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Query: UMLS:C0022104 (irritable bowel syndrome)
 8,033 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

"Digest" is a international effort to record the prevalence of digestive symptoms in the general population. The international questionnaire was tested in German translation for reliability and reproducibility. The questionnaire consists of 14 symptoms, which were investigated by standardized questions. Each symptom was described in 3 dimensions: frequency, severity and impact on daily activities. 127 successive patients referred for upper gastrointestinal endoscopy were interviewed twice by a young assistant and by an experienced gastroenterologist before the diagnostic work-up. A further 72 volunteers served as a control group. In these volunteers no upper gastrointestinal endoscopy was performed. Reliability and reproducibility were calculated by the Spearman rank test. The most frequent diagnoses were: organic diseases (oesophagitis [28], gastric ulcer/erosive gastritis [32] and duodenal ulcer [18]); functional diseases (dyspepsia [32] and irritable bowel syndrome [14]). Reproducibility was satisfactory by accepted standards (p > 0.7). Reliability was very good, with r-values for each symptom between p 0.96-0.99. The impact on daily activities was highest in the case of heart-burn or localized upper gastrointestinal pain, and lowest in the case of belching and fullness. The questionnaire can be easily administered by the non-specialist and the results discriminate well between functional/organic diseases and healthy people, thanks to excellent reproducibility and reliability.
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PMID:[Validation of the "Digest Questionnaire" for consistency and reproducibility with reference to upper abdominal symptoms]. 965 26

A body of clinical and research literature is accumulating suggesting that there are significant alterations in gastrointestinal functioning during sleep, as well as sleep complaints and disorders in patients suffering from gastrointestinal disease. This review addresses the clinical applications of some basic alterations in gastrointestinal functioning during sleep, with a particular focus on gastroesophageal reflux disease and functional bowel disorders. Recent studies have shown that gastroesophageal reflux during sleep results in a marked prolongation of esophageal acid clearance time, and consequent mucosal damage. Data are reviewed which suggest that the more serious complications of gastroesophageal reflux, e.g. esophagitis and the extra-esophageal complications of reflux such as the exacerbation of bronchial asthma, laryngopharyngitis, and pulmonary aspiration are the result of sleep-related gastroesophageal reflux. Recent studies have also shown that patients with functional bowel disorder (e.g. irritable bowel syndrome and dyspepsia) have a high incidence of sleep complaints as well as abnormalities of autonomic functioning. Recent studies have shown that the measurement of autonomic functioning during sleep can differentiate the patients with functional bowel disorders from normal controls. The continued study of gastrointestinal functioning during sleep clearly establishes a new horizon of investigation in both sleep medicine and gastroenterology. 2001 Harcourt Publishers Ltd
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PMID:Gastrointestinal functioning during sleep: a new horizon in sleep medicine. 1253 Oct 48

Over the past years, a number of idiopathic, chronic, inflammatory gastrointestinal diseases have been recognized, which can be distinguished from Crohn's disease and ulcerative colitis. These entities are grouped under the term "variant forms" of IBD. In this review, three distinctive, variant-IBD entities--all of which with individual and uniform histories and characteristic, histological abnormalities, but unremarkable or even absent endoscopical features--are presented: 1. The adult form of primary eosinophilic esophagitis mainly affects male patients and leads to a history of acute and recurrent dysphagia with a typical on-off-phenomenon. 2. Patients with celiac disease often present a long history of anemia and complain of symptoms resembling irritable bowel syndrome. 3. The main symptom of microscopic colitis is watery diarrhea, sometimes associated with weight loss. Faced with one of these histories, it is necessary to insist, that during the endoscopic procedures--even in the absence of mucosal alterations--representative biopsy specimens are taken and histologically worked up with adequate stainings.
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PMID:[Inflammatory bowel disease: 3 mainly by histology detectable variant forms]. 1269 18

The appropriateness of further wide prevalence of diagnostics of gastroesophageal reflux disease, functional non-ulcer dyspepsia and irritable bowel syndrome is discussed. All these diseases are believed to be found in 30-50% of adults. It is very difficult to find a healthy person taking into account such an approach to the problem. As a matter of fact, gastroesophageal disease was invented by merging two different diseases: esophagitis and reflux esophagitis plus such a prevalent symptom as heartburn. All this leads to the hyperdiagnosis of this disease. The irritable bowel syndrome also includes two conditions: that of the irritable large intestine and dyskinesia of the small one. They are very different. The application of the diagnosis of functional dyspepsia leads to the practical disappearance of the diagnosis of chronic gastritis. At that symptoms of the dyskinetic form of functional dyspepsia coincide with minor symptoms of gastric carcinoma, which can lead to late diagnostics of this oncological disease. In this connection, it is necessary to narrow the limits of these diseases because their actual prevalence is much lower than that found in medical literature.
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PMID:[Modern myths of clinical gastroenterology]. 1556 Apr 7

