功能性胃肠障碍患者的心理和社会因素研究

目的　探讨功能性胃肠障碍 (FGD)与心理社会因素的关系。方法　应用艾森克个性问卷 [EPQ]、心理应付方式问卷[CSQ]、生活事件量表 [LES]、社会支持评定量表 [SSRS]对 5 6例FGD患者进行心理社会因素调查。并与健康人对照比较分析。结果　FGD患者具有内向、神经质个性倾向者显著高于对照组 (P <0 0 5～ 0 0 1) ;应付防御方式多采用消极应付 (P <0 0 5 ) ;就诊前 ,年内遇到的生活事件 ,特别是负性生活事件显著高于对照组 (P <0 0 5 ) ;而社会支持却明显不足 (P <0 0 5 )。结论　FGD患者具有内向、神经质个性倾向和消极应付防御等心理人格上的易感因素 ,在生活事件 ,特别是负性生活事件和社会支持不足的外界社会因素作用下 ,促发了其心理—生理应激机制 ,可能是导致FGD的重要原因     

胃肠起搏在功能性胃肠病中的应用

功能性胃肠病是临床上最常见的消化系统疾病之一,其发病机制涉及多方面的因素,部分患者对于常规内科治疗不能获得满意效果,严重影响患者生活质量。近年来,胃肠起搏在功能性胃肠病治疗中的作用引起许多学者的关注,目前已应用于胃轻瘫综合征、功能性消化不良、肠易激综合征和胃食管反流病的治疗,并取得了良好的疗效。对近年来胃肠起搏在功能性胃肠病治疗中的应用进行简要综述,为临床应用提供一定的理论基础。     

Nutritional Aspects of Pediatric Gastrointestinal Diseases

In the last decade, the role of nutritional management in pediatric gastrointestinal diseases has gained increasing popularity. Disease-specific diets have been introduced as conventional treatments by international guidelines. Patients tend to more willingly accept food-based therapies than drugs because of their relatively “harmless” nature. Apart from a diet’s therapeutic role, nutritional support is crucial in maintaining growth and improving clinical outcomes in pediatric patients. Despite the absence of classical “side effects”, however, it should be emphasized that any dietary modification might have negative consequences on children’s growth and development. Hence, expert supervision is always advised, in order to support adequate nutritional requirements. Unfortunately, the media provide an inaccurate perception of the role of diet for gastrointestinal diseases, leading to misconceptions by patients or their caregivers that tends to overestimate the beneficial role of diets and underestimate the potential adverse effects. Moreover, not only patients, but also healthcare professionals, have a number of misconceptions about the nutritional benefits of diet modification on gastrointestinal diseases. The aim of this review is to highlight the role of diet in pediatric gastrointestinal diseases, to detect misconceptions and to give a practical guide for physicians on the basis of current scientific evidence.     

Non–IgE- or Mixed IgE/Non–IgE-Mediated Gastrointestinal Food Allergies in the First Years of Life: Old and New Tools for Diagnosis

non-IgE and mixed gastrointestinal food allergies present various specific, well-characterized clinical pictures such as food protein-induced allergic proctocolitis, food protein-induced enterocolitis and food protein-induced enteropathy syndrome as well as eosinophilic gastrointestinal disorders such as eosinophilic esophagitis, allergic eosinophilic gastroenteritis and eosinophilic colitis. The aim of this article is to provide an updated review of their different clinical presentations, to suggest a correct approach to their diagnosis and to discuss the usefulness of both old and new diagnostic tools, including fecal biomarkers, atopy patch tests, endoscopy, specific IgG and IgG4 testing, allergen-specific lymphocyte stimulation test (ALST) and clinical score (CoMiss).     

Use of an interactive game to increase food acceptance--a pilot study

BACKGROUND: Techniques to improve food selection in healthy children with long standing food refusal are limited. The use of educational games has been successful in getting children to increase knowledge in healthy eating, but it is uncertain whether this translates into behaviour change. Therefore the purpose of this study was to test the use of an interactive food game to increase food acceptance in healthy-weight school-age children with chronic food refusal. METHODS: Children attended an outpatient clinic and played an interactive game with a therapist and one parent during which non-preferred foods were consumed. Weekly recording of food consumption occurred with diet analysis by a Registered Dietitian three times during a 1-year time span. RESULTS: The children increased their repertoire of foods and had a more balanced intake. The changes in intake were incorporated into their daily meal patterns in the home setting and were maintained for 1 year. CONCLUSIONS: An interactive food game is a successful tool for increasing food variety in healthy children with chronic food refusal. As this report included only three subjects, the results will be used for subsequent work on this topic.     

