in 28.2%, gas-bloat in 50.3%. Using the Visick criteria for classification we found Visick grade I and II for 75.5%, grade III for 17.2%, and IV for 7.4%. Diagnostic and therapeutic concepts in case of failed reflux control are discussed.

High-fibre diet and Lactobacillus paracasei B21060 in symptomatic uncomplicated diverticular disease.

PubMed

Lahner, Edith; Esposito, Gianluca; Zullo, Angelo; Hassan, Cesare; Cannaviello, Claudio; Paolo, Maria Carla Di; Pallotta, Lorella; Garbagna, Nicoletta; Grossi, Enzo; Annibale, Bruno

2012-11-07

To investigate in symptomatic uncomplicated diverticular disease the efficacy of symbiotics associated with a high-fibre diet on abdominal symptoms. This study was a multicentre, 6-mo randomized, controlled, parallel-group intervention with a preceding 4-wk washout period. Consecutive outpatients with symptomatic uncomplicated diverticular disease, aged 40-80 years, evaluated in 4 Gastroenterology Units, were enrolled. Symptomatic uncomplicated diverticular disease patients were randomized to two treatment arms A or B. Treatment A (n = 24 patients) received 1 symbiotic sachet Flortec(©) (Lactobacillus paracasei B21060) once daily plus high-fibre diet for 6 mo. Treatment B (n = 21 patients) received high-fibre diet alone for 6 mo. The primary endpoint was regression of abdominal symptoms and change of symptom severity after 3 and 6 mo of treatment. In group A, the proportion of patients with abdominal pain < 24 h decreased from 100% at baseline to 35% and 25% after 3 and 6 mo, respectively (P < 0.001). In group B the proportion of patients with this symptom decreased from 90.5% at baseline to 61.9% and 38.1% after 3 and 6 mo, respectively (P = 0.001). Symptom improvement became statistically significant at 3 and 6 mo in group A and B, respectively.The proportion of patients with abdominal pain >24 h decreased from 60% to 20% then 5% after 3 and 6 mo, respectively in group A (P < 0.001) and from 33.3% to 9.5% at both 3 and 6 mo in group B (P = 0.03). In group A the proportion of patients with abdominal bloating significantly decreased from 95% to 60% after 3 mo, and remained stable (65%) at 6-mo follow-up (P = 0.005) while in group B, no significant changes in abdominal bloating was observed (P = 0.11). After 6 mo of treatment, the mean visual analogic scale (VAS) values of both short-lasting abdominal pain (VAS, mean ± SD, group A: 4.6 ± 2.1 vs 2.2 ± 0.8, P = 0.02; group B: 4.6 ± 2.9 vs 2.0 ± 1.9, P = 0.03) and abdominal bloating (VAS, mean ± SD, group A: 5.3 ± 2.2 vs 3.0 ± 1.7, P = 0.005; group B: 5.3 ± 3.2 vs 2.3 ± 1.9, P = 0.006) decreased in both groups, whilst the VAS values of prolonged abdominal pain decreased in the Flortec(©) group, but remained unchanged in the high-fibre diet group (VAS, mean ± SD, group A: 6.5 ± 1.5 vs 4.5 ± 2.1, P = 0.052; group B: 4.5 ± 3.8 vs 5.5 ± 3.5). A high-fibre diet is effective in relieving abdominal symptoms in symptomatic uncomplicated diverticular disease. This treatment may be implemented by combining the high-fibre diet with Flortec(©).

The effect of inactivated Lactobacillus LB fermented culture medium on symptom severity: observational investigation in 297 patients with diarrhea-predominant irritable bowel syndrome.

PubMed

Tarrerias, A L; Costil, V; Vicari, F; Létard, J C; Adenis-Lamarre, P; Aisène, A; Batistelli, D; Bonnaud, G; Carpentier, S; Dalbiès, P; Ecuer, S; Etienne, J; Fantoli, M; Grunberg, B; Lannoy, P; Lapuelle, J; Margulies, A; Neumeier, M; Rouillon, J M; Schmets, L; Pingannaud, M P; Coulom, P; Kholer, F; Canard, J M

2011-01-01

Little is known about the intensity of symptoms of diarrhea-predominant IBS (IBS-D) or the consequences of the disease on patients' health-related quality of life (HRQOL). This observational investigation assessed the symptoms (abdominal pain, bloating, number of stools per day, and stool consistency), impact on HRQOL, and consequence on anal continence in 297 patients with IBS-D before and after 1 month of probiotic treatment with Lacteol (inactivated Lactobacillus LB plus fermented culture medium). Functional assessment using a standardized visual analogue scale in order to quantify abdominal pain, bloating, and quality of life before and after 1 month of treatment with 2 capsules/day of Lacteol. The number of symptomatic days per week, number of stools, consistency of stools, secondary fecal incontinence rate, and potential trigger effect of food were quantified. A χ2 test was used to compare qualitative data and the variance of quantitative criteria was analyzed. The pain score decreased from 4.46±0.15 on a scale of 0-10 before treatment to 2.8±0.14 after treatment (p<0.0001). Bloating decreased from 4.49±0.18 to 2.5±0.15 on a scale of 0-10 (p<0.0001). The HRQOL score, which is inversely correlated with quality of life, decreased from 5.99±0.14 to 3.92±0.16 (p<0.0001). In this cohort study, the fecal incontinence rate secondary to diarrhea was clearly higher than that of the general population: 18% versus a prevalence of 9-10%, according to different studies. The mean number of stools per week decreased from 17.59 to 12.83 after treatment (p<0.0001). Before treatment, 54% of patients had watery stools and 46% had smooth stools; at the end of treatment, only 18.5% of patients still had watery stools, and 34% had normal stools. 52% of patients attributed their symptoms to their diet: 34% to vegetables, 29% to fruit, 15% to milk, 15% to fat, 6% to peppers and spices, and 4% to sugar. This observational investigation shed new light on patients with IBS-D, the HRQOL of which is altered by a fecal incontinence rate twice as high as that of the general population. Correlation with diet is confirmed by 1 out of 2 patients reporting poor tolerance of fiber and dairy products. Nutritional management should thus be part of these patients' treatment. Inactivated Lactobacillus LB plus fermented culture medium is a probiotic drug that has been used by physicians for a long time to treat patients with diarrhea. Strongly concentrated, it has no side effects and seems to help these patients. Due to a strong placebo effect in patients with this pathology, however, a controlled study is necessary to confirm this result. Copyright © 2011 S. Karger AG, Basel.

[Mesenteric cyst in the Instituto Nacional de Salud del Niño, Lima, Peru: a case report].

PubMed

Cucho, Janetliz; Ormeño, Alexis; Valdivieso Falcon, Lidia; Pereyra, Sonia; Ramos Rodríguez, Karen

2013-01-01

Mesenteric cysts are rare abdominal tumors. About 60% of these cysts occurs before 5 years of age and can be located anywhere in the gastrointestinal tract, but are most often found in the small bowel mesentery. The clinical presentation depends on the location and size of the cyst and many cases are asymptomatic and are diagnosed incidentally. The most common symptoms are abdominal pain, bloating, abdominal mass, nausea, vomiting, constipation, diarrhea, weight loss, fever and peritonitis. Complications include torsion, infarction, volvulus formation, perforation, infection, anemia, intracystic hemorrhage, intestinal obstruction and obstructive uropathy. They are typically treated by simple excision, marsupialization or segmental bowel resection and have excellent long-term prognosis.

Itopride and pantoprazole outcomes in diabetic gastroparesis trial (IPOD trial).

PubMed

Venkatesh, Veena; Kulkarni, K P

2008-12-01

The most common cause of gastroparesis is diabetes mellitus. The present study was carried out to asses the combination of itopride and pantoprazole in the treatment of diabetic gastroparesis. The study was an open label, multicentre, conducted in 743 patients with diabetic gastroparesis for a period of 3 weeks. The efficacy parameters included nausea, vomiting, early satiety, bloating, postprandial fullness, epigastric pain and regurgitation. The patients were evaluated based on the frequency and severity of symptoms and compared with the baseline scores. There were significant improvement in severity as well as the frequency of all the symptom parameters of the disease (p<0.001). The physicians' evaluation to the therapy was rated either excellent or good.

Faecal retention: a common cause in functional bowel disorders, appendicitis and haemorrhoids--with medical and surgical therapy.

PubMed

Raahave, Dennis

2015-03-01

The present studies explored whether faecal retention in the colon is a causative factor in functional bowel disease, appendicitis, and haemorrhoids. Faecal retention was characterized by colon transit time (CTT) after radio-opaque marker ingestion and estimation of faecal loading on abdominal radiographs at 48 h and 96 h. Specific hypotheses were tested in patients (n = 251 plus 281) and in healthy random controls (n = 44). A questionnaire was completed for each patient, covering abdominal and anorectal symptoms and without a priori grouping. Patients with functional bowel disorders, predominantly women, had a significantly increased CTT and faecal load compared to controls. The CTT was significantly and positively correlated with segmental and total faecal loading. The faecal load was equal at 48 h and 96 h, mirroring the presence of permanent faecal reservoirs. In these first clinical studies to correlate bowel symptoms with CTT and colon faecal loading, abdominal bloating was significantly correlated with faecal loading in the right colon, total faecal load, and CTT. Abdominal pain was significantly and positively correlated to distal faecal loading and significantly associated with bloating. A new phenomenon with a high faecal load and a normal CTT was observed in a subset of patients (n = 90), proving faecal retention as hidden constipation. The CTT and faecal load were significantly higher in the right-side compared to the left and distal segments. Within the control group of healthy persons, the right-sided faecal load was significantly greater than the left and distal load. The CTT and faecal load significantly positively correlated with a palpable mass in the left iliac fossa and meteorism. Cluster analysis revealed that CTT and faecal load positively correlated with a symptom factor consisting of bloating, proctalgia and infrequent defecation of solid faeces. On the other hand, CTT and faecal load negatively correlated with a symptom factor comprising frequent easy defecations, repetitiveness, and incompleteness with solid or liquid faeces. The majority of patients with a heavy faecal load but normal CTT had repetitive daily defecation, mostly with ease and with altering faecal consistence. Flue-like episodes co-existed in symptom factors with abdominal pain and meteorism, and these symptoms together with a palpable right iliac fossa mass and tenderness, and in other factors with seldom and difficult defecation, and with epigastric discomfort and halitosis. Patients with seldom and difficult defecation of solid faeces experienced abdominal pain significantly more often and presented a palpable mass in the right iliac fossa with tenderness and meteorism. The CTT was significantly prolonged and faecal load significantly increased. In patients with a normal CTT and increased faecal load, only patients with abdominal pain had a significant correlation between faecal loading and bloating. CTT and faecal load were shown for the first time to increase significantly with the number of colonic redundancies (colon length), which also resulted in significantly increased bloating and pain. Intervention with a bowel stimulation regimen combining a fibre-rich diet, fluid, physical activity, and a prokinetic drug was essential to proving that abdominal symptoms and defecation disorders are caused by faecal retention, with or without a prolonged CTT. The CTT was significantly reduced, as was faecal load. Bloating and pain were reduced significantly. The defecation became easy with solid faeces, towards one per day and with significant reductions in incompleteness and repetitiveness. Proctalgia and flue-like episodes were significantly reduced. The intervention significantly reduced the presence of a tender palpable mass in the right fossa and rectal constipation. In patients with a normal CTT but increased faecal load, the intervention did not significantly change the CTT or load, but bloating and pain were significantly reduced, just as defecation improved overall. The novel knowledge of faecal retention in the patients does not explain why faecal retention occurs. However, it may be inferred from the present results that a constipated or irritable bowel may belong to the same underlying disease dimension, where faecal retention is a common factor. Thus, measuring CTT and faecal load is suggested as a guide to a positive functional diagnosis of bowel disorders compared to the constellation of symptoms alone. Thirty-five patients underwent surgery after being refractory to the conservative treatment for constipation. They had a significantly prolonged CTT and heavy faecal loading, which was responsible for the aggravated abdominal and defaecatory symptoms. The operated patients presented with a redundant colon (dolichocolon) significantly more often. These patients also had an extremely high rate of previous appendectomy. Twenty-one patients underwent hemicolectomy, and 11 patients had a subtotal colectomy with an ileosigmoidal anastomosis; three patients received a stoma. However, some patients had to have the initial segmental colectomy converted to a final subtotal colectomy because of persisting symptoms. Six more subtotal colectomies have been performed and the leakage rate of all colectomies is then 4.9 % (one patient died). After a mean follow-up of 5 years, the vast majority of patients were without abdominal pain and bloating, having two to four defecations daily with control and their quality of life had increased considerably. A faecalith is often located in the appendix, the occlusion of which is responsible for many cases of acute appendicitis, which is infrequent in all except white populations. An effort to trace the origin of the faecalith to faecal retention in the colon was made in a case control study (56 patients and 44 random controls). The CTT was longer and faecal load greater in patients with appendicitis compared to controls, though the difference was not significant. Power calculations showed that more patients were needed to reach statistical significance for these parameters. The presence of a faecalith was most often associated with a gangrenous or perforated appendix. No significant differences were found between the CTT and faecal load of patients who had or did not have a faecalith. However, the right-sided faecal load was significantly higher than the left and distal load. Haemorrhoids are often a consequence of constipation and defaecatory disorders and were found in every second patient with functional bowel disorders. The present studies are the first Danish reports of a novel operation to cure this disease, stapled haemorrhoidopexy (n = 40 and 258 patients). The majority of patients had prolapsed haemorrhoids, and the durability of procedure was confirmed with a follow-up of up to 5 years, meaning a normal anus. The operation time was short, post-operative pain was low, and recovery was rapid. No incontinence was observed, and patient satisfaction was high and significantly correlated with the appearance of a normal anus without prolapse. The cumulative risk of re-operation was greatest in the first 2 years after the stapled haemorrhoidopexy. Patients with persisting haemorrhoidal prolapse had the procedure repeated with results as good as those obtained in the rest of the patients. It was shown in a statistical model that the preoperative severity of haemorrhoidal disease and the immediate postoperative result contributed significantly to predicting the outcome that is the durability of the operation. The most frequent post-operative complication was bleeding requiring surgical haemostasis. One serious complication occurred after an anastomotic leak from a highly placed anastomosis, resulting in retro rectal, retro- and intra-peritoneal, and mediastinal gas. The patient recovered after conservative treatment and without surgical intervention. The stapling technique now used has revolutionized the surgical treatment of prolapsing haemorrhoids. Finally, a common cause may be suspected for diseases constantly associated with one another. Epidemiological evidence has recognized that constipation, diverticulosis and IBS increase the risk of colon cancer (and adenomas), diseases exceedingly rare in communities exempt from appendicitis. Haemorrhoids are a colonic co-morbidity as well. Notably, the patients with a functional bowel disorder had a much higher rate of a previous appendectomy than the background population. In addition, the patients who had previously had an appendectomy had a significantly longer CTT compared to patients, who had not. The data points to the involvement of faecal retention in the origin of faecaliths and, thus, acute appendicitis. Faecal reservoirs were shown in the right and left colon segments in both patients and controls, which are the same areas bearing the highest incidences of adenomateous polyps and malignancies. Familial colorectal cancer occurred significantly more often in patients who had a higher faecal load than the controls. Four malignancies and 25 adenomas were identified. An increased faecal load in the colon with or without delayed transit will increase bacterial counts and create a chronic inflammation of the colonic mucosa, which is a risk factor for cancer onset. A functional bowel disorder is then likely to occur with gradually transition from a primary functional disease into specific organic diseases. A diet rich in fibre and regular physical activity have a therapeutic and preventive effect on colorectal diseases associated with faecal retention. A “common cause” was earlier proposed for constipation, colon diverticula, cancer, appendicitis, and haemorrhoids. The actual results of the present studies support this unifying theory for these diet-related diseases, in which the functional retention of faeces maybe the common cause.

Patients with symptoms of delayed gastric emptying have a high prevalence of oesophageal dysmotility, irrespective of scintigraphic evidence of gastroparesis.

PubMed

Triadafilopoulos, George; Nguyen, Linda; Clarke, John O

2017-01-01

Patients with symptoms suggestive of gastroparesis exhibit several symptoms, such as epigastric pain, postprandial fullness, bloating and regurgitation. It is uncertain if such symptoms reflect underlying oesophageal motor disorder. To examine whether patients with epigastric pain and postprandial distress syndrome suggestive of functional dyspepsia and/or gastroparesis also have concomitant oesophageal motility abnormalities and, if so, whether there are any associations between these disturbances. In this retrospective cohort study, consecutive patients with functional gastrointestinal symptoms suggestive of gastric neuromuscular dysfunction (gastroparesis or functional dyspepsia) underwent clinical assessment, gastric scintigraphy, oesophageal high-resolution manometry and ambulatory pH monitoring using standard protocols. We studied 61 patients with various functional upper gastrointestinal symptoms who underwent gastric scintigraphy, oesophageal high-resolution manometry and ambulatory pH monitoring. Forty-four patients exhibited gastroparesis by gastric scintigraphy. Oesophageal motility disorders were found in 68% and 42% of patients with or without scintigraphic evidence of gastroparesis respectively, suggesting of overlapping gastric and oesophageal neuromuscular disorder. Forty-three per cent of patients with gastroparesis had abnormal oesophageal acid exposure with mean % pH <4.0 of 7.5 in contrast to 38% of those symptomatic controls with normal gastric emptying, with mean %pH <4.0 of 5.4 (NS). Symptoms of epigastric pain, heartburn/regurgitation, bloating, nausea, vomiting, dysphagia, belching and weight loss could not distinguish patients with or without gastroparesis, although weight loss was significantly more prevalent and severe (p<0.002) in patients with gastroparesis. There was no relationship between oesophageal symptoms and motor or pH abnormalities in either groups. Irrespective of gastric emptying delay by scintigraphy, patients with symptoms suggestive of gastric neuromuscular dysfunction have a high prevalence of oesophageal motor disorder and pathological oesophageal acid exposure that may contribute to their symptoms and may require therapy. High-resolution oesophageal manometry and pH monitoring are non-invasive and potentially useful in the assessment and management of these patients.

Perceptions of flatulence from bean consumption among adults in 3 feeding studies.

PubMed

Winham, Donna M; Hutchins, Andrea M

2011-11-21

Many consumers avoid eating beans because they believe legume consumption will cause excessive intestinal gas or flatulence. An increasing body of research and the 2010 Dietary Guidelines for Americans supports the benefits of a plant-based diet, and legumes specifically, in the reduction of chronic disease risks. The purpose of the current research was to investigate the perception of increased flatulence and gastrointestinal discomfort among participants who consumed a ½ cup of beans daily for 8 or 12 weeks. Participants in three studies to test the effects of beans on heart disease biomarkers completed the same weekly questionnaire to assess gastrointestinal discomfort issues such as increased flatulence, stool changes, and bloating. Studies 1 and 2 were randomized crossover trials. Participants consumed ½ cup of pinto beans, black-eyed peas, and canned carrots as control (n = 17) in Study 1 for three randomized 8-week phases. For Study 2, participants ate ½ cup baked beans or canned carrots as control (n = 29) for two randomized 8-week phases. Study 3 was a parallel arm trial with 40 subjects receiving ½ cup pinto beans and 40 consuming a control soup for 12 weeks. Changes in the frequency of perceived flatulence, stool characteristics, and bloating were the primary outcome measures. Chi-square distributions were examined for the presence or absence of symptoms and demographic characteristics to determine differences by gender, age, body mass index (BMI), and bean type. Less than 50% reported increased flatulence from eating pinto or baked beans during the first week of each trial, but only 19% had a flatulence increase with black-eyed peas. A small percentage (3-11%) reported increased flatulence across the three studies even on control diets without flatulence-producing components. People's concerns about excessive flatulence from eating beans may be exaggerated. Public health nutritionists should address the potential for gastrointestinal discomfort when increasing fiber intake from beans with clients. It is important to recognize there is individual variation in response to different bean types.

A Randomized Crossover Trial Comparing Autotitrating and Continuous Positive Airway Pressure in Subjects With Symptoms of Aerophagia: Effects on Compliance and Subjective Symptoms.

PubMed

Shirlaw, Teresa; Hanssen, Kevin; Duce, Brett; Hukins, Craig

2017-07-15

To assess the benefit and tolerance of autotitrating positive airway pressure (APAP) versus continuous positive airway pressure (CPAP) in subjects who experience aerophagia. This is the report of a prospective, two-week, double-blinded, randomized crossover trial set in an Australian clinical sleep laboratory in a tertiary hospital. Fifty-six subjects who reported symptoms of aerophagia that they attributed to CPAP were recruited. Full face masks were used by 39 of the 56 subjects recruited. Subjects were randomly and blindly allocated to either CPAP at their treatment recommended pressure or APAP 6-20 cm H 2 O, in random order. Subjects spent two weeks on each therapy mode. Therapy usage hours, 95th centile pressure, maximum pressure, 95th centile leak, and residual apnea-hypopnea index (AHI) were reported at the end of each two-week treatment period. Functional Outcome of Sleepiness Questionnaire, Epworth Sleepiness Scale, and visual analog scale to measure symptoms of aerophagia were also completed at the end of each 2-week treatment arm. The median pressure ( P < .001) and 95th centile pressure ( P < .001) were reduced with APAP but no differences in compliance ( P = .120) and residual AHI were observed. APAP reduced the symptoms of bloating ( P = .011), worst episode of bloating ( P = .040), flatulence ( P = .010), and belching ( P = .001) compared to CPAP. There were no differences in Epworth Sleepiness Scale or Functional Outcome of Sleepiness Questionnaire outcomes between CPAP and APAP. APAP therapy reduces the symptoms of aerophagia while not affecting compliance when compared with CPAP therapy. Australian and New Zealand Clinical Trials Registry at https://www.anzctr.org.au, trial number ACTRN12611001250921. A commentary on this article appears in this issue on page 859. © 2017 American Academy of Sleep Medicine

Longitudinal shifts in bacterial diversity and fermentation pattern in the rumen of steers grazing wheat pasture.

PubMed

Pitta, D W; Pinchak, W E; Dowd, S; Dorton, K; Yoon, I; Min, B R; Fulford, J D; Wickersham, T A; Malinowski, D P

2014-12-01

Grazing steers on winter wheat forage is routinely practiced in the Southern Great Plains of the US. Here, we investigated the dynamics in bacterial populations of both solid and liquid ruminal fractions of steers grazing on maturing wheat forage of changing nutritive quality. The relationship between bacterial diversity and fermentation parameters in the liquid fraction was also investigated. During the first 28 days, the wheat was in a vegetative phase with a relatively high crude protein content (CP; 21%), which led to the incidence of mild cases of frothy bloat among steers. Rumen samples were collected on days 14, 28, 56 and 76, separated into solid and liquid fractions and analyzed for bacterial diversity using 16S pyrotag technology. The predominant phyla identified were Bacteroidetes (59-77%) and Firmicutes (20-33%) across both ruminal fractions. Very few differences were observed in the rumen bacterial communities within solid and liquid fractions on day 14. However, by day 28, the relatively high CP content complemented a distinct bacterial and chemical composition of the rumen fluid that was characterized by a higher ratio (4:1) of Bacteroidetes:Firmicutes and a corresponding lower acetate:propionate (3:1) ratio. Further, a greater accumulation of biofilm (mucopolysaccharide complex) on day 28 was strongly associated with the abundance of Firmicutes lineages such as Clostridium, Ruminococcus, Oscillospira and Moryella (P<0.05) in the fiber fraction. Such changes were diminished as the CP concentration declined over the course of the study. The abundance of Firmicutes was noticeable by 76 d in both fractions which signifies the development of a core microbiome associated with digestion of a more recalcitrant fiber in the mature wheat. This study demonstrates dynamics in the rumen microbiome and their association with fermentation activity in the rumen of steers during the vegetative (bloat-prone) and reproductive stages of wheat forage. Copyright © 2014 Elsevier Ltd. All rights reserved.

Comparison of Chang Run Tong and Forlaxin Treatment of Constipation in Elderly Diabetic Patients.

PubMed

Zhao, Dong; Zhao, Jing-Bo

2018-05-01

Constipation is quite common and has impact on life quality in the elderly diabetic patients; therefore it is important to seek better treatments. The aim of this study is to evaluate the effect of Chang Run Tong (CRT) decoction on constipation in elderly diabetic patients in comparison with the effect of Macrogol 4000 powder (Forlax). This study was designed as a prospective study consisting of two parallel arms: CRT group and Forlax group. The study was conducted in China-Japan Hospital. Subject interventions: Eighty elderly diabetic patients with constipation were evaluated, among them 52 patients were treated with CRT and 28 patients were treated with Forlax. The patients were interviewed for Bristol stool scale, spontaneous complete bowel movements (SCBM) and symptoms of defecation feeling, defecation weakness, feeling of incomplete evacuation, bloating, and flatulence at different time points. The changes of all above parameters from treatment for 2 and 4 weeks and follow-up for 1 and 2 months with reference to the baseline (before treatment) were compared between CRT and Forlax treatments. The treatment efficiency was evaluated and compared between two different treatments. For the improvement of Bristol stool scale, SCBM and feeling of incomplete evacuation, CRT was significantly better than Forlax at different time points (p < 0.01, p < 0.001). For the symptoms of defecation feeling, defecation weakness, bloating, and flatulence, CRT was significantly better than Forlax for follow-up improvement (p < 0.01, p < 0.001); whereas no difference was found at other time points of the treatment (p > 0.05). Furthermore, CRT had a significantly better treatment efficiency than Forlax (p < 0.001). Both CRT and Forlax treatment could effectively improve bowel habits and symptoms of constipation in elderly diabetic patients. CRT was better than Forlax to treat constipation in elderly diabetic patients and had better follow-up improvement after stopping drugs.

Beetle succession and diversity between clothed sun-exposed and shaded pig carrion in a tropical dry forest landscape in Southern Mexico.

PubMed

Caballero, Ubaldo; León-Cortés, Jorge L

2014-12-01

Over a 31-day period, the decomposition process, beetle diversity and succession on clothed pig (Sus scrofa L.) carcasses were studied in open (agricultural land) and shaded habitat (secondary forest) in Southern Mexico. The decomposition process was categorised into five stages: fresh, bloated, active decay, advanced decay and remains. Except for the bloated stage, the elapsed time for each decomposition stage was similar between open and shaded habitats, all carcasses reached an advanced decay stage in seven days, and the fifth stage (remains) was not recorded in any carcass during the time of this study. A total of 6344 beetles, belonging to 130 species and 21 families, were collected during the entire decomposition process, and abundances increased from fresh to advanced decay stages. Staphylinidae, Scarabaeidae and Histeridae were taxonomically and numerically dominant, accounting for 61% of the species richness and 87% of the total abundance. Similar numbers of species (87 and 88 species for open and shaded habitats, respectively), levels of diversity and proportions (open 49%; shaded 48%) of exclusive species were recorded at each habitat. There were significantly distinct beetle communities between habitats and for each stage of decomposition. An indicator species analysis ("IndVal") identified six species associated to open habitats, 10 species to shaded habitats and eight species to advanced decay stages. In addition, 23 beetle species are cited for the first time in the forensic literature. These results showed that open and shaded habitats both provide suitable habitat conditions for the carrion beetle diversity with significant differences in community structure and identity of the species associated to each habitat. This research provides the first empirical evidence of beetle ecological succession and diversity on carrion in Mexican agro-pastoral landscapes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

IBS Patients Show Frequent Fluctuations between Loose/Watery and Hard/Lumpy Stools: Implications for Treatment

PubMed Central

Palsson, Olafur S.; Baggish, Jeffrey S.; Turner, Marsha J.; Whitehead, William E.

2013-01-01

Aims To determine how variable stool consistency is in patients with irritable bowel (IBS) and assess the relationship between stool consistency and gastrointestinal symptoms. Methods Individuals with a physician diagnosis of IBS were recruited by advertisement. Enrollment questionnaires included the Rome III Diagnostic Questionnaire and IBS Symptom Severity Scale. Then 185 patients meeting Rome criteria for IBS rated the consistency (using the Bristol Stool Scale) of each bowel movement (BM) for 90 days and whether the BM was accompanied by pain, urgency, or soiling. Each night they transferred BM ratings from a paper diary to an internet form and also reported the average daily intensity of abdominal pain, bloating, bowel habit dissatisfaction, and life interference of bowel symptoms. Only the longest sequence of consecutive days of diary data was used in analysis (average of 73 days). Results Patients were 89% female with average age 36.6 years. 78% had both loose/watery and hard/lumpy stools; the average was 3 fluctuations between these extremes per month. The proportion of loose/watery stools correlated r=.78 between the first and second months and the proportion of hard/lumpy stools correlated r=.85 between months. Loose/watery stools were associated with more BM-related pain, urgency, and soiling than hard/lumpy or normal stools; however, IBS-C patients had significantly more BM-unrelated abdominal pain, bloating, dissatisfaction with bowel habits, and life interference than IBS-D. Questionnaires overestimated the frequency of abnormal stool consistency and gastrointestinal symptoms compared to diaries. Conclusions Stool consistency varies greatly within individuals. However, stool patterns are stable within an individual from month to month. The paradoxical findings of greater symptom severity after individual loose/watery BMs vs. greater overall symptom severity in IBS-C implies different physiological mechanisms for symptoms in constipation compared to diarrhea. Daily symptom monitoring is more sensitive and reliable than a questionnaire. PMID:22068664

Gastric emptying effects of dietary fiber during 8 hours at two simulated cabin altitudes.

PubMed

Hinninghofen, Heidemarie; Musial, Frauke; Kowalski, Axel; Enck, Paul

2006-02-01

In a questionnaire survey, long-distance flying staff of a charter airline reported significantly more dyspeptic symptoms than did short-haul crewmember and ground personnel (belching: 57% vs. 37%, bloating: 51% vs. 36%). To elucidate the reason for increased frequency of gastrointestinal symptoms during long-distance flights, we investigated the effects of altitude and diet on gastric emptying, cardiovascular function, and bodily complaints. In a 2 x 2 repeated measurement design we simulated an 8-h flight in a hypobaric chamber in 16 healthy men subjected to 2 meal conditions (high fiber vs. low fiber) on separate days, and assigned to either a flight altitude of 2500 m (8200 ft) or 1000 m (3280 ft). The subjects were blinded toward altitude. Heart rate and gastrointestinal symptoms were taken every hour, and gastric emptying was assessed by 13C-octanoic acid breath-test. In a separate experiment, we examined the effect of the two test meals (2 g vs. 20 g of fiber) in 30 healthy men under conventional laboratory conditions and found no significant differences. At an altitude of 2500 m, heart rate was significantly increased independent of the dietary condition. Gastric emptying (T1/2) was significantly delayed at 2500 m (8200 ft) when a high-fiber meal was given (146.3 +/- 58.4 min low fiber vs. 193.9 +/- 54.3 min high fiber). The symptom score for gastric distension (mean: 1.33 +/- 0.3 vs. mean: 1.07 +/- 0.15) and bloating (mean: 1.82 +/- 0.47 vs. mean: 1.34 +/- 0.35) were also significantly increased at 2500 m for the high-fiber meal compared with the low-fiber meal. Flight altitude is a physiological load. In combination with a high-fiber diet, this induces significant delays in gastric emptying that may explain symptoms of cabin and cockpit crew and passengers on long-distance flights.

Emerging therapeutic options in GERD.

PubMed

Woodland, Philip; Amarasinghe, Gehanjali; Sifrim, Daniel

2013-06-01

Gastroesophageal reflux disease (GERD) is a prevalent problem resulting in a high level of healthcare consultation and expenditure in the Western World. Although standard medical therapy (in the form of proton pump inhibitor drugs) is effective in the majority of cases, there remains a significant proportion who are refractory to treatment. In addition, surgical therapy (in the form of laparoscopic fundoplication) is not always effective, and in some can be associated with significant side-effects, particularly gas-bloat, flatulence and dysphagia. As such there remains an unmet need in GERD to develop new therapies for refractory cases, and to develop alternatives to fundoplication with fewer side-effects. This article discusses the current state of pharmacological and non-pharmacological emerging therapies for GERD. Copyright © 2013 Elsevier Ltd. All rights reserved.

Exocrine pancreatic insufficiency in type 1 and type 2 diabetes mellitus: do we need to treat it? A systematic review.

PubMed

Zsóri, Gábor; Illés, Dóra; Terzin, Viktória; Ivány, Emese; Czakó, László

2018-05-17

The exocrine and endocrine pancreata are very closely linked both anatomically and physiologically. Abdominal symptoms such as nausea, bloating, diarrhea, steatorrhea, and weight loss can often occur in diabetic patients. Impairments of the exocrine pancreatic function seem to be a frequent complication of diabetes mellitus; however, they are largely overlooked. The aim of this paper is to provide an overview of the current concepts of exocrine pancreatic insufficiency (PEI) in diabetes mellitus. The prevalence and symptoms of PEI in diabetes mellitus, the pathomechanism, and difficulties of diagnosis and therapy of PEI are summarized in this systematic review. Copyright © 2018 IAP and EPC. Published by Elsevier B.V. All rights reserved.

The ‘mystery’ of opioid-induced diarrhea

PubMed Central

Bril, Silviu; Shoham, Yoav; Marcus, Jeremy

2011-01-01

Bowel dysfunction, mainly constipation, is a well-known and anticipated side effect of opioids. The physician prescribing an opioid frequently confronts the challenge of preventing and treating bowel dysfunction. Different strategies have emerged for managing opioid-induced constipation. These strategies include physical activity, maintaining adequate fluid intake, adhering to regular daily bowel habits, using laxatives and other anticonstipation medications and, recently, using a peripheral opioid antagonist, either as a separate drug or in the form of an opioid agonist-antagonist combination pill. What options exist for the physician when a patient receiving opioids complains of diarrhea, cramps and bloating, rather than the expected constipation? The present article describes a possible cause of opioid-induced diarrhea and strategies for management. PMID:21766071

Giant Hepatic Hemangioma Presenting as Gastric Outlet Obstruction

PubMed Central

Aydin, Cemalettin; Akbulut, Sami; Kutluturk, Koray; Kahraman, Aysegul; Kayaalp, Cuneyt; Yilmaz, Sezai

2013-01-01

Hemangioma, a most frequently encountered primary benign tumor of the liver, is generally determined incidentally during the course of radiologic tests for other reasons. Most lesions are less than 3 cm and a significant proportion of patients are asymptomatic, although the size and location of the lesion in some patients may be associated with the onset of symptoms. Pressure on the stomach and duodenum of giant hemagiomas developing in the left lobe of the liver, in particular, may result in the development of abdominal pain, nausea, vomiting, and feeling bloated, which are characteristic of a gastric outlet obstruction. A 42-year-old man presented with findings of gastric outlet obstruction and weight loss as a result of a giant hepatic hemangioma. PMID:23438272

DOE Office of Scientific and Technical Information (OSTI.GOV)

Addison, B. C.; Tinney, C. G.; Wright, D. J.

We report the measurement of a spin-orbit misalignment for WASP-79b, a recently discovered, bloated hot Jupiter from the Wide Angle Search for Planets (WASP) survey. Data were obtained using the CYCLOPS2 optical-fiber bundle and its simultaneous calibration system feeding the UCLES spectrograph on the Anglo-Australian Telescope. We have used the Rossiter-McLaughlin effect to determine the sky-projected spin-orbit angle to be {lambda}= -106{sup +19}{sub -13} {sup o}. This result indicates a significant misalignment between the spin axis of the host star and the orbital plane of the planet-the planet being in a nearly polar orbit. WASP-79 is consistent with other starsmore » that have T{sub eff} > 6250 K and host hot Jupiters in spin-orbit misalignment.« less

Evaluation of new gastro-intestinal prokinetic (ENGIP-II) study.

PubMed

Walwaikar, Pradeep P; Kulkarni, Sujay S; Bargaje, Rahul S

2005-12-01

Non-ulcer dyspepsia is a common clinical disorder characterised by reduced gastric motility. Safety concerns have restricted use of currently available prokinetic drugs. Itopride is a new safer prokinetic drug with dopamine D2 antagonism and acetylcholinesterase inhibitory actions. The ENGIP-II study was conducted to investigate the efficacy, and safety of itopride in patients of non-ulcer dyspepsia. There were significant reductions in upper abdominal pain, heartburn frequency, gastro-oesophageal regurgitation, nausea, bloating, early satiety after meals at day 3 only; whereas significant improvements were noted in belching, anorexia at day 6 and in vomiting at day 9. Thus, ENGIP-II study shows that itopride was well tolerated patients and appears to be the drug of choice in patients with non-ulcer dyspepsia.

Understanding non ulcer dyspepsia.

PubMed

Loh, K Y; Siang, T K

2008-06-01

Non ulcer dyspepsia is one of the most common problems encountered in primary care practice. The underlying pathophysiology of non ulcer dyspepsia is not fully understood, but it is known that this condition is associated with H. pylori infection and motility disorder. The presenting abdominal symptoms are non specific: they include bloating, belching, flatulence, excessive fullness after eating and nausea. Psychological condition such as anxiety, depression and stress do play a role in the recurrence of symptoms. Upper GI endoscopy is necessary in patients who presents with alarm symptoms suggestive of possible underlying organic condition before one makes the diagnosis of non ulcer dyspepsia. Pharmacological therapy using H2 receptor antagonist and proton pump inhibitors are effective for symptom relief. Patient's education and supportive care should be part of the management strategy in recurrent chronic dyspepsia.

Lactose intolerance: from diagnosis to correct management.

PubMed

Di Rienzo, T; D'Angelo, G; D'Aversa, F; Campanale, M C; Cesario, V; Montalto, M; Gasbarrini, A; Ojetti, V

2013-01-01

This review discusses one of the most relevant problems in gastrointestinal clinical practice: lactose intolerance. The role of lactase-persistence alleles the diagnosis of lactose malabsorption the development of lactose intolerance symptoms and its management. Most people are born with the ability to digest lactose, the major carbohydrate in milk and the main source of nutrition until weaning. Approximately, 75% of the world's population loses this ability at some point, while others can digest lactose into adulthood. Symptoms of lactose intolerance include abdominal pain, bloating, flatulence and diarrhea with a considerable intraindividual and interindividual variability in the severity. Diagnosis is most commonly performed by the non invasive lactose hydrogen breath test. Management of lactose intolerance consists of two possible clinical choice not mutually exclusive: alimentary restriction and drug therapy.

Women and family planning. "Now I will tell my daughters".

PubMed

1994-08-01

A Bolivian woman with three daughters became pregnant while practicing the rhythm method. Method failure occurred seven years after she bore her most recent child and prompted her, with her husband's consent, to obtain an unsafe abortion. The decision to abort the fetus was based upon her husband's lack of employment, the meager monthly income of US$45 which she earns, and the inability of her to continue working once pregnant. The abortion process consisted of a three-hour scraping/general cleaning which left the woman dizzy. She returned to the physician several days later, bloated and in pain, when the possibility of a perforated uterus was voiced and surgery conducted. The woman regrets having the abortion, for the couple wanted to bear a fourth child once they could afford it.

Lightweight aggregate production from claystone and shale in Bangladesh

USGS Publications Warehouse

Parker, Norbert A.; Khan, M.A.

1976-01-01

Muffle furnace tests were made on samples of clay, claystone, and shale collected in the Chittagong and Dacca areas of East Pakistan to determine their amenability to bloating for the commercial production of light-weight aggregate. Several areas, sampled in some detail, were selected for investigation because of their proximity to market, and accessibility to fuel and electricity. Muffle furnace tests show that the clay, claystone, and shale are natural bloaters at temperatures in the 1700? to 2200? F range, and do not require additives. The most desirable deposit, insofar as producing a strong aggregate is concerned, can be determined only by pilot-kiln testing and by crushing-strength tests made on concrete test cylinders. Reserves of suitable raw material are large in both the Chittagong and Dacca areas.

Endoscopic Options for Gastroesophageal Reflux: Where Are We Now and What Does the Future Hold?

PubMed

Triadafilopoulos, George

2016-09-01

Early in the twenty-first century, novel endoscopic techniques were introduced for the management of gastroesophageal reflux disease, providing minimally invasive ways to eliminate pharmacologic acid inhibition and avoid the need for anti-reflux surgery. These techniques do not significantly alter the anatomy of the gastroesophageal junction, minimizing short- and long-term adverse effects, such as dysphagia and bloating. After extensive clinical testing, many endoscopic therapies were abandoned due to either lack of durable efficacy or unfavorable safety profile. Today, only four such therapies remain clinically available, each with variable levels of clinical validation and market penetration. This review will provide an assessment of these endoscopic therapies, highlighting their respective strengths and weaknesses and their present and future applicability to patients with gastroesophageal reflux disease.

Management of belching, hiccups, and aerophagia.

PubMed

Bredenoord, Albert J

2013-01-01

Although belching and hiccups are regarded as normal behaviors, they can occur at high frequency or become persistent, becoming bothersome and requiring medical care. Patients with excessive belching frequently have supragastric belches. Excessive belching should be treated as a behavioral disorder. Persistent hiccups, however, can be the first presentation of a serious disorder that requires extensive diagnostic testing. When no cause is found, only the symptoms can be treated. Aerophagia is an episodic or chronic disorder in which patients (children and adults) swallow large quantities of air, which accumulate in the gastrointestinal tract to cause abdominal distention and bloating. These patients should not undergo explorative laparotomy because they do not have ileus. New treatment approaches are needed for patients with aerophagia. Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights reserved.

An Approach to Management of Gas in the Elderly

PubMed Central

Hogan, David B.

1989-01-01

In this article I shall review the physiology, clinical manifestations, and management of gaseousness in the elderly. While not an infrequent complaint, little scientific study has been done of the causes or management of this problem. The regualtion of bowel gas is surprisingly complex. When problems occur, it is usually either because of excessive swallowing of air or because of the intraluminal producation of gas by colonic bacteria. Patients present with excessive belching, abdominal pain and bloating, or excessive passage of flatus. Management is determined, in the main, by the results of the history and physical examination. Medications are usually not indicated. Once a malabsorptive state is ruled out, the mainstay of management usually involves either alterations in the patient's diet or avoidance of aerophagia. PMID:21249002

Carum copticum L.: A Herbal Medicine with Various Pharmacological Effects

PubMed Central

Boskabady, Mohammad Hossein; Alitaneh, Saeed; Alavinezhad, Azam

2014-01-01

Carum copticum L. commonly known as “Ajwain” is cultivated in many regions of the world including Iran and India, states of Gujarat and Rajasthan. Traditionally, C. copticum has been used in the past for various therapeutic effects including bloating, fatigue, diarrhea, abdominal tumors, abdominal pain, respiratory distress, and loss of appetite. It has other health benefits such as antifungal, antioxidant, antibacterial, antiparasitic, and hypolipidemic effects. This plant contains different important components such as carbohydrates, glucosides, saponins and phenolic compounds (carvacrol), volatile oils (thymol), terpiene, paracymene and beta-pinene, protein, fat, fiber, and minerals including calcium, phosphorus, iron, and nicotinic acid (niacin). In the previous studies, several pharmacological effects were shown for C. copticum. Therefore, in this paper, the pharmacological effects of the plant were reviewed. PMID:25089273

FATAL GASTRIC DILATION IN TWO ADULT BLACK-FOOTED FERRETS (MUSTELA NIGRIPES).

PubMed

Hinton, Jenna D; Aitken-Palmer, Copper; Joyner, Priscilla H; Ware, Lisa; Walsh, Timothy F

2016-03-01

Acute gastric dilation resulting in death was identified in two adult black-footed ferrets (Mustela nigripes) housed at the Smithsonian Conservation Biology Institute in Front Royal, Virginia. Both individuals were adult males (3 and 5 yr) and previously clinically healthy prior to the event. The etiology of gastric dilation in both cases could not be definitively determined, and necropsy revealed severe cardiovascular compromise secondary to bloat. Limited literature is available regarding a syndrome of this type in adult black-footed ferrets. Differential diagnoses considered included gastric dilatation volvulus (GDV), severe gastric distention of unknown origin, and gastric outflow obstruction. Given the severity of this syndrome and the findings in these two cases, acute gastric dilation should be considered in black-footed ferrets presenting with acute abdominal distention, respiratory distress, and cardiovascular compromise.

Small intestinal bacterial overgrowth in irritable bowel syndrome: are there any predictors?

PubMed Central

2010-01-01

Background Small intestinal bacterial overgrowth (SIBO) is a condition in which excessive levels of bacteria, mainly the colonic-type species are present in the small intestine. Recent data suggest that SIBO may contribute to the pathophysiology of Irritable bowel syndrome (IBS). The purpose of this study was to identify potential predictors of SIBO in patients with IBS. Methods Adults with IBS based on Rome II criteria who had predominance of bloating and flatulence underwent a glucose breath test (GBT) to determine the presence of SIBO. Breath samples were obtained at baseline and at 30, 45, 60, 75 and 90 minutes after ingestion of 50 g of glucose dissolved in 150 mL of water. Results of the glucose breath test, which measures hydrogen and methane levels in the breath, were considered positive for SIBO if 1) the hydrogen or methane peak was >20 ppm when the baseline was <10 ppm, or 2) the hydrogen or methane peak increased by 12 ppm when baseline was ≥10 ppm. Results Ninety-eight patients were identified who underwent a GBT (mean age, 49 y; 78% female). Thirty-five patients (36%) had a positive GBT result suggestive of SIBO. A positive GBT result was more likely in patients >55 years of age (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.4-9.0) and in females (OR, 4.0; 95% CI, 1.1-14.5). Hydrogen was detected more frequently in patients with diarrhea-predominant IBS (OR, 8; 95% CI, 1.4-45), and methane was the main gas detected in patients with constipation-predominant IBS (OR, 8; 95% CI, 1.3-44). There was no significant correlation between the presence of SIBO and the predominant bowel pattern or concurrent use of tegaserod, proton pump inhibitors, or opiate analgesics. Conclusions Small intestinal bacterial overgrowth was present in a sizeable percentage of patients with IBS with predominance of bloating and flatulence. Older age and female sex were predictors of SIBO in patients with IBS. Identification of possible predictors of SIBO in patients with IBS could aid in the development of successful treatment plans. PMID:20175924

Charges, outcomes, and complications: a comparison of magnetic sphincter augmentation versus laparoscopic Nissen fundoplication for the treatment of GERD.

PubMed

Reynolds, Jessica L; Zehetner, Joerg; Nieh, Angela; Bildzukewicz, Nikolai; Sandhu, Kulmeet; Katkhouda, Namir; Lipham, John C

2016-08-01

Magnetic sphincter augmentation (MSA) is approved for uncomplicated GERD. Multiple studies have shown MSA to compare favorably to laparoscopic Nissen fundoplication (LNF) in terms of symptom control with results out to 5 years. The MSA device itself, however, is an added cost to an anti-reflux surgery, and direct cost comparison studies have not been done between MSA and LNF. The aim of the study was to compare charges, complications, and outcome of MSA versus LNF at 1 year. This is a retrospective analysis of all patients who underwent MSA or LNF for the treatment of GERD between January 2010 and June 2013. Patient charges were collected for the surgical admission. We also collected data on 30-day complications and symptom control at 1 year assessed by GERD-HRQL score and PPI use. There were 119 patients included in the study, 52 MSA and 67 LNF. There was no significant difference between the mean charges for MSA and LNF ($48,491 vs. $50,111, p = 0.506). There were significant differences in OR time (66 min MSA vs. 82 min LNF, p < 0.01) and LOS (17 h MSA vs. 38 h LNF, p < 0.01). At 1-year follow-up, mean GERD-HRQL was 4.3 for MSA versus 5.1 for LNF (p = 0.47) and 85 % of MSA patients versus 92 % of LNF patients were free from PPIs (p = 0.37). MSA patients reported less gas bloat symptoms (23 vs. 53 %, p ≤ 0.01) and inability to belch (10 vs. 36 %, p ≤ 0.01) and vomit (4 vs. 19 %, p ≤ 0.01). The side effect profile of MSA is better than LNF as evidenced by less gas bloat and increase ability to belch and vomit. LNF and MSA are comparable in symptom control, safety, and overall hospital charges. The charge for the MSA device is offset by less charges in other categories as a result of the shorter operative time and LOS.

Small intestinal bacterial overgrowth in irritable bowel syndrome: are there any predictors?

PubMed

Reddymasu, Savio C; Sostarich, Sandra; McCallum, Richard W

2010-02-22

Small intestinal bacterial overgrowth (SIBO) is a condition in which excessive levels of bacteria, mainly the colonic-type species are present in the small intestine. Recent data suggest that SIBO may contribute to the pathophysiology of Irritable bowel syndrome (IBS). The purpose of this study was to identify potential predictors of SIBO in patients with IBS. Adults with IBS based on Rome II criteria who had predominance of bloating and flatulence underwent a glucose breath test (GBT) to determine the presence of SIBO. Breath samples were obtained at baseline and at 30, 45, 60, 75 and 90 minutes after ingestion of 50 g of glucose dissolved in 150 mL of water. Results of the glucose breath test, which measures hydrogen and methane levels in the breath, were considered positive for SIBO if 1) the hydrogen or methane peak was >20 ppm when the baseline was <10 ppm, or 2) the hydrogen or methane peak increased by 12 ppm when baseline was >or=10 ppm. Ninety-eight patients were identified who underwent a GBT (mean age, 49 y; 78% female). Thirty-five patients (36%) had a positive GBT result suggestive of SIBO. A positive GBT result was more likely in patients >55 years of age (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.4-9.0) and in females (OR, 4.0; 95% CI, 1.1-14.5). Hydrogen was detected more frequently in patients with diarrhea-predominant IBS (OR, 8; 95% CI, 1.4-45), and methane was the main gas detected in patients with constipation-predominant IBS (OR, 8; 95% CI, 1.3-44). There was no significant correlation between the presence of SIBO and the predominant bowel pattern or concurrent use of tegaserod, proton pump inhibitors, or opiate analgesics. Small intestinal bacterial overgrowth was present in a sizeable percentage of patients with IBS with predominance of bloating and flatulence. Older age and female sex were predictors of SIBO in patients with IBS. Identification of possible predictors of SIBO in patients with IBS could aid in the development of successful treatment plans.

