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We present the case of a 24-year-old woman who presented to the emergency department with mid-epigastric pain and nausea. Contrast enhanced dual-energy CT showed high iodine signal in the small bowel lumen concerning for gastrointestinal bleeding since oral contrast was not given. However, overt bleeding symptoms were absent. Further in-house analysis of the dual-energy CT data revealed the hyperattenuating intraluminal material to be oral indigestion medicine containing magnesium, aluminum, or bismuth, and not extravasated iodine.

Flatulence as the continuous feeling of abdominal distension is equal to “Nafkh” in Iranian Traditional Medicine. Nafkh is believed to derive from the amount of stomach temperature, humidity of food or abnormal humidity in digestive tract and their interactions. Mentha spicata as cool and spicy plant with astringent and digestive property is recommended for treatment of flatulence. The information was extracted from accessible international databases, traditional books, electronic resources, and unpublished data. M. spicata essential oil with main component of carvone has potency for treatment of flatulence related to indigestion, cesarean section and dysmenorrhea. Also, it can reduce the pain severity during the colonoscopy or dysmenorrheal conditions. No hazardous effects were reported for M. spicata essential oil, if it is used in proper dosages. M. spicata essential oil can be applied for other intestinal complaints with pain and flatulence such as Irritable Bowel Syndrome (IBS) that needs more deep clinical trials for demonstrating its potential., Graphical abstract Image 1

Dyspepsia affects a large percentage of the general population and can lead to lost work productivity and reduced quality of life. Patients with dyspepsia younger than 60 should not routinely undergo endoscopy but instead should pursue Helicobacter pylori test-and-treat approach. For patients 60 and older, endoscopy should be performed. Patients without any identifiable cause for their symptoms are diagnosed with functional dyspepsia. Guideline-based treatment includes H pylori eradication and proton pump inhibitor use. If acid suppression is not adequate, treatment with a tricyclic antidepressant followed by a prokinetic agent and psychological therapy are considered. Complementary therapies are not recommended due to limited evidence.

Gastrointestinal (GI) problems affect half of Western populations. Symptoms can vary from frequent reflux to irritable bowel syndrome. The Nutrition Care (NC) Gut Relief Formula contains a combination of herbs and nutrients including curcumin, Aloe vera, slippery elm, guar gum, pectin, peppermint oil, and glutamine shown to benefit the GI system. The 16-week pre-post study tested the hypothesis that the NC Gut Relief Formula would be tolerable and effective in improving GI symptoms and gut health in adults with digestive disorders. A total of 43 participants completed the study. After a control phase, participants took 5 g/d and then 10 g/d of the formula for 4 weeks. GI symptoms and GI health were assessed by a series of validated questionnaires, for example, Leeds Dyspepsia Questionnaire, Bristol Stool Chart, Birmingham IBS Symptom Questionnaire, and by intestinal permeability and gut microbiota profile. The NC Gut Relief Formula significantly improved the frequency and severity of upper and lower GI symptoms by 60%-80%, including indigestion, heartburn, nausea, constipation or diarrhea, abdominal pain, and troublesome flatulence, and significantly improved physical functioning, energy levels, mood, and sleep by 60%-80%. All participants with normal stool, 90% with hard stool, and 66% with soft stool recovered from intestinal permeability, evident by normal lactulose to mannitol ratios. The NC Gut Relief Formula generally improved microbial profile, with a marked increase in Lactobacillus, Clostridium, and Faecalibacterium prausnitzii. Almost half of the participants with upper GI symptoms taking proton pump inhibitors for heartburn no longer required proton pump inhibitors at the end of the study. A third of participants were able to reintroduce food triggers, such as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols garlic, onion, and beans, or reflux-causing acidic/spicy foods, for example, citrus, tomato, and caffeine, in their diet after 3 months without symptom aggravation. The NC Gut Relief Formula significantly improved GI symptoms and associated quality of life over 3 months while reducing intestinal permeability, improving the microbial profile, reducing the need for reflux medication, and enabling the consumption of previous food triggers.

Case Presentation A 70-year-old lifelong nonsmoking woman with a past medical history of hypertension was referred to the respiratory clinic for evaluation of chronic cough. She presented with a 5-month history of dry cough, night sweats, fatigue, and a 4.5-kg weight loss. Her cough tended to be worse while lying flat. She denied having shortness of breath, chest pain, wheeze, or hemoptysis. She was taking amlodipine for her blood pressure as well as omeprazole for indigestion. She denied having any reflux symptoms or heartburn. She worked as a receptionist for an optician. She did not have any pets at home and had no family history of asthma or allergic conditions. She had not been abroad recently.

Tibetan medicine has been practiced for 3800 years. Anzhijinhua San (AZJHS), which is a traditional Tibetan medicine, has been effective in the treatment of indigestion, anorexia and cold diarrhea. However, the effects of AZJHS on allergic diarrhea have not been reported.The aim of the present study was to elucidate the effect of AZJHS on experimental ovalbumin-induced diarrhea and elucidate its possible mechanism.Female BALB/c mice were sensitized by intraperitoneal injection with 50 μg ovalbumin (OVA) and 1 mg alum in saline twice during a 2-week period. From day 28, mice were orally challenged with OVA (50 mg) every other day for a total of ten times. AZJHS (46.8 and 468.0 mg/kg) was orally administered every other day from day 0-46. Food allergy symptoms were evaluated. OVA- specific IgE, 5-HT and its metabolites in serum were determined. Immunohistochemical and histopathology were performed in gastrointestinal tract tissues. 5-HT-related gene expression was assayed in the colon.Severe symptoms of allergic diarrhea were observed in the model group (diarrhea, anaphylactic response, and rectal temperature). AZJHS (46.8 and 468.0 mg/kg) significantly reduced mouse diarrhea and significantly prevented the increases in OVA-specific IgE levels (P 0.05), which challenge with OVA. AZJHS (46.8 and 468.0 mg/kg) significantly prevented the increases in 5-HT-positive cells. The nuclei of EC cells in the AZJHS (46.8 and 468.0 mg/kg) group increased in size and the secretory granules were fewer in number compared with those in the model group. AZJHS (46.8 and 468.0 mg/kg) significantly increased the relative fold changes of 5-HTP and 5-HT compared with the model group. The mRNA expression of the serotonin transporter (Sert) and serotonin receptor 3A (Htr3a) was significantly decreased after the 10th challenge with OVA, and AZJHS (46.8 and 468.0 mg/kg) significantly increased these levels.We demonstrated that the administration of AZJHS attenuated OVA-induced diarrhea by regulating the serotonin pathway. These results indicated that AZJHS may be a potential candidate as an anti-allergic diarrhea agent.

