Association of upper gastrointestinal symptoms with functional and clinical characteristics in the elderly

AIM： To evaluate the prevalence of upper gastrointestinal symptoms and their association with clinical and functional characteristics in elderly outpatients. METHODS： The study involved 3238 outpatients ≥ 60 years consecutively enrolled by 107 general practitioners. Information on social, behavioral and de- mographic characteristics, function in the activities of daily living （ADL）, co-morbidities and drug use were collected by a structured interview. Upper gastroin- testinal symptom data were collected by the 15-items upper gastro-intestinal symptom questionnaire for the elderly, a validated diagnostic tool which includes the following five symptom clusters： （1） abdominal pain syndrome; （2） reflux syndrome; （3） indigestion syn- drome; （4） bleeding, and （5） non-specific symptoms. Presence and severity of gastrointestinal symptoms were analyzed through a logistic regression model. RESULTS： 3100 subjects were included in the final analysis. The overall prevalence of upper gastrointes- tinal symptoms was 43.0%, i.e. cluster （1） 13.9%, （2） 21.9%, （3） 30.2%, （4） 1.2%, and （5） 4.5%. Upper gastrointestinal symptoms were more frequently re- ported by females （P 〈 0.0001）, with high number of co-morbidities （P 〈 0.0001）, who were taking higher number of drugs （P 〈 0.0001） and needed assistance in the ADL. Logistic regression analysis demonstrated that female sex （OR = 1.39, 95% CI： 1.17-1.64）, dis- ability in the ADL （OR = 1.47, 95% CI： 1.12-1.93）, smoking habit （OR = 1.29, 95% C]： 1.00-1.65）, and body mass index （OR = 1.06, 95% CI： 1.04-1.08）, as well as the presence of upper （OR = 3.01, 95% C]： 2.52-3.60） and lower gastroenterological diseases （OR = 2.25, 95%CI： 1.70-2.97）, psychiatric （OR = 1.60, 95% CI： 1.28-2.01） and respiratory diseases （OR = 1.25, 95% C]： 1.01-1.54） were significantly associated with the presence of upper gastrointestinal symptoms. CONCLUSION： Functional and clinical characteristics are associated with upper gastrointestinal symptoms. A multidimensional comprehensive evaluation may be useful when approaching upper gastrointestinal symp- toms in older subjects.

Evaluation of visual stress symptoms in age-matched dyslexic, Meares-Irlen syndrome and normal adults

AIM： To examine the prevalence of dyslexia and Meares-Irlen syndrome（MIS） among female students and determine their level of visual stress in comparison with normal subjects.·METHODS： A random sample of 450 female medical students of King Saud University Riyadh（age range, 18-30y） responded to a wide range of questions designed to accomplish the aims of this study. The detailed questionnaire consisted of 54 questions with 12 questions enquiring on ocular history and demography of participants while 42 questions were on visual symptoms. Items were categorized into critical and non-critical questions（CQ and NCQ） and were rated on four point Likert scale. Based on the responses obtained, the subjects were grouped into normal（control）, dyslexic with or without MIS（Group 1） and subjects with MIS only（Group 2）. Responses were analysed as averages and mean scores were calculated and compared between groups using one way analysis of variance to evaluate total visual stress score（TVSS =NCQ ＋CQ）, critical and non-critical visual stress scores. The relationship between categorical variables such as age, handedness and condition were assessed with Chi-square test.·RESULTS： The completion rate was 97.6% and majority of the respondents（92%） were normal readers, 2%dyslexic and 6% had MIS. They were age-matched. More than half of the participants had visited an eye care practitioner in the last 2y. About 13% were recommendedeye exercises and one participant experienced pattern glare. Hand preference was not associated with any condition but Group 1 subjects（3/9, 33%） were significantly more likely to be diagnosed of lazy eye than Group 2（2/27, 7%） and control（27/414, 7%） subjects. The mean±SD of TVSS responses were 63±14 and it was 44±9for CQ and 19 ±5 for NCQ. Responses from all three variables were normally distributed but the CQ responses were on the average more positive（82%） in Group 2 and less positive（46%） in Group 1 than control. With NCQ,the responses were equally less positive in Group 1 and2 than control. Group 2 subjects showed significantly higher TVSS（P =0.002）, NCQ（P =0.006） and CQ（P =0.008）visual stress scores than control but no difference between Group 1 and control subjects, was observed for all scores（P 〉0.05, for all comparisons）.·CONCLUSION： The prevalence of dyslexia and MIS among Saudi female students was 2% and 6%,respectively. Critical questions performed best for assessing visual stress symptoms in dyslexic and MIS subjects. Generally, students with MIS were more sensitive to visual stress than normal students but dyslexics were more likely to present with a lazy eye than MIS and normal readers.

