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OBJECTIVE: A link between dyspepsia symptoms and weight loss is controversial. We aimed to determine whether or not weight loss is a marker of dyspepsia. METHODS: Independent community-based cross-sectional studies. Subjects were randomly selected from the general population in Sydney, Australia. All subjects completed validated community health surveys. Two distinct data collections were used; the first as a training sample (N = 888) and the second as a validation sample to confirm the findings of the first (N = 2,907). The study was focused on weight loss, which was categorized as (a) any weight loss, (b) substantive weight loss (≥3 kg), and (c) weight loss expressed as percentage of body weight. RESULTS: All dyspepsia symptoms studied were positively associated with weight loss although the strength of association did vary. Nausea and vomiting were most strongly associated with weight loss as were meal-related complaints such as postprandial fullness. Similarly, clusters formed based on symptoms were strongly differentiated in terms of weight loss with clusters characterized by nausea, vomiting, and early satiety/postprandial fullness reporting 25–30% weight loss prevalence over the previous 3 months compared with around 10% prevalence in clusters characterized by low dyspepsia symptom burden. Weight loss ≥3 kg followed a similar pattern but with a prevalence approximately half that of any weight loss, while weight loss expressed as percentage of body weight followed the same pattern. CONCLUSIONS: Dyspepsia symptoms are clearly and, in some cases, strongly associated with weight loss, both any loss of weight and substantive weight loss. Weight loss should be considered a warning symptom of dyspepsia. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To prospectively determine the turnover (gain or loss) of gastrointestinal (GI) symptoms in diabetic subjects in relation to glycemic control, autonomic neuropathy and psychiatric disease over a 2-year follow-up. METHODS: Type 1 and type 2 diabetic subjects were recruited from the community, as were community controls. Individual GI symptoms were examined by a validated questionnaire and classified as diarrhea, irritable bowel syndrome, upper GI symptoms, and any GI symptoms at baseline, 12 and 24 months. Glycemic control (glycated hemoglobin), autonomic function (using standardized tests), and psychiatric disease (using the Composite International Diagnostic Interview) were also assessed at these time points. RESULTS: Baseline and 2-year follow-up data were available for 139 diabetic subjects and 55 controls. Glycated hemoglobin at baseline was 7.7% (±1.36) in the diabetic group; 5% had severe autonomic dysfunction. There was a significantly higher prevalence of diarrhea in the diabetic subjects. GI symptom turnover varied between 15% and 25% in the diabetic group and was not significantly different from the controls. There was no clear association between turnover of GI symptoms and either glycemic control or autonomic neuropathy. The appearance of depression was associated with gaining of most symptoms apart from irritable bowel syndrome, although the associations did not always reach significance. The univariate results were confirmed after adjusting for age, gender, body mass index, and metformin use. CONCLUSION: The turnover of GI symptoms in diabetic subjects was not associated with glycemic control but there was a positive association with change in depression. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Recent reports suggest that abnormalities of lactulose breath testing (LBT) are common in patients with irritable bowel syndrome (IBS), although the criteria for abnormal studies are poorly validated, and controlled comparisons are limited. The goal of this study was to determine the prevalence of abnormal LBT using the previously published criteria in both IBS patients and healthy controls, as well as to determine the prevalence and symptom association with methane (CH4) and hydrogen (H2) productions during LBT. METHODS: Consecutive LBT from patients meeting Rome II criteria for IBS and healthy control subjects were examined. Patients listed their most bothersome digestive symptom at the start of the test. LBT was performed using 10 g of lactulose mixed in 240 mL of water, and breath samples collected every 20 min for a 180-min period. Both breath H2 and CH4 were measured. LBT was considered positive if it met any of the previously published criteria: (a) breath H2 of >20 parts per million (ppm), (b) increase in breath H2 in <90 min, (c) dual H2 peaks (12-ppm increase over baseline with a decrease of ≥5 ppm before 2nd peak), and (d) breath CH4 of >1 ppm. RESULTS: In total, 224 patients with IBS and 40 controls were studied. Twenty percent of IBS patients were CH4(+) compared with 15% of controls. CH4(+) IBS patients were significantly more likely than CH4(–) IBS patients to have constipation, and significantly less likely to have diarrhea; however, the association did not hold for symptoms of bloating or pain. Patients and controls did not differ significantly with respect to the frequency of a positive study defined by increase in breath H2 in <90 min (121 per 180 vs 26 per 40, P= 0.79), increase in breath H2 of >20 ppm (92 per 180 vs 24 per 40, P= 0.31), or dual peaks (25 per 180 vs 9 per 40, P= 0.17). CONCLUSIONS: The majority of patients with IBS and healthy subjects meet criteria for an “abnormal” LBT using previously published test criteria, and groups are not discriminated using this diagnostic method. Similarly, while CH4 production was associated with constipation among IBS patients, the prevalence of CH4-positive subjects did not significantly differ between IBS patients and controls. The utility of LBT, in its current form as a diagnostic tool in IBS requires critical reappraisal. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The Internet is used increasingly to recruit patients for studies of gastroenterological disorders. The Internet allows access to potentially large study populations but no data exist comparing Internet-based populations with patients recruited from a clinical setting. We conducted an assessment of the quality of life (QOL) in patients with active inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) recruited from a gastroenterology clinic and the Internet. METHODS: Patients were recruited from a university gastroenterology clinic and several condition-specific support group web sites. The diagnosis of IBD and IBS was confirmed for clinic patients while Internet respondents were self-identified. Subjects completed both general (SF-36) and condition specific (IBS-QOL) measures. RESULTS: Subjects with IBD included 47 recruited from clinic and 96 recruited from the Internet. The IBS group included 147 patients recruited from clinic and 84 recruited from the Internet. Both IBS and IBD clinic and Internet IBD groups did not differ by. IBD Internet respondents were more likely to be women (clinic: 28F/19M, online: 80F/16M, P= 0.002) while IBS Internet respondents were more likely to be male (123F/24M) than IBS clinic patients (62F/22M) ( P= 0.09). Compared with patients seen in clinic, both IBS and IBD Internet respondents had significantly poorer QOL as measured by both SF-36 and IBS-QOL. The greatest decrements in QOL occurred on SF-36 scales for physical and emotional roles and social functioning. On the IBS-QOL, the greatest decrement was seen on scales for dysphoria and life interference. Significant differences were maintained after controlling for gender. CONCLUSIONS: For both IBS and IBD, Internet-respondents had significantly poorer QOL than subjects recruited from clinic. These data demonstrate that subjects recruited from the Internet may represent a clinically distinct population and data obtained from online surveys may not generalize to broader clinical populations. Further study is needed to determine whether these differences reflect psychosocial characteristics of Internet responders or simply self-report behaviors in a relatively anonymous environment. [ABSTRACT FROM AUTHOR]

