Diagnostic Yield of Colonoscopy in Young Adults with Lower Gastrointestinal Symptoms in a Multicenter Midwest Cohort

2020 ◽  
Vol 38 (6) ◽  
pp. 484-489
Author(s):  
Ray Lu ◽  
Thamer Kassim ◽  
Devashree Dave ◽  
Jagpal Singh Klair ◽  
Muhammad Ashfaq ◽  
...  
Keyword(s):  
Young Adults ◽  
Abdominal Pain ◽  
Diagnostic Yield ◽  
Significant Proportion ◽  
Gastrointestinal Symptoms ◽  
Advanced Adenoma ◽  
Gi Symptoms ◽  
Inflammatory Bowel ◽  
Case Basis ◽  
Abnormal Pathology

<b><i>Background/Aims:</i></b> Serious gastrointestinal (GI) pathologies are common in older adults compared to young adults (≤40 years). Data on the diagnostic yield (DY) of colonoscopy in young adults with lower GI symptoms are lacking. We aimed to evaluate the overall DY of colonoscopy; and the DY stratified by the presence or absence of bright red blood per rectum (BRBPR) in young adults ≤40 years. <b><i>Methods:</i></b> We reviewed diagnostic colonoscopies performed in young adults by 18 gastroenterologists at 2 different institutions from ­October 2016 to April 2019. Patients with familial colorectal cancer (CRC) syndromes were excluded. DY was calculated based on the proportion of abnormal colonoscopy defined as having inflammatory bowel disease (IBD), microscopic colitis (MC), advanced adenoma, or CRC. <b><i>Results:</i></b> We included 454 patients, mean (SD) age was 31 (3) years, 162 (36%) were males and mean (SD) BMI was 30 (8.5). BRBPR was the indication for colonoscopy in 194 (43%) patients, 260 (57%) patients had colonoscopy for other lower GI symptoms (abdominal pain, chronic diarrhea, constipation) but without BRBPR. Overall DY of colonoscopy in young adults with lower GI symptoms was 15%; IBD was seen in 43 (10%) patients, MC 10 (2%), and advanced neoplasia/CRC 20 (4%). Overall DY in patients with BRBPR was significantly higher than in patients without BRBPR (22 vs. 11%, <i>p</i> = 0.001). The DY for IBD was also higher in young adults with BRBPR versus without BRBPR (15 vs. 6%, <i>p</i> = 0.003). The DY of patients with both BRBPR and abdominal pain was 34%, for BRBPR and diarrhea was 40%, and for all 3 symptoms of BRBPR, diarrhea, and abdominal pain was 52%. <b><i>Conclusions:</i></b> Significant proportion of young adults with BRBPR have abnormal pathology (22%) justifying evaluation by colonoscopy. For other lower GI symptoms without BRBPR, the necessity of endoscopic evaluation should be determined clinically on a case-to-case basis due to the low overall DY.

scholarly journals Lactobacillus Reuteri DSM 17938 (Limosilactobacillus reuteri) in Diarrhea and Constipation: Two Sides of the Same Coin?

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 643
Author(s):  
Angela Saviano ◽  
Mattia Brigida ◽  
Alessio Migneco ◽  
Gayani Gunawardena ◽  
Christian Zanza ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Human Health ◽  
Bowel Disease ◽  
Chronic Constipation ◽  
Lactobacillus Reuteri ◽  
Current Knowledge ◽  
Gastrointestinal Symptoms ◽  
Inflammatory Bowel

