Functional gastrointestinal disorders in inflammatory bowel disease: Time for a paradigm shift?

Recent advances in biological therapies have revolutionalised and redefined treatment targets in inflammatory bowel disease(IBD).There is now a stronger emphasis on achieving the more stringent therapeutic goals of mucosal and histological healing,rather than clinical remission alone.Consequently,the treatment of refractory“functional”gastrointestinal symptoms,often attributed as the aftermath of previous inflammation,has recently become more prominent in quiescent disease.With further expected advances in anti-inflammatory treatments on the horizon,the burden of such symptoms in quiescent disease,which have been relatively neglected,is set to become an even bigger problem.In this article,we highlight the current state of research and understanding in this field,including recent developments and clinical practice guidelines on the diagnosis and management of functional gastrointestinal symptoms,such as irritable bowel syndrome and functional anorectal and pelvic floor disorders,in patients with quiescent IBD.These disorders are not only highly prevalent in these patients,they are often misdiagnosed,and are difficult to treat,with very few evidence-based therapies.Moreover,they are associated with substantial impairment in quality-of-life,considerable morbidity,and psychological distress.There is therefore an urgent need for a change in emphasis towards earlier recognition,positive diagnosis,and targeted treatment for patients with ongoing functional gastrointestinal symptoms in the absence of active IBD.This article also highlights the need for further research to develop much needed evidence-based therapies.

Non-pharmacological management of pediatric functional abdominal pain disorders:Current evidence and future perspectives

Functional abdominal pain disorders(FAPDs) are an important and prevalent cause of functional gastrointestinal disorders among children, encompassing the diagnoses of functional dyspepsia, irritable bowel syndrome, abdominal migraine, and the one not previously present in Rome Ⅲ, functional abdominal pain not otherwise specified. In the absence of sufficiently effective and safe pharmacological treatments for this public problem, non-pharmacological therapies emerge as a viable means of treating these patients, avoiding not only possible side effects, but also unnecessary prescription, since many of the pharmacological treatments prescribed do not have good efficacy when compared to placebo. Thus, the present study provides a review of current and relevant evidence on non-pharmacological management of FAPDs, covering the most commonly indicated treatments, from cognitive behavioral therapy to meditation, acupuncture, yoga, massage, spinal manipulation, moxibustion, and physical activities. In addition, this article also analyzes the quality of publications in the area, assessing whether it is possible to state if non-pharmacological therapies are viable, safe, and sufficiently well-based for an appropriate and effective prescription of these treatments. Finally, it is possible to observe an increase not only in the number of publications on the non-pharmacological treatments for FAPDs in recent years, but also an increase in the quality of these publications. Finally, the sample selection of satisfactory age groups in these studies enables the formulation of specific guidelines for this age group, thus avoiding the need for adaptation of prescriptions initially made for adults, but for children use.

Prevalence of functional gastrointestinal disorders in children with celiac disease on different types of gluten-free diets

BACKGROUND Functional gastrointestinal disorders(FGIDs)are common during the pediatric age.FGIDs are not related to biochemical or structural abnormalities.However,since they have a high prevalence,several studies have evaluated an overlap between FGIDs and organic diseases.Individuals with celiac disease(CD)have been shown to be at an increased risk for functional abdominal pain,even if they adhere well to a gluten-free diet(GFD).Little information is available for the pediatric age group.The aims of our study were to evaluate the prevalence of FGIDS in CD children 1 year after diagnosis and to compare the prevalence of FGIDs in CD children on a GFD with processed foods compared with those on a GFD with natural products.AIM To assess the prevalence of FGIDs in children with CD after 1 year of follow-up and to compare the prevalence of FGIDs in children with CD on a GFD with processed foods and in children on a GFD with natural products.METHODS We recruited pediatric patients aged 1-18 years with a new CD diagnosis.Participants were randomized to two groups:Group A on a GFD with processed foods(diet 1);and group B on a GFD with natural products(diet 2).Clinical monitoring,diet assessment and the questionnaire on pediatric gastrointestinal symptoms-Rome IV version were performed at diagnosis(T0)and after 12 mo of follow-up(T1).Dietary intake was assessed using a 3-d food diary record.Data from the diaries were evaluated using WinFood nutrient analysis software.We assessed the prevalence of FGIDs at T1 and the correlation with the type of GFD.RESULTS We registered 104 CD children,with 55 patients in group A(53.0%)and 49 patients in group B(47.0%).Initially,30 of the 55(54.5%)CD children were symptomatic in group A,while 25 of 49(51.0%)were symptomatic in group B.At T1,in spite of a low or negative serology for CD,FGIDs prevalence was 10/55(18.0%)in group A and 8/49(16.3%)in group B,with no statistically significant difference between the two groups(P=0.780).At T1 the macro-and micronutrient intake was similar across the two groups with no significant differences in nutrient analysis.However,in both groups at T1 we found that a lower prevalence of FGIDs(P=0.055)was associated with an inferior caloric(odds ratio=0.99,95%confidence interval:0.99-1.00)and fat(odds ratio=0.33,95%confidence interval:0.65-0.95)intake.CONCLUSION Our results showed that CD children on a GFD have gastrointestinal symptoms with an elevated prevalence of FGIDs.Our study suggests that developing FGIDs may be linked to caloric intake and percentage of food fat,but it does not change between a GFD with processed foods or a GFD with natural products.However,long-term monitoring is required to evaluate a correlation between FGIDs and various types of GFDs.