Alcohol intolerance and myalgic encephalomyelitis/chronic fatigue

BACKGROUND The literature is mixed about the occurrence of alcohol intolerance among patients with myalgic encephalomyelitis/chronic fatigue syndrome(ME/CFS).Surveys that asked respondents with ME/CFS whether they experienced alcohol intolerance within a recent time frame might produce inaccurate results because respondents may indicate that the symptom was not present if they avoid alcohol due to alcohol intolerance.AIM To overcome this methodologic problem,participants in the current study were asked whether they have avoided alcohol in the past 6 mo,and if they had,how severe their alcohol intolerance would be if they were to drink alcohol.METHODS The instrument used was a validated scale called the DePaul symptom questionnaire.Independent t-tests were performed among the alcohol intolerant or not alcohol intolerant group.The alcohol intolerant group had 208 participants,and the not alcohol intolerant group had 96 participants.RESULTS Using specially designed questions to properly identify those with alcohol intolerance,those who experienced alcohol intolerance vs those who did not experience alcohol intolerance experienced more frequent/severe symptoms and domains.In addition,using a multiple regression analysis,the orthostatic intolerance symptom domain was related to alcohol intolerance.CONCLUSION The findings from the current study indicated that those with ME/CFS are more likely to experience alcohol intolerance.In addition,those with this symptom have more overall symptoms than those without alcohol intolerance.

Endocrine cells in the oxyntic mucosa of the stomach in patients with irritable bowel syndrome

