Search

Background and Aim: In immunochemical fecal occult blood test (iFOBT) positive subjects, colonoscopy screening can detect colorectal cancers and advanced adenomas, yet most iFOBT‐positive subjects find no relevant lower gastrointestinal lesions. Limited data are available on upper gastrointestinal (UGI) cancer risk in iFOBT‐positive patients. This study investigated the incidence of UGI malignancies diagnosed within 3 years post‐colonoscopy after a positive iFOBT. Methods: Retrospective analysis of iFOBT‐positive patients aged 50–75 years who underwent a colonoscopy at a single institution. All patients with a diagnosis of UGI cancer within 3 years post‐colonoscopy were identified by linking with the Queensland Cancer Register. This was used to compare to the geographical population aged 50–74 years based on the Australian Bureau of Statistics and Queensland Cancer Council data. Results: From 1748 eligible participants, 0.23% (95% confidence interval [CI] 0.06–0.58) were diagnosed with UGI cancer within 3 years post‐colonoscopy. This indicates an esophageal cancers rate of 114.42 per 100 000 (95% CI 100.56–298.28) and gastric cancer rate of 57.21 per 100 000 (95% CI 55.76–261.12). Of the patients with a UGI cancer, 75% would have had an unexplained iFOBT. Annual incidence for the same geographic region, ages, and period for the combined esophageal and gastric cancer was 36.08 per 100 000 (95% CI 32.87–39.52). Conclusions: Among individuals with a positive iFOBT in a bowel cancer screening program, the rates of gastric and esophageal cancers were 2.7 and 7.5 times higher than the general population. Adding gastroscopy to a colonoscopy for iFOBT‐positive patients in cancer surveillance programs may be justifiable. [ABSTRACT FROM AUTHOR]

Background and Aims: The group of disorders known as Disorders of Gut Brain Interaction (DGBI) were originally labeled functional GI disorders and were thought to be disorders of the gastrointestinal tract that had several psychological conditions as comorbidities. Despite mounting evidence that psychological morbidity plays an innate role in the etiology and maintenance of DGBI, none of the Rome IV criteria include any measure of psychological symptoms. This study tested the hypothesis that individuals would cluster differently if GI symptoms alone were considered versus GI symptoms combined with measures of psychological symptoms. Methods: Data were obtained from the Rome Foundation Global Epidemiology Study measuring Rome IV GI symptoms, psychological measures and demographic characteristics. Latent profile models were used to cluster individuals based on (i) GI symptoms only (GI only) and then (ii) GI and psychological measures (GI + Psych). Key Results: Individuals clustering into the same group of individuals whether formed via GI only or GI + Psych, ranged from 96% for a 2‐class solution (the most simplistic) to 76% with 6 classes (the parsimonious system) and 59% with twenty‐two classes (mimicking Rome IV). The generalisability of this finding between six geographic regions was confirmed with agreement varying between 95%–97% for 2 clusters and 71–79% for 6 classes and 51%–63% for 22 classes. These findings were also consistent between DGBI (range 94% with 2 classes to 50% with 22 classes) and non‐DGBI (range 97% with 2 clusters to 65% with 22 classes) groups. Conclusions & Inferences: Our data suggest that considering psychological as well as gastrointestinal symptoms would lead to a different clustering of individuals in more complex, and accurate, classification systems. For this reason, future work on DGBI classification should consider inclusion of psychological traits. [ABSTRACT FROM AUTHOR]