Patients with symptoms of delayed gastric emptying have a high prevalence of oesophageal dysmotility, irrespective of scintigraphic evidence of gastroparesis

PubMed Central

Triadafilopoulos, George; Nguyen, Linda; Clarke, John O

2017-01-01

Background Patients with symptoms suggestive of gastroparesis exhibit several symptoms, such as epigastric pain, postprandial fullness, bloating and regurgitation. It is uncertain if such symptoms reflect underlying oesophageal motor disorder. Aims To examine whether patients with epigastric pain and postprandial distress syndrome suggestive of functional dyspepsia and/or gastroparesis also have concomitant oesophageal motility abnormalities and, if so, whether there are any associations between these disturbances. Methods In this retrospective cohort study, consecutive patients with functional gastrointestinal symptoms suggestive of gastric neuromuscular dysfunction (gastroparesis or functional dyspepsia) underwent clinical assessment, gastric scintigraphy, oesophageal high-resolution manometry and ambulatory pH monitoring using standard protocols. Results We studied 61 patients with various functional upper gastrointestinal symptoms who underwent gastric scintigraphy, oesophageal high-resolution manometry and ambulatory pH monitoring. Forty-four patients exhibited gastroparesis by gastric scintigraphy. Oesophageal motility disorders were found in 68% and 42% of patients with or without scintigraphic evidence of gastroparesis respectively, suggesting of overlapping gastric and oesophageal neuromuscular disorder. Forty-three per cent of patients with gastroparesis had abnormal oesophageal acid exposure with mean % pH <4.0 of 7.5 in contrast to 38% of those symptomatic controls with normal gastric emptying, with mean %pH <4.0 of 5.4 (NS). Symptoms of epigastric pain, heartburn/regurgitation, bloating, nausea, vomiting, dysphagia, belching and weight loss could not distinguish patients with or without gastroparesis, although weight loss was significantly more prevalent and severe (p<0.002) in patients with gastroparesis. There was no relationship between oesophageal symptoms and motor or pH abnormalities in either groups. Conclusions Irrespective of gastric emptying delay by scintigraphy, patients with symptoms suggestive of gastric neuromuscular dysfunction have a high prevalence of oesophageal motor disorder and pathological oesophageal acid exposure that may contribute to their symptoms and may require therapy. High-resolution oesophageal manometry and pH monitoring are non-invasive and potentially useful in the assessment and management of these patients. PMID:29177065

Influence of grain and monensin supplementation on ruminal fermentation, intake, digesta kinetics and incidence and severity of frothy bloat in steers grazing winter wheat pastures.

PubMed

Branine, M E; Galyean, M L

1990-04-01

Three 10-d collection periods (April 4 to 14, early April, EApr; April 23 to May 3, late April, LApr; May 10 to 20, 1984, mid-May, MMay) were conducted to evaluate effects of no supplement (C), .5 kg-head-1.d-1 (as-fed basis) supplemental grain (steam-flaked milo, G) or G plus 170 mg monensin.head-1.d-1 (M) on forage intake and digestion by 12 ruminally cannulated beef steers (four/treatment; avg initially BW = 393 kg) grazing irrigated winter wheat pasture. Ruminal pH was greater (P less than .01) for M than for C or G during EApr but was not altered by treatments in LApr or MMay. Compared with C, ruminal NH3 was decreased (P less than .10) by G and M (5 h after supplementation) in EApr, decreased (P less than .05) by G (2h) and increased (P less than .05) by M (8 h) in LApr and decreased (P less than .10) by G (-1h) in MMay. Treatments had little influence on total VFA concentrations or on molar proportions of acetate and propionate. Butyrate molar proportion was decreased (P less than .10) by M during EApr and LApr, but not during MMay. Monensin increased (P less than .05) fluid passage rate compared with C and G in EApr but not in other periods, Particulate passage measurements did not differ (P greater than .10) among treatments within periods. Forage DM intake was not influenced (P greater than .10) by supplementation during any period. Extent of in situ forage DM disappearance was greater (P less than .10) for M than for C or G during EApr (12 and 30 h of incubation) but was not different (P greater than .10) in LApr or MMay. Incidence of frothy bloat was decreased (P less than .05) by M during EApr; this reduction may have been related to effects of M on ruminal pH, forage digestion and fluid passage.

Perceptions of flatulence from bean consumption among adults in 3 feeding studies

PubMed Central

2011-01-01

Background Many consumers avoid eating beans because they believe legume consumption will cause excessive intestinal gas or flatulence. An increasing body of research and the 2010 Dietary Guidelines for Americans supports the benefits of a plant-based diet, and legumes specifically, in the reduction of chronic disease risks. The purpose of the current research was to investigate the perception of increased flatulence and gastrointestinal discomfort among participants who consumed a ½ cup of beans daily for 8 or 12 weeks. Methods Participants in three studies to test the effects of beans on heart disease biomarkers completed the same weekly questionnaire to assess gastrointestinal discomfort issues such as increased flatulence, stool changes, and bloating. Studies 1 and 2 were randomized crossover trials. Participants consumed ½ cup of pinto beans, black-eyed peas, and canned carrots as control (n = 17) in Study 1 for three randomized 8-week phases. For Study 2, participants ate ½ cup baked beans or canned carrots as control (n = 29) for two randomized 8-week phases. Study 3 was a parallel arm trial with 40 subjects receiving ½ cup pinto beans and 40 consuming a control soup for 12 weeks. Changes in the frequency of perceived flatulence, stool characteristics, and bloating were the primary outcome measures. Chi-square distributions were examined for the presence or absence of symptoms and demographic characteristics to determine differences by gender, age, body mass index (BMI), and bean type. Results Less than 50% reported increased flatulence from eating pinto or baked beans during the first week of each trial, but only 19% had a flatulence increase with black-eyed peas. A small percentage (3-11%) reported increased flatulence across the three studies even on control diets without flatulence-producing components. Conclusions People's concerns about excessive flatulence from eating beans may be exaggerated. Public health nutritionists should address the potential for gastrointestinal discomfort when increasing fiber intake from beans with clients. It is important to recognize there is individual variation in response to different bean types. PMID:22104320

Lotus tenuis x L. corniculatus interspecific hybridization as a means to breed bloat-safe pastures and gain insight into the genetic control of proanthocyanidin biosynthesis in legumes

PubMed Central

2014-01-01

Background Proanthocyanidins (PAs) are secondary metabolites that strongly affect plant quality traits. The concentration and the structure of these metabolites influence the palatability and nutritional value of forage legumes. Hence, modulating PAs in the leaves of forage legumes is of paramount relevance for forage breeders worldwide. The lack of genetic variation in the leaf PA trait within the most important forage species and the difficulties in engineering this pathway via the ectopic expression of regulatory genes, prompted us to pursue alternative strategies to enhance this trait in forage legumes of agronomic interest. The Lotus genus includes forage species which accumulate PAs in edible organs and can thus be used as potential donor parents in breeding programs. Results We recovered a wild, diploid and PA-rich population of L. corniculatus and crossed with L. tenuis. The former grows in an alkaline-salty area in Spain while the latter is a diploid species, grown extensively in South American pastures, which does not accumulate PAs in the herbage. The resulting interspecific hybrids displayed several traits of outstanding agronomic relevance such as rhizome production, PA levels in edible tissues sufficient to prevent ruminal bloating (around 5 mg of PAs/g DW), biomass production similar to the cultivated parent and potential for adaptability to marginal lands. We show that PA levels correlate with expression levels of the R2R3MYB transcription factor TT2 and, in turn, with those of the key structural genes of the epicatechin and catechin biosynthetic pathways leading to PA biosynthesis. Conclusions The L. tenuis x L. corniculatus hybrids, reported herein, represent the first example of the introgression of the PA trait in forage legumes to levels known to provide nutritional and health benefits to ruminants. Apart from PAs, the hybrids have additional traits which may prove useful to breed forage legumes with increased persistence and adaptability to marginal conditions. Finally, our study suggests the hybrids and their progeny are an invaluable tool to gain a leap forward in our understanding of the genetic control of PA biosynthesis and tolerance to stresses in legumes. PMID:24490637

A Randomized Crossover Trial Comparing Autotitrating and Continuous Positive Airway Pressure in Subjects With Symptoms of Aerophagia: Effects on Compliance and Subjective Symptoms

PubMed Central

Shirlaw, Teresa; Hanssen, Kevin; Duce, Brett; Hukins, Craig

2017-01-01

Study Objectives: To assess the benefit and tolerance of autotitrating positive airway pressure (APAP) versus continuous positive airway pressure (CPAP) in subjects who experience aerophagia. Methods: This is the report of a prospective, two-week, double-blinded, randomized crossover trial set in an Australian clinical sleep laboratory in a tertiary hospital. Fifty-six subjects who reported symptoms of aerophagia that they attributed to CPAP were recruited. Full face masks were used by 39 of the 56 subjects recruited. Subjects were randomly and blindly allocated to either CPAP at their treatment recommended pressure or APAP 6–20 cm H2O, in random order. Subjects spent two weeks on each therapy mode. Therapy usage hours, 95th centile pressure, maximum pressure, 95th centile leak, and residual apnea-hypopnea index (AHI) were reported at the end of each two-week treatment period. Functional Outcome of Sleepiness Questionnaire, Epworth Sleepiness Scale, and visual analog scale to measure symptoms of aerophagia were also completed at the end of each 2-week treatment arm. Results: The median pressure (P < .001) and 95th centile pressure (P < .001) were reduced with APAP but no differences in compliance (P = .120) and residual AHI were observed. APAP reduced the symptoms of bloating (P = .011), worst episode of bloating (P = .040), flatulence (P = .010), and belching (P = .001) compared to CPAP. There were no differences in Epworth Sleepiness Scale or Functional Outcome of Sleepiness Questionnaire outcomes between CPAP and APAP. Conclusions: APAP therapy reduces the symptoms of aerophagia while not affecting compliance when compared with CPAP therapy. Clinical Trial Registration: Australian and New Zealand Clinical Trials Registry at https://www.anzctr.org.au, trial number ACTRN12611001250921. Commentary: A commentary on this article appears in this issue on page 859. Citation: Shirlaw T, Hanssen K, Duce B, Hukins C. A randomized crossover trial comparing autotitrating and continuous positive airway pressure in subjects with symptoms of aerophagia: effects on compliance and subjective symptoms. J Clin Sleep Med. 2017;13(7):881–888. PMID:28558864

Discovery of four new low-mass white-dwarf companions in the Kepler data

NASA Astrophysics Data System (ADS)

Faigler, Simchon; Kull, Ilya; Mazeh, Tsevi; Kiefer, Flavien; Latham, David W.; Bloemen, Steven

2015-12-01

We report the discovery of four new short-period eclipsing systems in the Kepler light curves, consisting of an A-star primary and a low-mass white-dwarf (WD) secondary (dA+WD) - KIC 4169521, KOI-3818, KIC 2851474 and KIC 9285587. These add to the 6 Kepler, and 19 non-Kepler, previously known short-period eclipsing dA+WD binaries.The discoveries were made through searching the light curves of bright Kepler stars for BEaming, Ellipsoidal and Reflection (BEER) modulations that are consistent with a compact companion, using the BEER search algorithm. This was followed by inspection of the search top hits, looking for eclipsing systems with a secondary eclipse deeper than the primary one, as expected for a WD that is hotter than the primary star. Follow-up spectroscopic radial-velocity (RV) observations confirmed the binarity of the systems. We derive the systems' parameters through analyses of the light curves' eclipses and phase modulations, combined with RV orbital solutions and stellar evolution models.The four systems' orbital periods of 1.17-3.82 days and WD masses of 0.19-0.22 Msun are similar to those reported for the previously known systems. These values are consistent with evolution models of such systems, that undergo a stable mass transfer from the WD progenitor to the current A star.For KIC 4169521 we derive a bloated WD radius of 0.09 Rsun that is well within the WD radius range of 0.04-0.43 Rsun of the known systems. For the remaining three systems we report WD radii of 0.026-0.035 Rsun, the smallest WD radii derived so far for short-period eclipsing dA+WD binaries.As suggested before, the previously known systems, together with KIC 4169521, all with hot and bloated WD secondaries, represent young systems probably at a proto-WD, or initial WD cooling track stage. The other three new systems - KOI-3818, KIC 2851474, and KIC 9285587, are probably positioned further along the WD cooling track, and extend the known population to older systems with cooler and smaller WD secondaries.

IgG-based elimination diet in migraine plus irritable bowel syndrome.

PubMed

Aydinlar, Elif Ilgaz; Dikmen, Pinar Yalinay; Tiftikci, Arzu; Saruc, Murat; Aksu, Muge; Gunsoy, Hulya G; Tozun, Nurdan

2013-03-01

To evaluate therapeutic potential of the immunoglobulin G (IgG)-based elimination diet among migraine patients with irritable bowel syndrome (IBS). Food elimination has been suggested as an effective and inexpensive therapeutic strategy in patients with migraine and concomitant IBS in the past studies. A total of 21 patients (mean [standard deviation] age: 38.0 [11.2] years; 85.7% females) diagnosed with migraine and IBS were included in this double-blind, randomized, controlled, cross-over clinical trial composed of baseline (usual diet), first diet (elimination or provocation diets), and second diet (interchange of elimination or provocations diets) phases and 4 visits. IgG antibody tests against 270 food allergens revealed mean (standard deviation) reaction count to be 23.1 (14.1). Compared with baseline levels, elimination diet per se was associated with significant reductions in attack count (4.8 [2.1] vs 2.7 [2.0]; P < .001), maximum attack duration (2.6 [0.6] vs. 1.4 [1.1] days; P < .001), mean attack duration (1.8 [0.5] vs. 1.1 [0.8] days; P < .01), maximum attack severity (visual analog scale 8.5 [1.4] vs. visual analog scale 6.6 [3.3]; P < .001), and number of attacks with acute medication (4.0 [1.5] vs. 1.9 [1.8]; P < .001). There was a significant reduction in pain-bloating severity (1.8 [1.3] vs. 3.2 [0.8]; P < .05), pain-bloating within the last 10 days (3.2 [2.8] vs. 5.5 [3.1]; P < .05), and improvement obtained in quality of life (3.6 [1.4] vs. 2.9 [1.0]; P < .05) by the elimination diet as compared with provocation diet. Our findings indicate that food elimination based on IgG antibodies in migraine patients who suffer from concomitant IBS may effectively reduce symptoms from both disorders with possible positive impact on the quality of life of the patients as well as potential savings to the health-care system. © 2012 American Headache Society.

Effects of two natural medicine formulations on irritable bowel syndrome symptoms: a pilot study.

PubMed

Hawrelak, Jason A; Myers, Stephen P

2010-10-01

The study objective was to assess the effects and tolerability of two novel natural medicine formulations in improving bowel habit and abdominal symptoms in patients with irritable bowel syndrome (IBS). The DA-IBS formula was designed to treat diarrhea-predominant and alternating bowel habit IBS, and the C-IBS formula was designed to treat constipation-predominant IBS. This was a two arm, open-label, uncontrolled pilot study. Subjects were recruited from the greater Lismore area (NSW, Australia) in 2001. The study included 31 patients who fulfilled the Rome II criteria for IBS. Twenty-one (21) patients were classified as suffering from diarrhea-predominant or alternating bowel habit IBS and 10 patients were classified with constipation-predominant IBS. The DA-IBS formula consisted of a mixture of dried, powdered bilberry fruit, slippery elm bark, agrimony aerial parts, and cinnamon quills. The C-IBS formula consisted of a mixture of dried powdered slippery elm bark, lactulose, oat bran, and licorice root. The aim of each formula was to normalize stool frequency and stool consistency. Ingestion of the DA-IBS formula was associated with a small, but significant increase in bowel movement frequency (p = 0.027). Subjects in the DA-IBS group also experienced reductions in straining (p = 0.004), abdominal pain (p = 0.006), bloating (p < 0.0001), flatulence (p = 0.0001), and global IBS symptoms (p = 0.002) during the treatment phase of the trial. Subjects in the C-IBS group experienced a 20% increase in bowel movement frequency (p = 0.016) and significant reductions in straining (p < 0.0001), abdominal pain (p = 0.032), bloating (p = 0.034), and global IBS symptom severity (p = 0.0005), as well as improvements in stool consistency (p < 0.0001). Both formulas were well-tolerated. The DA-IBS formula was not effective in improving bowel habit in individuals with diarrhea-predominant or alternating bowel habit IBS, although it did significantly improve a number of IBS symptoms. The C-IBS formula significantly improved both bowel habit and IBS symptoms in patients with constipation-predominant IBS. Further research is warranted on C-IBS, as a potentially useful therapeutic formula.

In vitro batch fecal fermentation comparison of gas and short-chain fatty acid production using "slowly fermentable" dietary fibers.

PubMed

Kaur, Amandeep; Rose, Devin J; Rumpagaporn, Pinthip; Patterson, John A; Hamaker, Bruce R

2011-01-01

Sustained colonic fermentation supplies beneficial fermentative by-products to the distal colon, which is particularly prone to intestinal ailments. Blunted/delayed initial fermentation may also lead to less bloating. Previously, we reported that starch-entrapped alginate-based microspheres act as a slowly fermenting dietary fiber. This material was used in the present study to provide a benchmark to compare to other "slowly fermentable" fibers. Dietary fibers with previous reports of slow fermentation, namely, long-chain inulin, psyllium, alkali-soluble corn bran arabinoxylan, and long-chain β-glucan, as well as starch-entrapped microspheres were subjected to in vitro upper gastrointestinal digestion and human fecal fermentation and measured over 48 h for pH, gas, and short-chain fatty acids (SCFA). The resistant fraction of cooked and cooled potato starch was used as another form of fermentable starch and fructooligosaccharides (FOS) served as a fast fermenting control. Corn bran arabinoxylan and long-chain β-glucan initially appeared slower fermenting with comparatively low gas and SCFA production, but later fermented rapidly with little remaining in the final half of the fermentation period. Long-chain inulin and psyllium had slow and moderate, but incomplete, fermentation. The resistant fraction of cooked and cooled potato starch fermented rapidly and appeared similar to FOS. In conclusion, compared to the benchmark slowly fermentable starch-entrapped microspheres, a number of the purported slowly fermentable fibers fermented fairly rapidly overall and, of this group, only the starch-entrapped microspheres appreciably fermented in the second half of the fermentation period. Consumption of dietary fibers, particularly commercial prebiotics, leads to uncomfortable feelings of bloating and flatulence due to their rapid degradation in our large intestine. This article employs claimed potential slowly fermenting fibers and compares their fermentation rates with a benchmark slow fermenting fiber that we fabricated in an in vitro simulation of the human digestive system. Results show a variety of fermentation profiles only some of which have slow and extended rate of fermentation. © 2011 Institute of Food Technologists®

Rumen bacteria: interaction with particulate dietary components and response to dietary variation.

PubMed

Cheng, K J; Akin, D E; Costerton, J W

1977-02-01

The bovine rumen resembles many other ecosystems in that its component bacterial cells are universally surrounded and protected by extracellular structures. The most common form of these structures is a fibrous carbohydrate slime that extends away from the cell and may mediate the attachment of the bacterium to a surface. This attachment is relatively specific and it may occur at the surface of the rumen epithelium or on the cell walls of a specific tissue within the plant-derived food of the animal. The production of the extracellular slime is under nutritional control and slime may be overproduced when soluble carbohydrates are available in high concentration. This overproduction results in cell-cell adhesion among the rumen bacteria with the eventual formation of slime-enclosed microcolonies and, in extreme cases, the generation of sufficient viscosity to cause feedlot bloat.

High-Grade Mixed Adenoneuroendocrine Carcinoma in the Cecum: A Case Report

PubMed Central

Shin, Sang Ho; Jung, Sung Hee; Jang, Ji Woong; Kang, Min Seok; Kim, Sang Il; Kim, Ji Hye; Lee, Jun Ho

2017-01-01

Gastrointestinal neoplasms with an exocrine and a neuroendocrine component are rare. Such neoplasms are called “mixed adenoneuroendocrine carcinomas” (MANECs) according to the most recent World Health Organization classification of gastrointestinal tract neoplasms. MANECs have no specific findings that distinguish them from pure adenocarcinomas. In addition, the optimal management strategy of MANECs is largely unknown. We describe the case of a 32-year-old man with dizziness and abdominal bloating. A cecal mass was suspected based on an image study done at a local clinic. We evaluated the cecal mass by using colonoscopy, contrast enhanced computed tomography of the abdomen, positron emission tomography-computed tomography, and laboratory studies. The patient underwent a right hemicolectomy and adjuvant chemotherapy. The final histopathological diagnosis was a high-grade MANEC of the ascending colon, tumor stage T3N2M0. PMID:28289663

Ovarian dysgerminomas in two mountain chicken frogs (Leptodactylus fallax).

PubMed

Fitzgerald, Scott D; Duncan, Ann E; Tabaka, Chris; Garner, Michael M; Dieter, April; Kiupel, Matti

2007-03-01

This report describes the gross, histologic, and immunohistochemical features of ovarian dysgerminomas in two adult female mountain chicken frogs (Leptodactylusfallax) from the same zoological institution. One frog was found dead, and the other frog had been ill for several days with a bloated abdomen and lethargy. On necropsy, large, pale multilobulated masses replaced the left ovary in both frogs, and one frog also had numerous smaller nodules scattered throughout the coelomic viscera. Histologically, these masses were composed of sheets and cords of polyhedral discrete germ cells consistent with the diagnosis of dysgerminoma. Neoplastic cells stained positive with immunohistochemistry for Oct4, which has been reported to detect stem cells including germ cells in a variety of species, including humans. Ovarian tumors are uncommonly encountered in both reptiles and amphibians, and this report is the first report of dysgerminoma in any amphibian species.

New insights in IBS-like disorders: Pandora's box has been opened; a review.

PubMed

Borghini, Raffaele; Donato, Giuseppe; Alvaro, Domenico; Picarelli, Antonio

2017-01-01

The most complained gastrointestinal symptoms are chronic diarrhea, bloating and abdominal pain. Once malignancies and inflammatory bowel diseases are excluded, irritable bowel syndrome (IBS) and the so called "IBS-like disorders" should be taken into account. The relationship between IBS as defined by Rome IV criteria and these clinical conditions is sometimes obscure, since many IBS patients identify food as a possible trigger for their symptoms. Here, we discuss IBS and the most common IBS-like disorders (celiac disease, non-celiac gluten sensitivity, fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), lactose intolerance, small intestinal bacterial overgrowth (SIBO), α-amylase/trypsin inhibitor (ATIs), nickel allergic contact mucositis), focusing on epidemiologic, clinical, diagnostic and therapeutic aspects. Given the lack of specificity of symptoms, clinical investigation will be facilitated by awareness of these disorders as well as new specific diagnostic tools.

Cryptogenia multifocal ulcerous stenosing enteritis: an entity on its own as a cause of abdominal pain, iron deficiency anemia and protein-losing enteropathy.

PubMed

Guisado Vasco, P; Fraile Rodríguez, G

2014-01-01

We studied a patient with edema secondary to protein losing enteropathy, and recurrent bouts of bloating and abdominal pain secondary to intestinal subocclusion episodes. After the clinical study, the patient was diagnosed of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), that is a rare disease, probably caused by mutations in the gene PLA2G4A, and characterized by multiple short stenosis of the small bowel with superficial ulcers, which do not exceed the submucosa layer. Inflammatory bowel disease (Chron's disease), intestinal tuberculosis and intestinal ulcers secondary to non-steroidal anti-inflammatory drugs are the main differential diagnosis. To sum up, physicians should included CMUSE in the differential diagnosis of recurrent abdominal pain, iron deficiency anaemia, occult intestinal bleeding, edema and protein losing enteropathy. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Succession pattern of carrion-feeding insects in Paramo, Colombia.

PubMed

Martinez, Efrain; Duque, Patricia; Wolff, Marta

2007-03-02

The minimum postmortem interval can be estimated based on knowledge of the pattern of insect succession on a corpse. To use this approach requires that we take into account the rates of insect development associated with particular climatological conditions of the region. This study is the first to look at insect succession on decomposing carcasses in the high altitude plains (Paramo) in Colombia, at 3035 m above sea level. Five stages of decomposition were designated with indicator species identified for each stage: Callíphora nigribasis at the fresh stage; Compsomyiops verena at the bloated stage; Compsomyiops boliviana during active decay; Stearibia nigriceps and Hydrotaea sp. during advanced decay and Leptocera sp. for dry remains. A succession table is presented for carrion-associated species of the region, which can be used for estimating time since death in similar areas. Compsomyiops boliviana is reported for the first time in Colombia.

Ileus caused by cholesterol crystal embolization: A case report.

PubMed

Azuma, Shunjiro; Ikenouchi, Maiko; Akamatsu, Takuji; Seta, Takeshi; Urai, Shunji; Uenoyama, Yoshito; Yamashita, Yukitaka

2016-03-28

Cholesterol crystal embolization (CCE) is a rare systemic embolism caused by formation of cholesterol crystals from atherosclerotic plaques. CCE usually occurs during vascular manipulation, such as vascular surgery or endovascular catheter manipulation, or due to anticoagulation or thrombolytic therapy. We report a rare case of intestinal obstruction caused by spontaneous CCE. An 81-year-old man with a history of hypertension was admitted for complaints of abdominal pain, bloating, and anorexia persisting for 4 mo. An abdominal computed tomography revealed intestinal ileus. His symptoms were immediately relieved by an ileus tube insertion, and he was discharged 6 d later. However, these symptoms immediately reappeared and persisted, and partial resection of the small intestine was performed. A histopathological examination indicated that small intestine obstruction was caused by CCE. At the 12-mo follow-up, the patient showed no evidence of CCE recurrence. Thus, in cases of intestinal obstruction, CCE should also be considered.

The plastid genomes of nonphotosynthetic algae are not so small after all

PubMed Central

Figueroa-Martinez, Francisco; Nedelcu, Aurora M.; Reyes-Prieto, Adrian

2017-01-01

ABSTRACT The thing about plastid genomes in nonphotosynthetic plants and algae is that they are usually very small and highly compact. This is not surprising: a heterotrophic existence means that genes for photosynthesis can be easily discarded. But the loss of photosynthesis cannot explain why the plastomes of heterotrophs are so often depauperate in noncoding DNA. If plastid genomes from photosynthetic taxa can span the gamut of compactness, why can't those of nonphotosynthetic species? Well, recently we showed that they can. The free-living, heterotrophic green alga Polytoma uvella has a plastid genome boasting more than 165 kilobases of noncoding DNA, making it the most bloated plastome yet found in a heterotroph. In this addendum to the primary study, we elaborate on why the P. uvella plastome is so inflated, discussing the potential impact of a free-living vs. parasitic lifestyle on plastid genome expansion in nonphotosynthetic lineages. PMID:28377793

Alkaline phosphatase activity of rumen bacteria.

PubMed

Cheng, K J; Costerton, J W

1977-11-01

Of the 54 strains of rumen bacteria examined for alkaline phosphatase (APase) production, 9 of 33 gram-negative strains and none of 21 gram-positive strains produced the enzyme. The APase of the cells of the three strains of Bacteroides ruminicola that produced significant amounts of the enzyme was located in the periplasmic area of the cell envelope, whereas the enzyme was located in the strains of Selenomonas ruminantium and Succinivibrio dextrinosolvens was associated with the outer membrane. The localization of APase production in the cells of natural populations of rumen bacteria from hay-fed sheep was accomplished by reaction product deposition, and both the proportion of APase-producing bacteria and the location of the enzyme in the cell envelope of the producing cells could be determined. We suggest that this procedure is useful in detecting shifts in the bacterial population and the release of cell-bound APase that accompany feedlot bloat and other sequelae of dietary manipulation in ruminants.

Tolazoline reversal of xylazine in bison (Bison bison): Mitigation of adverse effects

USGS Publications Warehouse

Roffe, Thomas J.; Sweeney, Steven J.; Williams, Beth; Quist, Charlotte

2002-01-01

Tolazoline is a mixed alpha-1 and -2 adrenergic antagonist used to reverse the sedative, analgesic and muscle-relaxing effects of xylazine, a potent alpha adrenergic agonist. Tolazoline has been used in cattle and is superior to yohimbine, another alpha adrenergic antagonist, in this species. In white-tailed deer, tolazoline shortened recovery times and reversed xylazine-induced bradycardia, respiratory depression, and bloat following xylazine-ketamine anesthesia (Kreeger et al. 1986). We have used it for a number of years in moose without any detected adverse reactions. Caulkett et al. (2000) used tolazoline in wood bison to reverse the xylazine-induced effects of xylazine-tiletamine/zolazepam anesthesia and did not report any ill effects. However, the reported side effects of tolazoline in horses (species for which the drug was developed and is labeled) include abdominal discomfort, gastrointestinal hypermotility, diarrhea, tachycardia, ventricular dysrhythmia, hypertension and apprehensiveness.

Neutrino-heated stars and broad-line emission from active galactic nuclei

NASA Technical Reports Server (NTRS)

Macdonald, James; Stanev, Todor; Biermann, Peter L.

1991-01-01

Nonthermal radiation from active galactic nuclei indicates the presence of highly relativistic particles. The interaction of these high-energy particles with matter and photons gives rise to a flux of high-energy neutrinos. In this paper, the influence of the expected high neutrino fluxes on the structure and evolution of single, main-sequence stars is investigated. Sequences of models of neutrino-heated stars in thermal equilibrium are presented for masses 0.25, 0.5, 0.8, and 1.0 solar mass. In addition, a set of evolutionary sequences for mass 0.5 solar mass have been computed for different assumed values for the incident neutrino energy flux. It is found that winds driven by the heating due to high-energy particles and hard electromagnetic radiation of the outer layers of neutrino-bloated stars may satisfy the requirements of the model of Kazanas (1989) for the broad-line emission clouds in active galactic nuclei.

Neuroimmune Cross Talk in the Gut. Neuroendocrine and neuroimmune pathways contribute to the pathophysiology of irritable bowel syndrome.

PubMed

O'Malley, Dervla

2016-11-01

Irritable bowel syndrome (IBS) is a common disorder characterized by recurrent abdominal pain, bloating, and disturbed bowel habit, symptoms that impact the quality of life of sufferers. The pathophysiological changes underlying this multifactorial condition are complex and include increased sensitivity to luminal and mucosal factors, resulting in altered colonic transit and visceral pain. Moreover, dysfunctional communication in the bidirectional signaling axis between the brain and the gut, which involves efferent and afferent branches of the peripheral nervous system, circulating endocrine hormones, and local paracrine and neurocrine factors, including immune and perhaps even microbial signaling molecules, has a role to play in this disorder. This minireview will examine recent advances in our understanding of the pathophysiology of IBS and assess how cross talk between hormones, immune, and microbe-derived factors and their neuromodulatory effects on peripheral nerves may underlie IBS symptomatology. Copyright © 2016 the American Physiological Society.

Premenstrual syndrome in Turkish medical students and their quality of life.

PubMed

Goker, A; Artunc-Ulkumen, B; Aktenk, F; Ikiz, N

2015-04-01

This study aimed to analyse the frequency and symptoms of premenstrual syndrome (PMS) and its effect on quality of life in medical students. Sociodemographic data, a symptom calendar for the following consecutive two menstrual periods and SF-36 quality of life questionnaire were collected. A total of 228 students joined the survey. The average age of the students was 20.77 ± 1.90. The frequency of PMS was 91.8%. The most frequent symptoms were abdominal bloating (89.5%), irritability (88.3%) and breast tenderness (82.6%). Quality of life scores ranged from 17.00 to 97.00 and were lowest in the severe PMS group. Alcohol consumption, stress events and fat rich diets increased the severity of PMS. Family history significantly affected the severity of PMS and quality of life scores. Premenstrual syndrome was found to be a frequent entity among medical students and seemed to affect quality of life in a moderate way.

Current and Novel Therapeutic Options for Irritable Bowel Syndrome Management

PubMed Central

Camilleri, Michael; Andresen, Viola

2009-01-01

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder affecting up to 3-15% of the general population in western countries. It is characterized by unexplained abdominal pain, discomfort, and bloating in association with altered bowel habits. The pathophysiology of IBS is multifactorial involving disturbances of the brain-gut-axis. The pathophysiology provides the rationale for pharmacotherapy: abnormal gastrointestinal motor functions, visceral hypersensitivity, psychosocial factors, autonomic dysfunction, and mucosal immune activation. Understanding the mechanisms, and their mediators or modulators including neurotransmitters and receptors have led to several therapeutic approaches including agents acting on the serotonin receptor or serotonin transporter system, antidepressants, novel selective anticholinergics, α-adrenergic agonists, opioid agents, cholecystokinin-antagonists, neurokinin-antagonists, somatostatin receptor agonists, corticotropin releasing factor antagonists, chloride-channel activators, guanylate-cyclase-c agonists, melatonin, atypical benzodiazepines, antibiotics, immune modulators and probiotics. The mechanisms and current evidence regarding efficacy of these agents are reviewed. PMID:19665953

Irritable Bowel Syndrome: Yoga as Remedial Therapy

PubMed Central

Kavuri, Vijaya; Raghuram, Nagarathna; Malamud, Ariel; Selvan, Senthamil R.

2015-01-01

Irritable bowel syndrome (IBS) is a group of symptoms manifesting as a functional gastrointestinal (GI) disorder in which patients experience abdominal pain, discomfort, and bloating that is often relieved with defecation. IBS is often associated with a host of secondary comorbidities such as anxiety, depression, headaches, and fatigue. In this review, we examined the basic principles of Pancha Kosha (five sheaths of human existence) concept from an Indian scripture Taittiriya Upanishad and the pathophysiology of a disease from the Yoga approach, Yoga Vasistha's Adhi (originated from mind) and Vyadhi (ailment/disease) concept. An analogy between the age old, the most profound concept of Adhi-Vyadhi, and modern scientific stress-induced dysregulation of brain-gut axis, as it relates to IBS that could pave way for impacting IBS, is emphasized. Based on these perspectives, a plausible Yoga module as a remedial therapy is provided to better manage the primary and secondary symptoms of IBS. PMID:26064164

The maternal-effect, selfish genetic element Medea is associated with a composite Tc1 transposon.

PubMed

Lorenzen, Marcé D; Gnirke, Andreas; Margolis, Jonathan; Garnes, Jeffrey; Campbell, Margie; Stuart, Jeffrey J; Aggarwal, Rajat; Richards, Stephen; Park, Yoonseong; Beeman, Richard W

2008-07-22

Maternal-Effect Dominant Embryonic Arrest ("Medea") factors are selfish nuclear elements that combine maternal-lethal and zygotic-rescue activities to gain a postzygotic survival advantage. We show that Medea(1) activity in Tribolium castaneum is associated with a composite Tc1 transposon inserted just downstream of the neurotransmitter reuptake symporter bloated tubules (blot), whose Drosophila ortholog has both maternal and zygotic functions. The 21.5-kb insertion contains defective copies of elongation initiation factor-3, ATP synthase subunit C, and an RNaseD-related gene, as well as a potentially intact copy of a prokaryotic DUF1703 gene. Sequence comparisons suggest that the current distribution of Medea(1) reflects global emanation after a single transpositional event in recent evolutionary time. The Medea system in Tribolium represents an unusual type of intragenomic conflict and could provide a useful vehicle for driving desirable genes into populations.

The maternal-effect, selfish genetic element Medea is associated with a composite Tc1 transposon

PubMed Central

Lorenzen, Marcé D.; Gnirke, Andreas; Margolis, Jonathan; Garnes, Jeffrey; Campbell, Margie; Stuart, Jeffrey J.; Aggarwal, Rajat; Richards, Stephen; Park, Yoonseong; Beeman, Richard W.

2008-01-01

Maternal-Effect Dominant Embryonic Arrest (“Medea”) factors are selfish nuclear elements that combine maternal-lethal and zygotic-rescue activities to gain a postzygotic survival advantage. We show that Medea1 activity in Tribolium castaneum is associated with a composite Tc1 transposon inserted just downstream of the neurotransmitter reuptake symporter bloated tubules (blot), whose Drosophila ortholog has both maternal and zygotic functions. The 21.5-kb insertion contains defective copies of elongation initiation factor-3, ATP synthase subunit C, and an RNaseD-related gene, as well as a potentially intact copy of a prokaryotic DUF1703 gene. Sequence comparisons suggest that the current distribution of Medea1 reflects global emanation after a single transpositional event in recent evolutionary time. The Medea system in Tribolium represents an unusual type of intragenomic conflict and could provide a useful vehicle for driving desirable genes into populations. PMID:18621706

Use of rifaximin in gastrointestinal and liver diseases.

PubMed

Shayto, Rani H; Abou Mrad, Rachel; Sharara, Ala I

2016-08-07

Rifaximin is a broad spectrum oral antibiotic with antimicrobial activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria. It is poorly absorbed and thus has a highly favorable safety profile. Rifaximin has been shown to be effective in the treatment of traveler's diarrhea, functional bloating and irritable bowel syndrome, small bowel bacterial overgrowth and in the prevention of recurrent overt hepatic encephalopathy. In addition, there is emerging evidence for a possible beneficial effect of rifaximin in the treatment of uncomplicated diverticular disease and in the prevention of recurrent diverticulitis. The use of rifaximin is associated with a low incidence of development, or persistence of spontaneous bacterial mutants. Moreover, the development of important drug resistance among extra-intestinal flora during rifaximin therapy is unlikely because of minimal systemic absorption and limited cross-resistance of rifaximin with other antimicrobials. This review addresses the current and emerging role of rifaximin in the treatment of gastrointestinal and liver disorders.

The low FODMAP diet: fundamental therapy in the management of irritable bowel syndrome.

PubMed

Ireton-Jones, Carol

2017-09-01

The low FODMAP diet is now recognized as first-line therapy for treatment of irritable bowel syndrome (IBS) symptoms including abdominal pain, gas, bloating, diarrhea and or constipation. This information must be disseminated for application to clinical practice. There are many people with IBS worldwide who can benefit from following the low FODMAP diet to alleviate or minimize symptoms. Clinical studies and trials demonstrating the positive outcomes of the low FODMAP diet have been based on diet education provided by dietitians. Understanding the types of carbohydrates that are high in FODMAPs and the associated symptoms, nutrition intervention can be targeted using the low FODMAP diet. The nutrition intervention is relatively in expensive, noninvasive and basically without side-effects if monitored by a dietitian and clinical team. Applying the low FODMAP diet in IBS can greatly improve health and quality of life outcomes by alleviating or significantly improves symptoms.

Behavioral treatment of chronic belching due to aerophagia in a normal adult.

PubMed

Cigrang, Jeffrey A; Hunter, Christine M; Peterson, Alan L

2006-05-01

Aerophagia, or excessive air swallowing, is a potential cause of belching, flatulence, bloating, and abdominal pain and may contribute to a worsening of gastrointestinal (GI) disorders. A limited number of published reports of aerophagia treatment indicate that behavioral methods may be of benefit. A case report is presented describing the behavioral treatment of chronic belching due to aerophagia in an adult female. The collaborative application of single-participant design research helped identify open-mouth, diaphragmatic breathing and minimized swallowing as an effective intervention. Belching frequency was reduced from an average rate of 18 per 5-min interval during the baseline period to 3 per 5-min period after treatment. Results were maintained at an 18-month follow-up. Recommendations for the use of a brief treatment protocol with adults referred for chronic belching or other GI complaints attributed to aerophagia are discussed.

Mature cystic teratoma with high proportion of solid thyroid tissue: a controversial case with unusual imaging findings.

PubMed

Gil, Rui; Cunha, Teresa Margarida; Rolim, Ines

2017-07-01

We describe a case of a mature cystic teratoma of the ovary with high proportion of solid thyroid tissue (< 50% of the entire tumor) in a childbearing woman. The patient presented with non-specific abdominal bloating. Pelvic ultrasound and magnetic resonance imaging revealed a complex cystic-solid tumor confined to the left ovary with an anterior fat-containing locus compatible with mature cystic teratoma and a posterior predominantly solid component with low signal intensity on T2-weighted images that was histopatologically diagnosed as benign thyroid tissue. Thyroglobulin levels were in normal range. Although thyroid tissue is present in up to 20% of mature cystic teratomas, with exception of struma ovarii, it is not usually macroscopically nor radiologically identified. The differential diagnosis should include T2-hypointense adnexal lesions associated with mature cystic teratoma, malignant transformation of mature teratoma, and immature teratoma.

Cannonballs Shoot from Star (Artist Concept)

NASA Image and Video Library

2016-10-06

This four-panel graphic illustrates how the binary-star system V Hydrae is launching balls of plasma into space. Panel 1 shows the two stars orbiting each other. One of the stars is nearing the end of its life and has swelled in size, becoming a red giant. In panel 2, the smaller star's orbit carries the star into the red giant's expanded atmosphere. As the star moves through the atmosphere, it gobbles up material from the red giant that settles into a disk around the star. The buildup of material reaches a tipping point and is eventually ejected as blobs of hot plasma along the star's spin axis, as shown in panel 3. This ejection process is repeated every eight years, which is the time it takes for the orbiting star to make another pass through the bloated red giant's envelope, as shown in panel 4. http://photojournal.jpl.nasa.gov/catalog/PIA21071

Fructan, Rather Than Gluten, Induces Symptoms in Patients With Self-Reported Non-Celiac Gluten Sensitivity.

PubMed

Skodje, Gry I; Sarna, Vikas K; Minelle, Ingunn H; Rolfsen, Kjersti L; Muir, Jane G; Gibson, Peter R; Veierød, Marit B; Henriksen, Christine; Lundin, Knut E A

2018-02-01

Non-celiac gluten sensitivity is characterized by symptom improvement after gluten withdrawal in absence of celiac disease. The mechanisms of non-celiac gluten sensitivity are unclear, and there are no biomarkers for this disorder. Foods with gluten often contain fructans, a type of fermentable oligo-, di-, monosaccharides and polyols. We aimed to investigate the effect of gluten and fructans separately in individuals with self-reported gluten sensitivity. We performed a double-blind crossover challenge of 59 individuals on a self-instituted gluten-free diet, for whom celiac disease had been excluded. The study was performed at Oslo University Hospital in Norway from October 2014 through May 2016. Participants were randomly assigned to groups placed on diets containing gluten (5.7 g), fructans (2.1 g), or placebo, concealed in muesli bars, for 7 days. Following a minimum 7-day washout period (until the symptoms induced by the previous challenge were resolved), participants crossed over into a different group, until they completed all 3 challenges (gluten, fructan, and placebo). Symptoms were measured by Gastrointestinal Symptom Rating Scale Irritable Bowel Syndrome (GSRS-IBS) version. A linear mixed model for analysis was used. Overall GSRS-IBS scores differed significantly during gluten, fructan, and placebo challenges; mean values were 33.1 ± 13.3, 38.6 ± 12.3, and 34.3 ± 13.9, respectively (P = .04). Mean scores for GSRS-IBS bloating were 9.3 ± 3.5, 11.6 ± 3.5, and 10.1 ± 3.7, respectively, during the gluten, fructan, and placebo challenges (P = .004). The overall GSRS-IBS score for participants consuming fructans was significantly higher than for participants consuming gluten (P = .049), as was the GSRS bloating score (P = .003). Thirteen participants had the highest overall GSRS-IBS score after consuming gluten, 24 had the highest score after consuming fructan, and 22 had the highest score after consuming placebo. There was no difference in GSRS-IBS scores between gluten and placebo groups. In a randomized, double-blind, placebo-controlled crossover study of individuals with self-reported non-celiac gluten sensitivity, we found fructans to induce symptoms, measured by the GSRS-IBS. Clinicaltrials.gov no: NCT02464150. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Gas-related symptoms after laparoscopic 360 degrees Nissen or 270 degrees Toupet fundoplication in gastrooesophageal reflux disease patients with aerophagia as comorbidity.

PubMed

Granderath, F A; Kamolz, T; Granderath, U M; Pointner, R

2007-04-01

Aerophagia is a rare but well-known comorbidity in patients with gastrooesophageal reflux disease. Particularly after laparoscopic Nissen fundoplication, it has proven to result in worse symptomatic outcome and a lower postoperative quality of life in comparison to patients without preoperative gas-related symptoms. Aim of the study was to compare the postoperative outcome in gastrooesophageal reflux disease patients with aerophagia as comorbidity after either laparoscopic 360 degrees 'floppy' Nissen fundoplication or 270 degrees Toupet fundoplication with main focus on the frequency and subjective impairment of gas-related symptoms. In 56 gastrooesophageal reflux disease patients, the comorbidity of aerophagia was diagnosed prior to laparoscopic antireflux surgery. Irrespective of their preoperative manometric findings, the patients were either scheduled to a laparoscopic 360 degrees 'floppy' Nissen (n=28) or a laparoscopic 270 degrees Toupet fundoplication (n=28). All patients have been analysed concerning the presence of gas-related symptoms preoperatively as well as 3 months after surgery. Additionally, the subjective degree of impairment was evaluated using a numerous rating scale (0=no perception/impairment, 100=most severe perception/impairment). The following symptoms have been analysed: ability/inability to belch, 'gas bloat', flatulence, postprandial fullness and epigastric pain. Before surgery, there were no significant differences between both surgical groups. Three months after surgery, significant differences (p<0.05-0.01) were found: patients who underwent a laparoscopic 270 degrees Toupet fundoplication suffered from less impairing gas bloat, flatulence and postprandial fullness when compared with patients with a 360 degrees 'floppy' Nissen fundoplication. The majority of these patients were able to belch postoperatively but felt no impairment due to this symptom. In contrast, patients of the Nissen group felt a significant impairment due to the inability to belch. Gas-related symptoms are very common in gastrooesophageal reflux disease patients with aerophagia as a comorbidity. Patients who undergo a laparoscopic Toupet fundoplication show less impairment in relation to gas-related problems compared with patients treated with a Nissen fundoplication for a follow-up period of at least 3 months. In the Toupet group, the ability to belch postoperatively seems to be a positive aspect from the patients' view which also improves the percentage of gas-related problems. However, long-term results are necessary.

Four years Follow-up of Patients with Irritable Bowel Syndrome.

PubMed

Rusu, F; Dumitraşcu, D L

2015-01-01

There is little data on the long term evolution of patients with irritable bowel syndrome (IBS) and of associated conditions. We therefore studied the evolution of IBS patients in a single tertiary center during a long interval of time. We carried out a retrospective study based on the survey of patients records. We analyzed the records of symptoms, therapy, associated diseases, as consigned at follow-up visits for an interval of 4 years in average (2008-2011). A cohort of 114 patients with IBS diagnosed based on Rome III criteria were included (29 men and 85 women), age 19-85 years (mean age: 43.45 years). Urban patients were predominant. The main three symptoms were: abdominal pain, bowel disorders (constipation, diarrhea) and bloating. IBS--constipation (IBS--C) is associated with a favorable course of symptoms (increasing the number of stools, decrease intensity of abdominal pain and bloating) after treatment and IBS--diarrhea (IBS--D) is associated with variable symptoms after treatment (p = 0.031). Using trimebutin or mebeverin in association with other drugs for one month correlates with a favorable evolution of symptoms after treatment and monotherapy is associated with fluctuating symptoms ( p< 0.001). Favorable symptoms are associated with the use of probiotics in combination, but not in monotherapy (p< 0.001). Favorable evolution of symptoms is also associated with the use of anxiolytics in combination. Persistence of symptoms after treatment was correlated with the presence or absence of depression. The absence of depression was correlated with a favorable evolution of symptoms (p = 0.005). IBS-C is associated at limit (marginal significance) with hemorrhoidal disease (p = 0.56). 33 patients (29%)--received monotherapy (trimebutin or mebeverin or probiotics); 81 patients (71%)--received combined therapy: (trimebutin or mebeverin or probiotics) + anxiolytics or proton pump inhibitors (PPI) or nonsteroidal anti-inflammatory (NSAI) or spasmolytics. The most common associated diseases observed in patients with IBS were: depression (27.19%), dyslipidemia (25.43%), hemorrhoidal disease (22.80%) and fibromyalgia (21%). The highest response rate was obtained with trimebutin or mebeverin + anxiolitics + probiotics. The most frequent disease associated with IBS was depression. Other diseases with a high incidence: dyslipidemia, hemorrhoidal disease and fibromyalgia. Further studies are needed to analyze the link between IBS and some associated diseases.

[Using a multicomponent functional food in IBS patients with constipation a comparative controlled study].

PubMed

Pilipenko, V I; Teplyuk, D A; Shakhovskaya, A K; Isakov, V A; Vorobyova, V M; Vorobyova, I S; Sarkisyan, V A; Kochetkova, A A; Mikheeva, G A; Yudina, A V

2016-01-01

Irritable bowel syndrome (IBS) is highly prevalent functional gastrointestinal disorder associated with decrease in quality of life and a high social cost. Diet is one of several therapeutic options in IBS treatment; therefore the development and clinical evaluation of innovative functional food for IBS patients are actual. Instant drink containing 4 g inulin, 4 mg menthol and 2 mg of pyridoxine (in daily dose) has been evaluated. 49 patients 18-68 (41.5±16.5) years old fulfilling the Rome III criteria for IBS-C were randomly assigned into two groups: one received standard diet plus two drinks per day for 2 weeks and control group received standard diet. Response to therapy was recorded daily using Likert scale of abdominal pain, bloating and feeling of incomplete bowel emptying, frequency of bowel movement, Bristol stool scale, and quality of life was assessed by IBSQoL questionnaire before and after the treatment. The consumption of the drink with inulin and menthol contributed to a significant positive effect on the stool parameters (from 0.91±0.73 to 1.12±0.45 bowel movements per day in stool frequency, p=0.05, from 2.68±1.63 to 3.43±1.27 index Bristol scale, p=0.05), reduced the severity of abdominal pain (from 1.78±0.58 to 1.47?0.61 Likert scale points, p=0.05), bloating (from 2.22±0.83 to 1.53±0.71 points ofLikertscale,p= 0.01) and a sense of incomplete bowelemptying (from 2.22 ± 0.88 to 1.61± 0.81 points of Likert scale, p=0.001), as well as increased the quality of life (from 75.3± 12.0 to 83.3±6.7%, p=0.05), but a significant part of patients (10 of 25) complained the appearance of heartburn after the start of the treatment. In conclusion, the consumption of the functional drink containing inulin, menthol and pyridoxine is associated with improve in stool parameters, abdominal pain, Bristol scale index and increase in quality of life in patients with IBS-C, but produce noticeable heartburn. Changes in functional drink composition are needed to reduce adverse effects.

Co-occurrence of carbohydrate malabsorption and primary epiploic appendagitis

PubMed Central

Schnedl, Wolfgang J; Kalmar, Peter; Mangge, Harald; Krause, Robert; Wallner-Liebmann, Sandra J

2015-01-01

Unspecific abdominal complaints including bloating and irregular bowel movements may be caused by carbohydrate malabsorption syndromes, e.g., lactose and fructose malabsorption. These symptoms were investigated with hydrogen (H2) breath tests and correlated to carbohydrate malabsorption. During performing these H2-breath tests the patient presented with an acute, localized, non-migratory pain in the left lower abdominal quadrant. Primary epiploic appendagitis is a rare cause of abdominal acute or subacute complaints and diagnosis of primary epiploic appendagitis (PEA) is made when computed tomography reveals a characteristic lesion. We report on a patient with co-occurrence of lactose and fructose malabsorption, which was treated successfully with a diet free of culprit carbohydrates, with PEA recovering without medication or surgical treatment within few days. Since the abdominal unspecific symptoms had been present for months, they appeared not to be correlated to the acute localized abdominal pain, therefore we speculate on a random co-occurrence of combined carbohydrate malabsorption and PEA. PMID:26401090

Management of bile acid malabsorption using low-fat dietary interventions: a useful strategy applicable to some patients with diarrhoea-predominant irritable bowel syndrome?