INTRODUCTION: High-resolution manometry (HRM) combined with novel interpretive software allows for the interpolation of manometric recordings into highly detailed topographical plots of intraluminal pressure events relative to time and location. To date, HRM has been used primarily in the study of esophageal disorders and has been shown to provide greater physiologic resolving power compared with standard manometric techniques. This preliminary feasibility study is the first report evaluating HRM and simultaneously performed water-perfused manometry (WPM) in patients referred for anorectal manometry (ARM). METHODS: Consecutive patients referred for ARM underwent simultaneous WPM and HRM. WPM was performed using a 6-cm sleeve assembly with side-holes spaced at 3-cm intervals. HRM was performed using the ManoScan™ system (Sierra Scientific Instruments, Los Angeles, CA) consisting of a 36-channel catheter with sensors spaced at 1-cm intervals. Space–time pressure data were displayed in topographic form using ManoView™ analysis software that is part of the ManoScan system. Measurements of anal sphincter pressure at rest, during voluntary contraction, and during 40-mL rectal balloon distension were compared. RESULTS: A total of 29 patients were studied. Indications for manometry were constipation (19), incontinence (7), and fecal soilage (3). Simultaneously recorded resting, squeeze, and relaxation pressures showed the two methods to be significantly correlated although anal sphincter pressures recorded by HRM tended to be higher than those recorded with WPM. HRM provided greater resolution of the intraluminal pressure environment of the anorectum. CONCLUSIONS: These preliminary observations demonstrate that anorectal HRM highly correlated with WPM measurements and provided greater anatomic detail. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Reporting of symptoms and visceral sensations in functional dyspepsia is subjective and influenced by such factors as somatization and depression. To better understand the role of these factors in symptom reporting, somatization, somatosensory amplification, alexithymia, and depression were evaluated in patients with functional dyspepsia undergoing a water load test.METHODS: Sixty-seven controls and 103 patients with functional dyspepsia underwent a 5-min water load. Participants both recalled dyspeptic symptoms from the previous 2 wk and rated symptoms of nausea, fullness, and bloating during water load. Participants also completed the symptom checklist-90-R, somatosensory amplification scale, and the Toronto alexithymia scale.RESULTS: Compared with controls, patients with dyspepsia had greater psychiatric distress and higher scores for somatosensory amplification and alexithymia. Patients with dyspepsia also reported fullness at significantly lower volumes of water and experienced greater symptoms during water load than controls. Receiver operator characteristics of water load volume and provoked symptoms suggested that water load (WL) volume was a better discriminator of patients with dyspepsia from controls. Patients with dyspepsia recalled significantly more symptoms in the 2 wk prior to study. Symptoms provoked during WL were not associated with measured psychiatric constructs in either controls or patients with dyspepsia whereas recalled symptoms in patients with functional dyspepsia were significantly associated with several measured psychiatric constructs.CONCLUSIONS: Patients with functional dyspepsia report fullness at lower volumes of ingested water and develop more symptoms than do controls. Water load volume better discriminates patients with dyspepsia from controls than does symptoms provoked during water load. Provoked symptoms in dyspepsia are not associated with measured psychiatric constructs but recalled symptoms are.(Am J Gastroenterol 2005;100:1–6) [ABSTRACT FROM AUTHOR]

