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OBJECTIVE To examine the prevalence and comorbidity of gastro-oesophageal reflux disease (GORD) with generalised anxiety disorder (GAD) and major depressive episodes (MDE) in a general population using DSM-IV, and to evaluate the associations between these conditions and healthcare utilisation. METHODS A random population-based telephone survey was conducted to record frequency of GORD symptoms, symptoms of GAD and MDE based on DSM-IV, and healthcare utilisation. RESULTS Of 2011 respondents, 4.2% had weekly GORD and 13.9% had monthly GORD, whereas 3.8% reported GAD and 12.4% reported MDE. Those with monthly GORD had higher risk of GAD (p = 0.01) and MDE (p < 0.001). GORD symptom frequency was independently correlated with MDE and GAD in a dose-response manner. The number of psychiatric diagnoses was independently correlated with GORD. GORD symptom frequency, GAD, and MDE were correlated with consultation frequency. GORD symptom frequency was corelated with high investigation expenditure. CONCLUSION GORD had a strong dose-response relationship with GAD and MDE in a Hong Kong population. Excessive healthcare utilisation should alert clinicians to the risk of psychiatric comorbidity.

Summary Background Guidelines recommend the use of neuromodulators in patients with functional dyspepsia not responding to proton pump inhibitors (PPIs) and prokinetics; however, there is a lack of data from randomised controlled trials supporting their use. We aimed to assess the safety and efficacy of imipramine, a tricyclic antidepressant (TCA), in treatment-refractory functional dyspepsia. Methods In this single-centre, double-blind, randomised controlled trial, we enrolled consecutive patients with Rome II functional dyspepsia aged 18–80 years. Eligible patients were Helicobacter pylori-negative, had a normal upper gastrointestinal endoscopy and abdominal ultrasound, and remained symptomatic after open-label treatment with 8 weeks of esomeprazole and 4 weeks of domperidone. Patients completed questionnaires assessing dyspepsia symptoms, mood, and insomnia, and were then randomly assigned (1:1) via a computer-generated list of random numbers to receive imipramine (at a dose of 25 mg once nightly for the first 2 weeks, and then 50 mg thereafter) or placebo for 12 weeks. The primary endpoint was overall satisfactory relief of global dyspepsia symptoms at 12 weeks, via patient-reported assessment in the intention-to-treat population. This trial is registered with ClinicalTrials.gov , number NCT00164775 , and is completed. Findings Between Sept 11, 2005, and Aug 20, 2010, 107 patients with treatment-refractory functional dyspepsia were randomly assigned to receive imipramine (n=55) or placebo (n=52). Relief of global dyspepsia symptoms at 12 weeks occurred in 35 (63·6%, 95% CI 50·4–75·1) of 55 patients on imipramine compared with 19 (36·5%, 95% CI 24·8–50·1) of 52 on placebo (p=0·0051). Ten (18%) patients on imipramine discontinued the study due to adverse events (three dry mouth, two constipation, two drowsiness, and one each insomnia, palpitations, and blurred vision), compared with four (8%) on placebo (one dry mouth and constipation, and one each palpitations, worsening of gastro-oesophageal reflux, and limb paraesthesia). There were no serious adverse events. Interpretation Low-dose imipramine should be considered as a possible therapy for patients with functional dyspepsia refractory to both PPIs and prokinetics, although patients should be cautioned about the adverse event profile. Funding None.

BACKGROUND AND AIM A well-validated, comprehensive checklist of functional gastrointestinal (FGI) disorder (FGID) symptom severity for tracking symptom profile changes over time is lacking. We aim to develop and validate a comprehensive symptom severity checklist for FGID. METHODS A 20-item scale, including both upper and lower gastrointestinal symptoms, was generated to measure the symptom severity commonly found in FGID. Patients who experienced at least monthly symptoms of FGID with negative endoscopy findings were invited to complete the FGI-Checklist, Patient Health Questionaire-9 for assessing depressive symptoms, and Patient Health Questionnaire-15 for assessing somatic symptoms at baseline. A subset of patients who met Rome III diagnostic criteria of gastroesophageal reflux disease, functional dyspepsia, and irritable bowel syndrome received medication treatment for 8-12 weeks and completed the FGI-Checklist again at a follow-up visit. Exploratory factor analysis was performed for subscales formation and psychometric properties were measured. RESULTS Six hundred and forty-one patients were recruited for current study and 108 (16.8%) of them completed the FGI-Checklist again at follow-up. Exploratory factor analysis identified a five-factor solution accounting for 66.8% of the total variance. The five factors are named esophageal syndrome, reflux syndrome, functional dyspepsia syndrome, nausea and vomiting syndrome, and abdominal and bowel syndrome. The FGI-Checklist total score correlated with Patient Health Questionaire-9 and Patient Health Questionnaire-15 (all P < 0.001), which demonstrated good construct validity. Good item-internal consistency was found (Cronbach's alphas: 0.69-0.87). Responsiveness for reflux syndrome subscale, functional dyspepsia syndrome subscale, and abdominal and bowel syndrome subscale after medication treatment was significant (paired-t-test: all P < 0.01). CONCLUSION The instrument, Checklist, is valid and reliable.