In this review, an integration of GI functioning is attempted with regard to its relationship to sleep, how this interaction may lead to complaints of sleep disorders, and the pathogenesis of some GI disorders. Data are presented to support the notion that sleep-related GER is an important factor not only in the development of esophagitis but also in the respiratory complications of GER. Although sensory functioning is altered markedly during sleep with regard to most standard sensory functions (eg, auditory), there seems to be an enhancement of some visceral sensation during sleep that seems to protect the tracheobronchial tree from aspiration of gastric contents reflux during sleep. Patients who have functional bowel disorders reveal an increase in sleep complaints compared with normal volunteers. The actual mechanisms of these disturbances remain somewhat obscure and studies do not demonstrate any consistent abnormalities in sleep patterns of these patients. Some studies show that autonomic functioning during sleep, particularly REM sleep, can distinguish patients who have IBS. Thus, the continued study of sleep and GI functioning promises to create a new dimension in the understanding of the pathophysiology of a variety of GI disorders.
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PMID:Sleep and the gastrointestinal tract. 1624 13

We previously found in Giemsa-stained colorectal sections from IBD patients that eosinophilic granulocytes turned fluorescent when excited with indirect fluorescent light, while other inflammatory cells were non-fluorescent. We now studied with that method, the frequency of eosinophilic granulocytes in sections from patients with eosinophilic esophagitis (EE). Cell counting was done in consecutive sections stained with Giemsa stain using indirect fluorescence light (G-IFL setting) and with hematoxylin-eosin using transmitted light (HE-TL setting) in 5 cases of EE and in 10 consecutive cases of reflux esophagitis (RE) grade 2. In EE 45.0 eosinophils/case (range 39-51) were recorded with the G-IFL setting but only 33.4 eosinophils/case (range 28-39) with the HE-TL setting (p < 0.05). In RE cases, 3 eosinophils/case (range 2-4) were found with the G-IFL setting and 2 eosinophil/case (range 1-3) with the HE-TL setting. The G-IFL method is not only more sensitive in detecting eosinophils than the conventional HE-TL method but also quicker, since a differential cell counting is not necessary.
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PMID:An improved method to visualize eosinophils in eosinophilic esophagitis. 1709 78

The aim of this study was to evaluate the reasons for trial exclusion among dyspeptic patients and estimate the proportion that may have benefited from proton pump inhibitor (PPI) therapy. Stringent inclusion criteria for enrollment in two multicenter functional dyspepsia trials included dyspepsia (predominant persistent/recurrent upper abdominal discomfort [UAD] during the prior 3 months) of at least moderate intensity during > or =30% of days during the prior 2 to 3 weeks. Exclusion criteria were mild/infrequent UAD; heartburn and UAD of equal frequency; predominant heartburn with UAD; endoscopic evidence of erosive esophagitis or Barrett's or gastric and/or duodenal erosions (>5) or ulcers; irritable bowel syndrome (IBS); other gastrointestinal diagnoses; or other "non-categorized" disorders. Of 2,588 screened patients, 1,667 were excluded. Excluded patients by category had mild/infrequent UAD (12.5%, n=324), heartburn and UAD of equal frequency (1.1%, n=29), predominant heartburn with UAD (11.6%, n=300), endoscopic evidence of erosive esophagitis or Barrett's (6.2%, n=160), gastric and/or duodenal erosions (1.4%, n=36), gastric and/or duodenal ulcers (2.0%, n=53), IBS (7%, n=180), "other" gastrointestinal diagnoses (2.8%, n=73), or other "non-categorized" disorders (19.8%, n=512). Fifty-four percent of patients (902/1,667) had symptoms/diagnoses that would be expected to improve with PPI therapy. Individuals with IBS, "other," or "non-categorized" disorders were considered to have symptoms unlikely to respond to PPI treatment. Empiric PPI treatment would be expected to provide symptom relief to the majority of dyspepsia sufferer who present in clinical practice. PPIs represent the best currently available therapy for acid-related disorders and should be considered the first-line management approach in patients with uninvestigated dyspepsia.
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PMID:Proton pump inhibitors: effective first-line treatment for management of dyspepsia. 1734 2

