The Impact of Gastrointestinal Symptoms on Patients’ Well-Being: Best–Worst Scaling (BWS) to Prioritize Symptoms of the Gastrointestinal Symptom Score (GIS)

Background: The gastrointestinal symptom score (GIS) is used in a standardized form to ascertain dyspeptic symptoms in patients with functional dyspepsia in clinical practice. As a criterion for evaluating the effectiveness of a treatment, the change in the summed total point value is used. The total score ranges from 0 to 40 points, in which a higher score represents a more serious manifestation of the disease. Each symptom is included with equal importance in the overall evaluation. The objective of this study was to test this assumption from a patients’ perspective. Our aim was to measure the priorities of patients for the ten gastrointestinal symptoms by using best–worst scaling. Method: A best–worst scaling (BWS) object scaling (Case 1) was applied. Therefore, the symptoms of the GIS were included in a questionnaire using a fractional factorial design (BIBD—balanced incomplete block design). In each choice set, the patients selected the component that had the most and the least impact on their well-being. The BIB design generated a total of 15 choice sets, which each included four attributes. Results: In this study, 1096 affected patients were asked for their priorities regarding a treatment of functional dyspepsia and motility disorder. Based on the data analysis, the symptoms abdominal cramps (SQRT (B/W): −1.27), vomiting (SQRT (B/W): −1.07) and epigastric pain (SQRT (B/W): −0.76) were most important and thus have the greatest influence on the well-being of patients with functional dyspepsia and motility disorders. In the middle range are the symptoms nausea (SQRT (B/W): −0.69), acid reflux/indigestion (SQRT (B/W): −0.29), sickness (SQRT (B/W): −0.26) and retrosternal discomfort (SQRT (B/W): 0.26), whereas the symptoms causing the least impact are the feeling of fullness (SQRT (B/W): 0.80), early satiety (SQRT (B/W): 1.54) and loss of appetite (SQRT(B/W): 1.95). Discussion: Unlike the underlying assumption of the GIS, the BWS indicated that patients did not weight the 10 symptoms equally. The results of the survey show that the three symptoms of vomiting, abdominal cramps and epigastric pain are weighted considerably higher than symptoms such as early satiety, loss of appetite and the feeling of fullness. The evaluation of the BWS data has illustrated, however, that the restrictive assumption of GIS does not reflect the reality of dyspeptic patients. Conclusions: In conclusion, a preference-based GIS is necessary to make valid information about the real burden of illness and to improve the burden of symptoms in the indication of gastrointestinal conditions. The findings of the BWS demonstrate that the common GIS is not applicable to represent the real burden of disease. The results suggest the potential modification of the established GIS by future research using a stated preference study.

Predictive Factors of Crucial Nutrition Impact Symptom Clusters in Patients With Head and Neck Cancer Undergoing Radiotherapy

Purpose: To identify crucial nutrition impact symptom (NIS) clusters related to both weight loss rate (WLR) and quality of life (QoL) in patients with head and neck cancer (HNC) receiving RT, and analyze their predictive factors.Methods: This prospective study enrolled 334 patients. At baseline (T1), we collected the demographics, clinical information, nutritional risk (Nutritional risk screening 2002, NRS 2002), nutritional status (Global Leadership Initiative on Malnutrition, GLIM), weight, and QoL before RT. At the third week (T2) and the end of RT (T3), we evaluated the severity and interference of NIS using the head and neck patient symptom checklist (HNSC), weight, and QoL. Exploratory factor analysis was used to extract the symptom clusters. Generalized estimating equations were used to analyze NIS clusters’ relationship with WLR and QoL, and cluster’s predictive factors.Results: Four NIS clusters were identified: RT-specific symptom cluster, upper gastrointestinal symptom cluster, psychological status cluster, and eating experience cluster. The former two NIS clusters had a negative impact on both WLR and QoL, so they were defined as crucial NIS clusters. Patients who were female, with older age, oral cavity cancer, had nutritional risk or were malnutrition at baseline were more likely to get severe RT-specific symptom cluster. Patients who were female, accepted intensive therapy were more likely to get severe upper gastrointestinal symptom cluster.Conclusions: Healthcare professionals should recognize patients at risk and intervene early, and give early nutritional management before RT to improve HNC patients’ NIS severity, nutritional status and QoL during treatment.