Milk is a key contributor to improving nutrition and food security particularly in developing countries. Milk composition of mammalian species varies widely with reference to genetic, physiological, nutritional factors and environmental conditions. It is necessary to know the maximum value addition in the dairy food chain as the nutrient, to not only determine the dietary value of milk for human consumption, but also help to define market strategy for various classes of consumer like; growing children, nursing mothers, young people involved in hard jobs or elderly people. The use of cow, camel, goat, buffalo milk gained worldwide acceptance and importance throughout the world, while consumption of mare milk popular only in Western Europe. Goat milk prescribed by many doctors for children, who are sensitive to cow milk, and is an alternative for people who are allergic to cow milk. Goat milk is very useful for people suffering from problems such as acidity, eczema, asthma, migraine, colitis, stomach ulcer, digestive disorder, liver and gallbladder diseases and stress-related symptoms such as insomnia, constipation and neurotic indigestion. For some people with digestive difficulties, goat’s milk can be easily digested. Camel milk is an important source of proteins for the people living in the arid lands of the world camel milk is considered to have anti-cancer, hypo-allergenic and anti- diabetic properties. Buffalo milk is a natural product that can be consumed like any other milk. It is one of the richest products from a compositional point of view and characterized by higher fat, total solids, proteins, caseins, and lactose and ash contents than cow, goat, camel and human milk. The major constituents of buffalo milk are higher in concentration than that of human, cow, goat and camel milk with respect to nutritional values. In addition to its advantage as a rich source of nutrients, a recent study indicated that subjects with cow milk allergy are able to tolerate buffalo milk. Therefore, this review is aimed to explore composition of milk of farm animals and to make awareness on availability of different sources of milks.

Made available in DSpace on 2021-06-25T11:05:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-30 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Ethnopharmacological relevance: In folk medicine Hyptis suaveolens (Lamiaceae) has been reported to relieve respiratory and gastrointestinal infections, indigestion, cold, pain, fever, cramps, skin diseases, gastric ulcer and inflammatory disorders. This study investigated the effects and the mechanisms of action of Hyptis suaveolens (L.) Poit (Lamiaceae) ethanol extract (Hs-EtOH) and hexane phase (Hs-HexF) against intestinal inflammation. Material and methods: Acute and relapse TNBS-induced ulcerative colitis protocols were used to evaluate intestinal anti-inflammatory activity. Damage evaluations, biochemical, histological and immunostaining parameters were determined. Results: Both extracts decreased macroscopic colonic inflammation and the area of lesion induced by TNBS. Nevertheless, only Hs-HexF was able to reduce colonic wall thickness, edema and diffuse inflammatory cell infiltration and to prevent GSH depletion in the acute model of ulcerative colitis. In the chronic phase with relapse of colonic ulceration, yet again only Hs-HexF significantly attenuated inflammatory parameters and presented a decrease in nitrite/nitrate, MDA, MPO, IL-1-β and TNF-α and increased levels of SOD, CAT, GSH and IL-10. Hs-HexF also significantly reduced positive cells immunostained for PCNA. Conclusion: The data indicate intestinal anti-inflammatory activity for H. suaveolens, due to the participation of the antioxidant system, decreased neutrophil infiltration and cytokine modulation, as well as, owing to regulation of cell proliferation. Postgraduate Program in Natural and Synthetic Bioactive Products Health Sciences Center Universidade Federal da Paraíba (UFPB) Laboratory of Natural Products Universidade Federal do Ceará (UFC) Department of Biophysics and Pharmacology Universidade Federal do Rio Grande Norte (UFRN) Department of Morphology Histology and Basic Pathology Federal University of Rio Grande do Norte Laboratory of Histology UNIPEX-FMB Universidade de São Paulo (UNESP) Laboratory of Histology UNIPEX-FMB Universidade de São Paulo (UNESP) CNPq: 14/2014

Background Daikenchuto (DKT), a traditional Japanese herbal medicine, is widely used for treatment of gastrointestinal disorders. We evaluated the efficacy and safety of DKT for abdominal bloating in patients with chronic constipation. Objective To evaluate the efficacy and safety of DKT for the treatment of abdominal bloating. Methods After discontinuing as-needed use of laxatives, 10 patients received oral DKT for 14 days (15 g/d). To evaluate small intestinal bacteria overgrowth (SIBO), a glucose breath test was performed before and after treatment with DKT. Before beginning the treatment, 4 patients (40%) had a diagnosis of SIBO based on a positive glucose breath test result. In both the SIBO and non-SIBO groups, bowel movement frequency and stool form remained unchanged after DKT treatment. Results For all patients, median total Gastrointestinal Symptoms Rating Scale score and the median Gastrointestinal Symptoms Rating Scale indigestion and constipation subscales were significantly decreased, whereas the median visual analog score for decreased abdominal bloating was significantly increased. Improvements of those symptoms were the same in both the SIBO and non-SIBO groups, indicating that DKT does not have effects on small intestine bacteria. No serious side effects were reported. Conclusions DKT treatment improved quality of life for patients with chronic constipation regardless of the presence of SIBO and showed no effects on small intestine bacteria. UMIN Clinical Trial Registry identifier: UMIN000008070.

Objectives This descriptive and cross-sectional study was conducted to determine the herbal supplement products used by mothers for their children to cope with some frequently encountered health problems in childhood. Methods The study sample consisted of 202 mothers who applied to family health centers between January and March 2017 and agreed to participate in the study. A questionnaire was used for data collection. Results In this study, 41.5% of mothers used herbal supplement products for sore throat, 37.1% for nausea and vomiting, 28.2% for gas pain and indigestion, 26.7% for constipation, 17.8% for cough, and 12.3% for sleeping problems and calming their children down. Mothers used mint-lemon, fennel, linden, chamomile, apricot leaf, and anise teas, ginger, lemon balm (Melissa officinalis), cumin water, rosemary, rosehip, and sage to cope with childhood age health problems. One half of mothers had chosen to use herbal products based on recommendations from their family members or close relatives. Doctors recommended herbal supplement products at a lower rate. Four-fifths of mothers obtained herbal supplement products from herbal sellers, markets, and gardens; only 17.3% of mothers bought the products from the pharmacy. Conclusion Mothers used mint-lemon, fennel, linden, chamomile, apricot leaf, and anise teas, ginger, lemon balm, cumin water, rosemary, rosehip, and sage to treat children’s symptoms of upper respiratory tract infection, gastrointestinal system disorders, and sleep problems. Very few of the mothers used herbal supplements with the advice of doctors.

Gastrointestinal disorders (GDs) are common in renal transplant recipients. The main cause of GDs seems to be the use of immunosuppressive medications, especially mycophenolic acid in the form of mycophenolate mofetil (MMF).The aim of this study was to estimate the frequency and severity of GDs in renal allograft recipients with the use of the Gastrointestinal Symptom Rating Scale (GSRS).Eighty-five renal allograft recipients, 50 ± 12 years old, treated with methylprednisolone, calcineurin inhibitor (cyclosporine [CsA], n = 42; tacrolimus (TAC), n = 43), and MMF were studied.At the time of completion of the GSRS questionnaire, 38 of the 85 patients (45%) already had their MMF dose reduced because of GDs. Only 15 patients (18%) were totally free from GDs. The most frequent and severe GDs recorded were indigestion and diarrhea who were significantly more frequent in women (P = .045). GDs were recorded in patients receiving both standard and reduced dose of MMF. MMF dose was significantly associated only with diarrhea. Although TAC-treated patients had the highest mean GSRS scores, no statistically significant differences were observed compared with CsA-treated patients. In 31 patients, MMF was replaced by enteric-coated mycophenolate sodium (EC-MPS) and new questionnaires were completed 1 month later. Significant improvement in total and all subscores of GSRS was demonstrated (P.001). Although EC-MPS dose tolerated by the patients was higher than MMF dose, the difference was not statistically significant.Female sex and the use of MMF, especially in combination with TAC, are related to the occurrence of severe gastrointestinal symptoms. Substitution of MMF with EC-MPS significantly reduces the severity of symptoms and permits the use of higher doses.