Gastroparesis is characterized by delayed gastric emptying in the absence of obstruction. Common symptoms include nausea, vomiting, and abdominal pain. Severe gastroparesis might result in recurrent hospitalizations, malnutrition, and significant mortality. Patients failing medical therapy are often considered for a variety of surgical interventions, the efficacy of which is not well studied. This review summarizes available literature on surgical interventions in gastroparesis. A MEDLINE search for the period from 1966 to 2002 was performed to identify all English language literature regarding surgical interventions in gastroparesis. Therapies reviewed were gastrostomy, jejunostomy, gastric pacing/stimulation, and gastrectomy or surgical drainage procedures. Candidate studies involved human subjects and included surgical series or trials. The search was conducted independently by two authors and discrepancies resolved by consensus opinion. Seventeen articles met inclusion criteria. These included series reporting on gastrostomy (2), jejunostomy (3), gastric stimulation (2), and gastrectomy for postsurgical (6), diabetic (3), and idiopathic (1) gastroparesis. All trials were unblinded, uncontrolled case series or retrospective reviews. Methodologic differences did not allow for pooled analysis. Completion gastrectomy seems to provide symptom relief in postsurgical gastroparesis. Benefits of gastric surgery for other forms of gastroparesis are not adequately studied. Gastrostomy might provide symptom improvement, but only 26 subjects in two trials were evaluable. Jejunostomy improved symptoms and nutrition in 32 evaluable subjects in three trials but had significant complications. Gastric neurostimulation improves symptoms of nausea and vomiting, but therapeutic gain beyond placebo has not been demonstrated. Limited data exist concerning surgical therapies of gastroparesis. Completion gastrectomy seems effective for postsurgical gastroparesis, but a cautious approach is warranted before surgical therapies in diabetic or idiopathic gastroparesis are used. [Copyright &y& Elsevier]