Bowel Histology of CVID Patients Reveals Distinct Patterns of Mucosal Inflammation

Diarrhea is the commonest gastrointestinal symptom in patients with common variable immunodeficiency (CVID). Different pathologies in patients’ bowel biopsies have been described and links with infections have been demonstrated. The aim of this study was to analyze the bowel histology of CVID patients in the Royal-Free-Hospital (RFH) London CVID cohort. Ninety-five bowel histology samples from 44 adult CVID patients were reviewed and grouped by histological patterns. Reasons for endoscopy and possible causative infections were recorded. Lymphocyte phenotyping results were compared between patients with different histological features. There was no distinctive feature that occurred in most diarrhea patients. Out of 44 patients (95 biopsies), 38 lacked plasma cells. In 14 of 21 patients with nodular lymphoid hyperplasia (NLH), this was the only visible pathology. In two patients, an infection with Giardia lamblia was associated with NLH. An IBD-like picture was seen in two patients. A coeliac-like picture was found in six patients, four of these had norovirus. NLH as well as inflammation often occurred as single features. There was no difference in blood lymphocyte phenotyping results comparing groups of histological features. We suggest that bowel histology in CVID patients with abdominal symptoms falls into three major histological patterns: (i) a coeliac-like histology, (ii) IBD-like changes, and (iii) NLH. Most patients, but remarkably not all, lacked plasma cells. CVID patients with diarrhea may have an altered bowel histology due to poorly understood and likely diverse immune-mediated mechanisms, occasionally driven by infections.

The Relationship of Diarrhea in COVID-19 Patients With Transaminitis, Severity, and Mortality

Background: Coronavirus disease 2019 (COVID-19) is a pandemic that causes various types of symptoms. Diarrhea is a gastrointestinal symptom that is hypothesized to be associated with patient morbidity and mortality. Research on the relationship between diarrhea and the incidence of transaminitis, severity and mortality has never been carried out, so further research is neededMethod: Descriptive-analytic research design with a case-control study approach. Sampling using consecutive sampling on patients in the inpatient installation of dr. Saiful Anwar, Malang. Research data on diarrhea incidence, transaminitis, severity, and mortality were obtained from secondary data on COVID-19 patients. Data were analyzed using chi-square with a significance level p 0.05Results: The incidence of diarrhea in COVID-19 patients with transaminitis was 45.8% and significantly associated (p = 0.025). Diarrhea in COVID-19 patients was associated with severity (p = 0.046) and patient mortality (p = 0.028).Conclusion: There is a relationship between the incidence of diarrhea in COVID-19 patients with trasnsaminitis, severity and mortality

The Effects of a Partially Hydrolyzed Formula with Low Lactose and Probiotics on Mild Gastrointestinal Disorders of Infants: A Single-Armed Clinical Trial

