scholarly journals Prevalence, Impact and Attitudes Toward Lower Gastrointestinal Dysmotility and Sensory Symptoms, and Their Treatment in Canada: A Descriptive Study

2007 ◽  
Vol 21 (1) ◽  
pp. 31-37 ◽  
Author(s):  
Richard H Hunt ◽  
Surinder Dhaliwal ◽  
Gervais Tougas ◽  
Carmen Pedro ◽  
Jean-Francois Labbé ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Work Performance ◽  
Telephone Survey ◽  
Common Symptom ◽  
Care Seeking ◽  
Canadian Population ◽  
Gi Symptoms ◽  
Traditional Therapies ◽  
Stage 1 ◽  
The Impact

OBJECTIVES: To investigate the impact of lower gastrointestinal (GI) symptoms in the general Canadian population, and to explore patient satisfaction with traditional therapies and the level of patient interest in new treatments.PATIENTS AND METHODS: Stage 1: A telephone survey of a weighted sample of 1000 adults (18 years of age or older) was conducted to determine the prevalence of five GI symptoms – abdominal pain, abdominal discomfort, bloating, constipation or constipation with occasional diarrhea -- that were present for 12 weeks or more (not necessarily consecutive) over the past year. Respondents with only abdominal pain were excluded. Stage 2: A telephone survey of 689 women (18 to 64 years of age), experiencing the GI symptoms described in stage 1, was conducted to assess symptom impact and treatment satisfaction.RESULTS: Overall, 5.2% of the Canadian population (2.3% men and 7.9% women) experienced one or more lower GI symptoms (excluding those reporting abdominal pain alone). In stage 2, 26.2% of respondents had previously been diagnosed with irritable bowel syndrome. Overall, 78.1% of participants experienced two or more symptoms. Bloating was the most common symptom (75.3%) and abdominal pain the most bothersome and most severe. Over the previous three months, 13.2% of respondents missed work or school and 28.8% were less productive. At least one physician (average of 2.2 physicians) was consulted for symptoms in 80.9% of respondents. Of the 63.8% women receiving treatment, most used nonprescription products. Patients receiving prescription treatments for constipation were most often dissatisfied (75%).CONCLUSIONS: Abdominal pain and discomfort, bloating and constipation are common, frequently occurring symptoms in the Canadian population and have a high burden on work performance and health care seeking. Most patients were dissatisfied with traditional therapies.

Prognostic Factors and Outcomes of Severe Gastrointestinal Graft Versus Host Disease after Allogeneic Hematopoietic Cell Transplantation

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4341-4341
Author(s):  
Cristina Castilla-LLorente ◽  
Richard A. Nash ◽  
George B McDonald ◽  
Barry E. Storer ◽  
Paul J. Martin
Keyword(s):  
Abdominal Pain ◽  
Multivariable Analysis ◽  
High Dose ◽  
Upper Gi ◽  
Gi Symptoms ◽  
Days Of Therapy ◽  
Stage 1 ◽  
Dose Prednisone ◽  
Steroid Refractory ◽  
Stool Volume