Gastroesophageal reflux disease (GERD) is currently defined as a condition that develops when the reflux of stomach contents causes recurrent symptoms and/or complications. The clinical presentation of GERD has been recognized to be much broader than before, when the typical symptoms of heartburn and acid regurgitation were considered as the main clinical presentation. However, now it is recognized that GERD can present with various other mainly extraesophageal symptoms, abdominal pain, and even sleep disturbance. Moreover, there is an important overlap with functional gastrointestinal disorders such as functional dyspepsia and irritable bowel syndrome. The morphologic spectrum of esophageal involvement in GERD encompasses erosive (erosive reflux disease ), Barrett's esophagus (BE), and nonerosive reflux disease (NERD). However, there is still no consensus on whether GERD represents one disease that can progress from NERD to ERD and BE, or whether it is a spectrum of different conditions with its own clinical, pathophysiologic, and endoscopic characteristics. Recently published data suggest that mild erosive esophagitis behaves in a way similar to NERD and that there is considerable movement between these categories. But follow-up data also show that after 2 years, some patients with NERD or GERD Los Angeles A or B went on to develop severe GERD or even BE. A practical approach is to categorize patients with reflux symptoms into "functional heartburn" (ie, reflux symptoms and negative endoscopy and absent objective evidence of acid reflux into the esophagus), NERD (negative endoscopy but positive documentation of acid reflux into the esophagus), and ERD (erosions documented endoscopically). In conclusion, it appears that GERD is a disease with a spectrum of clinical and endoscopic manifestations, with characteristics that make it a continuum and not a categorical condition with separate entities. It is difficult to clearly delineate the spectrum of GERD based on the clinical, endoscopic, and pathophysiologic characteristics, but therapeutic trials and follow-up studies suggest that GERD is not composed of different conditions.
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PMID:Functional heartburn, nonerosive reflux disease, and reflux esophagitis are all distinct conditions--a debate: con. 1776 Nov 23

Studies comparing pH-metrically well-characterized gastro-oesophageal reflux disease (GORD) patients with physiological reflux to GORD patients with pathological reflux, with regard to clinical and epidemiological data, are lacking. We included 273 GORD patients with pathological 24-h pH-monitoring (pH+), defined as pH<4 > or = 6% of time. A symptom index (SI) > or = 50% was considered positive, as well as a symptom association probability (SAP) > or = 95%. We included 84 GORD patients with physiological acid exposure (pH-) and a positive SI and/or SAP. Manometry and endoscopy reports were reviewed. Subjects completed questionnaires about demographics and medical history, functional dyspepsia and irritable bowel syndrome, the Nepean Dyspepsia Index symptom score and the RAND-36 quality of life scale. pH- patients were younger (45 vs 50 years, P = 0.003), more often female (60%vs 39%, P = 0.001), smoked more (31%vs 19%, P = 0.021) and reported proton pump inhibition failure more often (47%vs 32%, P = 0.027). A hypotensive lower oesophageal sphincter was less common in pH- patients (18%vs 34%, P = 0.008) and distal oesophageal contraction amplitude was higher (11 vs 9.5 kPa, P = 0.045). pH- patients had hiatal hernia and oesophagitis less often (48%vs 73%, P < 0.0005; 36%vs 54%, P = 0.012 respectively). pH- patients less often reported no other symptoms besides GORD (20%vs 34%, P = 0.015). pH- patients scored worse at the Nepean (reflux 19 vs 12 out of 39, P < 0.0005; dyspepsia 54 vs 38 out of 156, P < 0.0005). In the subgroup of patients who have physiological oesophageal acid exposure the enhancement of the perceived symptom burden appears to be the most important mechanism in GORD pathogenesis.
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PMID:Patients with physiological acid exposure and positive symptom association scores: a distinct group within the GORD spectrum. 1923 23

A multitarget herbal preparation, STW 5, has been used clinically in different gastro-intestinal disorders including functional dyspepsia and irritable bowel syndrome. Previous studies have shown that it possesses properties that may render it useful in gastro-oesophageal reflux disease (GERD). We performed this study to test this compound in an acute model of reflux oesophagitis in rats. Oesophagitis was induced surgically by ligating the pyloric end and fore-stomach. Lower oesophageal pH was measured 3 h later in conscious animals. Five hours after surgery, animals were sacrificed and the oesophagi were examined macroscopically and histologically. Selected markers of inflammation were measured in oesophageal homogenates. STW 5 was given orally for 5 days before induction of oesophagitis. Pantoprazole was used as a reference standard. Ligated animals showed a high incidence of ulcerative lesions associated with a marked increase in myeloperoxidase, thiobarbituric acid-reactive substances, tumor necrosis factor-alpha, and interleukin-1beta. STW 5 did not affect oesophageal pH, but dose-dependently reduced the severity of the oesophageal lesions and normalized the deranged level of the inflammation markers. The beneficial effects were confirmed histopathologically. STW 5 proved to be effective in protecting against inflammatory lesions in this model of oesophagitis, thus warranting further investigation of its potential therapeutic usefulness in GERD.
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PMID:Effect of an herbal preparation, STW 5, in an acute model of reflux oesophagitis in rats. 2048 68


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