Background It is unknown whether cognitive dysfunction found in patients with irritable bowel syndrome (IBS) was attributable to the different subtypes, ongoing pathophysiological processes, trait characteristics, or psychiatric comorbidity. Methods Forty Rome-III patients with IBS (20 diarrhea-predominant [IBS-D] and 20 constipation-predominant [IBS-C]) and 40 age-, sex-, education-matched healthy controls were systematically recruited and compared on their cognitive function with continuous performance test (CPT), Wisconsin Card Sorting Test (WCST) and emotional Stroop test. Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire-15 (PHQ-15) and a structured bowel symptom questionnaire were performed to measure anxiety, depressive, somatization, and bowel symptoms, respectively. Psychiatric diagnoses were ascertained with SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders). Key results Patients with IBS showed significantly increased standard deviation of reaction time (SDRT) (P = .003) on CPT, increased failure to maintain set (FMS) (P=.002), and percentage of perseverative errors (P = .003) on WCST. SDRT did not correlate with illness chronicity or bowel symptoms. FMS correlated with bowel symptom severity. In logistic regression models controlled for BAI, BDI-II, and PHQ-15, SDRT (AOR = 1.08, P = .025), but not FMS (P = .25) or percentage of perseverative errors (P = .24), significantly differentiated IBS from controls. Cognitive function was not significantly different between IBS-C and IBS-D (P > .05), or between pure IBS (n = 22) and IBS with generalized anxiety disorder (GAD) (n = 17) (P > .05). Conclusions & inferences Patients with IBS showed attentional and executive function impairment irrespective of subtypes but otherwise heterogeneous in terms of its state-trait correlations and overlap with anxiety comorbidity.

This study investigates how 5- and 6-year-olds' evaluations of selfish, polite, and altruistic lies change as a result of whether these false statements are explicitly labelled as lies. We are also interested in how interpretive theory of mind may correlate with such evaluations with and without a lie label. Our results showed that labelling lowered children's evaluations for the polite and altruistic lies, but not for the selfish lies. Interpretive theory of mind correlated positively with the evaluation difference between the polite and altruistic lies and that between the selfish and altruistic lies in the label, but not in the non-label condition. Correlation between the selfish and altruistic lies and that between the polite and altruistic lies were stronger with than without labelling, after controlling for age, and verbal and non-verbal intelligence. We conclude that lie labelling biases children towards more negative evaluations for non-selfish lies and makes them see lies of different motives as more similar. If a lie label is applied, whether lies of different motives are still evaluated differently depends on interpretive theory of mind, which reflects the child's ability to represent and allow different interpretations of an ambiguous reality.

BACKGROUND We previously published that altered expression of gastric TRPV1, BDNF, and peripheral cytokines was present in patients with functional dyspepsia. We herein examine whether genetic predisposition in altered biomarkers influences dyspeptic, sleep, and mood symptoms in patients with FD without previous infection. METHODS Consecutive adult FD patients (Rome III) with no recent history of gastroenteritis and asymptomatic age- and sex-matched healthy controls were recruited for upper endoscopy. Subjects with GERD and IBS as predominant symptoms, diabetes mellitus, current or previous H pylori infection, psychiatric illness, and recent use of NSAID or PPI were excluded. The genetic associations with dyspeptic symptoms, sleep quality, and mood symptoms were evaluated. Genetic polymorphisms in TRPV1, TGFB1, TNF, COMT, BDNF, IL6, IL8, IL10, and IL12 were analyzed. KEY RESULTS Twenty-nine male FD patients and 104 female FD patients were age matched (±3 years) with 81 healthy subjects. All had postprandial distress syndrome (PDS) as predominant subtype (PDS: 130, EPS: 3). SNPs in TGFB1 showed significant associations in dyspeptic patients after age and sex adjustment [for RS4803455: in the codominant model (C/A, OR = 0.34 (0.18-0.65), P = .004); in the dominant model (genotype C/C vs C/A-A/A, OR = 0.42 (0.23-0.77), P = .004); and in the overdominant model (genotype C/C-A/A vs C/A, OR = 0.38 (0.21-0.70), P