Background and Aim: Patients with intestinal failure (IF) have abnormal intestinal anatomy, secretion, and dysmotility, which impairs intestinal homeostatic mechanisms and may lead to small intestinal bacterial overgrowth (SIBO). We conducted a systematic review and meta‐analysis to determine the prevalence of SIBO in patients with IF and to identify risk factors for SIBO. Methods: MEDLINE (PubMed) and Embase electronic databases were searched from inception to December 2023 for studies that reported the prevalence of SIBO in IF. The prevalence rates, odds ratio (OR), and 95% confidence intervals of SIBO in IF and the risk factors for SIBO in IF were calculated using random effects model. Results: Final dataset included nine studies reporting on 407 patients with IF. The prevalence of SIBO in IF was 57.5% (95% CI 44.6–69.4), with substantial heterogeneity in this analysis (I2 = 80.9, P = 0.0001). SIBO prevalence was sixfold higher in patients with IF who received parenteral nutrition (PN) compared with IF patients not on PN (OR = 6.0, 95% CI 3.0–11.9, P = 0.0001). Overall, the prevalence of SIBO in patients with IF using PPI/acid‐suppressing agents (72.0%, 95% CI 57.5–83.8) was numerically higher compared with IF patients not using these agents (47.6%, 95% CI 25.7–70.2). Conclusions: This systematic review and meta‐analysis suggests that there is an increased risk of SIBO in patients with IF and that PN, and potentially, the use of PPI/acid‐suppressing agents is risk factors for SIBO development in patients with IF. However, the quality of evidence is low and can be attributed to lack of case–control studies and clinical heterogeneity seen in the studies. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the biogeography of the mucosa associated microbiome (MAM) in patients with inflammatory bowel disease (IBD) versus controls in different segments of the gastrointestinal tract, as well as the links between the MAM, gastrointestinal symptoms, and use of proton pump inhibitors (PPI). Methods: We recruited 59 controls (without structural abnormalities and gastrointestinal symptoms), 44 patients with ulcerative colitis (UC) and 31 with Crohn's disease (CD). Biopsies from various segments of the upper and lower gastrointestinal tract were collected. Microbial composition was assessed via 16S rRNA gene amplicon analysis and the bacterial load of the mucosal biopsies were assessed via qPCR. The MAM was examined in the context of disease status, PPI usage, the severity of gastrointestinal symptoms, and the symptom response to a standardised nutrient challenge (SNC). Results: Microbial communities of the MAM in the upper and lower gastrointestinal tract differed. IBD patients were characterised by relative and absolute depletion of numerous genera known to produce butyrate and/or propionate, with the largest differentiation being the depletion of Faecalibacterium in the lower gastrointestinal tract of CD patients. Notably, PPI users exhibited an enrichment of Faecalibacterium in the lower gastrointestinal tract. The severity of gastrointestinal symptoms, as well as the symptom response to the SNC, were significantly associated with MAM composition in the gastrointestinal tract. Conclusion: The absolute and relative composition of the MAM is variable across different segments of the gastrointestinal tract. These quantitative changes indicates that MAM can be targeted in specific segments of the GI tract to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: This SRMA reviewed and assessed the changes in the severity of disorders of gut‐brain interaction (DGBI) symptoms during the COVID‐19 pandemic, and evaluated factors associated with symptom severity changes. Methods: Electronic databases were searched until February 2024, for articles reporting on changes in symptom severity in DGBI patients during the COVID‐19 pandemic. The proportion of DGBI patients who reported a change in their symptom severity were pooled using a random‐effects model, and subgroup analyses were conducted to assess the effect of socio‐cultural modifiers on symptom severity in DGBI. Key Results: Twelve studies including 3610 DGBI patients found that 31.4% (95% CI, 15.9–52.5) of DGBI patients experienced symptom deterioration, while 24.3% (95% CI, 10.2–47.5) experienced improvement. Countries with high gross domestic product (GDP) had a 43.5% (95% CI, 16.3–75.2) likelihood of symptom deterioration, compared to 9.2% (95% CI, 1.4–42.2) in lower GDP countries. Similarly, countries with low COVID fatality rates had a 60.1% (95% CI, 19.7–90.3) likelihood of symptom deterioration, compared to 18.3% (95% CI, 7.8–36.9) in higher fatality rate countries. Countries with lenient COVID policies had a 58.4% (95% CI, 14.1–92.3) likelihood of symptom deterioration, compared to 19% (95% CI, 8.2–38.1) in countries with stricter policies. Patients in high vaccine hesitancy countries had a 51.4% (95% CI, 19.5–82.2) likelihood of symptom deterioration, compared to 10.6% (95% CI, 2.7–33.4) in low vaccine hesitancy countries. Conclusions & Inferences: This meta‐analysis reveals that a significantly higher proportion of DGBI patients experienced deterioration of symptoms during the COVID‐19 pandemic. Various sociocultural, economic and environmental factors potentially modify the effects of the COVID‐19 pandemic on DGBI. [ABSTRACT FROM AUTHOR]