Role of a wireless surface electromyography in dystonic gait in functional movement disorders: A case report

BACKGROUND Dystonic gait(DG) is one of clinical symptoms associated with functional dystonia in the functional movement disorders(FMDs). Dystonia is often initiated or worsened by voluntary action and associated with overflow muscle activation. There is no report for DG in FMDs caused by an abnormal pattern in the ankle muscle recruitment strategy during gait.CASE SUMMARY A 52-year-old male patient presented with persistent limping gait. When we requested him to do dorsiflexion and plantar flexion of his ankle in the standing and seating positions, we didn’t see any abnormality. However, we could see the DG during the gait. There were no evidences of common peroneal neuropathy and L5 radiculopathy in the electrodiagnostic study. Magnetic resonance imaging of the lumbar spine, lower leg, and brain had no definite finding. No specific finding was seen in the neurologic examination. For further evaluation, a wireless surface electromyography(EMG) was performed. During the gait, EMG amplitude of left medial and lateral gastrocnemius(GCM) muscles was larger than right medial and lateral GCM muscles. When we analyzed EMG signals for each muscle, there were EMG bursts of double-contraction in the left medial and lateral GCM muscles, while EMG analysis of right medial and lateral GCM muscles noted regular bursts of single contraction. We could find a cause of DG in FMDs.CONCLUSION We report an importance of a wireless surface EMG, in which other examination didn’t reveal the cause of DG in FMDs.

Functional gastrointestinal disorders,mental health,genetic susceptibility,and incident chronic kidney disease

Background:Whether functional gastrointestinal disorders(FGIDs)are associated with the long-term risk of chronic kidney disease(CKD)remains unclear.We aimed to investigate the prospective association of FGIDs with CKD and examine whether mental health mediated the association.Methods:About 416,258 participants without a prior CKD diagnosis enrolled in the UK Biobank between 2006 and 2010 were included.Participants with FGIDs(including irritable bowel syndrome[IBS],dyspepsia,and other functional intestinal disorders[FIDs;mainly composed of constipation])were the exposure group,and non-FGID participants were the non-exposure group.The primary outcome was incident CKD,ascertained from hospital admission and death registry records.A Cox proportional hazard regression model was used to investigate the association between FGIDs and CKD,and the mediation analysis was performed to investigate the mediation proportions of mental health.Results:At baseline,33,156(8.0%)participants were diagnosed with FGIDs,including 21,060(5.1%),8262(2.0%),and 6437(1.6%)cases of IBS,dyspepsia,and other FIDs,respectively.During a mean follow-up period of 12.1 years,11,001(2.6%)participants developed CKD.FGIDs were significantly associated with a higher risk of incident CKD compared to the absence of FGIDs(hazard ratio[HR],1.36;95%confidence interval[CI],1.28-1.44).Similar results were observed for IBS(HR,1.27;95%CI,1.17-1.38),dyspepsia(HR,1.30;95%CI,1.17-1.44),and other FIDs(HR,1.60;95%CI,1.43-1.79).Mediation analyses suggested that the mental health score significantly mediated 9.05%of the association of FGIDs with incident CKD and 5.63-13.97%of the associations of FGID subtypes with CKD.Specifically,the positive associations of FGIDs and FGID subtypes with CKD were more pronounced in participants with a high genetic risk of CKD.Conclusion:Participants with FGIDs had a higher risk of incident CKD,which was partly explained by mental health scores and was more pronounced in those with high genetic susceptibility to CKD.

