scholarly journals What’s in the pipeline for lower functional gastrointestinal disorders in the next 5 years?

2019 ◽  
Vol 317 (5) ◽  
pp. G640-G650
Author(s):  
Michael Camilleri
Keyword(s):  
Abdominal Pain ◽  
Bile Acid ◽  
Functional Gastrointestinal Disorders ◽  
Unmet Need ◽  
Functional Constipation ◽  
Chronic Abdominal Pain ◽  
Farnesoid X Receptor ◽  
Gastrointestinal Disorders ◽  
Receptor Agonists ◽  
Novel Approaches

The overall objectives of this review are to summarize actionable biomarkers for organic etiology of lower functional gastrointestinal disorders (FGIDs) that lead to individualized treatment for their FGIDs and to assess the pipeline for novel approaches to the management of constipation, diarrhea, and chronic abdominal pain in lower FGIDs. The new approaches to therapy include ion exchangers/transporters for functional constipation (sodium-glucose cotransporter 1, Na+/H+ exchanger 3, and solute carrier family 26 member 3 inhibitors), bile acid modulators for constipation such as ileal bile acid transporter inhibitors and fibroblast growth factor 19 analog for functional constipation, and bile acid sequestrants or farnesoid X receptor agonists for functional diarrhea. Treatment for chronic abdominal pain remains an unmet need in patients with lower FGIDs, and promising novel approaches include delayed-release linaclotide, nonclassical opioid visceral analgesics, and selective cannabinoid receptor agonists. The role of probiotics, fecal microbial transplantation, and possible future microbiome therapies is discussed.

Calprotectin (S100 A8/A9) and TNF-alpha in differential diagnosis of chronic abdominal pain in children

2017 ◽  
Vol 53 (1) ◽  
pp. 5-10
Author(s):  
Stanisław Pieczarkowski ◽  
Kinga Kowalska-Duplaga ◽  
Andrzej Wędrychowicz ◽  
Krzysztof Fyderek ◽  
Przemko Kwinta ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Functional Gastrointestinal Disorders ◽  
Fecal Calprotectin ◽  
Chronic Abdominal Pain ◽  
Tnf Alpha ◽  
Gastrointestinal Disorders ◽  
Control Group ◽  
Healthy Children ◽  
Inflammatory Bowel

<i>Introduction:</i> Chronic abdominal pain in children is a very frequent and sometimes challenging diagnostic issue. Differential diagnosis in that cases is difficult and often connected with numerous, time-consuming, expensive, and frequently stressful diagnostic studies. The aim of the study was to establish whether fecal calprotectin concentration (FCC) and TNF-alpha may be useful in children with chronic abdominal pain to differentiate between inflammatory bowel disease (IBD), other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. Methods. The study included patients (median age 13 years), who were assigned to functional gastrointestinal disorders group (n=33); inflammatory gastrointestinal disorders other than IBD (n=71), children with IBD (n=37) and 22 healthy children served as a control group. The concertation of FCC and TNF-alpha in stool samples was measured using ELISA. <i>Results:</i> In healthy children and in children with functional disorders FCCs were below 100 μg/g. In patients with IBD FCCs and TNF-alpha were markedly elevated as compare to children with functional gastrointestinal disorders, however using ROC discrimination of IBD patients was significantly better using FCC than TNF-alpha. <i>Conclusion:</i> FCC is better test for differentiation between IBD, other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders as compare to TNF-alpha concentration in stool. FCC as screening test in patients with chronic abdominal pain should allow to diminish unnecessary diagnostic in cases of functional gastrointestinal disorders.

scholarly journals Functional constipation masked as irritable bowel syndrome

2020 ◽  
Author(s):  
Monica Tosto ◽  
Paola D’Andrea ◽  
Ignazio Salamone ◽  
Salvatore Pellegrino ◽  
Stefano Costa ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Abdominal Pain ◽  
Functional Gastrointestinal Disorders ◽  
Functional Constipation ◽  
Gastrointestinal Disorders ◽  
Number Of Patients ◽  
Erroneous Diagnosis ◽  
Irritable Bowel ◽  
Mixed Pattern ◽  
Rome Iv

Abstract Background Rome IV criteria for functional gastrointestinal disorders state that children suspected of having Irritable Bowel Syndrome (IBS) with Constipation (IBS-C) should be preliminarily treated for constipation. We aimed at verifying if functional constipation may indeed lead to an erroneous diagnosis of IBS with diarrhea (IBS-D) or IBS with mixed pattern of diarrhea and constipation (IBS-M).Methods We prospectively enrolled in an unblinded fashion 10 and 16 consecutive children referred to our center who met Rome IV criteria for a diagnosis of IBS-D and IBS-M, respectively. Patients who fulfilled criteria for suspect “occult constipation” were then given a bowel cleaning regimen with PEG 3350, re-evaluated at 2 months and followed up for at least 6 months. Sixteen additional patients with IBS with Constipation (IBS-C) referred in the same period served as control. The endpoints were: 1) a decrease of more than 50% in abdominal pain intensity and frequency scores; and 2) for patients with IBS-D and IBS-M: resolution of diarrhea.Results The endpoints were met by 8 (80%) and 14 (87%) of the patients with IBS-D and IBS-M, respectively, with decrease of abdominal pain and resolution of “diarrhea”. The response was not significantly different from that observed in 15 (93%) of the IBS-C control group.Conclusion acknowledging the limitations of the small number of patients and of the uncontrolled nature of the study, we suggest that a possibly large number of patients labeled as IBS-D or IBS-M may actually simply present functional constipation and should be managed as such.