Background The current study aimed to model the moment-to-moment relationship between daily life stress, negative emotions and bowel symptoms among patients with irritable bowel syndrome – diarrhoea subtype (IBS-D) in the flow of daily life using a smartphone-based experience-sampling method (ESM). Methods Patients with IBS-D (n=27) and healthy controls (HC) (n=30) completed ESM ratings of their real-time daily life stress, which was defined as the subjective stress related to daily activities, negative emotion and bowel symptoms 8 times a day for 14 consecutive days, following a baseline interview measuring bowel and mood symptoms. Moment-to-moment association between ESM variables was tested within and between groups using multilevel regression modelling. Results Patients with IBS-D reported more severe bowel symptoms (ps 0.05). Time-lagged analysis of ESM data revealed that, among patients with IBS-D, daily life stress predicted a decrease in abdominal pain and urgency to defecation at a subsequent time point (ps Conclusions ESM unveiled the dynamic relationship between bowel symptoms, stress and emotionality. Patients with IBS-D responded to bowel symptoms with more stress and distress momentarily. Counter-intuitively, daily life activity stress served as a protective factor for bowel symptoms. Our data informed the psychological understanding of IBS.

Summary Background The relationship between dyspepsia and psychiatric comorbidity such as anxiety and depression is poorly defined. Previous studies have been limited by lack of standardised diagnostic criteria. Aim To examine the prevalence and comorbidity of dyspepsia as defined by Rome III (6-month duration) with DSM-IV-TR generalised anxiety disorder (GAD) and major depressive episodes (MDE) in the general population. Methods A random population-based telephone survey was done using a questionnaire on symptoms of Rome III Dyspepsia, DSM-IV-TR GAD and MDE and their chronological relationship. Results Of the 2011 respondents 8.0% currently had Rome III Dyspepsia, 3.8% reported GAD and 12.4% reported MDE respectively. Dyspeptic subjects had a twofold increased risk of GAD (OR = 2.03, 95% CI: 1.06–3.89, P

Background/Aims Patients with irritable bowel syndrome (IBS) are characterized by abnormal central processing with altered brain activation in response to visceral nociceptive signals. The effect of electroacupuncture (EA) on IBS patients is unclear. The study is set to study the effect of EA on brain activation during noxious rectal distension in IBS patients using a randomized sham-controlled model. Methods Thirty IBS-diarrhea patients were randomized to true electroacupuncture or sham acupuncture. Functional MRI was performed to evaluate cerebral activation at the following time points: (1) baseline when there was rectal distension only, (2) rectal distension during application of EA, (3) rectal distension after cessation of EA and (4) EA alone with no rectal distension. Group comparison was made under each condition using SPM5 program. Results Rectal distension induced significant activation of the anterior cingulated cortex, prefrontal cortex, thalamus, temporal regions and cerebellum at baseline. During and immediately after EA, increased cerebral activation from baseline was observed in the anterior cingulated cortex, bilateral prefrontal cortex, thalamus, temporal regions and right insula in both groups. However, true electroacupuncture led to significantly higher activation at right insula, as well as pulvinar and medial nucleus of the thalamus when compared to sham acupuncture. Conclusions We postulate that acupuncture might have the potential effect of pain modulation in IBS by 2 actions: (1) modulation of serotonin pathway at insula and (2) modulation of mood and affection in higher cortical center via ascending pathway at the pulvinar and medial nucleus of the thalamus.

Background The current study aimed to model the moment-to-moment relationship between daily life stress, emotions, and bowel symptoms among patients with irritable bowel syndrome-diarrhea subtype (IBS-D) in the flow of daily life using a smartphone-based experience sampling method (ESM). Methods Patients with IBS-D (N = 27) and healthy controls (HC; N = 30) completed ESM ratings of their real-time daily life stress, which was defined as subjective stress related to daily activities, both positive and negative emotions, as well as bowel symptoms eight times a day for 14 consecutive days, following a baseline interview measuring bowel and mood symptoms. Moment-to-moment association between ESM variables was tested within and between groups using multilevel regression modeling. Key results Patients with IBS-D reported more severe bowel symptoms and lower positive affect than HCs, but levels of daily life stress and negative affect were comparable between groups. Time-lagged analysis of ESM data revealed that, among patients with IBS-D, daily life stress predicted a decrease in abdominal pain and urgency to defecation at a subsequent time point, whereas severity of bowel symptoms and occurrence of diarrhea predicted a subsequent increase in negative affect and daily life stress. The above associations were not found among HCs. Conclusions and inferences ESM unveiled the dynamic relationship between bowel symptoms, stress, and emotionality. Patients with IBS-D responded to bowel symptoms with more stress and distress momentarily. Counter-intuitively, daily life activity stress appeared to ameliorate bowel symptoms, although a more rigorous study design is required to testify this claim. Psychological understanding of IBS-D is discussed.