Background and Objectives: Lactobacillus reuteri DSM 17938 (L. reuteri) is a probiotic that can colonize different human body sites, including primarily the gastrointestinal tract, but also the urinary tract, the skin, and breast milk. Literature data showed that the administration of L. reuteri can be beneficial to human health. The aim of this review was to summarize current knowledge on the role of L. reuteri in the management of gastrointestinal symptoms, abdominal pain, diarrhea and constipation, both in adults and children, which are frequent reasons for admission to the emergency department (ED), in order to promote the best selection of probiotic type in the treatment of these uncomfortable and common symptoms. Materials and Methods: We searched articles on PubMed® from January 2011 to January 2021. Results: Numerous clinical studies suggested that L. reuteri may be helpful in modulating gut microbiota, eliminating infections, and attenuating the gastrointestinal symptoms of enteric colitis, antibiotic-associated diarrhea (also related to the treatment of Helicobacter pylori (HP) infection), irritable bowel syndrome, inflammatory bowel disease, and chronic constipation. In both children and in adults, L. reuteri shortens the duration of acute infectious diarrhea and improves abdominal pain in patients with colitis or inflammatory bowel disease. It can ameliorate dyspepsia and symptoms of gastritis in patients with HP infection. Moreover, it improves gut motility and chronic constipation. Conclusion: Currently, probiotics are widely used to prevent and treat numerous gastrointestinal disorders. In our opinion, L. reuteri meets all the requirements to be considered a safe, well-tolerated, and efficacious probiotic that is able to contribute to the beneficial effects on gut-human health, preventing and treating many gastrointestinal symptoms, and speeding up the recovery and discharge of patients accessing the emergency department.

scholarly journals Analysis of Gastrointestinal Symptoms in 281 Cases of Hospitalized Covid 19 Patients, Single-Center Study

2021 ◽  
Author(s):  
Gözde Derviş Hakim ◽  
Şükran Köse ◽  
Pınar Şamlıoğlu ◽  
Cengiz Ceylan ◽  
Mehmet Can Uğur ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Respiratory Symptoms ◽  
Clinical Presentation ◽  
Gastrointestinal Symptoms ◽  
Clinical Analysis ◽  
Clinical Findings ◽  
Gastrointestinal System ◽  
Detailed Review ◽  
Single Center Study ◽  
Gi Symptoms

Objective: Although Covid-19 which has been identified as the disease caused by SARS COV-2 virus mainly affects the respiratory tract, it was observed that many systems were affected. The gastrointestinal system is one of the main systems involved. The aim of this manuscript was to perform epidemiological, virological, and clinical analysis of 59 Covid 19-positive patients with gastrointestinal symptoms. Method: Covid-19 diagnosed patients have been started to be admitted since March, 20, 2020. Epidemiological, demographical, clinical findings, laboratory analyses as well as hospitalization periods and disease progression of the patients presenting gastrointestinal system (GIS) symptoms admitted between March, 31, 2020 and August, 1, 2020. Results: Totally 710 Covid 19-positive patients hospitalized were screened. Among these patients, those with incomplete medical history and deficient data were excluded. The analysis of 281 patients admitted due to Covid-19 diagnosis with complete data since admission revealed that 59 patients presented GIS symptoms at admission. The aforesaid patients were compared with 222 patients admitted due to Covid-19 without GIS symptoms within the same period. GIS symptoms were detected on 59 (59/281) (20.99%) patients admitted due to Covid-19. Detailed review of these patients revealed that 18 (18/59) (30.50%) patients had nausea-vomiting, 10 (10/59) (16.95%) patients had abdominal pain, and 31 (31/59) (52.55%) patients had GIS bleeding. It was observed that vomiting was added into the clinical presentation in 7 of 18 patients. Although there is not any diarrhea symptom alone, total number of cases with diarrhea+abdominal pain, diarrhea+nausea-vomiting, diarrhea+nausea-vomiting+abdominal pain was 17 (17/59) (28.81%) of 59 patients. Conclusion: According to the results of this study, we have found 20.99% gi symptoms in the hospitalizated patients due to Covid 19. Although GIS symptoms are not associated with disease severity, they are important for the identification and spread of the disease, along with respiratory symptoms.

scholarly journals Prevalence and Duration of Gastrointestinal Symptoms Before Diagnosis of Inflammatory Bowel Disease and Predictors of Timely Specialist Review: A Population-Based Study

