Using GI-specific patient outcome measures in renal transplant patients: Validation of the GSRS and GIQLI

Introduction: Gastrointestinal (GI) side-effects occur frequently as a result of immunosuppressant regimens used in renal transplant patients. Little effort has been made to quantify the impact of these side-effects on patients’ health-related quality of life and symptom severity. Objective: To assess the psychometric characteristics of two GI-specific outcome instruments (the Gastrointestinal Rating Scale (GSRS) and the Gastrointestinal Quality of Life Index (GIQLI)) for use in post-renal transplant patients. Methods: Cross-sectional study conducted at 5 clinical centers in 4 countries. Patients were required to be on mycophenolate mofetil and a calcineurin inhibitor. Patients completed the GSRS, GIQLI and two generic instruments (the Psychological General Well-Being Index and the EQ-5D) at one timepoint. Reliability, construct and known groups validity were assessed. Results: In general the GSRS and the GIQLI demonstrated Cronbach’s alphas higher than 0.70. The GIQLI was moderately to highly correlated with the PGWB and EQ-5D. Correlations among the GSRS and generic instruments were slightly lower. The GSRS and GIQLI both distinguished between patients with and without GI complaints (all p<0.05). Conclusions: The GSRS and the GIQLI are appropriate for use in a post-renal transplant population. Scores on both instruments demonstrated significant differences between renal transplant patients with GI complications and without GI complications.     

Hypervigilance in irritable bowel syndrome compared with organic gastrointestinal disease

Objective

Irritable bowel syndrome (IBS) patients are suggested to selectively attend to gastrointestinal (GI) sensations compared with healthy controls. However, it remains unclear whether there are differences between IBS and other chronic GI disorders. We aimed to evaluate the presence of hypervigilance towards the GI tract in IBS compared with patients with organic GI diseases.

Methods

We included 36 IBS patients and 40 age- and gender-matched patients with organic GI disease. They completed the Hospital Anxiety and Depression Scale (HADS) and underwent three tests: (1) word association—write down as many words as possible representing signs of disease; (2) word recognition (tachistoscope)—four categories of words (positive affects, non-GI symptoms, GI symptoms, negative affects) displayed for increasing time until identified; (3) word recollection—memorize words (10 GI symptoms, 10 positive affects, 10 negative affects).

Results

The word-association task did not show group differences. IBS patients were significantly faster than organic GI patients at recognizing words representing GI symptoms (21 vs. 26 ms; P=.04) and negative affects (27 vs. 34 ms; P=.03), but also tended to be faster at recognizing positive affects (24 vs. 29 ms; P=.08) and non-GI symptoms (22 vs. 27 ms; P=.2). Both groups remembered a similar number of words, but IBS patients tended to recall more incorrect GI words than organic patients (1.3 vs. 1.0; P=.06). There were no group differences in HADS scores.

Conclusion

Compared to patients with organic GI disease, IBS patients seem to be hypervigilant for information regarding GI sensations and maybe also negative information.     

粪菌移植对肠易激综合征临床疗效和肠道菌群影响的非对照初步研究

目的:探讨粪菌移植治疗IBS的有效性、安全性及其对IBS患者肠道菌群的影响。方法:选择2016年9月至2017年8月在广州市第一人民医院行粪菌移植的IBS住院患者28例。所有IBS患者于粪菌移植前、粪菌移植后4和12周完成肠易激综合征生活质量量表(IBS-QOL)、肠易激综合征严重程度系统评分(IBS-SSS)和胃肠道...     