Partially hydrolyzed formula (pHF) containing low lactose and probiotics may benefit the gastrointestinal health of infants. We aimed to assess the effects of pHF on mild gastrointestinal disorders (MGDs) of infants. In this single-armed trial, 80 full-term infants with MGDs were enrolled and fed a pHF for 14 consecutive days. The primary outcome resulted from the scores of gastrointestinal symptoms reported by parents using a validated Infant Gastrointestinal Symptom Questionnaire (IGSQ) at Day 0 (baseline), Day 7, and Day 14. The total IGSQ scores ranged from 13 to 65. Higher scores indicated worse gastrointestinal symptoms. The IGSQ scores (mean ± SD) decreased from Day 0 (36.0 ± 5.7) to Day 7 (28.7 ± 7.4) and Day 14 (26.5 ± 8.1 (p < 0.001), with corresponding digestive distress prevalence (IGSQ score > 30) decreasing from 87.5% to 35.0% and 28.8% (p < 0.001). In the first three days, vomiting and flatulence scores decreased at Day 1 versus Day 0, and the crying score decreased at Day 2, but no significant changes were observed for fussy and stool characteristics. All growth parameters increased and no parents reported adverse events. In conclusion, feeding with a pHF containing low lactose and probiotics may comfort infants with MGDs, and the comforting effect likely manifests early in the first three days of the feeding interventions. Trial registration: ClinicalTrials.gov NCT04112056

KHẢO SÁT RỐI LOẠN DẠ DÀY RUỘT Ở BỆNH NHÂN THẬN NHÂN TẠO CHU KỲ TẠI BỆNH VIỆN ĐA KHOA KHU VỰC THỦ ĐỨC

Mục tiêu: Xác định đặc điểm rối loạn dạ dày ruột theo bảng điểm Gastrointestinal Symptom Rating Scale-GSRSở bệnh nhân bệnh thận mạn giai đoạn cuối thận nhân tạo chu kỳ. Đối tượng và phương pháp: Nghiên cứu cắt ngang trên 80 bệnh nhân thận nhân tạo chu kỳ. Tất cả các bệnh nhân điều được hỏi tình trạng rối loạn dạ dày ruột theo bảng điểm GSRS. Kết quả: Điểm GSRS trung bình là 8 (2,25 - 13), có 80% bệnh nhân xuất hiện ít nhất 01 triệu chứng dạ dày ruột. Nhóm bệnh nhân tuổi ≥ 60; lọc máu ≥ 10 năm có chỉ số GSRS trung bình cao hơn nhóm không có đặc điểm trên, p< 0,01. Có mối tương quan nghịch điểm GSRS với nồng độ hemoglobin và albumin máu, p< 0,01. Kết luận: Rối loạn dạ dày ruột là thường gặp và có liên quan đến tuổi cao, thời gian lọc máu dài và suy dinh dưỡng ở bệnh nhân thận nhân tạo chu kỳ.

Who uses probiotics and why? A survey study conducted among general gastroenterology patients

BackgroundThe rapid growth of the probiotic industry suggests patients will continue to seek advice from gastroenterologists about probiotics. To best address patient questions and concerns, we must first understand who uses probiotics and why.MethodsThis was a cross-sectional study conducted in the endoscopy suite of an academic hospital from June to October of 2019. Surveys were anonymous and contained a combination of multiple choice, free text and Likert scale questions. Participants privately completed a paper survey in English or Spanish and the results were reviewed with them by study personnel to clarify responses. Descriptive statistics were generated and multivariable logistic regression modelling was used to compare characteristics of probiotic users versus non-users.ResultsDuring the 5-month study period, 600 patients were approached and 537 (90%) agreed to participate. Among participants, 89% completed at least 24 survey items and were included in the analysis. Overall, 27% of patients reported probiotic use. Bloating, rather than diarrhoea, was the main gastrointestinal symptom associated with use of probiotics (aOR 2.59, 95% CI 1.52 to 4.44 for bloating; aOR 1.03, 95% CI 0.55 to 1.94 for diarrhoea). Frequent reasons cited for taking probiotics were the beliefs that they improved overall health and longevity (54%) and that they improved gastrointestinal symptoms (45%).ConclusionsProbiotic use is common among general gastroenterology patients, many of whom believe that probiotics confer general rather than specific gastrointestinal health benefits. Symptoms—especially bloating—and not sociodemographic factors seem to motivate probiotic use. By understanding patient expectations for probiotics, clinicians can better advise them.