PubMed

Watson, Lorraine; Lalji, Amyn; Bodla, Shankar; Muls, Ann; Andreyev, H Jervoise N; Shaw, Clare

2015-12-01

This study evaluates the efficacy of low-fat dietary interventions in the management of gastrointestinal (GI) symptoms due to bile acid malabsorption. In total, 40 patients with GI symptoms and a 7-day (75)selenium homocholic acid taurine (SeHCAT) scan result of <20%, were prospectively recruited and then advised regarding a low-fat dietary intervention. Before and after dietary intervention, patients rated their GI symptoms using a 10-point numerical scale, and recorded their intake in 7-day dietary diaries. After dietary intervention, the median scores for all GI symptoms decreased, with a significant reduction for urgency, bloating, lack of control, bowel frequency (p ≥: 0.01). Mean dietary fat intake reduced to 42 g fat after intervention (p ≥: 0.01). Low-fat dietary interventions in patients with a SeHCAT scan result of <20% leads to clinically important improvement in GI symptoms and should be widely used. © Royal College of Physicians 2015. All rights reserved.

The opioid effects of gluten exorphins: asymptomatic celiac disease.

PubMed

Pruimboom, Leo; de Punder, Karin

2015-11-24

Gluten-containing cereals are a main food staple present in the daily human diet, including wheat, barley, and rye. Gluten intake is associated with the development of celiac disease (CD) and related disorders such as diabetes mellitus type I, depression, and schizophrenia. However, until now, there is no consent about the possible deleterious effects of gluten intake because of often failing symptoms even in persons with proven CD. Asymptomatic CD (ACD) is present in the majority of affected patients and is characterized by the absence of classical gluten-intolerance signs, such as diarrhea, bloating, and abdominal pain. Nevertheless, these individuals very often develop diseases that can be related with gluten intake. Gluten can be degraded into several morphine-like substances, named gluten exorphins. These compounds have proven opioid effects and could mask the deleterious effects of gluten protein on gastrointestinal lining and function. Here we describe a putative mechanism, explaining how gluten could "mask" its own toxicity by exorphins that are produced through gluten protein digestion.

Diagnosis and management of small intestinal bacterial overgrowth.

PubMed

Bohm, Matthew; Siwiec, Robert M; Wo, John M

2013-06-01

Small intestinal bacterial overgrowth (SIBO) can result from failure of the gastric acid barrier, failure of small intestinal motility, anatomic alterations, or impairment of systemic and local immunity. The current accepted criteria for the diagnosis of SIBO is the presence of coliform bacteria isolated from the proximal jejunum with >10(5) colony-forming units/mL. A major concern with luminal aspiration is that it is only one random sampling of the small intestine and may not always be representative of the underlying microbiota. A new approach to examine the underlying microbiota uses rapid molecular sequencing, but its clinical utilization is still under active investigation. Clinical manifestations of SIBO are variable and include bloating, flatulence, abdominal distention, abdominal pain, and diarrhea. Severe cases may present with nutrition deficiencies due to malabsorption of micro- and macronutrients. The current management strategies for SIBO center on identifying and correcting underlying causes, addressing nutrition deficiencies, and judicious utilization of antibiotics to treat symptomatic SIBO.

Alkaline phosphatase activity of rumen bacteria.

PubMed Central

Cheng, K J; Costerton, J W

1977-01-01

Of the 54 strains of rumen bacteria examined for alkaline phosphatase (APase) production, 9 of 33 gram-negative strains and none of 21 gram-positive strains produced the enzyme. The APase of the cells of the three strains of Bacteroides ruminicola that produced significant amounts of the enzyme was located in the periplasmic area of the cell envelope, whereas the enzyme was located in the strains of Selenomonas ruminantium and Succinivibrio dextrinosolvens was associated with the outer membrane. The localization of APase production in the cells of natural populations of rumen bacteria from hay-fed sheep was accomplished by reaction product deposition, and both the proportion of APase-producing bacteria and the location of the enzyme in the cell envelope of the producing cells could be determined. We suggest that this procedure is useful in detecting shifts in the bacterial population and the release of cell-bound APase that accompany feedlot bloat and other sequelae of dietary manipulation in ruminants. Images PMID:563216

Blowflies (Diptera, Calliphoridae) Associated with Pig Carcasses in a Caatinga Area, Northeastern Brazil.

PubMed

Alves, A C F; Santos, W E; Farias, R C A P; Creão-Duarte, A J

2014-04-01

Studies that focused on Calliphoridae associated with pig carcasses are abundant in southern and southeastern Brazil; however, there are few in northeast. Here, we present an inventory of the blowfly species associated with the stages of decomposition of pig carcasses in a caatinga area during dry and rainy seasons. The study took place at the Private Reserve for the Environmental Inheritance "Fazenda Almas," state of Paraíba, Brazil. Using a modified version of the Shannon trap, 32,909 adult specimens belonging to eight species were captured. During the dry season, Cochliomyia macellaria (Fabricius) (52.2%) and Chrysomya albiceps (Wiedemann) (39.9%) were the most abundant species. In the rainy season, when the majority of individuals were captured (93.7%), Chloroprocta idioidea (Robineau-Desvoidy) (71.1%) was the most abundant. Five decomposition stages were recognized, being the active decay the most attractive to colonization by blowflies, except for Lucilia eximia (Wiedemann), which was more abundant in the bloated stage.

[Perforated duodenal diverticula. Case report and treatment options].

PubMed

Guardado-Bermúdez, Fernando; Ardisson-Zamora, Fernando Josafat; Rojas-González, Juan Daniel; Medina-Benítez, Alberto; Corona-Suárez, Fernando

2013-01-01

the presence of duodenal diverticula was first described in 1710 by Chromel. Duodenal diverticulum is the second most common site of diverticula in the digestive tract. Anatomically duodenal diverticula are located in 10 to 67% in the second portion of duodenum, and its finding in most cases incidental. About 90% of patients appear asymptomatic, manifesting symptoms mostly once established complications such as: gastrointestinal bleeding and perforation. 78-years-old woman who attended our Emergency department with dyspnea, moderate epigastralgia, abdominal bloating, constipation and difficulty to pass gas; Laparotomy was performed to identify duodenal diverticulum in the third portion of the duodenum with a perforation of 5 mm in its cupula. It proceeds with diverticulectomy. The diagnosis of duodenal diverticulum as a cause of acute abdomen must be considered in our differential diagnosis in acute abdomen supported by imaging and endoscopy. The surgical management of duodenal diverticulum, in particular the resection of the diverticulum, remains as the recommendation for treatment with less morbidity and a good recovery.

Improving recognition of hepatic perivascular epithelioid cell tumor: Case report and literature review.

PubMed

Maebayashi, Toshiya; Abe, Katsumi; Aizawa, Takuya; Sakaguchi, Masakuni; Ishibashi, Naoya; Abe, Osamu; Takayama, Tadatoshi; Nakayama, Hisashi; Matsuoka, Shunichi; Nirei, Kazushige; Nakamura, Hitomi; Ogawa, Masahiro; Sugitani, Masahiko

2015-05-07

A 58-year-old man presented with the chief complaint of abdominal bloating and was incidentally found to have a liver tumor. As diagnostic imaging studies could not rule out malignancy, the patient underwent partial resection of segment 3 of the liver. The lesion pathologically showed eosinophilic proliferation, in addition to immunohistochemical positivity for human melanoma black 45 and Melan-A, thereby leading to the diagnosis of a hepatic perivascular epithelioid cell tumor (PEComa). A PEComa arising from the liver is relatively rare. Moreover, the name 'PEComa' has not yet been widely recognized, and the same disease entity has been called epithelioid angiomyolipoma (EAML), further diminishing the recognition of PEComa. In addition, PEComa imaging findings mimic those of malignant liver tumors, and clinically, this tumor tends to enlarge. Therefore, a PEComa is difficult to diagnose. We conducted a systematic review of PEComa and EAML cases and discuss the results, including findings useful for differentiating perivascular epithelioid cell tumors from malignant liver tumors.

Improving recognition of hepatic perivascular epithelioid cell tumor: Case report and literature review

PubMed Central

Maebayashi, Toshiya; Abe, Katsumi; Aizawa, Takuya; Sakaguchi, Masakuni; Ishibashi, Naoya; Abe, Osamu; Takayama, Tadatoshi; Nakayama, Hisashi; Matsuoka, Shunichi; Nirei, Kazushige; Nakamura, Hitomi; Ogawa, Masahiro; Sugitani, Masahiko

2015-01-01

A 58-year-old man presented with the chief complaint of abdominal bloating and was incidentally found to have a liver tumor. As diagnostic imaging studies could not rule out malignancy, the patient underwent partial resection of segment 3 of the liver. The lesion pathologically showed eosinophilic proliferation, in addition to immunohistochemical positivity for human melanoma black 45 and Melan-A, thereby leading to the diagnosis of a hepatic perivascular epithelioid cell tumor (PEComa). A PEComa arising from the liver is relatively rare. Moreover, the name ‘PEComa’ has not yet been widely recognized, and the same disease entity has been called epithelioid angiomyolipoma (EAML), further diminishing the recognition of PEComa. In addition, PEComa imaging findings mimic those of malignant liver tumors, and clinically, this tumor tends to enlarge. Therefore, a PEComa is difficult to diagnose. We conducted a systematic review of PEComa and EAML cases and discuss the results, including findings useful for differentiating perivascular epithelioid cell tumors from malignant liver tumors. PMID:25954119

Investigation of nocturnal oviposition by necrophilous flies in central Texas.

PubMed

Baldridge, Robert S; Wallace, Susan G; Kirkpatrick, Ryan

2006-01-01

The need to accurately estimate the postmortem interval (PMI) has prompted research into factors affecting fly oviposition (i.e., oviposition and/or larviposition) on a corpse. Research efforts have focused on whether or not diurnally active flies oviposit during nighttime hours. This study reports that nocturnal oviposition (defined as occurring between 2100-0600 h CDST (Central Daylight Savings Time)) did not occur on freshly killed white rats or mice, on beef (fresh or aged up to 48 h), on freshly thawed pigs, nor, usually, on thawed pigs that were aged for up to 48 h. Limited oviposition did occur between 2100 and 2120 h on one bloated pig at a lighted rural site. Necrophilous flies were present and active at lighted and dark sites (urban and rural) before and immediately after sunset, but fly activity on the bait ceased within 50 min postsunset and did not resume until after 0600 h. These observations support other studies reporting that diurnally active flies do not oviposit during the nighttime.

Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

PubMed

Banerjee, Gourav; Rose, Alison; Briggs, Michelle; Johnson, Mark I

2017-02-24

We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function. 2017 BMJ Publishing Group Ltd.

Probiotics supplementation for athletes - clinical and physiological effects.

PubMed

Pyne, David B; West, Nicholas P; Cox, Amanda J; Cripps, Allan W

2015-01-01

Probiotic supplementation has traditionally focused on gut health. However, in recent years, the clinical applications of probiotics have broadened to allergic, metabolic, inflammatory, gastrointestinal and respiratory conditions. Gastrointestinal health is important for regulating adaptation to exercise and physical activity. Symptoms such as nausea, bloating, cramping, pain, diarrhoea and bleeding occur in some athletes, particularly during prolonged exhaustive events. Several studies conducted since 2006 examining probiotic supplementation in athletes or highly active individuals indicate modest clinical benefits in terms of reduced frequency, severity and/or duration of respiratory and gastrointestinal illness. The likely mechanisms of action for probiotics include direct interaction with the gut microbiota, interaction with the mucosal immune system and immune signalling to a variety of organs and systems. Practical issues to consider include medical and dietary screening of athletes, sourcing of recommended probiotics and formulations, dose-response requirements for different probiotic strains, storage, handling and transport of supplements and timing of supplementation in relation to travel and competition.

The Role of Phlebotomy (Fasd) and Wet Cupping (Hijamat) to Manage Dizziness and Vertigo From the Viewpoint of Persian Medicine

PubMed Central

Kordafshari, Gholamreza; Ardakani, Mohammad Reza Shams; Keshavarz, Mansoor; Esfahani, Mohammad Mehdi; Nazem, Esmaeil; Moghimi, Maryam; Zargaran, Arman; Kenari, Hoorieh Mohammadi

2016-01-01

Dizziness and vertigo are the most common complaints of patients that has a high economic burden on the health system. In modern medicine, treatment for dizziness and vertigo consists of chemical pharmacological therapy. Although these drugs are useful in controlling the disease, their side effects and inefficiency in full control of the disease require the use of complementary medicine in this field. Persian medicine consists of valuable experiences of Persian medicine scholars based on the theory of humors and temperaments. In Persian medicine, 2 types of disease are presented: dizziness (sadar) and vertigo (dovar). Persian medicine physicians expressed a different mechanism of action than modern medicine for these diseases. They believed that accumulation of abnormal humors, reeh (normal bloating) or causative pathologic substances, is the basic cause of sadar and dovar and that the most important treatment is cleansing the body, particularly the head from accumulated substances by bloodletting methods.

Premenstrual syndrome

PubMed Central

Yonkers, Kimberly Ann; O’Brien, P M Shaughn; Eriksson, Elias

2011-01-01

Most women of reproductive age have some physical discomfort or dysphoria in the weeks before menstruation. Symptoms are often mild, but can be severe enough to substantially affect daily activities. About 5–8% of women thus suffer from severe premenstrual syndrome (PMS); most of these women also meet criteria for premenstrual dysphoric disorder (PMDD). Mood and behavioural symptoms, including irritability, tension, depressed mood, tearfulness, and mood swings, are the most distressing, but somatic complaints, such as breast tenderness and bloating, can also be problematic. We outline theories for the underlying causes of severe PMS, and describe two main methods of treating it: one targeting the hypothalamus-pituitary-ovary axis, and the other targeting brain serotonergic synapses. Fluctuations in gonadal hormone levels trigger the symptoms, and thus interventions that abolish ovarian cyclicity, including long-acting analogues of gonadotropin-releasing hormone (GnRH) or oestradiol (administered as patches or implants), effectively reduce the symptoms, as can some oral contraceptives. The effectiveness of serotonin reuptake inhibitors, taken throughout the cycle or during luteal phases only, is also well established. PMID:18395582

Use of rifaximin in gastrointestinal and liver diseases

PubMed Central

Shayto, Rani H; Abou Mrad, Rachel; Sharara, Ala I

2016-01-01

Rifaximin is a broad spectrum oral antibiotic with antimicrobial activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria. It is poorly absorbed and thus has a highly favorable safety profile. Rifaximin has been shown to be effective in the treatment of traveler’s diarrhea, functional bloating and irritable bowel syndrome, small bowel bacterial overgrowth and in the prevention of recurrent overt hepatic encephalopathy. In addition, there is emerging evidence for a possible beneficial effect of rifaximin in the treatment of uncomplicated diverticular disease and in the prevention of recurrent diverticulitis. The use of rifaximin is associated with a low incidence of development, or persistence of spontaneous bacterial mutants. Moreover, the development of important drug resistance among extra-intestinal flora during rifaximin therapy is unlikely because of minimal systemic absorption and limited cross-resistance of rifaximin with other antimicrobials. This review addresses the current and emerging role of rifaximin in the treatment of gastrointestinal and liver disorders. PMID:27547007

Trastuzumab induces gastrointestinal side effects in HER2-overexpressing breast cancer patients.

PubMed

Al-Dasooqi, Noor; Bowen, Joanne M; Gibson, Rachel J; Sullivan, Thomas; Lees, Jude; Keefe, Dorothy M

2009-04-01

To characterise the gastrointestinal toxicities associated with Trastuzumab administration in HER2-overexpressing breast cancer patients. All patients (n = 46) who received Trastuzumab as a single agent or in conjunction with conventional anti-cancer treatment within the Royal Adelaide Hospital Cancer Centre from 2002-2007 were included in this study. A retrospective analysis of case-notes was conducted to investigate the toxicities associated with Trastuzumab. Trastuzumab as a single agent induced toxicities following 22% of administrations. Gastrointestinal toxicities were observed following 12% of administrations and included nausea and vomiting, diarrhoea, abdominal pain and bloating. However, other prominent toxicities that were not related to the gastrointestinal tract were also observed including fatigue and lung symptoms (10.4%). Elderly patients (> or =60 years) and those with metastatic disease experienced the highest frequency of toxicity. Trastuzumab induces a range of gastrointestinal toxicities in HER2-overexpressing breast cancer patients. These toxicities are separate to those caused by concurrent chemotherapy and/or radiotherapy.

Forensic entomology of decomposing humans and their decomposing pets.

PubMed

Sanford, Michelle R

2015-02-01

Domestic pets are commonly found in the homes of decedents whose deaths are investigated by a medical examiner or coroner. When these pets become trapped with a decomposing decedent they may resort to feeding on the body or succumb to starvation and/or dehydration and begin to decompose as well. In this case report photographic documentation of cases involving pets and decedents were examined from 2009 through the beginning of 2014. This photo review indicated that in many cases the pets were cats and dogs that were trapped with the decedent, died and were discovered in a moderate (bloat to active decay) state of decomposition. In addition three cases involving decomposing humans and their decomposing pets are described as they were processed for time of insect colonization by forensic entomological approach. Differences in timing and species colonizing the human and animal bodies were noted as was the potential for the human or animal derived specimens to contaminate one another at the scene. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Gastroparesis Updates on Pathogenesis and Management

PubMed Central

Liu, Nanlong; Abell, Thomas

2017-01-01

Gastroparesis (Gp) is a chronic disease that presents with clinical symptoms of early satiety, bloating, nausea, vomiting, and abdominal pain. Along with these symptoms, an objective finding of delayed gastric emptying, along with a documented absence of gastric outlet obstruction, are required for diagnosis. This article focuses on updates in the pathogenesis and management of Gp. Recent studies on full thickness biopsies of Gp patients have shed light on the complex interactions of the central, autonomic, and enteric nervous systems, which all play key roles in maintaining normal gut motility. The management of Gp has evolved beyond prokinetics and antiemetics with the use of gastric electrical stimulators (GES). In addition, this review aims to introduce the concept of gastroparesis-like syndrome (GLS). GLS helps groups of patients who have the cardinal symptoms of Gp but have a normal or rapid emptying test. Recent tests have shown that patients with Gp and GLS have similar pathophysiology, benefit greatly from GES placement, and likely should be treated in a similar manner. PMID:28535580

THE TRANSIT LIGHT-CURVE PROJECT. XIV. CONFIRMATION OF ANOMALOUS RADII FOR THE EXOPLANETS TrES-4b, HAT-P-3b, AND WASP-12b

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chan, Tucker; Ingemyr, Mikael; Winn, Joshua N.

2011-06-15

We present transit photometry of three exoplanets, TrES-4b, HAT-P-3b, and WASP-12b, allowing for refined estimates of the systems' parameters. TrES-4b and WASP-12b were confirmed to be 'bloated' planets, with radii of 1.706 {+-} 0.056R{sub Jup} and 1.736 {+-} 0.092R{sub Jup}, respectively. These planets are too large to be explained with standard models of gas giant planets. In contrast, HAT-P-3b has a radius of 0.827 {+-} 0.055R{sub Jup}, smaller than a pure hydrogen-helium planet and indicative of a highly metal-enriched composition. Analyses of the transit timings revealed no significant departures from strict periodicity. For TrES-4, our relatively recent observations allow formore » improvement in the orbital ephemerides, which is useful for planning future observations.« less

Application of the Taguchi Method for Optimizing the Process Parameters of Producing Lightweight Aggregates by Incorporating Tile Grinding Sludge with Reservoir Sediments

PubMed Central

Chen, How-Ji; Chang, Sheng-Nan; Tang, Chao-Wei

2017-01-01

This study aimed to apply the Taguchi optimization technique to determine the process conditions for producing synthetic lightweight aggregate (LWA) by incorporating tile grinding sludge powder with reservoir sediments. An orthogonal array L16(45) was adopted, which consisted of five controllable four-level factors (i.e., sludge content, preheat temperature, preheat time, sintering temperature, and sintering time). Moreover, the analysis of variance method was used to explore the effects of the experimental factors on the particle density, water absorption, bloating ratio, and loss on ignition of the produced LWA. Overall, the produced aggregates had particle densities ranging from 0.43 to 2.1 g/cm3 and water absorption ranging from 0.6% to 13.4%. These values are comparable to the requirements for ordinary and high-performance LWAs. The results indicated that it is considerably feasible to produce high-performance LWA by incorporating tile grinding sludge with reservoir sediments. PMID:29125576

Gastric dysmotility following orthopaedic scoliosis surgery in patients with cerebral palsy: a case series.

PubMed

Vande Velde, S; Van Biervliet, S; De Bruyne, R; Van Renterghem, K; Plasschaert, F; Van Winckel, M

2010-08-01

Scoliosis is a common complication in children with cerebral palsy (CP). In these patients, surgical correction carries a high risk of complications. CP is also associated with gastrointestinal dysmotility such as delayed gastric emptying and gastro-oesophageal reflux. We describe 5 patients with CP in whom symptoms of gastric dysmotility clearly exacerbated after orthopaedic scoliosis surgery. They all showed persisting vomiting, nausea, bloating, weight loss, and anorexia necessitating total parental nutrition and/or jejunal feeding. This intensified nutritional support resulted in weight gain. Symptoms, however, persisted in half of the patients. The aetiology of these gastro-intestinal motility problems following scoliosis surgery remains unclear. Mechanical obstruction needs to be ruled out. Delayed gastric emptying may be due to postprandial antral hypomotility as a consequence of sympathic stimulation. Malnutrition could further aggravate gastrointestinal dysmotility. This complication should be taken into account when surgery for spinal deformities in CP patients is planned, especially in patients with pre-existing gastrointestinal motility problems. © Georg Thieme Verlag KG Stuttgart · New York.

Comparison of Virulence of Legionella longbeachae Strains in Guinea Pigs and U937 Macrophage-Like Cells

PubMed Central

Doyle, Robyn M.; Cianciotto, Nicholas P.; Banvi, Shaila; Manning, Paul A.; Heuzenroeder, Michael W.

2001-01-01

A guinea pig model of experimental legionellosis was established for assessment of virulence of isolates of Legionella longbeachae. The results showed that there were distinct virulence groupings of L. longbeachae serogroup 1 strains based on the severity of disease produced in this model. Statistical analysis of the animal model data suggests that Australian isolates of L. longbeachae may be inherently more virulent than non-Australian strains. Infection studies performed with U937 cells were consistent with the animal model studies and showed that isolates of this species were capable of multiplying within these phagocytic cells. Electron microscopy studies of infected lung tissue were also undertaken to determine the intracellular nature of L. longbeachae serogroup 1 infection. The data showed that phagosomes containing virulent L. longbeachae serogroup 1 appeared bloated, contained cellular debris and had an apparent rim of ribosomes while those containing avirulent L. longbeachae serogroup 1 were compact, clear and smooth. PMID:11500403

Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

PubMed Central

Banerjee, Gourav; Rose, Alison; Briggs, Michelle; Johnson, Mark I

2017-01-01

We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function. PMID:28237944

Irritable bowel syndrome

PubMed Central

Enck, Paul; Aziz, Qasim; Barbara, Giovanni; Farmer, Adam D.; Fukudo, Shin; Mayer, Emeran A.; Niesler, Beate; Quigley, Eamonn M. M.; Rajilić-Stojanović, Mirjana; Schemann, Michael; Schwille-Kiuntke, Juliane; Simren, Magnus; Zipfel, Stephan; Spiller, Robin C.

2016-01-01

Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population prevalence. The disorder can be debilitating in some patients, whereas others may have mild or moderate symptoms. The most important single risk factors are female sex, younger age and preceding gastrointestinal infections. Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities. Currently, the diagnosis of IBS is based on symptoms and the exclusion of other organic diseases, and therapy includes drug treatment of the predominant symptoms, nutrition and psychotherapy. Although the underlying pathogenesis is far from understood, aetiological factors include increased epithelial hyperpermeability, dysbiosis, inflammation, visceral hypersensitivity, epigenetics and genetics, and altered brain–gut interactions. IBS considerably affects quality of life and imposes a profound burden on patients, physicians and the health-care system. The past decade has seen remarkable progress in our understanding of functional bowel disorders such as IBS that will be summarized in this Primer. PMID:27159638

Application of the Taguchi Method for Optimizing the Process Parameters of Producing Lightweight Aggregates by Incorporating Tile Grinding Sludge with Reservoir Sediments.

PubMed

Chen, How-Ji; Chang, Sheng-Nan; Tang, Chao-Wei

2017-11-10

This study aimed to apply the Taguchi optimization technique to determine the process conditions for producing synthetic lightweight aggregate (LWA) by incorporating tile grinding sludge powder with reservoir sediments. An orthogonal array L 16 (4⁵) was adopted, which consisted of five controllable four-level factors (i.e., sludge content, preheat temperature, preheat time, sintering temperature, and sintering time). Moreover, the analysis of variance method was used to explore the effects of the experimental factors on the particle density, water absorption, bloating ratio, and loss on ignition of the produced LWA. Overall, the produced aggregates had particle densities ranging from 0.43 to 2.1 g/cm³ and water absorption ranging from 0.6% to 13.4%. These values are comparable to the requirements for ordinary and high-performance LWAs. The results indicated that it is considerably feasible to produce high-performance LWA by incorporating tile grinding sludge with reservoir sediments.

Associational Patterns of Scavenger Beetles to Decomposition Stages.

PubMed

Zanetti, Noelia I; Visciarelli, Elena C; Centeno, Nestor D

2015-07-01

Beetles associated with carrion play an important role in recycling organic matter in an ecosystem. Four experiments on decomposition, one per season, were conducted in a semirural area in Bahía Blanca, Argentina. Melyridae are reported for the first time of forensic interest. Apart from adults and larvae of Scarabaeidae, thirteen species and two genera of other coleopteran families are new forensic records in Argentina. Diversity, abundance, and species composition of beetles showed differences between stages and seasons. Our results differed from other studies conducted in temperate regions. Four guilds and succession patterns were established in relation to decomposition stages and seasons. Dermestidae (necrophages) predominated in winter during the decomposition process; Staphylinidae (necrophiles) in Fresh and Bloat stages during spring, summer, and autumn; and Histeridae (necrophiles) and Cleridae (omnivores) in the following stages during those seasons. Finally, coleopteran activity, diversity and abundance, and decomposition rate change with biogeoclimatic characteristics, which is of significance in forensics. © 2015 American Academy of Forensic Sciences.

Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study.

PubMed

Paré, Pierre; Gray, James; Lam, Sy; Balshaw, Robert; Khorasheh, Shideh; Barbeau, Martin; Kelly, Suzanne; McBurney, Christopher R

2006-10-01

Abdominal pain/discomfort, bloating, and constipation are gastrointestinal dysmotility and sensory symptoms associated with irritable bowel syndrome (IBS). No studies have followed patients with IBS symptoms for 1 year under conditions of routine clinical practice to assess prospectively the impact of treatments on health outcomes. The objective of this ongoing, naturalistic study is to assess the long-term impact of IBS treatments on quality of life (QOL), work productivity, and resource utilization. This report describes the baseline characteristics and patterns of care of the patients enrolled in this study. Patients with physician-diagnosed IBS symptoms were enrolled from 147 physician sites across Canada between May 4, 2004, and March 31, 2005. Clinical data were collected at baseline and at the end of the 12-month follow-up (patients were followed for 1 year between May 4, 2005, and March 31, 2006). Patient-reported outcomes were collected at baseline and at months 1, 2, 6, 9, and 12. Health-related QOL, health status, and work productivity were assessed with the IBS-QOL, a 5-item EuroQol descriptive system, and Work Productivity and Activity Impairment questionnaires, respectively. A resource utilization questionnaire elicited information on physician; visits, treatments, and procedures. Baseline data are reported here. Data were obtained from 1555 patients; 85.1% (1320/1552) were women. Patients had a mean (SD) age of 45.8 (15.0) years and mean (SD) duration of IBS symptoms of 11.4 (11.5) years. Self-reported bowel patterns were predominantly constipation (41.0%, 587/1433) and constipation alternating with diarrhea (39.4%, 564/1433); 60.3% (938/1555) of subjects used > or =3 IBS treatments in the previous 4 weeks. Approximately 50% of all patients reported distress "quite a bit or "extremely" for abdominal pain, gas, bloating, and constipation. The mean overall IBS-QOL score (0-100 scale, with 0 indicating poor QOL) was 66.3; food avoidance (51.8) and health worry (59.3) were the most serious concerns. Patients reported 5.6% work absenteeism, 31.4% presenteeism, and 34.6% overall work productivity loss, equivalent to 13.8 hours lost productivity per 40-hour workweek. The baseline data from this ongoing, prospective, naturalistic study are consistent with previous findings that suggested significant use of health care resources with concomitant low QOL and decreased work productivity in patients with IBS symptoms.

The use of probiotics in healthy volunteers with evacuation disorders and hard stools: a double-blind, randomized, placebo-controlled study.

PubMed

Del Piano, Mario; Carmagnola, Stefania; Anderloni, Andrea; Andorno, Silvano; Ballarè, Marco; Balzarini, Marco; Montino, Franco; Orsello, Marco; Pagliarulo, Michela; Sartori, Massimo; Tari, Roberto; Sforza, Filomena; Capurso, Lucio

2010-09-01

Evacuation disorders and hard stools are common in industrialized countries, affecting on average 12% to 17% of the adult healthy population at any age. Dietary supplementation with probiotic microorganisms may be useful in reducing the disorder. We performed a double-blind, randomized, placebo-controlled study to evaluate the effectiveness of 2 different probiotic blends, either mixed Lactobacillus plantarum LP01 (LMG P-21021) and Bifidobacterium breve BR03 (DSM 16604) or Bifidobacterium animalis subspecies lactis BS01 (LMG P-21384), in the management of evacuation disorders and intestinal discomfort. In a period of 5 years (2003 to 2008), the study involved 300 healthy volunteers (151 males and 149 females; age 24 to 71 y) with evacuation disorders and hard stools. In particular, subjects were divided into 3 groups: 80 subjects in the group A received placebo, 110 subjects in the group B received mixed L. plantarum LP01 and B. breve BR03 (2.5 x 10 colony-forming units/d of each strain), and 110 subjects in the group C received B. animalis subsp. lactis BS01 (5 x 10 colony-forming units/d) for 30 days. At the beginning of the observational study, the healthy status of volunteers was evaluated by a complete, laboratory and ultrasound study of the abdomen. The physical examination was repeated after 15 and 30 days. In particular, the main troubles typically associated with evacuation disorders and hard stools as well as abdominal bloating were considered as parameters of interest. Exclusion criteria were items of gastrointestinal diseases and antibiotics intake. Subjects treated with the mixed probiotic strains L. plantarum LP01 and B. breve BR03 or B. animalis subsp. lactis BS01 reported a significant improvement in the number of weekly bowel movements and in the main troubles associated with evacuations, particularly consistency of feces and ease of expulsion. Discomfort items such as abdominal bloating and anal itching, burning, or pain also registered a relevant improvement in the active groups receiving probiotics. The intake of an effective amount of mixed L. plantarum LP01 and B. breve BR03 or B. animalis subsp. lactis BS01 for 30 days is able to significantly relieve the evacuation disorders and hard stools, thus providing a useful tool for the management of such condition, which is particularly widespread in industrialized countries at any age.

A Randomized Controlled Trial Comparing the Low FODMAP Diet vs. Modified NICE Guidelines in US Adults with IBS-D.

PubMed

Eswaran, Shanti L; Chey, William D; Han-Markey, Theresa; Ball, Sarah; Jackson, Kenya

2016-12-01

There has been an increasing interest in the role of fermentable oligo-, di-, and monosaccharides and polyols (FODMAPs) in irritable bowel syndrome (IBS). We report results from the first randomized controlled trial of the low FODMAP diet in US adults with IBS and diarrhea (IBS-D). The objectives were to compare the efficacy of the low FODMAP diet vs. a diet based upon modified National Institute for Health and Care Excellence guidelines (mNICE) on overall and individual symptoms in IBS-D patients. This was a single-center, randomized-controlled trial of adult patients with IBS-D (Rome III) which compared 2 diet interventions. After a 2-week screening period, eligible patients were randomized to a low FODMAP or mNICE diet for 4 weeks. The primary end point was the proportion of patients reporting adequate relief of IBS-D symptoms ≥50% of intervention weeks 3-4. Secondary outcomes included a composite end point which required response in both abdominal pain (≥30% reduction in mean daily pain score compared with baseline) and stool consistency (decrease in mean daily Bristol Stool Form of ≥1 compared with baseline), abdominal pain and stool consistency responders, and other key individual IBS symptoms assessed using daily questionnaires. After screening, 92 subjects (65 women, median age 42.6 years) were randomized. Eighty-four patients completed the study (45 low FODMAP, 39 mNICE). Baseline demographics, symptom severity, and nutrient intake were similar between groups. Fifty-two percent of the low FODMAP vs. 41% of the mNICE group reported adequate relief of their IBS-D symptoms (P=0.31). Though there was no significant difference in the proportion of composite end point responders (P=0.13), the low FODMAP diet resulted in a higher proportion of abdominal pain responders compared with the mNICE group (51% vs. 23%, P=0.008). Compared with baseline scores, the low FODMAP diet led to greater reductions in average daily scores of abdominal pain, bloating, consistency, frequency, and urgency than the mNICE diet. In this US trial, 40-50% of patients reported adequate relief of their IBS-D symptoms with the low FODMAP diet or a diet based on modified NICE guidelines. The low FODMAP diet led to significantly greater improvement in individual IBS symptoms, particularly pain and bloating, compared with the mNICE diet.

Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis.

PubMed

Marsh, Abigail; Eslick, Enid M; Eslick, Guy D

2016-04-01

Functional gastrointestinal symptoms such as abdominal pain, bloating, distension, constipation, diarrhea and flatulence have been noted in patients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD). The diversity of symptoms has meant that finding an effective treatment has been challenging with most treatments alleviating only the primary symptom. A novel treatment option for IBS and IBD currently generating much excitement is the low fermentable, oligo-, di-, mono-saccharides and polyol (FODMAP) diet. The aim of this meta-analysis was to determine the evidence of the efficacy of such a diet in the treatment of functional gastrointestinal symptoms. Electronic databases were searched through to March 2015 to identify relevant studies. Pooled odds ratios (ORs) and 95 % confidence intervals were calculated for the effect of a low FODMAP diet on the reduction in IBS [Symptoms Severity Score (SSS)] score and increase in IBS quality of life (QOL) score for both randomized clinical trials (RCTs) and non-randomized interventions using a random-effects model. Six RCTs and 16 non-randomized interventions were included in the analysis. There was a significant decrease in IBS SSS scores for those individuals on a low FODMAP diet in both the RCTs (OR 0.44, 95 % CI 0.25-0.76; I (2) = 35.52, p = 0.00) and non-randomized interventions (OR 0.03, 95 % CI 0.01-0.2; I (2) = 69.1, p = 0.02). In addition, there was a significant improvement in the IBS-QOL score for RCTs (OR 1.84, 95 % CI 1.12-3.03; I (2) = 0.00, p = 0.39) and for non-randomized interventions (OR 3.18, 95 % CI 1.60-6.31; I (2) = 0.00, p = 0.89). Further, following a low FODMAP diet was found to significantly reduce symptom severity for abdominal pain (OR 1.81, 95 % CI 1.13-2.88; I (2) = 0.00, p = 0.56), bloating (OR 1.75, 95 % CI 1.07-2.87; I (2) = 0.00, p = 0.45) and overall symptoms (OR 1.81, 95 % CI 1.11-2.95; I (2) = 0.00, p = 0.4) in the RCTs. In the non-randomized interventions similar findings were observed. The present meta-analysis supports the efficacy of a low FODMAP diet in the treatment of functional gastrointestinal symptoms. Further research should ensure studies include dietary adherence, and more studies looking at greater number of patients and long-term adherence to a low FODMAP diet need to be conducted.

Pin Worms Presenting as Suspected Crohn’s Disease

PubMed Central

Al-Saffar, Farah; Najjar, Nimeh; Ibrahim, Saif; Clark, Matthew

2015-01-01

Patient: Female, 24 Final Diagnosis: Pinworms infection Symptoms: Abdominal pain • bloating Medication: — Clinical Procedure: Colonoscopy and biopsy Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Inflammatory bowel disease (IBD) is well recognized in developed countries and is generally among the differential diagnoses of young patients presenting with refractory diarrhea once other more common etiologies have been excluded. Pinworm infections, on the other hand, are not as common among adults in the United States. Case Report: Based on computed tomography features, a 24-year-old female patient with a history of multiple autoimmune disorders presented with abdominal pain and was diagnosed recently with Crohn’s disease. Colonoscopy was significant for pinworms seen throughout the colon. Colonic biopsy was negative for inflammatory bowel disease (IBD)-related changes. Conclusions: The diagnosis of IBD is a serious label that requires biopsy confirmation before committing to possibly lifelong treatment and possible adverse effects. Even in the most typical patient and when the presentation and imaging are classical, uncommon conditions (like Enterobius infection in this case) may preclude appropriate diagnosis and management. PMID:26471462

The mind-body connection in irritable bowel syndrome: A randomised controlled trial of hypnotherapy as a treatment.

PubMed

Phillips-Moore, Julie S; Talley, Nicholas J; Jones, Michael P

2015-01-01

Hypnotherapy has been reported as being beneficial in the treatment of irritable bowel syndrome (IBS). We aimed to test the hypothesis that patients with IBS treated 'holistically' by hypnosis (i.e. by combined psychological and physiological symptom imagery) would have greater improvement in their IBS symptoms than patients treated by hypnosis using standard 'gut-directed' hypnotherapy, and both would be superior to simple relaxation therapy. Patients ( n  = 51) with Rome II criteria were randomised to 'individualised' (holistic) hypnotherapy, standard 'gut-directed' hypnotherapy or relaxation therapy for a period of 11 weeks with two follow-up assessments at 2 weeks and at 3 months after the completion of the trial. The primary outcome was bowel symptom severity scale (BSSS). All the participants in this study improved their IBS symptoms (pain, bloating, constipation and diarrhoea) and physical functioning at the end of the treatment from baseline, but this was not significantly different across the treatment arms. Neither 'individualised' nor 'gut-directed' hypnotherapy is superior to relaxation therapy in IBS.

Families of FPGA-Based Accelerators for Approximate String Matching1

PubMed Central

Van Court, Tom; Herbordt, Martin C.

2011-01-01

Dynamic programming for approximate string matching is a large family of different algorithms, which vary significantly in purpose, complexity, and hardware utilization. Many implementations have reported impressive speed-ups, but have typically been point solutions – highly specialized and addressing only one or a few of the many possible options. The problem to be solved is creating a hardware description that implements a broad range of behavioral options without losing efficiency due to feature bloat. We report a set of three component types that address different parts of the approximate string matching problem. This allows each application to choose the feature set required, then make maximum use of the FPGA fabric according to that application’s specific resource requirements. Multiple, interchangeable implementations are available for each component type. We show that these methods allow the efficient generation of a large, if not complete, family of accelerators for this application. This flexibility was obtained while retaining high performance: We have evaluated a sample against serial reference codes and found speed-ups of from 150× to 400× over a high-end PC. PMID:21603598

Frothy feedlot bloat in cattle: production of extracellular polysaccharides and development of viscosity in cultures of Streptococcus bovis.

PubMed

Cheng, K J; Hironaka, R; Jones, G A; Nicas, T; Costerton, J W

1976-04-01

Streptococcus bovis was cultured in a synthetic medium with three concentrations of sucrose. Initial viscosity of the media was 1.5 centipoise (cp). After incubation for 8 h, the viscosity of the medium with 0.5% sucrose was unchanged, that with 3% sucrose had increased to 8 cp, and that with 6% sucrose to 112 cp. Similar results were found with a rumen fluid medium. A slimy material, responsible for increased viscosity of these cultures, was digested by dextranase. The material appeared as a complex system of intercellular fibers when viewed under the electron microscope after freeze-etching. With proteins and other polymers released from lysed bacteria, this slimy material may contribute directly to increased viscosity and foam formation. In addition to these intercellular fibers, each cell was surrounded by a fibrous capsule that was not digested by dextranase. This capsule stained with lead citrate and uranyl acetate, but not with ruthenium red. The amount of capsular material produced was similar whether the media contained 0.5, 3.0, or 6% sucrose.

Prevalence of premenstrual syndrome and premenstrual dysphoric disorder in a population-based sample in China.

PubMed

Qiao, Mingqi; Zhang, Huiyun; Liu, Huimin; Luo, Songping; Wang, Tianfang; Zhang, Junlong; Ji, Lijin

2012-05-01

To investigate the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), and the frequency and severity of the symptoms in a population-based sample of Chinese women of reproductive age. Women aged 18-45 years were screened for suspected PMS and PMDD based on the ACOG recommendations for a diagnosis of PMS and diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV). For those who were consistent with PMS diagnostic criteria, the daily record of severity of problems (DRSP) questionnaire was used to assess the symptoms prospectively over 2 months. Participants were then categorized as having no perceived symptoms, mild PMS, moderate PMS, and PMDD, based on a validated algorithm. Among the study group, the incidence of PMDD was 2.1% and PMS was 21.1%. The most common symptoms were irritability (91.21%), breast tenderness (77.62%), depression (68.31%), abdominal bloating (63.70%) and angry outbursts (59.62%). The prevalence of PMS/PMDD and the frequency and severity of the symptoms have their own characteristics in Chinese women. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Update on Research and Treatment of Premenstrual Dysphoric Disorder

PubMed Central

Cunningham, Joanne; Yonkers, Kimberly Ann; O'Brien, Shaughn; Eriksson, Elias

2011-01-01

Many women in their reproductive years experience some mood, behavioral. or physical symptoms in the week prior to menses. Variability exists in the level of symptom burden in that some women experience mild symptoms, whereas a small minority experience severe and debilitating symptoms. For an estimated 5%–8% of premenopausal women, work or social functioning are affected by severe premenstrual syndrome. Many women in this group meet diagnostic criteria for premenstrual dysphoric disorder (PMDD). Among women who suffer from PMDD, mood and behavioral symptoms such as irritability, depressed mood, tension, and labile mood dominate. Somatic complaints, including breast tenderness and bloating, also can prove disruptive to women's overall functioning and quality of life. Recent evidence suggests that individual sensitivity to cyclical variations in levels of gonadal hormones may predispose certain women to experience these mood, behavioral, and somatic symptoms. Treatments include: antidepressants of the serotonin reuptake inhibitor class, taken intermittently or throughout the menstrual cycle; medications that suppress ovarian cyclicity; and newer oral contraceptives with novel progestins. (Harv Rev Psychiatry 2009;17:120–137.) PMID:19373620

MtPAR MYB transcription factor acts as an on switch for proanthocyanidin biosynthesis in Medicago truncatula

PubMed Central

Verdier, Jerome; Zhao, Jian; Torres-Jerez, Ivone; Ge, Shujun; Liu, Chenggang; He, Xianzhi; Mysore, Kirankumar S.; Dixon, Richard A.; Udvardi, Michael K.

2012-01-01

MtPAR (Medicago truncatula proanthocyanidin regulator) is an MYB family transcription factor that functions as a key regulator of proanthocyanidin (PA) biosynthesis in the model legume Medicago truncatula. MtPAR expression is confined to the seed coat, the site of PA accumulation. Loss-of-function par mutants contained substantially less PA in the seed coat than the wild type, whereas levels of anthocyanin and other specialized metabolites were normal in the mutants. In contrast, massive accumulation of PAs occurred when MtPAR was expressed ectopically in transformed hairy roots of Medicago. Transcriptome analysis of par mutants and MtPAR-expressing hairy roots, coupled with yeast one-hybrid analysis, revealed that MtPAR positively regulates genes encoding enzymes of the flavonoid–PA pathway via a probable activation of WD40-1. Expression of MtPAR in the forage legume alfalfa (Medicago sativa) resulted in detectable levels of PA in shoots, highlighting the potential of this gene for biotechnological strategies to increase PAs in forage legumes for reduction of pasture bloat in ruminant animals. PMID:22307644

Physiologic and psychologic symptoms associated with use of injectable contraception and 20 microg oral contraceptive pills.

PubMed

Berenson, Abbey B; Odom, Susan D; Breitkopf, Carmen Radecki; Rahman, Mahbubur

2008-10-01

The objective of the study was to compare menstrual, physiologic, and psychologic symptoms over 2 years among women initiating use of depot medroxyprogesterone acetate or an oral contraceptive pill with a reduced pill-free interval and those not using hormonal contraception. A total of 608 women reported their experience regarding 17 symptoms prior to initiating contraception and every 6 months thereafter for 24 months. Longitudinal relationships between symptoms and contraceptives were assessed after adjusting for age, visits, and baseline status of symptoms. Oral contraceptive pills were protective against mastalgia (odds ratio [OR], 0.7), cramping (OR, 0.5), hair loss (OR, 0.6), acne (OR, 0.4), nervousness (OR, 0.5), and mood swings (OR, 0.7). Depot medroxyprogesterone acetate (DMPA) was protective against bloating (OR, 0.5) and mood swings (OR, 0.7) but caused weight gain (OR, 2.3), bleeding episodes more than 20 days (OR, 13.4), and missed periods (OR, 96.9). Both methods caused intermenstrual bleeding. Evidence-based data regarding beneficial and adverse symptoms associated with these methods may help clinicians counsel patients appropriately prior to contraceptive initiation.

Excessive belching and aerophagia: two different disorders.

PubMed

Bredenoord, Albert J

2010-05-01

Belching is physiological venting of excessive gastric air. Excessive and bothersome belching is a common symptom, which is often seen in patients with functional dyspepsia and gastroesophageal reflux disease. Other symptoms are usually predominant. However, a small group of patients complain of isolated excessive belching, with a frequency of several belches per minute. In these patients, the eructated air does not originate from the stomach but is sucked or injected in the esophagus from the pharynx and expelled immediately afterward in oral direction. This behavior is called supragastric belching because the air does not originate from the stomach and does not reach the stomach either. Excessive belching can be treated by speech therapy or behavior therapy. The term aerophagia should be reserved for those patients where there is evidence that they swallow air too frequently and in too large quantities. These patients have excessive amounts of intestinal gas visualized on a plain abdominal radiogram and their primary symptoms are bloating and abdominal distension and they belch only to a lesser degree. Aerophagia and excessive supragastric belching are thus two distinct disorders.

Initial insights into bacterial succession during human decomposition.

PubMed

Hyde, Embriette R; Haarmann, Daniel P; Petrosino, Joseph F; Lynne, Aaron M; Bucheli, Sibyl R

2015-05-01

Decomposition is a dynamic ecological process dependent upon many factors such as environment, climate, and bacterial, insect, and vertebrate activity in addition to intrinsic properties inherent to individual cadavers. Although largely attributed to microbial metabolism, very little is known about the bacterial basis of human decomposition. To assess the change in bacterial community structure through time, bacterial samples were collected from several sites across two cadavers placed outdoors to decompose and analyzed through 454 pyrosequencing and analysis of variable regions 3-5 of the bacterial 16S ribosomal RNA (16S rRNA) gene. Each cadaver was characterized by a change in bacterial community structure for all sites sampled as time, and decomposition, progressed. Bacteria community structure is variable at placement and before purge for all body sites. At bloat and purge and until tissues began to dehydrate or were removed, bacteria associated with flies, such as Ignatzschineria and Wohlfahrtimonas, were common. After dehydration and skeletonization, bacteria associated with soil, such as Acinetobacter, were common at most body sites sampled. However, more cadavers sampled through multiple seasons are necessary to assess major trends in bacterial succession.

Safety evaluation of lubiprostone in the treatment of constipation and irritable bowel syndrome.

PubMed

Chamberlain, Sherman M; Rao, Satish S C

2012-09-01

Lubiprostone is approved in the United States for the treatment of chronic idiopathic constipation and constipation predominant irritable bowel syndrome (IBS-C). Lubiprostone causes secretion of fluid and electrolytes in the small bowel, through the activation of chloride channels, and thereby induces laxation and improvement of bowel functions. It is generally considered to be safe and effective. Common side effects of lubiprostone include nausea, diarrhea, abdominal pain and bloating, and the rare side effect dyspnea. Likely mechanisms for these side effects may be related to lubiprostone's primary action on small bowel secretion and the associated intestinal distension, as well as smooth muscle contraction. This article reviews the pharmacokinetic and safety profile of lubiprostone, with particular relevance to the two FDA-approved dosages. Lubiprostone acts topically in the gut lumen and is almost completely metabolized in the gut lumen. Lubiprostone's M3 metabolite can be detected in low concentrations in the serum and may be responsible for some of its side effects. However, the exact mechanisms by which the side effects are produced are currently unknown.

Combination could be another tool for bowel preparation?

PubMed Central

Soh, Jae Seung; Kim, Kyung-Jo

2016-01-01

Optimal bowel preparation increases the cecal intubation rate and detection of neoplastic lesions while decreasing the procedural time and procedural-related complications. Although high-volume polyethylene glycol (PEG) solution is the most frequently used preparation for bowel cleansing, patients are often unwilling to take PEG solution due to its large volume, poor palatability, and high incidence of adverse events, such as abdominal bloating and nausea. Other purgatives include osmotic agents (e.g., sodium phosphate, magnesium citrate, and sodium sulfate), stimulant agents (e.g., senna, bisacodyl, and sodium picosulfate), and prokinetic agents (e.g., cisapride, mosapride, and itopride). A combination of PEG with an osmotic, stimulant, or prokinetic agent could effectively reduce the PEG solution volume and increase patients’ adherence. Some such solutions have been found in several published studies to not be inferior to PEG alone in terms of bowel cleansing quality. Although combination methods showed similar efficacy and safety, the value of these studies is limited by shortcomings in study design. New effective and well-tolerated combination preparations are required, in addition to rigorous new validated studies. PMID:26973388

Dismantling the dinosaurs: A look at U. S. M and A trends

DOE Office of Scientific and Technical Information (OSTI.GOV)

Caldwell, R.H.; Heather, D.I

1992-11-09

Current trends in the oil and gas merger and acquisition (M and A) marketplace suggest that business as usual isn't usual anymore. Are these trends the harbinger of bad tidings Will the industry collapse continue to take on dimensions of a full scale implosion, or are we sitting on the brink of the next boom What we know at this point is that the dinosaurs-the short-sighted, the bloated, the arrogant, the unchanging-are going extinct. Companies are disappearing. Survivors are turning lean and flexible. The industry isn't just changing; it's evolving a new breed, with M and A activity a bridgemore » between the old and the new. The current state of the industry is shocking. We all know that drilling activity is at its lowest level in 4 decades. That is why acquisitions are the only game in town and why the acquisition business is booming. If drilling activity is down about 25%, that is small beans compared with acquisitions, which are down 50-70%.« less

[Irritable bowel syndrome, celiac disease and gluten].