Background Early diagnosis of cancer is an important factor in increasing success in treatment. Nursing and nursing students who take care of the patient in clinical area practices can have a major impact on the disease by providing early diagnosis of the cancer. Limited study was explored awareness of nursing student about the warning signs of cancer. Methods A cross-sectional descriptive study was conducted from January-March 2019. The sample size was measured Raosoft online calculator programme. A total of 460 nursing students participated in this study. Data was was obtained from nursing student via self-report using the data collection form developed by researchers based on literature. The Chi-square test was performed to evaluate differences among groups. Results The mean age of the nursing students was 20.05 ± 2.04; most of the students were female (82.6%). The knowledge level of warning signs of cancer of the students who were female was significantly higher than male students; as following; the symptoms of change in bowel or bladder habits (p = 0.001); unusual bleeding or discharge (p = 0.01); thickening or lump in the breast or elsewhere (p = 0.004); indigestion or difficulty in swallowing (p = 0.002); obvious change in a wart or mole (p = 0.003); nagging cough or hoarseness (p = 0.04). The knowledge level of warning signs of cancer of the students who took ’Internal Medicine Nursing’ lesson was significantly higher than others; as following; the symptoms of change in bowel or bladder habits (p = 0.000); a sore that doesn’t heal (p = 0.002); unusual bleeding or discharge (p = 0.03); indigestion or difficulty in swallowing (p = 0.000); obvious change in a wart or mole (p = 0.000); nagging cough or hoarseness (p = 0.001). Conclusions It is thought that the majority of nursing students know warning signs of the cancer and are associated with the education given in ’Internal Medicine Nursing’. It is recommended that nursing students take part in early diagnosis and screening programs in cancer. Female nursing students more aware than male students. Because; cancer prevention campaigns have focused breast and cervical cancer which involves only females. Cancer prevention campaigns should be organized for lung, prostate and colorectal cancer which are more common in men. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

Ethnopharmacological relevance Fuzi-Lizhong pill (FLZ) is a traditional Chinese medicine for treating patients with Spleen Yang deficient syndrome. Ghrelin, a peptide with 28 amino acid residues, plays multiple roles in thermogenesis. This study aims to explore FLZ regulating ghrelin to compensate hypothermia in rats with hypothyroid and indigestion. Materials and methods In litter-matched rats, hypothermia was developed with both thyroidectomy at d1 and interscapular brown adipose (IBA) removal at d42, indigestion was induced with both high fat diet and fasting-feeding cycle from d56; the littermates with hypothermia and indigestion were administrated with FLZ from d70. Adaptive thermogenesis, thyroid hormones, metabolites, ghrelin dynamics were measured at d98. Results The results showed that plasma ghrelin levels were inversely correlated with the gastric ghrelin levels and adaptive thermogenesis in rats undergone both thyroidectomy and IBA removal. Fatty diet and FLZ enhanced the increase of plasma ghrelin of hypothyroid rats. These were supported by the changes of plasma thyroid related hormones, plasma metabolites, gastric ghrelin mRNA and protein, and the effects of fatty diet or FLZ. Conclusions Our results suggest that more ghrelin release compensate chronic hypothermia in rats with both hypothyroidism and indigestion. It could explain the mechanisms of FLZ in relieving chronic hypothermia.

Caesalpinia pyramidalis Tul. (Fabaceae), known as "catingueira", has been used in folk medicine in the treatment of various disorders such as gastritis, heartburn, indigestion, and stomach ache. However, the gastroprotective properties of this species have not yet been studied.The ethanol extract of Caesalpinia pyramidalis inner bark was used in rats via oral route, at the doses of 30, 100, and 300 mg/kg. The antiulcer assays were performed using the ethanol- and nonsteroidal anti-inflammatory drug-induced ulcer models. Gastric secretion parameters (volume, pH, and total acidity) were also evaluated by the pylorus ligated model, and the mucus in the gastric content was determined. The anti-Helicobacter pylori activity of the ethanol extract of Caesalpinia pyramidalis was performed using the agar-well diffusion and broth microdilution methods.The ethanol extract (30, 100, and 300 mg/kg) produced dose dependent inhibition (P0.01) on the ulcer lesion index, the total lesion area, and the percentage of lesion area in the ethanol-induced ulcer model. The ethanol extract (30, 100, and 300 mg/kg) also reduced (P0.001) the ulcer index in the indomethacin-induced ulcer model. In the model ligature pylorus, the treatment with Caesalpinia pyramidalis ethanol extract failed to significantly change the gastric secretion parameters. However, after treatment with the ethanol extract of Caesalpinia pyramidalis (30, 100, and 300 mg/kg), there was a significant increase (P0.05) in mucus production. The ethanol extract showed anti-Helicobacter pylori activity, with inhibition halos of 12.0 ± 1.7 mm at 10,000 μg/mL. The minimum inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) values of the ethanol extract were of 625 and 10,000 μg/mL, respectively.Collectively, the present results suggest that the ethanol extract of Caesalpinia pyramidalis displays gastroprotective actions, supporting the folkloric usage of the plant to treat various gastrointestinal disturbances.

BACKGROUND: Pancreatic cancer is the tenth most common cancer in the UK; however, outcomes are poor, in part due to late diagnosis. We aimed to identify symptoms and other clinical and sociodemographic factors associated with pancreatic cancer diagnosis and diagnostic intervals. METHODS: We did this prospective cohort study at seven hospitals in two regions in England. We recruited participants aged 40 years or older who were referred for suspicion of pancreatic cancer. Data were collected by use of a patient questionnaire and primary care and hospital records. Descriptive and regression analyses were done to examine associations between symptoms and patient factors with the total diagnostic interval (time from onset of the first symptom to the date of diagnosis), comprising patient interval (time from first symptom to first presentation) and health system interval (time from first presentation to diagnosis). FINDINGS: We recruited 391 participants between Jan 1, 2011, and Dec 31, 2014 (24% response rate). 119 (30%) participants were diagnosed with pancreatic cancer (41 [34%] had metastatic disease), 47 (12%) with other cancers, and 225 (58%) with no cancer. 212 (54%) patients had multiple first symptoms whereas 161 (41%) patients had a solitary first symptom. In this referred population, no initial symptoms were reported more frequently by patients with cancer than by those with no cancer. Several subsequent symptoms predicted pancreatic cancer: jaundice (51 [49%] of 105 patients with pancreatic cancer vs 25 [12%] of 211 patients with no cancer; p