Aliment Pharmacol Ther 31, 452–460 Summary Background A simple and meaningful health-related quality of life (HRQoL) questionnaire for gastro-oesophageal reflux disease (GERD) patients is lacking. Aim To develop and validate a disease-specific HRQoL instrument (GERD-QOL) for GERD patients. Methods An 18-item questionnaire was generated to measure the impact of GERD on sleep, exercise, diet, need for medication, sex life, work, social activity and psychological well-being. GERD patients were invited to complete the GERD-QOL, a visual analogue scale (VAS) and a validated Chinese generic QoL (SF-36) questionnaire before and after esomeprazole treatment. Factor analysis was performed for item selection and psychometric properties were measured. An English version was developed by a forward-backward translation process. Results A final 16-item GERD-QOL questionnaire was developed. The items were grouped into four subscales (Daily activity, Treatment effect, Diet, and Psychological well-being) after factor analysis. GERD-QOL had good item-internal consistency (Cronbach’s alpha: 0.64–0.88), high test-retest reliability (intraclass correlation coefficient: 0.73–0.94, P

Introduction Psychiatric comorbidity is common in patients with functional dyspepsia (FD) but a good screening tool for psychiatric disorders in gastrointestinal clinical practice is lacking. Aims 1) Evaluate the performance and optimal cut-off of 12-item General Health Questionnaire (GHQ-12) as a screening tool for psychiatric disorders in FD patients; 2) Compare health-related quality of life (HRQoL) in FD patients with and without psychiatric comorbidities. Methods Consecutive patients fulfilling Rome III criteria for FD without medical co-morbidities and gastroesophageal reflux disease were recruited in a gastroenterology clinic. The followings were conducted at 4 weeks after index oesophagogastroduodenoscopy: self-administrated questionnaires on socio-demographics, dyspeptic symptom severity (4-point Likert scale), GHQ-12, and 36-item short-form health survey (SF-36). Psychiatric disorders were diagnosed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) by a trained psychiatrist, which served as reference standard. Results 55 patients underwent psychiatrist-conducted interview and questionnaire assessment. 27 (49.1%) had current psychiatric disorders as determined by SCID (anxiety disorders: 38.2%, depressive disorders: 16.4%). Receiver operating characteristic curve analysis of GHQ-12 revealed an area under curve of 0.825 (95%CI: 0.698-0.914). Cut-off of GHQ-12 at ≥3 gave a sensitivity of 63.0% (95%CI = 42.4-80.6%) and specificity of 92.9% (95%CI = 76.5%-98.9%). Subjects with co-existing psychiatric disorders scored significantly lower in multiple domains of SF-36 (mental component summary, general health, vitality and mental health). By multivariate linear regression analysis, current psychiatric morbidities (Beta = -0.396, p = 0.002) and family history of psychiatric illness (Beta = -0.299, p = 0.015) were independent risk factors for poorer mental component summary in SF-36, while dyspepsia severity was the only independent risk factor for poorer physical component summary (Beta = -0.332, p = 0.027). Conclusions Concomitant psychiatric disorders adversely affect HRQoL in FD patients. The use of GHQ-12 as a reliable screening tool for psychiatric disorders allows early intervention and may improve clinical outcomes of these patients.

Background & Aims The long-term prognosis of peptic ulcers associated with neither Helicobacter pylori nor nonsteroidal anti-inflammatory drugs (NSAIDs) is unknown. Methods This 7-year prospective cohort study recruited patients with bleeding ulcers from January to December 2000. H pylori –negative idiopathic bleeding ulcers were defined as having tested negative for H pylori , having no exposure to aspirin or analgesics within 4 weeks before endoscopy, and having no other identifiable causative factors. After ulcers healed, patients were divided into 2 groups: patients with prior H pylori –negative idiopathic bleeding ulcers ( H pylori –negative idiopathic ulcer cohort; n=120) and those with H pylori –positive, NSAID-negative bleeding ulcers who received eradication therapy ( H pylori ulcer cohort; n=213). Both groups were followed for ≤7 years without gastroprotective therapy. The primary endpoints were recurrent ulcer bleeding and mortality. Results The 7-year cumulative incidence of recurrent ulcer bleeding was 42.3% (95% CI, 36.5%–48.1%) in the H pylori –negative idiopathic ulcer cohort and 11.2% (95% CI, 8.8%–13.6%) in the H pylori ulcer cohort (a difference of 31.1%; 95% CI, 27.7%–34.5%; P H pylori –negative idiopathic ulcer cohort (87.6%; 95% CI, 83.0%–92.2%) than in the H pylori ulcer cohort (37.3%; 95% CI, 34.0%–40.6%) with a difference of 50.3% (95% CI, 49.0%–51.6%; P Conclusions Patients with history of H pylori –negative idiopathic bleeding ulcers have a high risk of recurrent ulcer bleeding and mortality.