The prevalence of irritable bowel syndrome in outpatients with bulimia nervosa

Objective:

This study examined the prevalence of irritable bowel syndrome (IBS) in patients with bulimia nervosa (BN), and the relationship between these disorders.

Method:

Sixty‐four participants with a diagnosis of BN or a related condition were recruited from an outpatient eating disorders service. Questionnaire and interview measures were used to assess bulimic symptoms and attitudes, IBS symptoms, anxiety and depression. Cases of IBS were identified using the Manning criteria.

Results:

There was a high prevalence of IBS in the patient group (68.8%), but IBS status was not predicted by any of the other variables measured. Patients who met criteria for IBS reported more frequent self‐induced vomiting than those who did not (U = 256.0, p = 0.038).

Discussion:

There is evidence of an high incidence of IBS in outpatients with BN, but the relationship between these conditions remains unclear. Future research should consider possible common risk factors. © 2011 by Wiley Periodicals, Inc.     

Eating Disorders: Cultural Model and Consensus Regarding Food

The cultural model of food was applied to 112 adult patients with eating disorders (PG) and 36 healthy adult women (CG) of similar age. The Free List and Ranking of Foods was used to group foods and verify consensus and cultural aspects. Calories, health, and taste were the dimensions used by the participants to group the foods, and strong consensus was achieved in regard to calories and health. There were, however, inter- and intra-group divergences in regard to these ideas, especially in the PG. The CG used distinct criteria, showing a more complex model.     

Gastrointestinal Contributions to the Postprandial Experience

Food ingestion induces homeostatic sensations (satiety, fullness) with a hedonic dimension (satisfaction, changes in mood) that characterize the postprandial experience. Both types of sensation are secondary to intraluminal stimuli produced by the food itself, as well as to the activity of the digestive tract. Postprandial sensations also depend on the nutrient composition of the meal and on colonic fermentation of non-absorbed residues. Gastrointestinal function and the sensitivity of the digestive tract, i.e., perception of gut stimuli, are determined by inherent individual factors, e.g., sex, and can be modulated by different conditioning mechanisms. This narrative review examines the factors that determine perception of digestive stimuli and the postprandial experience.     

The RUsick2 Foodborne Disease Forum for syndromic surveillance

The RUsick2 Foodborne Disease Forum at the National Food Safety and Toxicology Center increased reporting of foodborne diseases to more than four times the rate seen in the previous 2 years. Since November 2002, the Forum has allowed pilot-area residents with sudden-onset vomiting or diarrhea to share and compare information regarding what they ate and did before becoming sick. The purpose is to identify a common food source, perhaps resulting in identifying a cluster of persons who ate the same contaminated food item. Such information can assist health departments in detecting foodborne outbreaks while the possibility for intervention remains.     

Gastrointestinal Vagal Afferents and Food Intake: Relevance of Circadian Rhythms

Gastrointestinal vagal afferents (VAs) play an important role in food intake regulation, providing the brain with information on the amount and nutrient composition of a meal. This is processed, eventually leading to meal termination. The response of gastric VAs, to food-related stimuli, is under circadian control and fluctuates depending on the time of day. These rhythms are highly correlated with meal size, with a nadir in VA sensitivity and increase in meal size during the dark phase and a peak in sensitivity and decrease in meal size during the light phase in mice. These rhythms are disrupted in diet-induced obesity and simulated shift work conditions and associated with disrupted food intake patterns. In diet-induced obesity the dampened responses during the light phase are not simply reversed by reverting back to a normal diet. However, time restricted feeding prevents loss of diurnal rhythms in VA signalling in high fat diet-fed mice and, therefore, provides a potential strategy to reset diurnal rhythms in VA signalling to a pre-obese phenotype. This review discusses the role of the circadian system in the regulation of gastrointestinal VA signals and the impact of factors, such as diet-induced obesity and shift work, on these rhythms.     

抗抑郁药治疗功能性胃肠病的临床研究

目的探讨精神情绪因素与功能性胃肠病(FGID)的关系及抗抑郁药对其的疗效.方法对62例FGID患者进行心理卫生自评表(SCL-90)评分,其结果与我国常模标准分比较.然后按其消化道临床症状严重程度评分并随机分成二组,一组给予抗抑郁药5-羟色胺再摄取抑制剂(SSRI)帕罗西汀(赛乐特)或氟西汀(百忧解),均为20mg/d,疗程8周后再重新予SCL-90量表评分和消化道临床症状严重程度评分.另一组服用安慰剂相对照.结果 FGID患者SCL-90总分和各因子分显著高于我国常模标准分(P＜0.05～0.001),其中焦虑和抑郁因子分最高.抗抑郁药治疗后,其SCL-90总分和各因子分较前显著性下降(P＜0.05～0.001),且对改善消化道临床症状效果显著优于安慰剂组(P＜0.001).结论 FGID患者存在精神情绪障碍,其中焦虑和抑郁情绪障碍尤为突出.抗抑郁药物在改善FGID患者精神情绪障碍的同时对改善其消化道症状有确切的疗效.     