Background: The timely and accurate identification of symptoms of acute coronary syndrome (ACS) is a challenge for patients and clinicians. It is unknown whether response times and clinical outcomes differ with specific symptoms. We sought to identify which ACS symptoms are related-symptom clusters-and to determine if sample characteristics, response times, and outcomes differ among symptom cluster groups. Methods: In a multisite randomized clinical trial, 3522 patients with known cardiovascular disease were followed up for 2 years. During follow-up, 331 (11%) had a confirmed ACS event. In this group, 8 presenting symptoms were analyzed using cluster analysis. Differences in symptom cluster group characteristics, delay times, and outcomes were examined. Results: The sample was predominately male (67%), older (mean 67.8, S.D. 11.6 years), and white (90%). Four symptom clusters were identified: Classic ACS characterized by chest pain; Pain Symptoms (neck, throat, jaw, back, shoulder, arm pain); Stress Symptoms (shortness of breath, sweating, nausea, indigestion, dread, anxiety); and Diffuse Symptoms, with a low frequency of most symptoms. Those in the Diffuse Symptoms cluster tended to be older (P = .08) and the Pain Symptoms group was most likely to have a history of angina (P = .01). After adjusting for differences, the Diffuse Symptoms cluster demonstrated higher mortality at 2 years (17%) than the other 3 clusters (2%-5%, P < .001), although prehospital delay time did not differ significantly. Conclusion: Most ACS symptoms occur in groups or clusters. Uncharacteristic symptom patterns may delay diagnosis and treatment by clinicians even when patients seek care rapidly. Knowledge of common symptom patterns may facilitate rapid identification of ACS. © 2010 Mosby, Inc. All rights reserved.

Objective. The objective of this prospective study was to evaluate the effect of conversion from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) in renal transplant recipients with gastrointestinal tract (GI) reverse effects using patient-reported outcomes instrument. Methods. A multicenter, open-label, prospective study was undertaken in renal transplant recipients treated with MMF. In patients experiencing GI tract symptoms, treatment was changed to equimolar EC-MPS (myfortic). At baseline and visit 2 (4-6 weeks after baseline), patients completed the Gastrointestinal Symptom Rating Scale (GSRS) and Gastrointestinal Quality of Life Index (GIQLI), and physicians completed the Overall Treatment Effect (OTE) scale at visit 2. A difference of 0.5 or greater in the OTE score is indicative of clinical relevance. Results. Of 154 patients screened, 118 fulfilled the inclusion or exclusion criteria. Eighty-five men and 33 women with a mean age of 41.6 years participated in this study. Median time since transplantation was 12 months. Mean (SD) dose of MMF reported at baseline was 1209.4 (422.89) mg/d. More than 50% of patients reported MMF-associated nausea, dyspepsia, and abdominal pain. After conversion to an equimolar dose of EC-MPS, patients showed improvement in GI symptoms. This benefit was predominantly observed in patients with moderate to severe symptoms at baseline. On the GSRS, patients reported a significant (P

Because fundoplication-related side effects are frequent, we evaluated laparoscopic mesh-augemented hiatoplasty (LMAH) as a potential treatment option for gastroesophageal reflux disease and/or symptomatic hiatal herania. LMAH aims to prevent reflux solely by mesh-reinforced narrowing of the hiatus and lengthening of the intra-abdominal esophagus.Twenty-two consecutive patients with LMAH were evaluated prospectively using a modified Gastrointestinal Symptom Rating Scale questionnaire, pH measurement, manometry, and endoscopy. Follow-up was scheduled at 3 and 12 months after surgery.Total reflux decreased from 16.3% before surgery to 3.5% 3 months after surgery (P = .001). The reflux score decreased from 3.8 before surgery to 2.1 1 year after surgery (P = .001). The respective values of the indigestion score were 3.4 and 2.0 (P.001). After surgery, all patients were able to belch. Vomiting was impossible only for 2 patients, and 90% of patients assessed their results as good to excellent.LMAH seems to be feasible, safe, and has no significant side effects.

Objectives: The aim of this study was to evaluate the efficacy of the natural antioxidant astaxanthin in functional dyspepsia in different doses and compared with placebo. Design: The study was a controlled, prospective, randomized, and double blind trial. Participants: Patients with functional dyspepsia, divided into three groups with 44 individuals in each group (placebo, 16 mg, or 40 mg astaxanthin, respectively). Interventions: Participants were asked to accept gastroscopy before treatment, together with questionnaires: GSRS and SF-36. Urea breath test (UBT) was done before the treatment. Main outcome: The primary objective was to test the hypothesis that the antioxidant astaxanthin at two doses regimens compared to placebo should ameliorate gastrointestinal discomfort measured as GSRS in patients with functional dyspepsia, who were either positive or negative for Helicobacter pylori, after 4 weeks of treatment. Results: At the end of therapy (week 4) no difference between the three treatment groups was observed regarding mean Gastrointestinal Symptom Rating Scale (GSRS) scores of abdominal pain, indigestion and reflux syndromes. The same results were observed at the end of follow-up. However reduction of reflux syndrome before treatment to week 4 was significantly pronounced in the higher (40 mg) dose compared to the other treatment groups (16 mg and placebo, p = 0.04). Conclusion: In general, no curative effect of astaxanthin was found in functional dyspepsia patients. Significantly greater reduction of reflux symptoms were detected in patients treated with the highest dose of the natural antioxidant astaxanthin. The response was more pronounced in H. pylori-infected patients. (c) 2008 Elsevier GmbH. All rights reserved. (Less)

Dyspepsia (heartburn, epigastric pain, and indigestion) affects approximately 50% of the population and therefore is a familiar complaint in the primary care setting. The differential diagnoses for dyspepsia are many; however, the two most common causes are gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD). Nurse practitioners must be able to discriminate between these two disorders and recognize the risks factors and clinical manifestations (typical and atypical) of each to correctly manage. This article serves as a review and update for these two disorders.

Summary This study was designed to survey college students about their knowledge and use of Uwhangchungsimwon (UC), a Traditional Oriental herbal remedy for emergency and acute treatment of stroke, numbness, hypertension, epilepsy and arteriosclerosis. Students at three female nursing colleges in Korea completed a questionnaire containing 29 questions about the students’ demographics, knowledge and use of UC, and the placebo effect. Of 608 respondents, 217 (36%) had taken UC. Eighty-three per cent reported that UC alleviated examination tension and 28% knew that it is used as an emergency drug for stroke. Forty-two per cent believed that UC has a “placebo effect” and 20% considered its effects were more than that of a placebo. Fifty-eight per cent of those using UC felt that it was effective in inducing psychological relaxation, 4% considered that it increased their energy levels, and 6% felt it was effective in “clearing the head”; 33% reported no effects. Users also reported adverse effects: 30% reported drowsiness, 17% reported a “heavy head” and 15% experienced indigestion. Most respondents (73%) obtained information about UC from family members and friends and 33% from newspapers or the media. These results confirm health practitioner should recognize that UC is used widely for purposes other than its intended purpose (i.e., to treat stroke and hypertension) and that such use can cause adverse effects. More systematic research is needed to increase the safety of consumers when using herbs and herbal supplements.

Diaphragm-like stricture of the small bowel is an infrequent complication of the treatment of patients with nonsteroidal anti-inflammatory drugs (NSAIDs) and is part of the spectrum of diseases associated with NSAIDs injury. We report a patient with this condition who had used various forms of NSAIDs for over 20 years. Patient presented with abdominal pain and indigestion. Plain abdominal film revealed small bowel obstruction. Surgical resection of jejunum and proximal part of ileum identified dilated thickened hyperemic mucosa alternating with areas of small bowel fibrotic constriction. The mucosal surface showed multiple pink-tan mucosal folds (circumferential ridges) with focal hemorrhage and edema. Our findings support the local stimulation and damage and reparative process seen with NSAIDs use. A high degree of suspicion and awareness of diaphragm disease is necessary in those patients.

