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Query: UMLS:C0017160 (gastroenteritis)
 11,398 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastrointestinal problems account for a significant proportion of general practitioners' workload, and gastrointestinal cancers, taken together, make up the largest group of malignancies. Approximately 10% of consultations in general practice in the UK are for gastrointestinal symptoms or problems, split roughly equally between the upper and lower gastrointestinal tract. Gastroenterology represents about 10% of the work of hospital specialists and the prescribing costs involved in the management of gastrointestinal disorders in general practice are around 14% of the drug budget. These disorders range from relatively minor and self limiting conditions such as acute gastritis and acute gastroenteritis, through the more significant, chronic digestive disorders such as gastro-oesophageal reflux disease (GORD), irritable bowel syndrome (IBS) and coeliac disease, to much more serious problems including inflammatory bowel disease (IBD) and upper gastrointestinal and colorectal cancer.
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PMID:Primary care research and clinical practice: gastroenterology. 1894 Sep 46

The mammalian GI tract contains a large and diverse ecosystem of microorganisms that play a profound role in our development and physiology. Interestingly, the microbial make-up within the intestine has been found to be altered in many clinically important diseases, including inflammatory bowel disease, irritable bowel syndrome, Types 1 and 2 diabetes, and obesity. Barman et al. used a Salmonella-induced murine model of gastroenteritis to show that the intestinal microbiota are transiently altered during the host inflammatory response to infection. These findings are of interest as understanding how the microbiota are altered during disease states may offer insight into which microbial populations are important in maintaining intestinal homeostasis. Recently, probiotics have been shown to modulate the mucosal immune system and improve intestinal barrier function, validating their potential as therapeutics for gastrointestinal-associated diseases. As we begin to understand the benefits conferred to the intestine by microbiota, the use of probiotics to modify its composition is an attractive option to improve human health.
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PMID:Intestinal microbiota are transiently altered during Salmonella-induced gastroenteritis. 1816 Apr 81

One of the most topical areas of human nutrition is the role of the gut in health and disease. Specifically, this involves interactions between the resident microbiota and dietary ingredients that support their activities. Currently, it is accepted that the gut microflora contains pathogenic, benign and beneficial components. Some microbially induced disease states such as acute gastroenteritis and pseudomembranous colitis have a defined aetiological agent(s). Speculation on the role of microbiota components in disorders such as irritable bowel syndrome, bowel cancer, neonatal necrotising enterocolitis and ulcerative colitis are less well defined, but many studies are convincing. It is evident that the gut microflora composition can be altered through diet. Because of their perceived health-promoting status, bifidobacteria and lactobacilli are the commonest targets. Probiotics involve the use of live micro-organisms in food; prebiotics are carbohydrates selectively metabolized by desirable moieties of the indigenous flora; synbiotics combine the two approaches. Dietary intervention of the human gut microbiota is feasible and has been proven as efficacious in volunteer trials. The health bonuses of such approaches offer the potential to manage many gut disorders prophylactically. However, it is imperative that the best methodologies available are applied to this area of nutritional sciences. This will undoubtedly involve a genomic application to the research and is already under way through molecular tracking of microbiota changes to diet in controlled human trials.
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PMID:Perspectives on the role of the human gut microbiota and its modulation by pro- and prebiotics. 1908 41

Until now, Irritable Bowel Syndrome (IBS) has been one of gastrointestinal disorders which have not been fully understood. Clinically, there are some findings that indicate the role of inflammatory process in pathogenesis of IBS; such as, the onset of IBS that occurs after an episode of gastroenteritis (post-infective IBS (PI-IBS)). Although there is less evidence supporting genetic factors in pathogenesis of IBS, there are some reports about serotonin release in the plasma correlated to predominant constipation symptom. In contrast, increased serotonin release in IBS cases correlated to predominant diarrhea symptom. The stress-mast cell axis is one of pathophysiologic pathway that is expected to be able to explain the correlation between stress and characteristics found in IBS symptoms. Psychosocial factor has been well-considered to have important role in pathogenesis of IBS. Diagnosis of IBS is based on history of pain or abdominal discomfort that correlated to abnormal defecation pattern, without any obvious alarm sign. Nowadays, there is no specific laboratory test or physical or biochemical marker pathognomonic for IBS; therefore, clinical symptoms become the main modality in diagnosing IBS. This article will discuss the pathophysiology and diagnosis of IBS which will be helpful for clinicians in the management of IBS in daily practice.
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PMID:Irritable bowel syndrome: current review on pathophysiology and diagnotic aspects. 1915 51