Abstract Introduction: Treatment of severe GI GVHD poses a challenge, as little progress has been made in developing better treatments and survival remains poor. One problem is that it is difficult to know the ultimate severity of GVHD and the outcome at the onset of symptoms. We analyzed patients with peak stage 3–4 GI GVHD to identify factors within 2 weeks of the onset of GVHD that predicted the eventual outcome. This information could be useful in initial patient management and to inform the design of clinical trials. Patients and methods: We reviewed the records of 117 consecutive patients transplanted between 2000–2005 who developed stages 3–4 GI GVHD. Data were collected for more than 20 parameters, including stool volume, abdominal pain, melena, upper GI symptoms, serum albumin, number of GVHD treatments, visual findings at endoscopy and histopathologic grade of GI biopsies. Clinical parameters were measured as the peak value during each 14 day period starting from 2 weeks before the diagnosis of GI GVHD to the resolution of symptoms, loss of follow-up or patient death. Patients had been treated with myeloablative or reduced intensity conditioning regimens and received either marrow or growth factor-mobilized blood cells from related or unrelated HLA-matched donors. All patients received prophylactic pharmacologic immunosuppression for GVHD. Results: Median onset of symptoms was day 28 (range 4 – 113); 11 (9.6%) patients presented after day 80. Mean daily stool volume at diagnosis was 1494 ±1450 mL/day. At onset of GI symptoms, 75% of patients had ≥ stage 1 skin GVHD and 65% had ≥ stage 1 liver GVHD. At onset, 78% had upper GI symptoms (nausea and vomiting); less than 50% of patients presented with severe abdominal pain. Within the first 2 weeks after the diagnosis of GI GVHD, 52 (44.8%), 45 (38.7%), 7 (6.2%) and 12 (10.3%) patients had a peak GI stage of 4, 3, 2 and 1 respectively. All patients received high dose prednisone/prednisolone as initial treatment; 67 received 2nd line therapy; and 32 received three or more lines of treatment. Steroid refractoriness was defined as worsening GI symptoms after 3 days of high-dose steroid therapy, or non-response after 7 days, or only partial response after 14 days of therapy. Patients who developed stage 3 or 4 GI GVHD while receiving high dose prednisone for skin or liver GVHD were also considered steroid refractory. Non-relapse mortality was 71% and 41% at 1 year after transplant in patients with steroid-refractory and steroid-responsive GVHD, respectively. Overall survival was 30% at 1 year after HCT and 26% at 2 years. Thirteen patients relapsed, and all but 1 died subsequently. Adult patients who had steroid-refractory GVHD within 2 weeks of onset had a 1-year survival of 16% compared to 88% among steroid refractory pediatric patients. During the 14 day periods immediately before or after the onset of GI symptoms, these risk factors for overall mortality were identified by multivariable analysis: All patients, no endoscopy result considered (N=117) Factor Hazard Ratio p-value Adult age 3.2 .007 Jaundice (bilirubin >3.1 mg/dL) 1.97 .006 Albumin ≤1.6 g/dL 1.91 .01 Steroid refractory 1.76 .02 In a subgroup of patients who underwent endoscopy (N=73), a finding of ulcerated mucosa was predictive of mortality (HR 2.52, p=0.02). Conclusions: Within 2 weeks of GI symptom onset, mortality in patients with GVHD can be predicted by age, jaundice, hypoalbuminemia, response to prednisone, and presence of ulcerated mucosa at endoscopy. More effective early treatment in GI GVHD patients at risk for mortality is likely to be more useful than salvage therapy for steroid-refractory patients.

scholarly journals Impact COVID-19 Infection and Persistent Lingering Symptoms on Patient Reported Indicators of Nutritional Risk and Malnutrition

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 213-213
Author(s):  
Rachel Deer ◽  
Christopher Messenger ◽  
Blair Brown ◽  
Maria Swartz ◽  
Justin Seashore
Keyword(s):  
Clinical Symptoms ◽  
Caloric Intake ◽  
Chronic Fatigue ◽  
Nutritional Risk ◽  
Common Symptom ◽  
Dietary Recommendations ◽  
Persistent Symptoms ◽  
Gi Symptoms ◽  
Patient Reported ◽  
The Impact