Fecal calprotectin in pediatric gastrointestinal diseases:Pros and cons

BACKGROUND Fecal calprotectin is a valuable biomarker for assessing intestinal inflammation in pediatric gastrointestinal diseases.However,its role,pros,and cons in various conditions must be comprehensively elucidated.AIM To explore the role of fecal calprotectin in pediatric gastrointestinal diseases,including its advantages and limitations.METHODS A comprehensive search was conducted on PubMed,PubMed Central,Google Scholar,and other scientific research engines until February 24,2024.The review included 88 research articles,56 review articles,six metaanalyses,two systematic reviews,two consensus papers,and two letters to the editors.RESULTS Fecal calprotectin is a non-invasive marker for detecting intestinal inflammation and monitoring disease activity in pediatric conditions such as functional gastrointestinal disorders,inflammatory bowel disease,coeliac disease,coronavirus disease 2019-induced gastrointestinal disorders,gastroenteritis,and cystic fibrosis-associated intestinal pathology.However,its lack of specificity and susceptibility to various confounding factors pose challenges in interpretation.Despite these limitations,fecal calprotectin offers significant advantages in diagnosing,monitoring,and managing pediatric gastrointestinal diseases.CONCLUSION Fecal calprotectin holds promise as a valuable tool in pediatric gastroenterology,offering insights into disease activity,treatment response,and prognosis.Standardized protocols and guidelines are needed to optimize its clinical utility and mitigate interpretation challenges.Further research is warranted to address the identified limitations and enhance our understanding of fecal calprotectin in pediatric gastrointestinal 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.

Connectivity differences between adult male and female patients with attention deficit hyperactivity disorder according to resting-state functional MRI

Attention deficit hyperactivity disorder（ADHD） is a pervasive psychiatric disorder that affects both children and adults. Adult male and female patients with ADHD are differentially affected, but few studies have explored the differences. The purpose of this study was to quantify differences between adult male and female patients with ADHD based on neuroimaging and connectivity analysis. Resting-state functional magnetic resonance imaging scans were obtained and preprocessed in 82 patients. Group-wise differences between male and female patients were quantified using degree centrality for different brain regions. The medial-, middle-, and inferior-frontal gyrus, superior parietal lobule, precuneus, supramarginal gyrus, superior- and middle-temporal gyrus, middle occipital gyrus, and cuneus were identified as regions with significant group-wise differences. The identified regions were correlated with clinical scores reflecting depression and anxiety and significant correlations were found. Adult ADHD patients exhibit different levels of depression and anxiety depending on sex, and our study provides insight into how changes in brain circuitry might differentially impact male and female ADHD patients.

Cow’s milk-induced gastrointestinal disorders:From infancy to adulthood

Milk is related to many gastrointestinal disorders from the cradle to the grave due to the many milk ingredients that can trigger gastrointestinal discomfort and disorders.Cow’s milk protein allergy(CMPA)is the most common food allergy,especially in infancy and childhood,which may persist into adulthood.There are three main types of CMPA;immunoglobulin E(IgE)-mediated CMPA,non-IgEmediated CMPA,and mixed type.CMPA appears before the first birthday in almost all cases.Symptoms may start even during the neonatal period and can be severe enough to simulate neonatal sepsis.CMPA(often non-IgE mediated)can present with symptoms of gastroesophageal reflux,eosinophilic esophagitis,hemorrhagic gastritis,food protein-induced protein-losing enteropathy,and food protein-induced enterocolitis syndrome.Most CMPAs are benign and outgrown during childhood.CMPA is not as common in adults as in children,but when present,it is usually severe with a protracted course.Lactose intolerance is a prevalent condition characterized by the development of many symptoms related to the consumption of foods containing lactose.Lactose intolerance has four typical types:Developmental,congenital,primary,and secondary.Lactose intolerance and CMPA may be the underlying pathophysiologic mechanisms for many functional gastrointestinal disorders in children and adults.They are also common in inflammatory bowel diseases.Milk consumption may have preventive or promoter effects on cancer development.Milk may also become a source of microbial infection in humans,causing a wide array of diseases,and may help increase the prevalence of antimicrobial resistance.This editorial summarizes the common milk-related disorders and their symptoms from childhood to adulthood.

