Gastrointestinal (GI) symptoms, quality of life and endoscopic diagnoses in patients with upper GI symptoms

Abstract Background Patients with type 1 Diabetes Mellitus (T1DM) often suffer with gastrointestinal (GI) symptoms, such as abdominal pain, bloating, early satiety, nausea and vomiting. T1DM patients are at a higher risk to develop celiac disease, and those patient with both disorders benefit from a gluten-free diet (GFD). However, it is unknown whether GFD has any benefit in patients with T1DM without celiac disease who present with upper GI symptoms. Aims To investigate the role of GFD in the management of moderate to severe dyspeptic symptoms in non-celiac patients with T1DM. Methods We enrolled adult T1DM patients, in whom celiac disease was ruled out by serology and/or endoscopy, suffering with two or more of upper GI symptoms. The patients were instructed to undergo a strict GFD for a period of 1 month, under supervision of a dietitian. Glycemic levels were monitored by a continuous glucose monitoring device (CGM) for 2 weeks before, and for 2 weeks at the end of the GFD period. Upper GI symptoms, general quality of life, anxiety and depression were assessed using standardized questionnaires. Blood samples were collected to assess glycaemia (Hb1Ac) and lipid profiles. Scintigraphy and videofluoroscopy were used to assess gastric emptying. Results Seven patients finished the study so far. They reported a significant improvement in nausea (p<0.05), sensation of fullness (p<0.01), bloating (p<0.01), feeling of excessive fullness after meals (p<0.01) and having stomach visibly larger after meals (p<0.01). 5 out of the 7 patients reported an improvement in general quality of life, based on PAGI-QOL (Patient Assessment of Upper Gastrointestinal Disorders – Quality of Life), and decreased anxiety levels (HADS, Hospital Anxiety and Depression Score). There was no significant change in mean glucose level, time in target, glucose variance and HbA1c levels after GFD. However, there was a trend for less time spent in hypoglycemia, namely in those patients who experienced frequent hypoglycemia prior to GFD. Overall, there was no change in serum lipid profile or gastric emptying. Conclusions One month of GFD improved dyspepsia-like symptoms, general quality of life and anxiety levels in T1D patients without concomitant celiac disease. GFD also improved the blood glucose management of patients with frequent hypoglycemia. Thus, this dietary intervention appears to improve upper GI symptoms in T1D patients but the results need to be replicated in a larger patient cohort. Funding Agencies CIHR

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Gastrointestinal (GI) symptoms, quality of life and endoscopic diagnoses in patients with upper GI symptoms

Gastroenterology ◽

10.1016/s0016-5085(01)81187-2 ◽

2001 ◽

Vol 120 (5) ◽

pp. A239-A240

Author(s):

E BOLLINGSTERNEVALD ◽

R CARLSSON ◽

C AALYKKE ◽

B WILSON ◽

O JUNGHARD ◽

...

Keyword(s):

Quality Of Life ◽

Upper Gi ◽

Gi Symptoms

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Improved gastrointestinal profile with diroximel fumarate is associated with a positive impact on quality of life compared with dimethyl fumarate: results from the randomized, double-blind, phase III EVOLVE-MS-2 study

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286421993999 ◽

2021 ◽

Vol 14 ◽

pp. 175628642199399 ◽

Cited By ~ 1

Author(s):

Annette Wundes ◽

Sibyl Wray ◽

Ralf Gold ◽

Barry A. Singer ◽

Elzbieta Jasinska ◽

...

Keyword(s):

