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Objectives: Irritable bowel syndrome (IBS) may be associated with disturbances in gut microbiota composition and functions. We recently performed a study of fecal microbiota transplantation (FMT) in diarrhea-predominant IBS (IBS-D) and found that IBS symptoms improved and the gut microbiota profile changed following FMT. We now aimed to explore the effects of FMT on the gut microenvironment in further detail by using 16S rRNA sequencing for more extended microbiota profiling and analyzing bacterial fermentation products (SCFAs: short chain fatty acids). Materials and methods: The study included 13 patients (four females and nine males) with IBS-D according to Rome III criteria and 13 healthy donors. Freshly donated feces were administered into duodenum via gastroscopy. The patients completed symptom and quality of life (QoL) questionnaires and delivered feces before and 1, 3, 12 and 20/28 weeks after FMT. Microbiota analysis was performed by sequencing 16S rRNA gene with Illumina Miseq technology. Fecal concentrations of SCFAs were analyzed by vacuum distillation followed by gas chromatography. Results: Several gut microbiota taxa and SCFAs were significantly different in the patients at baseline compared to their donors. These differences normalized by the third week following FMT in parallel with significant improvement in symptoms and QoL. Responders had different gut microbiota profile and SCFAs than nonresponders. Significant correlations were found between the gut microenvironment and IBS symptoms. No adverse effects were reported. Conclusions: FMT restores alterations of the gut microenvironment in IBS-D patients during the first 3 weeks and improves their symptoms for up to 28 weeks. ClinicalTrials.gov ID: NCT03333291.

Patients with irritable bowel syndrome (IBS) in Asia show distinctive differences from those in the western world. The gastrointestinal endocrine cells appear to play an important role in the pathophysiology of IBS. The present study aimed at studying the density of chromogranin A (CgA) cells in the large intestine of Thai and Norwegian IBS patients.Thirty Thai IBS patients and 20 control subjects, and 47 Norwegian IBS patients and 20 control subjects were included. A standard colonoscopy was performed in both the patients and controls, and biopsy samples were taken from the colon and the rectum. The biopsy samples were stained with hematoxylin-eosin and immunostained for CgA. The density of CgA cells was determined by computerized image analysis.In the colon and rectum, the CgA cell densities were far higher in both IBS and healthy Thai subjects than in Norwegians. The colonic CgA cell density was lower in Norwegian IBS patients than in controls, but did not differ between Thai IBS patients and controls. In the rectum, the CgA cell densities in both Thai and Norwegian patients did not differ from those of controls.The higher densities of CgA cells in Thai subjects than Norwegians may be explained by a higher exposure to infections at childhood and the development of a broad immune tolerance, by differences in the intestinal microbiota, and/or differing diet habits. The normal CgA cell density in Thai IBS patients in contrast to that of Norwegians may be due to differences in pathophysiology.

To compare the effect of anti-reflux surgery (ARS) versus proton pump inhibitor therapy on lower oesophageal sphincter (LOS) function and oesophageal acid exposure in patients with chronic gastro-oesophageal reflux disease (GORD) over a decade of follow-up.In this randomised, prospective, multicentre study we compared LOS pressure profiles, as well as oesophageal exposure to acid, at baseline and at 1 and 10 years after randomisation to either open ARS (n = 137) or long-term treatment with omeprazole (OME) 20-60 mg daily (n = 108).Median LOS resting pressure and abdominal length increased significantly and remained elevated in patients operated on with ARS, as opposed to those on OME. The proportion of total time (%) with oesophageal pH4.0 decreased significantly in both the surgical and medical groups, and was significantly lower after 1 year in patients treated with ARS versus OME. After 10 years, oesophageal acid exposure was normalised in both groups, with no significant differences, and bilirubin exposure was within normal limits. After 10 years, patients with or without Barrett's oesophagus did not differ in acid reflux control between the two treatment options.Open ARS and OME were both effective in normalising acid reflux into the oesophagus even when studied over a period of 10 years. Anatomically and functionally the LOS was repaired durably by surgery, with increased resting pressure and abdominal length.

To report on the primary care consultation rates and clinical characteristics of patients with gastro-oesophageal reflux disease (GERD) as part of the RANGE (Retrospective ANalysis of GERD) observational study.RANGE was conducted at 134 primary care centres across six European countries. All subjects who consulted their primary care physician during a 4-month identification period were screened retrospectively. Those consulting for GERD-related reasons were identified, and a randomly selected cohort underwent clinical interview.Out of 373,610 consultations in the six countries, 12,815 (3.4%) were for GERD-related reasons (inter-country range: 1.4-7.4%). From 2678 patients interviewed (24.7% of whom had been previously diagnosed with reflux oesophagitis), symptom recurrence following remission was the most common reason for primary care consultation (35.1%; range: 22.3-51.7%). Some 12.7% of patients (range: 9.1-21.4%) consulted due to persistence of previous symptoms, and 16.2% (range: 8.2-35.6%) had never consulted before regarding GERD-related symptoms.consultation rates for GERD-related reasons, and the clinical characteristics of consulting patients, vary widely across Europe. Symptom recurrence after an initial period of remission, and persistent symptoms, were important reasons for consultation, emphasizing the need for improved management of primary care patients with GERD across Europe.