The present study was planned to investigate the ethnoveterinary methods practiced by the owners of pneumatic-cart pulling camels in Faisalabad Metropolis (Pakistan). During a 7-year-period (November 1992-November 1999), 200 owners of draught camels working in the city were interviewed. Information concerning the ethnoveterinary practices for the treatment of common disorders of digestive tract (indigestion, colic and diarrhea), respiratory tract (cold/rhinitis, pneumonia), skin problems (mange, ulceration of nostrils with or without nasal myiasis, ticks and lice, harness sores), systemic states (fever, ze/rba/d, anhidrosis) and preventive therapy of indigestion and halitosis was collected through interviews and collated with those documented for the treatment of desert-dwelling camels. Familiarity of owners with two traditional methods of surra (trypanosomiasis) diagnosis ('Sand-ball test' and 'Hair-stick test') known to pastorilists was also probed. In addition, the dose and frequency of use of common salt was investigated. Traditional inputs utilized by the camel owners included various plant products, insecticides, sulphur, sump oil, common salt, aspirin, naphthalene balls and milk fat. Different owners used different combinations of traditional drugs for the treatment of disorders/conditions investigated. None of the camel owners was found familiar with the 'Sand-ball test' or 'Hair-stick test' of trypanosomiasis diagnosis. For the prevention of indigestion and halitosis all camel owners had practiced administration of 'massaulas' (physic drench/balls) along with common salt (average 250 g) on weekly basis. Firing had not been used by any owner. In general, the ethnoveterinary treatment practices used by the owners of city-dwelling camels appear to be different from those documented for the treatment of diseases of desert-dwelling camels.

Purpose The patent covering mycophenolate mofetil (MMF) in Korea has expired and, thus, several generic MMF agents are now commercially available. The supply of Cellcept (Roche Korea) was interrupted at the end of 2011, so it was inevitable that a generic MMF would be used instead. During this period, we performed a prospective pilot study to examine the safety and efficacy of a generic mycophenolate agent (Myconol: Hanmi Pharmaceutical, Seoul Korea) for use as conversion maintenance therapy in stable liver transplantation (OLT) recipients. Methods OLT recipients, who were treated with MMF on an outpatient basis from January 2012 to March 2012, attended follow-up interviews conducted. The patients had undergone OLT ≥ 2 years before the study, had tolerated Cellcept, and showed stable liver function. Fifty-three patients were followed up for more than 3 months after conversion to the same dose of Myconol. Results After conversion to Myconol, 6 patients (11.3%) experienced new side effects, which disappeared when they reverted to Cellcept ( n = 5) or stopped taking Myconol medication ( n = 1). The side effects associated with Myconol included gastrointestinal symptoms (indigestion and diarrhea; n = 3), skin eruptions ( n = 1), pruritus ( n = 1), and insomnia ( n = 1). The mean mycophenolic acid levels were 1.71 ± 0.88 μg/mL for Cellcept and 1.83 ± 0.91 μg/mL for Myconol, which showed a strong correlation ( r 2 = 0.92, P Conclusions Myconol showed similar pharmacokinetics to those of Celcept, but a small proportion of patients experienced agent-specific side effects; therefore, patients should be closely monitored when taking Myconol. Also, further studies, with a greater number of patients, are required to identify the full spectrum of drug-associated side effects.

The sodium-proton exchanger NHE6 contributes to proper endosomal acidification. NHE6 mutations are also linked to autism-related disorders. In this issue of Neuron, using NHE6-knockout mice, Ouyang et al. (2013) uncover how dysregulation of endosomal pH leads to disturbances in BDNF signaling and neuronal morphogenesis defects.

This paper reports a case of vagus nerve damage in a ewe due to the presence of a mineralized Cysticercus tenuicollis cyst in the omentum, adjacent to the reticulum and over the ventral branch of the nerve. The clinical course, surgical management and post-mortem findings of vagus indigestion are described. For the author's knowledge this is the first description of this syndrome in sheep.

Background Coronary heart disease is a major problem in both men and women, but several studies have shown sex differences in symptoms of acute coronary syndromes (ACS). Some findings, however, have been disparate and inadequate, and thus a comprehensive overview of this literature would be of value. Method Fifteen studies that identified symptoms of ACS for both women and men were examined through a review of the literature from 1989 to 2002. Terms used for the search included “myocardial infarction,” “symptoms,” “gender differences,” and “acute coronary syndromes.” Results Although chest pain was the most common symptom in both men and women, several differences were also noted. In all types of ACS, women had significantly more back and jaw pain, nausea and/or vomiting, dyspnea, indigestion, and palpitations. In a number of studies, which solely sampled patients with acute myocardial infarction, women demonstrated more back, jaw, and neck pain and nausea and/or vomiting, dyspnea, palpitations, indigestion, dizziness, fatigue, loss of appetite, and syncope. Men reported more chest pain and diaphoresis in the myocardial infarction sample. The designs and methodologies of the studies varied considerably. Conclusion In addition to the typical symptom of chest pain in ACS, women experience other atypical symptoms more frequently than men. Thus, there may be sex differences in the symptoms of ACS, differences that have a bearing not only on clinical practice, but also on the interpretation of available clinical studies and the design of future investigations.

Question: A 67-year-old woman, who is a hepatitis C virus carrier, suffered from early satiety, indigestion, and occasional abdominal fullness since 2013. Physical examination and laboratory tests were unremarkable. Esophagogastroduodenoscopy disclosed a polypoid nodule at anterior wall of duodenal bulb (Figure A). Biopsy showed inflammatory changes. Abdominal computed tomography revealed a 1.4-cm protruding, heterogeneously hypodense nodule at the duodenal bulb (Figure B, C; black arrow). Endoscopic ultrasonography with 12-MHz miniprobe showed an 18.6 10.8-mm isoechoic tumor with cystic change arising from the submucosal layer (Figure D). The patient underwent endoscopic resection of the tumor. What is your diagnosis of this duodenal tumor? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

Background Over half of U.S. adults use vitamin or mineral supplements, and some are likely using supplements to treat chronic diseases or risk factors for disease. Information on the relationship between supplement use and medical conditions is useful to health professionals to understand the self-medication behavior of their patients, and important for researchers because medical conditions may be potential confounding factors in observational studies of supplement use and disease risk. Methods The cross-sectional data in this report are from 45,748 participants, aged 50 to 75 years, who completed a self-administered, mailed questionnaire on current dietary supplement use (multivitamins plus 16 individual vitamins or minerals), medical history (cancer, cardiovascular-related diseases, and other self-reported medical conditions), and demographic characteristics. Results Supplement use (mean number used at least once a week) was higher among respondents who were older, female, highly educated, Caucasian, and of normal body mass index (all p

A prospective, randomised, double-blind, parallel group, two center, single-dose study was conducted to evaluate and compare the incidence of upper gastrointestinal complaints of acetylsalicylic acid and paracetamol. 600 healthy volunteers received acetylsalicylic acid (2 effervescent tablets of 400 mg), paracetamol (2 effervescent tablets of 500 mg) or placebo (2 effervescent tablets) in three treatment groups. Subjects filled in a questionnaire at 0.5, 1, 2, 3 and 4 h after dosing to evaluate eight upper gastrointestinal symptoms, which were stomach pain, burning sensation, nausea, heartburn, gas, burping, indigestion and upset stomach. The primary study objective was to show equivalence between acetylsalicylic acid and paracetamol. Results: The absolute number of subjects reporting gastrointestinal intolerance were 50 of 200 in the placebo group, 46 of 200 in the paracetamol group and 56 of 201 in the acetylsalicylic acid group. The statistical test showed equivalence between both active substances. Conclusion: The rate of gastrointestinal intolerance following a single dose of two effervescent tablets of acetylsalicylic acid is equivalent to that of paracetamol and not different from gastrointestinal intolerance of placebo.