PubMed

Mearin, Fermín; Montoro, Miguel

2014-08-04

For many years irritable bowel syndrome (IBS) and celiac disease (CD) have been considered 2 completely separate entities, with CD being clearly related to a permanent gluten intolerance and IBS having no relation with gluten ingestion. However IBS and CD symptoms may be indistinguishable, especially when diarrhea, bloating or abdominal pain predominate. In the last decade several studies have shown that the separation between CD and IBS is not so clear. Thus, some patients who have been diagnosed of IBS suffer in fact from CD. In addition, it seems that there is a group of patients who, without having CD, suffer gluten intolerance that cause them digestive symptoms similar to those of IBS. Gluten sensitivity is defined as the spectrum of morphological, immunological and functional abnormalities that respond to a gluten-free diet. This concept includes histological, immunological and clinical manifestations in the absence of evident morphological abnormalities. Therefore, it is mandatory to establish in a scientific way in which patients a gluten-free diet will be beneficial as well as when this is not justified. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Bit-Grooming: Shave Your Bits with Razor-sharp Precision

NASA Astrophysics Data System (ADS)

Zender, C. S.; Silver, J.

2017-12-01

Lossless compression can reduce climate data storage by 30-40%. Further reduction requires lossy compression that also reduces precision. Fortunately, geoscientific models and measurements generate false precision (scientifically meaningless data bits) that can be eliminated without sacrificing scientifically meaningful data. We introduce Bit Grooming, a lossy compression algorithm that removes the bloat due to false-precision, those bits and bytes beyond the meaningful precision of the data.Bit Grooming is statistically unbiased, applies to all floating point numbers, and is easy to use. Bit-Grooming reduces geoscience data storage requirements by 40-80%. We compared Bit Grooming to competitors Linear Packing, Layer Packing, and GRIB2/JPEG2000. The other compression methods have the edge in terms of compression, but Bit Grooming is the most accurate and certainly the most usable and portable.Bit Grooming provides flexible and well-balanced solutions to the trade-offs among compression, accuracy, and usability required by lossy compression. Geoscientists could reduce their long term storage costs, and show leadership in the elimination of false precision, by adopting Bit Grooming.

An Appraisal of Decomposition Cases Received at the Johannesburg Forensic Pathology Service Medico-legal Mortuary During 2010-2011.

PubMed

Keyes, Craig A; Hill, Lawrence; Gordon, Guinevere M

2016-03-01

Decomposed bodies pose many questions for researchers regarding environmental effects, cause of death, and patterns. This study aimed to observe the factors associated with decomposed bodies autopsied at the Johannesburg Forensic Pathology Service Medico-legal Mortuary. A total of 4876 autopsies were conducted from 2010 to 2011, of which 109 were decomposed. Black individuals made up the largest proportion (67%) followed by White (26%). Males comprised 86.2%, while 12.8% were female. The mean age was 42.78 years. Most cases were in the early stages of decomposition (49.5%), with 32.1% bloated, 11.9% in active decay, 2.8% in advanced decay, and 3.7% were skeletal. Insect activity was identified in 25.7% of decomposition cases. Cause of death was determined in 48.6% of cases. Of all the cases, 64% were found indoors and 23% outdoors, while 23% had insufficient information regarding the location. Of considerable interest was the number of cases from hospitals and clinics. © 2015 American Academy of Forensic Sciences.

Herbal Medicines for the Management of Irritable Bowel Syndrome: A Systematic Review.

PubMed

Bahrami, Hamid Reza; Hamedi, Shokouhsadat; Salari, Roshanak; Noras, Mohammadreza

2016-08-01

Irritable Bowel Syndrome (IBS) is a chronic digestive disorder, which is characterized by abdominal pain, bloating, diarrhea and constipation periods. The etiology is unknown. Based on the different mechanisms in the etiology, treatment focuses on controlling symptoms. Due to the longtime of syndrome, inadequacy of current treatments, financial burden for patients and pharmacologic effects, several patients have turned to the use of complementary and alternative medicine (CAM). Complementary and alternative treatments for IBS include hypnosis, acupuncture, cognitive behavior therapy, yoga, and herbal medicine. Herbal medicines can have therapeutic effects and adverse events in IBS. The aim of this study was to evaluate the efficacy of herbal medicines in the control of IBS, and their possible mechanisms of action were reviewed. Herbal medicines are an important part of the health care system in many developing countries It is important for physicians to understand some of the more common forms of CAM, because some herbs have side effects and some have interactions with conventional drugs. However herbal medicines may have therapeutic effects in IBS, and further clinical research is needed to assess its effectiveness and safety.

[An analysis of clinical features of celiac disease patients in different ethnic].

PubMed

Geng, W; Qiao, X B; Ji, K Y; Wang, H F; Yang, A M

2016-08-01

To summarize the clinical features of different racial patients with celiac disease (CD) and analyze the disease prevalence, diagnosis and treatment in Chinese population. All the patients were diagnosed as CD and enrolled in Beijing United Family Hospital between January 2005 and July 2015.Clinical data including nationality, age, symptoms, endoscopic and pathological findings, outcome were collected and compared in patients from different countries. A total of 87 patients were enrolled including 63 Caucasians, 18 Asian patients and 6 Middle East patients.The peak age of disease onset was 40-60 years old.Patients with typical symptoms such as chronic diarrhea and weight loss only accounted for 20.7%(18/87) and 9.2%(8/87) respectively.Some patients presented with nonspecific symptoms such as abdominal pain and bloating [32.2%(28/87)], even constipation [5.7%(5/87)].13.8%(12/87) patients were previously diagnosed as irritable bowel syndrome.The incidence of abdominal pain, bloating, diarrhea and constipation between Asians and Caucasians had no statistical significance (P>0.05); but the proportions of weight loss, growth retardation, iron deficiency anemia and dermatitis herpetiformis in Asian group were significantly higher than that in Caucasian group (P<0.05). IgA type of anti-gliadin antibody (AGA), endomysium antibody (EMA) and tissue transglutaminase antibody (tTGA) were dominant autoimmune antibodies in patients with CD, which accounted for 58.6%(51/87), 44.8%(39/87) and 36.8%(32/87) respectively.The endoscopy showed that the lesion of CD was mainly located in small intestine, with reducing severity from the proximal to the distal small intestine.The lesions of duodenal bulb and descending duodenum appeared more significant in Asian group.Accordingly pathological intestinal atrophy and the degree of intraepithelial lymphocytosis were more severe in Asian patients.All 87 cases took the gluten-free diet (GFD). Eighty-one cases received serological follow up and 8 with endoscopic intestinal biopsy.The celiac disease antibodies in 47 patients turned negative from 6-9 months after GFD treatment, while 34 patients turned negative from 12-18 months after GFD.All patients reported disease remission to some extent.After 1 year GFD treatment, the pathology of endoscopic intestinal biopsy in 8 patients showed significant improvement of villous atrophy and lymphocyte infiltration. CD patients with typical clinical manifestations are not the majority.Serological celiac disease antibodies (AGA, EMA and tTGA) have a high diagnostic value.GFD treatment is effective on majority of celiac patients.Clinical manifestations, endoscopy, intestinal pathology, and response to GFD in Chinese patients are not the same as Caucasians.Clinicians need to pay attention to the differential diagnosis.

Effects of dietary changes and yeast culture (Saccharomyces cerevisiae) on rumen microbial fermentation of Holstein heifers.

PubMed

Moya, D; Calsamiglia, S; Ferret, A; Blanch, M; Fandiño, J I; Castillejos, L; Yoon, I

2009-09-01

The effects of a dietary challenge to induce digestive upsets and supplementation with yeast culture on rumen microbial fermentation were studied using 12 Holstein heifers (277 +/- 28 kg of BW) fitted with a ruminal cannula, in a crossover design with 2 periods of 5 wk. In each period, after 3 wk of adaptation to a 100% forage diet, the dietary challenge consisted of increasing the amount of grain at a rate of 2.5 kg/d (as-fed basis) over a period of 4 d, until a 10:90 forage:concentrate diet was reached, and then it was maintained for 10 d. Between periods, animals were fed again the 100% forage diet without any treatment for 1 wk as a wash-out period. Treatments started the first day of each period, and they were a control diet (CL) or the same diet with addition of yeast culture (YC, Diamond V XPCLS). Digestive upsets were determined by visual observation of bloat or by a reduction in feed intake (as-fed basis) of 50% or more compared with intake on the previous day. Feed intake was determined daily at 24-h intervals during the adaptation period and daily at 2, 6, and 12 h postfeeding during the dietary challenge. Ruminal liquid samples were collected daily during the dietary challenge to determine ruminal pH at 0, 3, 6, and 12 h postfeeding, and total and individual VFA, lactic acid, ammonia-N, and rumen fluid viscosity at 0 and 6 h postfeeding. The 16s rRNA gene copies of Streptococcus bovis and Megasphaera elsdenii were determined by quantitative PCR. Foam height and strength of the rumen fluid were also determined the day after the digestive upset to evaluate potential foam production. A total of 20 cases (83.3%) of digestive upsets were recorded in both periods during the dietary challenge, all diagnosed due to a reduction in feed intake. Rumen fermentation profile at 0 h on the digestive upset day was characterized by low ruminal pH, which remained under 6.0 for 18 h, accompanied by elevated total VFA concentration and, in some cases, by elevated lactate concentration. Addition of YC during the dietary challenge did not affect the incidence (10 cases per treatment) or time (7.00 +/- 0.62 d) to digestive upset. However, YC reduced (P < 0.05) the foam strength on the day after digestive upset, suggesting potential benefits of reducing the risk of developing bloat. The proposed dietary challenge model was successful in causing a digestive upset as indicated by reduced feed intake, but the YC addition had no significant impact on rumen fermentation.

Transoral incisionless fundoplication: current status.

PubMed

Sami Trad, Karim

2016-07-01

Transoral incisionless fundoplication (TIF) performed with the EsophyX device (Redmond, Washington, USA) is a totally endoscopic procedure with the objectives to mechanically repair a defective gastroesophageal valve and to reduce small hiatal hernias. The recent publication of randomized controlled trials and long-term follow-up data offers the opportunity to reevaluate this treatment modality and its role in the management of patients with chronic gastroesophageal reflux disease (GERD). Randomized controlled trials have confirmed the ability of TIF to eliminate troublesome GERD symptoms, heal esophagitis, and improve distal esophageal acid exposure in appropriately selected patient populations. These studies establish TIF's superiority to conventional medical therapy, especially in clinical scenarios where proton-pump inhibitors fail to provide complete symptom relief across the spectrum of classic and atypical GERD manifestations, including regurgitation and laryngopharyngeal reflux. Long-term data indicate sustained positive outcomes and durability up to 6 years after procedure. These results were achieved with a low rate of serious adverse events and usually without introducing troublesome dysphagia, gas bloat, or flatulence. Based on the most recent data, TIF appears to be a valuable treatment alternative for the management of appropriately selected patients with moderate to severe chronic GERD symptoms.

Irritable bowel syndrome: new insights into symptom mechanisms and advances in treatment

PubMed Central

Spiller, Robin

2016-01-01

Despite being one of the most common conditions leading to gastroenterological referral, irritable bowel syndrome (IBS) is poorly understood. However, recent years have seen major advances. These include new understanding of the role of both inflammation and altered microbiota as well as the impact of dietary intolerances as illuminated by magnetic resonance imaging (MRI), which has thrown new light on IBS. This article will review new data on how excessive bile acid secretion mediates diarrhea and evidence from post infectious IBS which has shown how gut inflammation can alter gut microbiota and function. Studies of patients with inflammatory bowel disease (IBD) have also shown that even when inflammation is in remission, the altered enteric nerves and abnormal microbiota can generate IBS-like symptoms. The efficacy of the low FODMAP diet as a treatment for bloating, flatulence, and abdominal discomfort has been demonstrated by randomized controlled trials. MRI studies, which can quantify intestinal volumes, have provided new insights into how FODMAPs cause symptoms. This article will focus on these areas together with recent trials of new agents, which this author believes will alter clinical practice within the foreseeable future. PMID:27158477

The mind–body connection in irritable bowel syndrome: A randomised controlled trial of hypnotherapy as a treatment

PubMed Central

Talley, Nicholas J; Jones, Michael P

2015-01-01

Background: Hypnotherapy has been reported as being beneficial in the treatment of irritable bowel syndrome (IBS). We aimed to test the hypothesis that patients with IBS treated ‘holistically’ by hypnosis (i.e. by combined psychological and physiological symptom imagery) would have greater improvement in their IBS symptoms than patients treated by hypnosis using standard ‘gut-directed’ hypnotherapy, and both would be superior to simple relaxation therapy. Methods: Patients (n = 51) with Rome II criteria were randomised to ‘individualised’ (holistic) hypnotherapy, standard ‘gut-directed’ hypnotherapy or relaxation therapy for a period of 11 weeks with two follow-up assessments at 2 weeks and at 3 months after the completion of the trial. The primary outcome was bowel symptom severity scale (BSSS). Results: All the participants in this study improved their IBS symptoms (pain, bloating, constipation and diarrhoea) and physical functioning at the end of the treatment from baseline, but this was not significantly different across the treatment arms. Conclusion: Neither ‘individualised’ nor ‘gut-directed’ hypnotherapy is superior to relaxation therapy in IBS. PMID:28070348

Addition of senna improves quality of colonoscopy preparation with magnesium citrate.

PubMed

Vradelis, Stergios; Kalaitzakis, Evangelos; Sharifi, Yalda; Buchel, Otto; Keshav, Satish; Chapman, Roger W; Braden, Barbara

2009-04-14

To prospectively investigate the effectiveness and patient's tolerance of two low-cost bowel cleansing preparation protocols based on magnesium citrate only or the combination of magnesium citrate and senna. A total of 342 patients who were referred for colonoscopy underwent a colon cleansing protocol with magnesium citrate alone (n = 160) or magnesium citrate and senna granules (n = 182). The colonoscopist rated the overall efficacy of colon cleansing using an established score on a 4-point scale. Patients were questioned before undergoing colonoscopy for side effects and symptoms during bowel preparation. The percentage of procedures rescheduled because of insufficient colon cleansing was 7% in the magnesium citrate group and 4% in the magnesium citrate/senna group (P = 0.44). Adequate visualization of the colonic mucosa was rated superior under the citramag/senna regimen (P = 0.004). Both regimens were well tolerated, and did not significantly differ in the occurrence of nausea, bloating or headache. However, abdominal cramps were observed more often under the senna protocol (29.2%) compared to the magnesium citrate only protocol (9.9%, P < 0.0003). The addition of senna to the bowel preparation protocol with magnesium citrate significantly improves the cleansing outcome.

Addition of senna improves quality of colonoscopy preparation with magnesium citrate

PubMed Central

Vradelis, Stergios; Kalaitzakis, Evangelos; Sharifi, Yalda; Buchel, Otto; Keshav, Satish; Chapman, Roger W; Braden, Barbara

2009-01-01

AIM: To prospectively investigate the effectiveness and patient’s tolerance of two low-cost bowel cleansing preparation protocols based on magnesium citrate only or the combination of magnesium citrate and senna. METHODS: A total of 342 patients who were referred for colonoscopy underwent a colon cleansing protocol with magnesium citrate alone (n = 160) or magnesium citrate and senna granules (n = 182). The colonoscopist rated the overall efficacy of colon cleansing using an established score on a 4-point scale. Patients were questioned before undergoing colonoscopy for side effects and symptoms during bowel preparation. RESULTS: The percentage of procedures rescheduled because of insufficient colon cleansing was 7% in the magnesium citrate group and 4% in the magnesium citrate/senna group (P = 0.44). Adequate visualization of the colonic mucosa was rated superior under the citramag/senna regimen (P = 0.004). Both regimens were well tolerated, and did not significantly differ in the occurrence of nausea, bloating or headache. However, abdominal cramps were observed more often under the senna protocol (29.2%) compared to the magnesium citrate only protocol (9.9%, P < 0.0003). CONCLUSION: The addition of senna to the bowel preparation protocol with magnesium citrate significantly improves the cleansing outcome. PMID:19360920

Baccharis megapotamica var. weirii poisoning in water buffalo (Bubalus bubalis).

PubMed

Oliveira-Filho, José C; Carmo, Priscila M S; Lucena, Ricardo B; Pierezan, Felipe; Barros, Claudio S L

2011-05-01

An outbreak of an acute disease in buffalo (Bubalus bubalis) caused by the ingestion of Baccharis megapotamica var. weirii occurred in the southern region of Brazil. Ten out of 50 buffalo died 24-48 hr after being introduced into a pasture containing abundant amounts of the plant. Factors influencing the ingestion of the plant and consequent toxicosis included hunger, stress caused by shipment, and unfamiliarity with the plant. Clinical signs included serous ocular discharge, incoordination, mild bloat, and muscle trembling. One buffalo was necropsied. Gross findings included dehydration, abundant liquid in the rumen, reddening of the mucosa of forestomachs, abomasum, and intestine, and edema of the wall of the rumen. The main histologic lesions were superficial to full thickness degeneration and necrosis of the stratified epithelium lining the forestomachs, necrosis of the intestinal mucosa, and widespread lymphoid necrosis. A calf (Bos taurus) was fed a single dose of 5 g/kg/body weight of B. megapotamica var. weirii harvested from the same site where the buffalo died. Twenty hours after the administration of the plant this calf died with clinical signs and lesions similar to those observed in the naturally poisoned buffalo. © 2011 The Author(s)

Fiber sources for complete calf starter rations.

PubMed

Murdock, F R; Wallenius, R W

1980-11-01

Complete calf starter rations containing either 1) alfalfa hay, 2) cottonseed hulls, or 3) alfalfa-beet pulp as sources of fiber were fed to Holstein heifer calves at two locations on a limited milk program from 3 days to 12 wk of age. Rations were isonitrogenous and similar in content of crude fiber and acid detergent fiber. Although growth and development were normal on all rations, calves fed the cottonseed hull ration consumed more starter and gained more body weight than calves fed the other sources of fiber. The similarity of feed efficiencies, rumen pH, and molar ratios of volatile fatty acids between rations indicated no appreciable differences in rumen development or function. The growth response of calves fed the cottonseed hull ration appeared to be a result of better ration acceptability for which no reason was evident. Calves raised at Puyallup gained more body weight than calves at Pullman, and these gains were made more efficiently. These location effects may be related to seasonal differences and greater demands for production of body heat. Although the incidence of scours was less for calves fed alfalfa hay starter, the incidence and severity of bloat were higher for that ration.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anderson, D. R.; Hellier, C.; Smalley, B.

We report the discovery of the transiting giant planet WASP-17b, the least-dense planet currently known. It is 1.6 Saturn masses, but 1.5-2 Jupiter radii, giving a density of 6%-14% that of Jupiter. WASP-17b is in a 3.7 day orbit around a sub-solar metallicity, V = 11.6, F6 star. Preliminary detection of the Rossiter-McLaughlin effect suggests that WASP-17b is in a retrograde orbit (lambda approx -150{sup 0}), indicative of a violent history involving planet-planet or star-planet scattering. WASP-17b's bloated radius could be due to tidal heating resulting from recent or ongoing tidal circularization of an eccentric orbit, such as the highlymore » eccentric orbits that typically result from scattering interactions. It will thus be important to determine more precisely the current orbital eccentricity by further high-precision radial velocity measurements or by timing the secondary eclipse, both to reduce the uncertainty on the planet's radius and to test tidal-heating models. Owing to its low surface gravity, WASP-17b's atmosphere has the largest scale height of any known planet, making it a good target for transmission spectroscopy.« less

Premenstrual syndrome and premenstrual dysphoric disorder in perimenopausal women.

PubMed

Chung, Soo-Ho; Kim, Tae-Hee; Lee, Hae-Hyeog; Lee, Arum; Jeon, Dong-Su; Park, Junsik; Kim, Yesol

2014-08-01

To evaluate the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) of perimenopausal women at a university hospital along with their menstrual characters. A questionnaire survey regarding premenstrual symptoms was carried out in 100 perimenopausal women (43 to 53, years). The pattern of menstruation and, the intensity of dysmenorrhea were assessed; and further, the symptoms were classified according to their number, intensity, and persistence. The PMS criteria of American College of Obstetrics and Gynecology (ACOG) and PMDD criteria by American Psychiatric Association (APA) were evaluated. The approximate prevalence of PMS criteria was 95% and that of PMDD criteria was 23%. The most dominant symptoms were 'breast tenderness', 'abdominal bloating', 'and headache'. PMDD was significantly associated with the severity of dysmenorrhea (P = 0.020). There was no significant relation with age, height, weight, body mass index and the cycle of menstruation. Most women experience PMS and PMDD, which and have a significant impact on the activity of perimenopause women. However in most women that do not know well about PMS and PMDD. We should educate and inform women of PMS and PMDD, thus helping them increase their quality of life.

Premenstrual Syndrome and Premenstrual Dysphoric Disorder in Perimenopausal Women

PubMed Central

Chung, Soo-Ho; Lee, Hae-Hyeog; Lee, Arum; Jeon, Dong-Su; Park, Junsik; Kim, Yesol

2014-01-01

Objectives To evaluate the prevalence of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) of perimenopausal women at a university hospital along with their menstrual characters. Methods A questionnaire survey regarding premenstrual symptoms was carried out in 100 perimenopausal women (43 to 53, years). The pattern of menstruation and, the intensity of dysmenorrhea were assessed; and further, the symptoms were classified according to their number, intensity, and persistence. The PMS criteria of American College of Obstetrics and Gynecology (ACOG) and PMDD criteria by American Psychiatric Association (APA) were evaluated. Results The approximate prevalence of PMS criteria was 95% and that of PMDD criteria was 23%. The most dominant symptoms were 'breast tenderness', 'abdominal bloating', 'and headache'. PMDD was significantly associated with the severity of dysmenorrhea (P = 0.020). There was no significant relation with age, height, weight, body mass index and the cycle of menstruation. Conclusion Most women experience PMS and PMDD, which and have a significant impact on the activity of perimenopause women. However in most women that do not know well about PMS and PMDD. We should educate and inform women of PMS and PMDD, thus helping them increase their quality of life. PMID:25371896

A device for 24 hour ambulatory monitoring of abdominal girth using inductive plethysmography.

PubMed

Reilly, B P; Bolton, M P; Lewis, M J; Houghton, L A; Whorwell, P J

2002-11-01

Inductive plethysmography (IP) sensors and oscillator modules were assessed for their potential use in the ambulatory monitoring of abdominal girth in subjects with irritable bowel syndrome (IBS) in order to objectively quantify their bloating symptoms. A dedicated microprocessordata logger was designed to record over 24 h the frequency output of IP oscillators connected to a belt around the subject's lower abdomen. Posture was also recorded via tilt switches (standing, sitting and lying). The system was separately calibrated by placing the belts around a variable rectangular phantom and measuring the frequency of oscillation. A theoretical geometric model was devised to convert measured frequency into circumference and account for changes caused by variations in shape. Using the calibration factors, it was found that the circumference of a circular phantom could be measured accurately (mean difference 1.27 cm and SD 0.25 cm). The system has been tested over 24 h with 20 volunteers. Movement introduced variations in measured girth larger than those found during periods of non-movement during sleep. We conclude that IP promises to be a useful and quantitative tool suitable for ambulatory monitoring of abdominal girth, a hitherto relatively unexplored symptom of IBS.

Particle sensor array

NASA Technical Reports Server (NTRS)

Buehler, Martin G. (Inventor); Blaes, Brent R. (Inventor); Lieneweg, Udo (Inventor)

1994-01-01

A particle sensor array which in a preferred embodiment comprises a static random access memory having a plurality of ion-sensitive memory cells, each such cell comprising at least one pull-down field effect transistor having a sensitive drain surface area (such as by bloating) and at least one pull-up field effect transistor having a source connected to an offset voltage. The sensitive drain surface area and the offset voltage are selected for memory cell upset by incident ions such as alpha-particles. The static random access memory of the present invention provides a means for selectively biasing the memory cells into the same state in which each of the sensitive drain surface areas is reverse biased and then selectively reducing the reversed bias on these sensitive drain surface areas for increasing the upset sensitivity of the cells to ions. The resulting selectively sensitive memory cells can be used in a number of applications. By way of example, the present invention can be used for measuring the linear energy transfer of ion particles, as well as a device for assessing the resistance of CMOS latches to Cosmic Ray induced single event upsets. The sensor of the present invention can also be used to determine the uniformity of an ion beam.

ASK Talks With Judy Stokley

NASA Technical Reports Server (NTRS)

Stokley, Judy

2002-01-01

In the summer of 1997, Judy Stokley took over as Program Director of the Air-to-Air Joint System Project Office (JSPO) at Eglin Air Force Base in Florida. As the JSPO Program Director, she directed much of her attention to reforming the Advanced Medium Range Air to Air Missile (AMRAAM) program, which had been operational since 1991 and was presently being produced for the Air Force, Navy, Marine Corps, and many international customers. Upon careful analysis of the program, she found it rife with problems. Two of the most pressing included a bloated Average Unit Procurement Cost and an Air Force mandated draw down plan that had not been met. In this interview, following her presentation at the Fourth NASA Masters Forum of Program and Project Managers in Dallas last February, Stokley discusses some of the difficulties she experienced in carrying out the AMRAAM reforms. Stokley is presently Air Force Program Executive Officer for Weapons in Washington, D.C. She is responsible for the cost, schedule, and technical performance of a portfolio of air-to-air and air-to-ground weapons programs. These programs represent the leading edge of weapons technology, including developing the next generation of precision-guided munitions -- 'smart' bombs -- and air superiority missiles.

Association of Medical Directors of Information Systems consensus on inpatient electronic health record documentation.

PubMed

Shoolin, J; Ozeran, L; Hamann, C; Bria, W

2013-01-01

In 2013, electronic documentation of clinical care stands at a crossroads. The benefits of creating digital notes are at risk of being overwhelmed by the inclusion of easily importable detail. Providers are the primary authors of encounters with patients. We must document clearly our understanding of patients and our communication with them and our colleagues. We want to document efficiently to meet without exceeding documentation guidelines. We copy and paste documentation, because it not only simplifies the documentation process generally, but also supports meeting coding and regulatory requirements specifically. Since the primary goal of our profession is to spend as much time as possible listening to, understanding and helping patients, clinicians need information technology to make electronic documentation easier, not harder. At the same time, there should be reasonable restrictions on the use of copy and paste to limit the growing challenge of 'note bloat'. We must find the right balance between ease of use and thoughtless documentation. The guiding principles in this document may be used to launch an interdisciplinary dialogue that promotes useful and necessary documentation that best facilitates efficient information capture and effective display.

The Place of Stress and Emotions in the Irritable Bowel Syndrome.

PubMed

Pellissier, S; Bonaz, B

2017-01-01

Our emotional state can have many consequences on our somatic health and well-being. Negative emotions such as anxiety play a major role in gut functioning due to the bidirectional communications between gut and brain, namely, the brain-gut axis. The irritable bowel syndrome (IBS), characterized by an unusual visceral hypersensitivity, is the most common disorder encountered by gastroenterologists. Among the main symptoms, the presence of current or recurrent abdominal pain or discomfort associated with bloating and altered bowel habits characterizes this syndrome that could strongly alter the quality of life. This chapter will present the physiopathology of IBS and explain how stress influences gastrointestinal functions (permeability, motility, microbiota, sensitivity, secretion) and how it could be predominantly involved in IBS. This chapter will also describe the role of the autonomic nervous system and the hypothalamic-pituitary axis through vagal tone and cortisol homeostasis. An analysis is made about how emotions and feelings are involved in the disruption of homeostasis, and we will see to what extent the balance between vagal tone and cortisol may reflect dysfunctions of the brain-gut homeostasis. Finally, the interest of therapeutic treatments focused on stress reduction and vagal tone enforcement is discussed. © 2017 Elsevier Inc. All rights reserved.

Ovarian Sertoli-Leydig cell tumor with heterologous elements of gastrointestinal type associated with elevated serum alpha-fetoprotein level: an unusual case and literature review

PubMed Central

Horta, Mariana; Cunha, Teresa Margarida; Marques, Rita Canas; Félix, Ana

2014-01-01

Here we describe the case of a 19-year-old woman with a poorly differentiated ovarian Sertoli-Leydig cell tumor and an elevated serum alpha-fetoprotein level. The patient presented with diffuse abdominal pain and bloating. Physical examination, ultrasound, and magnetic resonance imaging revealed a right ovarian tumor that was histopathologically diagnosed as a poorly differentiated Sertoli-Leydig cell tumor with heterologous elements. Her alpha-fetoprotein serum level was undetectable after tumor resection. Sertoli-Leydig cell tumors are rare sex cord-stromal tumors that account for 0.5% of all ovarian neoplasms. Sertoli-Leydig cell tumors tend to be unilateral and occur in women under 30 years of age. Although they are the most common virilizing tumor of the ovary, about 60% are endocrine-inactive tumors. Elevated serum levels of alpha-fetoprotein are rarely associated with Sertoli-Leydig cell tumors, with only approximately 30 such cases previously reported in the literature. The differential diagnosis should include common alpha-fetoprotein-producing ovarian entities such as germ cell tumors, as well as other non-germ cell tumors that have been rarely reported to produce this tumor marker. PMID:25926909

Ovarian Sertoli-Leydig cell tumor with heterologous elements of gastrointestinal type associated with elevated serum alpha-fetoprotein level: an unusual case and literature review.

PubMed

Horta, Mariana; Cunha, Teresa Margarida; Marques, Rita Canas; Félix, Ana

2014-11-01

Here we describe the case of a 19-year-old woman with a poorly differentiated ovarian Sertoli-Leydig cell tumor and an elevated serum alpha-fetoprotein level. The patient presented with diffuse abdominal pain and bloating. Physical examination, ultrasound, and magnetic resonance imaging revealed a right ovarian tumor that was histopathologically diagnosed as a poorly differentiated Sertoli-Leydig cell tumor with heterologous elements. Her alpha-fetoprotein serum level was undetectable after tumor resection. Sertoli-Leydig cell tumors are rare sex cord-stromal tumors that account for 0.5% of all ovarian neoplasms. Sertoli-Leydig cell tumors tend to be unilateral and occur in women under 30 years of age. Although they are the most common virilizing tumor of the ovary, about 60% are endocrine-inactive tumors. Elevated serum levels of alpha-fetoprotein are rarely associated with Sertoli-Leydig cell tumors, with only approximately 30 such cases previously reported in the literature. The differential diagnosis should include common alpha-fetoprotein-producing ovarian entities such as germ cell tumors, as well as other non-germ cell tumors that have been rarely reported to produce this tumor marker.

[Irritable bowel syndrome, levator ani syndrome, proctalgia fugax and chronic pelvic and perineal pain].

PubMed

Watier, Alain; Rigaud, Jérôme; Labat, Jean-Jacques

2010-11-01

To define functional gastrointestinal pain, irritable bowel syndrome (IBS), levator ani syndrome, proctalgia fugax, the pathophysiology of these syndromes and the treatments that can be proposed. Review of articles published on the theme based on a Medline (PubMed) search and consensus conferences selected according to their scientific relevance. IBS is very common. Patients report abdominal pain and/or discomfort, bloating, and abnormal bowel habit (diarrhoea, constipation or both), in the absence of any structural or biochemical abnormalities. IBS has a complex, multifactorial pathophysiology, involving biological and psychosocial interactions resulting in dysregulation of the brain-gut axis associated with disorders of intestinal motility, hyperalgesia, immune disorders and disorders of the intestinal bacterial microflora and autonomic and hormonal dysfunction. Many treatments have been proposed, ranging from diet to pharmacology and psychotherapy. Patients with various types of chronic pelvic and perineal pain, especially those seen in urology departments, very often report associated IBS. This syndrome is also part of a global and integrated concept of pelviperineal dysfunction, avoiding a rigorous distinction between the posterior segment and the midline and anterior segments of the perineum. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Aerophagia in adults: a comparison with functional dyspepsia.

PubMed

Chitkara, D K; Bredenoord, A J; Rucker, M J; Talley, N J

2005-11-01

Aerophagia is a functional upper gastrointestinal disorder that has not previously been well described in a large patient group. To describe the initial evaluation of patients who presented with symptoms of aerophagia at a tertiary medical centre. A computerized search was used to identify all patients who were diagnosed with aerophagia at the Mayo Clinic, Rochester between 1996 and 2003 (n = 79). Individual medical charts were abstracted for information on the demographics, clinical features, co-morbid diagnoses, diagnostic workup and treatment. Information on presenting symptoms was also collected for a group of patients who were classified as having functional dyspepsia for comparison (n = 121). The median duration of symptoms in patients with aerophagia was 24 months. The most common symptoms were belching (56%), abdominal pain (19%), bloating (27%) and abdominal distension (19%). Patients with functional dyspepsia had a higher prevalence of reporting nausea, vomiting, early satiety, weight loss and abdominal pain (all P < 0.01, adjusting for age, gender and body mass index). Significantly more patients with aerophagia had anxiety (19%) than those with functional dyspepsia (6%, P < 0.01). Individuals with aerophagia experience prolonged upper gastrointestinal symptoms. Initial presenting symptoms appear to be distinctly different from those who have functional dyspepsia.

Aerophagia and Intestinal Gas.

PubMed

Quigley, Eamonn M. M.

2002-08-01

Aerophagia refers to a rather rare disorder that may occur in both children and adults that features repetitive air swallowing and belching and that may result in abdominal distention. There are few, if any, controlled studies to guide therapy, which remains largely supportive but may include behavioral therapy and psychotherapy. Bloating, distention, and other gas-related symptoms are common in functional gastrointestinal disorders, including the irritable bowel syndrome; their pathophysiology remains, for the most part, poorly understood. Two separate phenomena need to be distinguished in these disorders: gas production and gas perception. Thus, whereas gas production, which relates most closely to flatus emissions, is probably within the normal range in most patients with irritable bowel syndrome, gas transport or transit through the gut may be impaired and may lead to the retention of gas within segments of the gut. Visceral hypersensitivity, a common phenomenon in all functional disorders, may exacerbate the sensation of distention and contribute to other "gas-related" symptoms. Few controlled studies have addressed any of these issues. Although, on an empiric basis, dietary therapy may be partially effective in some situations, there is at present no data to support the use of any form of pharmacologic, endoscopic, or surgical therapy for any of these symptoms.

K2-30 b and K2-34 b: Two inflated hot Jupiters around solar-type stars

NASA Astrophysics Data System (ADS)

Lillo-Box, J.; Demangeon, O.; Santerne, A.; Barros, S. C. C.; Barrado, D.; Hébrard, G.; Osborn, H. P.; Armstrong, D. J.; Almenara, J.-M.; Boisse, I.; Bouchy, F.; Brown, D. J. A.; Courcol, B.; Deleuil, M.; Delgado Mena, E.; Díaz, R. F.; Kirk, J.; Lam, K. W. F.; McCormac, J.; Pollacco, D.; Rajpurohit, A.; Rey, J.; Santos, N. C.; Sousa, S. G.; Tsantaki, M.; Wilson, P. A.

2016-10-01

We report the discovery of the two hot Jupiters K2-30 b and K2-34 b. The two planets were detected during campaigns 4 and 5 of the extension of the Kepler mission, K2; they transit their main-sequence stars with periods of ~4.099 and ~2.996 days. Subsequent ground-based radial velocity follow-up with SOPHIE, HARPS-N, and CAFE established the planetary nature of the transiting objects. We analyzed the transit signal, radial velocity, and spectral energy distributions of the two systems to characterize their properties. Both planets (K2-30 b and K2-34 b) are bloated hot Jupiters (1.20 RJup and 1.22 RJup) around relatively bright (V = 13.5 and V = 11.5) slow rotating main-sequence (G8 and F9) stars. Thus, these systems are good candidates for detecting the Rossiter-MacLaughlin effect in order to measure their obliquity and for atmospheric studies. Full Tables 1 and 2 are only available at the CDS via anonymous ftp to http://cdsarc.u-strasbg.fr (http://130.79.128.5) or via http://cdsarc.u-strasbg.fr/viz-bin/qcat?J/A+A/594/A50

Somatization symptoms and hypochondriacal features in the general population.

PubMed

Rief, W; Hessel, A; Braehler, E

2001-01-01

The principal goal of this study is to examine the base rates of somatoform symptoms and of hypochondriacal features in the general population. A representative sample of 2050 persons in Germany was examined by use of screening for somatoform symptoms and the Whiteley Index. The most frequent somatoform symptoms were back pain, joint pain, pain in extremities, and headache, as well as abdominal symptoms (bloating or intolerance of several foods) and cardiovascular symptoms (palpitation). People reported a mean of two somatization symptoms of DSM-IV somatization disorder (SD) during the prior 2 years. Strong age and medium gender effects were found for most somatoform symptoms, as well as for composite indices. However, the sex ratio suggested in DSM-IV for SD seems to be an overestimation. Hypochondriacal features showed only small sex differences but, again, pronounced age effects. In contrast to low rates for SD, the base rates for somatization and hypochondriacal features were high and represented the health care relevance of subthreshold syndromes. We present base rates of hypochondriacal and somatization features that may be important facets in the development of classification criteria and in the interpretation of health care expenditure.

Osteolipomatous metaplasia in the liver of cameloids

USGS Publications Warehouse

Stroud, R.K.; Griner, L.A.; Higgins, W.Y.

1982-01-01

An aged male Bactrian camel (Camelus ferus f. bactriana), originally from the San Diego Zoo, died suddenly. Necropsy showed acute bloat and chronic liver disease. In samples of liver tissue fixed in 10% neutral buffered formalin, approximately 25% of the total volume of tissue was comprised of multiple white to cream-colored circumscribed nodules up to 1 cm in diameter, which were gritty when cut (fig. 1).Samples of liver were cut at 6 μm for histologic examination. Microscopically, the nodules consisted of aggregations of large, vacuolated cells resembling fat cells with spicules of mature bone scattered throughout many nodules (fig. 2). Most nodules were circumscribed but not encapsulated. Single or small clusters of vacuolated cells, however, were scattered diffusely in the hepatic parenchyma surrounding the nodules. We found cholangitis and peribiliary fibrosis in some areas, but no generalized cirrhosis. Degeneration of hepatocytes was seen in some areas peripheral to the nodules. Compression of the hepatic architecture was evident in the liver parenchyma surrounding some nodules, but the primary change was infiltrative rather than expansive. Foci of lymphocytes and a few neutrophils were present in some nodules. Hematopoietic cells, described as a characteristic of myelolipomas, were not found in any of the nodules examined [2, 4].

Advancing treatment options for chronic idiopathic constipation.

PubMed

Quigley, Eamonn M M; Neshatian, Leila

2016-01-01

Chronic constipation is a global problem affecting all ages and associated with considerable morbidity and significant financial burden for society. Though formerly defined on the basis of a single symptom, infrequent defecation; constipation is now viewed as a syndrome encompassing several complaints such as difficulty with defecation, a sense of incomplete evacuation, hard stools, abdominal discomfort and bloating. The expanded concept of constipation has inevitably led to a significant change in outcomes in clinical trials, as well as in patient expectations from new therapeutic interventions. The past decades have also witnessed a proliferation in therapeutic targets for new agents. Foremost among these have been novel prokinetics, a new category, prosecretory agents and innovative approaches such as inhibitors of bile salt transport. In contrast, relatively few effective therapies exist for the management of those anorectal and pelvic floor problems that result in difficult defecation. Though constipation is a common and often troublesome disorder, many of those affected can resolve their symptoms with relatively simple measures. For those with more resistant symptoms a number of novel, effective and safe options now exist. Those with defecatory difficulty (anismus, pelvic floor dysfunction) continue to represent a significant management challenge.

Calcium vitamin D3 supplementation in clinical practice: side effect and satisfaction.

PubMed

Sanaei, Maryam; Banasiri, Mohammad; Shafiee, Gita; Rostami, Mahsa; Alizad, Saba; Ebrahimi, Mehdi; Larijani, Bagher; Heshmat, Ramin

2015-01-01

The objective of this study was to assess side effects and satisfaction about OsteoCalVitFort (500 mg calcium and 400 I.U. of vitamin D3) usage. A total 186 people were participated with range age from 18 to 65 years old. Each participant received 1 pack that contains 60 OsteoCalVitFort tablet and used two tablet OsteoCalVitFort daily (1 tablet after breakfast and 1 after dinner). By a phone call, side effects and satisfaction about OsteoCalVitFort were assessed. The rate of constipating (8.0 %) and bloating (12.5 %) were decreased significantly after OsteoCalVitFort supplement intake (1.2 %, and 0.6 %, respectively). Similar results were observed in metallic taste in mouth, tiredness, weakness, loss of appetite, bone/muscle pain and mental/mood change after Calcium Vitamin D3 supplementation intake. Totally, 94 % of patients were satisfied about OsteoCalVitFort usage. The results of the research indicate despite the high quality of OsteoCalVitFort supplement, there are no side effects which have been seen in other supplements.

Efficacy of an activated charcoal-simethicone combination in dyspeptic syndrome: results of a randomized prospective study in general practice.

PubMed

Lecuyer, M; Cousin, T; Monnot, M-N; Coffin, B

2009-01-01

The aim of this prospective, multicenter, randomized, placebo-controlled trial was to evaluate the efficacy of a commercial combination of simethicone and activated charcoal (Carbosylane) on dyspeptic symptoms in patients consulting a general practitioner. A total of 132 patients were studied. Treatment duration was 3 months, followed by a 2 months follow-up period. At the end of the treatment period, the percentage of patients with a reduction of at least two points on the symptom intensity scale was significantly higher with Carbosylane than with a placebo (P=0.043). Compared with placebo, the intensity of three symptoms (abdominal fullness, bloating and the sensation of slow digestion) was significantly decreased after 90 days of Carbosylane (P<0.05). At the end of the post-treatment follow-up, the percentages of patients with moderate or severe global complaints were 6.78% and 21.43% in the Carbosylane and placebo groups, respectively (P<0.03). Among patients consulting a general practitioner for dyspeptic syndrome, 3 months of treatment with Carbosylane resulted in significant symptomatic improvement. The improvement was still evident 2 months after the end of treatment.

[Diet and lifestyle rules in chronic constipation in adults: From fantasy to reality…].

PubMed

Fathallah, Nadia; Bouchard, Dominique; de Parades, Vincent

2017-01-01

Chronic constipation is one of the most common chronic gastrointestinal complaints and a frequent reason for consultation. Lifestyle modification and dietary advice attract a lot of patients, often dissatisfied with a long-term drug intake. These behavioral modifications are recommended as a first-line approach in the treatment of chronic mild constipation in the majority of current guidelines despite a low level of evidence. Fiber supplementation is probably the most relevant measure because of a satisfactory level of proof. It improves stool frequency and consistency. It has a positive effect on excessive straining and colonic transit time. The recommended daily fiber intake is at least 20 to 25g. To avoid side effects like bloating and abdominal pain, it must be gradually adjusted after a several days period. The benefice of increasing water intake or daily physical exercise in the treatment of chronic constipation have a lack of evidence, except specific situations such as elderly, hospitalized, institutionalized, dehydrated people or people consuming fluids less than 500mL/day. Change in environmental defecation conditions or bowel habits are probably anecdotal recommendations. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Point of view: Paul Simon.

PubMed

Simon, P

1999-02-01

In this article, former US Senator Paul Simon notes that, in his lifetime, the population of the world has tripled and is expected to quadruple. Among the effects of this population growth will be a 55% increase in nitrate emissions that will feed algae and compromise fish supplies. The US was extremely short-sighted when it reduced funding for the international family planning (FP) programs that benefit all nations. False accusations that the UN Population Fund (UNFPA) operates with a "bloated bureaucracy" ignore the fact that this agency has only 166 employees. More appropriate criticism would assert that the task the UNFPA is trying to accomplish is too important and too vast for such a small staff. Without FP programs, earth would now have to support an additional 400 million people. While contraceptive use by married women in developing countries has increased from 10% in 1965 to above 50% today and life expectancy is increasing, we must recognize the fact that we are currently unable to provide most of the world's population with safe water and sanitation and that increased population size will only exacerbate this problem. Encouraging voluntary FP is humanitarian and prudent and will help protect the entire population of the world.

Mesh cruroplasty in laparoscopic repair of paraesophageal hernias is not associated with better long-term outcomes compared to primary repair.

PubMed

Tam, Vernissia; Luketich, James D; Levy, Ryan M; Christie, Neil A; Awais, Omar; Shende, Manisha; Nason, Katie S

2017-10-01

Equipoise still exists regarding routine mesh cruroplasty during laparoscopic paraesophageal hernia (PEH). We aimed to determine whether selective mesh cruroplasty is associated with differences in recurrence and patient-reported outcomes. We compared symptom outcomes (n = 688) and radiographic recurrences (n = 101; at least 10% [or 2 cm] of stomach above hiatus) for 795 non-emergent PEH repair with fundoplication (n = 106 with mesh). Heartburn, regurgitation, epigastric pain, and anti-reflux medication use decreased significantly in both groups while postoperative dysphagia (mesh; p = 0.14), and bloating (non-mesh; p = 0.32), were unchanged. Radiographic recurrence rates were similar (15 mesh [22%] versus 86 non-mesh [17%]; p = 0.32; median 27 [IQR 14, 53] months), but was associated with surgical dissatisfaction (13% vs 4%; p = 0.007). Selective mesh cruroplasty was not associated with differences in symptom outcomes or radiographic recurrence rates during laparoscopic PEH repair. Radiographic recurrence was associated with dissatisfaction, emphasizing the need for continued focus on reducing recurrences. Copyright © 2017. Published by Elsevier Inc.

Characterization and control of Mucor circinelloides spoilage in yogurt.

PubMed

Snyder, Abigail B; Churey, John J; Worobo, Randy W

2016-07-02

Consumer confidence in the food industry is severely affected by large-scale spoilage incidents. However, relatively little research exists on spoilage potential of members of the fungal subphylum Mucormycotina (e.g. Mucor), which includes dimorphic spoilage organisms that can switch between a yeast-like and hyphal phase depending on environmental conditions. The presence of Mucor circinelloides in yogurt may not cause spoilage, but growth and subsequent changes in quality (e.g. container bloating) can cause spoilage if not controlled. The purpose of this study was to evaluate the effects on M. circinelloides of pasteurization regimen, natamycin concentrations, and storage temperature in yogurt production, as measured by fungal proliferation and carbon dioxide production. A strain of M. circinelloides isolated from commercially spoiled yogurt showed greater yogurt-spoilage potential than clinical isolates and other industrial strains. D-values and z-values were determined for the spoilage isolate in milk as an evaluation of the fungus' ability to survive pasteurization. Natamycin was added to yogurt at 0, 5, 10, 15, and 20ppm (μg/ml) to determine its ability to inhibit M. circinelloides over the course of month-long challenge studies at 4°C, 15°C, and 25°C. Survivors were recovered on acidified PDA and carbon dioxide levels were recorded. The D-values at 54°C, 56°C, and 58°C for hyphae/sporangiospores were (in min) 38.31±0.02, 10.17±0.28, and 1.94±0.53, respectively, which yielded a z-value of 3.09°C. The D-values at 51°C, 53°C, and 55°C for yeast-like cells were (in min) 14.25±0.12, 6.87±1.19, and 2.44±0.35, respectively, which yielded a z-value of 0.34°C. These results indicated that M. circinelloides would not survive fluid milk pasteurization if contamination occurred prior to thermal treatment. CO2 production was only observed when M. circinelloides was incubated under low-oxygen conditions, and occurred only at temperatures above 4°C. Addition of 10ppm and greater of natamycin inhibited the growth and CO2 production of M. circinelloides under moderate temperature abuse when compared to the untreated control. These data suggest that yogurt spoilage (container bloating) caused by anaerobic growth of M. circinelloides is due to post-pasteurization contamination. Temperature abuse facilitated spoilage as CO2 production was observed in yogurt incubated at 15°C and 25°C, but not at 4°C. The addition of at least 10ppm of natamycin prevented M. circinelloides growth in both hyphal and yeast-like phases, as well as CO2 production in temperatures of up to 15°C for 30days. Copyright © 2016 Elsevier B.V. All rights reserved.

Precision modelling of M dwarf stars: the magnetic components of CM Draconis

NASA Astrophysics Data System (ADS)

MacDonald, J.; Mullan, D. J.

2012-04-01

The eclipsing binary CM Draconis (CM Dra) contains two nearly identical red dwarfs of spectral class dM4.5. The masses and radii of the two components have been reported with unprecedentedly small statistical errors: for M, these errors are 1 part in 260, while for R, the errors reported by Morales et al. are 1 part in 130. When compared with standard stellar models with appropriate mass and age (≈4 Gyr), the empirical results indicate that both components are discrepant from the models in the following sense: the observed stars are larger in R ('bloated'), by several standard deviations, than the models predict. The observed luminosities are also lower than the models predict. Here, we attempt at first to model the two components of CM Dra in the context of standard (non-magnetic) stellar models using a systematic array of different assumptions about helium abundances (Y), heavy element abundances (Z), opacities and mixing length parameter (α). We find no 4-Gyr-old models with plausible values of these four parameters that fit the observed L and R within the reported statistical error bars. However, CM Dra is known to contain magnetic fields, as evidenced by the occurrence of star-spots and flares. Here we ask: can inclusion of magnetic effects into stellar evolution models lead to fits of L and R within the error bars? Morales et al. have reported that the presence of polar spots results in a systematic overestimate of R by a few per cent when eclipses are interpreted with a standard code. In a star where spots cover a fraction f of the surface area, we find that the revised R and L for CM Dra A can be fitted within the error bars by varying the parameter α. The latter is often assumed to be reduced by the presence of magnetic fields, although the reduction in α as a function of B is difficult to quantify. An alternative magnetic effect, namely inhibition of the onset of convection, can be readily quantified in terms of a magnetic parameter δ≈B2/4πγpgas (where B is the strength of the local vertical magnetic field). In the context of δ models in which B is not allowed to exceed a 'ceiling' of 106 G, we find that the revised R and L can also be fitted, within the error bars, in a finite region of the f-δ plane. The permitted values of δ near the surface leads us to estimate that the vertical field strength on the surface of CM Dra A is about 500 G, in good agreement with independent observational evidence for similar low-mass stars. Recent results for another binary with parameters close to those of CM Dra suggest that metallicity differences cannot be the dominant explanation for the bloating of the two components of CM Dra.