Age-related connectivity differences between attention deficit and hyperactivity disorder patients and typically developing subjects：a resting-state functional MRI study

Attention deficit and hyperactivity disorder（ADHD） is a disorder characterized by behavioral symptoms including hyperactivity/impulsivity among children,adolescents,and adults.These ADHD related symptoms are influenced by the complex interaction of brain networks which were under explored.We explored age-related brain network differences between ADHD patients and typically developing（TD） subjects using resting state f MRI（rs-f MRI） for three age groups of children,adolescents,and adults.We collected rs-f MRI data from 184 individuals（27 ADHD children and 31 TD children;32 ADHD adolescents and 32 TD adolescents;and 31 ADHD adults and 31 TD adults）.The Brainnetome Atlas was used to define nodes in the network analysis.We compared three age groups of ADHD and TD subjects to identify the distinct regions that could explain age-related brain network differences based on degree centrality,a well-known measure of nodal centrality.The left middle temporal gyrus showed significant interaction effects between disease status（i.e.,ADHD or TD） and age（i.e.,child,adolescent,or adult）（P 0.001）.Additional regions were identified at a relaxed threshold（P 0.05）.Many of the identified regions（the left inferior frontal gyrus,the left middle temporal gyrus,and the left insular gyrus） were related to cognitive function.The results of our study suggest that aberrant development in cognitive brain regions might be associated with age-related brain network changes in ADHD patients.These findings contribute to better understand how brain function influences the symptoms of ADHD.

Effectiveness of Electro-acupuncture Combined with Biofeedback in Patients with Functional Defecation Disorder:A Meta-analysis

Objective:To systematically evaluate and compare the effects of electro-acupuncture combined with biofeedback training and simple biofeedback training on the intervention of patients with functional defecation disorder.Methods:Computer retrieval was performed to search randomized controlled trials about electroacupuncture combined with biofeedback training in the treatment of patients with functional defecation disoder from January 2000 to January 2019 via websites,including CNKI,Wanfang data knowledge service platform,CBM,VIP,Pub Med,EMBase,Cochrane Library,Web of Science,and Springerlink,JBI evidence-based Nursing database,RNAO,Nursing Consult,BIOSIS,Medline and so on.Screening was performed according to the inclusion and exclusion criteria,data were extracted,literature quality was evaluated,and Meta analysis was performed on the extracted data using Rev Man5.3 software.Results:Five studies including 363 subjects were included.The results of meta-analysis showed that the effective rate of electroacupuncture combined with biofeedback group(combined group)in the treatment of functional defecation disorder was higher than that of biofeedback group(control group)[RR=1.29,95%CI(1.17,1.42),P<0.00001],the difficulty score of defecation in combined group was lower than that of control group[MD=–0.71,95%CI(–1.22,–0.21),P=0.006],and anal rest pressure was lower than that of control group[MD=–0.44,95%CI(-0.80,–0.09),P=0.02].Tubing maximum systolic pressure is lower than the control group[MD=–2.06,95%CI(–3.60,–0.52),P=0.009).Conclusion:Acupuncture combined with biofeedback can effectively improve the defecation difficulty of patients with functional defecation disorder,as well as the anal resting pressure and the maximum anal systolic pressure.Due to the limitation of the number of included literatures and the heterogeneity among evaluation indexes,the evaluation of defecation difficulty score and anal dynamics still needs to be further evaluated under the support of clinical studies with more centers,high quality and large sample size.

Enduring association between irritable bowel syndrome and war trauma during the Nicaragua civil war period:A population-based study

