The prevalence of gastrointestinal symptoms in patients with chronic renal failure is increased and associated with impaired psychological general well-being.

BACKGROUND: Malnutrition occurs frequently in patients with end-stage renal disease (ESRD). Gastrointestinal (GI) symptoms may lead to reduced food intake, resulting in malnutrition and impaired well-being in these patients. The prevalence of GI symptoms in various chronic renal failure (CRF) groups is unexplored. We assessed the prevalence of GI complaints in patients on either haemodialysis (HD), peritoneal dialysis (PD), or in the pre-dialysis stage. Patients with and without diabetic nephropathy were also compared. METHODS: A total of 233 patients with CRF (128 HD, 55 PD, and 50 pre-dialytic patients) completed two self-administered questionnaires: the Psychological General Well-Being (PGWB) index and the Gastrointestinal Symptom Rating Scale (GSRS), which measures GI symptoms. The values were compared with reference values obtained from the general population. The association between GI symptoms and serum (s-)albumin was also studied. RESULTS: The total GSRS score in patients with CRF was significantly higher than the reference values (HD 2.14 (1.97-2.31), PD 2.24 (2.00-2.48), and pre-dialytic patients 2.03 (1.82-2.25) vs controls 1.53 (1.50-1.55; P<0.001). When comparing CRF subgroups there was no overall difference between the groups, but PD patients had more severe reflux and eating dysfunction. In patients with diabetic nephropathy, only eating dysfunction was significantly more common than in the non-diabetic patients. There was a negative correlation between GI symptoms and psychological general well-being in CRF patients (Rho=-0.46, P<0.001) indicating that patients with a high GI symptom profile have impaired psychological general well-being. A negative correlation was found between eating dysfunction and s-albumin (Rho=-0.33, P<0.01). CONCLUSION: The prevalence of GI symptoms is high in patients with CRF and is associated with impairment in psychological general well-being. Presence of dialysis or not, type of dialysis, and presence or absence of diabetes mellitus seem to have limited impact on GI symptoms.     

Lower urinary tract symptoms in women with irritable bowel syndrome

Objectives: To investigate lower urinary tract symptoms (LUTS) in women with irritable bowel syndrome (IBS) and to evaluate risk factors associated with the psychiatric morbidity of these patients. Methods: The study group included 52 female patients with a diagnosis of IBS. Fifty‐five women without gastrointestinal symptoms were used as controls. LUTS were evaluated using the American Urological Association Symptom Index questionnaire. Psychiatric morbidity was evaluated using a 12‐item version of the Chinese Health Questionnaire. Multiple logistic regression analysis was performed to identify the risk factors associated with psychiatric morbidity in IBS patients. Results: There were no significant differences between the two groups in any of the demographic variables. The most common LUTS in patients with IBS were storage symptoms. These patients had significantly higher scores of frequency, nocturia, urge incontinence, lower maximal flow rate and lower voiding volume (P < 0.05). In addition, significantly higher storage and total American Urological Association Symptom Index questionnaire scores were also noted in IBS patients (P < 0.05). The prevalence of psychiatric morbidity in IBS patients was 28.8%, which was significantly higher than in the control group (20%). The urinary storage symptom score (odds ratio: 1.518; 95% confidence interval: 1.17–1.96; P = 0.002) was significantly correlated with psychiatric morbidity. Conclusions: LUTS are common in IBS patients and have a negative impact on their psychiatric status. Healthcare providers should be aware of the psychological consequences of LUTS in these patients.     

Effects of cisapride on symptoms of digestive and gastrointestinal hormones in chronic renal failure patients

Objective To study the effects of cisapride on symptoms of digestive and gastrointestinal hormones in chronic renal failure patients. Methods There were 46 cases of chronic renal failure patients in this paper, all patients were given routine treatment of the underlying disease and were randomly divided into two groups. 23 patients were additionally treated with cisapride as research group, and the others as control group. The gastrointestinal symptoms, serum somatostatin (SS), motilin (MOT) and vasoactive intestinal peptide (VIP) and other gastrointestinal hormones and renal function in two groups of patients were compared before and after treatment. Results The score of acid reflux, nausea, vomiting, abdominal distension, belching and other symptoms of hard feces and other gastrointestinal after treatment were significantly lower than that before treatment in research group and after treatment in control group (all P＜0.05). There was no significant change between before and after treatment in SS and VIP of two group (all P＞0.05), and MOT in control group (P＞0.05), but the MOT in research group was decreased significantly(P＜0.05). There was no significant difference in Scr, Ccr and BUN between the control and research group after treatment (all P＞0.05). Conclusion Conventional treatment combined with cisapride can improve the effect of gastrointestinal symptoms in patients with chronic renal failure, while reducing serum motilin level.     