2020 ◽  
Author(s):  
J Blackwell ◽  
S Saxena ◽  
N Jayasooriya ◽  
A Bottle ◽  
I Petersen ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Delayed Diagnosis ◽  
Gastrointestinal Symptoms ◽  
Care Physician ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Background Population ◽  
Gi Symptoms ◽  
Inflammatory Bowel

Abstract Background and Aims Lack of timely referral and significant waits for specialist review amongst individuals with unresolved gastrointestinal [GI] symptoms can result in delayed diagnosis of inflammatory bowel disease [IBD]. Aims To determine the frequency and duration of GI symptoms and predictors of timely specialist review before the diagnosis of both Crohn’s disease [CD] and ulcerative colitis [UC]. Methods This is a case control study of IBD matched 1:4 for age and sex to controls without IBD using the Clinical Practice Research Datalink from 1998 to 2016. Results We identified 19 555 cases of IBD and 78 114 controls. One in four cases of IBD reported GI symptoms to their primary care physician more than 6 months before receiving a diagnosis. There was a significant excess prevalence of GI symptoms in each of the 10 years before IBD diagnosis. GI symptoms were reported by 9.6% and 10.4% at 5 years before CD and UC diagnosis respectively compared to 5.8% of controls. Amongst patients later diagnosed with IBD, &lt;50% received specialist review within 18 months from presenting with chronic GI symptoms. Patients with a previous diagnosis of irritable bowel syndrome [IBS] or depression were less likely to receive timely specialist review (IBS: hazard ratio [HR] = 0.77, 95% confidence interval [CI] 0.60–0.99, depression: HR = 0.77, 95% CI 0.60–0.98). Conclusions There is an excess of GI symptoms 5 years before diagnosis of IBD compared to the background population, probably attributable to undiagnosed disease. Previous diagnoses of IBS and depression are associated with delays in specialist review. Enhanced pathways are needed to accelerate specialist referral and timely IBD diagnosis.

scholarly journals Global prevalence of prolonged gastrointestinal symptoms in COVID-19 survivors and potential pathogenesis: A systematic review and meta-analysis

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 301
Author(s):  
Fauzi Yusuf ◽  
Marhami Fahriani ◽  
Sukamto S. Mamada ◽  
Andri Frediansyah ◽  
Azzaki Abubakar ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Meta Analysis ◽  
Gastrointestinal Symptoms ◽  
Global Prevalence ◽  
Number Of Patients ◽  
Gi Symptoms ◽  
Study Characteristics ◽  
Loss Of Appetite ◽  
Cumulative Prevalence

Background: This study aimed to determine the cumulative prevalence of prolonged gastrointestinal (GI) symptoms, including nausea, vomiting, diarrhea, lack of appetite, abdominal pain, and dysgeusia, in survivors of both mild and severe COVID-19 worldwide and to discuss the potential pathogenesis.   Methods: Three databases (PubMed, Scopus, and Web of Science) were searched for relevant articles up to January 30, 2021. Data on study characteristics, clinical characteristics during follow-up, the number of patients with prolonged GI symptoms, and total number of COVID-19 survivors were retrieved according to PRISMA guidelines. The quality of eligible studies was assessed using the Newcastle-Ottawa scale. The pooled prevalence of specific prolonged GI symptoms was calculated and the association between COVID-19 severity and the occurrence of prolonged GI symptoms was assessed if appropriate.   Results: The global prevalence of prolonged nausea was 3.23% (95% CI: 0.54%–16.53%) among 527 COVID-19 survivors. Vomiting persisted in 93 of 2,238 COVID-19 survivors (3.19%, 95% CI: 1.62%–6.17%) and prolonged diarrhea was found in 34 of 1,073 survivors (4.12%, 95% CI: 1.07%–14.64%). A total of 156 patients among 2,238 COVID-19 survivors (4.41%, 95% CI: 1.91%–9.94%) complained of persistent decreased or loss of appetite. The cumulative prevalence of prolonged abdominal pain was 1.68% (95% CI: 0.84%–3.32%), whereas persistent dysgeusia was identified in 130 cases among 1,887 COVID-19 survivors (7.04%, 95% CI: 5.96%–8.30%). Data was insufficient to assess the relationship between COVID-19 severity and the occurrence of all prolonged GI symptoms.   Conclusion: Persistent GI symptoms among COVID-19 survivors after discharge or recovery raises a concern regarding the long-term impact of the COVID-19 infection on the quality of life of the survivors. Despite several potential explanations proposed, studies that aim to follow patients after recovery from COVID-19 and determine the pathogenesis of the prolonged symptoms of COVID-19 survivors are warranted.   PROSPERO registration: CRD42021239187.