BACKGROUND Psychosocial and physical trauma are known risk factors for irritable bowel syndrome(IBS),including in war veterans,whereas war exposure in civilians is unclear.Nicaragua experienced two wars,1970-1990:The Sandinistas Revolution(1970s)and The Contra War(1980s).Our aim was to investigate the role of exposure to war trauma in the subsequent development of IBS in the context of an established health surveillance system(11000 households).AIM To investigate in a civilian population the relationship between exposure to war trauma and events and the subsequent development of IBS in the context of an established public health and demographic surveillance system in western Nicaragua.METHODS We conducted a nested population-based,cross-sectional study focused on functional gastrointestinal disorders based on Rome II criteria.1617 adults were randomly selected.The Spanish Rome II Modular Questionnaire and Harvard Trauma Questionnaire were validated in Nicaragua.War exposure was assessed with 10 measures of direct and indirect war trauma and post-war effects.Multiple exposures were defined by≥3 measures.RESULTS The prevalence of IBS was 15.2%[Female(F)17.1%,Male(M)12.0%],war exposure 19.3%(F 9.3%,M 36.7%),and post-traumatic stress disorder(PTSD)5.6%(F 6.4%,M 4.3%).Significant associations with IBS in the civilian population were observed(adjusted by gender,age,socioeconomic status,education):physical and psychological abuse[adjusted odds ratio(aOR):2.25;95%confidence interval:1.1-4.5],witnessed execution(aOR:2.4;1.1-5.2),family member death(aOR:2.2;1.2-4.2),and multiple exposures(aOR:2.7;1.4-5.1).PTSD was independently associated with IBS(aOR:2.6;1.2-5.7).CONCLUSION An enduring association was observed in the Nicaragua civilian population between specific civil war-related events and subsequent IBS.Civilian populations in regions with extended armed conflict may warrant provider education and targeted interventions for patients.

Associations between irritable bowel syndrome and non-alcoholic fatty liver disease:A systematic review

BACKGROUND Irritable bowel syndrome(IBS)is associated with obesity and metabolic syndrome.IBS and non-alcoholic fatty liver disease(NAFLD)are highly prevalent entities worldwide and may share similar mechanisms including gut dysbiosis,impaired intestinal mucosal barrier and immune system activation.AIM To systematically review their association according to the Preferred Reporting Items for Systemic Review and Meta-analyses guidelines.METHODS PubMed,EMBASE and Cochrane Database of Systematic Reviews were searched for relevant papers.Manual searches were also performed.RESULTS Six studies were included.Both IBS and NAFLD subjects had significantly more metabolic risk factors like hypertension,obesity,dyslipidaemia and diabetes.Our review showed that 23.2%to 29.4%of NAFLD patients had IBS.IBS was significantly higher in NAFLD patients compared with patients without NAFLD(23.2%vs 12.5%,P<0.01).A higher proportion of IBS patients had NAFLD(65.8%to 74.0%).IBS patients were three times more likely to have NAFLD compared with non-IBS patients(P<0.001).Two studies showed a significant correlation between the severity of IBS and NAFLD.The proportion of NAFLD subjects with IBS increased with NAFLD severity.CONCLUSION Further prospective studies are warranted to evaluate the relationship and shared pathways between IBS and NAFLD,potentially leading to the development of future therapeutics.

Clinical Study on Therapy of Clearing Hallow Viscera in Treating Critical Patients with Gastro-enteric Function Disorder

Objective： To explore the clinical effect of therapy of clearing hallow viscera in treating critical patients with gastro-enteric function disorder （GEFD）. Methods： Retrospective analysis was carried out on 96 critical patients. They were 48 patients in the treated group treated with Dachengqi Decoction （ 大承气汤） and 48 patients in the control group treated with Western medicine for promoting gastric dynamic force. The recovery rate, recovery time of gastro-enteric function, incidence rate and fatality rate of multiple organ dysfunction syndrome （MODS）, as well as the level of plasma endotoxin （ET） before and after treatment between the two groups were compared. Results： Comparison between the two groups in gastro-enteric function recovery rate （81.3% vs 45.8 %）, functional disorder sustaining time in patients who got recovered （1.2± 0.3 daysvs4.0±1.1 days）, incidence rate （29. 17% vs 52.08%） and fatality rate （28.57% vs 56.00%） of MODS all showed significant difference （ P〈0.05 or P〈0.01 ）. The plasma level of ET after treatment in the treated group was significantly lower than that in the control group （P〈0.05）. Conclusion： Therapy of clearing hallow viscera has a good effect in treating critical patients with gastro-enteric function disorder, and could reduce the incidence and fatality of MODS.