Abstract Objectives This study investigated the impact of COVID-19 infection and its persistent lingering symptoms on known risk factors for malnutrition. Methods Patients with confirmed history of COVID infection and persistent symptoms were referred to the Post-COVID Recovery Clinic. Standardized telehealth screening included: Patient Generated Subjective Global Assessment (PG-SGA), Shortness of Breath (SOBQ), Patient Health Questionnaire (PHQ9), CDC 18 common symptom COVID, Generalized Anxiety Disorder (GAD7), and (Instrumental) Activities of Daily Living (I)ADL. Results Eighty-six patients were evaluated in the first 2.5 months. Average age was 52 years (23–90), 67% were female, and 58% Caucasian. COVID+ test to clinic visit was 49 days (14–140). Forty eight percent did not require hospitalization, 62% were obese, and 73% had ≥1 comorbidity. At infection onset, 80% complained of GI symptoms (75% loss of taste, 61% loss of smell, 59% diarrhea, 57% nausea). At the telehealth visit, 51% reported lingering GI symptoms (45% taste, 41% smell, 41% diarrhea, 36% nausea). Other common symptoms were: dyspnea on exertion, chronic fatigue, cough, and weakness. Survivors required referrals for the following specialty services: 84% pulmonary, 77% physical/occupational therapy, 73% behavioral health, and 51% registered dietitian consult. Average PG-SGA score was 5.7 ± 5.02 with sub-scores: weight 1.37 ± 1.65, food 0.58 ± 0.64, symptoms 2.19 ± 3.30, activities/function 1.59 ± 0.93. Preliminary analysis of 2-day 24h dietary recalls of a subset of clinic patients (n = 33) found >50% of COVID survivors failed to meet basic dietary recommendations. Daily caloric intake was low, protein intake was below 0.8 g/kg, and the daily distribution of protein skewed towards a single meal. Conclusions We found that the clinical symptoms experienced by COVID survivors, particularly fatigue, dyspnea, and eating difficulties (nausea, vomiting, changes in smell and taste, trouble breathing) created difficulties in maintaining an adequate nutritional intake. This is concerning because malnutrition, specifically inadequate protein, leads to weaker immune function, slower recovery from illness, and loss of lean body mass. Funding Sources NIA Pepper OAIC, CTSA NCATS

The canadian population constipation survey: Prevalence, rome Il adjustment and health care seeking

2001 ◽  
Vol 120 (5) ◽  
pp. A634-A635
Author(s):  
P PARE ◽  
S FERRAZZI ◽  
W THOMPSON ◽  
E IRVINE ◽  
L RANCE
Keyword(s):  
Health Care ◽  
Health Care Seeking ◽  
Care Seeking ◽  
Canadian Population

Enterogastric Reflux: an Uncommon Diagnosis Analyzed by Hepatobiliary Imaging

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Peter Wang
Keyword(s):  
Abdominal Pain ◽  
Digestive Enzymes ◽  
Gallbladder Disease ◽  
Hepatobiliary Scintigraphy ◽  
Hepatobiliary Imaging ◽  
Upper Gi ◽  
Gi Symptoms ◽  
Upper Abdominal ◽  
Enterogastric Reflux

Enterogastric reflux (EGR) is the reflux of bile and digestive enzymes from the small bowel into the stomach. While it is a normal physiologic process in small amounts, excessive reflux and chronic EGR can cause upper GI symptoms often mimicking more common diseases such as gallbladder disease and GERD that often leads to its underdiagnosis. Identifying EGR is significant as it has been associated with the development of gastroesophogeal pathology including gastritis, esophagitis, ulcers, and mucosal metaplasia. This article presents a 22-year-old male with enterogastric reflux causing upper abdominal pain and will discuss the role of hepatobiliary scintigraphy in its diagnosis.

scholarly journals Non-Celiac Gluten Sensitivity: A Challenging Diagnosis in Children with Abdominal Pain

2018 ◽  
Vol 73 (Suppl. 4) ◽  
pp. 39-46 ◽  
Author(s):  
Frank M. Ruemmele
Keyword(s):  
Abdominal Pain ◽  
Celiac Disease ◽  
Clinical Symptoms ◽  
Gluten Sensitivity ◽  
Gluten Free ◽  
Clear Cut ◽  
Clinical Presentations ◽  
New Findings ◽  
Three Phase ◽  
Gi Symptoms