scholarly journals Noninvasive vagal nerve stimulation for gastroenterology pain disorders

2021 ◽  
Vol 11 (1) ◽  
pp. 89-96
Author(s):  
Andres Gottfried-Blackmore ◽  
Aida Habtezion ◽  
Linda Nguyen
Keyword(s):  
Chronic Pain ◽  
Abdominal Pain ◽  
Nerve Stimulation ◽  
Therapeutic Approach ◽  
Review Paper ◽  
Unmet Need ◽  
Chronic Abdominal Pain ◽  
Vagal Nerve ◽  
Vagal Nerve Stimulation ◽  
Gastrointestinal Disorders

Abdominal pain continues to be a major challenge and unmet need in clinical practice. Normalization of bidirectional gut-brain signaling has generated much interest as a therapeutic approach to treat chronic abdominal pain. Vagal nerve stimulation (VNS) is emerging as a potential non-pharmacologic strategy for the treatment of abdominal pain. In this review paper, we will summarize the etiologies of chronic pain in gastrointestinal disorders and discuss the rational for VNS as a therapeutic approach to chronic abdominal pain, with particular emphasis in the gammaCore stimulator which allows for noninvasive VNS.

scholarly journals Diagnostic Value of Fecal Calprotectin (S100 A8/A9) Test in Children with Chronic Abdominal Pain

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Stanisław Pieczarkowski ◽  
Kinga Kowalska-Duplaga ◽  
Przemko Kwinta ◽  
Przemysław Tomasik ◽  
Andrzej Wędrychowicz ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Functional Gastrointestinal Disorders ◽  
Fecal Calprotectin ◽  
Chronic Abdominal Pain ◽  
Gastrointestinal Disorders ◽  
Control Group ◽  
Healthy Children ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objectives. The aim of the study was to establish whether fecal calprotectin concentration (FCC) may be useful in children with chronic abdominal pain to differentiate between inflammatory bowel disease (IBD), other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. Methods. The study included 163 patients (median age 13 years), who were assigned to four study groups: group 0 (control), 22 healthy children; group 1, 33 children with functional gastrointestinal disorders; group 2, 71 children with inflammatory gastrointestinal disorders other than IBD; group 3, 37 children with IBD. FCC was measured using ELISA assay. Results. In group 0 and group 1 FCCs were below 100 μg/g. Low FCCs were found in 91% of patients in group 2. In patients with IBD FCCs were markedly elevated with median value of 1191.5 μg/g. However, in children with inflammatory gastrointestinal disorders other than IBD and in children with IBD mean FCCs were significantly higher compared with the control group. Significant differences in FCCs were also found between group 1 and group 2, between group 1 and group 3, and between group 2 and group 3. Conclusion. FCC is the best parameter allowing for differentiation between IBD, other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. High FCC is associated with a high probability of IBD and/or other inflammatory gastrointestinal disorders, and it allows excluding functional gastrointestinal disorders.

scholarly journals Diagnostic Effect of Consultation Referral from Gastroenterologists to Generalists in Patients with Undiagnosed Chronic Abdominal Pain: A Retrospective Study

Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1150
Author(s):  
Ren Kawamura ◽  
Yukinori Harada ◽  
Taro Shimizu
Keyword(s):  
Abdominal Pain ◽  
Myofascial Pain ◽  
Functional Gastrointestinal Disorders ◽  
Descriptive Study ◽  
Chronic Abdominal Pain ◽  
University Hospital ◽  
Gastrointestinal Disorders ◽  
Single Center ◽  
Diagnostic Medicine ◽  
Nerve Entrapment Syndrome

This study aimed to investigate consultation outcomes from gastroenterologists to generalist physicians for the diagnostic workup of undiagnosed chronic abdominal pain. This was a single-center, retrospective, descriptive study. Patients were included who were ≥15 years old and consulted from the Department of Gastroenterology to the Department of Diagnostic Medicine, to establish a diagnosis for chronic abdominal pain, at the Dokkyo University Hospital from 1 April 2016 to 31 August 2020. We retrospectively reviewed the patients’ medical charts and extracted data. A total of 12 cases were included. Eight patients (66.7%) were diagnosed with and treated for functional gastrointestinal disorders (FGID) at the Department of Gastroenterology; their lack of improvement under treatment for FGID was the reason for their referral to the Department of Diagnostic Medicine for further examination. After this consultation, new possible diagnoses were generated for eight patients (66.7%). Six of the eight patients (75.0%) were diagnosed with abdominal wall pain (anterior cutaneous nerve entrapment syndrome, n = 3; myofascial pain, n = 1; falciform pain, n = 1; and herpes zoster non-herpeticus; n = 1). Consultation referral from gastroenterologists to generalists could generate new possible diagnoses in approximately 70% of patients with undiagnosed chronic abdominal pain.

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