Attention deficit hyperactivity disorder and gastrointestinal morbidity in a large cohort of young adults

BACKGROUND Although the association of attention deficit hyperactivity disorder(ADHD)with psychiatric disorders is well known,its association with somatic diseases is unclear.Only few studies have investigated the gastrointestinal(GI)morbidity in adult patients with ADHD.AIM To measure gastrointestinal comorbidity and its burden on healthcare in young adults with ADHD.METHODS The cohort included subjects aged 17-35 years recruited to the Israel Defense Forces in 2007-2013,33380 with ADHD and 355652 without(controls).The groups were compared for functional and inflammatory conditions of the gastrointestinal tract and clinic and specialist visits for gastrointestinal symptoms/disease during service(to 2016).Findings were analyzed by generalized linear models adjusted for background variables.RESULTS Compared to controls,the ADHD group had more diagnoses of functional gastrointestinal disorders(referred to as FGID),namely,dyspepsia[odds ratio(OR):1.48,95%confidence interval(CI):1.40-1.57,P<0.001],chronic constipation(OR:1.64,95%CI:1.48-1.81,P<0.001),and irritable bowel syndrome(OR:1.67,95%CI:1.56-1.80,P<0.001)but not of organic disorders(inflammatory bowel disease,celiac disease).They had more frequent primary care visits for gastrointestinal symptoms[rate ratio(RR):1.25,95%CI:1.24-1.26,P<0.001]and referrals to gastrointestinal specialists(RR:1.96,95%CI:1.88-2.03,P<0.001)and more episodes of recurrent gastrointestinal symptoms(RR:1.29,95%CI:1.21-1.38,P<0.001).Methylphenidate use increased the risk of dyspepsia(OR:1.49,95%CI:1.28-1.73,P<0.001)and constipation(OR:1.42,95%CI:1.09-1.84,P=0.009).CONCLUSION ADHD in young adults is associated with an excess of FGID and increased use of related health services.Research is needed to determine if an integrative approach treating both conditions will benefit these patients and cut costs.

Abnormal activation of the occipital lobes during emotion picture processing in major depressive disorder patients

A large number of studies have demonstrated that depression patients have cognitive dysfunction. With recently developed brain functional imaging, studies have focused on changes in brain function to investigate cognitive changes. However, there is still controversy regarding abnormalities in brain functions or correlation between cognitive impairment and brain function changes. Thus, it is important to design an emotion-related task for research into brain function changes. We selected positive, neutral, and negative pictures from the International Affective Picture System. Patients with major depressive disorder were asked to judge emotion pictures. In addition, functional MRI was performed to synchronously record behavior data and imaging data. Results showed that the total correct rate for recognizing pictures was lower in patients compared with normal controls. Moreover, the consistency for recognizing pictures for depressed patients was worse than normal controls, and they frequently recognized positive pictures as negative pictures. The consistency for recognizing pictures was negatively correlated with the Hamilton Depression Rating Scale. Functional MRI suggested that the activation of some areas in the frontal lobe, temporal lobe, parietal lobe, limbic lobe, and cerebellum was enhanced, but that the activation of some areas in the frontal lobe, parietal lobe and occipital lobe was weakened while the patients were watching positive and neutral pictures compared with normal controls. The activation of some areas in the frontal lobe temporal lobe, parietal lobe, and limbic lobe was enhanced, but the activation of some areas in the occipital lobe were weakened while the patients were watching the negative pictures compared with normal controls. These findings indicate that patients with major depressive disorder have negative cognitive disorder and extensive brain dysfunction. Thus, reduced activation of the occipital lobe may be an initiating factor for cognitive disorder in depressed patients.

Association between gastrointestinal symptoms and affectivity in patients with bipolar disorder

AIM To study if anxiety, depression and experience of stress are associated with gastrointestinal(GI) symptoms in patients with bipolar disorder.METHODS A total of 136 patients with bipolar disorder(mean age 49.9 years; 61% women) and 136 controls from the general population(mean age 51.0 years; 60% women) were included in the study. GI symptoms were assessed with The Gastrointestinal Symptom Rating Scale-irritable bowel syndrome(GSRS-IBS), level of anxiety and depression with The Hospital Anxiety and Depression Scale(HADS) and stress-proneness with Perceived Stress Questionnaire. Over a ten year period, all visits in primary care were retrospectively recorded in order to identify functional GI disorders.RESULTS In subjects with low total HADS-score, there were no significant differences in GI-symptoms between patients and controls(GSRS-IBS 7.0 vs 6.5, P = 0.513). In the patients with bipolar disorder there were significant correlations between all GSRS and HADS subscores for all symptom clusters except for "constipation" and "reflux". Factors associated to GI symptoms in the patient group were female sex(adjusted OR = 2.37, 95%CI: 1.07-5.24) and high HADS-Depression score(adjusted OR = 3.64, 95%CI: 1.07-12.4). These patients had also significantly more visits for IBS than patients with low HADS-Depression scores(29% vs 8%, P = 0.008). However, there was no significant differences in consulting behaviour for functional GI disorders between patients and controls(25% vs 17%, P = 0.108).CONCLUSION Female patients and patients with high HADS depression score reported significantly more GI symptoms, whereas patients with low HADS scores did not differ from control subjects.