Local Anesthesia Systemic Toxicity (LAST) Treated as Anaphylaxis

Local anesthesia systemic toxicity (LAST) and anaphylaxis are the life-threatening adverse effects of lignocaine. Both have different presentations and treatments. We report a case of 35-year-old female who came to our Emergency Department (ED) with symptoms of lethargy, drowsiness, and difficulty breathing with foreign body sensation and a metallic taste in the throat which started 15 minutes after a right shoulder injection with 250 mg of lignocaine mixed with Triamcinolone in the Orthopedic Clinic. She was pushed to the resuscitation bay and was treated as anaphylaxis. Upon further evaluation, the blood pressure was never hypotensive, no sign of compromised airway, no gastrointestinal symptom, and no mucosal involvement which directs to the diagnosis of LAST rather than anaphylaxis. Surprisingly, she was gradually improving and was discharged home after six hours of observation in the ED. This is the first case report that LAST had been effectively treated as anaphylaxis.

AB0274 METHOTREXATE INTOLERANCE IN MOROCCAN RHEUMATOID ARTHRITIS PATIENTS

Background:Methotrexate intolerance is a principal reason for treatment discontinuation, hence the interest in a more in-depth study.Objectives:We aimed to study the prevalence of methotrexate gastrointestinal intolerance and determine its associated factors in rheumatoid arthritis (RA) patients.Methods:We designed a cross-sectional study on our RA patients recruited in January 2021 at our rheumatology department. Methotrexate Intolerance Severity Score (MISS) [1], previously validated in juvenile idiopathic arthritis patients, was used to determine methotrexate (MTX) intolerance prevalence in RA patients. The MISS consisted of four domains: abdominal pain, nausea, vomiting, and behavioral symptoms, occurring before (anticipatory), after, and when thinking of MTX (associative). MTX intolerance was defined as six or more points on the MISS. Our statistical analysis was based on a descriptive study and logistic regression with SPSS20.Results:We included 102 RA patients with a mean age of 51.60 ± 14.33 years, Women were predominant (93.1%). The mean disease duration was 14.86 ± 9.78 years, with a mean methotrexate use duration of 7.42 ± 6.44 years. The mean dose of methotrexate was 12.13 ± 9.06 mg per week. The prevalence of methotrexate intolerance was 55.9%, and seventy-six patients (74.5 %) experienced at least one gastrointestinal symptom during MTX treatment. After MTX administration, the most prevalent gastrointestinal symptom was nausea (93% of the intolerant patient), whereas abdominal pain occurred in 73.7% and vomiting in 57.9%. These symptoms were also prevalent before and when thinking of MTX. Anticipatory nausea was reported in 45.6% and associative nausea in 54.5% of the cases, abdominal pain occurred anticipatory in 22.8% and associative in 42.1 %, anticipatory vomiting was the least prevalent, affecting 8.8 %. Behavioral symptoms affected 87.7% of intolerant patients, with restlessness being the most prominent symptom in 71.9% of them. Among the intolerant patients, 45 patients (79%) took parenteral MTX, and 12 (21.1%) took methotrexate orally. In comparison, young patients (49.11 ± 14.95 years) were more intolerant to MTX than old (54.76 ± 13 years, p = 0.048) ones. However, in univariate logistic regression analysis, we did not find any significant association between methotrexate administration route, dose, duration, and digestive intolerance.Conclusion:Methotrexate intolerance was highly prevalent in our RA population. These results strengthen the idea that early detection of MTX intolerance may avoid effective treatment discontinuation, especially in younger patients.References:[1]Bulatović M, Heijstek MW, Verkaaik M, van Dijkhuizen EH, Armbrust W, Hoppenreijs EP et al. High prevalence of methotrexate intolerance in juvenile idiopathic arthritis: development and validation of a methotrexate intolerance severity score. Arthritis Rheum. 2011 Jul; 63(7):2007-13.Disclosure of Interests:None declared