Association between Symptoms of Irritable Bowel Syndrome and Methane and Hydrogen on Lactulose Breath Test

PubMed Central

Lee, Kang Nyeong; Koh, Dong Hee; Sohn, Won; Lee, Sang Pyo; Jun, Dae Won; Lee, Hang Lak; Yoon, Byung Chul; Choi, Ho Soon; Hahm, Joon Soo

2013-01-01

Whether hydrogen and methane gas produced during lactulose breath test (LBT) are associated with symptoms of irritable bowel syndrome (IBS) is not determined. We aimed to investigate whether hydrogen and methane on LBT are associated with IBS symptoms. Sixty-eight IBS patients meeting the Rome III criteria for IBS, and 55 healthy controls, underwent LBT. The IBS subjects recorded their customary gastrointestinal symptoms on a questionnaire using visual analogue scales. LBT positivity was defined to be above 20 ppm rise of hydrogen or 10 ppm rise of methane within 90 min. Gas amounts produced during LBT were determined by calculating area under the curve of hydrogen and methane excretion. Symptom severity scores were not different between the LBT (+) IBS and LBT (-) IBS subjects and also between methane producers and non-methane producers. Gas amounts produced during LBT were not associated with IBS symptoms, except a weak correlation between total gas amounts and a few IBS symptoms such as bloating (r = 0.324, P = 0.039), flatulence (r = 0.314, P = 0.046) and abdominal pain (r = 0.364, P = 0.018) only in LBT (+) IBS. In conclusion, hydrogen and methane gas on LBT are not useful for predicting the customary symptoms and subtypes of IBS. PMID:23772156

Urban poor program launched.

PubMed

1991-01-01

The government of the Philippines has launched a program to deal with the rapidly growing urban poor population. 60 cities (including Metro Manila) are expected to increase their bloated population by 3.8% over 1990 which would be 27.7 million for 1991. Currently there is an exodus of people from the rural areas and by 2000 half the urban population will be squatters and slum dwellers. Basic services like health and nutrition are not expected to be able to handle this type of volume without a loss in the quality of service. The basic strategy of the new program is to recruit private medical practitioners to fortify the health care delivery and nutrition services. Currently the doctor/urban dweller ration is 1:9000. The program will develop a system to pool the efforts of government and private physicians in servicing the target population. Barangay Escopa has been chosen as the pilot city because it typifies the conditions of a highly populated urban area. The projects has 2 objectives: 1) demonstrate the systematic delivery of health and nutrition services by the private sector through the coordination of the government, 2) reduce mortality and morbidity in the community, especially in the 0-6 age group as well as pregnant women and lactating mothers.

The Tolerability and Efficacy of Oral Isotonic Solution versus Plain Water in Dengue Patients: A Randomized Clinical Trial.

PubMed

Nainggolan, Leonard; Bardosono, Saptawati; Ibrahim Ilyas, Ermita I

2018-01-01

Plasma leakage plays an important role in dengue infection, and this condition can lead to hemoconcentration, hypovolemia, and shock. Fluid replacement is the main treatment for dengue. There is a lack of evidence to support certain oral fluid therapy as a treatment for dengue patients. The objective of this study is to evaluate tolerability and efficacy of oral isotonic solution (OIS) compared to plain water as a fluid replacement in dengue patients. A randomized, clinical trial with single-blinded groups was conducted to compare tolerability and efficacy of OIS and plain water in dengue patients. We evaluated gastrointestinal disturbances (nausea, vomiting, and bloating), body temperature, mean arterial pressure (MAP), fluid balance, hematocrit, Na + , and K + levels. Data were analyzed with SPSS 20.0, and figures were made with GraphPad Prism version 5.01. Twenty four subjects were included and divided equally into two groups. Our results showed that there are no significant differences but indicate several noteworthy trends. The intervention group (OIS) experienced less nausea, less vomiting, had positive fluid balance and higher MAP, and became afebrile faster compared to the control group (plain water). Although not statistically significant, this study shows the trend that OIS is well-tolerated and effective for dengue patients compared to plain water.

Chili Peppers, Curcumins, and Prebiotics in Gastrointestinal Health and Disease.

PubMed

Patcharatrakul, Tanisa; Gonlachanvit, Sutep

2016-04-01

There is growing evidence for the role of several natural products as either useful agents or adjuncts in the management of functional GI disorders (FGIDs). In this review, we examine the medical evidence for three such compounds: chili, a culinary spice; curcumin, another spice and active derivative of a root bark; and prebiotics, which are nondigestible food products. Chili may affect the pathogenesis of abdominal pain especially in functional dyspepsia and cause other symptoms. It may have a therapeutic role in FGIDs through desensitization of transient receptor potential vanilloid-1 receptor. Curcumin, the active ingredient of turmeric rhizome, has been shown in several preclinical studies and uncontrolled clinical trials as having effects on gut inflammation, gut permeability and the brain-gut axis, especially in FGIDs. Prebiotics, the non-digestible food ingredients in dietary fiber, may serve as nutrients and selectively stimulate the growth and/or activity of certain colonic bacteria. The net effect of this change on colonic microbiota may lead to the production of acidic metabolites and other compounds that help to reduce the production of toxins and suppress the growth of harmful or disease-causing enteric pathogens. Although some clinical benefit in IBS has been shown, high dose intake of prebiotics may cause more bloating from bacterial fermentation.

Prevalence and Characterization of Self-Reported Gluten Sensitivity in The Netherlands.

PubMed

van Gils, Tom; Nijeboer, Petula; IJssennagger, Catharina E; Sanders, David S; Mulder, Chris J J; Bouma, Gerd

2016-11-08

A growing number of individuals reports symptoms related to the ingestion of gluten-containing food in the absence of celiac disease. Yet the actual prevalence is not well established. Between April 2015 and March 2016, unselected adults visiting marketplaces, dental practices and a university in The Netherlands were asked to complete a modified validated questionnaire for self-reported gluten sensitivity (srGS). Among the 785 adults enquired, two had celiac disease. Forty-nine (6.2%) reported symptoms related to the ingestion of gluten-containing food. These individuals were younger, predominantly female and lived more frequently in urban regions compared with the other respondents. Symptoms reported included bloating (74%), abdominal discomfort (49%) and flatulence (47%). A total of 23 (47%) srGS individuals reported having had tried a gluten-free or gluten-restricted diet. Abdominal discomfort related to fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP)-containing food was more often reported in srGS individuals compared with the other respondents (73.5% vs. 21.7%, p < 0.001). Self-reported GS is common in The Netherlands, especially in younger individuals, females and urban regions, although the prevalence was lower than in a comparable recent UK study. It cannot be excluded that FODMAPs are in part responsible for these symptoms.

Lactose malabsorption and intolerance: pathogenesis, diagnosis and treatment.

PubMed

Misselwitz, Benjamin; Pohl, Daniel; Frühauf, Heiko; Fried, Michael; Vavricka, Stephan R; Fox, Mark

2013-06-01

Lactose malabsorption is a common condition caused by reduced expression or activity of lactase in the small intestine. In such patients, lactose intolerance is characterized by abdominal symptoms (e.g. nausea, bloating, and pain) after ingestion of dairy products. The genetic basis of lactose malabsorption is established and several tests for this condition are available, including genetic, endoscopic, and H2-breath tests. In contrast, lactose intolerance is less well understood. Recent studies show that the risk of symptoms after lactose ingestion depends on the dose of lactose, lactase expression, intestinal flora, and sensitivity of the gastrointestinal tract. Lactose intolerance has recently been defined as symptoms developing after ingestion of lactose which do not develop after placebo challenge in a person with lactose maldigestion. Such blinded testing might be especially important in those with functional gastrointestinal diseases in whom self-reported lactose intolerance is common. However, placebo-controlled testing is not part of current clinical practice. Updated protocols and high-quality outcome studies are needed. Treatment options of lactose intolerance include lactose-reduced diet and enzyme replacement. Documenting the response to multiple doses can guide rational dietary management; however, the clinical utility of this strategy has not been tested. This review summarizes the genetic basis, diagnosis, and treatment of lactose malabsorption and intolerance.

Lactose malabsorption and intolerance: pathogenesis, diagnosis and treatment

PubMed Central

Pohl, Daniel; Frühauf, Heiko; Fried, Michael; Vavricka, Stephan R; Fox, Mark

2013-01-01

Lactose malabsorption is a common condition caused by reduced expression or activity of lactase in the small intestine. In such patients, lactose intolerance is characterized by abdominal symptoms (e.g. nausea, bloating, and pain) after ingestion of dairy products. The genetic basis of lactose malabsorption is established and several tests for this condition are available, including genetic, endoscopic, and H2-breath tests. In contrast, lactose intolerance is less well understood. Recent studies show that the risk of symptoms after lactose ingestion depends on the dose of lactose, lactase expression, intestinal flora, and sensitivity of the gastrointestinal tract. Lactose intolerance has recently been defined as symptoms developing after ingestion of lactose which do not develop after placebo challenge in a person with lactose maldigestion. Such blinded testing might be especially important in those with functional gastrointestinal diseases in whom self-reported lactose intolerance is common. However, placebo-controlled testing is not part of current clinical practice. Updated protocols and high-quality outcome studies are needed. Treatment options of lactose intolerance include lactose-reduced diet and enzyme replacement. Documenting the response to multiple doses can guide rational dietary management; however, the clinical utility of this strategy has not been tested. This review summarizes the genetic basis, diagnosis, and treatment of lactose malabsorption and intolerance. PMID:24917953

Symptoms Experienced and Information Needs of Women Receiving Chemotherapy.

PubMed

Uysal, Neşe; Toprak, Filiz Ünal; Kutlutsürkan, Sevinç; Erenel, Ayten Şentürk

2018-01-01

This study is carried out to determine the symptoms and information necessity on chemotherapy (CT) treatment of the women with breast cancer. A total of 170 women older than 18 years old, who receive CT with breast cancer diagnosis, are volunteered to participate in the study. Mixed method was used in the study. Data are collected using Descriptive Data Form, Interview Form and Memorial Symptom Assessment Scale. As a result of the cluster analysis, four clusters and the symptoms within have been obtained. These are: pain, lack of energy, feeling drowsy, sweat, swelling of hands, and feet in the first cluster; feeling nervous, difficulty sleeping, feeling sad, worrying in the second cluster; nausea, feeling bloating, change in the way food tastes, hair loss, constipation in the third cluster; vomiting, diarrhea, problems with sexual interest, lack of appetite, dizziness, and weight loss in the forth cluster. Women's information necessity related to the CT are follows: the effects of CT, other treatment options beyond CT, complementary methods, the effect of the CT treatment on reproductive health and sexuality, nutrition, and symptom control. The results of this study will enable determination of symptom clusters, which health professionals are easier to focus on these symptoms. An understanding information need of patients can help to ensure that individual's coping strategies and self-management.

Intoxication of goats by Plumbago scandens in Northeastern Brazil.

PubMed

Medeiros, R M; Barbosa, R C; Lima, E F; Simões, S V; Riet-Correa, F

2001-06-01

In the State of Paraiba, Northeastern Brazil, goat mortality occurred with the ingestion of Plumbago scandens. The fresh plant was then given experimentally to 4 goats at 5, 10, 17.5 or 25 g/kg bw. Depression, anorexia, salivation with foamy saliva, bellowing, bruxism, humpbacked posture, bloat, ruminal atony, continuous lateral head movements, tachycardia, dyspnea and dark brown to black urine were observed in the goats given 17.5 or 25 g/kg bw. The goats receiving 5 or 10 g/kg bw had less severe signs. The goat dosed with 25 g/kg bw died after 18-20 h. All others recovered in 3-9 d. At necropsy of the high dose goat, the main lesions were dark violet to black discoloration of the mucosa of the tongue, esophagus, reticulum and ventral sac of the rumen, and gelatinous edema in the visceral ruminal peritoneum. Histologically the reticulum and ventral rumen sac had diffuse epithelial necrosis and severe edema and neutrophilic infiltration of the submucosa. Separation of the ruminal epithelium from the submucosa was observed. Epithelial degeneration and necrosis was also seen in the omasum, esophagus and tongue. Reproduction of the disease with clinical signs similar to those observed by the farmer in the spontaneously affected goats suggests that the clinical mortality was caused by ingestion of Plumbago scandens.

[Experiences with the use of xylazine for sacral epidural anesthesia in cattle].

PubMed

Rehage, J; Kehler, W; Scholz, H

1994-01-01

The effect of epidural administered xylazine was investigated in 10 mature Holstein cows (mean age: 5.4 +/- 1.2 years, mean BW: 572 +/- 23 kg): 5 cows were treated with xylazine in a low dose of 0.05 mg/kg body weight, 3 cows in a medium dose (0.07 mg/kg BW) and 2 cows in a high dose (0.1 mg/kg BW). Xylazine dosages were diluted in sterile saline to a final volume of 5 ml. As a control, lidocaine (5 ml of a 2% solution) was given to 5 cows epidurally. Duration of regional anaesthesia after low dose of xylazine (0.05 mg/kg BW) was significant longer (mean: 2.2 hours) compared to lidocaine treated cows (mean: 1.1 hour). Regional extension of anaesthesia was comparable after dosing with xylazine and lidocaine (tail, after, vulva and perineum). All cows remained standing, but in xylazine treated cows systemic effects, e.g. mild sedation, decreased heart- and respiratory rates, decreased rumen motility and mild bloat were observed. With increased dosages of xylazine a prolongation of epidural anaesthesia up to 3 hours was achieved, but regional extension of this effect remained nearly unchanged. With increased xylazine dosages, cows showed marked sedation and ataxia and sternal recumbency were induced.

Frequency of Celiac Disease in Patients With Increased Intestinal Gas (Flatulence).

PubMed

Masoodi, Mohsen; Mokhtare, Marjan; Agah, Shahram; Sina, Mohammad; Soltani-Kermanshahi, Mojtaba

2015-10-26

Excessive flatulence which impairs social performance in patients is one of the common reasons for referrals to gastroenterology clinics. Celiac Disease is a rare but important cause of increased intestinal gas (bloating) and if not diagnosed, patients face complications such as malabsorption, anemia, osteoporosis and even intestinal lymphoma. This study aimed to determine the frequency of Celiac Disease in patients with excessive flatulence.One hundred and fifty patients with a chief complaint of experiencing flatulence more than 15 times a day and lasting for three months were referred to the gastroenterology clinic of Rasoul-e-Akram Teaching Hospital. Serological tests for Celiac Disease, Anti TTG Ab (IgA-IgG) were requested and the patients with positive tests underwent upper GI endoscopy. Biopsies of the second part of the duodenum were then sent to the laboratory.From one hundred and thirty patients who completed the study, 92 (70.7%) were female. Mean age of the patients was 32 ± 13 years. Anti TTG Ab was found in 5 patients (3.85%). Only 2 patients (1.5%) had a documented positive pathology for Celiac Disease.According to the results of this study and other studies, we conclude that Celiac Disease is an uncommon etiology for excessive flatulence but it is of importance to investigate it in excessive flatulence patients.

Symptoms and risk factors of ovarian cancer: a survey in primary care.

PubMed

Gajjar, Ketan; Ogden, Gemma; Mujahid, M I; Razvi, Khalil

2012-01-01

In spite of the increased awareness of ovarian cancer symptoms, the predictive value of symptoms remains very low. The aim of this paper is to obtain the views of general practitioners (GPs) in relation to symptom-based detection of ovarian cancer and to assess their knowledge for family history of breast and/or ovarian cancer as a predisposing factor for ovarian cancer. In this questionnaire survey, postal questionnaires were sent to 402 GPs in 132 primary care clinics, out of which we obtained 110 replies (27.4%). Approximately 26% of respondent GPs thought that the symptoms were more likely to be frequent, sudden, and persistent, and one-fifth were unsure of the importance of family history of breast cancer in relation to ovarian cancer. The participant GPs scored a set of symptoms for their relevance to ovarian cancer from 0 (not relevant) to 10 (most relevant). The highest scored symptoms were abdominal swelling (mean ± SD, 8.19 ± 2.33), abdominal bloating (7.01 ± 3.01), and pelvic pain (7.46 ± 2.26). There was a relative lack of awareness for repetitive symptoms as well as gastrointestinal symptoms as an important feature in a symptom-based detection of ovarian cancer.

Symptoms and Risk Factors of Ovarian Cancer: A Survey in Primary Care

PubMed Central

Gajjar, Ketan; Ogden, Gemma; Mujahid, M. I.; Razvi, Khalil

2012-01-01

In spite of the increased awareness of ovarian cancer symptoms, the predictive value of symptoms remains very low. The aim of this paper is to obtain the views of general practitioners (GPs) in relation to symptom-based detection of ovarian cancer and to assess their knowledge for family history of breast and/or ovarian cancer as a predisposing factor for ovarian cancer. In this questionnaire survey, postal questionnaires were sent to 402 GPs in 132 primary care clinics, out of which we obtained 110 replies (27.4%). Approximately 26% of respondent GPs thought that the symptoms were more likely to be frequent, sudden, and persistent, and one-fifth were unsure of the importance of family history of breast cancer in relation to ovarian cancer. The participant GPs scored a set of symptoms for their relevance to ovarian cancer from 0 (not relevant) to 10 (most relevant). The highest scored symptoms were abdominal swelling (mean ± SD, 8.19 ± 2.33), abdominal bloating (7.01 ± 3.01), and pelvic pain (7.46 ± 2.26). There was a relative lack of awareness for repetitive symptoms as well as gastrointestinal symptoms as an important feature in a symptom-based detection of ovarian cancer. PMID:22957264

Nationwide survey of partial fundoplication in Korea: comparison with total fundoplication.

PubMed

Lee, Chang Min; Park, Joong-Min; Lee, Han Hong; Jun, Kyong Hwa; Kim, Sungsoo; Seo, Kyung Won; Park, Sungsoo; Kim, Jong-Han; Kim, Jin-Jo; Han, Sang-Uk

2018-06-01

Laparoscopic total fundoplication is the standard surgery for gastroesophageal reflux disease. However, partial fundoplication may be a viable alternative. Here, we conducted a nationwide survey of partial fundoplication in Korea. The Korean Anti-Reflux Surgery study group recorded 32 cases of partial fundoplication at eight hospitals between September 2009 and January 2016. The surgical outcomes and postoperative adverse symptoms in these cases were evaluated and compared with 86 cases of total fundoplication. Anterior partial fundoplication was performed in 20 cases (62.5%) and posterior in 12 (37.5%). In most cases, partial fundoplication was a secondary procedure after operations for other conditions. Half of patients who underwent partial fundoplication had typical symptoms at the time of initial diagnosis, and most of them showed excellent (68.8%), good (25.0%), or fair (6.3%) symptom resolution at discharge. Compared to total fundoplication, partial fundoplication showed no difference in the resolution rate of typical and atypical symptoms. However, adverse symptoms such as dysphagia, difficult belching, gas bloating and flatulence were less common after partial fundoplication. Although antireflux surgery is not popular in Korea and total fundoplication is the primary surgical choice for gastroesophageal reflux disease, partial fundoplication may be useful in certain conditions because it has less postoperative adverse symptoms but similar efficacy to total fundoplication.

Primary Care Management of Chronic Constipation in Asia: The ANMA Chronic Constipation Tool

PubMed Central

Ghoshal, Uday C; Gonlachanvit, Sutep; Chua, Andrew Seng Boon; Myung, Seung-Jae; Rajindrajith, Shaman; Patcharatrakul, Tanisa; Choi, Myung-Gyu; Wu, Justin C Y; Chen, Min-Hu; Gong, Xiao-Rong; Lu, Ching-Liang; Chen, Chien-Lin; Pratap, Nitesh; Abraham, Philip; Hou, Xiao-Hua; Ke, Meiyun; Ricaforte-Campos, Jane D; Syam, Ari Fahrial; Abdullah, Murdani

2013-01-01

Chronic constipation (CC) may impact on quality of life. There is substantial patient dissatisfaction; possible reasons are failure to recognize underlying constipation, inappropriate dietary advice and inadequate treatment. The aim of these practical guidelines intended for primary care physicians, and which are based on Asian perspectives, is to provide an approach to CC that is relevant to the existing health-care infrastructure. Physicians should not rely on infrequent bowel movements to diagnose CC as many patients have one or more bowel movement a day. More commonly, patients present with hard stool, straining, incomplete feeling, bloating and other dyspeptic symptoms. Physicians should consider CC in these situations and when patients are found to use laxative containing supplements. In the absence of alarm features physicians may start with a 2-4 week therapeutic trial of available pharmacological agents including osmotic, stimulant and enterokinetic agents. Where safe to do so, physicians should consider regular (as opposed to on demand dosing), combination treatment and continuous treatment for at least 4 weeks. If patients do not achieve satisfactory response, they should be referred to tertiary centers for physiological evaluation of colonic transit and pelvic floor function. Surgical referral is a last resort, which should be considered only after a thorough physiological and psychological evaluation. PMID:23667746

Analysis and Management of Rectal Gas with Kampo Formulas During Intensity-Modulated Radiotherapy of Prostate Cancer: A Case Series Study.

PubMed

Nagai, Aiko; Shibamoto, Yuta; Ogawa, Keiko; Inoda, Koji; Yoshida, Masanori; Kikuchi, Yuzo

2016-06-01

During intensity-modulated radiation therapy (IMRT) for prostate cancer, the target, bladder, and rectum positions should be kept constant to reduce adverse events, such as radiation proctitis, and to increase local tumor control. For this purpose, decreasing the rectal contents as much as possible is important. Daisaikoto (DST) and bukuryoingohangekobokuto (BIHKT) are traditional Japanese herbal (Kampo) formulas that have been used to treat patients with abdominal bloating or constipation. This study investigated the effect of DST and BIHKT on the rectal gas volume during prostate IMRT according to Kampo diagnosis. Five patients were treated with DST or BIHKT at a dose of 5.0 or 7.5 g/d. The volume of rectal gas in 189 megavoltage computed tomographic images taken before each treatment session and the frequency of rectal gas drainage were evaluated before and after DST or BIHKT administration. After DST or BIHKT treatment, the mean volume of rectal gas was reduced from 6.4 to 2.1 mL, and the mean frequency of gas drainage decreased from 43% to 9%. DST and BIHKT appear to be useful in reducing rectal gas, which would help prevent radiation proctitis and improve the local control of prostate cancer with IMRT.

Laparoscopic Nissen fundoplication offers high patient satisfaction with relief of extraesophageal symptoms of gastroesophageal reflux disease.

PubMed

Rakita, Steven; Villadolid, Desiree; Thomas, Ashley; Bloomston, Mark; Albrink, Michael; Goldin, Steven; Rosemurgy, Alexander

2006-03-01

Nissen fundoplication is applied for patients with gastroesophageal reflux disease (GERD), usually because of symptoms of esophageal injury. When presenting symptoms are extraesophageal, there is less enthusiasm for operative control of reflux because of concerns of etiology and efficacy. This study was undertaken to evaluate the efficacy of laparoscopic Nissen fundoplication in palliating extraesophageal symptoms of GERD. Patients were asked to score their symptoms before and after laparoscopic Nissen fundoplication on a Likert scale (0 = never/none to 5 = always/every time I eat). A total of 322 patients with extraesophageal symptoms (asthma, cough, gas/bloat, chest pain, and odynophagia) of 4 to 5 were identified and analyzed. After fundoplication, all extraesophageal symptom scores improved (P < 0.0001 for all, Wilcoxon matched-pairs test). Likewise, postoperative symptoms were noted to be greatly improved or resolved in 67 per cent to 82 per cent of patients for each symptom. Furthermore, after fundoplication, patients were less likely to modify their dietary (82% vs 49%) or sleeping habits (70% vs 28%) to avoid initiating/ exacerbating symptoms. Although extraesophageal symptoms are conventionally thought to be inadequately palliated by surgery, this study documents excellent relief of extraesophageal symptoms after laparoscopic Nissen fundoplication, denotes high patient satisfaction, and encourages application of laparoscopic Nissen fundoplication.

Frequency of Celiac Disease in Patients with Increased Intestinal Gas (Flatulence)

PubMed Central

Masoodi, Mohsen; Mokhtare, Marjan; Agah, Shahram; Sina, Mohammad; Soltani-Kermanshahi, Mojtaba

2016-01-01

Excessive flatulence which impairs social performance in patients is one of the common reasons for referrals to gastroenterology clinics. Celiac Disease is a rare but important cause of increased intestinal gas (bloating) and if not diagnosed, patients face complications such as malabsorption, anemia, osteoporosis and even intestinal lymphoma. This study aimed to determine the frequency of Celiac Disease in patients with excessive flatulence. One hundred and fifty patients with a chief complaint of experiencing flatulence more than 15 times a day and lasting for three months were referred to the gastroenterology clinic of Rasoul-e-Akram Teaching Hospital. Serological tests for Celiac Disease, Anti TTG Ab (IgA-IgG) were requested and the patients with positive tests underwent upper GI endoscopy. Biopsies of the second part of the duodenum were then sent to the laboratory. From one hundred and thirty patients who completed the study, 92 (70.7%) were female. Mean age of the patients was 32 ± 13 years. Anti TTG Ab was found in 5 patients (3.85%). Only 2 patients (1.5%) had a documented positive pathology for Celiac Disease. According to the results of this study and other studies, we conclude that Celiac Disease is an uncommon etiology for excessive flatulence but it is of importance to investigate it in excessive flatulence patients. PMID:26755470

Rifaximin and eluxadoline - newly approved treatments for diarrhea-predominant irritable bowel syndrome: what is their role in clinical practice alongside alosetron?

PubMed

Cash, Brooks D; Lacy, Brian E; Rao, Tharaknath; Earnest, David L

2016-01-01

Diarrhea-predominant irritable bowel syndrome (IBS-D) is a common functional gastrointestinal condition in which patients experience abdominal pain, diarrhea, bloating, cramps, flatulence, fecal urgency, and incontinence. We review two recently approved therapies that focus on treating underlying pathogenic mechanisms of IBS-D: (1) the non-absorbable antibiotic rifaximin, and (2) the opioid receptor agonist/antagonist eluxadoline. We compare the safety and efficacy data emerging from rifaximin and eluxadoline registration trials with safety and efficacy data from the alosetron clinical development program. The rifaximin and eluxadoline clinical development programs for IBS-D have demonstrated significant improvement in IBS-D endpoints compared to placebo. Direct comparison of primary endpoint results from the alosetron, rifaximin, and eluxadoline pivotal trials is not possible; however, general estimates of efficacy can be made, and these demonstrate similar and significantly greater responses to 'adequate relief' and a composite endpoint of abdominal pain/stool form for each agent compared to placebo. With the recent approval in the United States of rifaximin and eluxadoline for IBS-D, how should clinicians employ these agents? We suggest that they be utilized sequentially, taking into consideration patient symptoms and severity, prior medical history, mode of action, cost, availability, managed care coverage, and adverse event profiles.

A screen to identify Drosophila genes required for integrin-mediated adhesion.

PubMed Central

Walsh, E P; Brown, N H

1998-01-01

Drosophila integrins have essential adhesive roles during development, including adhesion between the two wing surfaces. Most position-specific integrin mutations cause lethality, and clones of homozygous mutant cells in the wing do not adhere to the apposing surface, causing blisters. We have used FLP-FRT induced mitotic recombination to generate clones of randomly induced mutations in the F1 generation and screened for mutations that cause wing blisters. This phenotype is highly selective, since only 14 lethal complementation groups were identified in screens of the five major chromosome arms. Of the loci identified, 3 are PS integrin genes, 2 are blistered and bloated, and the remaining 9 appear to be newly characterized loci. All 11 nonintegrin loci are required on both sides of the wing, in contrast to integrin alpha subunit genes. Mutations in 8 loci only disrupt adhesion in the wing, similar to integrin mutations, while mutations in the 3 other loci cause additional wing defects. Mutations in 4 loci, like the strongest integrin mutations, cause a "tail-up" embryonic lethal phenotype, and mutant alleles of 1 of these loci strongly enhance an integrin mutation. Thus several of these loci are good candidates for genes encoding cytoplasmic proteins required for integrin function. PMID:9755209

The Burden of Diverticular Disease on Patients and Healthcare Systems

PubMed Central

Reddy, Vikram B.; Longo, Walter E.

2013-01-01

Diverticulitis is a debilitating complication of diverticular disease that affects approximately 2.5 million individuals in the United States. Compared to many other gastrointestinal conditions, diverticular disease is poorly understood in terms of its burden on patients and healthcare systems. This review examines the existing literature and discusses the current knowledge of the burden of diverticular disease. Literature confirmed that bothersome symptoms (such as abdominal pain and bloating) and potentially serious, disease-related complications (such as diverticulitis and diverticular bleeding) place a significant burden on patients. Broad-spectrum antibiotic therapy and surgery are the generally accepted mainstays of treatment for acute complications of diverticular disease. Despite these options, patients frequently experience substantially reduced quality of life (particularly in terms of social and emotional functioning) and increased mortality (predominantly due to disease-related complications) compared to healthy controls. Furthermore, diverticular disease accounted for 254,179 inpatient discharges and 1,493,865 outpatient clinic visits in the United States in 2002, at an estimated cost per hospitalization of $9,742-$11,729. Enhancing the quality of life of patients with diverticular disease and reducing disease exacerbations and complications will substantially benefit patients and healthcare systems. However, long-established treatment algorithms fall short of these therapeutic goals. Research into new treatment options for patients with diverticular disease should therefore be pursued. PMID:24707230

Non-absorbable antibiotics for managing intestinal gas production and gas-related symptoms.

PubMed

Di Stefano, M; Strocchi, A; Malservisi, S; Veneto, G; Ferrieri, A; Corazza, G R

2000-08-01

Simethicone, activated charcoal and antimicrobial drugs have been used to treat gas-related symptoms with conflicting results. To study the relationship between gaseous symptoms and colonic gas production and to test the efficacy of rifaximin, a new non-absorbable antimicrobial agent, on these symptoms. Intestinal gas production was measured by hydrogen (H2) and methane (CH4) breath testing after lactulose in 21 healthy volunteers and 34 functional patients. Only the 34 functional patients took part in a double-blind, double-dummy controlled trial, receiving, at random, rifaximin (400 mg b.d per 7 days), or activated charcoal (400 mg b.d per 7 days). The following parameters were evaluated at the start of the study and 1 and 10 days after therapy: bloating, abdominal pain, number of flatus episodes, abdominal girth, and cumulative breath H2 excretion. Hydrogen excretion was greater in functional patients than in healthy volunteers. Rifaximin, but not activated charcoal, led to a significant reduction in H2 excretion and overall severity of symptoms. In particular, in patients treated with rifaximin, a significant reduction in the mean number of flatus episodes and of mean abdominal girth was evident. In patients with gas-related symptoms the colonic production of H2 is increased. Rifaximin significantly reduces this production and the excessive number of flatus episodes.

A comparison of carcass decomposition and associated insect succession onto burnt and unburnt pig carcasses.

PubMed

McIntosh, Craig S; Dadour, Ian R; Voss, Sasha C

2017-05-01

The rate of decomposition and insect succession onto decomposing pig carcasses were investigated following burning of carcasses. Ten pig carcasses (40-45 kg) were exposed to insect activity during autumn (March-April) in Western Australia. Five replicates were burnt to a degree described by the Crow-Glassman Scale (CGS) level #2, while five carcasses were left unburnt as controls. Burning carcasses greatly accelerated decomposition in contrast to unburnt carcasses. Physical modifications following burning such as skin discolouration, splitting of abdominal tissue and leathery consolidation of skin eliminated evidence of bloat and altered microambient temperatures associated with carcasses throughout decomposition. Insect species identified on carcasses were consistent between treatment groups; however, a statistically significant difference in insect succession onto remains was evident between treatments (PERMANOVA F (1, 224)  = 14.23, p < 0.01) during an 8-day period that corresponds with the wet stage of decomposition. Differences were noted in the arrival time of late colonisers (Coleoptera) and the development of colonising insects between treatment groups. Differences in the duration of decomposition stages and insect assemblages indicate that burning has an effect on both rate of decomposition and insect succession. The findings presented here provide baseline data for entomological casework involving burnt remains criminal investigations.

Stimulatory Effects of Gamma Irradiation on Phytochemical Properties, Mitotic Behaviour, and Nutritional Composition of Sainfoin (Onobrychis viciifolia Scop.)

PubMed Central

Mat Taha, Rosna; Lay, Ma Ma; Khalili, Mahsa

2014-01-01

Sainfoin (Onobrychis viciifolia Scop. Syn. Onobrychis sativa L.) is a bloat-safe forage crop with high levels of tannins, which is renowned for its medicinal qualities in grazing animals. Mutagenesis technique was applied to investigate the influence of gamma irradiation at 30, 60, 90, and 120 Gy on mitotic behavior, in vitro growth factors, phytochemical and nutritional constituents of sainfoin. Although a percentage of plant necrosis and non-growing seed were enhanced by irradiation increment, the germination speed was significantly decreased. It was observed that gamma irradiated seeds had higher value of crude protein and dry matter digestibility compared to control seeds. Toxicity of copper was reduced in sainfoin irradiated seeds at different doses of gamma rays. Anthocyanin content also decreased in inverse proportion to irradiation intensity. Accumulation of phenolic and flavonoid compounds was enhanced by gamma irradiation exposure in leaf cells. HPLC profiles differed in peak areas of the two important alkaloids, Berberine and Sanguinarine, in 120 Gy irradiated seeds compared to control seeds. There were positive correlations between irradiation dose and some abnormality divisions such as laggard chromosome, micronucleus, binucleated cells, chromosome bridge, and cytomixis. In reality, radiocytological evaluation was proven to be essential in deducing the effectiveness of gamma irradiation to induce somaclonal variation in sainfoin. PMID:25147870

Maintenance therapy: is there still a place for antireflux surgery?

PubMed

Armstrong, D; Nicolet, M; Monnier, P; Chapuis, G; Savary, M; Blum, A L

1992-01-01

Effective and safe maintenance medical therapy for uncomplicated reflux esophagitis is now feasible with omeprazole and it is likely that other H+K+ATPase blockers, and possibly very high dose H2 receptor antagonist regimens, will also be acceptable. In addition, many patients with ulceration, strictures, and Barrett's esophagus will respond to conservative medical therapy and a proportion of patients with erosive esophagitis may remain in remission with cisapride or with low dose H2 receptor antagonists, if disease is less severe. Thus, there is now a medical "gold standard" against which surgical therapy for uncomplicated esophagitis must be judged and it is essential that all future studies be conducted with clearly defined criteria for the assessment of the symptoms and endoscopic signs of esophagitis and its complications. As ever, the patient's wishes are paramount, but he or she must be allowed to select his or her therapy on the basis of a balanced and fully informed assessment of the long-term and short-term risks of all therapeutic modalities. The burdensome prospect of lifelong tablet ingestion and its potential dangers must be weighed against the alternative, in up to 30% of cases, that surgery may produce dysphagia, gas bloat, or dumping with no guarantee of a long-term cure.

A preliminary study of the tolerance of healthy foals to a low residue enteral feeding solution.

PubMed

Kohn, C W; Knight, D A; Yvorchyk-St Jean, K E; Scaman, P A; Ruey, P R

1991-09-01

After a three day acclimatization period, six healthy, young (aged 4 to 20 days) orphan foals of mixed breeding were fed 100 per cent of their caloric needs (estimated at 523 kjoules/kg bodyweight [bwt] or 125 kcal/kg bwt/day) as a low residue isotonic feeding solution (LRF) for seven days. The solution provided 4.18 kjoules (1 kcal/ml) and was fortified with minerals and protein to meet estimated foal requirements. The solution was fed through an indwelling 12 French feeding tube. Five of the six foals completed the study; the loss of the sixth foal apparently was unrelated to the feeding protocol. The foals tolerated LRF well. Signs of intolerance were noted in two foals and were limited to flatulence, mild bloat and very mild abdominal pain associated with a decreased interval between two feedings during the first 48 h on 100 per cent LRF. Complete recovery without therapy occurred within 6 h and feedings were resumed. Growth in height and weight were comparable to published data for healthy foals raised with their dams. Feeding tubes were easily maintained with no apparent dysphagia, regurgitation or discomfort to foals. This low residue, calorically dense, isotonic feeding solution may be useful for enteral feeding of selected foals aged at least seven days.

Comparative gastrointestinal tolerance of sucrose, lactitol, or D-tagatose in chocolate.

PubMed

Lee, A; Storey, D M

1999-04-01

D-tagatose is a potential new sugar substitute. Ingested D-tagatose is incompletely absorbed from the small intestine; unabsorbed D-tagatose reaches the colon where it is completely fermented. In a double-blind, controlled crossover study, the gastrointestinal effects were compared following acute consumption of 40 g plain chocolates containing 20 g of sucrose, lactitol, or D-tagatose by 50 healthy adults ages 18 to 24 years. Consumption of D-tagatose was not associated with a significant increase in the frequency of passing feces, or in the number of subjects passing watery feces. However, lactitol consumption was associated with an increase in both of these occurrences. Consumption of chocolate containing D-tagatose and lactitol resulted in significant increases in colic, flatulence, borborygmi, and bloating compared to consumption of the sucrose-containing chocolate, but the majority of symptoms were described as only "slightly more than usual." D-tagatose-containing chocolate did not provoke significantly more of these symptoms than lactitol-containing chocolate. A significant number of subjects reported nausea following consumption of D-tagatose chocolate compared to the sucrose chocolate control, and multiple symptoms occurred in some subjects. Overall, these results demonstrate that a 20-g dose of D-tagatose is tolerated well in comparison to lactitol. Copyright 1999 Academic Press.

Infantile scurvy: an old diagnosis revisited with a modern dietary twist.

PubMed

Burk, Cynthia J; Molodow, Rona

2007-01-01

Ascorbic acid (vitamin C) is necessary for the formation of collagen, reducing free radicals, and aiding in iron absorption. Scurvy, a disease of dietary ascorbic acid deficiency, is uncommon today. Indeed, implementation of dietary recommendations largely eradicated infantile scurvy in the US in the early 1900s. We present a case of an otherwise healthy 2-year-old Caucasian girl who presented with refusal to walk secondary to pain in her lower extremities, generalized irritability, sleep disturbance, and malaise. The girl's parents described feeding the patient an organic diet recommended by the Church of Scientology that included a boiled mixture of organic whole milk, barley, and corn syrup devoid of fruits and vegetables. Physical examination revealed pale, bloated skin with edematous, violaceous gums and loosening of a few of her teeth. Dermatologic findings included xerosis, multiple scattered ecchymoses of the extremities, and perifollicular hemorrhage. Laboratory and radiographic evaluation confirmed the diagnosis of scurvy. The patient showed dramatic improvement after only 3 days of treatment with oral ascorbic acid and significant dietary modification. In this case report, we revisit the old diagnosis of scurvy with a modern dietary twist secondary to religious practices. This case highlights the importance of taking a detailed dietary history when evaluating diseases involving the skin.

The treatment of irritable bowel syndrome.

PubMed

Lacy, Brian E; Weiser, Kirsten; De Lee, Ryan

2009-07-01

Irritable bowel syndrome (IBS) is a highly prevalent functional bowel disorder routinely encountered by healthcare providers. Although not life-threatening, this chronic disorder reduces patients' quality of life and imposes a significant economic burden to the healthcare system. IBS is no longer considered a diagnosis of exclusion that can only be made after performing a battery of expensive diagnostic tests. Rather, IBS should be confidently diagnosed in the clinic at the time of the first visit using the Rome III criteria and a careful history and physical examination. Treatment options for IBS have increased in number in the past decade and clinicians should not be limited to using only fiber supplements and smooth muscle relaxants. Although all patients with IBS have symptoms of abdominal pain and disordered defecation, treatment needs to be individualized and should focus on the predominant symptom. This paper will review therapeutic options for the treatment of IBS using a tailored approach based on the predominant symptom. Abdominal pain, bloating, constipation and diarrhea are the four main symptoms that can be addressed using a combination of dietary interventions and medications. Treatment options include probiotics, antibiotics, tricyclic antidepressants, selective serotonin reuptake inhibitors and agents that modulate chloride channels and serotonin. Each class of agent will be reviewed using the latest data from the literature.

Prevalence and Characterization of Self-Reported Gluten Sensitivity in The Netherlands

PubMed Central

van Gils, Tom; Nijeboer, Petula; IJssennagger, Catharina E.; Sanders, David S.; Mulder, Chris J. J.; Bouma, Gerd

2016-01-01

Background: A growing number of individuals reports symptoms related to the ingestion of gluten-containing food in the absence of celiac disease. Yet the actual prevalence is not well established. Methods: Between April 2015 and March 2016, unselected adults visiting marketplaces, dental practices and a university in The Netherlands were asked to complete a modified validated questionnaire for self-reported gluten sensitivity (srGS). Results: Among the 785 adults enquired, two had celiac disease. Forty-nine (6.2%) reported symptoms related to the ingestion of gluten-containing food. These individuals were younger, predominantly female and lived more frequently in urban regions compared with the other respondents. Symptoms reported included bloating (74%), abdominal discomfort (49%) and flatulence (47%). A total of 23 (47%) srGS individuals reported having had tried a gluten-free or gluten-restricted diet. Abdominal discomfort related to fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP)-containing food was more often reported in srGS individuals compared with the other respondents (73.5% vs. 21.7%, p < 0.001). Conclusion: Self-reported GS is common in The Netherlands, especially in younger individuals, females and urban regions, although the prevalence was lower than in a comparable recent UK study. It cannot be excluded that FODMAPs are in part responsible for these symptoms. PMID:27834802

The relationship between intestinal parasites and some immune-mediated intestinal conditions

PubMed Central

Mohammadi, Rasoul; Hosseini-Safa, Ahmad; Ehsani Ardakani, Mohammad Javad; Rostami-Nejad, Mohammad

2015-01-01

Over the last decades, the incidence of infestation by minor parasites has decreased in developed countries. Infectious agents can also suppress autoimmune and allergic disorders. Some investigations show that various protozoa and helminthes are connected with the main immune-mediated intestinal conditions including celiac disease (CD), inflammatory bowel diseases (IBD) and irritable bowel syndrome (IBS). Celiac disease is a digestive and autoimmune disorder that can damage the small intestine and characterized by a multitude gastrointestinal (GI) and extra GI symptoms. IBD (including ulcerative colitis and Crohn’s disease) is a group of inflammatory conditions of the small intestine and colon. The etiology of IBD is unknown, but it may be related to instability in the intestinal microflora that leading to an immoderate inflammatory response to commensal microbiota. Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system. Bloating, diarrhoea and/or constipation are nonspecific symptoms of IBS. Various studies have shown that some intestinal parasites can effect on immune system of infected hosts and in some cases, they are able to modify and change the host’s immune responses, particularly in autoimmune disorders like celiac disease and IBD. The main objective of this review is to investigate the relationship between intestinal parasites and different inflammatory bowel disorders. PMID:25926937

Freeze-dried powdered yacon: effects of FOS on serum glucose, lipids and intestinal transit in the elderly.

PubMed

Scheid, M M A; Genaro, P S; Moreno, Y M F; Pastore, G M

2014-10-01

Freeze-dried powdered yacon (FDY) can be considered a prebiotic product due to its fructooligosaccharides (FOS) content. The effect of 9 weeks of daily intake of FDY containing 7.4 g of FOS on glucose, lipid metabolism and intestinal transit in a group of elderly people was investigated. Seventy-two elderly (mean age 67.11 ± 6.11) men and women were studied for 9 weeks in a double-blind, placebo-controlled experiment. They were randomly assigned to the supplement group (which received 7.4 g of FOS as FDY) or the control group. At the beginning and end of the study, anthropometric measurements, blood sampling, clinical analyses and dietary intake were assessed. A daily intake of FDY containing 7.4 g of FOS for 9 weeks was associated with a mean decrease in serum glucose (p = 0.013), but supplementation did not reduce serum lipids in the study group. The administered dose did not adversely affect intestinal transit. It did not cause bloating, flatulence or intestinal discomfort. Freeze-dried powdered yacon is a good source of FOS, and daily consumption can have a favourable effect on serum glucose in the elderly. It is also practical, easy and safe to use and store.

Efficacy of a simethicone, activated charcoal and magnesium oxide combination (Carbosymag®) in functional dyspepsia: results of a general practice-based randomized trial.

PubMed

Coffin, Benoit; Bortolloti, Claude; Bourgeois, Odile; Denicourt, Luc

2011-06-01

A simethicone, activated charcoal and magnesium oxide combination (Carbosymag(®)) has been used for almost 20 years in functional dyspepsia, but there is limited scientific evidence of efficacy. We evaluated the efficacy of Carbosymag(®) in 18- to 49-year-old patients with functional dyspepsia. A total of 276 dyspeptic patients consulting a general practitioner and meeting the Rome III criteria were included in this prospective placebo-controlled study. Variations in overall and individual dyspeptic symptoms were evaluated after 1 month of treatment. At the end of the treatment period, overall dyspeptic symptom intensity was significantly lower in the Carbosymag(®) group (P=0.01). The intensity of post-prandial fullness, epigastric pain, epigastric burning and abdominal bloating was significantly reduced in the Carbosymag(®) group relative to the placebo group (P<0.05). The number need to treat to induce a 70-% decrease in overall dyspeptic symptoms by Carbosymag(®) was 7 (IC 95%: 4-32). A simethicone, activated charcoal and magnesium oxide combination (Carbosymag(®)) was significantly more effective than a placebo on overall symptom intensity in dyspeptic patients consulting a general practitioner. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Clinical measurement of gastrointestinal motility and function: who, when and which test?

PubMed

Fox, Mark R; Kahrilas, Peter J; Roman, Sabine; Gyawali, C Prakash; Scott, S Mark; Rao, Satish S; Keller, Jutta; Camilleri, Michael

2018-06-05

Symptoms related to abnormal gastrointestinal motility and function are common. Oropharyngeal and oesophageal dysphagia, heartburn, bloating, abdominal pain and alterations in bowel habits are among the most frequent reasons for seeking medical attention from internists or general practitioners and are also common reasons for referral to gastroenterologists and colorectal surgeons. However, the nonspecific nature of gastrointestinal symptoms, the absence of a definitive diagnosis on routine investigations (such as endoscopy, radiology or blood tests) and the lack of specific treatments make disease management challenging. Advances in technology have driven progress in the understanding of many of these conditions. This Review serves as an introduction to a series of Consensus Statements on the clinical measurements of gastrointestinal motility, function and sensitivity. A structured, evidence-based approach to the initial assessment and empirical treatment of patients presenting with gastrointestinal symptoms is discussed, followed by an outline of the contribution of modern physiological measurement on the management of patients in whom the cause of symptoms has not been identified with other tests. Discussions include the indications for and utility of high-resolution manometry, ambulatory pH-impedance monitoring, gastric emptying studies, breath tests and investigations of anorectal structure and function in day-to-day practice and clinical management.

Microscopic colitis and small intestinal bacterial overgrowth--diagnosis behind the irritable bowel syndrome?

PubMed

Stoicescu, Adriana; Andrei, M; Becheanu, G; Stoicescu, M; Nicolaie, T; Diculescu, M

2012-01-01

Some patients previously diagnosed with irritable bowel syndrome (IBS) may develop microscopic colitis or small intestinal bacterial overgrowth (SIBO). To estimate the prevalence of microscopic colitis and SIBO in patients with IBS, to evaluate the symptoms and the efficacy of treatment. We examined patients with IBS admitted in our clinic during a three-year period. We identified patients with microscopic colitis by performing total colonoscopy with multiple biopsies from normal intestinal mucosa and those with SIBO by performing a H2-breath test with glucose. We compared the symptoms and the effectiveness of the treatment. Out of the 132 patients initially diagnosed with IBS 3% (n=4) had microscopic colitis and 43.9% (n=58) had SIBO. Diarrhea was the main symptom in patients with microscopic colitis and SIBO (p=0.041), while abdominal pain, abdominal bloating and flatulence were prominent in IBS patients (p=0.042; p=0.039; p=0.048). Specific treatment with rifaximin in SIBO patients negativated H2-breath test in 70.9% cases. Patients suspected to have irritable bowel syndrome should be evaluated for microscopic colitis and SIBO. The proper diagnosis and the specific treatment may cure some difficult cases of the so called "irritable bowel syndrome".

Ocular toxoplasmosis: adverse reactions to treatment in a Brazilian cohort.

PubMed

Guaraldo, Lusiele; Villar, Bianca Balzano de la Fuente; Durão, Nicolle Marins Gomes; Louro, Virgínia Clare; Quintana, Marcel de Souza Borges; Curi, André Luiz Land; Neves, Elizabeth Souza

2018-05-19

The purpose of this study was to estimate the frequency and describe the adverse drug reactions (ADRs) associated with the classic treatment of ocular toxoplasmosis (OT), namely sulfadiazine, pyrimethamine, corticosteroids and folinic acid. We performed a descriptive study of a prospective cohort of patients with OT treated with the classic therapy. Data were collected during medical consultations and treatment. Of the 147 patients studied, 85% developed one or more ADR. Women presented more ADRs than men (95% vs 77%). Of the total reactions (n=394), 82% were mild, but we found one life-threatening event (Stevens-Johnson syndrome). The most frequent types (71%) of ADRs were gastrointestinal, skin and neurological or psychiatric. The majority of ADRs (90.3%) occurred before the second week of treatment. A third of the patients were treated for the ADR and 10% dropped out of OT treatment. Most (70%) of the ADRs were characterized as being probably caused by the drugs and may be associated with prednisone, sulfadiazine and sulfadiazine/prednisone. Six percent of ADRs were not previously described, such as taste alteration, constipation/bloating, dyspnoea, sweating and somnolence. Our results suggest a high rate of ADRs to OT classic treatment, which requires careful follow-up in order to identify and treat ADRs early.

Subthreshold Psychiatric Psychopathology in Functional Gastrointestinal Disorders: Can It Be the Bridge between Gastroenterology and Psychiatry?