Quality Of Life ◽

Medication Use ◽

Dimethyl Fumarate ◽

Daily Activities ◽

Phase Iii ◽

Symptomatic Medication ◽

Gi Symptoms ◽

Symptom Intensity ◽

The Impact

Background: Diroximel fumarate (DRF) is a novel oral fumarate approved for relapsing forms of multiple sclerosis (MS). DRF demonstrated significantly improved gastrointestinal (GI) tolerability versus dimethyl fumarate (DMF) with fewer days of Individual Gastrointestinal Symptom and Impact Scale (IGISIS) scores ⩾2, GI adverse events (AEs), and treatment discontinuations due to GI AEs. Our aim was to evaluate the impact of GI tolerability events on quality of life (QoL) for patients with relapsing–remitting MS who received DRF or DMF in EVOLVE-MS-2. Methods: A post hoc analysis was conducted in patients who were enrolled in the randomized, blinded, 5-week, EVOLVE-MS-2 [ClinicalTrials.gov identifier: NCT03093324] study of DRF versus DMF. Patients completed daily IGISIS and Global GISIS (GGISIS) eDiary questionnaires to assess GI symptom intensity and interference with daily activities and work. Results: In total, 504 patients (DRF, n = 253; DMF, n = 251) received study drug and 502 (DRF, n = 253; DMF, n = 249) completed at least one post-baseline questionnaire. With DRF, GI symptoms were less likely to interfere ‘quite a bit’ or ‘extremely’ with regular daily activities [IGISIS: DRF, 9.5% (24/253) versus DMF, 28.9% (72/249)] or work productivity [GGISIS: DRF, 6.1% (10/165) versus DMF, 11.3% (18/159)]. DRF-treated patients had fewer days with ⩾1 h of missed work (DRF, 43 days, n = 20 versus DMF, 88 days, n = 26). DMF-treated patients reported highest GI symptom severity and missed work at week 2–3 shortly after completing the titration period, which coincided with the majority of GI-related treatment discontinuations [58.3% (7/12)]. GI tolerability AEs [DRF, 34.8% (88/253); DMF, 48.2% (121/251)], concomitant symptomatic medication use [DRF, 19.3% (17/88) versus DMF, 30.6% (37/121)], and GI-related discontinuations (DRF, 0.8% versus DMF, 4.8%) were lower with DRF versus DMF. Conclusions: The improved GI tolerability with DRF translated into clinically meaningful benefits to QoL, as patients experienced less impact on daily life and work and required less concomitant symptomatic medication use. Trial registration: [ClinicalTrials.gov identifier: NCT03093324]

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Quality of life in patients with upper GI malignancies managed by a strategy of chemoradiotherapy alone versus surgery

Surgical Oncology ◽

10.1016/j.suronc.2019.05.021 ◽

2019 ◽

Vol 30 ◽

pp. 33-39

Author(s):

Lauren O'Connell ◽

Mary Coleman ◽

N. Kharyntiuk ◽

Thomas N. Walsh

Keyword(s):

Quality Of Life ◽

Upper Gi

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FRI0233 IMPACT AND ADHERENCE TO THE MEDITERRANEAN DIET IN SYSTEMIC SCLEROSIS ITALIAN PATIENTS: CORRELATION WITH GASTROINTESTINAL SYMPTOMS, MOOD DISTURBANCES AND QUALITY OF LIFE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5470 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 700.2-700

Author(s):

G. De Luca ◽

G. Natalello ◽

G. Abignano ◽

C. Campochiaro ◽

D. Temiz Karadağ ◽

...

Keyword(s):