scholarly journals Relationships between disaccharidase deficiencies, duodenal inflammation and symptom profile in children with abdominal pain

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jennifer M. Colombo ◽  
Chance S. Friesen ◽  
Uttam Garg ◽  
Craig A. Friesen ◽  
William San Pablo
Keyword(s):  
Inflammatory Bowel Disease ◽  
Abdominal Pain ◽  
Celiac Disease ◽  
Bowel Disease ◽  
Gastrointestinal Symptoms ◽  
Activity Levels ◽  
Lactase Deficiency ◽  
Symptom Profile ◽  
Inflammatory Bowel ◽  
H Pylori

AbstractAbdominal pain has been associated with disaccharidase deficiencies. While relationships with individual symptoms have been assessed, relationships between disaccharidase deficiencies and symptom complexes or inflammation have not been evaluated in this group. The primary aims of the current study were to assess relationships between disaccharidase deficiency and symptoms or symptom complexes and duodenal inflammation, respectively. Patients with abdominal pain who underwent endoscopy with evaluation of disaccharidase activity levels were identified. After excluding all patients with inflammatory bowel disease, celiac disease, H. pylori, or gross endoscopic lesions, patients were evaluated for disaccharidase deficiency frequency. Disaccharidase were compared between patients with and without histologic duodenitis. Lastly, relationships between individual gastrointestinal symptoms or symptom complexes were evaluated. Lactase deficiency was found in 34.3% of patients and disaccharidase pan-deficiency in 7.6%. No individual symptoms or symptom complexes predicted disaccharidase deficiency. While duodenitis was not associated with disaccharidase deficiency, it was only present in 5.9% of patients. Disaccharidase deficiency, particularly lactase deficiency, is common in youth with abdominal pain and multiple deficiencies are not uncommon. Disaccharidase deficiency cannot be predicted by symptoms in this population. Further studies are needed to assess the clinical significance of disaccharidase deficiency.

scholarly journals A123 GASTROINTESTINAL SYMPTOMS AND DISORDERS OF GUT BRAIN INTERACTION ARE COMMON IN PATIENTS WITH EHLERS-DANLOS SYNDROME (EDS) IN TERTIARY REFERRAL CENTER

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 143-144
Author(s):  
E Abu-Farhaneh ◽  
Y Tse ◽  
C H Parker ◽  
L W Liu
Keyword(s):  
Abdominal Pain ◽  
Fecal Incontinence ◽  
Gastrointestinal Symptoms ◽  
Retrospective Chart Review ◽  
Final Analysis ◽  
Ehlers Danlos Syndrome ◽  
Early Satiety ◽  
Tertiary Referral Center ◽  
Gi Symptoms ◽  
Danlos Syndrome