Obesity has been associated with gastroesophageal reflux disease (GERD) and its complication, but the mechanism is unclear. We evaluated the association between obesity and function of lower esophageal sphincter (LOS) in subjects without GERD.We prospectively recruited consecutive obese (BMI30) patients referred for weight reduction procedure and age- and sex-matched overweight (BMI 25-30) and normal weight (BMIor =20 and25) subjects. Exclusion criteria included esophagitis, reflux symptoms, use of proton pump inhibitor, hiatus hernia2 cm, and diabetes mellitus with microvascular complication. All participants underwent combined 2-hour postprandial esophageal manometry and pH monitoring after a standard test meal followed by 24-hour ambulatory pH monitoring.Eighty-four subjects (obese, 28; overweight, 28; normal weight, 28) were studied. All 3 groups had comparable mean LOS pressure, LOS length, and peristaltic function. During the postprandial period, both obese and overweight groups had substantial increase in 2-hour rate of transient lower esophageal sphincter relaxation (TLOSR) (normal weight: 2.1 +/- 1.2 vs overweight: 3.8 +/- 1.6 vs obese: 7.3 +/- 2.0, P.001), proportion of TLOSR with acid reflux (normal weight: 17.6% +/- 22.0% vs overweight 51.8% +/- 22.5% vs obese: 63.5% +/- 21.7%, P.001), and gastroesophageal pressure gradient (GOPG) (normal weight: 4.5 +/- 1.2 mm Hg vs overweight: 7.1 +/- 1.4 mm Hg vs obese: 10.0 +/- 1.5 mm Hg, P.001). Using multiple regression model, BMI (r(2): 0.70, B: 0.28, 95% CI: 0.24-0.33, P.001) and waist circumference (r(2): 0.65, unstandardized regression coefficient [B]: 0.10, 95% CI: 0.08-0.11, P.001) were significantly correlated with TLOSR.Obesity is associated with increased TLOSR and acid reflux during the postprandial period in subjects without GERD. Abnormal postprandial LOS function may be an early event in the pathogenesis of obesity-related GERD.

Diseases of the gastrointestinal tract, such as intestinal bleeding and ulceration, are very common. To determine the location of the disease, as well as to diagnose the problem, endoscopy is performed. A wireless capsule endoscope is a pill-sized device that is easily swallowed by the patient. It is equipped with a camera and a wireless transmitter so that as it travels through the patient's gastrointestinal tract, it takes pictures or video images of the tract and transmits the information out of the patient's body. This article discusses the possible solutions and challenges of a wireless capsule endoscope in terms of the choice of wireless frequency and circuit components. A prototype is built with commercially available components to demonstrate the concept of the device.

BACKGROUND The role of immune activation in Functional Dyspepsia (FD) patients without previous infection is unclear. We compare the gastric and circulating brain-derived neurotropic factor (BDNF), receptor potential vanilloid type (TRPV) families and various cytokines in FD patients. METHODS Consecutive adult FD patients (Rome III) with no recent history of gastroenteritis and asymptomatic healthy controls were recruited for upper endoscopy. Subjects with GERD and IBS as predominant symptoms, diabetes mellitus, current or previous Helicobacter pylori infection, psychiatric illness and recent use of NSAID or PPI were excluded. Corpus biopsies and serum samples were collected. KEY RESULTS Forty three [M:F=8:35, mean age: 35.0 (9.3)] FD patients were compared with 23 healthy controls [M:F=8:15, mean age: 36.6 (10.2)]. FD patients had postprandial distress syndrome (PDS) as predominant sub-type (PDS: 36, EPS: 2). There was no significant difference in the median inflammation score (FD:0 (0-1) vs Control:0 (0-1), P=.79). However, FD patients had significantly higher mRNA expression of TRPV1 (FD:0.014±0.007, Control:0.003±0.001, 4.6 fold, P=.02) and TRPV2 (FD:0.012±0.006, Control:0.003±0.001, 4 fold, P=.02) compared to controls. The serum (FD:258.0±12.3 ng ml-1 , Control:319.7±18.1 ng ml-1 , P

Background Functional constipation is a common clinical complaint. Although the effectiveness of Ma Zi Ren Wan for alleviating functional constipation symptoms has been proven in a previous randomized placebo-controlled study, further evidence is needed to make clinical recommendations about Chinese herbal medicine. In particular, a comparison with conventional western medicine for functional constipation patients is needed. Methods/Design This is a prospective, double-blinded, double dummy, randomized, controlled trial. After a 2-week run-in period, eligible patients (Rome III) with excessive traditional Chinese medicine syndrome will randomly be assigned to the Chinese medicine arm (Ma Zi Ren Wan and western medicine placebo), western medicine arm (senna and Chinese medicine placebo) or placebo arm (Chinese medicine placebo and western medicine placebo). Patients will undergo an 8-week treatment and an 8-week follow-up. The primary outcome is the responder rate for complete spontaneous bowel movement (CSBM) during treatment. Patients with a mean increase of CSBM ≧1/week in comparison with their baselines are defined as responders. The secondary outcomes include responder rate during follow-up, changes of colonic transit as measured with radio-opaque markers, individual and global symptom assessments, and reported adverse effects. Discussion This study is the first study to compare a Chinese Herbal Medicine (Ma Zi Ren Wan) with a laxative that is commonly used in the clinical practice of western medicine, and with a placebo. This study will complete the investigation of Ma Zi Ren Wan for functional constipation, and should, therefore, suggest recommendations for clinical practice. Furthermore, the process of first conducting a systematic review, then implementing a dose determination study followed by a placebo-control trial, and finally, comparing traditional Chinese medicine with an active conventional medicine in a controlled trial can be a reference to other researches on Chinese medicine interventions in the future. Trial registration NCT01695850

