Up to two-thirds of patients with IBS attribute their gastrointestinal symptoms to food. The therapeutic focus of IBS has been to alleviate gastrointestinal symptoms, approached by pharmaceutical and ...non-pharmaceutical treatments. Although the most traditional approach has involved the use of medications such as bulking agents, anticholinergics, antispasmodics, and antidiarrheals, unfortunately these are only modestly effective and patients are left with a small menu of successful pharmacologic agents. These treatments, however, are not always enough to alleviate symptoms. Alternative approaches have therefore been tried, including dietary manipulation. This article aims to review dietary restrictions as a non-pharmaceutical management approach for IBS, covering literature on various dietary triggers and the impact of dietary manipulation on gastrointestinal symptoms.
Vitamin D has emerged as a promising anti-cancer agent due to its diverse biological effects on tumor differentiation, apoptosis and suppression of cellular proliferation. Current evidence suggests a ...protective role of vitamin D in colon cancer. The effect of vitamin D on esophageal cancer remains controversial. Multiple studies investigated the association between vitamin D and esophageal cancer, employing different modes of assessment of vitamin D status such as serum 25-hydroxyvitamin D levels, vitamin D dietary intake or exposure to ultraviolet B(UVB) radiation. Genetic variations of the vitamin D receptor(VDR) gene and VDR expression in esophageal specimens have also been investigated. Ecological studies evaluating exposure to UVB radiation yielded an inverse correlation with esophageal cancer. When vitamin D dietary intake was assessed, direct association with esophageal cancer was observed. However, circulating 25-hydroxyvitamin D concentrations showed inconsistent results. In this review article, we present a detailed summary of the current data on the effects of vitamin D on various histological subtypes of esophageal cancer and their precursor lesions. Well-powered prospective studies with accurate measurement of vitamin D status are needed before chemoprevention with vitamin D is recommended, as current evidence does not support a chemopreventive role of vitamin D against esophageal cancer. Future studies looking at the incidence of esophageal cancer in patients with pre-cancerous lesions(Barrett’s esophagus and squamous cell dysplasia) receiving vitamin D supplementation are needed.
Summary
Ambulatory esophageal pH monitoring is a diagnostic tool in patients with heartburn and regurgitation. The aim of this study is to evaluate 96-hour esophageal pH monitoring in patients with ...gastroesophageal reflux disease (GERD), at baseline and under diet that impedes GER. We hypothesized that diet would potentially reduce pathologic acid exposure time (AET). Retrospective series of 88 patients with GERD undergoing wireless 96-hour pH monitoring. Two-day (48 hours) tandem periods, one on liberal, followed by another on restricted diet assessed esophageal AET. Primary end point was >30% reduction in AET while on anti-GER diet. Of the 88 patients, 16 were excluded because of probe migration. Endoscopy and biopsies assessed erosive esophagitis (EE) and Barrett’s esophagus (BE), or normal esophagus. Abnormal AET (% pH < 4.0 ≥ 6) further defined nonerosive reflux disease (NERD), whereas normal AET (% pH < 4.0 < 6) with normal endoscopy defined patients as functional heartburn (FH). There were 6 patients with EE (n = 5) and BE (n = 1), 23 with NERD and 43 with FH. Anti-GER diet led to >30% reduction in AET in EE and NERD patients, but not in those with FH. Most patients (n = 43/72; 60%) had FH and could have avoided acid suppression. Furthermore, (14/23; 61%) of patients with NERD completely normalized AET with diet, potentially negating acid suppression. Ninety-six-hour esophageal pH distinguishes GERD patients from those with FH. Fifty percent of EE/BE patients and 61% of those with NERD completely normalize AET with diet. If pathologic AET occurs despite diet, acid suppression is indicated.
This retrospective pilot study conducted on a community-based cohort of both men and women of various ages and underlying clinical presentations examined the durability and reproducibility of HR-ARM ...findings influencing their potential impact on clinical decision-making at the point of care (Jameson et al. in Br J Surg 81:1689–1692, 1994). The key finding of our study was that only a minority of patients who underwent repeat anorectal manometry as analyzed by the London Classification had stable manometric findings, raising questions regarding the validity of a single manometric measurement, as currently analyzed, for clinical decision-making.
ABSTRACT We report a case of a 44-year-old woman with a history of orthotopic heart transplant on tacrolimus (TC) for immunosuppression who developed large-volume hematochezia. She was found to have ...a large mid-esophageal ulcer and several large colon ulcers. Biopsies showed granulation tissue and inflammatory debris without an identifiable culprit. Extensive workup was performed, including for infectious causes, which was unrevealing. TC was ultimately considered to be a possible culprit, and after stopping it, all her symptoms improved. We suggest considering TC as the possible cause of gastrointestinal ulcers if no other culprit can be identified.
INTRODUCTION:
Gastroparesis refers to delayed gastric emptying in the absence of a gastric outlet obstruction, as diagnosed by >10% gastric retention at 4 hours on Gastric Emptying Scintigraphy ...(GES). It presents with nausea/vomiting, upper abdominal fullness/discomfort, and early satiety. Several conditions can predispose patients to developing the disease, but ∼50% of affected patients are found to have idiopathic gastroparesis. The gastrointestinal tract is well connected through a series of neuronal reflexes that act to stimulate/inhibit specific segments based on stimuli detected at other “upstream or downstream” locations. The existence of a “cologastric brake” has been postulated in the past – where stimuli in the colon activate ascending tracts that may modulate upper gastrointestinal function. Based on this premise, the aim of our study was to determine the relationship between constipation and gastroparesis.
METHODS:
We conducted a retrospective study of patients who had undergone both GES as well as Wireless Motility Capsule (WMC) testing at our institution. Patients were divided into two groups based on the results of the GES: normal gastric emptying or gastroparesis. Constipation was assessed via WMC and anorectal manometry (when available). Demographic data, co-morbidities, selected labs, and medications were analyzed.
RESULTS:
A total of 224 patients were reviewed (101 with normal gastric emptying and 123 with gastroparesis). Mean colonic transit time was 2,321 min (normal <3,540 min) for patients with normal gastric emptying and 2,665 min for patients with gastroparesis (
P
= 0.361). There were no significant differences between the groups in demographics, co-morbidities, labs, or medications with the exception of prokinetics (
P
= 0.004) which were more common in the gastroparesis group. Univariate logistical regression found no association between slow-transit constipation and mild/moderate gastroparesis (OR 1.13/0.92,
P
= 0.82/0.81) but did find a correlation with severe gastroparesis (OR 2.45,
P
= 0.01). This relationship was strengthened with the exclusion of diabetes mellitus (OR 3.5,
P
= 0.008). Dyssynergic defecation did not appear to be associated with gastroparesis regardless of severity.
CONCLUSION:
Severe gastroparesis appears to be associated with an increased prevalence of slow-transit constipation – even more so after eliminating confounders (diabetes mellitus). Conversely, dyssynergic defecation does not appear to have any impact on gastric emptying.
PDF