Abstract Background Ehlers Danlos Syndrome (EDS) is a group of rare connective tissue disorders. Gastrointestinal (GI) symptoms such as abdominal pain, nausea, vomiting, bloating and altered bowel habits are common in patients with EDS. Specifically, disorders of gut brain interaction (DGBI) appear to be more common in this patient population. The University Health Network (UHN) has the first and only multi-disciplinary clinic, including specialized gastroenterology services, in Canada for the management of EDS. Aims The aim of this study is to describe the GI symptoms and DGBI that are present in our cohort of EDS patients. Methods A retrospective chart review of all EDS who were seen in the gastroenterologist clinic of the GoodHope EDS clinic at UHN were reviewed from November 1, 2017 to September 26, 2019. Demographic information including age, sex and EDS subtype were collected. GI symptoms that were collected include constipation, diarrhea, fecal incontinence, nausea, vomiting, bloating, abdominal pain, early satiety, heart burn, dysphagia and regurgitation. A physician made diagnosis of irritable bowel syndrome (IBS) was recorded. Descriptive statistics were performed. Results The charts of 79 EDS patients were reviewed; 4 were excluded due to missing data. 75 patients were included in the final analysis. 93.3% of patients were female with a mean age of 36.4 +/- 12.5 years. Of these 75 patients, 43 (57.3%) had EDS-hypermobile subtype, 13 (17.3%) EDS-classic, 3 (4%) EDS-vascular, 3 (4%) unknown EDS subtype and 13 (17.3%) were categorized as having a hypermobile spectrum disorder. The most common GI symptoms observed in this patient group included abdominal pain in 85.5%, bloating in 64.4%, heartburn in 61.8%, constipation in 57.9%, nausea in 50%, diarrhea 43.4%, dysphagia in 43.4%, regurgitation in 34.2%, early satiety in 32.89%, vomiting in 30.2%,and fecal incontinence in 13.1%. It was also observed that 50.7% (n=38) had a physician made diagnosis of IBS. Of these patients with IBS, 16 (42.1%) had IBS constipation, 12 (31.5%) had IBS mixed, and 10 (26.3%) had IBS diarrhea. Conclusions Our study demonstrated that GI symptoms are common in patients with EDS. In our cohort, abdominal pain is the most commonly reported GI symptom, though other various GI symptoms are also reported in high numbers. DGBI are also common, with IBS being much more common than what has been reported in the general population. Further studies are needed to better understand the pathophysiology and impact of these GI symptoms and DGBI in patients with EDS. Funding Agencies UNH Foundation Goodhope Fund

scholarly journals Frequency and Clinical Presentation of Colorectal Carcinoma among Patients with Lower Gastrointestinal Symptoms

2021 ◽  
pp. 136-142
Author(s):  
Shahnawaz Khatti ◽  
Riaz Ahmed Memon ◽  
Abdul Salam Memon ◽  
Fazila Hashmi ◽  
Sandesh Kumar ◽  
...  
Keyword(s):  
Weight Loss ◽  
Abdominal Pain ◽  
Colorectal Carcinoma ◽  
Clinical Symptoms ◽  
Gastrointestinal Symptoms ◽  
Digital Rectal Examination ◽  
Presenting Symptoms ◽  
Gi Symptoms ◽  
Bleeding Per Rectum ◽  
Local Examination

Objective: To determine the frequency and presentation of colorectal carcinoma (CRC) among the patients presenting with lower gastrointestinal (GI) symptoms. Study Design: Observational study Place and Duration: Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad from January 2013 to February 2014. Methodology: A sample of 105 patients complaining of lower GI symptoms was selected. Data regarding the age, sex, presenting symptoms and signs, local examination and location of lesions were noted in a pre-structured proforma. Patients were examined by digital rectal examination (DRE), proctoscopy, colonoscopy; computerized tomography and biopsy. Data analyzed on SPSS 21.0 at 95% CI (P≤ 0.05). Results: Age of the patients was 53.17±14.90 years (95%CI: 51.28 to 55.05). Of 105 subjects; 65 (61.9%) were males and 40 (38.09%) were females. The CRC was observed in 11 (10.47%) patients of ≤ 40 years, 77 (73.3%) patients of 40 – 59.9 years and 17 (16.19%) cases were ≥60 years of age. Anemia 81 (77.14%), weight loss 74 (70.47%), abdominal pain 60 (57.14%), bleeding per rectum 79 (75.23%), tenesmus 55 (52.38%) and constipation 48 (45.71%) were common presenting symptoms of the CRC patients. Adenocarcinoma was found in 87 (82.85%), carcinoid tumor in 11 (10.47%), lymphoma in 5 (4.76%) and squamous cell carcinoma in 2 (1.9%). Conclusion: Colorectal adenocarcinoma was most common tumor found in males in their sixth decade of life. Anemia, weight loss, abdominal pain and bleeding per rectum were common clinical symptoms and rectum was common tumor site.

