Gastrointest. Disord., Volume 1, Issue 3 (September 2019) – 5 articles

Introduction: Helicobacter pylori (H. pylori) is a well-recognized risk factor for upper gastrointestinal bleeding (UGIB). The exposure to tissue plasminogen activator (tPA), anti-platelets, and anticoagulants increases the risk of UGIB in acute ischemic stroke (AIS) patients, the risk stratification of H. pylori infection is not known. In this retrospective cross-sectional study, we aimed to evaluate the relationship between H. pylori and GIB in patients hospitalized with AIS. Methods: In the nationwide data, hospitalization for AIS was identified by primary diagnosis using International Classification of Diseases, clinical modification (ICD-9-CM) codes. Subgroup of patients with GIB and H. pylori were identified in AIS cohort. A stepwise multivariable logistic regression model was fitted to evaluate the outcome of upper GIB and role of H. Pylori in UGIB. Results: Overall 4,224,924 AIS hospitalizations were identified, out of which 18,629 (0.44%) had UGIB and 3122 (0.07%) had H. pylori. The prevalence of H. pylori-induced UGIB among UGIB in AIS was 3.05%. The prevalence of UGIB was markedly elevated among the H. pylori infection group (18.23% vs. 0.43%; p < 0.0001) compared to the non-H. pylori group. In multivariable regression analysis, H. pylori was associated with markedly elevated odds of UGIB (aOR:27.75; 95%CI: 21.07–36.55; p < 0.0001). Conclusion: H. pylori infection had increased risk-adjusted occurrence of UGIB amongst the AIS hospitalized patients. H. pylori testing may improve risk stratification for UGIB and lower the health care cost burden in stroke hospitalization. Full article

An organ-specific chronic inflammation–remodeling–carcinoma sequence has been proposed, mainly for the alimentary tract. As representative diseases, gastroesophageal reflux disease, chronic gastritis and inflammatory bowel disease (ulcerative colitis and Crohn’s disease of the colitis type) were adopted for this discussion. Tissue remodeling is such an important part of tumorigenesis in this sequence that an organ-specific chronic inflammation–remodeling–carcinoma sequence has been proposed in detail. Chronic inflammation accelerates the cycle of tissue injury and regeneration; in other words, cell necrosis (or apoptosis) and proliferation result in tissue remodeling in long-standing cases of inflammation. Remodeling encompasses epithelial cell metaplasia and stromal fibrosis, and modifies epithelial–stromal cell interactions. Further, the accumulation of genetic, epigenetic and molecular changes—as well as morphologic disorganization—also occurs during tissue remodeling. The expression of mucosal tissue adapted to chronic inflammatory injury is thought to occur at an early stage. Subsequently, dysplasia and carcinoma develop on a background of remodeling due to continuous, active inflammation. Accordingly, organ-specific chronic inflammation should be ameliorated or well controlled with appropriate monitoring if complete healing is unachievable. Full article

Significant shortcomings in irritable bowel syndrome (IBS) diagnosis and treatment may arise from IBS being an “umbrella” diagnosis that clusters several underlying identifiable and treatable causes for the same symptom presentation into one classification. This view is compatible with the emerging understanding that the pathophysiology of IBS is heterogeneous with varied disease mechanisms responsible for the central pathological features. Collectively, these converging views of the pathophysiology, assessment and management of IBS render the traditional diagnosis and treatment of IBS less relevant; in fact, they suggest that IBS is not a disease entity per se and posit the question “does IBS exist?” The aim of this narrative review is to explore identifiable and treatable causes of digestive symptoms, including lifestyle, environmental and nutritional factors, as well as underlying functional imbalances, that may be misinterpreted as being IBS. Full article

The purpose of this study was to evaluate the impact of biofeedback therapy on evacuation difficulty level and the pain grade during defecation of elderly female patients with dyssynergic defecation. With this aim, after one month of initial assessment, 16 chronically constipated female patients with dyssynergic defecation were randomized to either a electromyographic biofeedback group (n = 8) or to a conventional treatment group (n = 8). The results showed a significant decrease in the evacuation difficulty level and pain grade during defecation following behavioral treatment through biofeedback. At the same time, the treatment produced significant improvements in the weekly stool frequency and a decrease in the mean electromyographic (EMG) activity (µV) of the external anal sphincter during straining to defecate. Clinical gains were maintained during the follow-up carried out six months later. Full article

Recreational cannabis use is increasing with its legalization in many states. Animal studies suggest cannabis can reduce transient lower esophageal sphincter relaxations (TLESRS), reflux and vomiting, while human studies report conflicting findings. There are currently no large studies investigating gastrointestinal symptoms in patients with chronic cannabis use. This was a retrospective case-control study including patients who presented to an outpatient Gastroenterology office, with documented cannabis use. Their main presenting complaint, demographics, frequency and duration of cannabis use, endoscopic and high-resolution esophageal manometry (HREM) with impedance findings were recorded. Cannabis users were more likely to complain of abdominal pain (25% vs. 8%, p < 0.0001), heartburn (15% vs. 9%, p < 0.0001), and nausea & vomiting (7% vs. 1%, p < 0.0001). They were also more likely to have findings of esophagitis (8% vs. 3%, p = 0.0002), non-erosive gastritis (30% vs. 15%, p = 0.0001) and erosive gastritis (14% vs. 3%, p < 0.0001) on upper endoscopy. Cannabis users were more likely to have impaired esophageal bolus clearance (43% vs. 17%, p = 0.04) and a hypertensive lower esophageal sphincter (LES) (29% vs. 7%, p = 0.04). This study is the largest to date evaluating GI complaints of patients with chronic recreational cannabis use. Our results suggest that cannabis use may potentiate or fail to alleviate a variety of GI symptoms which goes against current knowledge. Full article