Pathological processes and diseases of the upper gastrointestinal tract have become increasingly recognized over recent years as childhood entities responsible for a variety of upper gastrointestinal symptoms previously labelled as functional or non-organic. The term 'dyspepsia' is an adult one whose definition requires clarification before use in the paediatric context, but it encompasses age-dependent symptoms such as feed-associated irritability in the infant, peri-umbilical pain in the younger child, and heart-burn, nausea, and indigestion in the older child as in adults. The possible organic conditions giving rise to such symptoms are multiple and multiorgan and include: gastro-oesophageal reflux; peptic ulcer disease; upper gastrointestinal Crohn's disease; antroduodenal motility disorders; pancreatitis; cholecystitis; cholelithiasis; biliary dyskinesia; and abdominal migraine. However, Munchausen syndrome by proxy must not be forgotten. Non-ulcer dyspepsia, it is now clear, has a basis in altered gastroduodenal motility and may be amenable to propulsion agents. In many individuals the dyspeptic symptoms of recurrent abdominal pain may be altered by psychotherapeutic intervention. Indeed there remains a proportion of children who undoubtedly have a behavioural or psychological base to their complaint. Nevertheless, with the recent increase in diagnostic yield from improved technical investigative aids available to paediatrics in the last 5-10 years, it is clear that the responsibility of the paediatrician to the child to find a cause of their symptoms is paramount. The variety of presenting features, possible causes of these symptoms, and appropriate investigation and treatment will be discussed, and management algorithms based on published literature and personal practice will be offered.

Objective Delays in providing thrombolytic agents to patients with chest pain occur mainly in the prehospital arena. To reduce prehospital delay in treating patients with chest pain, we created a discharge teaching video that emphasized calling 911 in the event of a possible heart attack and a written action plan to be posted near the telephone. We also gave patients their EKG readings to bring with them on their next visit to the emergency department. Setting and sample All patients with chest pain admitted to the Chest Pain Observation Unit at Baystate Medical Center, Springfield, Mass, were eligible for this teaching effort. We tracked 127 nonconsecutive patients from January 1997 to May 1997. Of these patients, 108 were included in the study. Results We interviewed 102 patients (94%) 3 days after they were discharged from the Chest Pain Observation Unit. Within this group, 92% were able to describe what a heart attack might feel like, and 81.4% said they would call 911 or go to the hospital if they had symptoms of a heart attack. If they thought that their symptoms might be indigestion, 69% said they would take an antacid, then go to the hospital if they did not feel better. Fifty-one percent remembered what to do with their EKG readings, and 60.7% knew how to take their nitroglycerin correctly. Conclusion We concluded that patients understood the message they were given and retained some of the material 3 days after discharge from the Chest Pain Observation Unit. The follow-up telephone calls revealed areas for improvement in the discharge teaching tools.

This survey was carried out to explore the relationship between symptoms and functional status in the elderly living at home. The setting is an urban area of Turin (Northern Italy). A cross-sectional screening for 20 symptoms was completed in 747 subjects, aged 75 and older. Dependence in basic Activities of Daily Living (ADL) and in Instrumental Activities of Daily Living (IADL), Short Portable Mental Status Questionnaire and Cumulative Illness Rating Scale were also ascertained. A discriminant analysis was performed to determine the potential value of symptoms in predicting functional impairment. The mean number of symptoms was 6.0 per subject (±S.D. 3.3) and dependence in ADLs was 8.2%. Amongst a 20-symptom list, six symptoms (fatigue, memory loss, indigestion, nutrition, hearing and speaking problems), either alone or in association, showed sufficient discriminatory power to identify dependence in ADLs (sensitivity=72%), mental impairment (72%), psychological distress (80%), but not dependence in IADLs (48%). Symptoms are common in the free-living elders, but their functional status is good. A short (6 items) formal screening for symptoms may be a simple way to predict functioning and to rapidly manage problems.

Background> The increasing application of cholecystectomy has increased the need to assess the effects of cholecystectomy on presenting symptoms. Patients and methods Three surgeon-derived and two patient-derived data forms were collected for each patient in a series of 225 laparoscopic cholecystectomies. Results Eighty-two percent of patients had documented gallstones preoperatively, 91% had biliary pain, and 77% had both biliary pain and documented gallstones prior to surgery. Fifteen percent of patients were believed to have acalculous cholecystitis. Eighty-two percent also had bothersome nonpain symptoms (gassiness, bloating, indigestion, fatty-food intolerance, and nausea). The cure rate for biliary colic was 82% if stones were documented preoperatively, and 52% when they were not ( P = 0.002). Atypical pain was cured 80% of the time, and nonpain symptoms, 44% of the time. Conclusions Most patients (82%) with biliary colic and gallstones have complete reh'ef of upper abdominal pain after cholecystectomy. Pain relief in patients felt to have acalculous cholecystitis was only 52%. Nonpain symptoms were common preoperatively (82%) and were relieved in 44% of patients.

Male erectile dysfunction is common and frustrating after the age of forty years. Erectile dysfunction is a cause of misery, relationship difficulties, and significantly reduced quality of life. Sildenafil citrate (Viagra) has shown promising results in recently published clinical trials. Sildenafil is a potent and competitive inhibitor of cGMp specific phosphodiesterase-5, predominant isoenzyme in the human corpus cavernosum. It is effective in erectile dysfunction of diverse origin, however it requires a patent vascular system to be effective. It is not effective in patients with endocrinal impotence, loss of libido, premature ejaculation or infertility. Its main adverse effects are headache, flushing, dyspepsia, diarrhoea, nasal congestion, indigestion, visual disturbances, dizziness and rash. Ventricular tachycardia and acute myocardial infraction have been reported in patients of ischaemic heart disease after consumption of sildenafil. Six deaths have been reported in patients taking nitrates. In India it is likely to be prescribed by a primary care physician without complete evaluation of patient on complaint of impotence. Hence the ethical question of who should prescribe this drug should be addressed by medical fraternity and proper guidelines formulated to avoid misuse of sildenafil. Phosphodiesterase is distributed in nerve, central nervous system, and systemic vasculature, hence long-term effects of drug on these tissues has to be ascertained. It should be made mandatory to report all adverse drug reactions to ADR monitoring centres. It is a wonder for those who require it, but has potentially dangerous adverse effects and drug interactions and hence is and not a wonder pill for all kinds of impotence.

