Investigation of the effect of military stress on the prevalence of functional bowel disorders

AIM: To investigate the morbidity of functional bowel disorders (FBD) under military stress conditions in order to lay foundations for the prevention and treatment of this disease. METHODS: Four hundred and fifty-seven soldiers who were assigned to specified services and 471 soldiers who were assigned to routine services were enrolled using cluster sampling, with the latter as a control group. They were surveyed using the Rome Ⅲ FBD standard questionnaire. The FBD symptom question-naire included FBD-related symptoms, severity, dura- tion or attack time, and accompanying symptoms. RESULTS: The morbidity of the military stress group (14.6%) was significantly higher than in the control group (9.98%) ( 2 = 4.585, P < 0.05). The incidence of smoking, abdominal pain and acid regurgitation ( 2 = 4.761, P < 0.05) as well as the ZUNG anxiety/depression scores ( 2 = 7.982, P < 0.01) were also sig- nificantly higher in the military stress group compared with the control group. ZUNG anxiety ( 2 = 11.523, P < 0.01) and depression ( 2 = 5.149, P < 0.05) scores were higher in the FBD group compared with the non-FBD group. The differences in the ZUNG self-rated anxiety and depression scales between the 2 groups were statistically significant ( 2 = 14.482, P < 0.01 and 2 = 6.176, P < 0.05). CONCLUSION: The morbidity of FBD was higher under military stress conditions.

Differential diagnosis between functional and organic intestinal disorders:Is there a role for non-invasive tests?

Abdominal pain and bowel habits alterations are common symptoms in the general population. The investigation to differentiate organic from functional bowel disorders represents a considerable burden both for patients and public health service. The selection of patients who should undergo endoscopic and/or radiological procedures is one of the key points of the diagnostic process, which should avoid the abuse of invasive and expensive tests as well as the underestimation of potentially harmful diseases. Over the cominci years,dinidans and researchers will be challenged to develop strategies to increase the patient＇s compliance and to reduce the economic and social costs of the intestinal diseases.

Patients with functional bowel disorder have disaccharidase deficiency:A single-center study from Russia

BACKGROUND Functional bowel disorder(FBD)may be caused by a decrease in disaccharidase activity.Thus,the timely diagnosis of disaccharidase deficiency could lead to a better prognosis in patients with this condition.AIM To determine the potential value of intestinal disaccharidases glucoamylase,maltase,sucrase,and lactase in understanding the etiology and pathogenesis of FBD.METHODS A total of 82 FBD patients were examined.According to the Rome IV criteria(2016),23 patients had diarrhea-predominant irritable bowel syndrome(IBS),33 had functional diarrhea,10 had constipation-predominant IBS,4 had functional constipation,and 12 had mixed IBS.The Dahlqvist method was used to measure disaccharidase activity in the brush-border membrane of mature enterocytes of the small intestine,in duodenal biopsies obtained during esophagogastroduodenoscopy.RESULTS Lactase deficiency was detected in 86.5%of patients,maltase deficiency in 48.7%,sucrase deficiency in 50%,and glucoamylase deficiency in 84.1%.The activities of all enzymes were reduced in 31.7%of patients,and carbohydrase deficiency was detected in 63.5%of patients.The low activity of enzymes involved in membrane digestion in the small intestine was found in 95.2%of patients.CONCLUSION In 78 of the 82 patients with FBD,gastrointestinal symptoms were associated with disaccharidase deficiency.

Electrogastrography: Poor correlation with antro-duodenal manometry and doubtful clinical usefulness in adults

AIM: To investigate if there is a correlation between electrical activity measured by electrogastrography (EGG) and contractile activity of the stomach as measured by antroduodenal manometry (ADM). We also studied whether the underlying motility disorder could be predicted from EGG parameters. METHODS: We compared 21 parameters measured from EGG with 8 parameters measured from ADM. The ability of EGG to identify the underlying diagnosis was tested by comparing EGG parameters for each diagnosis group against other patients. The study comprised recordings from 148 patients and 125 females. Their median age was 45 (range 17-76) years. RESULTS: We found few and weak correlations between EGG and ADM. Specifically the correlation between parameters reflecting the response to meal was poor (r = -0.07, P = 0.39). The discriminatory power of EGG for underlying motility disorder was also low. Patients with slow transit constipation (STC) showed a lower postprandial power in normogastric (3.7 ± 0.5 vs 4.0 ± 0.5) and tachygastric (3.5 ± 0.4 vs 3.7 ± 0.4) regions, a lower percentage of time with normogastria [87.2 (56.5-100)% vs 95.7 (0-100)%], and a higher percentage of time with tachygastria [9.3 (0-33)% vs 3.5 (0-100)%] and bradygastria [1.8 (0-20)% vs 0 (0-17.1)%]. Patients with irritable bowel syndrome had a higher percentage of time with normogastria [96.5 (62.5-100)% vs 93.3 (0-100)%] and a less unstable dominant frequency as measured by the instability coefficient [15 (3-77) vs 24 (2-72)]. CONCLUSION: EGG and ADM seem to measure different aspects of gastric motor activity but cannot show a spatial correlation. The diagnostic value of EGG is poor, but EGG may have some value for the identification of patients with STC.

Hypnosis and upper digestive function and disease

Hypnosis is a therapeutic technique that primarily involves attentive receptive concentration. Even though a small number of health professionals are trained in hypnosis and lingering myths and misconceptions associated with this method have hampered its widespread use to treat medical conditions hypnotherapy has gained relevance as an effective treatment for irritable bowel syndrome not responsive to standard care. More recently, a few studies have addressed the potential infl uence of hypnosis on uppe digestive function and disease. This paper reviews the efficacy of hypnosis in the modulation of uppe digestive motor and secretory function. The presen evidence of the effectiveness of hypnotherapy as a treatment for functional and organic diseases o the upper bowel is also summarized, coupled with a discussion of potential mechanisms of its therapeutic action.

Holistic Acupuncture approach to idiopathic refractory nausea,abdominal pain and bloating

AIM： To evaluate the effectiveness of a holistic acupuncture approach on nausea, pain, bloating and electrogastrogram （EGG） parameters in patients with intractable symptoms.METHODS： Twelve patients with no or mild nausea （those without nausea had bloating or pain） and 10 with a histool of moderate to severe nausea were referred for acupuncture. All underwent an EGG and were treated at acupuncture points PC6, SP4 and DU20. Visual analog scales （VAS） assessing severity of nausea, pain and bloating were obtained before and after acupuncture treatment. Nineteen patients received three and three patients received two treatments.RESULTS： VAS scores for nausea reflected the clinical assessment and differed significantly between mild and moderate/severe nausea groups. Acupuncture significantly improved severity of nausea in both groups with improved pre-treatment nausea between the first and third treatments in the moderate/severe nausea group. Pain scores improved with acupuncture in the mild nausea group only and bloating improved only with the first treatment in this group. Patients with bloating with VAS scores greater than 35 pre-treatment improved with acupuncture and over all VAS scores for pain improved with treatment. Acupuncture increased the power in the 2.7 to 3.5 cpm range in the EGG.CONCLUSION： In this uncontrolled clinical study, a holistic acupuncture approach significantly improved nausea in patients with refractory symptoms and increased the power in the 2,7-3,5 cpm component of the electrogastrogram, Bloating and pain VAS scores improved acutely with treatment, This study suggests that acupuncture may be effective in this refractory group of patients and further study using appropriate controls is warranted,