BACKGROUND Symptomatic response to acid inhibition can be used as a guide in diagnosing patients with reflux symptoms. The proton-pump inhibitor (PPI) omeprazole has been used as such a diagnostic tool. Intragastric acid control with esomeprazole is more effective than other PPIs and has the potential to offer an advance in the diagnostic use of PPIs. METHODS Patients experiencing heartburn (for > or = 6 months) were studied in this randomized, double-blind, multicenter study. Following a 3-day placebo run-in, 440 patients were randomized to 14 days' treatment with esomeprazole 40 mg once daily (o.d.), esomeprazole 20 mg twice daily (b.i.d.) or placebo. Heartburn symptoms were recorded daily. Endoscopy and 24-h esophageal pH-monitoring were performed to determine the presence of gastroesophageal reflux disease (GERD). The esomeprazole treatment test was considered positive if patients' symptoms improved during the treatment period compared with symptoms recorded on Day 0. RESULTS 63 patients were excluded from the analysis due to lack of symptoms on Day 0 or failure to complete pH-monitoring. The sensitivity of an esomeprazole treatment test in confirming GERD increased during the first days of treatment and stabilized between 79% and 86% after 5 days (both esomeprazole arms). The corresponding figure for the placebo arm was 36%. Specificity was variable (24%-65%) for both active treatment and placebo. CONCLUSION A treatment test with esomeprazole 40 mg has a high sensitivity in confirming GERD. Furthermore, the data indicate that 1-week treatment with a once-daily dosage is sufficient to ensure adequate diagnosis.

A substantial minority of patients with gastro-oesophageal reflux disease (GERD) are infected with Helicobacter pylori, but there is controversy as to whether these patients should be treated for their infection. We hypothesized that H. pylori eradication increases gastro-oesophageal acid reflux in such patients with time.Thirty-five consecutive H. pylori-infected patients (16 M and 19 F) with mild or moderate reflux oesophagitis were enrolled. Twenty-four-hour intra-oesophageal (n = 35) and intragastric (n = 12) pH-metry was recorded before and 15 months after H. pylori eradication. Gastric biopsy specimens from the antrum and corpus were obtained from 10 consecutive patients before and 15 months after H. pylori eradication.Fifteen months after eradication of H. pylori there was a significant decrease in percentage time oesophageal pH4 in the recumbent position only (P = 0.04). Despite a marked reduction in the severity of gastritis, there was no significant change in gastric acidity, total intra-oesophageal acid exposure or symptom score. Heartburn improved in 12, worsened in 7. and remained unchanged in 16 patients (P = 0.36) without any significant relationship to individual changes in acid exposure (P = 0.60).H. pylori eradication does not increase gastric acidity or gastro-oesophageal acid reflux in patients with mild to moderate reflux oesophagitis over the first 15 months.

The recognition of minor endoscopic changes is important in correctly diagnosing patients with reflux oesophagitis, but the significance of minor lesions and what observations to use in endoscopic classification are disputed. Our aim was to relate endoscopic observations in reflux oesophagitis with the severity of gastro-oesophageal reflux.On endoscopy of 64 consecutive untreated patients with uncomplicated reflux oesophagitis, accurate records were made prospectively of the following variables: axial extent of endoscopic changes, width of the lesions, presence of whitish exudate in the lesions, and presence and length of a hiatal hernia. Multiple linear regression analysis examined which of these factors were significantly related, at the 5% level, with gastro-oesophageal reflux as measured at intraoesophageal 24-h pH-metry.Presence of whitish exudate and width of lesions were significantly associated with severity of gastro-oesophageal reflux. Median fraction of the recording period with pH4 was 5.9% in patients with narrow red lesions, 12.5% in patients with narrow, whitish lesions, and 20.3% in patients with broad lesions (P0.0001). The mean duration of reflux episodes was significantly longer and the number of nocturnal episodes lasting more than 5 min was significantly higher in patients with broad lesions.Red spots and streaks, even without whitish exudate, are significantly related to pathologic gastro-oesophageal reflux. Whitish exudate is related to more severe reflux, and broad lesions to a longer mean duration of the episodes. The presence of whitish exudate in lesions and the width of the lesions are important observations to use in the classification of reflux oesophagitis.

Background: Gastro-oesophageal reflux disease (GORD) must be distinguished from functional dyspepsia and peptic ulcer disease because, albeit similar symptomatology, they are different diseases with greatly differing pathogenesis and treatment. Methods: A new endoscopic grading of reflux oesophagitis was applied in two large prospective studies. Results: High consistency of endoscopic findings and low predictive value of symptoms. Conclusions: The low predictive value of symptoms stresses the importance of applying solid endoscopic criteria in the assessment of GORD.

Lansoprazole is a potent antisecretory drug also possessing anti-Helicobacter pylori activity in vitro. It is a candidate drug for combination regimens with antibiotics for treating H. pylori infections.In a semiblind study, 65 patients with duodenal and/or gastric ulcer and pathologic 14C urea breath test results were treated with either 60 mg lansoprazole every morning only for 14 days or combined with 500 mg amoxicillin oral suspension four times daily between meals, given for 11 days. Endoscopy and breath test were repeated after 6 weeks and 6 months. Patients with unhealed ulcers were withdrawn.Eradication of H. pylori infection was attained in 46% of patients receiving lansoprazole and amoxicillin but in no patient receiving lansoprazole alone. Ulcers healed significantly more often in those who were H. pylori-negative (18 of 19 (95%)) than in those who were H. pylori-positive (20 of 41 (49%)). Adverse events, particularly stomatitis/sore throat and diarrhea, occurred significantly more often when amoxicillin was combined with lansoprazole.Lansoprazole eradicated H. pylori infection only when combined with amoxicillin. Eradication rates in this study are hardly acceptable, and further studies are necessary to define optimal doses and duration of treatment. Using amoxicillin as an oral suspension may not be of any substantial benefit and may cause stomatitis and sore throat.