Several disorders related to the ingestion of gluten are well recognized despite overlapping clinical presentations: celiac disease, an autoimmune enteropathy triggered by gluten ingestions in susceptible individuals, allergy to wheat, and more recently non-celiac gluten sensitivity (NCGS). While celiac disease and wheat allergy are well-known disorders with a clear-cut diagnosis based on clinical tests and biological parameters, NCGS is a more difficult diagnosis, especially in children with functional gastrointestinal (GI) complaints. NCGS is considered a syndrome of intestinal but also extraintestinal symptoms occurring within hours, but sometimes even after several days of gluten ingestion. In children, the leading symptoms of NCGS are abdominal pain and diarrhea, while extraintestinal symptoms are rare, in contrast to adult patients. No precise diagnostic test nor specific biomarkers exist, except a rather cumbersome three-phase gluten-exposure, gluten-free diet, followed by a blinded placebo-controlled gluten challenge with crossover to provoke symptoms elicited by gluten in a reproducible manner that disappear on gluten-free alimentation. Recent data indicate that the peptide part of wheat proteins is not necessarily the sole trigger of clinical symptoms. Mono- or oligosaccharides, such as fructan and other constituents of wheat, were able to provoke GI symptoms in clinical trials. These new findings indicate that the term gluten sensitivity is probably too restrictive. The incidence of NCGS was reported in the range of 1–10% in the general population and to increase steadily; however, most data are based on patients’ self-reported gluten intolerance or avoidance without a medically confirmed diagnosis. Treatment consists of gluten avoidance for at least several weeks or months. Patients with NCGS require regular reassessment for gluten tolerance allowing with time the reintroduction of increasing amounts of gluten.

scholarly journals POS0329 GASTROINTESTINAL INVOLVEMENT IN SYSTEMIC SCLEROSIS: PATHOGENETIC ROLE OF GUT MICROBIOME, CYTOKINES AND ADIPOKINES

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 392.1-392
Author(s):  
E. Pigatto ◽  
M. Schiesaro ◽  
M. Caputo ◽  
M. Beggio ◽  
P. Galozzi ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Gut Microbiome ◽  
Serum Levels ◽  
High Serum ◽  
Healthy Population ◽  
Gastrointestinal Involvement ◽  
Degrading Bacteria ◽  
Gi Symptoms ◽  
Low Levels ◽  
The Impact

Background:Gastrointestinal (GI) involvement is very common in patients with Systemic Sclerosis (SSc). The pathophysiology of GI manifestations has not yet been defined. Cell-mediated immunological reactions appear to lead to endothelial damage resulting in fibrosis. The risk of developing malnutrition reinforces the need to better understand GI pathophysiology in these patients.Objectives:The study aimed to evaluate GI symptoms (GIT 2.0) and malnutrition status (MUST) and to determine specific bacterial changes in gut microbiome by investigating the possible presence of positive hot spots in bacterial species in SSc patients and their potential role in the disease progression. We also evaluated serum levels of adipokines and cytokines involved in the pathogenesis of SSc and their role, in addition to gut microbiome, in predicting the onset of GI involvement and malnutrition in SSc patients.Methods:We enrolled 25 scleroderma patients (EULAR/ACR 2013 criteria). UCLA-SCTC GIT 2.0 questionnaire to evaluate GI symptoms and MUST to investigate the risk of malnutrition were used. Gut microbiome was analyzed and the samples were subjected to extraction for the 16S rRNA gene (Earth Microbiome Project and the NIH-Human Microbiome Project). The microbiome was investigated at phenotypic and genotypic level. Serum levels of cytokines and adipokines (adiponectin and leptin) were evaluated by ELISA.Results:79.9% of patients had GERD and 63.5% abdominal distension at GIT 2.0 questionnaires. 48% of patients had moderate risk of malnutrition (MUST=2) and 12% had high risk (MUST=3). Gut microbioma: 19 patients (76%) had low similarity and 11 (44%) low diversity compared to the healthy population. The prevailing enterotypes of gut microbiome was Bacteroides (80%) and Prevotella (20%). The genotypic evaluation showed a reduced concentration of: gluten-digesting (Lactobacillus); lactose-digesting (Faecalibacterium); vitamin K-producing (Enterococcus, Desulfovibrio and Veillonella); acetaldehyde-degrading bacteria. 24 patients (96%) showed a reduction in bacteria devoted to maintaining weight control (Bifidobacterium and Ruminococcus). The patients had an altered intestinal permeability with less mucolytic bacteria (Bacteroides) and reduced production of LPS (Enterobacter and Escherichia). Low levels of butyrate (Eubacterium and Clostridium), acetate and propionate were found for SCFA-producing bacteria. Potentially pathogenic bacteria were also investigated: Salmonella was found in 14 (56%), Klebsiella in 9 (36%) and Enterococcus Faecalis in 3 (12%) patients. 11 (44%) patients had elevated serum levels of IL10 and IL12; 4 (16%) had high value of leptin. Correlation was found in patients who had a reduced concentration of gluten-digesting bacteria and MUST. Elevated MUST was correlated with serological increase in IL17A and IFN-α. Serum levels of IL12 and IL10 were found to correlate with specific bacteria alterations: high concentration of acetaldehyde-producing bacteria and low levels of acetaldehyde-degrade bacteria (also correlated with high serum levels of IL6), mucolytic bacteria and producers of hydrogen sulphide, acetate and propionate. Finally, reduced levels of mucolytic bacteria and acetate producing bacteria correlated with high serum leptin levels.Conclusion:The relationship between the gut microbiome and SSc seems to be multifactorial. In our study genotypic changes of gut microbioma might play a role in damaging the permeability of the mucosa and increasing risk of malnutrition. The evaluation of gut microbiome and cytokine profile is probably going to be of value in the follow-up of SSc. However, further studies are needed to clarify the impact of GI dysbiosis on the immune system in SSc.References:[1]Patrone V. et al. Gut microbiota profile in systemic sclerosis patients with and without clinical evidence of gastrointestinal involvement, Sci Rep. 2017; 7: 14874Disclosure of Interests:None declared

