Constipation and Syncope

2021 ◽  
pp. 143-145
Author(s):  
Michelle F. Devine ◽  
Sean J. Pittock
Keyword(s):  
Gastrointestinal Tract ◽  
Intravenous Immunoglobulin ◽  
Colonic Transit ◽  
Gastrostomy Tube ◽  
Gastrointestinal Dysmotility ◽  
Initial Onset ◽  
Thyroid Hormone Replacement Therapy ◽  
Sweat Testing ◽  
Autonomic Reflex ◽  
Irritable Bowel

A 43-year-old woman sought care for severe constipation associated with syncopal episodes. Her constipation alternated with explosive diarrhea. Chronic left-sided abdominal pain and severe bloating developed after eating. She was diagnosed with irritable bowel syndrome. After the initial onset of symptoms, nausea, bloating, and intractable vomiting developed. Symptoms were exacerbated by food and were partially relieved with vomiting. She had multiple episodes of bilious, undigested emesis per day. Trials of antiemetics and motility agents provided no substantial relief. She adopted a liquid diet, avoided solid foods, and eventually had a gastrostomy tube placed. She lost at least 15.9 kg over 2 years. Review of systems was significant for generalized fatigue and a burning sensation in her hands and feet. Her medical history was pertinent for Graves disease previously treated with remote thyroid radioablation, and she was now taking thyroid hormone replacement therapy. Neurologic examination findings were normal except for unreactive pupillary light reflexes. A gastrointestinal tract transit study showed persistently delayed colonic transit with mildly delayed gastric emptying. Autonomic reflex screening showed diffuse postganglionic sympathetic sudomotor, severe cardiovagal, and severe cardiovascular adrenergic impairment. Thermoregulatory sweat testing showed diffuse anhidrosis. Creatinine value was mildly increased. The serum was strongly positive for ganglionic (alpha 3) acetylcholine receptor-immunoglobulin G. The findings strongly suggested an autonomic autoimmune polyganglionopathy, with autoimmune gastrointestinal dysmotility as the predominant phenotype. She received intravenous immunoglobulin. She had complete resolution of her previous constipation, nausea, and vomiting. She regained 22.7 kg. Her gastrostomy tube was removed. Repeated gastrointestinal tract transit studies approached normal findings. Repeated autonomic testing and thermoregulatory sweat testing showed improvement. Over several months, the intravenous immunoglobulin dose was tapered. The patient remained asymptomatic for 8 years on long-term immunosuppression with azathioprine, she had a recurrence of her previous symptoms. Repeated gastrointestinal tract transit studies again showed delayed gastrointestinal tract emptying. Another intravenous immunoglobulin course controlled her symptoms, with normalization of gastrointestinal tract transit studies. Autoimmune gastrointestinal dysmotility can manifest as either hypomotility or hypermotility but most often presents as gastroparesis or pseudo-obstruction. Symptoms include nausea, vomiting, bloating, early satiety, diarrhea, constipation, and involuntary weight loss. It can be idiopathic or paraneoplastic. Risk factors for idiopathic cases include personal or family histories of autoimmunity.

Orthostatism, Constipation, and Early Satiety

2021 ◽  
pp. 140-142
Author(s):  
Kamal Shouman ◽  
Eduardo E. Benarroch
Keyword(s):  
Gastric Emptying ◽  
Intravenous Immunoglobulin ◽  
Disease Status ◽  
Pupillary Response ◽  
Neurologic Examination ◽  
Autoimmune Autonomic Ganglionopathy ◽  
Breast Nodule ◽  
Sweat Testing ◽  
Autonomic Reflex ◽  
Irritable Bowel