PubMed Central

Nisita, Cristiana; Cortopassi, Sonia; Corretti, Giorgio; Gambaccini, Dario; De Bortoli, Nicola; Fani, Bernardo; Simonetti, Natalia; Ricchiuti, Angelo; Dell'Osso, Liliana; Marchi, Santino; Bellini, Massimo

2017-01-01

Background and Aims Functional gastrointestinal disorders (FGDs) are multifactorial disorders of the gut-brain interaction. This study investigated the prevalence of Axis I and spectrum disorders in patients with FGD and established the link between FGDs and psychopathological dimensions. Methods A total of 135 consecutive patients with FGD were enrolled. The symptoms' severity was evaluated using questionnaires, while the psychiatric evaluation by clinical interviews established the presence/absence of mental (Diagnostic and Statistical Manual—4th edition, Axis I Diagnosis) or spectrum disorders. Results Of the 135 patients, 42 (32.3%) had functional dyspepsia, 52 (40.0%) had irritable bowel syndrome, 21 (16.2%) had functional bloating, and 20 (15.4%) had functional constipation. At least one psychiatric disorder was present in 46.9% of the patients, while a suprathreshold panic spectrum was present in 26.2%. Functional constipation was associated with depressive disorders (p < 0.05), while functional dyspepsia was related to the current major depressive episode (p < 0.05). Obsessive-compulsive spectrum was correlated with the presence of functional constipation and irritable bowel syndrome (p < 0.05). Conclusion The high prevalence of subthreshold psychiatric symptomatology in patients with FGD, which is likely to influence the expression of gastrointestinal symptoms, suggested the usefulness of psychological evaluation in patients with FGDs. PMID:29213280

Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy.

PubMed

Ghoshal, Uday C; Shukla, Ratnakar; Ghoshal, Ujjala

2017-03-15

The pathogenesis of irritable bowel syndrome (IBS), once thought to be largely psychogenic in origin, is now understood to be multifactorial. One of the reasons for this paradigm shift is the realization that gut dysbiosis, including small intestinal bacterial overgrowth (SIBO), causes IBS symptoms. Between 4% and 78% of patients with IBS and 1% and 40% of controls have SIBO; such wide variations in prevalence might result from population differences, IBS diagnostic criteria, and, most importantly, methods to diagnose SIBO. Although quantitative jejunal aspirate culture is considered the gold standard for the diagnosis of SIBO, noninvasive hydrogen breath tests have been popular. Although the glucose hydrogen breath test is highly specific, its sensitivity is low; in contrast, the early-peak criteria in the lactulose hydrogen breath test are highly nonspecific. Female gender, older age, diarrhea-predominant IBS, bloating and flatulence, proton pump inhibitor and narcotic intake, and low hemoglobin are associated with SIBO among IBS patients. Several therapeutic trials targeting gut microbes using antibiotics and probiotics have further demonstrated that not all symptoms in patients with IBS originate in the brain but rather in the gut, providing support for the micro-organic basis of IBS. A recent proof-of-concept study showing the high frequency of symptom improvement in patients with IBS with SIBO further supports this hypothesis.

Management of gastroesophageal reflux disease.

PubMed

Tutuian, Radu; Castell, Donald O

2003-11-01

Gastroesophageal reflux disease (GERD) is a chronic condition requiring long-term treatment. Simple lifestyle modifications are the first methods employed by patients and, because of their low cost and simplicity, should be continued even when more potent therapies are initiated. Potent acid-suppressive therapy is currently the most important and successful medical therapy. Whereas healing of the esophageal mucosa is achieved with a single dose of any proton pump inhibitor (PPI) in more than 80% of cases, symptoms are more difficult to control. Patients with persistent symptoms on therapy should be tested (preferably with combined multichannel intraluminal impedance and pH) for association of symptoms with acid, nonacid, or no GER. Long-term follow-up studies indicate that PPIs are efficacious, tolerable, and safe medication. So far, promotility agents have shown limited efficacy, and their side-effect profile outweighs their benefits. Antireflux surgery in carefully selected patients (ie, young, typical GERD symptoms, abnormal pH study, and good response to PPI) is as effective as PPI therapy and should be offered to these patients as an alternative to medication. Still, patients should be informed about the risks of antireflux surgery (ie, risk of postoperative dysphagia; decreased ability to belch, possibly leading to bloating; increased flatulence). Endoscopic antireflux procedures are recommended only in selected patients and given the relative short experience with these techniques, patients treated with endoscopic procedures should be enrolled in a rigorous follow-up program.

Evaluation of Self-Perceived Changes in Gastrointestinal Symptoms During Ramadan Fasting.

PubMed

Keshteli, A H; Sadeghpour, S; Feizi, A; Boyce, P; Adibi, P

2017-10-01

Little is known regarding the effects of Ramadan fasting on common gastrointestinal symptoms. The aim of this study was to assess the alterations of these symptoms in a healthy Iranian adult population during Ramadan. In a cross-sectional study, self-administered questionnaires were used to evaluate the alterations in seven groups of gastrointestinal symptoms (esophageal symptoms, dyspeptic symptoms, bloating and abdominal distension, constipation, diarrhea, abdominal pain, and nausea) after Ramadan. A total of 900 individuals participated in the study. Almost 87 % of participants reported to fast for at least 2 weeks during Ramadan. After adjusting for potential confounders, we found no relationship between alteration in frequency of gastrointestinal symptoms and Ramadan fasting, except for constipation which increased significantly after Ramadan fasting (odds ratio 1.99, 95 % confidence interval 1.05-3.80, P < 0.05). In addition, those who fasted for at least 2 weeks reported to experience severe or very severe constipation-related symptoms three times more in comparison with those who fasted for less than 2 weeks (P < 0.05). There was no relationship between severity of other gastrointestinal symptoms and Ramadan fasting. We found that Ramadan fasting does not increase frequency and severity of common gastrointestinal symptoms in the general population except for constipation that may be experienced more frequently and severely among those who fast for 2 weeks or more.

Therapeutic effect of Vitex agnus castus in patients with premenstrual syndrome.

PubMed

Zamani, Mehrangiz; Neghab, Nosrat; Torabian, Saadat

2012-01-01

Medical therapies have been widely used for premenstrual syndrome (PMS), but in all of them side effects are predominant. Herbal remedies rarely have side effects and people have more tendencies toward them than chemical therapies. In this study the therapeutic effect of Vitex agnus castus on women who had the PMS, in comparison with placebo, were investigated. In this randomized, placebo-controlled, double-blind study, from 134 selected patients 128 women suffered from PMS were evaluated (active 62, placebo 66). All patients answered to a self assessment questionnaire about their headache, anger, irritability, depression, breast fullness and bloating and tympani during the premenstrual period before the study. Forty drops of Vitex agnus extract or matching placebo, administrated for 6 days before menses for 6 consecutive cycles. Patients answered the self-assessment questionnaires after 6 menstrual cycles, again. Each item rated using a visual analogue scale (VAS). The mean age was 30.77 (SD=4.37) years in the active group and 30.89 (SD=4.02) years in the placebo group.Rank of variables had significantly difference in active and placebo group before and after the study (P<0.0001) also we noticed significant differences on the use of Vitex agnus in comparison with placebo (P<0.0001). Vitex agnus can be considered as an effective and well tolerated treatment for the relief of symptoms of mild and moderate PMS.

Preference for gel over suppository as delivery vehicle for a rectal microbicide: results of a randomised, crossover acceptability trial among men who have sex with men.

PubMed

Carballo-Diéguez, A; Dolezal, C; Bauermeister, J A; O'Brien, W; Ventuneac, A; Mayer, K

2008-11-01

To assess whether men who have sex with men (MSM) prefer a gel or a suppository as a delivery vehicle for a rectal microbicide. 77 HIV-negative MSM with a recent history of inconsistent condom use during receptive anal intercourse (RAI) who acknowledged being at risk of contracting HIV were enrolled in a randomised, crossover acceptability trial. They compared 35 ml placebo gel with 8 g placebo rectal suppositories used on up to three RAI occasions each. Participants preferred the gel over the suppository (75% versus 25%, p<0.001) and so did their partners (71% versus 29%, p<0.001). The gel received more favourable ratings overall and on attributes such as colour, smell, consistency, feeling in rectum immediately after insertion and/or 30 minutes after insertion and application process. The gel resulted in less negative ratings in terms of participants being bothered by leakage, soiling, bloating, gassiness, stomach cramps, urge to have bowel movement, diarrhoea, pain or trauma. Participants liked the gel more in terms of feelings during anal sex, sexual satisfaction, partners' sexual satisfaction and liking the product when condoms were used and when condoms were not used. In this sample taken from one of the populations most likely to benefit from rectal microbicide availability, gel had greater acceptability than a suppository as a potential microbicide vehicle.

The Use of Gene Modification and Advanced Molecular Structure Analyses towards Improving Alfalfa Forage.

PubMed

Lei, Yaogeng; Hannoufa, Abdelali; Yu, Peiqiang

2017-01-29

Alfalfa is one of the most important legume forage crops in the world. In spite of its agronomic and nutritive advantages, alfalfa has some limitations in the usage of pasture forage and hay supplement. High rapid degradation of protein in alfalfa poses a risk of rumen bloat to ruminants which could cause huge economic losses for farmers. Coupled with the relatively high lignin content, which impedes the degradation of carbohydrate in rumen, alfalfa has unbalanced and asynchronous degradation ratio of nitrogen to carbohydrate (N/CHO) in rumen. Genetic engineering approaches have been used to manipulate the expression of genes involved in important metabolic pathways for the purpose of improving the nutritive value, forage yield, and the ability to resist abiotic stress. Such gene modification could bring molecular structural changes in alfalfa that are detectable by advanced structural analytical techniques. These structural analyses have been employed in assessing alfalfa forage characteristics, allowing for rapid, convenient and cost-effective analysis of alfalfa forage quality. In this article, we review two major obstacles facing alfalfa utilization, namely poor protein utilization and relatively high lignin content, and highlight genetic studies that were performed to overcome these drawbacks, as well as to introduce other improvements to alfalfa quality. We also review the use of advanced molecular structural analysis in the assessment of alfalfa forage for its potential usage in quality selection in alfalfa breeding.

A field study of culling and mortality in beef cows from western Canada.

PubMed

Waldner, Cheryl L; Kennedy, Richard I; Rosengren, Leigh; Clark, Edward G

2009-05-01

The objectives were to describe the pattern of losses through culling, sales of breeding stock, mortality, and disappearance, and to characterize the causes of mortality of cows and replacement heifers of breeding age from Western Canadian beef herds. Cows and replacement heifers from 203 herds were observed for a 1-year period starting June 1, 2001. Veterinarians examined dead animals on-farm using a standard postmortem protocol. The incidence of culling in cows and replacements heifers was 14.3 per 100 cow-years at risk, and the frequencies of sales for breeding stock, mortality, and cows reported missing per cow-years at risk were 4.0, 1.1, and 0.4, respectively. During the study, 355 animals died or were euthanized, 209 were examined postmortem, and the requested tissues were submitted for histopathologic examination from 184. A cause of death was determined for 70% (128/184) of the cows with complete gross postmortem and histopathologic examinations. Hardware disease (traumatic reticuloperitonitis), malignant neoplasia (cancer), calving-associated injury, rumen tympany (bloat), myopathy, and pneumonia accounted for 56% (72/128) of the animals where a cause of death was determined. Twenty-three other causes of death accounted for the remaining 44% (56/128). Factors relating to cow nutrition accounted for 25% of the deaths, emphasizing the importance of feeding management as a determinant of cow health in western Canada.

The Use of Gene Modification and Advanced Molecular Structure Analyses towards Improving Alfalfa Forage

PubMed Central

Lei, Yaogeng; Hannoufa, Abdelali; Yu, Peiqiang

2017-01-01

Alfalfa is one of the most important legume forage crops in the world. In spite of its agronomic and nutritive advantages, alfalfa has some limitations in the usage of pasture forage and hay supplement. High rapid degradation of protein in alfalfa poses a risk of rumen bloat to ruminants which could cause huge economic losses for farmers. Coupled with the relatively high lignin content, which impedes the degradation of carbohydrate in rumen, alfalfa has unbalanced and asynchronous degradation ratio of nitrogen to carbohydrate (N/CHO) in rumen. Genetic engineering approaches have been used to manipulate the expression of genes involved in important metabolic pathways for the purpose of improving the nutritive value, forage yield, and the ability to resist abiotic stress. Such gene modification could bring molecular structural changes in alfalfa that are detectable by advanced structural analytical techniques. These structural analyses have been employed in assessing alfalfa forage characteristics, allowing for rapid, convenient and cost-effective analysis of alfalfa forage quality. In this article, we review two major obstacles facing alfalfa utilization, namely poor protein utilization and relatively high lignin content, and highlight genetic studies that were performed to overcome these drawbacks, as well as to introduce other improvements to alfalfa quality. We also review the use of advanced molecular structural analysis in the assessment of alfalfa forage for its potential usage in quality selection in alfalfa breeding. PMID:28146083

Effect of sugar fatty acid esters on rumen fermentation in vitro.

PubMed

Wakita, M; Hoshino, S

1987-11-01

1. The effect of sugar fatty acid esters (SFEs; currently used as food additives for human consumption) on rumen volatile fatty acids (VFA) and gas production was studied with sheep rumen contents in vitro. 2. Some SFEs having monoester contents of more than 70% increased the molar proportion of propionate in conjunction with reduction in the acetate:propionate ratio when the individual SFE was added to rumen contents in a final concentration of 4 g/l. Laurate sugar ester was the most potent propionate enhancer and rumen gas depressor, the effective dose being as low as 1 g/l in a final concentration. Fatty acid esters other than SFEs had little, if any, effect on rumen VFA production and their molar proportions. 3. Approximately 50% of laurate sugar ester was hydrolysed by in vitro incubation with rumen fluid for 2 h. The addition of fatty acids and sucrose was also effective in the alterations of rumen VFA and gas production. However, the effect of SFEs on in vitro rumen fermentation was significantly greater than that of their constituent fatty acids or sucrose, or both. Accordingly, the effect appeared to be ascribed to the complex action of SFE itself and to its constituents, free fatty acids and sucrose. 4. SFEs, at the level of 4 g/l, reduced substantially the froth formation (ingesta volume increase) and seemed to be effective for the prevention of bloat.

A galactic mega-merger

NASA Image and Video Library

2016-01-11

The subject of this NASA/ESA Hubble Space Telescope image is known as NGC 3597. It is the product of a collision between two good-sized galaxies, and is slowly evolving to become a giant elliptical galaxy. This type of galaxy has grown more and more common as the Universe has evolved, with initially small galaxies merging and progressively building up into larger galactic structures over time. NGC 3597 is located approximately 150 million light-years away in the constellation of Crater (The Cup). Astronomers study NGC 3597 to learn more about how elliptical galaxies form — many ellipticals began their lives far earlier in the history of the Universe. Older ellipticals are nicknamed “red and dead” by astronomers because these bloated galaxies are not anymore producing new, bluer, stars in ages, and are thus packed full of old and redder stellar populations. Before infirmity sets in, some freshly formed elliptical galaxies experience a final flush of youth, as is the case with NGC 3597. Galaxies smashing together pool their available gas and dust, triggering new rounds of star birth. Some of this material ends up in dense pockets initially called proto-globular clusters, dozens of which festoon NGC 3597. These pockets will go on to collapse and form fully-fledged globular clusters, large spheres that orbit the centres of galaxies like satellites, packed tightly full of millions of stars.

Asian consensus on irritable bowel syndrome.

PubMed

Gwee, Kok-Ann; Bak, Young-Tae; Ghoshal, Uday Chand; Gonlachanvit, Sutep; Lee, Oh Young; Fock, Kwong Ming; Chua, Andrew Seng Boon; Lu, Ching-Liang; Goh, Khean-Lee; Kositchaiwat, Chomsri; Makharia, Govind; Park, Hyo-Jin; Chang, Full-Young; Fukudo, Shin; Choi, Myung-Gyu; Bhatia, Shobna; Ke, Meiyun; Hou, Xiaohua; Hongo, Michio

2010-07-01

Many of the ideas on irritable bowel syndrome (IBS) are derived from studies conducted in Western societies. Their relevance to Asian societies has not been critically examined. Our objectives were to bring to attention important data from Asian studies, articulate the experience and views of our Asian experts, and provide a relevant guide on this poorly understood condition for doctors and scientists working in Asia. A multinational group of physicians from Asia with special interest in IBS raised statements on IBS pertaining to symptoms, diagnosis, epidemiology, infection, pathophysiology, motility, management, and diet. A modified Delphi approach was employed to present and grade the quality of evidence, and determine the level of agreement. We observed that bloating and symptoms associated with meals were prominent complaints among our IBS patients. In the majority of our countries, we did not observe a female predominance. In some Asian populations, the intestinal transit times in healthy and IBS patients appear to be faster than those reported in the West. High consultation rates were observed, particularly in the more affluent countries. There was only weak evidence to support the perception that psychological distress determines health-care seeking. Dietary factors, in particular, chili consumption and the high prevalence of lactose malabsorption, were perceived to be aggravating factors, but the evidence was weak. This detailed compilation of studies from different parts of Asia, draws attention to Asian patients' experiences of IBS.

Services under siege--the restructuring imperative.

PubMed

Roach, S S

1991-01-01

Recent job losses in the U.S. service sector do not reflect a temporary recession. Those jobs are gone, the result of a massive restructuring of the sector that is just getting under way. The explanation for the restructuring is quite simple. Until recently, services have been shielded by regulation and confronted by few foreign competitors. They have allowed their white-collar payrolls to become bloated, their investment in information technology to outstrip the paybacks, and their productivity to stagnate. Now competition is heating up and exposing these inefficiencies. Just as intense competition forced the restructuring of Smokestack America in the 1980s, deregulation and foreign direct investment are shaking out service companies that cannot confront their shortcomings. The need for sweeping change in the service sector may come as a great shock to Americans who saw services as the means to continued economic prosperity. But there is a painful irony at work: job creation, the very thing proponents use to demonstrate the U.S. service sector's strength, is in fact a symptom of the sector's chronic neglect of economic efficiency. It is precisely that neglect that makes the service sector vulnerable as the race for market share intensifies and new players shift the terms of competition. Services must respond to the new competitive environment, but not by indiscriminate cost cutting. Instead, they should balance financial discipline with a comprehensive and immediate reexamination of strategy.

Diseases and pathogens associated with mortality in Ontario beef feedlots.

PubMed

Gagea, Mihai I; Bateman, Kenneth G; van Dreumel, Tony; McEwen, Beverly J; Carman, Susy; Archambault, Marie; Shanahan, Rachel A; Caswell, Jeff L

2006-01-01

This study determined the prevalence of diseases and pathogens associated with mortality or severe morbidity in 72 Ontario beef feedlots in calves that died or were euthanized within 60 days after arrival. Routine pathologic and microbiologic investigations, as well as immunohistochemical staining for detection of bovine viral diarrhea virus (BVDV) antigen, were performed on 99 calves that died or were euthanized within 60 days after arrival. Major disease conditions identified included fibrinosuppurative bronchopneumonia (49%), caseonecrotic bronchopneumonia or arthritis (or both) caused by Mycoplasma bovis (36%), viral respiratory disease (19%), BVDV-related diseases (21%), Histophilus somni myocarditis (8%), ruminal bloat (2%), and miscellaneous diseases (8%). Viral infections identified were BVDV (35%), bovine respiratory syncytial virus (9%), bovine herpesvirus-1 (6%), parainfluenza-3 virus (3%), and bovine coronavirus (2%). Bacteria isolated from the lungs included M. bovis (82%), Mycoplasma arginini (72%), Ureaplasma diversum (25%), Mannheimia haemolytica (27%), Pasteurella multocida (19%), H. somni (14%), and Arcanobacterium pyogenes (19%). Pneumonia was the most frequent cause of mortality of beef calves during the first 2 months after arrival in feedlots, representing 69% of total deaths. The prevalence of caseonecrotic bronchopneumonia caused by M. bovis was similar to that of fibrinosuppurative bronchopneumonia, and together, these diseases were the most common causes of pneumonia and death. M. bovis pneumonia and polyarthritis has emerged as an important cause of mortality in Ontario beef feedlots.

Rifaximin: The Revolutionary Antibiotic Approach for Irritable Bowel Syndrome.

PubMed

Triantafyllou, Konstantinos; Sioulas, Athanasios D; Giamarellos-Bourboulis, Evangelos J

2015-01-01

A large number of clinical studies using breath testing and a smaller number of studies using quantitative cultures of the upper small intestine established a link between irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO). A series of 12 studies both prospective and retrospective in design in a population of patients with SIBO without IBS showed that the non-absorbable antibiotic rifaximin can eradicate SIBO as proved through decrease of the exhaled hydrogen and methane in breath tests. The efficacy of rifaximin was superior over the comparator treatment in most of these studies. Based on these findings, short course rifaximin was tested in various concentrations in eight open-label trials in patients with IBS and proven SIBO by breath test. Similar efficacy of rifaximin was shown in SIBO eradication; this was accompanied by improvement of the global score for IBS symptoms. Finally, five double-blind randomized clinical trials were conducted in patients with IBS; four were placebo-controlled. The larger trials were TARGET 1 and TARGET 2 studies testing rifaximin at a regimen of 550 mg tid for 14 days. All trials showed a significant superiority of rifaximin over comparator for the improvement of global symptoms of IBS and bloating. Although the aforementioned results render rifaximin a revolutionary therapeutic approach for IBS, several concerns on induction of antimicrobial resistant flora remain.

Efficacy of mulberry leaf tablets in patients with mild dyslipidemia.

PubMed

Aramwit, Pornanong; Petcharat, Kanokwan; Supasyndh, Ouppatham

2011-03-01

Mulberry leaf is well known for its several biological effects. The purpose of this study was to evaluate the hypolipidemic effect of mulberry leaf in non-diabetic patients with mild dyslipidemia. A within-subjects research design was conducted at the out-patient clinic in Thailand. Twenty-three patients who met the NCEP ATP III criteria guideline for dyslipidemia and failed a 4 week diet therapy were enrolled and assigned to receive three tablets of 280 mg mulberry leaf tablet three times a day before meals for a period of 12 weeks. Routine blood analyses including lipid parameters and liver function tests were performed every 4 weeks. At 4 and 8 weeks of mulberry leaf tablet therapy, triglyceride was significantly decreased by 10.2% (p < 0.05) and 12.5% (p < 0.05), respectively, from baseline. At the end of the study, total cholesterol, triglyceride and LDL were significantly decreased by 4.9% (p < 0.05), 14.1% (p < 0.05) and 5.6% (p < 0.05), respectively, from baseline, whereas HDL was significantly increased by 19.7% (p < 0.05). Even though some patients experienced side effects such as mild diarrhea (26%), dizziness (8.7%) or constipation and bloating (4.3%), mulberry leaf tablet therapy is still capable and safe in reducing cholesterol levels and enhancing HDL in patients with mild dyslipidemia. Copyright © 2010 John Wiley & Sons, Ltd.

Chiropractic Management Using Multimodal Therapies on 2 Pediatric Patients With Constipation.

PubMed

Iyer, Madhu Mia; Skokos, Evangelia; Piombo, Denise

2017-12-01

The purpose of this case report is to describe chiropractic management of 7-month-old male twins who had had constipation since birth. Identical male twins presented with the chief complaint of constipation and bloating. Both patients were born premature after 29 weeks of gestation and had invasive abdominal surgeries in the right lower quadrant resulting in healed postsurgical scars. Patient A underwent ileostomy for a perforation in his ileum. Patient B underwent surgery to repair an inguinal hernia. Motion palpation restrictions indicated bilateral sacroiliac, cervical, and thoracic joint restrictions. The treatment plan included chiropractic manipulation, acupressure stimulation, and dynamic neuromuscular stabilization. Manipulation of the sacroiliac, cervical, and thoracic spine joint restrictions was performed using minimal force. Cross-frictional massage and myofascial manipulation and scar tissue mobilization of the abdominal scar in the right lower quadrant were performed. Acupressure stimulation was performed on both patients' feet. Both patients had improved bowel movements after the first treatment. Patient A had 5 weeks of treatment (2 visits per week). Patient B had 4 weeks of treatment (2 visits per week). The patients' clinical progress improved, and once the goal of regular bowel movements was reached, as confirmed by their mother, follow-up visits were reduced to once a week and gradually to once a month. Both pediatric patients with constipation responded to chiropractic care using multimodal therapies.

Daily thanatomicrobiome changes in soil as an approach of postmortem interval estimation: An ecological perspective.

PubMed

Adserias-Garriga, Joe; Hernández, Marta; Quijada, Narciso M; Rodríguez Lázaro, David; Steadman, Dawnie; Garcia-Gil, Jesús

2017-09-01

Understanding human decomposition is critical for its use in postmortem interval (PMI) estimation, having a significant impact on forensic investigations. In recognition of the need to establish the scientific basis for PMI estimation, several studies on decomposition have been carried out in the last years. The aims of the present study were: (i) to identify soil microbiota communities involved in human decomposition through high-throughput sequencing (HTS) of DNA sequences from the different bacteria, (ii) to monitor quantitatively and qualitatively the decay of such signature species, and (iii) to describe succesional changes in bacterial populations from the early putrefaction state until skeletonization. Three donated individuals to the University of Tennessee FAC were studied. Soil samples around the body were taken from the placement of the donor until advanced decay/dry remains stage. Bacterial DNA extracts were obtained from the samples, HTS techniques were applied and bioinformatic data analysis was performed. The three cadavers showed similar overall successional changes. At the beginning of the decomposition process the soil microbiome consisted of diverse indigenous soil bacterial communities. As decomposition advanced, Firmicutes community abundance increased in the soil during the bloat stage. The growth curve of Firmicutes from human remains can be used to estimate time since death during Tennessee summer conditions. Copyright © 2017 Elsevier B.V. All rights reserved.

A double-blind, placebo-controlled, cross-over study to establish the bifidogenic effect of a very-long-chain inulin extracted from globe artichoke (Cynara scolymus) in healthy human subjects.

PubMed

Costabile, Adele; Kolida, Sofia; Klinder, Annett; Gietl, Eva; Bäuerlein, Michael; Frohberg, Claus; Landschütze, Volker; Gibson, Glenn R

2010-10-01

There is growing interest in the use of inulins as substrates for the selective growth of beneficial gut bacteria such as bifidobacteria and lactobacilli because recent studies have established that their prebiotic effect is linked to several health benefits. In the present study, the impact of a very-long-chain inulin (VLCI), derived from globe artichoke (Cynara scolymus), on the human intestinal microbiota compared with maltodextrin was determined. A double-blind, cross-over study was carried out in thirty-two healthy adults who were randomised into two groups and consumed 10 g/d of either VLCI or maltodextrin, for two 3-week study periods, separated by a 3-week washout period. Numbers of faecal bifidobacteria and lactobacilli were significantly higher upon VLCI ingestion compared with the placebo. Additionally, levels of Atopobium group significantly increased, while Bacteroides-Prevotella numbers were significantly reduced. No significant changes in faecal SCFA concentrations were observed. There were no adverse gastrointestinal symptoms apart from a significant increase in mild and moderate bloating upon VLCI ingestion. These observations were also confirmed by in vitro gas production measurements. In conclusion, daily consumption of VLCI extracted from globe artichoke exerted a pronounced prebiotic effect on the human faecal microbiota composition and was well tolerated by all volunteers.

Lubiprostone--a novel treatment for irritable bowel syndrome with constipation.

PubMed

Owen, Richard T

2008-09-01

Irritable bowel syndrome (IBS) is a chronic, highly prevalent gastrointestinal motility disorder characterized by abdominal discomfort/pain associated with altered bowel habits such as diarrhea or constipation or both. Current therapy for the constipation-predominant form (IBS-C) comprises fiber or osmotic or stimulant laxatives. However, these may exacerbate the condition or cause electrolyte disturbances. Lubiprostone is a novel selective chloride channel-2 activator that increases fluid secretion in the intestinal apical cell membrane, increasing gut motility and frequency of stool passage, and alleviating abdominal discomfort/pain. Lubiprostone has very low systemic bioavailability and cannot be quantitated in blood, but its active metabolite, M3, has been pharmacokinetically profiled. Lubiprostone reaches peak plasma concentrations within approximately 1 h and has a half-life of 0.9-1.4 h. Despite this short half-life, lubiprostone can be administered orally twice daily. Its efficacy in IBS-C has been demonstrated in two phase III studies; spontaneous bowel movement frequency increased and stool consistency improved, whereas straining, bloating and severity of constipation decreased. The beneficial effects continued for up to 4 weeks after cessation of lubiprostone. Lubiprostone was well tolerated in the long-term, with nausea and diarrhea being the commonest adverse events. Further studies are ongoing in opioid-induced bowel dysfunction. Copyright 2008 Prous Science, S.A.U. or its licensors. All rights reserved.

Effects of acetic acid and hydrogen peroxide application during defeathering on the microbiological quality of broiler carcasses prior to evisceration.

PubMed

Dickens, J A; Whittemore, A D

1997-04-01

The microbiological quality and skin appearance of New York dressed broiler carcasses were determined in two separate experiments after a water control, acetic acid, or H2O2 spray during defeathering. Broilers were picked up from a local processor and transported in coops to the pilot facility. In both experiments, commercial processing parameters were followed up to the defeathering step. After feather removal, the vents of all carcasses were blocked with a cotton plug to prevent contamination of the whole carcass rinse diluent with fecal material from the lower gut. The neck and feet were removed, and the carcasses were placed in individual plastic bags in preparation for a whole carcass rinse. Results showed a statistically significant reduction (P < 0.05) in the log10 total aerobic plate counts for carcasses treated with 1% acetic acid in comparison to the water control (log10 cfu counts = 3.93 and 4.53, respectively). No differences were observed in skin appearance due to the 1% acid treatment. The addition of 0.5, 1, or 1.5% H2O2 to spray waters had no effect on microbiological quality of the carcasses when compared to the water control (4.92, 5.01, 4.91, and 4.99 log10 counts, respectively). The skin of carcasses treated with hydrogen peroxide, regardless of the concentration was bleached and bloated.

Histologic effects of different technologies for dissection in endoscopic surgery: Nd:YAG laser, high frequency and water-jet.

PubMed

Schurr, M O; Wehrmann, M; Kunert, W; Melzer, A; Lirici, M M; Trapp, R; Kanehira, E; Buess, G

1994-01-01

Precise cutting combined with reliable coagulation of the margins of the lesion is an important requirement for dissection techniques in endoscopic surgery. These requirements are met by the two most common ancillary energy sources applied for endoscopic dissection today, electrosurgery and "thermal lasers", mostly the Nd:YAG. For the comparison of the histological effects of monopolar and bipolar high frequency with the Nd:YAG laser an experimental in vitro and in vivo study has been performed. In order to evaluate the advantages of non thermal dissection for endoscopic procedures, a water jet cutting system was included in the in vitro study. In parenchymatous tissue the water jet was found to be the least traumatic technique, followed by bipolar high frequency, laser and monopolar high frequency. The water jet was not applicable for intestinal dissection since uncontrolled bloating of the rectal wall with uncontrolled disruption of the tissue layers occurred. A general disadvantage is that secure haemostasis in the line of incision is hard to achieve. In the microscopic comparison of the shape of the incision, the Nd:YAG laser produced the smoothest lesions with well-defined margins. The monopolar technique was more often associated with irregular and sometimes fissured margins. These results were confirmed in the in vivo part of the study (Transanal Endoscopic Microsurgery).

Probiotics and irritable bowel syndrome

PubMed Central

Korpela, Riitta; Niittynen, Leena

2012-01-01

Background Irritable bowel syndrome (IBS) is a major cause of abdominal discomfort and gut dysfunction worldwide. It is a poorly understood functional gastrointestinal disorder for which no effective medication is available. It is a benign condition, but its social and economic burden is significant. The symptoms consist of abdominal pain, bloating, flatulence, and irregular bowel movements. Alterations in the intestinal microbiota and mucosal inflammation may contribute to the development of IBS and probiotics could thus relieve the symptoms. This review gives an overview on the existing data on the effects of probiotics on the gastrointestinal symptoms of IBS. Methods A PUBMED search was made to review the relevant literature, and additional studies were obtained from the references of the selected articles. Results Clinical trials suggest that certain probiotics or combinations of bacteria have beneficial effects on the IBS symptoms. However the heterogeneity of studies, e.g. suboptimal study design, inadequate number of subjects, different doses and vehicles, inadequate length, make it difficult to compare the differences between probiotics and the effect may be strain-specific. Conclusions Though evidence is very promising, no general recommendations on the use of probiotics in IBS can be given yet. Further clinical trials and data on the mechanisms of action are needed. Probiotics are considered safe and if future scientific data is able to substantiate their efficacy in IBS, they certainly could be a treatment option in relieving the symptoms in IBS. PMID:23990830

Do the digestive tract symptoms in eating disorder patients represent functional gastrointestinal disorders?

PubMed Central

2013-01-01

Background Gastrointestinal (GI) symptoms are common in patients with eating disorders. The aim of this study was to determine, using factor analysis, whether these GI symptom factors (clusters) in eating disorder patients hold true to the Rome II classification of functional gastrointestinal disorders (FGIDs). Methods Inpatients in a specialised eating disorder unit completed the Rome II questionnaire. Data from 185 patients were analysed using factor analysis of 17 questions cited as present in 30% to 70% of the patients. Results Five factors emerged accounting for 68% of the variance and these were termed: ‘oesophageal discomfort’, ‘bowel dysfunction’, ‘abdominal discomfort’, ‘pelvic floor dysfunction’, and ‘self-induced vomiting’. These factors are significantly related to the Rome II FGID categories of functional oesophageal, bowel and anorectal disorders, and to the specific FGIDs of IBS, functional abdominal bloating, functional constipation and pelvic floor dyssynergia. Both heartburn and chest pain were included in the oesophageal discomfort factor. The ‘pelvic floor dysfunction’ factor was distinct from functional constipation. Conclusions The GI symptoms common in eating disorder patients very likely represent the same FGIDs that occur in non-ED patients. Symptoms of pelvic floor dysfunction in the absence of functional constipation, however, are prominent in eating disorder patients. Further investigation of the items comprising the ‘pelvic floor dysfunction’ factor in other patient populations may yield useful results. PMID:23448363

New insights into visceral hypersensitivity —clinical implications in IBS

PubMed Central

Zhou, QiQi; Verne, G. Nicholas

2012-01-01

A subset of patients with IBS have visceral hypersensitivity and/or somatic hypersensitivity. Visceral hypersensitivity might have use as a clinical marker of IBS and could account for symptoms of urgency for bowel movements, bloating and abdominal pain. The mechanisms that lead to chronic visceral hypersensitivity in patients who have IBS are unclear. However, several working models may be considered, including: nociceptive input from the colon that leads to hypersensitivity; increased intestinal permeability that induces a visceral nociceptive drive; and alterations in the expression of microRNAs in gastrointestinal tissue that might be delivered via blood microvesicles to other target organs, such as the peripheral and/or central nervous system. As such, the chronic visceral hypersensitivity that is present in a subset of patients with IBS might be maintained by both peripheral and central phenomena. The theories underlying the development of chronic visceral hypersensitivity in patients with IBS are supported by findings from new animal models in which hypersensitivity follows transient inflammation of the colon. The presence of somatic hypersensitivity and an alteration in the neuroendocrine system in some patients who have IBS suggests that multisystemic factors are involved in the overall disorder. Thus, IBS is similar to other chronic pain disorders, such as fibromyalgia, chronic regional pain disorder and temporomandibular joint disorder, as chronic nociceptive mechanisms are activated in all of these disorders. PMID:21643039

Chronic intestinal pseudo-obstruction.

PubMed

Gabbard, Scott L; Lacy, Brian E

2013-06-01

Chronic intestinal pseudo-obstruction (CIP) is a rare and serious disorder of the gastrointestinal (GI) tract characterized as a motility disorder with the primary defect of impaired peristalsis; symptoms are consistent with a bowel obstruction, although mechanical obstruction cannot be identified. CIP is classified as a neuropathy, myopathy, or mesenchymopathy; it is a neuropathic process in the majority of patients. The natural history of CIP is generally that of a progressive disorder, although occasional patients with secondary CIP note significant symptomatic improvement when the underlying disorder is identified and treated. Symptoms vary from patient to patient depending on the location of the luminal GI tract involved and the degree of involvement; however, the small intestine is nearly always involved. Common symptoms include dysphagia, gastroesophageal reflux, abdominal pain, nausea, vomiting, bloating, abdominal distension, constipation or diarrhea, and involuntary weight loss. Unfortunately, these symptoms are nonspecific, which can contribute to misdiagnosis or a delay in diagnosis and treatment. Since many of the symptoms and signs suggest a mechanical bowel obstruction, diagnostic tests typically focus on uncovering a mechanical obstruction, although routine tests do not identify an obstructive process. Nutrition supplementation is required for many patients with CIP due to symptoms of dysphagia, nausea, vomiting, and weight loss. This review discusses the epidemiology, etiology, pathogenesis, diagnosis, and treatment of patients with CIP, with an emphasis on nutrition assessment and treatment options for patients with nutrition compromise.

Adverse Food Reaction and Functional Gastrointestinal Disorders: Role of the Dietetic Approach.

PubMed

Pasqui, Francesca; Poli, Carolina; Colecchia, Antonio; Marasco, Giovanni; Festi, Davide

2015-09-01

Bloating, abdominal discomfort or pain, disturbed bowel habits are very common symptoms, frequently reported by the patients soon after food ingestion. These symptoms may occur in different clinical conditions, such as functional bowel disorders, food adverse reactions, gluten-related syndromes, which frequently are interrelated. Consequently, in clinical practice, it is necessary to perform a correct diagnosis in order to identify, for the single patient, the most appropriate therapeutic strategy, which may include not only specific drugs, but also, and mainly, life style changes (healthy nutritional behavior and constant physical activity). The aim of this review is to provide to the general physician, according to the available evidence, the most appropriate diagnostic work-ups for recognizing the different clinical scenarios (i.e. food allergy and intolerance, functional bowel diseases, gluten-related syndromes), to identify their clinical interrelationships and to suggest the most appropriate management. In fact, as far as food intolerances are concerned, it is well known that the number of patients who believe that their symptoms are related to food intolerance is increasing and consequently they restrict their diet, possibly causing nutritional deficiencies. Furthermore, there is an increasing use of unconventional diagnostic tests for food intolerance which lack accurate scientific evidence; the application of their results may induce misdiagnosis and unhealthy therapeutic choices. Consequently the recognition of food intolerance has to be performed on the basis of reliable tests within an agreed diagnostic workup.

"Leopard skin sign": the use of narrow-band imaging with magnification endoscopy in celiac disease.

PubMed

Tchekmedyian, Asadur J; Coronel, Emmanuel; Czul, Frank

2014-01-01

Celiac Disease (CD) is an immune reaction to gluten containing foods such as rye, wheat and barley. This condition affects individuals with a genetic predisposition; it targets the small bowel and may cause symptoms including diarrhea, malabsorption, weight loss, abdominal pain and bloating. The diagnosis is made by serologic testing of celiac-specific antibodies and confirmed by histology. Certain endoscopic characteristics, such as scalloping, reduction in the number of folds, mosaic-pattern mucosa or nodular mucosa, are suggestive of CD and can be visualized under white light endoscopy. Due to its low sensitivity, endoscopy alone is not recommended to diagnose CD; however, enhanced visual identification of suspected mucosal abnormalities through the use of new technologies, such as narrow band imaging with magnification (NBI-ME), could assist in targeting biopsies and thereby increasing the sensitivity of endoscopy. This is a case series of seven patients with serologic and histologic diagnoses of CD who underwent upper endoscopies with NBI-ME imaging technology as part of their CD evaluation. By employing this imaging technology, we could identify patchy atrophy sites in a mosaic pattern, with flattened villi and alteration of the central capillaries of the duodenal mucosa. We refer to this epithelial pattern as "Leopard Skin Sign". Since epithelial lesions are easily seen using NBI-ME, we found it beneficial for identifying and targeting biopsy sites. Larger prospective studies are warranted to confirm our findings.

NetCDF4/HDF5 and Linked Data in the Real World - Enriching Geoscientific Metadata without Bloat

NASA Astrophysics Data System (ADS)

Ip, Alex; Car, Nicholas; Druken, Kelsey; Poudjom-Djomani, Yvette; Butcher, Stirling; Evans, Ben; Wyborn, Lesley

2017-04-01

NetCDF4 has become the dominant generic format for many forms of geoscientific data, leveraging (and constraining) the versatile HDF5 container format, while providing metadata conventions for interoperability. However, the encapsulation of detailed metadata within each file can lead to metadata "bloat", and difficulty in maintaining consistency where metadata is replicated to multiple locations. Complex conceptual relationships are also difficult to represent in simple key-value netCDF metadata. Linked Data provides a practical mechanism to address these issues by associating the netCDF files and their internal variables with complex metadata stored in Semantic Web vocabularies and ontologies, while complying with and complementing existing metadata conventions. One of the stated objectives of the netCDF4/HDF5 formats is that they should be self-describing: containing metadata sufficient for cataloguing and using the data. However, this objective can be regarded as only partially-met where details of conventions and definitions are maintained externally to the data files. For example, one of the most widely used netCDF community standards, the Climate and Forecasting (CF) Metadata Convention, maintains standard vocabularies for a broad range of disciplines across the geosciences, but this metadata is currently neither readily discoverable nor machine-readable. We have previously implemented useful Linked Data and netCDF tooling (ncskos) that associates netCDF files, and individual variables within those files, with concepts in vocabularies formulated using the Simple Knowledge Organization System (SKOS) ontology. NetCDF files contain Uniform Resource Identifier (URI) links to terms represented as SKOS Concepts, rather than plain-text representations of those terms, so we can use simple, standardised web queries to collect and use rich metadata for the terms from any Linked Data-presented SKOS vocabulary. Geoscience Australia (GA) manages a large volume of diverse geoscientific data, much of which is being translated from proprietary formats to netCDF at NCI Australia. This data is made available through the NCI National Environmental Research Data Interoperability Platform (NERDIP) for programmatic access and interdisciplinary analysis. The netCDF files contain both scientific data variables (e.g. gravity, magnetic or radiometric values), but also domain-specific operational values (e.g. specific instrument parameters) best described fully in formal vocabularies. Our ncskos codebase provides access to multiple stores of detailed external metadata in a standardised fashion. Geophysical datasets are generated from a "survey" event, and GA maintains corporate databases of all surveys and their associated metadata. It is impractical to replicate the full source survey metadata into each netCDF dataset so, instead, we link the netCDF files to survey metadata using public Linked Data URIs. These URIs link to Survey class objects which we model as a subclass of Activity objects as defined by the PROV Ontology, and we provide URI resolution for them via a custom Linked Data API which draws current survey metadata from GA's in-house databases. We have demonstrated that Linked Data is a practical way to associate netCDF data with detailed, external metadata. This allows us to ensure that catalogued metadata is kept consistent with metadata points-of-truth, and we can infer complex conceptual relationships not possible with netCDF key-value attributes alone.

Probiotics for standard triple Helicobacter pylori eradication: a randomized, double-blind, placebo-controlled trial.

PubMed

Hauser, Goran; Salkic, Nermin; Vukelic, Karina; JajacKnez, Alenka; Stimac, Davor

2015-05-01

The primary objective in the study is determination of efficacy of probiotic preparation as a supportive therapy in eradication of Helicobacter pylori.The study was multicenter, prospective, randomized, placebo controlled, and double-blind. The subjects first filled out a specially designed questionnaire to assess the severity of the 10 symptoms, which can be related to eradication therapy to be monitored during the trial. Each subject then received 28 capsules of probiotic preparation or matching placebo capsules, which they were supposed to take over the following 14 days, twice a day, at least 2 hours prior to or after the antibiotic therapy administration.A total of 804 patients were enrolled in the trial, of which 650 (80.85%) were included in the analysis. The results show a significantly larger share of cured subjects in the probiotic arm versus the placebo arm (87.38% vs 72.55%; P < 0.001). Additionally, presence and intensity of epigastric pain, bloating, flatulence, taste disturbance, loss of appetite, nausea, vomiting, heartburn, rash, and diarrhea were monitored over the study period. At 15 days postinclusion, probiotic treatment was found superior to placebo in 7 of 10 mentioned symptoms. Average intensity for symptoms potentially related to antibiotic therapy was significantly higher in the placebo group, 0.76 vs 0.55 (P < 0.001).Adding probiotics to the standard triple therapy for H pylori eradication significantly contributes to treatment efficacy and distinctly decreases the adverse effects of therapy and the symptoms of the underlying disease.

Ovarian hyperstimulation syndrome in gonadotropin-treated laboratory South African clawed frogs (Xenopus laevis).

PubMed

Green, Sherril L; Parker, John; Davis, Corrine; Bouley, Donna M

2007-05-01

Ovarian hyperstimulation syndrome (OHS) is a rare but sometimes fatal iatrogenic complication of ovarian stimulation associated with the administration of exogenous gonadotropins to women undergoing treatment for infertility. Laboratory Xenopus spp are commonly treated with human chorionic gonadotropin (hCG) to stimulate ovulation and optimize the number of oocytes harvested for use in biomedical research. Here we report cases of OHS in 2 gonadotropin-treated laboratory Xenopus laevis. After receiving hCG, the frogs developed severe subcutaneous accumulation of fluid, coelomic distention, and whole-body edema and were unable to dive, although they continued to eat and swim. At postmortem examination, extensive subcutaneous edema was present; ascites and massive numbers of free-floating eggs were found in the coelomic cavity and in aberrant locations: around the heart-sac and adhered to the liver capsule. Whole-body edema, gross enlargement of the ovaries, ascites, and abdominal distention are findings comparable to those observed in women with OHS. The pathophysiology of OHS is thought to be related to hormonally induced disturbances of vasoactive mediators, one of which may be vascular endothelial growth factor secreted by theca and granulosa cells. We know of no other report describing OHSlike symptoms in gonadotropin-treated frogs, and the cases described here are 2 of the 3 we have observed at our respective institutions over the last 6 y. According to these results, OHS appears to be rare in gonadotropin-treated laboratory Xenopus. However, the condition should be included in the differential diagnosis for the bloated frog.

Short term (14 days) consumption of insoluble wheat bran fibre-containing breakfast cereals improves subjective digestive feelings, general wellbeing and bowel function in a dose dependent manner.

PubMed

Lawton, Clare L; Walton, Jenny; Hoyland, Alexa; Howarth, Elaine; Allan, Peter; Chesters, David; Dye, Louise

2013-04-22

This study investigated whether increasing insoluble (predominantly wheat bran) fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline) monitoring period followed by a 14 day fibre consumption (intervention) period was performed. 153 low fibre consumers (<15 g/day AOAC 985.29) completed a daily symptom diary for 14 days after which they consumed one bowl of ready-to-eat breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran) for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation) and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort). Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches). In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran) per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption.

Influence of inhomogeneous static magnetic field-exposure on patients with erosive gastritis: a randomized, self- and placebo-controlled, double-blind, single centre, pilot study

PubMed Central

Juhász, Márk; Nagy, Viktor L.; Székely, Hajnal; Kocsis, Dorottya; Tulassay, Zsolt; László, János F.

2014-01-01

This pilot study was devoted to the effect of static magnetic field (SMF)-exposure on erosive gastritis. The randomized, self- and placebo-controlled, double-blind, pilot study included 16 patients of the 2nd Department of Internal Medicine, Semmelweis University diagnosed with erosive gastritis. The instrumental analysis followed a qualitative (pre-intervention) assessment of the symptoms by the patient: lower heartburn (in the ventricle), upper heartburn (in the oesophagus), epigastric pain, regurgitation, bloating and dry cough. Medical diagnosis included a double-line upper panendoscopy followed by 30 min local inhomogeneous SMF-exposure intervention at the lower sternal region over the stomach with peak-to-peak magnetic induction of 3 mT and 30 mT m−1 gradient at the target site. A qualitative (post-intervention) assessment of the same symptoms closed the examination. Sham- or SMF-exposure was used in a double-blind manner. The authors succeeded in justifying the clinically and statistically significant beneficial effect of the SMF- over sham-exposure on the symptoms of erosive gastritis, the average effect of inhibition was 56% by p = 0.001, n = 42 + 96. This pilot study was aimed to encourage gastroenterologists to test local, inhomogeneous SMF-exposure on erosive gastritis patients, so this intervention may become an evidence-based alternative or complementary method in the clinical use especially in cases when conventional therapy options are contraindicated. PMID:25008086

Genetics, environment, and asthma associated with celiac disease in the extended family of an affected child.

PubMed

Sigala-Robles, R; Aguayo-Patrón, S V; Calderón de la Barca, A M

2017-11-18

Celiac disease (CD) is an autoimmune enteropathy associated with gluten ingestion. In extended families of celiac patients that live in close proximity of one another, shared genetic and environmental factors can predispose them to CD. The aim of this study was to provide evidence about the genetic and environmental factors involved in the development of CD in the extended family of a pediatric patient. The medical history, environmental conditions, and participant weight, height, and peripheral blood samples were evaluated. The HLA-DQ2/DQ8 haplotypes were genotyped through qPCR testing and the IgA anti-gliadin and anti-transglutaminase antibodies were quantified using the ELISA test. Twelve close-living maternal relatives of the index case participated in the study. Eight of them presented with the HLA-DQ2 haplotype, inherited from the grandfather, and 7/12 and 9/12 were positive for IgA anti-gliadin and IgA anti-transglutaminase antibodies, respectively. The main intestinal symptoms stated by the participants were abdominal bloating, excess flatulence, constipation, and gastroesophageal reflux. The most frequent extra-intestinal symptoms were fatigue, stress, and anxiety. In addition, 6/13 participants had bronchial asthma. The extended family living in close proximity of one another shared a genetic predisposition, environmental conditions, and asthma, which could have predisposed them to celiac disease. Copyright © 2017 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

Gastrointestinal Physiology and Function.

PubMed

Greenwood-Van Meerveld, Beverley; Johnson, Anthony C; Grundy, David

2017-01-01

The gastrointestinal (GI) system is responsible for the digestion and absorption of ingested food and liquids. Due to the complexity of the GI tract and the substantial volume of material that could be covered under the scope of GI physiology, this chapter briefly reviews the overall function of the GI tract, and discusses the major factors affecting GI physiology and function, including the intestinal microbiota, chronic stress, inflammation, and aging with a focus on the neural regulation of the GI tract and an emphasis on basic brain-gut interactions that serve to modulate the GI tract. GI diseases refer to diseases of the esophagus, stomach, small intestine, colon, and rectum. The major symptoms of common GI disorders include recurrent abdominal pain and bloating, heartburn, indigestion/dyspepsia, nausea and vomiting, diarrhea, and constipation. GI disorders rank among the most prevalent disorders, with the most common including esophageal and swallowing disorders, gastric and peptic ulcer disease, gastroparesis or delayed gastric emptying, irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD). Many GI disorders are difficult to diagnose and their symptoms are not effectively managed. Thus, basic research is required to drive the development of novel therapeutics which are urgently needed. One approach is to enhance our understanding of gut physiology and pathophysiology especially as it relates to gut-brain communications since they have clinical relevance to a number of GI complaints and represent a therapeutic target for the treatment of conditions including inflammatory diseases of the GI tract such as IBD and functional gut disorders such as IBS.

Diptera of Medico-Legal Importance Associated With Pig Carrion in a Tropical Dry Forest.