: ObjectiveErythromycin is a motilin agonist that greatly increases the fractional rate of gastric emptying. Although a number of studies document the efficacy of erythromycin in improving gastric emptying, little information exists concerning symptom improvement in patients with gastroparesis. The aim of this study was to review clinical trials of erythromycin to determine the efficacy of this agent in producing symptom relief in patients with gastroparesis.: MethodsA MEDLINE search from 1966 to 2001 was performed to identify all clinical trials using erythromycin in patients with gastroparesis. The search was further limited to clinical trials using symptom assessment as an endpoint. References from index citations were reviewed to identify additional studies. The search was conducted independently by two authors, and discrepancies were resolved by consensus opinion.: ResultsThirty-five clinical trials were identified, and five met inclusion criteria. One study each involved gastroparesis caused by surgery and systemic sclerosis. Three studies evaluated patients with diabetic or idiopathic gastroparesis. No study used symptoms as a primary endpoint. Improvement was reported in 26 of 60 (43%) patients. Individual symptom scores were available for 23 of 60 subjects in these studies, and symptom improvement was seen in 11 of 23 (48%) patients. One study compared erythromycin and metoclopromide in an open-label, crossover fashion, and found no difference between the two agents. All studies were methodologically weak and highly subject to bias. Four of five studies were open-label trials. Sample sizes in all studies were ≤13 subjects, and treatment duration was ≤4 wk in all studies.: ConclusionsAlthough clearly a potent prokinetic, limited data exist concerning efficacy of erythromycin in treating gastroparesis. Small sample sizes, uncontrolled designs, short duration, and inadequate symptom assessment limit available studies. Well-designed trials designed to assess symptom relief in gastroparesis are needed. [Copyright &y& Elsevier]

BACKGROUND:Both the natural history of GI symptoms and factors influencing symptom turnover in diabetes mellitus are unknown. We aimed to determine the natural history of GI symptoms in diabetes mellitus over a 3-yr period.METHODS:Subjects with predominantly Type 2 diabetes on the mailing list of Diabetes Australia were recruited and completed a validated questionnaire (n = 892); of these, 64% completed the questionnaire again 3 yr later. Subjects were classified as never having GI symptoms (abdominal pain, constipation, diarrhea, fecal incontinence), fluctuating (only on one survey), or persistent symptoms.RESULTS:Symptoms more often fluctuated than persisted, but the prevalence at recruitment and 3 yr later was similar. Predictors of symptom turnover varied. In a multivariate model, abnormal sweating and diabetic foot problems predicted symptom turnover for abdominal pain (OR = 2.01, 95% CI = 1.07–3.76 and 2.54, 1.23–5.24, respectively), and paresthesiae (“pins and needles”) and foot problems predicted fecal incontinence (OR = 2.24, 1.06–4.75 and 2.38, 1.04–5.45, respectively), but not constipation or diarrhea. Symptom turnover in constipation was associated with depression (OR = 2.73, CI = 1.89–3.94) and neuroticism (OR = 0.57, CI = 0.36–0.89), and depression was associated with abdominal pain (OR = 1.56, CI = 1.02–2.38), but psychological factors were not related to the other symptoms. The odds for symptoms persisting were not generally related to type or duration of diabetes, or self-rated glycemic control.CONCLUSION:The natural history of GI symptoms in diabetes has been described for the first time; symptoms may either persist or fluctuate, but the prevalence is constant because symptom onset is balanced by disappearance. Glycemic control does not seem to predict symptom change. [Copyright &y& Elsevier]

Physicians caring for patients with motility or functional digestive diorders often decry the unhappy state of prokinetic therapy. There appears to be a paucity of agents brought to market and several of the agents felt to be truly efficacious have been withdrawn. While treatment options remain limited, the scenario may not be as bleak as initially thought. Treatment options are available particularly if practitioners are willing to pursue alternative prescribing approaches. This article describes mechanisms by which physicians may safely obtain prokinetic agents commonly regarded as inaccessible. [Copyright &y& Elsevier]