scholarly journals GASTROINTESTINAL MANIFESTATIONS OF COVID 19: A BRIEF REVIEW

2020 ◽  
pp. 195-197
Author(s):  
Nikhat Naaz
Keyword(s):  
Abdominal Pain ◽  
Respiratory Symptoms ◽  
Gastrointestinal Symptoms ◽  
Viral Pneumonia ◽  
Google Scholar ◽  
Gastrointestinal Manifestations ◽  
Common Presentation ◽  
Pubmed Database ◽  
Gi Symptoms

Background: In Dec 2019, a series of pneumonia cases were identified in Wuhan, China with presentations similar to viral pneumonia which later spread worldwide and was declared as COVID 19 Pandemic. Most common presentation were fever and respiratory symptoms and less common symptoms include GI symptoms like nausea, vomiting, abdominal pain and diarrhea. Objectives: The objective of this article is to review the gastrointestinal manifestations of COVID 19 patients and to understand its importance while diagnosing patients with COVID 19. Methodology: Pubmed database and Google scholar database were searched between Dec 2019 to June 2020 for studies including COVID 19 confirmed patients with GI symptoms. Findings: Many of these studies observed gastrointestinal symptoms like decreased appetite, diarrhea, nausea, vomiting and abdominal pain to be present in a substantial no of COVID 19 confirmed patients. Conclusions: Failure to recognize COVID 19 patients with predominant digestive symptoms may lead to undue spread of virus for a much longer period and may lead to uncontrollable dissemination of the virus. Recommendation: All COVID 19 confirmed patients should be evaluated for GI symptoms also apart from respiratory symptoms. Patients with predominantly GI symptoms should also be suspected as COVID 19 patients during the current COVID 19 pandemic phase.

200 Diagnostic Yield of Colonoscopy in Young Adults With Lower Gastrointestinal Symptoms in Multicenter Midwest Cohort

2019 ◽  
Vol 114 (1) ◽  
pp. S122-S122
Author(s):  
Ray Lu ◽  
Devashree Dave ◽  
Jagpal S. Klair ◽  
Thamer Kassim ◽  
Muhammad Ashfaq ◽  
...  
Keyword(s):  
Young Adults ◽  
Diagnostic Yield ◽  
Gastrointestinal Symptoms

Spasmodic Abdominal Pain and Other Gastrointestinal Symptoms in Pontocerebellar Hypoplasia Type 2

2021 ◽  
Author(s):  
Wibke G. Janzarik ◽  
Ingeborg Krägeloh-Mann ◽  
Thorsten Langer ◽  
Miriam van Buiren ◽  
Hans E. Schaefer ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Gastrointestinal Symptoms ◽  
Failure To Thrive ◽  
Pontocerebellar Hypoplasia ◽  
Intestinal Alkaline Phosphatase ◽  
Neurodevelopmental Disease ◽  
Gi Symptoms ◽  
High Disease Burden

Abstract Introduction Pontocerebellar hypoplasia type 2 (PCH2) is a rare neurodevelopmental disease with a high disease burden. Besides neurological symptoms, somatic symptoms, such as gastroesophageal reflux (GERD) and failure to thrive, are major contributors to this burden. Methods We report three patients with genetically confirmed PCH2A and significant gastrointestinal (GI) symptoms. Results Apart from impaired swallowing and GERD, which are frequently reported in patients with PCH2, all three patients suffered from episodes of spasmodic abdominal pain and restlessness. In one severely affected patient, lack of intestinal alkaline phosphatase (IAP) is demonstrated. Conclusion GI symptoms are common in PCH2. We draw attention to episodes of spasmodic abdominal pain seriously, aggravating the condition of the patients, especially their movement disorder, and discuss the role of IAP.

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