PubMed

Vasconcelos, S D; Salgado, R L; Barbosa, T M; Souza, J R B

2016-06-20

The diversity of necrophagous Diptera is largely unknown in seasonally dry tropical forests, despite their medical, veterinary, and forensic relevance. We performed a study in the dry Caatinga forest exclusive to Brazil in order to assess the diversity and temporal pattern of Diptera species using pig carcasses as substrates. Adults were collected daily until complete skeletonization. We collected 17,142 adults from 18 families, 10 of which comprise species with known necrophagous habits. The most abundant families were Calliphoridae (47.3% of specimens), Sarcophagidae (20.8%), and Muscidae (15.5%), whereas Sarcophagidae stood out in terms of richness with 21 species. The native Cochliomyia macellaria (F.) (Diptera: Calliphoridae) and the invasive Chrysomya albiceps (Wiedmann) (Calliphoridae) were the dominant species. A total of 18 species reached the carcass during the first 48 h postdeath. The bloated and active decay stages had the highest richness and abundance of dipterans. From a forensic standpoint, C. macellaria and C. albiceps are likely to aid in establishing postmortem interval due to their early arrival and high abundance on the carcass. Despite harsh environmental conditions, the Caatinga harbors a rich assemblage of dipterans that play a key role in carrion decomposition. Their medico-veterinary importance is strengthened by the poor local sanitary conditions. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The impact of meal timing on performance, sleepiness, gastric upset, and hunger during simulated night shift.

PubMed

Grant, Crystal Leigh; Dorrian, Jillian; Coates, Alison Maree; Pajcin, Maja; Kennaway, David John; Wittert, Gary Allen; Heilbronn, Leonie Kaye; Vedova, Chris Della; Gupta, Charlotte Cecilia; Banks, Siobhan

2017-10-07

This study examined the impact of eating during simulated night shift on performance and subjective complaints. Subjects were randomized to eating at night (n=5; 23.2 ± 5.5 y) or not eating at night (n=5; 26.2 ± 6.4 y). All participants were given one sleep opportunity of 8 h (22:00 h-06:00 h) before transitioning to the night shift protocol. During the four days of simulated night shift participants were awake from 16:00 h-10:00 h with a daytime sleep of 6 h (10:00 h-16:00 h). In the simulated night shift protocol, meals were provided at ≈0700 h, 1900 h and 0130 h (eating at night); or ≈0700 h, 0930 h, 1410 h and 1900 h (not eating at night). Subjects completed sleepiness, hunger and gastric complaint scales, a Digit Symbol Substitution Task and a 10-min Psychomotor Vigilance Task. Increased sleepiness and performance impairment was evident in both conditions at 0400 h (p<0.05). Performance impairment at 0400 h was exacerbated when eating at night. Not eating at night was associated with elevated hunger and a small but significant elevation in stomach upset across the night (p<0.026). Eating at night was associated with elevated bloating on night one, which decreased across the protocol. Restricting food intake may limit performance impairments at night. Dietary recommendations to improve night-shift performance must also consider worker comfort.

Gastric volvulus through morgagni hernia: an easily overlooked emergency.

PubMed

Sonthalia, Nikhil; Ray, Sayantan; Khanra, Dibbendhu; Saha, Avishek; Maitra, Subhasis; Saha, Manjari; Talukdar, Arunansu

2013-06-01

Intractable vomiting in an elderly patient is an emergency condition requiring prompt diagnosis and intervention. Acute gastric outlet obstruction due to gastric volvulus through Morgagni-type diaphragmatic hernia is an exceedingly rare cause of this nonspecific complaint. Our aim was to highlight that Morgagni hernia, although rare in adults, should be suspected in the appropriate clinical setting, and that a clue toward diagnosis often comes from routine chest and abdominal x-ray studies. In addition, we emphasize the atypical radiological findings and importance of emergency surgical intervention in such a case. We describe the case of a 78-year-old woman who presented to the Emergency Department with a 4-day history of intractable vomiting, and with no definitive clue to the diagnosis on examination. Her routine chest and abdomen x-ray studies suggested abnormal air-fluid level at right hemithorax, which prompted a computed tomography (CT) scan of the abdomen and an upper gastrointestinal contrast study. Gastric volvulus through a foramen of Morgagni was diagnosed and transthoracic reduction of the contents was performed, along with repair of the defect. A symptomatic Morgagni hernia in adults, although rare, can present with a variety of symptoms ranging from nonspecific complaints of bloating and indigestion to the more severe complaint of intestinal obstruction. Gastric volvulus and obstructive features are less frequently reported as acute complications of these hernias, which need early identification and intervention. Copyright © 2013 Elsevier Inc. All rights reserved.

A Study on the Dietary Intake and the Nutritional Status among the Pancreatic Cancer Surgical Patients.

PubMed

Kang, Jimin; Park, Joon Seong; Yoon, Dong Sup; Kim, Woo Jeong; Chung, Hae-Yun; Lee, Song Mi; Chang, Namsoo

2016-10-01

The adequate dietary intake is important to maintain the nutritional status of the patients after pancreatic cancer surgery. This prospective study was designed to investigate the dietary intake and the nutritional status of the patients who had pancreatic cancer surgery. Thirty-one patients (15 men, 16 women) were enrolled and measured body weight, body mass index (BMI), nutritional risk index (NRI), and Malnutrition Universal Screening Tool (MUST). Actual oral intake with nutritional impact symptoms recorded on the clinical research foam at every meal and medical information were collected from electronic medical charts. The rates of malnutrition at admission were 45.1% (14/31) and 28.9% (9/31) by NRI and MUST method, respectively, but those were increased to 87% (27/31) and 86.6% (26/31) after operation on discharge. The median values of daily intake of energy, carbohydrates, fat, and protein were 588.1 kcal, 96.0 g, 11.8 g, and 27.0 g, respectively. Most patients (n = 20, 64.5%) experienced two or more symptoms such as anorexia, abdominal bloating and early satiety. There were negative correlations between C-reactive protein (CRP) levels and the intake of total energy, protein, fat, and zinc. The rates of malnutrition were increased sharply after surgery and the dietary intake also influenced the inflammatory indicators. The results suggested that need of considering special therapeutic diets for the patients who received pancreatic surgery.

Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study

PubMed Central

Schellenberg, R

2001-01-01

Objectives To compare the efficacy and tolerability of agnus castus fruit (Vitex agnus castus L extract Ze 440) with placebo for women with the premenstrual syndrome. Design Randomised, double blind, placebo controlled, parallel group comparison over three menstrual cycles. Setting General medicine community clinics. Participants 178 women were screened and 170 were evaluated (active 86; placebo 84). Mean age was 36 years, mean cycle length was 28 days, mean duration of menses was 4.5 days. Interventions Agnus castus (dry extract tablets) one tablet daily or matching placebo, given for three consecutive cycles. Main outcome measures Main efficacy variable: change from baseline to end point (end of third cycle) in women's self assessment of irritability, mood alteration, anger, headache, breast fullness, and other menstrual symptoms including bloating. Secondary efficacy variables: changes in clinical global impression (severity of condition, global improvement, and risk or benefit) and responder rate (50% reduction in symptoms). Results Improvement in the main variable was greater in the active group compared with placebo group (P<0.001). Analysis of the secondary variables showed significant (P<0.001) superiority of active treatment in each of the three global impression items. Responder rates were 52% and 24% for active and placebo, respectively. Seven women reported mild adverse events (four active; three placebo), none of which caused discontinuation of treatment. Conclusions Dry extract of agnus castus fruit is an effective and well tolerated treatment for the relief of symptoms of the premenstrual syndrome. PMID:11159568

Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study.

PubMed

Schellenberg, R

2001-01-20

To compare the efficacy and tolerability of agnus castus fruit (Vitex agnus castus L extract Ze 440) with placebo for women with the premenstrual syndrome. Randomised, double blind, placebo controlled, parallel group comparison over three menstrual cycles. General medicine community clinics. 178 women were screened and 170 were evaluated (active 86; placebo 84). Mean age was 36 years, mean cycle length was 28 days, mean duration of menses was 4.5 days. Agnus castus (dry extract tablets) one tablet daily or matching placebo, given for three consecutive cycles. Main efficacy variable: change from baseline to end point (end of third cycle) in women's self assessment of irritability, mood alteration, anger, headache, breast fullness, and other menstrual symptoms including bloating. Secondary efficacy variables: changes in clinical global impression (severity of condition, global improvement, and risk or benefit) and responder rate (50% reduction in symptoms). Improvement in the main variable was greater in the active group compared with placebo group (P<0.001). Analysis of the secondary variables showed significant (P<0.001) superiority of active treatment in each of the three global impression items. Responder rates were 52% and 24% for active and placebo, respectively. Seven women reported mild adverse events (four active; three placebo), none of which caused discontinuation of treatment. Dry extract of agnus castus fruit is an effective and well tolerated treatment for the relief of symptoms of the premenstrual syndrome.

Evolving paradigms in the treatment of opioid-induced bowel dysfunction.

PubMed

Poulsen, Jakob Lykke; Brock, Christina; Olesen, Anne Estrup; Nilsson, Matias; Drewes, Asbjørn Mohr

2015-11-01

In recent years prescription of opioids has increased significantly. Although effective in pain management, bothersome gastrointestinal adverse effects are experienced by a substantial proportion of opioid-treated patients. This can lead to difficulties with therapy and subsequently inadequate pain relief. Collectively referred to as opioid-induced bowel dysfunction, these adverse effects are the result of binding of exogenous opioids to opioid receptors in the gastrointestinal tract. This leads to disturbance of three important gastrointestinal functions: motility, coordination of sphincter function and secretion. In the clinic this manifests in a wide range of symptoms such as reflux, bloating, abdominal cramping, hard, dry stools, and incomplete evacuation, although the most known adverse effect is opioid-induced constipation. Traditional treatment with laxatives is often insufficient, but in recent years a number of novel pharmacological approaches have been introduced. In this review the pathophysiology, symptomatology and prevalence of opioid-induced bowel dysfunction is presented along with the benefits and caveats of a suggested consensus definition for opioid-induced constipation. Finally, traditional treatment is appraised and compared with the latest pharmacological developments. In conclusion, opioid antagonists restricted to the periphery show promising results, but use of different definitions and outcome measures complicate comparison. However, an international working group has recently suggested a consensus definition for opioid-induced constipation and relevant outcome measures have also been proposed. If investigators within this field adapt the suggested consensus and include symptoms related to dysfunction of the upper gut, it will ease comparison and be a step forward in future research.

THE NASA-UC ETA-EARTH PROGRAM. II. A PLANET ORBITING HD 156668 WITH A MINIMUM MASS OF FOUR EARTH MASSES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Howard, Andrew W.; Marcy, Geoffrey W.; Isaacson, Howard

2011-01-10

We report the discovery of HD 156668 b, an extrasolar planet with a minimum mass of M{sub P} sin i = 4.15 M{sub +}. This planet was discovered through Keplerian modeling of precise radial velocities from Keck-HIRES and is the second super-Earth to emerge from the NASA-UC Eta-Earth Survey. The best-fit orbit is consistent with circular and has a period of P = 4.6455 days. The Doppler semi-amplitude of this planet, K = 1.89 m s{sup -1}, is among the lowest ever detected, on par with the detection of GJ 581 e using HARPS. A longer period (P {approx} 2.3more » years), low-amplitude signal of unknown origin was also detected in the radial velocities and was filtered out of the data while fitting the short-period planet. Additional data are required to determine if the long-period signal is due to a second planet, stellar activity, or another source. Photometric observations using the Automated Photometric Telescopes at Fairborn Observatory show that HD 156668 (an old, quiet K3 dwarf) is photometrically constant over the radial velocity period to 0.1 mmag, supporting the existence of the planet. No transits were detected down to a photometric limit of {approx}3 mmag, ruling out transiting planets dominated by extremely bloated atmospheres, but not precluding a transiting solid/liquid planet with a modest atmosphere.« less

Type 2 diabetes mellitus: A risk factor for Helicobacter pylori infection: A hospital based case-control study

PubMed Central

Devrajani, Bikha Ram; Shah, Syed Zulfiquar Ali; Soomro, Aftab Ahmed; Devrajani, Tarachand

2010-01-01

Objective: To determine the frequency of Helicobacter pylori (H. pylori) infection in diabetic and non-diabetic patients and to compare the frequency of H. pylori infection in both groups. Study Design: Case control. Place and Duration: Department of Medicine, Liaquat University Hospital from October 2007 to March 2008. Materials and Methods: This hospital-based case-control study was conducted on 148 subjects and divided into two groups i.e. type 2 diabetics and non-diabetics; each group consisting of 74 patients. All diabetic patients of ≥ 35 years of age, both gender and the known cases with history of dyspepsia, epigastric pain or bloating for more than a month were screened for Helicobacter pylori infection. The collected data of both groups was evaluated and separated for analysis. Results: Majority of the patients were male with mean age ± SD, 52.86 ± 8.51. Among the diabetic group, HpSA was positive in 54/74 (73%), whereas in the non-diabetic group HpSA was positive in 38/74 (51.4%) cases. Fasting blood glucose was identified as low in 04 (5.40%) H. pylori infected - diabetic patients where as the blood glucose level of 07 (9.45%) known diabetic patients was raised despite the ongoing medication. Conclusion: Diabetic patients are more prone and at risk to acquire H. Pylori infection. Therefore proper monitoring of blood glucose level and screening for H. pylori infection are effective preventive measures for this life threatening infection. PMID:20431802

The Use of Gene Modification and Advanced Molecular Structure Analyses towards Improving Alfalfa Forage

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lei, Yaogeng; Hannoufa, Abdelali; Yu, Peiqiang

Alfalfa is one of the most important legume forage crops in the world. In spite of its agronomic and nutritive advantages, alfalfa has some limitations in the usage of pasture forage and hay supplement. High rapid degradation of protein in alfalfa poses a risk of rumen bloat to ruminants which could cause huge economic losses for farmers. Coupled with the relatively high lignin content, which impedes the degradation of carbohydrate in rumen, alfalfa has unbalanced and asynchronous degradation ratio of nitrogen to carbohydrate (N/CHO) in rumen. Genetic engineering approaches have been used to manipulate the expression of genes involved inmore » important metabolic pathways for the purpose of improving the nutritive value, forage yield, and the ability to resist abiotic stress. Such gene modification could bring molecular structural changes in alfalfa that are detectable by advanced structural analytical techniques. These structural analyses have been employed in assessing alfalfa forage characteristics, allowing for rapid, convenient and cost-effective analysis of alfalfa forage quality. In this article, we review two major obstacles facing alfalfa utilization, namely poor protein utilization and relatively high lignin content, and highlight genetic studies that were performed to overcome these drawbacks, as well as to introduce other improvements to alfalfa quality. We also review the use of advanced molecular structural analysis in the assessment of alfalfa forage for its potential usage in quality selection in alfalfa breeding.« less

A survey of supervised machine learning models for mobile-phone based pathogen identification and classification

NASA Astrophysics Data System (ADS)

Ceylan Koydemir, Hatice; Feng, Steve; Liang, Kyle; Nadkarni, Rohan; Tseng, Derek; Benien, Parul; Ozcan, Aydogan

2017-03-01

Giardia lamblia causes a disease known as giardiasis, which results in diarrhea, abdominal cramps, and bloating. Although conventional pathogen detection methods used in water analysis laboratories offer high sensitivity and specificity, they are time consuming, and need experts to operate bulky equipment and analyze the samples. Here we present a field-portable and cost-effective smartphone-based waterborne pathogen detection platform that can automatically classify Giardia cysts using machine learning. Our platform enables the detection and quantification of Giardia cysts in one hour, including sample collection, labeling, filtration, and automated counting steps. We evaluated the performance of three prototypes using Giardia-spiked water samples from different sources (e.g., reagent-grade, tap, non-potable, and pond water samples). We populated a training database with >30,000 cysts and estimated our detection sensitivity and specificity using 20 different classifier models, including decision trees, nearest neighbor classifiers, support vector machines (SVMs), and ensemble classifiers, and compared their speed of training and classification, as well as predicted accuracies. Among them, cubic SVM, medium Gaussian SVM, and bagged-trees were the most promising classifier types with accuracies of 94.1%, 94.2%, and 95%, respectively; we selected the latter as our preferred classifier for the detection and enumeration of Giardia cysts that are imaged using our mobile-phone fluorescence microscope. Without the need for any experts or microbiologists, this field-portable pathogen detection platform can present a useful tool for water quality monitoring in resource-limited-settings.

Consequences of plant phenolic compounds for productivity and health of ruminants.

PubMed

Waghorn, Garry C; McNabb, Warren C

2003-05-01

Plant phenolic compounds are diverse in structure but are characterised by hydroxylated aromatic rings (e.g. flavan-3-ols). They are categorised as secondary metabolites, and their function in plants is often poorly understood. Many plant phenolic compounds are polymerised into larger molecules such as the proanthocyanidins (PA; condensed tannins) and lignins. Only the lignins, PA, oestrogenic compounds and hydrolysable tannins will be considered here. Lignins slow the physical and microbial degradation of ingested feed, because of resilient covalent bonding with hemicellulose and cellulose, rather than any direct effects on the rumen per se. The PA are prevalent in browse and are expressed in the foliage of some legumes (e.g. Lotus spp.), but rarely in grasses. They reduce the nutritive value of poor-quality diets, but can also have substantial benefits for ruminant productivity and health when improved temperate forages are fed. Beneficial effects are dependent on the chemical and physical structure, and concentration of the PA in the diet, but they have been shown to improve live-weight gain, milk yield and protein concentration, and ovulation rate. They prevent bloat in cattle, reduce gastrointestinal nematode numbers, flystrike and CH4 production. Some phenolic compounds (e.g. coumestans) cause temporary infertility, whilst those produced by Fusarium fungi found in pasture, silage or stored grains can cause permanent infertility. The HT may be toxic because products of their metabolism can cause liver damage and other metabolic disorders.

The implications of condensed tannins on the nutritive value of temperate forages fed to ruminants.

PubMed

Barry, T N; McNabb, W C

1999-04-01

New methodology for measuring forage condensed tannin (CT) content is described and the effects of CT upon forage feeding and nutritive value for ruminant animals are reviewed. CT react with forage proteins in a pH-reversible manner, with reactivity determined by the concentration, structure and molecular mass of the CT. Increasing concentrations of CT in Lotus corniculatus and Lotus pedunculatus reduce the rates of solubilization and degradation of fraction 1 leaf protein in the rumen and increase duodenal non-NH3 N flow. Action of medium concentrations of total CT in Lotus corniculatus (30-40 g/kg DM) increased the absorption of essential amino acids from the small intestine and increased wool growth, milk secretion and reproductive rate in grazing sheep without affecting voluntary feed intake, thus improving the efficiency of food conversion. High concentrations of CT in Lotus pedunculatus (75-100 g/kg DM) depressed voluntary feed intake and rumen carbohydrate digestion and depressed rates of body and wool growth in grazing sheep. The minimum concentration of CT to prevent rumen frothy bloat in cattle is defined as 5 g/kg DM and sheep grazing CT-containing legumes were shown to better tolerate internal parasite infections than sheep grazing non CT-containing forages. It was concluded that defined concentrations of forage CT can be used to increase the efficiencies of protein digestion and animal productivity in forage-fed ruminants and to develop more ecologically sustainable systems of controlling some diseases under grazing.

Exploitation of dietary tannins to improve rumen metabolism and ruminant nutrition.

PubMed

Patra, Amlan K; Saxena, Jyotisna

2011-01-15

Tannins (hydrolysable and condensed tannin) are polyphenolic polymers of relatively high molecular weight with the capacity to form complexes mainly with proteins due to the presence of a large number of phenolic hydroxyl groups. They are widely distributed in nutritionally important forage trees, shrubs and legumes, cereals and grains, which are considered as anti-nutritional compounds due to their adverse effects on intake and animal performance. However, tannins have been recognised to modulate rumen fermentation favourably such as reducing protein degradation in the rumen, prevention of bloat, inhibition of methanogenesis and increasing conjugated linoleic acid concentrations in ruminant-derived foods. The inclusion of tannins in diets has been shown to improve body weight and wool growth, milk yields and reproductive performance. However, the beneficial effects on rumen modulation and animal performance have not been consistently observed. This review discusses the effects of tannins on nitrogen metabolism in the rumen and intestine, and microbial populations (bacteria, protozoa, fungi and archaea), metabolism of tannins, microbial tolerance mechanisms to tannins, inhibition of methanogenesis, ruminal biohydrogenation processes and performance of animals. The discrepancies of responses of tannins among different studies are attributed to the different chemical structures (degree of polymerisation, procyanidins to propdelphinidins, stereochemistry and C-C bonding) and concentrations of tannins, and type of diets. An establishment of structure-activity relationship would be required to explain differences among studies and obtain consistent beneficial tannin effects. Copyright © 2010 Society of Chemical Industry.

Experimental induction of abdominal tympany, abomasitis, and abomasal ulceration by intraruminal inoculation of Clostridium perfringens type A in neonatal calves.

PubMed

Roeder, B L; Chengappa, M M; Nagaraja, T G; Avery, T B; Kennedy, G A

1988-02-01

The etiologic role of Clostridum perfringens type A in the acute abdominal syndrome characterized by abomasal and rumen tympany, abomasitis, and abomasal ulceration was investigated in neonatal calves. Eight calves, 4 to 12 days old, were inoculated intraruminally with toxigenic C perfringens type A. Before and after C perfringens inoculation, blood samples were collected from all calves for blood gas and serum biochemical analysis and for determination of serum copper concentration; ruminal fluid was obtained for isolation of C perfringens. Calves were monitored daily for clinical signs of the syndrome and, depending on the severity of clinical signs, they were either euthanatized or redosed within 4 to 7 days. After necropsy, specimens obtained from the abomasum and rumen for macroscopic and microscopic examination and for anaerobic bacteriologic culture were processed in routine manner. Intraruminal inoculation of C perfringens type A into healthy calves induced anorexia, depression, bloat, diarrhea, and in some calves, death. Serum copper concentration was within normal range. Necropsy revealed variable degrees of abomasitis, petechial and ecchymotic hemorrhages, and ulcers (ranging from pinpoint to nearly perforate) in the abomasum. Seven of those calves also had multiple trichobezoars in the rumen. These necropsy findings were not seen in calves (controls) given distilled H2O only. In affected calves, acute abdominal syndrome was unrelated to copper deficiency, and C perfringens type A given intraruminally was able to induce clinical signs similar to those of the naturally acquired disease.

FOOD INTOLERANCES AND ASSOCIATED SYMPTOMS IN PATIENTS UNDERGOING FOBI-CAPELLA TECHNIQUE WITHOUT GASTRIC RING

PubMed Central

MOREIRA, Marcella de Arruda; ESPÍNOLA, Patrícia Ramos Maciel; de AZEVEDO, Camila Wanderley

2015-01-01

Background Bariatric surgery is considered the only effective method to treat refractory obesity, and especially for those in which clinical treatment was not successful. However, the appearance of food intolerances and clinical manifestations are quite common. Aim To identify food intolerances and associated them to symptoms in patients undergoing Fobi-Capella technique without gastric ring. Methods This was a cross-sectional study of adult patients who had more than one year after surgery. Demographic, anthropometric, weight and preoperative height data were investigated. Nutritional status was classified according to the criteria established by the World Health Organization. It was considered food intolerance the presence of nausea, vomiting, diarrhea or bloating after eating a particular food. Results The sample consisted of 61 patients who attended the nutritional consultation of which 26 (42.6%) had food intolerance, mostly related to red meat (n=12; 34.3%) during the first six months of operation; there was a significant difference between the periods between 0 and 6 months, and 7 to 12 (p=0.02). Among the symptoms reported by patients, nausea was the most recurrent until the 6th month, but without significant differences between the two periods (p=0.06). Conclusions The Fobi-Capella procedure without gastric ring promoted high frequency of intolerance to meat in general, especially for the red, chicken and fish, on this sequence; nausea was the most frequent symptom. These data suggest the need for adequate nutritional monitoring throughout the postoperative period. PMID:25861067

Immunomodulation of enteric neural function in irritable bowel syndrome.

PubMed

O'Malley, Dervla

2015-06-28

Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder which is characterised by symptoms such as bloating, altered bowel habit and visceral pain. It's generally accepted that miscommunication between the brain and gut underlies the changes in motility, absorpto-secretory function and pain sensitivity associated with IBS. However, partly due to the lack of disease-defining biomarkers, understanding the aetiology of this complex and multifactorial disease remains elusive. Anecdotally, IBS patients have noted that periods of stress can result in symptom flares and many patients exhibit co-morbid stress-related mood disorders such as anxiety and depression. However, in addition to psychosocial stressors, infection-related stress has also been linked with the initiation, persistence and severity of symptom flares. Indeed, prior gastrointestinal infection is one of the strongest predictors of developing IBS. Despite a lack of overt morphological inflammation, the importance of immune factors in the pathophysiology of IBS is gaining acceptance. Subtle changes in the numbers of mucosal immune cell infiltrates and elevated levels of circulating pro-inflammatory cytokines have been reproducibly demonstrated in IBS populations. Moreover, these immune mediators directly affect neural signalling. An exciting new area of research is the role of luminal microbiota in the modulation of neuro-immune signalling, resulting in local changes in gastrointestinal function and alterations in central neural functioning. Progress in this area has begun to unravel some of the complexities of neuroimmune and neuroendocrine interactions and how these molecular exchanges contribute to GI dysfunction.

Conservative Measures for Managing Constipation in Patients Living With a Colostomy.

PubMed

Kuczynska, Barbara; Bobkiewicz, Adam; Studniarek, Adam; Szmyt, Krzsztof; Krokowicz, Łukasz; Matysiak, Konrad; Szmeja, Jacek; Walkowiak, Jarosław; Drews, Michał; Banasiewicz, Tomasz

The purpose of this study was to determine the effect of a conservative regimen for the treatment of constipation in persons living with a colostomy. Prospective, noncontrolled, single-center study. The study sample comprised 35 patients with a colostomy who were diagnosed with constipation. Subjects with morphologic changes causing constipation such as stomal stenosis and neoplastic and inflammatory changes were excluded. The study was conducted in the Proctology and Stoma Outpatient Clinic at Poznan University of Medical Sciences. Patients at our Stoma Outpatient Clinic underwent baseline evaluation, and those with symptoms of constipation (prolonged periods between bowel movements, passage of pasty or hardened fecal effluent, and associated symptoms such as abdominal discomfort or bloating, flatulence, and pain with passage of effluent into the stoma) received individualized dietary recommendations that typically included an increase in dietary fiber and fluid intake, along with increased fluid intake. The outcomes of dietary changes were evaluated during a follow-up visit 3 months later. If dietary changes alone did not improve constipation symptoms, we prescribed a psyllium-based bulk-forming agent, an osmotic stool softener, and a probiotic, with or without a prokinetic agent such as metoclopramide taken 3 times daily. Dietary interventions alone were deemed successful in 60% of study subjects (n = 21); the remaining 14 patients required additional treatment. Dietary modifications alone relieved constipation in more than half of a group of 35 patients with constipation. We therefore recommend a trial of dietary modifications prior to the initiation of pharmacotherapy in patients with a colostomy.

A Study on the Dietary Intake and the Nutritional Status among the Pancreatic Cancer Surgical Patients

PubMed Central

Park, Joon Seong; Yoon, Dong Sup; Kim, Woo Jeong; Chung, Hae-yun

2016-01-01

The adequate dietary intake is important to maintain the nutritional status of the patients after pancreatic cancer surgery. This prospective study was designed to investigate the dietary intake and the nutritional status of the patients who had pancreatic cancer surgery. Thirty-one patients (15 men, 16 women) were enrolled and measured body weight, body mass index (BMI), nutritional risk index (NRI), and Malnutrition Universal Screening Tool (MUST). Actual oral intake with nutritional impact symptoms recorded on the clinical research foam at every meal and medical information were collected from electronic medical charts. The rates of malnutrition at admission were 45.1% (14/31) and 28.9% (9/31) by NRI and MUST method, respectively, but those were increased to 87% (27/31) and 86.6% (26/31) after operation on discharge. The median values of daily intake of energy, carbohydrates, fat, and protein were 588.1 kcal, 96.0 g, 11.8 g, and 27.0 g, respectively. Most patients (n = 20, 64.5%) experienced two or more symptoms such as anorexia, abdominal bloating and early satiety. There were negative correlations between C-reactive protein (CRP) levels and the intake of total energy, protein, fat, and zinc. The rates of malnutrition were increased sharply after surgery and the dietary intake also influenced the inflammatory indicators. The results suggested that need of considering special therapeutic diets for the patients who received pancreatic surgery. PMID:27812517

Prevention and Treatment of Flatulence From a Traditional Persian Medicine Perspective.

PubMed

Larijani, Bagher; Esfahani, Mohammad Medhi; Moghimi, Maryam; Shams Ardakani, Mohammad Reza; Keshavarz, Mansoor; Kordafshari, Gholamreza; Nazem, Esmaiel; Hasani Ranjbar, Shirin; Mohammadi Kenari, Hoorieh; Zargaran, Arman

2016-04-01

The feeling of abdominal fullness, bloating, and movement of gas in the abdomen is a very uncomfortable sensation termed flatulence. Since flatulence is one of the most common gastrointestinal symptoms that is bothersome to patients, it is important to identify effective methods to resolve this issue. In modern medicine, management of flatulence is often not satisfactory. On the other hand, traditional systems of medicine can be considered good potential sources to find new approaches for preventing and treating flatulence. The aim of this study is to review flatulence treatments from a traditional Persian medicine (TPM) viewpoint. In this study, the reasons for flatulence and methods for its prevention and treatment are reviewed in traditional Persian medicine (TPM) texts and then related with evidence from modern medicine by searching in databases, including PubMed, Scopus, Google Scholar, and IranMedex. From a traditional Persian scholar viewpoint, one of the most important causes of flatulence is an incorrect manner of eating; valuable advice to correct bad eating habits will be illustrated. In addition, traditional practitioners describe some herbs and vegetables as well as herbal compounds that are effective food additives to relieve flatulence. The anti-flatulent effect of most of these herbs has been experimentally verified using modern medicine. Attention to TPM can lead to the identification of new preventive and curative approaches to avoid and treat flatulence. In addition, Persian viewpoints from the medieval era regarding flatulence are historically important.

Short Term (14 Days) Consumption of Insoluble Wheat Bran Fibre-Containing Breakfast Cereals Improves Subjective Digestive Feelings, General Wellbeing and Bowel Function in a Dose Dependent Manner

PubMed Central

Lawton, Clare L.; Walton, Jenny; Hoyland, Alexa; Howarth, Elaine; Allan, Peter; Chesters, David; Dye, Louise

2013-01-01

This study investigated whether increasing insoluble (predominantly wheat bran) fibre over 14 days improves subjective digestive feelings, general wellbeing and bowel function. A single centre, multi-site, open, within subjects design with a 14 day non-intervention (baseline) monitoring period followed by a 14 day fibre consumption (intervention) period was performed. 153 low fibre consumers (<15 g/day AOAC 985.29) completed a daily symptom diary for 14 days after which they consumed one bowl of ready-to-eat breakfast cereal containing at least 5.4 g fibre (3.5 g from wheat bran) for 14 days and completed a daily symptom diary. Significant improvements were demonstrated in subjective perception of bowel function (e.g., ease of defecation) and digestive feelings (bloating, constipation, feeling sluggish and digestive discomfort). Significant improvements were also found in subjective perception of general wellbeing (feeling less fat, more mentally alert, slim, happy and energetic whilst experiencing less stress, mental and physical tiredness, difficulty concentrating and fewer headaches). In general, improvements in study outcomes increased with increasing cereal/fibre consumption. However, consuming an additional minimum 5.4 g of fibre (3.5 g wheat bran) per day was shown to deliver measurable and significant benefits for digestive health, comfort and wellbeing. Encouraging consumption of relatively small amounts of wheat bran could also provide an effective method of increasing overall fibre consumption. PMID:23609776

The impact of meal timing on performance, sleepiness, gastric upset, and hunger during simulated night shift

PubMed Central

GRANT, Crystal Leigh; DORRIAN, Jillian; COATES, Alison Maree; PAJCIN, Maja; KENNAWAY, David John; WITTERT, Gary Allen; HEILBRONN, Leonie Kaye; DELLA VEDOVA, Chris; GUPTA, Charlotte Cecilia; BANKS, Siobhan

2017-01-01

This study examined the impact of eating during simulated night shift on performance and subjective complaints. Subjects were randomized to eating at night (n=5; 23.2 ± 5.5 y) or not eating at night (n=5; 26.2 ± 6.4 y). All participants were given one sleep opportunity of 8 h (22:00 h-06:00 h) before transitioning to the night shift protocol. During the four days of simulated night shift participants were awake from 16:00 h-10:00 h with a daytime sleep of 6 h (10:00 h-16:00 h). In the simulated night shift protocol, meals were provided at ≈0700 h, 1900 h and 0130 h (eating at night); or ≈0700 h, 0930 h, 1410 h and 1900 h (not eating at night). Subjects completed sleepiness, hunger and gastric complaint scales, a Digit Symbol Substitution Task and a 10-min Psychomotor Vigilance Task. Increased sleepiness and performance impairment was evident in both conditions at 0400 h (p<0.05). Performance impairment at 0400 h was exacerbated when eating at night. Not eating at night was associated with elevated hunger and a small but significant elevation in stomach upset across the night (p<0.026). Eating at night was associated with elevated bloating on night one, which decreased across the protocol. Restricting food intake may limit performance impairments at night. Dietary recommendations to improve night-shift performance must also consider worker comfort. PMID:28740034

Clinical trial: the effects of a trans-galactooligosaccharide prebiotic on faecal microbiota and symptoms in irritable bowel syndrome.

PubMed

Silk, D B A; Davis, A; Vulevic, J; Tzortzis, G; Gibson, G R

2009-03-01

Gut microflora-mucosal interactions may be involved in the pathogenesis of irritable bowel syndrome (IBS). To investigate the efficacy of a novel prebiotic trans-galactooligosaccharide in changing the colonic microflora and improve the symptoms in IBS sufferers. In all, 44 patients with Rome II positive IBS completed a 12-week single centre parallel crossover controlled clinical trial. Patients were randomized to receive either 3.5 g/d prebiotic, 7 g/d prebiotic or 7 g/d placebo. IBS symptoms were monitored weekly and scored according to a 7-point Likert scale. Changes in faecal microflora, stool frequency and form (Bristol stool scale) subjective global assessment (SGA), anxiety and depression and QOL scores were also monitored. The prebiotic significantly enhanced faecal bifidobacteria (3.5 g/d P < 0.005; 7 g/d P < 0.001). Placebo was without effect on the clinical parameters monitored, while the prebiotic at 3.5 g/d significantly changed stool consistency (P < 0.05), improved flatulence (P < 0.05) bloating (P < 0.05), composite score of symptoms (P < 0.05) and SGA (P < 0.05). The prebiotic at 7 g/d significantly improved SGA (P < 0.05) and anxiety scores (P < 0.05). The galactooligosaccharide acted as a prebiotic in specifically stimulating gut bifidobacteria in IBS patients and is effective in alleviating symptoms. These findings suggest that the prebiotic has potential as a therapeutic agent in IBS.

Dietary fiber in irritable bowel syndrome (Review).

PubMed

El-Salhy, Magdy; Ystad, Synne Otterasen; Mazzawi, Tarek; Gundersen, Doris

2017-09-01

Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder. It is widely believed that IBS is caused by a deficient intake of dietary fiber, and most physicians recommend that patients with IBS increase their intake of dietary fiber in order to relieve their symptoms. However, different types of dietary fiber exhibit marked differences in physical and chemical properties, and the associated health benefits are specific for each fiber type. Short-chain soluble and highly fermentable dietary fiber, such as oligosaccharides results in rapid gas production that can cause abdominal pain/discomfort, abdominal bloating/distension and flatulence in patients with IBS. By contrast, long-chain, intermediate viscous, soluble and moderately fermentable dietary fiber, such as psyllium results in a low gas production and the absence of the symptoms related to excessive gas production. The effects of type of fiber have been documented in the management of IBS, and it is known to improve the overall symptoms in patients with IBS. Dietary fiber acts on the gastrointestinal tract through several mechanisms, including increased fecal mass with mechanical stimulation/irritation of the colonic mucosa with increasing secretion and peristalsis, and the actions of fermentation byproducts, particularly short-chain fatty acids, on the intestinal microbiota, immune system and the neuroendocrine system of the gastrointestinal tract. Fiber supplementation, particularly psyllium, is both safe and effective in improving IBS symptoms globally. Dietary fiber also has other health benefits, such as lowering blood cholesterol levels, improving glycemic control and body weight management.

Dietary fiber in irritable bowel syndrome (Review)

PubMed Central

El-Salhy, Magdy; Ystad, Synne Otterasen; Mazzawi, Tarek; Gundersen, Doris

2017-01-01

Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disorder. It is widely believed that IBS is caused by a deficient intake of dietary fiber, and most physicians recommend that patients with IBS increase their intake of dietary fiber in order to relieve their symptoms. However, different types of dietary fiber exhibit marked differences in physical and chemical properties, and the associated health benefits are specific for each fiber type. Short-chain soluble and highly fermentable dietary fiber, such as oligosaccharides results in rapid gas production that can cause abdominal pain/discomfort, abdominal bloating/distension and flatulence in patients with IBS. By contrast, long-chain, intermediate viscous, soluble and moderately fermentable dietary fiber, such as psyllium results in a low gas production and the absence of the symptoms related to excessive gas production. The effects of type of fiber have been documented in the management of IBS, and it is known to improve the overall symptoms in patients with IBS. Dietary fiber acts on the gastrointestinal tract through several mechanisms, including increased fecal mass with mechanical stimulation/irritation of the colonic mucosa with increasing secretion and peristalsis, and the actions of fermentation byproducts, particularly short-chain fatty acids, on the intestinal microbiota, immune system and the neuroendocrine system of the gastrointestinal tract. Fiber supplementation, particularly psyllium, is both safe and effective in improving IBS symptoms globally. Dietary fiber also has other health benefits, such as lowering blood cholesterol levels, improving glycemic control and body weight management. PMID:28731144

Rifaximin for small intestinal bacterial overgrowth in patients without irritable bowel syndrome.

PubMed

Boltin, Doron; Perets, Tsachi Tsadok; Shporn, Einav; Aizic, Shoshana; Levy, Sigal; Niv, Yaron; Dickman, Ram

2014-10-17

Rifaximin is a minimally absorbed antibiotic with high luminal activity, used to treat various gastrointestinal diseases. Although rifaximin has been proposed as first line treatment for small intestinal bacterial overgrowth (SIBO), few data are available regarding its efficacy in non-IBS subjects. We aimed to assess the ability of rifaximin to normalize lactulose-H2 breath tests in non-IBS subjects with symptoms suggestive of SIBO. Consecutive non-IBS patients presenting with bloating and flatulence were prospectively recruited and submitted to lactulose-H2 breath testing (LBT). Patients who had a positive result were offered rifaximin 1200 mg daily for 10 days. Breath testing was repeated two weeks after treatment completion in all patients in order to assess for response. A total of 19 patients with a positive result received rifaximin and repeated the breath test (7 (36.8%) males, age 56.5 ± 17.6 years). The mean peak hydrogen excretion was 13.7 ± 2.8 and 10.3 ± 7.3 ppm at baseline and following rifaximin treatment, respectively (t = 1.98, p = 0.06). LBT normalized in 8/19 (42.1%) subjects. No patients reported symptom resolution. No adverse events were reported. Strengths include the study's prospective design. Limitations include the small sample size and open label design. Rifaximin was not effective in normalizing LBT in our cohort of non-IBS subjects with symptoms suggestive of SIBO.

Prevalence of inherited disorders among mixed-breed and purebred dogs: 27,254 cases (1995-2010).

PubMed

Bellumori, Thomas P; Famula, Thomas R; Bannasch, Danika L; Belanger, Janelle M; Oberbauer, Anita M

2013-06-01

To determine the proportion of mixed-breed and purebred dogs with common genetic disorders. Case-control study. 27,254 dogs with an inherited disorder. Electronic medical records were reviewed for 24 genetic disorders: hemangiosarcoma, lymphoma, mast cell tumor, osteosarcoma, aortic stenosis, dilated cardiomyopathy, hypertrophic cardiomyopathy, mitral valve dysplasia, patent ductus arteriosus, ventricular septal defect, hyperadrenocorticism, hypoadrenocorticism, hypothyroidism, elbow dysplasia, hip dysplasia, intervertebral disk disease, patellar luxation, ruptured cranial cruciate ligament, atopy or allergic dermatitis, bloat, cataracts, epilepsy, lens luxation, and portosystemic shunt. For each disorder, healthy controls matched for age, body weight, and sex to each affected dog were identified. Genetic disorders differed in expression. No differences in expression of 13 genetic disorders were detected between purebred dogs and mixed-breed dogs (ie, hip dysplasia, hypo- and hyperadrenocorticism, cancers, lens luxation, and patellar luxation). Purebred dogs were more likely to have 10 genetic disorders, including dilated cardiomyopathy, elbow dysplasia, cataracts, and hypothyroidism. Mixed-breed dogs had a greater probability of ruptured cranial cruciate ligament. Prevalence of genetic disorders in both populations was related to the specific disorder. Recently derived breeds or those from similar lineages appeared to be more susceptible to certain disorders that affect all closely related purebred dogs, whereas disorders with equal prevalence in the 2 populations suggested that those disorders represented more ancient mutations that are widely spread through the dog population. Results provided insight on how breeding practices may reduce prevalence of a disorder.

Prevention and Treatment of Flatulence From a Traditional Persian Medicine Perspective

PubMed Central

Larijani, Bagher; Esfahani, Mohammad Medhi; Moghimi, Maryam; Shams Ardakani, Mohammad Reza; Keshavarz, Mansoor; Kordafshari, Gholamreza; Nazem, Esmaiel; Hasani Ranjbar, Shirin; Mohammadi Kenari, Hoorieh; Zargaran, Arman

2016-01-01

Context The feeling of abdominal fullness, bloating, and movement of gas in the abdomen is a very uncomfortable sensation termed flatulence. Since flatulence is one of the most common gastrointestinal symptoms that is bothersome to patients, it is important to identify effective methods to resolve this issue. In modern medicine, management of flatulence is often not satisfactory. On the other hand, traditional systems of medicine can be considered good potential sources to find new approaches for preventing and treating flatulence. The aim of this study is to review flatulence treatments from a traditional Persian medicine (TPM) viewpoint. Evidence Acquisition In this study, the reasons for flatulence and methods for its prevention and treatment are reviewed in traditional Persian medicine (TPM) texts and then related with evidence from modern medicine by searching in databases, including PubMed, Scopus, Google Scholar, and IranMedex. Results From a traditional Persian scholar viewpoint, one of the most important causes of flatulence is an incorrect manner of eating; valuable advice to correct bad eating habits will be illustrated. In addition, traditional practitioners describe some herbs and vegetables as well as herbal compounds that are effective food additives to relieve flatulence. The anti-flatulent effect of most of these herbs has been experimentally verified using modern medicine. Conclusions Attention to TPM can lead to the identification of new preventive and curative approaches to avoid and treat flatulence. In addition, Persian viewpoints from the medieval era regarding flatulence are historically important. PMID:27275398

[ORAL CONTRACEPTIVES AND MOOD/SEXUAL DISORDERS IN WOMEN].

PubMed

Sirakov, M; Tomova, E

2015-01-01

Oral contraceptives are used since more than 50 years and are very popular due to offering more than 99% confidence in preventing pregnancy. Over 100 million women worldwide use oral contraceptives. In the UK 27% of women between 16 and 49 y. use pills. In the United States they are about 30%, in Germany - 40%, and in The Netherlands - 60%. According to a study by B. Pehlivanov, 2008, in Bulgaria only 4% of women use OC. (1) Despite the convenience and security, in the U.S.A. 29% of women taking OC interrupt prematurely their use (2), while the percentage of adolescents appears to be higher (3) Earlier studies of the reasons for refusal of OC focus on their influence on the menstrual cycle, as well as on some physical side effects such as the appearance of hair growth, weight gain, bloating etc. They paid very little attention to their impact on mood and sexual behavior of women (4). Newer studies suggest that the side effects associated with mood and sexual behavior proved more powerful factor leading to early termination of the use of OC (5). This paper is a review of the literature and evaluation of the facts presented in studies from different countries. They found a high incidence of symptoms such as anxiety, susceptibility to stress, mood changes, incl. depression, anxiety, increased irritability and affection of sexual desire of women. (6) There are many indications that OC-users are at increased risk of suicide and mental illnesses. (9).

Women's preferences for menstrual bleeding frequency: results of the Inconvenience Due to Women's Monthly Bleeding (ISY) survey.

PubMed

Nappi, Rossella E; Fiala, Christian; Chabbert-Buffet, Nathalie; Häusler, Günther; Jamin, Christian; Lete, Iñaki; Lukasiewic, Monika; Pintiaux, Axelle; Lobo, Paloma

2016-06-01

Our aim was to assess the level of inconvenience associated with monthly bleeding, determine how many women would prefer a bleeding frequency of less than once a month, and what would motivate their choice. A 15-min quantitative online survey was carried out among 2883 women aged between 18 and 45 years in six European countries (Austria, Belgium, France, Italy, Poland and Spain). Of those surveyed, 1319 women used a combined hormonal contraceptive (CHC group) and 1564 used a non-hormonal contraceptive or no contraceptive (non-HC group). The menstrual period was significantly longer (5 vs. 4.5 days), heavier (16% vs. 8% heavy menstrual flow) and associated with more symptoms (6.1 vs. 5.6) in non-HC users than in CHC users (p < 0.0001). More than half of the women in each group reported pelvic pain, bloating/swelling, mood swings and irritability, but the rate was significantly higher in the non-HC group. Given the choice, 57% of women in both groups said they would opt for longer intervals between periods. Sexuality, social life, work and sporting activities were key factors affecting their decision. The majority of women would prefer to have menstrual periods less than once a month, with a frequency ranging from once every 3 months to no periods at all. This can be explained by the desire to avoid the unpleasant aspects of menstruation and its negative impact on private and professional life.

Ethnoveterinary treatments for common cattle diseases in four districts of the Southern Province, Zambia.

PubMed

Syakalima, Michelo; Simuunza, Martin; Zulu, Victor Chisha

2018-02-01

Ethno veterinary knowledge has rarely been recorded, and no or limited effort has been made to exploit this knowledge despite its widespread use in Zambia. This study documented the types of plants used to treat important animal diseases in rural Zambia as a way of initiating their sustained documentation and scientific validation. The study was done in selected districts of the Southern Zambia, Africa. The research was a participatory epidemiological study conducted in two phases. The first phase was a pre-study exploratory rapid rural appraisal conducted to familiarize the researchers with the study areas, and the second phase was a participatory rural appraisal to help gather the data. The frequency index was used to rank the commonly mentioned treatments. A number of diseases and traditional treatments were listed with the help of local veterinarians. Diseases included: Corridor disease (Theileriosis), foot and mouth disease, blackleg, bloody diarrhea, lumpy skin disease, fainting, mange, blindness, coughing, bloat, worms, cobra snakebite, hemorrhagic septicemia, and transmissible venereal tumors. The plant preparations were in most diseases given to the livestock orally (as a drench). Leaves, barks, and roots were generally used depending on the plant type. Ethno veterinary medicine is still widespread among the rural farmers in the province and in Zambia in general. Some medicines are commonly used across diseases probably because they have a wide spectrum of action. These medicines should, therefore, be validated for use in conventional livestock healthcare systems in the country to reduce the cost of treatments.

Dynamics of the oral microbiota as a tool to estimate time since death.

PubMed

Adserias-Garriga, J; Quijada, N M; Hernandez, M; Rodríguez Lázaro, D; Steadman, D; Garcia-Gil, L J

2017-06-27

The oral cavity harbors one of the most diverse microbiomes in the human body. It has been shown to be the second most complex in the body after the gastrointestinal tract. Upon death, the indigenous microorganisms lead to the decomposition of the carcass. Therefore, the oral cavity and gastrointestinal tract microbiomes play a key role in human decomposition. The aim of the present study is to monitor the microbiome of decaying bodies on a daily basis and to identify signature bacterial taxa, that can improve postmortem interval estimation. Three individuals (one male and two female) donated to the University of Tennessee Forensic Anthropology Center for the W.M. Bass Donated Skeletal Collection were studied. Oral swab samples were taken daily throughout the different stages of cadaveric putrefaction. DNA was extracted and analyzed by next-generation sequencing techniques. The three cadavers showed similar overall successional changes during the decomposition process. Firmicutes and Actinobacteria are the predominant phyla in the fresh stage. The presence of Tenericutes corresponds to bloat stage. Firmicutes is the predominant phylum in advanced decay, but the Firmicutes community is a different one from the predominant Firmicutes of the fresh stage. This study depicts the thanatomicrobiome successional changes in the oral cavity, and highlights its potential use in forensic cases as a quantitative and objective approach to estimate postmortem interval, from an ecological rationale. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Preference for gel over suppository as delivery vehicle for a rectal microbicide: Results of a randomized, crossover acceptability trial among men who have sex with men

PubMed Central

Carballo-Diéguez, A.; Dolezal, C.; Bauermeister, J.A.; O’Brien, B.; Ventuneac, A.; Mayer, K.

2009-01-01

Objective To assess whether men who have sex with men (MSM) prefer a gel or a suppository as a delivery vehicle for a rectal microbicide. Methods 77 HIV-negative MSM with recent history of inconsistent condom use during receptive anal intercourse (RAI) who acknowledged being at risk of contracting HIV were enrolled in a randomized, crossover acceptability trial. They compared 35 ml of placebo gel with 8 g placebo rectal suppositories used in up to three RAI occasions each. Results Participants preferred the gel over the suppository (75% vs. 25%, p <.001), and so did their partners (71% vs. 29%, p <.001). The gel received more favorable ratings overall and on attributes such as color, smell, consistency, feeling in rectum immediately after insertion and/or 30 minutes after insertion, and application process. The gel resulted in less negative ratings in terms of participants being bothered by leakage, soiling, bloating, gassiness, stomach cramps, urge to have bowel movement, diarrhea, pain or trauma. Participants liked the gel more in terms of feelings during anal sex, sexual satisfaction, partners’ sexual satisfaction, and liking the product when condoms were used and when condoms were not used. Conclusions In this sample taken from one of the populations most likely to benefit from rectal microbicide availability, gel had higher acceptability than suppository as a potential microbicide vehicle. PMID:19028952

Dietary Carbohydrates and Childhood Functional Abdominal Pain.