OBJECTIVE:Diabetes mellitus is associated with an increased prevalence of GI symptoms, but the mechanisms underlying symptoms are poorly defined and controversial. We aimed to determine whether there is a relationship between GI symptoms and both diabetic complications and glycemic control.METHODS:We performed a cross-sectional questionnaire study of 1101 subjects with diabetes mellitus recruited from outpatient clinics (n = 209) and the community (n = 892). Data on eight GI symptom groups, complications of diabetes (retinopathy, neuropathy, nephropathy), and self-reported glycemic control were obtained from a validated questionnaire. Glycated hemoglobin was measured in 463 of the subjects. The association between diabetic complications, glycemic control, and GI symptoms was assessed using logistic regression analysis, adjusted for demographic and clinical factors.RESULTS:Of the 1101 subjects, 57% reported at least one complication. Diabetic complications were independently associated with both symptom complexity (number of symptom groups reported) (adjusted odds ratio = 1.92 per symptom group [95% CI = 1.51–2.45]) and seven of the eight GI symptom groups. For all symptom groups, the association was explained by self-reported symptoms of peripheral neuropathy. Poor glycemic control measured by both self-report and Hb A1c was an independent risk factor for upper GI symptoms, whereas other potential risk indicators, including duration and type of diabetes, were not significant.CONCLUSIONS:GI symptoms in diabetes mellitus may be linked to diabetic complications, particularly peripheral neuropathy, and to poor glycemic control. [Copyright &y& Elsevier]

OBJECTIVE: Symptomatic gastroesophageal reflux disease (GERD), dyspepsia, and irritable bowel syndrome (IBS) are generally considered to be chronic conditions, but community- based studies are sparse, and long term natural history data are unavailable. We aimed to determine the natural history of these conditions. METHODS: A representative Swedish sample (20-79 yr) completed a validated questionnaire over the preceding 3 months. The survey was repeated after 1 and 7 yr in the same target group (n = 1290, 1260, and 1065; response rates 90%, 87%, and 82%, respectively: 79% responded to all three mailings). RESULTS: The prevalence of GERD symptoms remained stable, whereas the prevalence of IBS increased over time, independent of aging. Dyspepsia decreased with advancing age. Although more than half of those with IBS reported the same symptom profile after 1 and 7 yr, there was a substantial symptom fluctuation and symptom profile flux between those reporting dyspepsia, IBS, or minor symptoms. Only a minority with GERD (:lt;10%) changed to dyspepsia and/or IBS, or vice versa. The symptom-free patients remained symptom-free or reported only minor symptoms in ≥90% of cases. CONCLUSION: There seem to be two distinct populations of symptom reporters, those with dyspepsia or IBS, and those with GERD. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Although reflux esophagitis is a multifactorial disease, the relative importance of these pathogenetic factors has not been clearly established. In this study, regression analysis was used to model the major determinants of esophagitis in patients with symptomatic gastroesophageal reflux disease (GERD). METHODS: Sixty-six GERD patients and 16 asymptomatic controls were evaluated. All patients underwent upper endoscopy, esophageal manometry, and 24-h pH monitoring. Esophagrams were performed in 38 of the GERD patients and all controls. Stepwise regression was performed using esophagitis severity as the dependent variable. Logistic regression was performed grouping subjects as controls, non-erosive GERD, or erosive esophagitis. RESULTS: Hiatal hernia size, lower esophageal sphincter pressure, esophageal acid exposure, and number of reflux episodes >5 min significantly correlated with esophagitis severity. Stepwise regression identified hiatal hernia size (p = 0.0001) and lower esophageal sphincter pressure (p = 0.0024) as significant predictors of esophagitis. Logistic regression also identified hiatal hernia size (χ² = 17.07, p < 0.0001) and lower esophageal sphincter pressure (χ² = 5.97, p = 0.0146) as significant predictors of erosive esophagitis. CONCLUSION: Esophagitis severity is best predicted by hiatal hernia size and lower esophageal sphincter pressure. Of these, hiatal hernia size is the strongest predictor. [ABSTRACT FROM AUTHOR]