Campylobacter pylori: prevalence and significance in patients with chronic renal failure

Since gastric symptoms are frequent in uremic patients, we have studied the prevalence and significance of Campylobacter pylori infection in patients with chronic renal failure. The prevalence of serum IgG antibodies to C. pylori in 50 patients on regular dialysis treatment (44%) was similar to that of a control group of 40 blood donors (45%), but was significantly lower (p = 0.0001) than that in 31 patients with peptic ulcer disease (93%). Furthermore, 11 of the 50 patients with chronic renal failure and a history of documented peptic ulcer disease had a similar prevalence of antibodies to C. pylori (45%) as did the 39 chronic renal failure patients without previous peptic ulcer (44%), which was significantly lower (p less than 0.01) than that in the control group of peptic ulcer patients (93%). Of 10 patients with chronic renal failure (6 with and 4 without gastric complaints) studied by endoscopical biopsies, two had chronic active antral gastritis and were positive for C. pylori by histology, culture and had IgG antibodies in their sera, while one patient with normal antral mucosa had IgG antibodies but was negative by culture and histology. Thus, this study shows that there is no predisposition to C. pylori infection among patients with chronic renal failure, and that C. pylori infection does not play a significant role in the ulcer diathesis in these patients.     

护理干预对肠易激综合征患者临床症状和生活质量的影响

目的探讨护理干预对肠易激综合征患者临床症状和生活质量的影响。方法对34例肠易激综合征患者进行食物过敏原皮肤试验,对19例试验阳性者进行食物激发试验,对13例食物激发试验阳性患者采取剔除过敏食物、记录日志等针对性护理干预,并观察其效果。结果护理干预4周、8周后,患者症状频率、严重程度评分显著低于干预前。生活质量总体健康评分和7个维度评分(除挑食外)显著高于干预前(均P0.05)。结论针对性护理干预措施能有效改善IBS患者的临床症状和生活质量。     

慢性疲劳综合征的胃肠道症状和对胃排空影响的调查

目的调查慢性疲劳综合征（CFS）患者胃肠道症状的发生情况与胃排空功能的相关性。方法采用问卷调查43例CFS患者胃肠道症状的发生情况并对胃部症状进行评分，通过同位素测定其液相和固相胃排空功能，与38例健康对照者比较。结果CFS患者胃肠道症状的发生率较健康对照组显著升高。胃部症状评分与固相（r=0．81）和液相（r=0．65）胃排空减慢显著相关（P〈0．001）。结论CFS患者的胃部症状与胃动力异常有关。     

Male accessory gland infection frequency in infertile patients with chronic microbial prostatitis and irritable bowel syndrome

Recently, we reported an increased prevalence of chronic bacterial prostatitis (CBP) in patients with prostatitis syndromes (PS) and irritable bowel syndrome (IBS) compared with patients with PS alone. The aim of this study was to evaluate the frequency of male accessory gland infections (MAGI) in patients with CBP plus IBS and to compare the sperm parameters of patients with or without MAGI. Fifty consecutive patients with the following criteria were enrolled: (i) infertility; (ii) diagnosis of CBP; and (iii) diagnosis of IBS according to the Rome III criteria. The following two aged-matched control groups were also studied: infertile patients with CBP alone (n = 56) and fertile men (n = 30) who fathered a child within the previous 3 months. Patients and controls underwent to an accurate anamnesis, administration of the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) and the Rome III questionnaires for prostatitis and IBS, respectively, physical examination, and semen analysis. A significantly higher frequency of MAGI was found in patients with CBP plus IBS (82.0%) compared with the patients with CBP alone (53.6%) or the fertile men (0%). The presence of MAGI in the patients with CBP plus IBS was associated with a significantly lower sperm concentration, total number, and forward motility, and with a higher seminal leucocyte concentration compared with the patients with CBP alone and MAGI. Sperm normal morphology was similar in the groups of patients. All sperm parameters did not differ significantly in both the groups of patients without MAGI. The patients with CBP plus IBS had a significantly higher frequency of MAGI compared with the patients with CBP alone. This was associated with worse sperm parameters and, hence, poorer reproductive prognosis. We suggest to search for the presence of IBS in the patients with PS and in particular when CBP and/or worse sperm parameters are present.     