Background and Aim In irritable bowel syndrome (IBS), the gut microbiota may be altered. Probiotic bacteria appear to be therapeutically effective. We characterized the mucosa-associated microbiota, and determined the clinical and microbiological effects of orally administered probiotic bacteria, in patients with IBS. Methods Mucosal microbiota from rectal biopsies of IBS patients and controls were assessed on the V1 and V2 variable regions of the 16S ribosomal RNA gene amplified using 454 pyrosequencing. Clinical symptoms and changes in mucosal microbiota were assessed in IBS patients before and after 4 weeks of treatment with probiotic mix VSL#3. Results Ten IBS subjects (eight female; mean age 46 years) were included. At week 4 of probiotic therapy, six patients showed symptom improvement on global symptom assessment compared with baseline (P = 0.031). Before therapy, intestinal microbiota of IBS subjects differed significantly from that of healthy controls, with less diversity and evenness than controls (n = 9; P

Background & Aims Patients with diarrhea-predominant irritable bowel syndrome (IBS) have been found to have increased postprandial levels of serotonin (5-HT). Functional dyspepsia (FD) and IBS have been proposed to have common methods of pathogenesis, but little is known about the role of 5-HT in FD. Methods We measured postprandial levels of 5-HT in 54 patients with FD (based on Rome III criteria) and 28 asymptomatic healthy individuals (controls). Patients with gastroesophageal reflux disease and IBS as their predominant symptom were excluded. After an overnight fast, the subjects drank a liquid meal (Ensure; 1.06 kcal/mL at 30 mL/min) and underwent a 13 C-octanoic acid breath test to measure gastric emptying times. Blood samples were collected at 0, 30, 60, 90, and 120 minutes after the liquid meal for the 5-HT assay. Results Thirty-five patients with FD (65%) had postprandial distress syndrome, and 6 (11%) had a combination of postprandial distress syndrome and epigastric pain syndrome. There were no differences in rates of gastric emptying between patients with FD (103.6 ± 19.4 minutes) and controls (83.1 ± 4.0 minutes; P = .30). However, patients with FD had lower caloric intake (823.40 ± 44.1 kcal) than controls (1021 ± 68.2 kcal; P = .026). Patients with FD also had lower basal ( P = .03) and postprandial plasma levels of serotonin at 30 minutes ( P = .04), 60 minutes ( P = .01), 90 minutes ( P = .02), and 120 minutes ( P = .002) than controls, as well as area under the curve values over the 120-minute time period ( P = .005). Repeated-measures analysis of variance correlated 5-HT level with FD ( P Conclusions In contrast to patients with diarrhea-predominant IBS, those with FD have decreased basal and postprandial plasma levels of 5-HT. These findings indicate that the pathogenic mechanism of FD differs from that of diarrhea-predominant IBS, and that strategies to alter 5-HT levels or activity might be developed to treat patients with FD.

Background Peroral endoscopic myotomy (POEM) is a novel approach to performing esophageal myotomy through a long submucosal tunnel. Objective This study aimed to investigate the feasibility and safety of POEM for treatment of achalasia. Design Preclinical animal study and prospective clinical study. Patients Consecutive patients diagnosed with achalasia with high-resolution manometry. Interventions POEM was standardized for preclinical and clinical studies. After submucosal injection, a mucosal incision was made 15 cm above the gastroesophageal junction (GEJ). A long submucosal tunnel was created to extend below the GEJ. The endoscopic myotomy started 10 cm above and extended 2 cm below the GEJ. We first conducted a preclinical animal study to confirm the safety of POEM. POEM was then performed for the treatment of achalasia in humans. Main Outcome Measurements Relief from dysphagia assessed by the dysphagia score and Eckhardt score. High-resolution manometry and pH monitoring were performed to evaluate the posttreatment effects and esophageal acid exposure. Results Seven 30-kg porcine models underwent POEM in the survival study. All of the pigs survived except 1, which sustained pneumomediastinum. POEM was performed for the treatment of achalasia in 16 patients. The mean operating time was 117.0 ± 34.1 minutes. All patients tolerated food on day 2, with a contrast study confirming no leakage. The median follow-up was 176.5 days (range 98-230 days). The postoperative basal lower esophageal sphincter pressure was significantly reduced (mean reduction, 13.9 ± 14.5 mm Hg; P = .005) and 4-second integrated relaxation pressure of the GEJ (mean reduction, 10.1 ± 7.4 mm Hg; P = .001). Of these patients, 58.3% had a normalized 4-second integrated relaxation pressure, whereas 20% had excessive esophageal acid exposure after the procedure. There was a significant improvement in quality of life 6 months after POEM measured by the Short Form-36 questionnaire. Limitation Small sample size. Conclusions POEM is a feasible, safe, and effective treatment for achalasia. (Clinical trial registration number: NCT01525732.)

