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Background: Chronic abdominal pain and frequent bowel disturbance are common symptoms experienced by more than 15% of apparently healthy people. In areas endemic for Entamoeba histolytica infection, these symptoms are often diagnosed as non-dysenteric intestinal amoebiasis even though no causal relation between such symptoms and E histolytica has been established and clinical presentation of non-dysenteric intestinal amoebiasis and irritable bowel syndrome (IBS) is not distinct. This study was done to assess the clinical significance of E histolytica infection in causation of such symptoms., Methods: Patients with symptoms suggestive of non-dysenteric intestinal amoebiasis were recruited from a survey to assess the prevalence of abdominal symptoms in the general population (group A; n = 78) and from medical outpatient clinics (group B; n = 66). Participants who had symptoms as well as symptom-free controls (group C; n = 100) were clinically examined and underwent stool examination, amoebic serology, colonoscopic examination, histopathological examination of colonoscopic biopsy samples, and a trial of antiamoebic therapy (only for participants with symptoms) with metronidazole and mebendazole., Findings: There were no significant differences between the 144 patients with symptoms and the 100 symptom-free controls in the proportion with E histolytica in stools (26 [18%] vs 18 [18%]), serological evidence of E histolytica infection (61 [42%] vs 41 [41%]), colonoscopic abnormalities (five of 66 vs one of 33), or histopathological abnormalities (36 [49%] of 73 vs ten [30%] of 33). Cyst-positive and cyst-negative individuals showed no significant difference in serological evidence of E histolytic infection, histological abnormalities, or response to therapeutic trial with metronidazole. A diagnosis of IBS was suggested on the basis of consensus criteria and Kruis diagnostic index in 127 of 144 patients with symptoms. The diagnosis of non-dysenteric intestinal amoebiasis could be made in only one patient, who had relapse of symptoms within 6 weeks of antiamoebic therapy and therefore the relapse did not meet criteria for the diagnosis of non-dysenteric intestinal amoebiasis. More than 60% of cyst-positive as well as cyst-negative patients with symptoms showed either complete or partial response to treatment strategy for IBS., Interpretation: Chronic bowel symptoms, such as pain in abdomen and frequent bowel disturbance, have no association with either past or present infection with E histolytica. Most patients with such symptoms are likely to have IBS. The clinical entity of non-dysenteric intestinal amoebiasis, if it exists, must be extremely rare.

Background: This study aimed to determine the prevalence, nature, and effects--both physical and psychological--of spinal-cord-injury (SCI) on bowel function., Methods: 115 consecutive hospital outpatients (89 male, median age 38 years) with chronic SCI (median duration 62 months, range 9-491 months, 48% cervical, 47% thoracic, 5% lumbar) completed a questionnaire about pre and post injury bowel function, the Hospital Anxiety and Depression Scale (HADS), and self assessment of the impact of their disabilities and symptoms., Findings: Nausea, diarrhoea, constipation, and fecal incontinence were all much more common (p<0.0001) after SCI. 95% of patients required at least one therapeutic method to initiate defaecation. Half the patients became dependent on others for toileting. 49% took more than 30 min to complete their toilet procedure. Bowel function was a source of distress in 54% of patients and this was significantly (p=0.005) associated with the time required for bowel management and frequency of incontinence (p=0.001). There was a highly significant correlation between the HADS scores and the time taken for bowel management. On a scale of 0 (for no perceived problem) to 10 (maximum perceived problem), patients rated their loss of mobility as a mean of 6.8 (SD 3.3) and their bowel management as 5.1 (SD 3.6)., Interpretation: Bowel function is a major physical and psychological problem in SCI patients.

Sixteen patients with bird-fancier's lung were screened for evidence of coeliac disease by assessing their clinical features, red-bloodcell or serum folate levels, and serum for reticulin antibodies. Five of nine patients selected for jejunal biopsy showed villous atrophy, and in some this seemed to be a true gluten-sensitive enteropathy.

To investigate local events in the gut as well as the location and duration of discomfort associated with colic, mild phasic pain was induced by balloon distension and bolus injection of normal saline at various sites in the gut of 1 normal volunteer and 12 patients with gut disorders. Intraluminal pressures were recorded. Pain was experienced only when a rise in baseline pressure occurred in a segment of gut at least 6 cm and up to 32 cm long. Painful segmental pressure rises were often low compared with non-painful localised pressure rises. Induced phasic pain had all the characteristics of colic, usually lasted less than a minute in both small and large intestine, and while frequently beginning paracentrally, tended to spread across the midline with increasing severity.