Post-infectious irritable bowel syndrome (PI-IBS) is a common disorder wherein symptoms of IBS begin after an episode of acute gastroenteritis. The Walkerton Health Study (WHS) was initiated in 2002 to study the long-term outcomes of tragic contamination of its municipal water supply with Escherichia coli and Campylobacter species in 2000. Within a cohort of 2069 adult Walkerton residents with no prior history of chronic gastrointestinal disorders, the incidence of PI-IBS 2 years after the outbreak was 10.1% among subjects with no acute gastroenteritis vs 36.2% among those with clinically suspected gastroenteritis (P<0.001). Long-term follow-up of the WHS cohort has shown PI-IBS to have a favorable prognosis, with spontaneous remission in most patients. A recent meta-analysis of nine cohort studies estimated the pooled odds ratio for developing IBS after enteric infection to be 5.86 (95% CI 3.60-9.54). Risk factors for PI-IBS include female gender, younger age, more severe acute enteric infection, and psychiatric comorbidity. A prevailing hypothesis is that PI-IBS results from a failure to downregulate inflammation after an acute insult from gastroenteritis, a model supported by preliminary studies of intestinal permeability and pro-inflammatory genotypes. Ongoing research is testing the hypothesis that PI-IBS denotes increased susceptibility to more overt inflammatory disorders such as Crohn's disease. Although the Walkerton outbreak of acute gastroenteritis was an awful human tragedy, it is hoped that the WHS will advance our understanding of PI-IBS and improve the outcomes of people who suffer similar tragedies in the future.
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PMID:Post-infectious irritable bowel syndrome following water contamination. 1918 Jan 33

Gastroenteritis is a nonspecific term for various pathologic states of the gastrointestinal tract. Gastroenteritis causing pathogens are the second leading cause of morbidity and mortality worldwide. In the developed countries diarrhea is the most common reason for missing work, while in the developing world, it is a leading cause of death. Internationally, the mortality rate is 5-10 million deaths each year. "Traveller's diarrhea" is a polyetiologic common health problem of international travellers which affects travellers generally for days, but it can result in chronic postinfectious irritable bowel syndrome as well. Infectious agents usually cause acute gastroenteritis either by adherence of the intestinal mucosa, or by mucosal invasion, enterotoxin production, and/or cytotoxin production. The incubation period can often suggest the cause of etiology. When symptoms occur within 6 hours of eating, ingestion of preformed toxin of S. aureus or Bacillus cereus should be suspected. The incidence of hypervirulent C. difficile associated colitis is an emerging problem as a healthcare system associated infection. While infectious agents do not commonly cause chronic diarrhea, those that do include C. difficile, Giardia lamblia, Entamoeba histolytica, Cryptosporidium, Aeromonas and Yersinia . Amoebiasis is the second to malaria as a protozoal cause of death. Infection with HIV is also a common cause of diarrhea.
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PMID:[Diarrhea from the infectologist's point of view]. 1921 45

We report a cost benefit analyses (CBA) for water interventions in rural populations of developed country sub-regions. A Bayesian belief network was used to estimate the cost benefit ratio using Monte Carlo simulation. Where possible we used input data from recently published primary research or systematic reviews. Otherwise variables were derived from previous work in the peer-reviewed or grey literature. For these analyses we considered the situation of people with small and very small community supplies that may not be adequately managed. For the three developed country sub-regions Amr-A (America region A), Eur-A (European region A) and Wpr-A (Western Pacific region A), we estimate the costs of acute diarrhoeal illness associated with small community supplies to be U$4671 million (95% CI 1721-9592), the capital costs of intervention to be USD 13703 million (95% CI 6670-20735), additional annual maintenance to be USD 804 million (95%CI 359-1247) and the CB ratio to be 2.78 (95%CI 0.86-6.5). However, we also estimated the cost of post infectious irritable bowel syndrome (IBS) following drinking water-associated acute gastroenteritis to be USD 11896 million (95%CI 3118-22657). When the benefits of reduced IBS are added to the analysis the CB ratio increases to 9.87 (95%CI 3.34-20.49). The most important driver of uncertainty was the estimate of the cost of illness. However, there are very few good estimates of costs in improving management of small rural supplies in the literature. Investments in drinking-water provision in rural settings are highly cost beneficial in the developed world. In the developed world, the CB ratio is substantially positive especially once the impact of IBS is included.
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PMID:An assessment of the costs and benefits of interventions aimed at improving rural community water supplies in developed countries. 1934 35