scholarly journals 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

2021 ◽  
Vol 14 ◽  
pp. 175628642199399 ◽  
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]

scholarly journals Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kirsten Austad ◽  
Michel Juarez ◽  
Hannah Shryer ◽  
Patricia L. Hibberd ◽  
Mari-Lynn Drainoni ◽  
...  
Keyword(s):  
Health Workers ◽  
Positive Impact ◽  
Qualitative Evaluation ◽  
Obstetric Care ◽  
Hospital Staff ◽  
Public Hospitals ◽  
Future Research ◽  
Care Seeking ◽  
Structured Interviews ◽  
The Impact

Abstract Background Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. Methods We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. Results Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. Conclusions Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.

scholarly journals ‘I’m fine!’: Assertions of lack of support need among patients with chronic obstructive pulmonary disease: A mixed-methods study

2021 ◽  
pp. 174239532110003
Author(s):  
A Carole Gardener ◽  
Caroline Moore ◽  
Morag Farquhar ◽  
Gail Ewing ◽  
Efthalia Massou ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Mixed Method ◽  
Self Report ◽  
Design Stage ◽  
Chronic Obstructive ◽  
Support Needs ◽  
Obstructive Pulmonary Disease ◽  
Stage 1 ◽  
The Impact

Objectives To understand how people with Chronic Obstructive Pulmonary Disease (COPD) disavow their support needs and the impact on care. Methods Two stage mixed-method design. Stage 1 involved sub-analyses of data from a mixed-method population-based longitudinal study exploring the needs of patients with advanced COPD. Using adapted criteria from mental health research, we identified 21 patients who disavowed their needs from the 235 patient cohort. Qualitative interview transcripts and self-report measures were analysed to compare these patients with the remaining cohort. In stage 2 focus groups (n = 2) with primary healthcare practitioners (n = 9) explored the implications of Stage 1 findings. Results Patients who disavowed their support needs described non-compliance with symptom management and avoidance of future care planning (qualitative data). Analysis of self-report measures of mental and physical health found this group reported fewer needs than the remaining sample yet wanted more GP contact. The link between risk factors and healthcare professional involvement present in the rest of the sample was missing for these patients. Focus group data suggested practitioners found these patients challenging. Discussion This study identified patients with COPD who disavow their support needs, but who also desire more GP contact. GPs report finding these patients challenging to engage.

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