The most certain symptomatic manifestation of gallstones is episodic upper abdominal pain. Characteristically, this pain is severe and located in the epigastrium and/or the right upper quadrant. The onset is relatively abrupt and often awakens the patient from sleep. The pain is steady in intensity, may radiate to the upper back, be associated with nausea and lasts for hours to up to a day. Dyspeptic symptoms of indigestion, belching, bloating, abdominal discomfort, heartburn and specific food intolerance are common in persons with gallstones, but are probably unrelated to the stones themselves and frequently persist after surgery. Many, if not most, persons with gallstones have no history of pain attacks. Persons discovered to have gallstones in the absence of typical symptoms appear to have an annual incidence of biliary pain of 2–5 % during the initial years of follow-up, with perhaps a declining rate thereafter. Gallstone-related complications occur at a rate of less than 1% annually. Those whose stones are symptomatic at discovery have a more severe course, with approximately 6–10% suffering recurrent symptoms each year and 2% biliary complications. The far higher rates of symptom development reported in a few studies raise the possibility that these incidence estimates may be too low. The best predictors of future biliary pain are a history of pain at the time of diagnosis, female gender and possibly obesity. The risk of acute cholecystitis appears to be greater in those with large solitary stones, that of biliary pancreatitis in those with multiple small stones, and that of gallbladder cancer in those with large stones of any number. Drugs that inhibit the synthesis of prostaglandins may now be the treatment of choice in patients with gallstones who are suffering acute pain attacks. Persistent dyspeptic symptoms occur frequently following cholecystectomy. A prolonged history of such symptoms prior to surgery and evidence of significant psychological distress appear to be the best predictors of unsatisfactory outcome.

Chiropractors claim to be able to affect somatic as well as visceral disorders by the use of spinal manipulation. Despite much research investigating the relationship between somatic and visceral structures the exact mechanism has not been established. This case describes how a 47-year old male suffering from indigestion, neck and mid-thoracic pain found relief of these symptoms following chiropractic spinal manipulation. He experienced symptoms severe enough to mimic ischaemic heart disease, but was diagnosed as having reflux oesophagitis. Possible relationships between somatic and visceral structures are discussed. It is suggested that patients suffering from true visceral disease may benefit from chiropractic care.

Malignant ascites is the build up of proteinrich fluid in the peritoneal cavity, accompanied by debilitating symptoms of breathlessness, indigestion, alteration in bowel habit, fatigue, reduced mobility, loss of appetite, nausea, abdominal swelling, pain and changes in body image (Preston 1995, Parsons et al 1996). Research into the management and effect of ascites on wellbeing has been limited. Currently, there is no nursing research related to the management or experience of malignant ascites and little reference is made to its management in textbooks. Medical research concentrates on evaluating different management methods but this research is usually limited in its potential application as there are no published randomized trials to evaluate the different therapies. Research is underway to evaluate new methods of control and the effect of ascites on wellbeing (Preston 1995). Audits of current practice are either underway or now published (Parsons et al 1996). There is no current 'Gold Standard' in treatment but the mainstay of treatment still appears to be frequent drainage. The purpose of these practice notes are to describe the aetiology of malignant ascites and also to summarize current approaches to management which healthcare workers can consider when trying to relieve this symptom in individual patients under their care.

Aim: The incidence of proximal gastric cancer has increased and it is known, that after proximal gastrectomy, postgastrectomy syndromes are still more or less unavoidable. That is why, the selecting of an ideal alimentary canal reconstructive pattern to elevate the quality of life has become more critical. Methods: 324 patients were randomized in three groups by type of gastroesofageal anastomosis use during proximal gastrectomy (PGE), (stapler (S), hand-sutured standard anastomosis by Ivor Lewis (HSA) or modified antireflux hand-sutured anastomosis (MAHSA)). Results: Endoscopic control at 1 year follow-up of S group showed reflux esophagitis with the following distributions: 40,6 %, 30,2 % and 13,2 %; the same control in HSA group show 17,3 %, 13,5 % and 8,6 % for grade A, B and C respectively. In contrast endoscopic control of MAHSA group showed reflux disease grade A and B only in 14,1 % and 1,7 % respectively. The evaluation scores measured by the EORTC QOL gastric cancer–specific questionnaire (QLQ-25) for acid indigestion or heartburn and acid or bile coming into mouth in main group MAHSA were 1,2 ± 0,08; 1,2 ± 0,08 whereas in groups HSA and S they were 1,8 ± 0,1; 1,8 ± 0,2 and 2,2 ± 0,2; 1,8 ± 0,1 respectively (p Conclusions: Our data showed that the presented modified method of esophagogastric anastomosis forming is a safe, easy to implement and effective in preventing the development of reflux after PGE for cancer of the upper third of the stomach. Disclosure: All authors have declared no conflicts of interest.

To evaluate whether uterine artery embolization (UAE) can reduce the premenstrual symptoms in women undergoing UAE for fibroid tumors or adenomyosis.Among 141 women who underwent UAE for symptomatic fibroid tumors or adenomyosis at a single institution between March 2011 and February 2013, 54 premenstrual symptoms in 39 patients were prospectively analyzed. Premenstrual symptoms were rated by the patient on a scale of 0 to 10, with 0 representing no symptom and 10 representing the baseline severity. The change in premenstrual symptom score was calculated by subtracting the baseline score from the post-UAE score. At 3-6 months after UAE, each woman also completed a symptom severity questionnaire to assess the severity of menstrual bleeding to compare the changes in premenstrual symptoms scores between women with and without menorrhagia.Back pain, headache, and gastrointestinal symptoms (eg, constipation, indigestion, lower abdominal pain) were significantly improved after UAE (P.05). Muscle pain, fatigue, nervousness, breast tenderness, and systemic edema were also improved, but not significantly so. The mean premenstrual symptom score change in patients with menorrhagia was significantly greater than in those without menorrhagia (-6.4 vs -3.7; P = .044).There was no correlation between the degree of menorrhagia score change and the degree of premenstrual symptom score change (P = .186).UAE could be a method to alleviate some premenstrual symptoms in patients with uterine fibroid tumors or adenomyosis.