Background: Disorders of gut–brain interaction (DGBI) are characterized by debilitating symptoms not explained by structural or biochemical abnormalities. While functional conditions present with complex, likely heterogeneous pathophysiology, we aimed to investigate if proxy measures of sociocultural and environmental factors are associated with the prevalence of various DGBI in populations across the world. Method s : We performed an ecological study utilizing peer‐reviewed published datasets reporting for 26 countries prevalence rates of DGBI (Rome Foundation Global Epidemiology Study, RFGES), with six independent variables: Helicobacter pylori prevalence and household size as proxy measures for orofecal infections, gross domestic product per capita (GDP), and median age as a proxy measures for socioeconomic development, density of fast food outlets (FFO) per 100,000 population as proxy measure for processed food exposure, and suicide mortality rate per 100,000 people, and world happiness scores were used as a proxy for psychological stress. The data were retrieved from publicly accessible datasets (United Nations, CIA World Factbook, World Bank, World Happiness Report, commercial/financial reports of a global FFO chain). We used linear regression to assess variables in univariate and multivariate analysis and report standardized β coefficients with 95% confidence intervals (CI). Key Results: The regression model revealed that the overall prevalence of DGBI was inversely associated with both GDP per capita (β = −0.57, 95% CI: −0.92, −0.22, p = 0.002) and happiness scores (β = −0.433 95% CI: 0.821, −0.065, p = 0.023), while being positively associated with H. pylori prevalence (β = 0.40, 95% CI: 0.008, 0.81, p = 0.046). The prevalence of functional constipation (FC) was also inversely associated with GDP per capita (β = −0.50, 95% CI: −0.86, −0.13, p = 0.01) and happiness scores (β = −0.497, 95% CI: −0.863, −0.132, p = 0.01), while being positively associated with H. pylori prevalence (β = 0.53, 95% CI: 0.16, 0.91, p = 0.007). The Multivariate model analysis revealed that combining the factors of H. pylori prevalence, suicide rate, household size and happiness scores showed statistically significant association with FC (p = 0.039). Household size (β = −0.43, 95% CI: −0.82, 0.038, p = 0.033) and suicide rates (β = 0.55, 95% CI: 0.19, 0.90, p = 0.004) were statistically significantly associated with functional diarrhea. Irritable bowel syndrome (IBS) was associated with GDP per capita (β = −0.40, 95% CI: −0.79, −0.014, p = 0.043) and happiness scores (β = −0.390, 95% CI: −0.778, −0.003, p = 0.049). Conclusions & Inferences: Utilizing publicly available data, the prevalence of DGBI across diverse countries is linked to various socio‐cultural and environmental factors. Collectively, the data suggests that the prevalence of DGBI is increased in less prosperous regions of the world. [ABSTRACT FROM AUTHOR]

Objectives: Approximately one third of patients with non cardiac chest pain (NCCP) report a history of abuse, however no data exists on the prevalence of abuse among people with unexplained chest pain in the general population. We aimed to determine if there is a relationship between childhood sexual, physical, emotional abuse and unexplained chest pain, and to identify whether any potential relationship is being driven by an association with psychological distress. Methods: Subjects were identified from 2 previous random population surveys that included people with irritable bowel syndrome (IBS) and/or functional dyspepsia (FD) and healthy controls. People in the unexplained chest pain group (n = 27) had chest pain in the past 12 months that was not heartburn or heart disease. People in the comparison group (n = 60) did not have chest pain for more than 12 months. Self-reported abuse and psychological variables were assessed using validated measures. Results: Emotional/verbal abuse (20.8% versus 4.4%, P = 0.032) and physical abuse (16.7% versus 2.2%, P = 0.028) were significantly more common in people with unexplained chest pain versus the comparison group. Only a history of emotional/verbal abuse was a significant independent predictor of meeting criteria for unexplained chest pain (OR = 5.66; 95%CI 1.01-31.80, P=0.049) even after controlling for IBS and/or FD (OR = 5.45; 95%CI 0.96-30.83, P = 0.05), but not when depression was controlled for (OR = 4.70; 95%CI 0.90-27.61), P = 0.08. Conclusions: A history of childhood emotional/verbal abuse is a risk factor for having unexplained chest pain but the association may be moderated by psychological distress, specifically depression. (Contains 3 tables.)