Studies the potential use of topical pharyngeal anesthesia during upper gastrointestinal endoscopy in conscious sedated patients by researchers from Dayton, Ohio. Determination whether topical pharyngeal anesthesia with conscious sedation is superior to conscious sedation alone; Impact of topical pharyngeal anesthesia on procedure performance or tolerability; Recommendations for the elimination of these agents in the performance of diagnostic upper endoscopy.

Gastrointestinal involvement occurs frequently in essential mixed cryoglobulinemia, and most often involves the liver and spleen. Intestinal involvement is much less common and is generally felt to be a late and often catastrophic manifestation of the disease due to severe vasculitis. Occasionally, the disorder mimics inflammatory bowel disease, both clinically and radiographically. We recently cared for a patient with essential mixed cryoglobulinemia who developed persistent diarrhea. Endoscopic evaluation revealed scattered petechial lesions in the duodenum and colon as well as prominent lymphoid hyperplasia in the terminal ileum. Mucosal biopsies disclosed the presence of diffuse inflammation. We suggest that this patient's diarrhea was due to intestinal vasculitis and that prominent ileal lymphoid hyperplasia may be a manifestation of essential mixed cryoglobulinemia. [ABSTRACT FROM AUTHOR]

Presents a recommendation for the use of prophylaxis in an elderly woman with arthritis requiring nonsteroidal anti-inflammatory drugs (NSAID). Factor that weakens mucosal defense mechanisms resulting in gastroduodenal ulceration, bleeding and perforation; Information on NSAID; Risk factors in elderly women using NSAID.

A response to a letter to the editor about the article "Lactulose breath testing does not discriminate patients with irritable bowel syndrome from healthy controls," by J. R. Bratten and colleagues in the previously published 2008 issue is presented.

Presents a letter to the editor about the definition of disease.

Presents a case report which highlights the potential usefulness of anticholeretic agents in the management of hepatobiliary disorders. Biliary drainage from Jackson-Pratt drain placed in the gallbladder bed; Disruption of enterohepatic circulation; Efficacy of lovastatin.

Presents a case report of a young woman with pseudomembranous colitis (PMC) developed from the use of clindamycin vaginal cream given for bacterial vaginosis late in pregnancy. Medical history of the woman; Treatment given to control PMC; Side effects of clindamycin; Other cases of PMC due to topical clindamycin.

Presents a letter to the editor about botulinum toxin in hypertensive Lower Esophageal Spinchter.

Presents a letter to the editor about the case of intrahepatic cholestasis due to ticarcillin-clavulanate.

An abstract of the article "Bloating and Somatosensory Amplification in Functional Dyspepsia (FD)," by Michael P. Jones and Christine C. Ebert is presented.

An abstract of the article "Predicting Symptom Scores for Abdominal Pain, Bloating and Nausea in Controls and PTS With Functional Dyspepsia (FD): A Psychophyiologic Regression Model," by Michael P. Jones, Christine C. Ebert, and Ann Shettler is presented.

An abstract of the article "Evaluation of Duodenal and Gastric Acid Exposure Using Radiotelemetry pH Monitoring," by Michael P. Jones, Christine C. Ebert, Laura Bianchi, John Pandolfino and Peter J. Kahrilas is presented.

An abstract of the article "Impact of somatization on gastrointestinal (GI) and extra-intestinal comorbidities in IBS," by Michael D. Crowell and colleagues is presented.

Presents a letter to the editor in response to an article regarding the association of small intestinal bacterial overgrowth with irritable bowel syndrome.

Presents a response by Michael P. Jones to a letter to the editor about his article on the effectiveness of topical pharyngeal anesthesia in improving tolerance of upper endoscopy.