心理护理干预对肠易激综合征患者的应用

目的：探讨心理干预对肠易激综合征患者的效果。方法选择本院2011年7月～2013年3月170例确诊为肠易激综合征的患者随机分为对照组和实验组,对照组（85例）进行常规护理干预,实验组（85例）在常规护理干预基础上再加以心理干预,3个月后采用自测健康评定量表（SRHMS）评估两组自测健康状况得分情况。结果两组自测健康状各维度得分比较,差异具有统计学意义（P＜0.05）。结论对肠易激综合征患者应及早进行心理干预,消除不良心理,促进康复,改善生活质量。     

Increased risk of osteoporosis-related fractures in patients with irritable bowel syndrome

Summary

We sought to determine whether patients with irritable bowel syndrome (IBS) have an increased risk of osteoporosis and related fractures using the Nationwide Emergency Department Sample (NEDS). Patients with IBS had increased adjusted odds of osteoporosis and osteoporotic fractures compared to the non-IBS control group, controlling for known risk factors for osteoporosis. Screening measures to identify osteoporosis in this group are advised.

Introduction

Ulcerative colitis, Crohn’s disease, and celiac disease have well-described augmented risk of osteoporosis and related fractures. We sought to determine whether IBS also indicates an increased risk of osteoporosis and related fractures.

Methods

The 2008 NEDS database was used to determine the adjusted odds of osteoporosis and related fractures in IBS patients. Only fractures (pathologic wrist (733.12), vertebrae (733.13), and femur fractures (733.14), traumatic wrist (813.x), vertebrae (805.x–806.x), and hip fractures (820.x–821.x)) with a secondary diagnosis of osteoporosis (733.0x) were included in the analysis. A multivariate logistic regression analysis was performed, controlling for known risk factors for osteoporosis and related fractures.

Results

We identified 317,857 ED visits in patients with a diagnosis of IBS. Of these, 17,752 carried a diagnosis of osteoporosis and 694 IBS patients had a concurrent diagnosis of a pathologic fracture of the wrist, hip, or vertebrae. A total of 1,503 IBS patients had a concurrent diagnosis of a traumatic fracture of the wrist, hip, or vertebra. Overall, patients with IBS had an increased adjusted odds of osteoporosis (odds ratio (OR) 4.28, 95 % confidence interval (CI) 4.21–4.35) and osteoporotic fractures (OR 2.36, CI 2.26–2.47) compared to the non-IBS control group. The highest adjusted odds of fracture was seen at the wrist (OR 2.41, CI 2.10–2.77 compared to controls).

Conclusions

IBS patients are at an increased risk of osteoporosis and related fractures. Screening measures to identify osteoporosis and prevent fractures are advised.     

Hypochlorhydria and hypergastrinemia and their association with gastrointestinal bleeding in young patients with chronic renal failure

In 40 young patients with chronic renal failure (CRF) on maintenance hemodialysis and 22 control subjects, (1) basal and test meal-stimulated gastrin concentrations, (2) basal and pentagastrin-stimulated gastric acid outputs, and (3) endoscopic examinations were studied. Age-matched CRF patients with control subjects had higher circulating gastrin levels both in the fasting and the test meal-stimulated state and they also had hypochlorhydria. After a test meal, the peak increment of serum gastrin in the CRF patients was more prolonged and greater than in controls. Endoscopic findings showed that the most predominant lesion in the CRF patients was hemorrhagic gastritis. Nine (64.2%) out of 14 patients were hyposecretors and none were hypersecretors. Patients with hyposecretion had higher gastrin levels as well as the same incidence of abnormal endoscopic findings as patients with normosecretion. It is concluded that hypergastrinemia in young CRF patients might be due to a combined effect of impaired renal clearance capacity and overproduction of gastrin associated with hypochlorhydria and also that the cause of gastritis in the young CRF patients might partly be due to a relative impairment of the mucosal defensive mechanism to acid. Our data suggest that the parietal cell response to gastrin in CRF patient may be impaired.     

慢性肾功能衰竭患者的高同型半胱氨酸血症

目的 研究慢性肾功能衰竭（ＣＲＦ）患者血浆同型半胱氨酸（Ｈｃｙ）水平、影响因素以及与心、脑血管疾病的关系。方法 采用荧光偏振免疫分析法测定１６０例ＣＲＦ患者血浆总同型半胱氨酸（ｔＨｃｙ）水平，以３１例冠心病患者和４５例正常人为对照。结果 以正常组血浆ｔＨｃｙｘ±２ｓ为９５％可信度上限，ＣＲＦ患者高同型半胱氨酸血症的发生率为８２．５０％，明显高于冠心病组（２２．５８％）（Ｐ＜０．０１）；血液透析（ＨＤ）组血浆ｔＨｅｙ水平［（２４．１３±１２．６８）μｍｏｌ／Ｌ，ｎ＝７３］明显高于持续性非卧床腹膜透析（ＣＡＰＤ）组［（１６．４３ ±５．５８）μｍｏｌ／Ｌ，ｎ＝１９］、冠心病组［（１１．１３±４．９７）μｍｏｌ／Ｌ，ｎ＝３１］以及正常组（７．９７±２．６５）μｍｏｌ／Ｌ，ｎ＝４５，Ｐ均＜０．０１。９２例透析治疗的ＣＲＦ患者中有明确心、脑血管病者的血浆ｔＨｃｙ水平［（２７．１２±１５．９４）μｍｏｌ／Ｌ，ｎ＝３０］明显高于无此类病史的患者［（２０．１７±８．７１）μｍｏｌ／Ｌ，ｎ＝６２］。未经透析的 ＣＲＦ患者血浆 ｔＨｃｙ水平与内生肌酐清除率呈负相关（ｒ＝－０．３７４，Ｐ＜０．０１），与患者年龄、血葡萄糖、血脂及血浆白     