A 65-year-old woman with a history of Graves disease, status post radioactive iodine therapy, and a biopsy-proven benign calcified breast nodule sought care for evaluation of multiple symptoms. She had constipation for 8 years, with prior fecal urgency, and intermittent diarrhea for the previous year. She was diagnosed with irritable bowel syndrome. Her weight remained stable until 1 1/2 years earlier, and she had lost 6.8 kg. For the previous 3 years, the patient had experienced multiple urinary symptoms including hesitancy, urgency, incontinence, and retention. She was diagnosed with a cystocele, the correction of which did not help. She had noted difficulty focusing her eyes when moving from a dark to a well-lit environment, or vice versa. She also reported orthostatic light-headedness for 1½years, which worsened on exposure to a hot environment. Neurologic examination showed abnormally dilated pupils with prominently sluggish constriction in response to light. Autonomic reflex screening indicated patchy postganglionic sympathetic sudomotor, marked cardiovagal, and cardiovascular adrenergic failure, with neurogenic orthostatic hypotension. Thermoregulatory sweat testing showed 82% anhidrosis. A nuclear medicine gastric-emptying study indicated delayed gastric emptying and colonic hypomotility. Serum testing was markedly positive for ganglionic (alpha 3) acetylcholine receptor autoantibodies. The patient was diagnosed with autoimmune autonomic ganglionopathy. The patient received intravenous immunoglobulin. She returned and reported 80% improvement in all symptoms, and neurologic examination showed normal pupillary response to light. Autonomic reflex screening indicated improvement of her adrenergic function, and thermoregulatory sweat testing showed an impressive improvement of her sudomotor function. Her postganglionic sympathetic sudomotor and cardiovagal function remained impaired. Gastric emptying remained mildly delayed. She was maintained on intravenous immunoglobulin, which was later tapered after azathioprine was started. Autoimmune autonomic ganglionopathy usually presents subacutely, much like other autoimmune neurologic diseases. Typical features of this disorder are the impaired pupillary reaction to light and prominent sicca symptoms, indicating prominent cranial parasympathetic (cholinergic) impairment. Also consistent with this diagnosis are the prominent gastrointestinal tract symptoms. Prominent cholinergic failure helps distinguish autoimmune autonomic ganglionopathy from peripheral autonomic neuropathy or neurodegenerative disorders such as pure autonomic failure.

scholarly journals Error analysis of classic colonic transit time estimates

2000 ◽  
Vol 279 (3) ◽  
pp. G520-G527 ◽  
Author(s):  
Michel Bouchoucha ◽  
S. Randall Thomas
Keyword(s):  
Colonic Transit ◽  
X Rays ◽  
Control Subjects ◽  
Time Estimates ◽  
Transit Times ◽  
Daily Ingestion ◽  
Kinetic Coefficients ◽  
Classic Approach ◽  
Healthy Control ◽  
Irritable Bowel

Estimates of colonic transit times (CTT) through the three colonic segments, right colon, left colon, and rectosigmoid, are commonly based on radiopaque markers. For a given segment, CTT is usually calculated from just the number of markers visible in that segment on abdominal X-rays. This procedure is only strictly valid for the theoretical, but unrealistic, case of continuous marker ingestion (i.e., not for a single or once-daily ingestion). CTT was analyzed using the usual estimate of the mean CTT of one marker and also using a new, more realistic estimate based on the kinetic coefficients of a three-compartment colonic model. We directly compared our compartmental approach to classic CTT estimates by double-marker studies in six patients. We also retrospectively studied CTT in 148 healthy control subjects (83 males, 65 females) and 1,309 subjects with functional bowel disorders (irritable bowel syndrome or constipation). Compared with the compartmental estimates, the classic approach systematically underestimates CTT in both populations, i.e., in patients and in healthy control subjects. The relative error could easily reach 100% independent of the site of colonic transit delay. The normal values of total CTT are then 44.3 ± 29.3 instead of 30.1 ± 23.6 h for males and 68.2 ± 54.4 instead of 47.1 ± 28.2 h for females.

scholarly journals Quality of Life and Level of Physical Activity In Students with and without Symptoms of Functional Dyspepsia and Irritable Bowel Syndrome Surveyed with Questionnaire “7×7” (7 Symptoms Per 7 Days)

2020 ◽  
Vol 30 (3) ◽  
pp. 36-41
Author(s):  
T. V. Zhestkova
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Irritable Bowel Syndrome ◽  
Gastrointestinal Tract ◽  
Functional Dyspepsia ◽  
Functional Disorders ◽  
Men And Women ◽  
Moderate Severity ◽  
Irritable Bowel

Aim. Assessment of the quality of life and physical activity level in students with and without symptoms of functional dyspepsia (FD) and irritable bowel syndrome (IBS) according to questionnaire “7×7” (7 symptoms per 7 days).Materials and methods. Symptoms of FD and IBS were surveyed using the “7×7” questionnaire. Level of physical activity was evaluated according to the short IPAQ, and quality of life — to WAM questionnaires.Results. The study surveyed 92 students aged 20.7 ± 0.2 years (56 men and 36 women). We report borderline manifestations of functional disorders of the gastrointestinal tract (GIT) in 51.1 %, and FD and/or IBS symptoms of mild to moderate severity in 23.9 % of respondents. Symptoms of FD and/or IBS were equally common in men and women. Severity of FD and/or IBS symptoms was rated 4 [[3; 7] in men and 4 [[4; 11] in women (p = 0.25). Physical activity of 57.6 % in students corresponded to a moderate level. Healthy students were more likely to exhibit higher physical activity than individuals with FD and/or IBS symptoms, 56.5 and 31.9 %, respectively (p = 0.04). The level of wellbeing and severity of FD and/or IBS symptoms correlated negatively (r = –0.28, p = 0.01). Wellbeing and mood correlated directly with physical activity, r = 0.33, p = 0.001 and r = 0.27, respectively (p = 0.01).Conclusions. 1. Symptoms of FD and/or IBS occur widely among students and equally in men and women. Functional disorders of the gastrointestinal tract of mild to moderate severity occur in 23.9 % of students, with borderline symptoms registered with every second individual. 2. Healthy students significantly more often exhibited higher physical activity compared to individuals with FD and/or IBS symptoms of varying severity in the ratios of 56.5 and 31.9 % (p = 0.04). 3. Severity of FD and/or IBS in students negatively correlates with the wellbeing component of quality of life (r = –0.28, p = 0.01).