Evaluating the efficacy of endoscopic sphincterotomy on biliary-type sphincter of Oddi dysfunction: A retrospective clinical trial

BACKGROUND Although endoscopic sphincterotomy(EST)has a positive therapeutic effect on biliary-type sphincter of Oddi dysfunction(SOD),some patients still have little relief after EST,which implies that other functional abdominal pain may also be present with biliary-type SOD and interfere with the diagnosis and treatment of it.AIM To retrospectively assess EST as a treatment for biliary-type SOD and analyze the importance of functional gastrointestinal disorder(FGID)in guiding endoscopic treatment of SOD.METHODS Clinical data of 79 patients with biliary-type SOD(type I and type II)treated with EST at Affiliated Hospital of Guizhou Medical University from January 2014 to January 2019 were retrospectively collected to evaluate the clinical therapeutic effect of EST.The significance of relationship between FGID and biliary-type SOD was analyzed.RESULTS Seventy-nine patients with biliary-type SOD received EST,including 29 type 1 patients and 50 type 2 patients.The verbal rating scale-5(VRS-5)scores before EST were all 3 or 4 points,and the scores decreased after EST;the difference was statistically significant(P<0.05).After EST,the serum indexes of alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase and total bilirubin in biliary-type SOD were significantly lower than before(P<0.05).After EST,67(84.8%)and 8(10.1%)of the 79 patients with biliary-type SOD had obviously effective(VRS-5=0 points)and effective treatment(VRS-5=1-2 points),with an overall effectiveness rate of 94.9%(75/79).There was no difference in VRS-5 scores between biliary-type SOD patients with or without FGID before EST(P>0.05).Of 12 biliary-type SOD(with FGID)patients,11 had abdominal pain after EST;of 67 biliary-type SOD(without FGID)patients,0 had abdominal pain after EST.The difference was statistically significant(P<0.05).The 11 biliary-type SOD(with FGID)patients with recurrence of symptoms,the recurrence time was about half a year after the EST,and the symptoms were significantly relieved after regular medical treatment.There were 4 cases of postendoscopic retrograde cholangiopancreatography pancreatitis(5.1%),and no cholangitis,bleeding or perforation occurred.Patients were followed up for 1 year to 5 years after EST,with an average follow-up time of 2.34 years,and there were no long-term adverse events such as sphincter of Oddi restenosis or cholangitis caused by intestinal bile reflux during the follow-up.CONCLUSION EST is a safe and effective treatment for SOD.For patients with type I and II SOD combined with FGID,single EST or medical treatment has limited efficacy.It is recommended that EST and medicine be combined to improve the cure rate of such patients.

Thinking and Strategy on the Diagnosis and Treatment of Functional Gastrointestinal Disorders with Integrative Medicine

The functional gastrointestinal disorders (FGIDs) are a group of diseases mainly manifested as gastrointestinal functional disorders,including 45 kinds of different diseases,such as functional dyspepsia(FD), irritable bowel syndrome (IBS),functional constipation

Childhood constipation:Current status,challenges,and future perspectives

Constipation in children is a major health issue around the world,with a global prevalence of 9.5%.They present to clinicians with a myriad of clinical signs.The Rome IV symptom-based criteria are used to diagnose functional constipation.Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children.There are various risk factors identified globally,including centrally connected factors such as child abuse,emotional and behavioral issues,and psychological stress.Constipation is also precipitated by a low-fiber diet,physical inactivity,and an altered intestinal microbiome.The main pathophysiological mechanism is stool withholding,while altered rectal function,anal sphincter,pelvic floor,and colonic dysfunction also play important roles.Clinical evaluation is critical in making a diagnosis,and most investigations are only required in refractory patients.In the treatment of childhood constipation,both nonpharmacological(education and demystification,dietary changes,toilet training,behavioral interventions,biofeedback,and pelvic floor physiotherapy),and pharmacological(osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone)interventions are used.For children with refractory constipation,transanal irrigation,botulinum toxin,neuromodulation,and surgical treatments are reserved.While frequent use of probiotics is still in the experimental stage,healthy dietary habits,living a healthy lifestyle and limiting exposure to stressful events,are all beneficial preventive measures.