Background: Fungi may colonize the small intestine and may be pathogenic and/or cause GI symptoms. In one study, 27% of patients with unexplained GI symptoms had SIFO (Jacobs et al). Whether SIFO causes symptoms and whether symptom profiles differ between those with or without SIFO is unknown. Our aim was to determine the presence of fungal overgrowth in patients with unexplained GI symptoms and to compare the symptom profiles of SIFO +ve and -ve patients. Methods: Patients with chronic gastrointestinal (GI) symptoms and negative endoscopy and computerized abdominal tomography (CAT) scan referred to motility center, underwent duodenal aspiration/culture. Under aseptic precautions, 3mL of duodenal juice was aspirated from the 3rd/4th parts of duodenum during esophagogastroduodenoscopy by using a 2mm Liguory catheter and cultured for fungi. Patients scored the frequency, intensity and duration of abdominal pain, belching, bloating, fullness, indigestion, nausea, diarrhea, vomiting, gas for previous 2 weeks on a Likert-like scale from 0-3 (frequency: 0=none, 1= 1 episode/wk. intensity: 0 = no symptoms, 1 = mild, 2 = moderate, 3 = severe symptom. Duration: 0 = none, 1= 30 min.). Mann-Whitney U test was used to compare symptom scores of SIFO +ve vs SIFO -ve patients. Results: 150 patients (F/M=117/33), mean age 47 years, and symptom duration of >6 months were enrolled. Duodenal culture yielded a positive fungal culture in 25.3% (38/150) patients. 37 (97.4%) were Candida spp.; 31 (83.8%) Candida Albicans, 6 (16.2%) Candida Glabrata, and 1 (2.6%) was Penicillum spp. 16 (42.1%) grew ≥102 CFU/ mL, 11 (28.9%) grew ≥103 CFU/mL, 4 (10.5%) grew ≥104 CFU/mL, and 3 (7.9%) grew ≥105 CFU/mL. Predominant symptoms were abdominal pain, bloating, fullness, nausea and gas, but symptom scores were not different between patients with or without SIFO, all p= ns (Table 1). Median total symptom scores were not significantly different in SIFO +ve vs SIFO -ve group; 45.043 vs 46.428 (p=0.651). Conclusion: Approximately 25% of patients with chronic GI symptoms may have SIFO. Symptoms do not appear to differentiate between those with or without SIFO and duodenal culture appears to be the only method of identifying this problem. Table 1

Background: Fungi may colonize the small intestine and may be pathogenic and/or cause GI symptoms. In one study, 27% of patients with unexplained GI symptoms had SIFO (Jacobs et al). Whether SIFO causes symptoms and whether symptom profiles differ between those with or without SIFO is unknown. Our aim was to determine the presence of fungal overgrowth in patients with unexplained GI symptoms and to compare the symptom profiles of SIFO +ve and -ve patients. Methods: Patients with chronic gastrointestinal (GI) symptoms and negative endoscopy and computerized abdominal tomography (CAT) scan referred to motility center, underwent duodenal aspiration/culture. Under aseptic precautions, 3mL of duodenal juice was aspirated from the 3rd/4th parts of duodenum during esophagogastroduodenoscopy by using a 2mm Liguory catheter and cultured for fungi. Patients scored the frequency, intensity and duration of abdominal pain, belching, bloating, fullness, indigestion, nausea, diarrhea, vomiting, gas for previous 2 weeks on a Likert-like scale from 0-3 (frequency: 0=none, 1= 1 episode/wk. intensity: 0 = no symptoms, 1 = mild, 2 = moderate, 3 = severe symptom. Duration: 0 = none, 1= 30 min.). Mann-Whitney U test was used to compare symptom scores of SIFO +ve vs SIFO -ve patients. Results: 150 patients (F/M=117/33), mean age 47 years, and symptom duration of >6 months were enrolled. Duodenal culture yielded a positive fungal culture in 25.3% (38/150) patients. 37 (97.4%) were Candida spp.; 31 (83.8%) Candida Albicans, 6 (16.2%) Candida Glabrata, and 1 (2.6%) was Penicillum spp. 16 (42.1%) grew ≥102 CFU/ mL, 11 (28.9%) grew ≥103 CFU/mL, 4 (10.5%) grew ≥104 CFU/mL, and 3 (7.9%) grew ≥105 CFU/mL. Predominant symptoms were abdominal pain, bloating, fullness, nausea and gas, but symptom scores were not different between patients with or without SIFO, all p= ns (Table 1). Median total symptom scores were not significantly different in SIFO +ve vs SIFO -ve group; 45.043 vs 46.428 (p=0.651). Conclusion: Approximately 25% of patients with chronic GI symptoms may have SIFO. Symptoms do not appear to differentiate between those with or without SIFO and duodenal culture appears to be the only method of identifying this problem. Table 1

Most drugs act by binding to proteins such as receptors and enzymes, but some act by physically or chemically changing the environment within the body to cause beneficial effects. The laxatives are the largest group of drugs with these properties and include osmotic laxatives such as lactulose and the saline purgatives as well as faecal softeners and lubricants. Given intravenously mannitol is an osmotic diuretic. A number of drugs can alter urinary or gastric pH, the former may be useful in increasing or decreasing the excretion of weakly acidic or basic drugs and the latter is used to treat indigestion.

Purpose: Sleep abnormalities are associated with serious adverse health consequences and all-cause mortality. Several studies have demonstrated associations between sleep quality and immune function and inflammation. The relationship between sleep quality and inflammatory bowel disease (IBD) activity and its impact on disease relapse has not been investigated. Methods: This is a prospective observational cohort study to assess the subjective sleep quality and its impact on disease activity and future relapse in patients with IBD. We used the Pittsburgh Sleep Quality Index (PSQI) to measure sleep quality, latency, duration, efficiency, disturbances and daytime dysfunction (A global PSQI score .5 is indicative of poor sleep quality). IBD activity was measured using the Harvey Bradshaw Index (HBI, ,5= inactive) or Modified Mayo Score (MMS, 0=inactive).We also recorded depression, anxiety, BMI and current medications including OTC or prescription sleep aids. Disease relapse was defined as an increase in the disease activity requiring steroid therapy, dose escalation or additional drug during the 6 months following the initial visit. Results: 41 patients (24 CD, 17 UC) were recruited; mean age 39y ± 16; 26 (63%) females. 20/41 (49%) patients were in clinical remission, among those 5/20 (25%) had normal PSQI score and 15/20 (75%) had abnormal PSQI score at baseline. None of the 5 patients with normal PSQI and clinical remission experienced a relapse after 6 months follow up compared to 67% (10/15) of those with abnormal PSQI and clinical remission (RR=3, 95% CI 1.5 to 6.1, p=0.03). There was no difference in disease type (CD: 40% vs. 73%, p=0.18), use of steroids (20% vs. 13%, p=0.72), use of sleep aids (40% vs. 47%, p=0.79), the presence of depression or anxiety (20% vs. 20%, p=1.00) or BMI (23.6±2.9 vs. 28.3±7.3, p=0.18) between the patients in clinical remission with normal and abnormal PSQI. We noticed a significant correlation between baseline PSQI and disease activity at 6 month follow up (CD: r=0.56, p=0.0046; UC: r=0.54, p=0.024). Conclusions: This is a first prospective study of sleep abnormalities in IBD demonstrating an association between abnormal sleep quality and the likelihood of clinical relapse. Further enrollment and follow-up of these patients are ongoing.

Introduction: Atypical abdominal symptoms may incorrectly be attributed to gall bladder stones discovered by chance at ultrasound. High rate of post-cholecystectomy symptoms has been reported and a group of patients may experience negative outcome after the surgery. Patient related psychological factors may also influence the decision for surgery. Aim: To assess shortand long-term effects of laparoscopic cholecystectomy on the patients gastrointestinal symptoms and psychological well-being. Methods: The patients were investigated before, 3 and 12 months after elective cholecystectomy. They completed two validated selfadministered questionnaires: the Gastrointestinal Symptom Rating Scale (GSRS) with a question on eating dysfunction added and Psychological General Well Being (PGWB) and body mass index (BMI) was registered. Results: One-hundred and two patients (69 female, mean age:48 (SD:14.5) and 33 male, mean age:59, SD:12) were investigated. The total GSRS score was significantly better after 3 months (mean:1.80, SD:1.30, p :1.54, SD:0.79, p