Genetic Susceptibility to Inflammation is Associated With Colonic Transit and Other Intermediate Phenotypes in Irritable Bowel Syndrome

2011 ◽  
Vol 140 (5) ◽  
pp. S-152 ◽  
Author(s):  
Michael Camilleri ◽  
Paula Carlson ◽  
Sanna McKinzie ◽  
Marco Zucchelli ◽  
Mauro D'Amato ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Genetic Susceptibility ◽  
Colonic Transit ◽  
Intermediate Phenotypes ◽  
Irritable Bowel

Combined detection of inorganic syndromes of the gastrointestinal tract and their differential diagnosis.

2021 ◽  
Vol 2021 (2) ◽  
pp. 68-71
Author(s):  
R.I. Khalafova ◽  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Differential Diagnosis ◽  
Gastrointestinal Tract ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Functional Dyspepsia ◽  
Military Personnel ◽  
Reflux Disease ◽  
Irritable Bowel ◽  
Combined Detection

To study the frequency of detection of combinations of the main syndromes of the gastrointestinal tract (GIT) and their differential diagnosis, consisting of irritable bowel syndrome (IBS), syndrome of functional dyspepsia (SFD), chronic idiopathic dyspepsia (CIT) and gastroesophageal reflux disease (GERD). The main gastrointestinal syndromes are quite often detected among different groups of military personnel and members of their families. ES plays an important role in their formation. International recommendations allow anamnestic diagnosis of each of the syndromes in separately and in combination with each other. The medical appealability of patients depends on the severity of the symptoms of the syndromes, it is most pronounced when they are combined.

scholarly journals 2103 Fecal bile acids, fecal short-chain fatty acids, and the intestinal microbiota in patients with irritable bowel syndrome (IBS) and control volunteers

2018 ◽  
Vol 2 (S1) ◽  
pp. 12-13
Author(s):  
Andrea Shin ◽  
David Nelson ◽  
John Wo ◽  
Michael Camilleri ◽  
Toyia James-Stevenson ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Bile Acid ◽  
Organic Acids ◽  
Gastrointestinal Transit ◽  
Fecal Microbiota ◽  
Colonic Transit ◽  
Short Chain ◽  
Fecal Excretion ◽  
Acid Excretion ◽  
Irritable Bowel

OBJECTIVES/SPECIFIC AIMS: Objectives and goals of this study will be to: (1) compare fecal microbiota and fecal organic acids in irritable bowel syndrome (IBS) patients and controls and (2) investigate the association between colonic transit and fecal microbiota in IBS patients and controls. METHODS/STUDY POPULATION: We propose an investigation of fecal organic acids, colonic transit and fecal microbiota in 36 IBS patients and 18 healthy controls. The target population will be adults ages 18–65 years meeting Rome IV criteria for IBS (both diarrhea- and constipation-predominant, IBS-D and IBS-C) and asymptomatic controls. Exclusion criteria are: (a) history of microscopic colitis, inflammatory bowel disease, celiac disease, visceral cancer, chronic infectious disease, immunodeficiency, uncontrolled thyroid disease, liver disease, or elevated AST/ALT>2.0× the upper limit of normal, (b) prior radiation therapy of the abdomen or abdominal surgeries with the exception of appendectomy or cholecystectomy >6 months before study initiation, (c) ingestion of prescription, over the counter, or herbal medications affecting gastrointestinal transit or study interpretation within 6 months of study initiation for controls or within 2 days before study initiation for IBS patients, (d) pregnant females, (e) antibiotic usage within 3 months before study participation, (f) prebiotic or probiotic usage within the 2 weeks before study initiation, (g) tobacco users. Primary outcomes will be fecal bile acid excretion and profile, short-chain fatty acid excretion and profile, colonic transit, and fecal microbiota. Secondary outcomes will be stool characteristics based on responses to validated bowel diaries. Stool samples will be collected from participants during the last 2 days of a 4-day 100 g fat diet and split into 3 samples for fecal microbiota, SCFA, and bile acid analysis and frozen. Frozen aliquots will be shipped to the Metabolite Profiling Facility at Purdue University and the Mayo Clinic Department of Laboratory Medicine and Pathology for SCFA and bile acid measurements, respectively. Analysis of fecal microbiota will be performed in the research laboratory of Dr David Nelson in collaboration with bioinformatics expertise affiliated with the Nelson lab. Colonic transit time will be measured with the previously validated method using radio-opaque markers. Generalized linear models will be used as the analysis framework for comparing study endpoints among groups. RESULTS/ANTICIPATED RESULTS: This study seeks to examine the innovative concept that specific microbial signatures are associated with increased fecal excretion of organic acids to provide unique insights on a potential mechanistic link between altered intraluminal organic acids and fecal microbiota. DISCUSSION/SIGNIFICANCE OF IMPACT: Results may lead to development of targets for novel therapies and diagnostic biomarkers for IBS, emphasizing the role of the fecal metabolome.