PubMed

Chumpitazi, Bruno P; Shulman, Robert J

2016-01-01

Childhood functional gastrointestinal disorders (FGIDs) affect a large number of children throughout the world. Carbohydrates (which provide the majority of calories consumed in the Western diet) have been implicated both as culprits for the etiology of symptoms and as potential therapeutic agents (e.g., fiber) in childhood FGIDs. In this review, we detail how carbohydrate malabsorption may cause gastrointestinal symptoms (e.g., bloating) via the physiologic effects of both increased osmotic activity and increased gas production from bacterial fermentation. Several factors may play a role, including: (1) the amount of carbohydrate ingested; (2) whether ingestion is accompanied by a meal or other food; (3) the rate of gastric emptying (how quickly the meal enters the small intestine); (4) small intestinal transit time (the time it takes for a meal to enter the large intestine after first entering the small intestine); (5) whether the meal contains bacteria with enzymes capable of breaking down the carbohydrate; (6) colonic bacterial adaptation to one's diet, and (7) host factors such as the presence or absence of visceral hypersensitivity. By detailing controlled and uncontrolled trials, we describe how there is a general lack of strong evidence supporting restriction of individual carbohydrates (e.g., lactose, fructose) for childhood FGIDs. We review emerging evidence suggesting that a more comprehensive restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) may be effective. Finally, we review how soluble fiber (a complex carbohydrate) supplementation via randomized controlled intervention trials in childhood functional gastrointestinal disorders has demonstrated efficacy. © 2016 S. Karger AG, Basel.

Efficacy of actinidin-containing kiwifruit extract Zyactinase on constipation: a randomised double-blinded placebo-controlled clinical trial.

PubMed

Weir, Iona; Shu, Quan; Wei, Nengding; Wei, Chengkai; Zhu, Yi

2018-01-01

Zyactinase® is an extract of green kiwifruit, formulated into the consumer healthcare products marketed as Phloe® and Kivia, used to assist in the relief of the symptoms associated with a range of digestive system dysfunction, including constipation and Irritable Bowel Syndrome (IBS). A randomised, double-blind, placebo-controlled clinical trial was undertaken to determine the ef-fects of the kiwifruit extract on bowel movement, stool formation and IBS associated symptoms amongst a sub-ject group of generally healthy individuals experiencing a period of moderate constipation. Fifty-eight partici-pants were randomized to the kiwifruit extract (28) or placebo (30). Selection criterion was decreased number of bowel movements (<3/week), with increased faecal hardness and IBS associated symptoms. The study ran for three weeks, with participants first undergoing a seven-day wash out period, followed by a seven-day dosing pe-riod, and then a seven-day follow up period. There was a significant increase in the defecation frequency (p<0.001), with a significant improvement in faecal score (p<0.01). There was a significant difference in pain-ful defecation and abdominal pain between the two groups (p<0.01). No side effects, including diarrhoea, urgen-cy or abdominal pain, were observed during the trial. The green kiwifruit extract significantly in-duced normal bowel movements with no adverse effects. The kiwifruit extract relieved constipation and the symptoms of IBS such as bloating, flatulence and abdominal pain.

Influence of inhomogeneous static magnetic field-exposure on patients with erosive gastritis: a randomized, self- and placebo-controlled, double-blind, single centre, pilot study.

PubMed

Juhász, Márk; Nagy, Viktor L; Székely, Hajnal; Kocsis, Dorottya; Tulassay, Zsolt; László, János F

2014-09-06

This pilot study was devoted to the effect of static magnetic field (SMF)-exposure on erosive gastritis. The randomized, self- and placebo-controlled, double-blind, pilot study included 16 patients of the 2nd Department of Internal Medicine, Semmelweis University diagnosed with erosive gastritis. The instrumental analysis followed a qualitative (pre-intervention) assessment of the symptoms by the patient: lower heartburn (in the ventricle), upper heartburn (in the oesophagus), epigastric pain, regurgitation, bloating and dry cough. Medical diagnosis included a double-line upper panendoscopy followed by 30 min local inhomogeneous SMF-exposure intervention at the lower sternal region over the stomach with peak-to-peak magnetic induction of 3 mT and 30 mT m(-1) gradient at the target site. A qualitative (post-intervention) assessment of the same symptoms closed the examination. Sham- or SMF-exposure was used in a double-blind manner. The authors succeeded in justifying the clinically and statistically significant beneficial effect of the SMF- over sham-exposure on the symptoms of erosive gastritis, the average effect of inhibition was 56% by p = 0.001, n = 42 + 96. This pilot study was aimed to encourage gastroenterologists to test local, inhomogeneous SMF-exposure on erosive gastritis patients, so this intervention may become an evidence-based alternative or complementary method in the clinical use especially in cases when conventional therapy options are contraindicated. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

Guidelines on the irritable bowel syndrome: mechanisms and practical management

PubMed Central

Spiller, R; Aziz, Q; Creed, F; Emmanuel, A; Houghton, L; Hungin, P; Jones, R; Kumar, D; Rubin, G; Trudgill, N; Whorwell, P

2007-01-01

Background IBS affects 5–11% of the population of most countries. Prevalence peaks in the third and fourth decades, with a female predominance. Aim To provide a guide for the assessment and management of adult patients with irritable bowel syndrome. Methods Members of the Clinical Services Committee of The British Society of Gastroenterology were allocated particular areas to produce review documents. Literature searching included systematic searches using electronic databases such as Pubmed, EMBASE, MEDLINE, Web of Science, and Cochrane databases and extensive personal reference databases. Results Patients can usefully be classified by predominant bowel habit. Few investigations are needed except when diarrhoea is a prominent feature. Alarm features may warrant further investigation. Adverse psychological features and somatisation are often present. Ascertaining the patients' concerns and explaining symptoms in simple terms improves outcome. IBS is a heterogeneous condition with a range of treatments, each of which benefits a small proportion of patients. Treatment of associated anxiety and depression often improves bowel and other symptoms. Randomised placebo controlled trials show benefit as follows: cognitive behavioural therapy and psychodynamic interpersonal therapy improve coping; hypnotherapy benefits global symptoms in otherwise refractory patients; antispasmodics and tricyclic antidepressants improve pain; ispaghula improves pain and bowel habit; 5‐HT3 antagonists improve global symptoms, diarrhoea, and pain but may rarely cause unexplained colitis; 5‐HT4 agonists improve global symptoms, constipation, and bloating; selective serotonin reuptake inhibitors improve global symptoms. Conclusions Better ways of identifying which patients will respond to specific treatments are urgently needed. PMID:17488783

Emerging treatments in neurogastroenterology: eluxadoline - a new therapeutic option for diarrhea-predominant IBS.

PubMed

Lacy, B E

2016-01-01

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder worldwide. The global prevalence of IBS is estimated to be as high as 15%. For many patients, IBS is a chronic disorder which can significantly reduce quality of life. Just as important as the effects on any one individual, IBS also places a significant impact on the population as a whole with its negative effects on the health care system. Irritable bowel syndrome is categorized into one of three main categories: IBS with diarrhea, IBS with constipation, and IBS with mixed bowel habits. Patients with diarrhea-predominant IBS (IBS-D) comprise a substantial proportion of the overall IBS population. A number of therapeutic options exist to treat the symptoms of abdominal pain, bloating, diarrhea, and fecal urgency, including non-pharmacologic therapies such as dietary changes and probiotics, or pharmacologic therapies such as loperamide and alosetron. However, many patients have persistent symptoms despite these therapies. This unmet need led to the development of eluxadoline, a mu-opioid receptor agonist/delta-opioid receptor antagonist/kappa-receptor agonist. Approved by the FDA in May 2015, this medication shows promise in the treatment of diarrhea-predominant IBS for both men and women. This monograph will briefly review the impact of IBS, discuss current treatments for IBS-D, and then focus on the pharmacology, clinical efficacy and safety of eluxadoline. Potential mechanisms related to rare events of acute pancreatitis or elevated liver tests will be discussed. © 2015 John Wiley & Sons Ltd.

Nursing implications: symptom presentation and quality of life in rectal cancer patients.

PubMed

O'Gorman, Claire; Barry, Amanda; Denieffe, Suzanne; Sasiadek, Wojciech; Gooney, Martina

2016-05-01

To determine the changes in symptoms experienced by rectal cancer patients during preoperative chemoradiotherapy, with a specific focus on fatigue and to explore how symptoms impact the quality of life. Rectal cancer continues to be a healthcare issue internationally, despite advances in management strategies, which includes the administration of preoperative chemoradiotherapy to improve locoregional control. It is known that this treatment may cause adverse effects; however, there is a paucity of literature that specifically examines fatigue, symptoms and quality of life in this patient cohort. A prospective, quantitative correlational design using purposive sampling was adopted. Symptoms and quality of life were measured with validated questionnaires in 35 patients at four time points. Symptoms that changed significantly over time as examined using rm-anova include fatigue, bowel function issues, nutritional issues, pain, dermatological issues and urinary function issues. Findings indicate that fatigue leads to poorer quality of life, with constipation, bloating, stool frequency, appetite loss, weight worry, nausea and vomiting, dry mouth and pain also identified as influencing factors on quality of life. Findings have highlighted the importance of thorough symptom assessment and management of patients receiving preoperative chemoradiotherapy, particularly midway through treatment, in order to optimise quality of life and minimise interruptions to treatment. Close monitoring of symptoms during preoperative chemoradiotherapy, particularly at week 4, will enable the implementation of timely interventions so that interruptions to treatment are prevented and the quality of life is optimised, which may hasten postoperative recovery times. © 2016 John Wiley & Sons Ltd.

Factors associated with postoperative complications and mortality in perforated peptic ulcer.

PubMed

Montalvo-Javé, Eduardo Esteban; Corres-Sillas, Omar; Athié-Gutiérrez, César

2011-01-01

Elective surgery for uncomplicated peptic ulcer has shown a significant decrease; however, complications such as perforation and obstruction persist and require urgent surgical management. The aim of this study was to identify factors associated with early postoperative complications and mortality of patients admitted to the emergency department with perforated peptic ulcer. We performed a clinical, retrospective, cross-sectional and descriptive study of patients who were treated at the General Hospital of Mexico with a diagnosis of perforated peptic ulcer from January 2006 to December 2008. Thirty patients were included in the study. We studied several clinical findings upon admission to the emergency department and intraoperative patient findings in order to determine the association of those with early postoperative complications and mortality. We studied 30 patients with an average age of 57.07 years (± 14.2 years). The male:female ratio was 2:1. We found that the risk of developing postoperative complications was 66.7% and is significantly influenced by time of onset of abdominal pain prior to admission, bloating, septic shock and blood type O positive. Mortality was 16.7% and was correlated with the presence of septic shock on admission. The surgical procedure performed was primary closure with Graham patch in 86.6%. Average hospital stay was 12.8 days. The presence of early postoperative complications is associated with time of onset of abdominal pain before admission, abdominal distension, blood type O positive and the presence of septic shock on admission.

Decomposition patterns of buried remains at different intervals in the Central Highveld region of South Africa.

PubMed

Marais-Werner, A; Myburgh, J; Meyer, A; Nienaber, W C; Steyn, M

2017-07-01

Burial of remains is an important factor when one attempts to establish the post-mortem interval as it reduces, and in extreme cases, excludes oviposition by Diptera species. This in turn leads to modification of the decomposition process. The aim of this study was to record decomposition patterns of buried remains using a pig model. The pattern of decomposition was evaluated at different intervals and recorded according to existing guidelines. In order to contribute to our knowledge on decomposition in different settings, a quantifiable approach was followed. Results indicated that early stages of decomposition occurred rapidly for buried remains within 7-33 days. Between 14 and 33 days, buried pigs displayed common features associated with the early to middle stages of decomposition, such as discoloration and bloating. From 33 to 90 days advanced decomposition manifested on the remains, and pigs then reached a stage of advanced decomposition where little change was observed in the next ±90-183 days after interment. Throughout this study, total body scores remained higher for surface remains. Overall, buried pigs followed a similar pattern of decomposition to those of surface remains, although at a much slower rate when compared with similar post-mortem intervals in surface remains. In this study, the decomposition patterns and rates of buried remains were mostly influenced by limited insect activity and adipocere formation which reduces the rate of decay in a conducive environment (i.e. burial in soil).

Ovarian Cancer Stroma: Pathophysiology and the Roles in Cancer Development

PubMed Central

Furuya, Mitsuko

2012-01-01

Ovarian cancer represents one of the cancers with the worst prognostic in adult women. More than half of the patients who present with clinical signs such as abdominal bloating and a feeling of fullness already show advanced stages. The majority of ovarian cancers grow as cystic masses, and cancer cells easily spread into the pelvic cavity once the cysts rupture or leak. When the ovarian cancer cells disseminate into the peritoneal cavity, metastatic nests may grow in the cul-de-sac, and in more advanced stages, the peritoneal surfaces of the upper abdomen become the next largest soil for cancer progression. Ascites is also produced frequently in ovarian cancers, which facilitates distant metastasis. Clinicopathologic, epidemiologic and molecular studies on ovarian cancers have improved our understanding and therapeutic approaches, but still further efforts are required to reduce the risks in the patients who are predisposed to this lethal disease and the mortality of the patients in advanced stages. Among various molecules involved in ovarian carcinogenesis, special genes such as TP53, BRCA1 and BRCA2 have been well investigated. These genes are widely accepted as the predisposing factors that trigger malignant transformation of the epithelial cells of the ovary. In addition, adnexal inflammatory conditions such as chronic salpingitis and ovarian endometriosis have been great research interests in the context of carcinogenic background of ovarian cancers. In this review, I discuss the roles of stromal cells and inflammatory factors in the carcinogenesis and progression of ovarian cancers. PMID:24213462

Gastrointestinal symptoms are still common in a general Western population.

PubMed

van Kerkhoven, L A S; Eikendal, T; Laheij, R J F; van Oijen, M G H; Jansen, J B M J

2008-01-01

Results from studies conducted in the late 1980s and early 1990 s showed that gastrointestinal symptoms were common among the general population. Meanwhile, lifestyle habits have changed and important treatment options have been introduced. This might have influenced symptom prevalence. This study aimed to describe the current prevalence of upper and lower gastrointestinal symptoms within the general population. For this purpose, a demographically representative sample of the Dutch population within the city of Nijmegen and surrounding areas was selected after careful comparison with demographic figures from a government demographic database. Participants were invited to fill in a valid self-report questionnaire about gastrointestinal symptoms and prevalence figures were calculated. A total of 5000 questionnaires was sent and 1616 (32%) were returned. Of these, 839 (52%) subjects reported having had upper (43%) or lower (38%) gastrointestinal symptoms in the past four weeks. The most prevalent individual symptoms reported were flatulence (47%), abdominal rumbling (40%), bloating (37%), alternating solid and loose stools (31%), belching (25%) and postprandial fullness (25%). People who smoked or used a proton pump inhibitor had an increased risk for reporting upper as well as lower gastrointestinal symptoms (OR 1.99; 95% CI 1.56 to 2.55, and OR 1.37; 95% CI 1.01 to 1.75, respectively for smoking; and OR 3.17; 95% CI 2.17 to 4.72, and OR 2.14; 95% CI 1.49 to 3.08, respectively for PPIs). Both upper and lower gastrointestinal symptoms are very common in a representative sample of a general Western population.

Motility alterations in celiac disease and non-celiac gluten sensitivity.

PubMed

Pinto-Sanchez, Maria Ines; Bercik, Premysl; Verdu, Elena F

2015-01-01

Regulation of gut motility is complex and involves neuromuscular, immune and environmental mechanisms. It is well established that patients with celiac disease (CD) often display gut dysmotility. Studies have shown the presence of disturbed esophageal motility, altered gastric emptying, and dysmotility of the small intestine, gallbladder and colon in untreated CD. Most of these motor abnormalities resolve after a strict gluten-free diet, suggesting that mechanisms related to the inflammatory condition and disease process are responsible for the motor dysfunction. Motility abnormalities are also a hallmark of functional bowel disorders such as irritable bowel syndrome (IBS), where it has been proposed as underlying mechanism for symptom generation (diarrhea, constipation, bloating). Non-celiac gluten sensitivity (NCGS) is a poorly defined entity, mostly self-diagnosed, that presents clinically with IBS symptoms in the absence of specific celiac markers. Patients with NCGS are believed to react symptomatically to wheat components, and some studies have proposed the presence of low-grade inflammation in these patients. There is little information regarding the functional characterization of these patients before and after a gluten-free diet. A study suggested the presence of altered gastrointestinal transit in NCGS patients who also have a high prevalence of nonspecific anti-gliadin antibodies. Results of an ongoing clinical study in NCGS patients with positive anti-gliadin antibodies before and after a gluten-free diet will be discussed. Elucidating the mechanisms for symptom generation in NCGS patients is important to find new therapeutic alternatives to the burden of imposing a strict gluten-free diet in patients who do not have CD. © 2015 S. Karger AG, Basel.

Latiglutenase Improves Symptoms in Seropositive Celiac Disease Patients While on a Gluten-Free Diet.

PubMed

Syage, Jack A; Murray, Joseph A; Green, Peter H R; Khosla, Chaitan

2017-09-01

Celiac disease (CD) is a widespread condition triggered by dietary gluten and treated with a lifelong gluten-free diet (GFD); however, inadvertent exposure to gluten can result in episodic symptoms. A previous trial of latiglutenase (clinicaltrials.gov; NCT01917630), an orally administered mixture of two recombinant gluten-specific proteases, was undertaken in symptomatic subjects with persistent injury. The primary endpoint for histologic improvement was not met, presumably due to a trial effect. In this post hoc analysis, we investigated the efficacy of latiglutenase for reducing symptoms in subgroups of the study participants based on their seropositivity. The study involved symptomatic CD patients following a GFD for at least one year prior to randomization. Patients were treated for 12 weeks with latiglutenase or placebo. Of 398 completed patients, 173 (43%) were seropositive at baseline. Symptoms were recorded daily, and weekly symptom scores were compiled. p values were calculated by analysis of covariance. A statistically significant, dose-dependent reduction was detected in the severity and frequency of symptoms in seropositive but not seronegative patients. The severity of abdominal pain and bloating was reduced by 58 and 44%, respectively, in the cohort receiving the highest latiglutenase dose (900 mg, n = 14) relative to placebo (n = 54). Symptom improvement increased from week 6 to week 12. There was also a trend toward greater symptom improvement with greater baseline symptom severity. Seropositive CD patients show symptomatic improvement from latiglutenase taken with meals and would benefit from the availability of this treatment.

Tolerability of a probiotic in subjects with a history of methicillin-resistant Staphylococcus aureus colonisation.

PubMed

Warrack, S; Panjikar, P; Duster, M; Safdar, N

2014-12-01

Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of major public health importance. Colonisation precedes infection; thus reducing MRSA carriage may be of benefit for reducing infection. Probiotics represent a novel approach to reducing MRSA carriage. We undertook a pilot feasibility randomised controlled trial of the tolerability and acceptability of probiotics for reducing nasal and intestinal carriage of MRSA. In addition, subjects were screened for vancomycin-resistant enterocococci (VRE). Subjects with a history of MRSA were recruited from a large, academic medical center and randomised to take either a placebo or probiotic (Lactobacillus rhamnosus HN001). Subjects returned to the clinic after four weeks for further testing to determine adherence to the probiotic regimen and colonisation of MRSA. 48 subjects were enrolled and randomised. Nearly 25% were transplant recipients and 30% had diabetes. The probiotic was well tolerated in the study population though minor side effects, such as nausea and bloating, were observed. A majority of the subjects randomised to HN001 had good adherence to the regimen. At the four week time point among subjects randomised to the probiotic, MRSA was detected in 67 and 50% of subjects colonised in the nares and the gastrointestinal tract, respectively. Three subjects who initially tested positive for VRE were negative after four weeks of probiotic exposure. Probiotics were well tolerated in our study population of largely immunocompromised subjects with multiple comorbidities. Adherence to the intervention was good. Probiotics should be studied further for their potential to reduce colonisation by multidrug resistant bacteria.

Dose-dependent efficacy of the Vitex agnus castus extract Ze 440 in patients suffering from premenstrual syndrome.

PubMed

Schellenberg, Ruediger; Zimmermann, Christian; Drewe, Jürgen; Hoexter, Godehard; Zahner, Catherine

2012-11-15

Preparations of Vitex agnus castus L. (VAC) have been shown to be effective to treat irregular menstrual cycles, cyclical mastalgia and symptoms of the premenstrual syndrome (PMS). However, the dose-effect relationship for the treatment of PMS has not yet been established. This study aimed to investigate the clinical effects of three different doses of the VAC extract Ze 440 in comparison to placebo in patients suffering from PMS. In a multicenter, double-blind, placebo-controlled, parallel-group study, 162 female patients with PMS (18-45 years) were randomized to either placebo or different doses of Ze 440 (8, 20 and 30 mg) over three menstrual cycles. PMS symptoms' severity was assessed by patients using visual analog scales (VAS) for the symptoms irritability, mood alteration, anger, headache, bloating and breast fullness. Each of the treatments was well tolerated. Improvement in the total symptom score (TSS) in the 20mg group was significantly higher than in the placebo and 8 mg treatment group. The higher dose of 30 mg, on the other hand, did not significantly decrease symptom severity compared to the 20mg treatment, providing a rational for the usage of 20mg. Corresponding results were observed with the single PMS symptom scores. This study demonstrated that the VAC extract Ze 440 was effective in relieving symptoms of PMS, when applied in a dose of 20mg. Therefore, for patients suffering from PMS, 20mg Ze 440 should be the preferred daily dose. Copyright © 2012 Elsevier GmbH. All rights reserved.

[Breath tests in children with suspected lactose intolerance].

PubMed

Parra, P Ángela; Furió, C Simone; Arancibia, A Gabriel

2015-01-01

Up to 70% of the world population is lactose intolerance. However, there are no epidemiological studies among Chilean pediatric population affected by this condition. Clinical characterization of a series of children who underwent the lactose intolerance breath test for lactose intolerance study, establishing intolerance and malabsorption frequencies, the most frequent symptoms, and test performance depending on the origin. Patients under 18 years old who took the lactose intolerance breath test in the Gastroenterology Laboratory of the Catholic University of Chile, and who were admitted due to clinically suspected lactose intolerance. Malabsorption was considered when there was as an increase of ≥20ppm above the baseline (H2) or ≥34ppm of H2 and methane (CH4) combined. Intolerance was considered when the above was associated with a symptom intensity score ≥7 during registration. The analysis included194 patients aged 1 to17 years of age. Of these, 102 (53%) presented with malabsorption, and 53 (27%) were intolerant. The frequency of lactose intolerance varied from 7.1 to 45.4%, and it occurred more frequently at older ages. The most common reported symptoms were abdominal pain, bloating and rumbling. Lactose malabsorption and intolerance can be investigated from the first years of life using the lactose breath test plus a symptom questionnaire. An increase in the frequency of intolerance with age, and a greater number of positive tests, if they were requested by a gastroenterologist, were observed. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Clinical evaluation, biochemistry and genetic polymorphism analysis for the diagnosis of lactose intolerance in a population from northeastern Brazil.

PubMed

Ponte, Paulo Roberto Lins; de Medeiros, Pedro Henrique Quintela Soares; Havt, Alexandre; Caetano, Joselany Afio; Cid, David A C; Prata, Mara de Moura Gondim; Soares, Alberto Melo; Guerrant, Richard L; Mychaleckyj, Josyf; Lima, Aldo Ângelo Moreira

2016-02-01

This work aimed to evaluate and correlate symptoms, biochemical blood test results and single nucleotide polymorphisms for lactose intolerance diagnosis. A cross-sectional study was conducted in Fortaleza, Ceará, Brazil, with a total of 119 patients, 54 of whom were lactose intolerant. Clinical evaluation and biochemical blood tests were conducted after lactose ingestion and blood samples were collected for genotyping evaluation. In particular, the single nucleotide polymorphisms C>T-13910 and G>A-22018 were analyzed by restriction fragment length polymorphism/polymerase chain reaction and validated by DNA sequencing. Lactose-intolerant patients presented with more symptoms of flatulence (81.4%), bloating (68.5%), borborygmus (59.3%) and diarrhea (46.3%) compared with non-lactose-intolerant patients (p<0.05). We observed a significant association between the presence of the alleles T-13910 and A-22018 and the lactose-tolerant phenotype (p<0.05). After evaluation of the biochemical blood test results for lactose, we found that the most effective cutoff for glucose levels obtained for lactose malabsorbers was <15 mg/dL, presenting an area under the receiver operating characteristic curve greater than 80.3%, with satisfactory values for sensitivity and specificity. These data corroborate the association of these single nucleotide polymorphisms (C>T-13910 and G>A-22018) with lactose tolerance in this population and suggest clinical management for patients with lactose intolerance that considers single nucleotide polymorphism detection and a change in the biochemical blood test cutoff from <25 mg/dL to <15 mg/dL.

The low FODMAP diet: recent advances in understanding its mechanisms and efficacy in IBS.

PubMed

Staudacher, Heidi M; Whelan, Kevin

2017-08-01

There is an intensifying interest in the interaction between diet and the functional GI symptoms experienced in IBS. Recent studies have used MRI to demonstrate that short-chain fermentable carbohydrates increase small intestinal water volume and colonic gas production that, in those with visceral hypersensitivity, induces functional GI symptoms. Dietary restriction of short-chain fermentable carbohydrates (the low fermentable oligosaccharide, disaccharide, monosaccharide and polyol (FODMAP) diet) is now increasingly used in the clinical setting. Initial research evaluating the efficacy of the low FODMAP diet was limited by retrospective study design and lack of comparator groups, but more recently well-designed clinical trials have been published. There are currently at least 10 randomised controlled trials or randomised comparative trials showing the low FODMAP diet leads to clinical response in 50%-80% of patients with IBS, in particular with improvements in bloating, flatulence, diarrhoea and global symptoms. However, in conjunction with the beneficial clinical impact, recent studies have also demonstrated that the low FODMAP diet leads to profound changes in the microbiota and metabolome, the duration and clinical relevance of which are as yet unknown. This review aims to present recent advances in the understanding of the mechanisms by which the low FODMAP diet impacts on symptoms in IBS, recent evidence for its efficacy, current findings regarding the consequences of the diet on the microbiome and recommendations for areas for future research. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Fermentation, degradation and microbial nitrogen partitioning for three forage colour phenotypes within anthocyanidin-accumulating Lc-alfalfa progeny.

PubMed

Jonker, Arjan; Gruber, Margaret Y; Wang, Yuxi; Narvaez, Nelmy; Coulman, Bruce; McKinnon, John J; Christensen, David A; Azarfar, Arash; Yu, Peiqiang

2012-08-30

Alfalfa has the disadvantage of having a rapid initial rate of protein degradation, which results in pasture bloat, low efficiency of protein utilisation and excessive nitrogen (N) pollution into the environment for cattle. Introducing a gene that stimulates the accumulation of monomeric/polymeric anthocyanidins might reduce the ruminal protein degradation rate (by fixing protein and/or direct interaction with microbes) and additionally reduce methane emission. The objectives of this study were to evaluate in vitro fermentation, degradation and microbial N partitioning of three forage colour phenotypes (green, light purple-green (LPG) and purple-green (PG)) within newly developed Lc-progeny and to compare them with those of parental green non-transgenic (NT) alfalfa. PG-Lc accumulated more anthocyanidin compared with Green-Lc (P < 0.05), with LPG-Lc intermediate. Volatile fatty acids and potentially degradable dry matter (DM) and N were similar among the four phenotypes. Gas, methane and ammonia accumulation rates were slower for the two purple-Lc phenotypes compared with NT-alfalfa (P < 0.05), while Green-Lc was intermediate. Effective degradable DM and N were lower in the three Lc-phenotypes (P < 0.05) compared with NT-alfalfa. Anthocyanidin concentration was negatively correlated (P < 0.05) with gas and methane production rates and effective degradability of DM and N. The Lc-alfalfa phenotypes accumulated anthocyanidin. Fermentation and degradation parameters indicated a reduced rate of fermentation and effective degradability for both purple anthocyanidin-accumulating Lc-alfalfa phenotypes compared with NT-alfalfa. Copyright © 2012 Society of Chemical Industry.

How Do Quality-of-Life and Gastrointestinal Symptoms Differ Between Post-cholecystectomy Patients and the Background Population?

PubMed

Wanjura, Viktor; Sandblom, Gabriel

2016-01-01

Previous studies have indicated a correlation between indication for cholecystectomy and long-term gastrointestinal quality-of-life (QoL). The aim of the present study was to compare QoL in a post-cholecystectomy cohort with the background population and with historical controls. A post-cholecystectomy study group (on average 4 years after cholecystectomy) was compared with a control group from the background population using the Gastrointestinal Quality-of-Life Index (GIQLI). EQ-5D scores were compared with expected scores derived from recent historical data. The post-cholecystectomy study group (N = 451) had better QoL measured by the EQ-5D compared with historical controls (p < 0.001), similar total GIQLI scores as the control group (N = 390), but scored worse on the GIQLI gastrointestinal symptoms subscale score (p < 0.001). The results include an item-by-item breakdown of the GIQLI questionnaire where the scores for diarrhea, bowel urgency, bloating, regurgitation, abdominal pain, flatus, fullness, nausea, uncontrolled stools, belching, heartburn, restricted eating, and bowel frequency were found to be significantly lower (i.e. worse) in the post-cholecystectomy cohort than in the control group. The opposite was true for relationships, endurance, sexual life, physical strength, feeling fit, not being frustrated by illness, and being able to carry out leisure activities, i.e. items related to general performance and well-being. In this study, QoL after cholecystectomy was good, but there was an increased prevalence of gastrointestinal symptoms compared to the background population.

Clinical significance of the glucose breath test in patients with inflammatory bowel disease.

PubMed

Lee, Ji Min; Lee, Kang-Moon; Chung, Yoon Yung; Lee, Yang Woon; Kim, Dae Bum; Sung, Hea Jung; Chung, Woo Chul; Paik, Chang-Nyol

2015-06-01

Small intestinal bacterial overgrowth which has recently been diagnosed with the glucose breath test is characterized by excessive colonic bacteria in the small bowel, and results in gastrointestinal symptoms that mimic symptoms of inflammatory bowel disease. This study aimed to estimate the positivity of the glucose breath test and investigate its clinical role in inflammatory bowel disease. Patients aged > 18 years with inflammatory bowel disease were enrolled. All patients completed symptom questionnaires. Fecal calprotectin level was measured to evaluate the disease activity. Thirty historical healthy controls were used to determine normal glucose breath test values. A total of 107 patients, 64 with ulcerative colitis and 43 with Crohn's disease, were included. Twenty-two patients (20.6%) were positive for the glucose breath test (30.2%, Crohn's disease; 14.1%, ulcerative colitis). Positive rate of the glucose breath test was significantly higher in patients with Crohn's disease than in healthy controls (30.2% vs 6.7%, P=0.014). Bloating, flatus, and satiety were higher in glucose breath test-positive patients than glucose breath test-negative patients (P=0.021, 0.014, and 0.049, respectively). The positivity was not correlated with the fecal calprotectin level. The positive rate of the glucose breath test was higher in patients with inflammatory bowel disease, especially Crohn's disease than in healthy controls; gastrointestinal symptoms of patients with inflammatory bowel disease were correlated with this positivity. Glucose breath test can be used to manage intestinal symptoms of patients with inflammatory bowel disease. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Gastrointestinal manifestations of Fabry disease: clinical response to enzyme replacement therapy.

PubMed

Banikazemi, Maryam; Ullman, Thomas; Desnick, Robert J

2005-08-01

Gastrointestinal symptoms are often an early and prominent manifestation of Fabry disease, an X-linked inborn error of metabolism caused by the deficient activity of the lysosomal enzyme, alpha-galactosidase A. This enzyme deficiency results in the progressive accumulation of globotriaosylceramide and other glycosphingolipids in tissue lysosomes throughout the body. In classically affected patients, glycosphingolipid accumulation in the vascular endothelium eventually culminates in life-threatening renal, cardiac, and cerebrovascular disease. In addition, over 50% of patients experience post-prandial abdominal pain and diarrhea that interferes with the ability to work and quality of life. Here, we describe four males aged 17-40 years with classic Fabry disease and severe gastrointestinal symptoms who participated in clinical trials of enzyme replacement therapy with agalsidase beta (Fabrazyme, 1 mg/kg every 2 weeks). Before therapy, the three adult patients experienced post-prandial abdominal pain, bloating, and severe diarrhea with 7-10 bowel movements per day every day and the 17-year-old had weekly episodes of diarrhea with six bowel movements per day. Other symptoms included vomiting, food intolerance, and poor weight gain. All patients took medications for these symptoms (diphenoxylate-atropine [Lomotil], ranitidine hydrochloride [Zantac], or sulfasalazine). After 6-7 months of agalsidase beta therapy, all patients reported "no or only occasional" abdominal pain or diarrhea, had discontinued their gastrointestinal medications, and had gained 3-8 kg. These marked improvements in gastrointestinal symptoms have persisted for over 3 years of treatment. In such patients, enzyme replacement at 1 mg/kg effects an early and significant clinical improvement in the gastrointestinal manifestations of Fabry disease.

Nausea as a sentinel symptom for cytotoxic chemotherapy effects on the gut-brain axis among women receiving treatment for recurrent ovarian cancer: an exploratory analysis.

PubMed

Donovan, Heidi S; Hagan, Teresa L; Campbell, Grace B; Boisen, Michelle M; Rosenblum, Leah M; Edwards, Robert P; Bovbjerg, Dana H; Horn, Charles C

2016-06-01

Nausea is a common and potentially serious effect of cytotoxic chemotherapy for recurrent ovarian cancer and may function as a sentinel symptom reflecting adverse effects on the gut-brain axis (GBA) more generally, but research is scant. As a first exploratory test of this GBA hypothesis, we compared women reporting nausea to women not reporting nausea with regard to the severity of other commonly reported symptoms in this patient population. A secondary analysis of data systematically collected from women in active chemotherapy treatment for recurrent ovarian cancer (n = 158) was conducted. The Symptom Representation Questionnaire (SRQ) provided severity ratings for 22 common symptoms related to cancer and chemotherapy. Independent sample t tests and regression analyses were used to compare women with and without nausea with regard to their experience of other symptoms. Nausea was reported by 89 (56.2 %) women. Symptoms that were significantly associated with nausea in bivariate and regression analyses included abdominal bloating, bowel disturbances, dizziness, depression, drowsiness, fatigue, headache, lack of appetite, memory problems, mood swings, shortness of breath, pain, sleep disturbance, urinary problems, vomiting, and weight loss. Symptoms that were not associated with nausea included hair loss, numbness and tingling, sexuality concerns, and weight gain. Nausea experienced during chemotherapy for recurrent ovarian cancer may be an indicator of broader effects on the gut-brain axis. A better understanding of the mechanisms underlying these effects could lead to the development of novel supportive therapies to increase the tolerability and effectiveness of cancer treatment.

Wild tobacco genomes reveal the evolution of nicotine biosynthesis.

PubMed

Xu, Shuqing; Brockmöller, Thomas; Navarro-Quezada, Aura; Kuhl, Heiner; Gase, Klaus; Ling, Zhihao; Zhou, Wenwu; Kreitzer, Christoph; Stanke, Mario; Tang, Haibao; Lyons, Eric; Pandey, Priyanka; Pandey, Shree P; Timmermann, Bernd; Gaquerel, Emmanuel; Baldwin, Ian T

2017-06-06

Nicotine, the signature alkaloid of Nicotiana species responsible for the addictive properties of human tobacco smoking, functions as a defensive neurotoxin against attacking herbivores. However, the evolution of the genetic features that contributed to the assembly of the nicotine biosynthetic pathway remains unknown. We sequenced and assembled genomes of two wild tobaccos, Nicotiana attenuata (2.5 Gb) and Nicotiana obtusifolia (1.5 Gb), two ecological models for investigating adaptive traits in nature. We show that after the Solanaceae whole-genome triplication event, a repertoire of rapidly expanding transposable elements (TEs) bloated these Nicotiana genomes, promoted expression divergences among duplicated genes, and contributed to the evolution of herbivory-induced signaling and defenses, including nicotine biosynthesis. The biosynthetic machinery that allows for nicotine synthesis in the roots evolved from the stepwise duplications of two ancient primary metabolic pathways: the polyamine and nicotinamide adenine dinucleotide (NAD) pathways. In contrast to the duplication of the polyamine pathway that is shared among several solanaceous genera producing polyamine-derived tropane alkaloids, we found that lineage-specific duplications within the NAD pathway and the evolution of root-specific expression of the duplicated Solanaceae-specific ethylene response factor that activates the expression of all nicotine biosynthetic genes resulted in the innovative and efficient production of nicotine in the genus Nicotiana Transcription factor binding motifs derived from TEs may have contributed to the coexpression of nicotine biosynthetic pathway genes and coordinated the metabolic flux. Together, these results provide evidence that TEs and gene duplications facilitated the emergence of a key metabolic innovation relevant to plant fitness.

More similarities than differences between men and women with irritable bowel syndrome.

PubMed

Björkman, I; Jakobsson Ung, E; Ringström, G; Törnblom, H; Simrén, M

2015-06-01

Differences regarding symptoms, coping abilities, and quality of life (QOL) between men and women with irritable bowel syndrome (IBS) have been reported but data are sparse and sometimes conflicting. The aim of present study was to investigate gender differences in gastrointestinal, extra-intestinal, and psychological symptoms, and sense of coherence (SOC) and QOL in a large group of patients diagnosed with IBS. We analyzed questionnaire data from 557 patients (152 men) diagnosed with IBS consecutively included in studies at an outpatient clinic for functional bowel disorders between 2002 and 2010. Following questionnaires were included: IBS severity scoring system (IBS-SSS), Hospital Anxiety and Depression Scale (HAD), IBSQOL Scale, Visceral Sensitivity Index (VSI), SOC Scale, Bristol Stool Form Scale (BSFS), and Patient Health Questionnaire (PHQ-15). Women had harder stools (FDR-adjusted p-value: q = 0.033), more severe bloating (q = 0.020), higher symptom severity (q = 0.042), higher total somatic symptom burden (q = 0.035), lower SOC (q = 0.042), and lower QOL. Women rated more general anxiety (q = 0.017) and gastrointestinal-specific anxiety (q = 0.042), but there were no group differences in depression, pain, stool frequency, impact on daily life, dissatisfaction with bowel habit, or extra-colonic symptoms. The differences found were small (effect sizes: r < 0.3). In this study, we demonstrated more similarities than differences between men and women with IBS. The largest difference were seen for QOL which might reflect certain structural stressors to which women in general are more exposed than men. © 2015 John Wiley & Sons Ltd.

Identifying symptoms of ovarian cancer: a qualitative and quantitative study.

PubMed

Bankhead, C R; Collins, C; Stokes-Lampard, H; Rose, P; Wilson, S; Clements, A; Mant, D; Kehoe, S T; Austoker, J

2008-07-01

Symptoms of ovarian cancer are often vague and consequently a high proportion of women with ovarian cancer are not referred to the appropriate clinic. To identify diagnostic factors for ovarian cancer. A qualitative and quantitative study. Four UK hospitals. One hundred and twenty-four women referred to hospital with suspected ovarian malignancy. Women were interviewed prior to diagnosis (n = 63), or soon after. A thematic analysis was conducted. Emergent symptoms were quantitatively analysed to identify distinguishing features of ovarian cancer. Symptoms in women with and without ovarian cancer. Diagnoses comprised 44 malignancies, 59 benign gynaecological pathologies and 21 normal findings. Of the malignancies, 25 women had stage III or more disease, with an average age of 59 years. The benign/normal cohort was significantly younger (48 years). Multivariate analysis revealed persistent abdominal distension (OR 5.2, 95% CI 1.3-20.5), postmenopausal bleeding (OR 9.2, 95% CI 1.1-76.1), appetite loss (OR 3.2, 95% CI 1.1-9.2), early satiety (OR 5.0, 95% CI 1.6-15.7) and progressive symptoms (OR 3.6, 95% CI 1.3-9.8) as independent, statistically significant variables associated with ovarian cancer. Fluctuating distension was not associated with ovarian cancer (OR 0.4, 95% CI 0-4.1). Women frequently used the term bloating, but this represented two distinct events: persistent abdominal distension and fluctuating distension/discomfort. Ovarian cancer is not a silent killer. Clinicians should distinguish between persistent and fluctuating distension. Recognition of the significance of symptoms described by women could lead to earlier and more appropriate referral.

Small intestinal bacterial overgrowth syndrome

PubMed Central

Bures, Jan; Cyrany, Jiri; Kohoutova, Darina; Förstl, Miroslav; Rejchrt, Stanislav; Kvetina, Jaroslav; Vorisek, Viktor; Kopacova, Marcela

2010-01-01

Human intestinal microbiota create a complex polymicrobial ecology. This is characterised by its high population density, wide diversity and complexity of interaction. Any dysbalance of this complex intestinal microbiome, both qualitative and quantitative, might have serious health consequence for a macro-organism, including small intestinal bacterial overgrowth syndrome (SIBO). SIBO is defined as an increase in the number and/or alteration in the type of bacteria in the upper gastrointestinal tract. There are several endogenous defence mechanisms for preventing bacterial overgrowth: gastric acid secretion, intestinal motility, intact ileo-caecal valve, immunoglobulins within intestinal secretion and bacteriostatic properties of pancreatic and biliary secretion. Aetiology of SIBO is usually complex, associated with disorders of protective antibacterial mechanisms (e.g. achlorhydria, pancreatic exocrine insufficiency, immunodeficiency syndromes), anatomical abnormalities (e.g. small intestinal obstruction, diverticula, fistulae, surgical blind loop, previous ileo-caecal resections) and/or motility disorders (e.g. scleroderma, autonomic neuropathy in diabetes mellitus, post-radiation enteropathy, small intestinal pseudo-obstruction). In some patients more than one factor may be involved. Symptoms related to SIBO are bloating, diarrhoea, malabsorption, weight loss and malnutrition. The gold standard for diagnosing SIBO is still microbial investigation of jejunal aspirates. Non-invasive hydrogen and methane breath tests are most commonly used for the diagnosis of SIBO using glucose or lactulose. Therapy for SIBO must be complex, addressing all causes, symptoms and complications, and fully individualised. It should include treatment of the underlying disease, nutritional support and cyclical gastro-intestinal selective antibiotics. Prognosis is usually serious, determined mostly by the underlying disease that led to SIBO. PMID:20572300

A prospective, randomized, double-blind, placebo-controlled parallel-group dual site trial to evaluate the effects of a Bacillus coagulans-based product on functional intestinal gas symptoms.

PubMed

Kalman, Douglas S; Schwartz, Howard I; Alvarez, Patricia; Feldman, Samantha; Pezzullo, John C; Krieger, Diane R

2009-11-18

This randomized double blind placebo controlled dual site clinical trial compared a probiotic dietary supplement to placebo regarding effects on gastrointestinal symptoms in adults with post-prandial intestinal gas-related symptoms (abdominal pain, distention, flatulence) but no gastrointestinal (GI) diagnoses to explain the symptoms. Sixty-one adults were enrolled (age 36.5 +/- 12.6 years; height 165.1 +/- 9.2 cm; weight 75.4 +/- 17.3 kg) and randomized to either Digestive Advantage Gas Defense Formula - (GanedenBC30 Bacillus coagulans GBI-30, 6086): n = 30; or Placebo: n = 31. Study subjects were evaluated every two weeks over a four-week period using validated questionnaires and standard biochemical safety testing. Outcome criteria of interest included change from baseline in Gastrointestinal Symptom Rating Scale (GSRS) abdominal pain, abdominal distention, flatus, and the Severity of Dyspepsia Assessment (SODA) bloating and gas subscores over four weeks of product use. Measured against the placebo, subjects in the probiotic group achieved significant improvements in GSRS abdominal pain subscore (p = 0.046) and the GSRS total score (p = 0.048), with a strong trend for improvement on the GSRS abdominal distension subscore (p = 0.061). A strong placebo effect was evident which could explain the lack of statistical significant differences between the groups for many of the efficacy variables. In conclusion, the Bacillus coagulans-based product was effective in improving the quality of life and reducing gastrointestinal symptoms in adults with post prandial intestinal gas-related symptoms and no GI diagnoses. ClinicalTrials.gov Identifier: NCT00881322.

Liquid nitrogen ingestion leading to massive pneumoperitoneum without identifiable gastrointestinal perforation.

PubMed

Walsh, Mike J; Tharratt, Steven R; Offerman, Steven R

2010-06-01

Liquid nitrogen (LN) ingestion is unusual, but may be encountered by poison centers, emergency physicians, and general surgeons. Unique properties of LN produce a characteristic pattern of injury. A 19-year-old male college student presented to the Emergency Department complaining of abdominal pain and "bloating" after drinking LN. His presentation vital signs were remarkable only for mild tachypnea and tachycardia. On physical examination, he had mild respiratory difficulty due to abdominal distention. His abdomen was tense and distended. Abdominal X-ray studies revealed a massive pneumoperitoneum. At laparotomy, he was found to have a large amount of peritoneal gas. No perforation was identified. After surgery, the patient made an uneventful recovery and was discharged 5 days later. At 2-week clinic follow-up, he was doing well without complications. Nitrogen is a colorless, odorless gas at room temperature. Due to its low boiling point (-195 degrees C), LN rapidly evaporates when in contact with body surface temperatures. Therefore, ingested LN causes damage by two mechanisms: rapid freezing injury upon mucosal contact and rapid volume expansion as nitrogen gas is formed. Patients who ingest LN may develop gastrointestinal perforation and massive pneumoperitoneum. Because rapid gas formation may allow large volumes to escape from tiny perforations, the exact site of perforation may never be identified. In cases of LN ingestion, mucosal injury and rapid gas formation can cause massive pneumoperitoneum. Although laparotomy is recommended for all patients with signs of perforation, the site of injury may never be identified. Copyright 2010 Elsevier Inc. All rights reserved.

Correlation between postpartum depression and premenstrual dysphoric disorder: Single center study.

PubMed

Lee, Young-Jae; Yi, Sang-Wook; Ju, Da-Hye; Lee, Sang-Soo; Sohn, Woo-Seok; Kim, In-Ju

2015-09-01

To describe the prevalence and correlates of the postpartum depression and premenstrual dysphoric disorder. One hundred sixty six women were assessed around 10th to 14th days after delivery in Gangneung Asan Hospital, Korea, from September 2011 to March 2012. We checked their risk factors for postpartum depressive disorders using the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale. Premenstrual dysphoric disorder was evaluated retrospectively and was defined as having more than 5 of the following 10 symptoms: breast tenderness, bloating, headache, peripheral edema (hand and foot), depressive symptoms, anger, irritability, anxiety, oversensitivity, and exaggerated mood swings. The prevalence rate of postpartum depression using the Edinburgh Postnatal Depression Scale ≥10 and Beck Depression Inventory ≥10 was 13.9% (23/166). We found statistical differences (P<0.01) between the postpartum depression group and the postpartum non-depression group in smoking history, past history of psychiatric problems, and level of marital satisfaction. The prevalence rate of premenstrual syndrome (PMS) was 9% (15/166) and among 23 women in the postpartum depression group, eight were determined to have premenstrual dysphoric disorder, yielding a prevalence rate of 34.8% (8/23). Among 143 women in the postpartum non-depression group, seven were determined to have PMS, yielding a prevalence rate of 4.9% (7/143). A correlation between postpartum depression and PMS was thus found (P<0.01). PMS appears to be associated with postpartum depression. This means that a hormone-related etiology appears to be one risk factor for postpartum depression.

Correlation between postpartum depression and premenstrual dysphoric disorder: Single center study

PubMed Central

Lee, Young-Jae; Yi, Sang-Wook; Lee, Sang-Soo; Sohn, Woo-Seok; Kim, In-Ju

2015-01-01

Objective To describe the prevalence and correlates of the postpartum depression and premenstrual dysphoric disorder. Methods One hundred sixty six women were assessed around 10th to 14th days after delivery in Gangneung Asan Hospital, Korea, from September 2011 to March 2012. We checked their risk factors for postpartum depressive disorders using the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale. Premenstrual dysphoric disorder was evaluated retrospectively and was defined as having more than 5 of the following 10 symptoms: breast tenderness, bloating, headache, peripheral edema (hand and foot), depressive symptoms, anger, irritability, anxiety, oversensitivity, and exaggerated mood swings. Results The prevalence rate of postpartum depression using the Edinburgh Postnatal Depression Scale ≥10 and Beck Depression Inventory ≥10 was 13.9% (23/166). We found statistical differences (P<0.01) between the postpartum depression group and the postpartum non-depression group in smoking history, past history of psychiatric problems, and level of marital satisfaction. The prevalence rate of premenstrual syndrome (PMS) was 9% (15/166) and among 23 women in the postpartum depression group, eight were determined to have premenstrual dysphoric disorder, yielding a prevalence rate of 34.8% (8/23). Among 143 women in the postpartum non-depression group, seven were determined to have PMS, yielding a prevalence rate of 4.9% (7/143). A correlation between postpartum depression and PMS was thus found (P<0.01). Conclusion PMS appears to be associated with postpartum depression. This means that a hormone-related etiology appears to be one risk factor for postpartum depression. PMID:26430659

Role of alimentation in irritable bowel syndrome.

PubMed

Dapoigny, M; Stockbrügger, R W; Azpiroz, F; Collins, S; Coremans, G; Müller-Lissner, S; Oberndorff, A; Pace, F; Smout, A; Vatn, M; Whorwell, P

2003-01-01

Different food items are made responsible for irritable bowel syndrome (IBS) symptoms, but the physiopathology of IBS remains unclear. During a meeting in Nice, France, experts of the European Working Team of the IBiS Club discussed selected data regarding the relationships between alimentation, food items (including fibers) and IBS symptoms. Food allergy remains a difficult diagnosis, but medical and general history, presence of general symptoms such as skin rash, and hypersensitivity tests may help in achieving a positive diagnosis. On the other hand, food intolerance is more confusing because of the subjectivity of the relationship between ingestion of certain foods and the appearance of clinical symptoms. Different food items which are commonly implicated in adverse reactions mimicking IBS were found to be stimulants for the gut, suggesting that patients with predominant diarrhea IBS have to be carefully questioned about consumption of different kinds of food (i.e., coffee, alcohol, chewing gum, soft drinks) and not only on lactose ingestion. Gas production is discussed on the basis of retention of intestinal gas as well as on malabsorption of fermentable substrates. The role of a large amount of this kind of substrate reaching the colon is suggested as a potential mechanism of IBS-type symptoms in overeating patients. Regarding the role of fiber in IBS, the expert group concluded that fibers are not inert substances and that they could trigger pain or bloating in some IBS patients. Despite numerous reviews on this subject, it is very difficult to give general dietary advice to IBS patients, but dieteticians may have a positive role in managing such patients. Copyright 2003 S. Karger AG, Basel