The use of Lactobacillus GG in irritable bowel syndrome in children: a double-blind randomized control trial

OBJECTIVE: To determine whether oral administration of the probiotic Lactobacillus GG under randomized, double-blinded, placebo-controlled conditions would improve symptoms of irritable bowel syndrome (IBS) in children. STUDY DESIGN: Fifty children fulfilling the Rome II criteria for IBS were given Lactobacillus GG or placebo for 6 weeks. Response to therapy was recorded and collected on a weekly basis using the Gastrointestinal Symptom Rating Scale (GSRS). RESULTS: Lactobacillus GG was not superior to placebo in relieving abdominal pain (40.0% response rate in the placebo group vs 44.0% in the Lactobacillus GG group; P=.774). There was no difference in the other gastrointestinal symptoms, except for a lower incidence of perceived abdominal distention (P=.02 favoring Lactobacillus GG). CONCLUSIONS: Lactobacillus GG was not superior to placebo in the treatment of abdominal pain in children with IBS but may help relieve such symptoms as perceived abdominal distention.     

Gastrointestinal quality of life before and short- and long-term after Roux-en-Y gastric bypass for severe obesity

BackgroundOverall quality of life (QoL) is generally improved after bariatric surgery. Gastrointestinal (GI) symptoms including abdominal pain have been reported in up to >30% of patients after Roux-en-Y gastric bypass (RYGB), and may negatively influence QoL, especially GI-QoL.ObjectivesTo evaluate the evolution of GI symptoms and GI-QoL short- and long-term after RYGB.SettingTwo public hospitalsMethodsCandidates for bariatric surgery (n = 128, BMI = 44.2 ± 7.4) or patients who had undergone RYGB 2–4 years (n = 161, BMI = 29.3 ± 15.9) and 5–10 years (n = 121, BMI = 31.3 ± 6.5) before were invited to complete a questionnaire combining 3 validated questionnaires (GIQLI, GSRS, and PCS) specifically designed to evaluate GI-QoL. Scores were compared between the preoperative, early, and late postoperative periods.ResultsThe GIQLI score improved from 88.1 before surgery to 118.6 (P < .0001) and 109.7 (P < .0001) in the early and late postoperative periods respectively. GSRS score improved from 15.6 to 10.1 (P = .0001) and 12.8 (P = .012), and PCS-score improved from 19 to 4.5 (P = .0001) and 8.3 (P = .0001), respectively. The GI subscore of the GIQLI improved from 57.4 to 62.1 (P = .007) in the early period but was not significantly different in the late period (59.3 versus 57.4, P = .3). The psychological impact of GI symptoms decreased at both postoperative time points.ConclusionGI-QoL is markedly improved after RYGB, and this improvement persists up to 10 years. GI symptoms decrease early after surgery and do not worsen in the longer term. Their psychological impact is markedly reduced.     

胃得安胶囊联合铝碳酸镁治疗老年慢性胃炎的临床研究

目的探讨胃得安胶囊联合铝碳酸镁治疗老年慢性胃炎的临床有效性与安全性。方法选取2015年7月—2017年7月在青海大学附属医院消化内科确诊并治疗的老年慢性胃炎患者152例作为研究对象,随机分为对照组和治疗组,每组各76例。对照组口服铝碳酸镁咀嚼片,1片/次,3次/d。治疗组在对照组治疗基础上口服胃得安胶囊,5片/次,3次/d。两组患者均连续治疗6周。观察两组的临床疗效,比较两组临床症状消失时间、胃蛋白酶原、胃肠道症状分级评分(GSRS)量表评分、症状积分。结果治疗后,对照组和治疗组患者的总有效率分别为80.85%、95.74%,两组比较差异有统计学意义(P0.05)。治疗后,治疗组患者上腹疼痛消失时间、烧灼反酸消失时间、嗳气消失时间等临床症状消失时间均显著短于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组患者的胃蛋白酶原I、胃蛋白酶原II、GSRS评分及症状积分均较治疗前显著降低,同组治疗前后比较差异有统计学意义(P0.05);治疗后,治疗组胃蛋白酶原I、胃蛋白酶原II、GSRS评分及症状积分显著低于对照组,两组比较差异有统计学意义(P0.05)。结论胃得安胶囊联合铝碳酸镁治疗老年慢性胃炎疗效显著,可显著改善患者临床症状,同时安全性高,具有一定的临床推广应用价值。