Muscarinic Analgesics with Potent and Selective Effects on the Gastrointestinal Tract:  Potential Application for the Treatment of Irritable Bowel Syndrome

1997 ◽  
Vol 40 (4) ◽  
pp. 538-546 ◽  
Author(s):  
Charles H. Mitch ◽  
Thomas J. Brown ◽  
Frank P. Bymaster ◽  
David O. Calligaro ◽  
Donna Dieckman ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Gastrointestinal Tract ◽  
Potential Application ◽  
Irritable Bowel ◽  
Selective Effects

Uncoordinated colonic transit in patients with irritable bowel syndrome

1995 ◽  
Vol 108 (4) ◽  
pp. A616
Author(s):  
Y. Horikawa ◽  
H. Mieno ◽  
T. Ishida ◽  
T. Shimatani ◽  
M. Inoue ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Colonic Transit ◽  
Irritable Bowel

scholarly journals Association of HLA-DQ gene with bowel transit, barrier function, and inflammation in irritable bowel syndrome with diarrhea

2012 ◽  
Vol 303 (11) ◽  
pp. G1262-G1269 ◽  
Author(s):  
Maria I. Vazquez-Roque ◽  
Michael Camilleri ◽  
Thomas Smyrk ◽  
Joseph A. Murray ◽  
Jessica O'Neill ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Protein Expression ◽  
Mrna Expression ◽  
Barrier Function ◽  
Intraepithelial Lymphocytes ◽  
Colonic Transit ◽  
Mucosal Inflammation ◽  
Hla Dq ◽  
Irritable Bowel ◽  
Hla Dq2

Patients with irritable bowel syndrome (IBS) with diarrhea (IBS-D) carrying human leukocyte antigen (HLA)-DQ2/8 genotypes benefit from gluten withdrawal. Our objective was to compare gastrointestinal barrier function, mucosal inflammation, and transit in nonceliac IBS-D patients and assess association with HLA-DQ2/8 status. In 45 IBS-D patients who were naive to prior exclusion of dietary gluten, we measured small bowel (SB) and colonic mucosal permeability by cumulative urinary lactulose and mannitol excretion (0–2 h for SB and 8–24 h for colon), inflammation on duodenal and rectosigmoid mucosal biopsies (obtained in 28 of 45 patients), tight junction (TJ) protein mRNA and protein expression in SB and rectosigmoid mucosa, and gastrointestinal and colonic transit by validated scintigraphy. SB mucosal biopsies were stained with hematoxylin-eosin to assess villi and intraepithelial lymphocytes, and immunohistochemistry was used to assess CD3, CD8, tryptase, and zonula occludens 1 (ZO-1); colonic biopsy intraepithelial lymphocytes were quantitated. Associations of HLA-DQ were assessed using Wilcoxon's rank-sum test. Relative to healthy control data, we observed a significant increase in SB permeability ( P < 0.001), a borderline increase in colonic permeability ( P = 0.10), and a decrease in TJ mRNA expression in rectosigmoid mucosa in IBS-D. In HLA-DQ2/8-positive patients, ZO-1 protein expression in the rectosigmoid mucosa was reduced compared with that in HLA-DQ2/8-negative patients and colonic transit was slower than in HLA-DQ2/8-negative patients. No other associations with HLA genotype were identified. There is abnormal barrier function (increased SB permeability and reduced mRNA expression of TJ proteins) in IBS-D relative to health that may be, in part, related to immunogenotype, given reduced ZO-1 protein expression in rectosigmoid mucosa in HLA-DQ2/8-positive relative to HLA-DQ2/8-negative patients.

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