In order to assess the sensitivities of the radiation characteristics and the compliance of ingestible wireless device (IWD) in human body due to the uncertainty and intersubject variability of dielectric properties of human body tissues, the specific absorption rate (SAR) and radiation characteristics of the IWD in two realistic human body models with changed and unchanged dielectric values are quantitatively compared using the finite-difference time-domain method. Simulations are carried out in 13 scenarios where the IWD is placed in the center positions of abdomens in the two body models at the operating frequency of 430 MHz with three orientations. Results show that the variation of radiation intensity near the surface of abdomen is around 2.5 dB within 20% variation of dielectric values. The maximum SAR values increase with the increase in conductivities of human body tissues and decrease with the increase in relative permittivities of human body tissues. A variation of up to 20% in conductivities and relative permittivities, alone or simultaneously, always causes a variation of SAR to be less than 10%. As far as the compliance of safety is concerned, the maxima of 1-g-averaged and 10-g-averaged SARs can reach 3.16 and 0.89 W/kg at the input power of 25 mW.

This paper measured the radiation characteristics of antennas inside the ingestible wireless devices (IWDs). Three monopole antennas were designed and put in two positions of the intestine of an adult female pig at the weight of 80 kg. The return losses of the antennas were measured when the pig was anesthetic and after euthanasia within one hour. The results demonstrate that the frequencies drift greatly from 2.78, 2.17, and 4.29 GHz at the free space into 1.42, 1.0, and 2.2 GHz when the antennas are put in the top position of the intestine of the anesthetic pig and the frequency will increase to 1.62, 1.15, and 2.85 GHz after the pigpsilas euthanasia within one hour. The frequencies increase from 1.5, 1.03, and 2.3 GHz to 1.67, 1.13, and 2.8 GHz when the antennas are put in the bottom position of the intestine of the pig after its euthanasia within one hour. The dead body of the pig absorbed less radiation energy than the living body. Our measurement results further validate the decrease of the dielectric properties of the animal tissues after death. These differences need to be taken into account in electromagnetic modeling for simulation, and should be taken into account before the design of ingested antennas.

Wireless capsule endoscope is a device used to examine the diseases in the small intestine. At present, the capsule endoscope moves through the gastrointestinal tract by natural propulsion of peristalsis. In order to achieve real-time diagnosis and treatment-related procedure, the capsule endoscope is required to be self-actuated and controlled. Different from soild environment, the small intestine is an extremely flexible tube. The unique structure and tissue cause many challenges for the capsule actuation. In this paper, the features, motility, and frictional force of the small intestine are analyzed for determining the design strategy. In-vitro experiment results show the power of magnetic force needed for driving the capsule and the factors that affect the magnitude of the driving force as well. Based on the analysis of the small intestime, a scheme of magnetically-actuated active endoscopy is proposed in the end.

G A A b st ra ct s overlapping (PD and ED) had the lowest scores in the 5 components of PAGI-QOL (P

Diseases of the gastrointestinal (GI) tract, such as intestinal bleeding and ulcer, are very common. In order to determine the location of the disease, as well as to diagnose the problem, endoscopy test is performed. A wireless capsule endoscope is a pill-sized device for the patient to swallow. It equips with a camera and a wireless transmitter so that as it travels through the patient's GI tract, it take pictures or video of the tract and transmit the information out of the patient body wirelessly. This paper discusses the possible solutions and challenges of the wireless capsule endoscope, in terms of the choice of wireless frequency and circuit components. A prototype is built with commercially available components to demonstrate the concept of the device.

Wireless Sensor Networks (WSN) is a research hotspot in recent years and has yielded many fruitful results. However, the biomedical applications of WSN haven’t received significant development due to its many unique challenges for the engineers and physicians. In this paper, a system architecture solution of body area network (BAN), our so called project “MediMesh”, is presented. A biomedical dedicated BAN node hardware platform is devised to fit the medical monitoring application. The sensor node is built up especially for healthcare monitoring while the biocompatibility and portability are considered. A light weight network protocol is designed considering the radiation effect and communication overhead. After data acquisition from sink stations, a data publishing system based on web service technology is implemented for typical hospital environment. The publishing of biomedical data is realized through 3 phases: first storing the data automatically in a database, then creating information sharing service by using Web Service technology, and finally allowing data access by the physicians and end users.