Zinc in patients with chronic renal failure

In order to assess zinc status in patients with chronic renal failure (CRF) plasma and erythrocyte zinc levels were determined in 13 patients undergoing regular haemodialysis. Additional determinations of plasma copper, plasma and erythrocyte magnesium and potassium were also performed. The mean plasma zinc level was slightly less than normal, but the difference was not statistically significant. The erythrocyte zinc content, however, as well as erythrocyte magnesium and potassium levels were significantly increased (p<0.001). This increase may be partly related to haemolysis in uraemia. Plasma copper concentration in CRF patients did not differ significantly from the control level. The almost normal plasma zinc concentration, elevated erythrocyte zinc, and normocupraemia do not indicate zinc deficiency in CRF patients.     

Preoperative symptoms of irritable bowel syndrome predict poor outcome after laparoscopic cholecystectomy

Background  

Laparoscopic cholecystectomy (LC) is the accepted treatment for symptomatic cholelithiasis. This study examines the effect LC has on quality of life (QOL) and gastrointestinal (GI) symptoms and determines whether patients with symptoms of irritable bowel syndrome (IBS) gain the same benefit as those without.     

Hypnotherapy in the irritable bowel syndrome

In a controlled clinical trial 30 patients with severe classic irritable bowel syndrome (IBS) were allocated to receive treatment with hypnotherapy or placebo medication plus supportive psychotherapy. After three months all the patients in the hypnotherapy group improved dramatically but only two patients in the control group improved. Since that time we have reported our additional experience with more patients and a mean follow-up time of 18 months. The technique of hypnosis is described and preliminary work that has been undertaken using direct measurements of gastrointestinal motility has demonstrated that hypnotised patients seem to have the ability to influence motility.     

Clinical outcome of Laparoscopic antireflux surgery for patients with irritable bowel syndrome

Background The prevalence of irritable bowel syndrome (IBS) is higher among subjects with gastroesophageal reflux disease (GERD). This study aimed to assess the effect of IBS on the postoperative outcome of antireflux surgery.Methods For this study, 102 patients who underwent laparoscopic fundoplication were screened preoperatively for IBS with the Rome II criteria. There were 32 patients in the IBS group and 70 patients in the non-IBS group. Most of the patients (97%) (31 of 32 IBS and 68 of 70 non-IBS patients) had both pre- and postoperative IBS evaluation. A visual analog GERD-specific scoring scale was used to evaluate GERD symptoms prospectively.Results In both groups, GERD symptom scores were statistically improved postoperatively. Of the 31 IBS patients 25 (80.6%) showed a reduction in their symptoms below the Rome II criteria for IBS diagnosis postoperatively.Conclusion Irritable bowel syndrome does not have a negative effect on the outcome of laparoscopic antireflux surgery. Surgical correction of GERD may improve the severity of irritable bowel symptoms.     

Low prevalence of restless legs syndrome in patients with advanced chronic renal failure in the Indian population: a case controlled study

BACKGROUND: Restless legs syndrome (RLS) is reported to occur in 20-70% of uremic patients. There is no study from India regarding the prevalence of RLS in chronic renal failure (CRF) patients. Studies from other Asian countries have shown a much lower prevalence compared to the West. This study investigated the prevalence of RLS in patients with advanced CRF in the Indian population. Patients and METHODS: Sixty-five CRF patients and 99 controls were evaluated using a predesigned standard questionnaire. The control group consisted of prospective renal donors. RESULTS: The mean age of our patients was 42.4 +/- 14.9 years as compared to 43.7 +/- 11.2 years (p = NS). The distribution of cause of CRF was as follows: diabetes 38.5%, hypertension 13.9%, chronic interstitial nephritis 29.2% and chronic glomerulonephritis 18.4%. RLS was present in 1 patient (1.5%) and none of the controls. CONCLUSION: The prevalence of RLS in CRF patients in India is very low as compared to the Western population.