Prevalence and Clinical Features of Celiac Disease in a Cohort of Italian Children with Autism Spectrum Disorders

Background: Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental conditions whose etiopathogenesis derives from a complex interaction between genetic liability and environmental factors. In this framework, mounting evidence suggests that immune system dysfunction could be a risk factor contributing to the development of ASD in at least a subpopulation of individuals. In particular, some studies suggest an association between celiac disease (CD)—a long-term autoimmune disorder that primarily affects the small intestine triggered by the ingestion of gluten—and ASD, while others hypothesized a random link. This investigation aimed to evaluate the prevalence of CD in a large sample of school-aged children with ASD and to characterize their clinical profile. Methods: Medical records of 405 children with ASD aged 5–11 years (mean age: 7.2 years; SD: 1.8 years) consecutively referred to a tertiary-care university hospital between January 2014 and December 2018 were reviewed; among them, 362 had carried out serological testing for CD. Results: Nine patients with positive CD serology were identified, eight of which satisfied the criteria for CD diagnosis. The estimated CD prevalence in ASD children was 2.18% (95% CI, 0.8–3.7), which was not statistically different (1.58%; p = 0.36) from that of an Italian population, matched for age range, considered as a control group (95% CI, 1.26–1.90). Three out of the eight ASD patients with CD did not have any symptoms suggestive of CD. Conclusions: Our findings did not show a higher prevalence of CD in ASD children than in the control population, but could suggest the utility of routine CD screening, given its frequent atypical clinical presentation in this population.     

Non-Celiac Gluten Sensitivity in the Context of Functional Gastrointestinal Disorders

Gluten-free diets are increasingly chosen in the Western world, even in the absence of a diagnosis of celiac disease. Around 10% of people worldwide self-report gluten-related complaints, including intestinal and extra-intestinal symptoms. In most cases, these subjects would be labeled as patients suffering from irritable bowel syndrome (IBS) who place themselves on a gluten-free diet even in the absence of celiac disease. In some instances, patients report a clear benefit by avoiding gluten from their diet and/or symptom worsening upon gluten reintroduction. This clinical entity has been termed non-celiac gluten sensitivity (NCGS). The symptoms referred by these patients are both intestinal and extra-intestinal, suggesting that similarly to functional gastrointestinal disorders, NCGS is a disorder of gut–brain interaction. It remains unclear if gluten is the only wheat component involved in NCGS. The mechanisms underlying symptom generation in NCGS remain to be fully clarified, although in the past few years, the research has significantly moved forward with new data linking NCGS to changes in gut motility, permeability and innate immunity. The diagnosis is largely based on the self-reported reaction to gluten by the patient, as there are no available biomarkers, and confirmatory double-blind challenge protocols are unfeasible in daily clinical practice. Some studies suggest that a small proportion of patients with IBS have an intolerance to gluten. However, the benefits of gluten-free or low-gluten diets in non-celiac disease-related conditions are limited, and the long-term consequences of this practice may include nutritional and gut microbiota unbalance. Here, we summarize the role of gluten in the clinical features, pathophysiology, and management of NCGS and disorders of gut–brain interaction.     

A case of hyperemesis in bulimia nervosa

Bulimia nervosa is an eating disorder defined by recurrent episodes of binge eating followed by compensatory behaviors, primarily self‐induced vomiting. Most common complications are due to purge behaviors and are frequently responsible for hospitalization. These include electrolyte disturbances, dehydration, hypovolemia, stomatitis, esophageal diseases, and functional impairment of the colon. However, an obstruction‐like syndrome has never been reported. We report the case of a middle‐age woman suffering from bulimia nervosa and referring at the emergency department with a 7‐day story of hyperemesis responsible for an acute renal failure. During hospitalization, after the most important and common medical causes of hyperemesis were excluded, an upper gastrointestinal endoscopy was performed. The endoscopist reported the presence of an impressive bezoar, which underwent to mechanical fragmentation and biopsy sampling, revealing it was made up exclusively of liquorice wheels. An endoscopy performed few days after showed the complete dissolution of the bezoar, and the patient was discharged without any further gastrointestinal complaint. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:446–448)