Developments of telemedicine have proliferated in recent years. While healthcare organizations and individual professionals have become increasingly interested in and knowledgeable about telemedicine, its ultimate success as a viable alternative service delivery or collaboration mode requires adequate addressing of crucial issues pertaining to technological and organizational concerns. This study examined the technology implementation that has taken place in a Hong Kong-based neurosurgical teleconsultation program. Using a fairly comprehensive stage-model framework, the study analyzed the major organizational and social change activities experienced or undertaken by the host clinical department, together with key factors and their principal stakeholders. The findings of the study suggest several implications for telemedicine management and research, and these are discussed as well.

In this paper, a position tracking method based on a magnetic marker and hall sensors array, which could be used in capsule endoscope localization, is introduced. The experiment setup is shown, together with the minimization algorithm to analyze the data. It was demonstrated that the calculated position errors could be around 2mm when the marker is moving with a velocity of 2mm/s. Compared with other tracking system, this system cost much lower.

The attenuation of human body trunk at frequency range of 100 MHz to 6 GHz from an internal source was estimated using a simplified experimental model. Antennas were placed in the model which was filled with distilled water, 0.9% NaCl saline solution, and porcine body tissue alternately to determine the attenuation of the system. Saline has greater attenuation than water due to its higher conductivity, while porcine body tissue has attenuation bounded by saline solution and water. Estimated attenuation at the four ISM bands, 434 MHz, 915 MHz, 2.45 GHz and 5.8 GHz were given and all of these bands satisfied the safety and sensitivity requirements of a biomedical telemetry system. 915MHz and 2.45GHz are good choices for the wireless link because of their relatively larger electrical size of RF components such as antenna. In addition, with the growth in wireless LAN and Bluetooth technology, miniaturized antennas, camera modules, and other RF devices have been developed which can be employed in biomedical ingested or implanted devices. This paper gives a reference of attenuation values of a human body trunk of average size. It should be noted that the attenuation values can be different for different body size and different body composition, and therefore the values in this paper serves as a reference only

This paper surveys the state-of-the-art in wireless capsule endoscopy in terms of commercially available products and prototypes currently under development in research labs worldwide. Challenges facing us in designing and manufacturing active wireless capsule endoscopes are outlined, together with potential methods to tackle them.

BACKGROUND: Increased postprandial 5-HT levels have been observed in patients with diarrhea-predominant irritable bowel syndrome (IBS). However, it is unclear whether patients with FD have 5-HT dysfunction. AIM: To compare the plasma 5-HT profile in FD patients and healthy controls. METHODS: Consecutive patients with FD (Rome III criteria) were recruited. Patients with GERD and IBS as predominant symptoms were excluded. After an overnight fast, they underwent caloric drinking test (Ensure O,1.06 kcal/ml at 30ml/min) and 13C-octanoic acid breath test for gastric emptying time measurement. Serial blood samples were collected at 0, 30, 60, 90, 120 min postprandially for plasma 5-HT assay. Healthy controls without history of peptic ulcer and dyspepsia were recruited for the same protocol. RESULTS: 29 FD patients (M:F, 8:21; mean age: 45±2) and 20 controls were studied. 18 (62%) patients had postprandial distress syndrome (PDS) and 11 (40%) had both PDS and epigastric pain syndrome. 7 (24%) patients had concomitant IBS. There was no significant difference in total calorie intake (FD: 762±59 kcal; Control: 940±89 kcal, p= 0.11) and gastric emptying rate (T1/2, FD: 76±4min.; Control: 80±5min., p=0.52). However, FD patients had significantly lower basal (FD: 139±17 ng/109platelets, Control: 238.0±11.7 ng/109platelets, p

In order to assess the compliance of ingested wireless device (IWD) with related international safety guidelines, the studies on the biological effects and the signal intensity of an IWD in two realistic human body models using the finite-difference time-domain (FDTD) method are reported in this paper. Simulation studies are carried out in 21 scenarios where the IWD is placed at seven positions with three orientations, for each of the two human models. Specific absorption rate (SAR), temperature rise, near fields and far fields are analyzed in the 21 scenarios at four selected operation frequencies of 430 and 800 MHz, and 1.2 and 2.4 GHz, respectively. Our study indicates that the radiation intensity outside of the human body decreases with the increase of operation frequency. Furthermore, the radiation characteristics of the IWD are orientation and position dependent. The polarization of electric field outside of the human body is similar to that of the radio frequency (RF) source. As far as the compliance of safety is concerned, among all the simulated scenarios the maxima of the averaged-1 g and averaged-10 g SARs can reach 3.71 W/kg and 1.37 W/kg at the input power of 25 mW, respectively.