AIM: To study the different endocrine cell types in the oxyntic mucosa of patients with irritable bowel syndrome(IBS).METHODS: Seventy-six patients with IBS were included in the study(62 females and 14 males; mean age 32 years, range 18-55 years), of which 40 also fulfilled the Rome Ⅲ criteria for functional dyspepsia(FDP). Of the entire IBS cohort, 26 had diarrhea as the predominant symptom(IBS-D), 21 had a mixture of diarrhea and constipation(IBS-M), and 29 had constipation as the predominant symptom(IBS-C). Fortythree age and sex-matched healthy volunteers withoutany gastrointestinal complaints served as controls. The patients were asked to complete the Birmingham IBS symptom questionnaire. Both the patients and controls underwent a standard gastroscopy, during which three biopsy samples were taken from the corpus. Sections from these biopsy samples were immunostained using the avidin-biotin complex(ABC) method, for ghrelin, serotonin, somatostatin and histamine. The densities of these cell types and immunoreactivity intensities were quantified using computerized image analysis with Olympus cellSens imaging software(version 1.7).RESULTS: The densities of the ghrelin cells in the control, IBS-total, IBS-D, IBS-M and IBS-C groups were 389(320, 771), 359(130, 966), 966(529, 1154), 358(120, 966) and 126(0, 262) cells/mm2, respectively. There was a significant difference between the tested groups(P < 0.0001). Dunn's multiple comparison test showed that the ghrelin cell density was significantly higher in IBS-D and lower in IBS-C than in the controls(P = 0.03 and 0.0008, respectively). The ghrelin cell density in patients with both IBS and FDP was 489(130, 966), and in those with IBS only 490(130, 956). There was no statistical significant difference between these 2 groups of patients(P = 0.9). The immunoreactivity intensity did not differ between any of the groups(P = 0.6). The diarrhea score of the Birmingham IBS symptom questionnaire was significantly positively correlated with ghrelin cell density(r = 0.65; P < 0.0001) and significantly inversely correlated with that of constipation(r = 90.69; P < 0.0001). The densities of the serotonin cells were 63(51, 82), 51(25, 115), 120(69, 128), 74(46, 123) and 40(0, 46) cells/mm2 in the control, IBS-total, IBS-D, IBS-M and IBS-C groups, respectively. A statistically significant difference was found between the tested groups(P < 0.0001). Posttest revealed that serotonin cell density was significantly higher in IBS-D and lower in IBS-C than in controls(P = 0.02 and 0.004, respectively), but did not differ in the IBS-total and IBS-M groups from that in controls(P = 0.5 and 0.4, respectively). The serotonin cell densityin patients with both IBS and FDP was 62(25, 115)and in those with IBS only 65(25, 123). There was no statistically significant difference between these2 groups of patients(P = 1). The immunoreactivity intensity of serotonin did not differ significantly between any of the groups(P = 0.0.9). The serotonin cell density was significantly positively correlated with the diarrhea score of the Birmingham IBS symptom questionnaire(r = 0.56; P < 0.0001) and significantly inversely correlated with that of constipation(r = 0.51;P < 0.0001). The densities of the somatostatin cells were 97(72, 126), 72(0, 206), 29(0, 80), 46(0, 103)and 206(194, 314) cells/mm2 in the control, IBS-total,IBS-D, IBS-M and IBS-C groups, respectively(Figures7 and 8). There was a statistically significant difference between the controls and the IBS subgroups(P <0.0001). The density of somatostatin cells was significantly lower in the IBS-D and IBS-M groups but higher in IBS-C patients than in the controls(P < 0.01, P =0.02, and P = 0.0008, respectively). The somatostatin cell density in patients with both IBS and FDP was 86(0-194), and in those with IBS only 110(0-206). There was no statistically significant difference between these 2 groups of patients(P = 0.6). There was no significant difference in somatostatin immunoreactivity intensity between the controls. The diarrhea score of the Birmingham IBS symptom questionnaire was inversely correlated with somatostatin cell density(r =0.38; P = 0.0007) and was positively correlated with that of constipation(r = 0.64; P < 0.0001).CONCLUSION: The finding of abnormal endocrine cells in the oxyntic mucosa shows that the endocrine cell disturbances in IBS are not restricted to the intestine. Furthermore, it appears that ghrelin, serotonin and somatostatin in the oxyntic mucosa of the stomach may play an important role in the changing stool habits in IBS through their effects on intestinal motility.

Peak stent discomfort occurs early and ureteral stent with distal loop design has less paineA pilot prospective randomised singleblinded trial over 2 weeks

Objectives:The Polarisloop ureteric stent reduces the severity of stent discomfort by minimising stent material in the bladder.Early impact of ureteral stenting on quality of life(QoL)within 1 week remains unclear.The usefulness of the patient-administered ureteral stent symptoms questionnaire(USSQ)during this period of stent insertion was assessed.In this pilot single-blinded prospective randomised study,we investigate 1)the presence of early(within the 1st week)stent discomfort via the visual analog scale(VAS);2)determine the QoL of the loop stent against conventional stent.Methods:Forty adults requiring retrograde unilateral ureteral stent placements were enrolled.Patients with single ureteric stone or benign stricture were selected.Patients were randomised in 1:1 ratio to the loop and pigtail arm.The USSQ was administered before placement(baseline),USSQ and VAS were administered on Day 3,7,and 14.Results:There were no significant differences between the USSQ scores.Median pain scores on Day 3 were lower in the loop stent group(2.9 vs.4.0,pZ0.047).There was a significant reduction in pain from Day 3e7(0 vs.1,pZ0.016)in the pigtail group.Conclusions:Our results suggest that peak stent discomfort occurs but resolves quickly within 1 week of post-stent insertion.The loop stent offers a better pain profile compared with conventional stents at Day 3 but no difference in QoL.The loop stent reduces early pain experience post-stent insertion and may have a role in the care of patients who experience significant stent discomfort previously.