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders and is that with the greatest socioeconomic impact worldwide. Diagnosis of IBS is based on clinical criteria that have been modified over time, the Rome II criteria being those that are currently followed. Some of the symptoms of IBS are similar to those in patients with inflammatory bowel disease (IBD), which can hamper or delay diagnosis. The use of inflammatory markers in stools (such as calprotectin) may help to distinguish between these two entities. A possible connection between IBS and IBD could be based on five points: (i) both disorders have similar symptoms; (ii) symptoms often overlap in the same patients; (iii) IBS and IBD have a common familial aggregation; (iv) some predisposing factors, such as a history of acute gastroenteritis, play a role in both disorders, and (v) importantly, signs of microinflammation are found in the bowels of patients with IBS. With regard to this latter point, an increase in inflammatory cells has been found in the intestinal mucosa of patients with IBS and, more specifically, mastocytes have been found to be increased in the jejunum and colon while CD3 and CD25 intraepithelial lymphocytes have be observed to be increased in the colon. Moreover, activated mastocytes are increased near to nerve endings in patients with IBS and this finding has been correlated with the intensity of both intestinal symptoms (abdominal pain) and psychological symptoms (depression and fatigue). A good model of microinflammation is post-infectious IBS, since the timing of the onset of the infectious process is known. In patients with post-infectious IBS, an increase in intraepithelial lymphocytes and enterochromaffin cells is initially found, which is reduced over time; consequently, although the symptoms of IBS persist, after 3 years no differences are detected in the number of inflammatory cells between IBS patients and controls. Among the various factors that can favor the development of IBS in these patients, two host-dependent mechanisms are most closely implicated in the physiopathology of IBS: polymorphism of the genes codifying pro- or anti-inflammatory cytokines and psychological factors such as anxiety, depression, somatization and neuroticism at the time of the acute infection. In view of all of the above, the similarities between IBS and IBD are probably more than mere coincidence and may reflect distinct manifestations of a broad spectrum of inflammation in the colon.
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PMID:[Irritable bowel syndrome and inflammatory bowel disease: Is there a connection?]. 1944 13

Functional dyspepsia (FD) symptoms may develop after an acute gastroenteritis. In post-infectious (PI) irritable bowel syndrome, persisting low-grade colonic inflammation and increased enterochromaffine cells (EC) counts have been reported. The aim was to compare signs of inflammation and EC hyperplasia on duodenal biopsies in presumed PI-FD and unspecified-onset (U-)FD. Duodenal biopsies were obtained in 12 U-FD and 12 PI-FD (on average 13 months after the acute event) patients. The presence of intra-epithelial, intravillar, and the number of CD3, CD4, CD8 and CD68+ cells per crypts, and the mean number of Chromogranine A (CA) positive cells per villus were compared. We also measured gastric emptying and assessed proximal stomach function with a barostat. Data are shown as mean +/- SEM. Focal aggregates of T cells and focal CD8+ aggregates, were found in PI-FD but not in U-FD patients (respectively 5/12 vs 0/12, P = 0.02 and 5/9 vs 0/11, P < 0.01). In patients with focal aggregates, gastric emptying was delayed (189 +/- 37 min vs 98 +/- 11 min, P = 0.002). The number of CD4+ cells per crypt (0.52 +/- 1.6 vs 1.22 +/- 2.18, P = 0.04), and the number of intravillar CD4+ cells (0.5 +/- 0.2 vs 2.7 +/- 0.7, P = 0.01) were reduced, while the number of CD68+ cells per crypt was increased (0.64 +/- 0.13 vs 0.40 +/- 0.05, P = 0.03) in PI-FD. The number of EC and CA were comparable. PI-FD is associated with persisting focal T-cell aggregates, decreased CD4+ cells and increased macrophage counts surrounding the crypts. This may indicate impaired ability of the immune system to terminate the inflammatory response after acute insult.
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PMID:Intestinal immune activation in presumed post-infectious functional dyspepsia. 1946 Jan 7

Studies of metagenomics and the human microbiome will tremendously expand our knowledge of the composition of microbial communities in the human body. As our understanding of microbial variation and corresponding genetic parameters is refined, this information can be applied to rational remodeling or "tailoring" of human-associated microbial communities and their associated functions. Physiologic features such as the development of innate and adaptive immunity, relative susceptibilities to infections, immune tolerance, bioavailability of nutrients, and intestinal barrier function may be modified by changing the composition and functions of the microbial communities. The specialty of gastroenterology will be affected profoundly by the ability to modify the gastrointestinal microbiota through the rational deployment of antibiotics, probiotics, and prebiotics. Antibiotics might be used to remove or suppress undesirable components of the human microbiome. Probiotics can introduce missing microbial components with known beneficial functions for the human host. Prebiotics can enhance the proliferation of beneficial microbes or probiotics, to maximize sustainable changes in the human microbiome. Combinations of these approaches might provide synergistic and effective therapies for specific disorders. The human microbiome could be manipulated by such "smart" strategies to prevent and treat acute gastroenteritis, antibiotic-associated diarrhea and colitis, inflammatory bowel disease, irritable bowel syndrome, necrotizing enterocolitis, and a variety of other disorders.
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PMID:Targeting the human microbiome with antibiotics, probiotics, and prebiotics: gastroenterology enters the metagenomics era. 1946 7


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