Quality Of Life ◽

Systemic Sclerosis ◽

Mediterranean Diet ◽

Dietary Habits ◽

Anxiety And Depression ◽

Research Support ◽

Work Impairment ◽

Gi Symptoms ◽

The Mediterranean

Background:Gastrointestinal involvement(GI) is a common feature of systemic sclerosis(SSc) and can be highly disabling, representing a major cause of morbidity and reduced quality of life(QoL). The impact of dietary habits on GI symptoms, mood and QoL has not been extensively evaluated.Objectives:To evaluate the adherence to the Mediterranean Diet(MD) in an Italian multicenter cohort of SSc patients, and its impact on GI symptoms and other disease features, depression, anxiety and overall QoL.Methods:Consecutive SSc(ACR/EULAR2013) patients from 4 Italian cohorts were enrolled. Dietary habits and adherence to the MD were assessed using the 14-item MEDAS and QueMD questionnaires. Presence and severity of depressive/anxious symptoms and QoL were evaluated with the Hospital Anxiety and Depression Scale(HADS) and the SSc-HAQ(S-HAQ). GI symptoms were assessed with the Reflux Disease Questionnaire(RDQ) and the UCLA SCTC GI Tract 2.0 questionnaire(USG). Associations with patients’ lifestyle, disease characteristics, and nutritional status were explored.Results:265 patients (94.7% females; age 55.8±13.6years; disease duration 9.1±7.0years; diffuse SSc 31.8%; Scl70 + 35.8%;ulcers 23.4%;ILD 29.4%;BMI 23.7±4.4 Kg/m2; obese 11.3%,overweight 23.4%,underweight 4.9%) were enrolled.Overall MD adherence was moderate(7.5±1.9) according to MEDAS and it correlated with QueMD score(4.53±1.96)(R=.371,p<0.001). MD adherence was optimal in 39 patients(14.7%), more frequently from Central-Southern Italy(p=0.036); 189 patients(71.3%) had a good and 37(14.0%) a poor MD adherence.GI symptoms were moderate/severe according to USG in 37(14.0%) patients(USG:0.41±0.40), and heartburn was the most common GI symptom(35.2%). The prevalence of significant anxiety and depression was 24.1% and 17.0%.An inverse correlation was found between MD adherence and mood disturbances at HADS(MEDAS; R=-0.181,p=0.04), work impairment(QueMD;R=-0.247,p=0.005) and reduced QoL, both for GI (constipation at USG: R=-0.133,p=0.032) and general S-HAQ items(bowel:R=-0.181,p=0.04;severity R=-0.202,p=0.01;Raynaud:R=-0.217,p<0.001;ulcers: R=-0.207,p=0.01). MD adherence directly correlated with lung function(MEDAS;R=0.181,p=0.023 for FVC and R=0.170,p=0.03 for DLCO). Patients with MD optimal adherence had lower HADS depression(p=0.04) and S-HAQ scores(HAQ,p=0.04; Raynaud,p=0.005; ulcers,p=0.02) and lower work impairment and lost work time(p=0.03). No significant correlation emerged between MD adherence and BMI, or specific symptoms. Depression and anxiety directly correlated with the severity of reported upper GI symptoms according to both scales (RDQ-GERD:R=0.261,p=0.001; USG:R=0.263,p<0.001) and general S-HAQ items (HAQ: R=0.136,p=0.032;severity R=0.233,p<0.001;bowel: R=0.135,p=0.04;breath: R=0.133,p=0.03; ulcers: R=0.132,p=0.037). Results were confirmed after exclusion of psychiatric(11.7%) and fibromyalgic(15.5%) patients.Conclusion:Unsatisfactory MD adherence is associated with a low mood, impaired QoL, work impairment, GI and vascular symptoms in Italian SSc patients. The promotion of a healthy lifestyle could positively impact on QoL and disease status of SSc patients.References:[1]Gnagnarella P, et a. NMCD 2018. DOI: 10.1016/j.numecd.2018.06.006[2]Jaeger VK et al. PLoS One, 2016.[3]Dinu M et al. Eur J Clin Nutr 2018. doi: 10.1038/ejcn.2017.58.[4]Khanna D, et al.Arthritis Rheum. 2009. doi: 10.1002/art.24730.Acknowledgments:GILSDisclosure of Interests:Giacomo De Luca Grant/research support from: SOBI, Speakers bureau: SOBI, Novartis, Pfizer, MSD, Celgene, Gerlando Natalello: None declared, Giuseppina Abignano: None declared, Corrado Campochiaro Speakers bureau: Novartis, Pfizer, Roche, GSK, SOBI, Duygu Temiz Karadağ: None declared, Maria De Santis: None declared, Elisa Gremese Speakers bureau: Abbvie, BMS, Celgene, Jannsen, Lilly, MSD, Novartis, Pfizer, Sandoz, UCB, Silvia Laura Bosello Speakers bureau: Abbvie, Pfizer, Boehringer, Lorenzo Dagna Grant/research support from: Abbvie, BMS, Celgene, Janssen, MSD, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, SG, SOBI, Consultant of: Abbvie, Amgen, Biogen, BMS, Celltrion, Novartis, Pfizer, Roche, SG, and SOBI

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Efficacy of Lactobacillus paracasei HA-196 and Bifidobacterium longum R0175 in Alleviating Symptoms of Irritable Bowel Syndrome (IBS): A Randomized, Placebo-Controlled Study

Nutrients ◽

10.3390/nu12041159 ◽

2020 ◽

Vol 12 (4) ◽

pp. 1159 ◽

Cited By ~ 1

Author(s):

Erin D. Lewis ◽

Joseph M. Antony ◽

David C. Crowley ◽

Amanda Piano ◽

Renu Bhardwaj ◽

...

Keyword(s):

Quality Of Life ◽

Irritable Bowel Syndrome ◽

Bifidobacterium Longum ◽

Well Being ◽

Lactobacillus Paracasei ◽

Controlled Study ◽

Double Blind ◽

Gi Symptoms ◽

Irritable Bowel

Specific probiotic strains can alleviate the gastrointestinal (GI) symptoms and psychiatric comorbidities of irritable bowel syndrome (IBS). In this randomized, double-blind, placebo-controlled study, the efficacy of Lactobacillus paracasei HA-196 (L. paracasei) and Bifidobacterium longum R0175 (B. longum) in reducing the GI and psychological symptoms of IBS was evaluated in 251 adults with either constipation (IBS-C), diarrhea (IBS-D), or mixed-pattern (IBS-M). Following a 2-week run-in period, participants were randomized to one of three interventions: L. paracasei (n = 84), B. longum (n = 83) or placebo (n = 81). IBS symptoms, stool frequency and consistency and quality of life were assessed by questionnaires. The differences from baseline in the severity of IBS symptoms at 4 and 8 weeks were similar between groups. Participants in this study were classified, after randomization, into subtypes according to Rome III. Within the L. paracasei group, complete spontaneous and spontaneous bowel movement frequency increased in participants with IBS-C (n = 10) after 8 weeks of supplementation (both p < 0.05) and decreased in participants with IBS-D (n = 10, p = 0.013). Both L. paracasei and B. longum supplementation improved the quality of life in emotional well-being and social functioning compared with baseline (all p < 0.05). In conclusion, L. paracasei and B. longum may reduce GI symptom severity and improve the psychological well-being of individuals with certain IBS subtypes.

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“Complications of Gastrointestinal System in Diabetes Mellitus”- Neglected Part of Diabetic Management

Iranian journal of diabetes and obesity ◽

10.18502/ijdo.v12i3.4459 ◽

2020 ◽

Author(s):

Jayanta Paul ◽

Ambalathu Veettil Hussain SHIHAZ

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

Daily Life ◽

Clinical Suspicion ◽

Complications Of Diabetes ◽

Gi Symptoms ◽

Liver And Pancreas ◽

Proper Diagnosis ◽

Prevalence Of Diabetes Mellitus

The incidence and prevalence of diabetes mellitus and its complications are increasing. Like other complications, most of the diabetes patients have gastrointestinal (GI) symptoms but in majority of cases GI complications are under diagnosed and not treated properly, resulting in impairment of the quality of daily life. GI system including liver and pancreas are involved in diabetes mellitus. These GI complications of diabetes mellitus need proper diagnosis and treatment to get a quality of life and clinician needs clinical suspicion to identify and proper knowledge to treat.

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Impact of Opioid Consumption in Patients With Functional Gastrointestinal Disorders

Frontiers in Pharmacology ◽

10.3389/fphar.2020.596467 ◽

2020 ◽

Vol 11 ◽

Author(s):

Chloé Melchior ◽

Charlotte Desprez ◽

Fabien Wuestenberghs ◽

Anne-Marie Leroi ◽

Antoine Lemaire ◽

...

Keyword(s):

Quality Of Life ◽

Irritable Bowel Syndrome ◽

Functional Dyspepsia ◽

Functional Gastrointestinal Disorders ◽

Opioid Consumption ◽

University Hospital ◽

Gastrointestinal Disorders ◽

Gi Symptoms ◽

Irritable Bowel

Objective: We aimed to determine the burden of opioid consumption in a cohort of patients with functional gastrointestinal disorders.Methods: All patients diagnosed with functional gastrointestinal disorders and referred to our university hospital were evaluated from 2013 to the beginning of 2019. Irritable bowel syndrome and functional dyspepsia diagnoses were determined according to Rome criteria and severity according to irritable bowel syndrome severity scoring system. Vomiting was quantified using a 5-point Likert scale, and constipation severity was measured using the Knowles-Eccersley-Scott-Symptom questionnaires. Quality of life was quantified by the GastroIntestinal Quality of Life Index. Patients were categorized as being treated on a chronic basis with either tramadol, step II opioids, step III opioids or as being opioid-free.Results: 2933 consecutive patients were included. In our cohort, 12.5% had only irritable bowel syndrome, 39.3% had only functional dyspepsia, 24.9% had a combination of both, and 23.4% had other functional gastrointestinal disorders. Among them, the consumption of tramadol, step II (tramadol excluded) and step III opioids was 1.8, 1.3 and 0.3 % respectively in 2013 and 4.3, 3.4 and 1.9% in 2018 (p < 0.03). Opioid consumption was associated with increased vomiting (p = 0.0168), constipation (p < 0.0001), symptom severity (p < 0.001), more altered quality of life (p < 0.0001) and higher depression score (p = 0.0045).Conclusion: In functional gastrointestinal disorders, opioid consumption has increased in the last years and is associated with more GI symptoms (vomiting, constipation and GI severity), higher depression and more altered quality of life.

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Gastrointestinal symptoms of pelvic radiation disease (part 1): literature review

Gastrointestinal Nursing ◽

10.12968/gasn.2020.18.2.40 ◽

2020 ◽

Vol 18 (2) ◽

pp. 40-45 ◽

Cited By ~ 1

Author(s):

Helen Ludlow ◽

John Green

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Literature Review ◽

Patient Experience ◽

Gastrointestinal Symptoms ◽

Pelvic Radiation ◽

Gi Symptoms ◽

Pelvic Cancer ◽

The Impact

Radiotherapy used to treat cancers in the pelvic region can have lasting side effects, and the persistence of these symptoms for 3 months or more is described as pelvic radiation disease (PRD). The growing number of pelvic cancer patients being diagnosed and successfully treated is increasing the incidence of PRD. This review examines the literature on the gastrointestinal symptoms of PRD. This includes how PRD is defined, how it is identified and how it relates specifically to the three pelvic cancers in which it most commonly manifests (prostate, gynaecological and colorectal). It pays particular attention to the impact of PRD on patient experience and quality of life. This review is the first part in a series on the GI symptoms of PRD.

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