Medical and Research News
A study using magnetic resonance imaging (MRI) of 48 people found that those with mild to moderate gastroesophageal reflux disease (GERD) had several anatomical differences relating to the reflux barrier compared to healthy volunteers.
Primary among them, the angle of the esophagus (food tube) into the stomach was found to be wider in individuals with GERD compared with healthy individuals. This angle is an essential part of the way the body prevents reflux, called the "flap valve" mechanism. Also, the opening from the esophagus to the stomach (the esophagogastric junction), a key defense against the reflux of stomach contents after a large meal, was found to open wider in individuals with GERD. Differences in both of these structures in individuals with GERD are suspected to contribute to reflux.
Source: Curcic J, et al. Am J Gastroenterol. May 2014.
A review of existing randomized controlled studies aimed to summarize the usefulness of probiotics in health and disease. The researchers concluded that certain strains or combinations may be of benefit in managing constipation and in improving irritable bowel syndrome (IBS) symptoms, among other things. The summary is intended to provide a guide to healthcare providers working with patients.
Source: Taibi A, Comelli EM. Appl Physiol Nutr Metab. May 2014.
A survey of over 500 individuals confirmed a 2.2% prevalence of a mutation in a gene (SCN5A) in individuals with irritable bowel syndrome (IBS), as reported in an earlier pilot study. The SCN5A gene encodes a mechanism (sodium channels) involved in maintaining normal gastrointestinal (GI) motility.
The role of individual genes in symptom generation and expression in IBS remains largely unknown. Identification of these genes and their effects on the structure and function of the GI tract has the potential to reveal the mechanism of IBS in a subset of individuals with the disorder and to shed light on new treatment pathways.
Source: Beyder A, et al. Gastroenterology. June 2014.
No current standards exist regarding decisions by medical professionals to refer children with severe gastroesophageal reflux disease (GERD) for anti-reflux procedures, including surgery. Decisions may be greatly influenced by parental and referring physician opinions. Standardization based on data showing the safety and effectiveness of treatments is recommended by the authors.
Source: Papic JC, et al. Surgery. May 2014.
A safety analysis recently published for the LINX system magnetic sphincter augmentation device (MSAD) for gastroesophageal reflux disease (GERD) reported a low risk profile with no serious events leading to long-term complications associated with the device. LINX is a surgically implanted device that works by reinforcing the lower esophageal sphincter (LES).
The first 1,000 individuals who underwent the procedure were reevaluated after 6 years. The analysis concluded that the safety profile for the procedure performed by an experienced surgeon establishes it as a viable option for individuals with uncomplicated GERD who are considering antireflux surgery.
Source: Lipham JC, et al. Dis Esophagus. June 2014.
Because of the long-term complications associated with intestinal transplantation, the authors in a new study for the treatment of infants with ultra-short bowel syndrome (U-SBS) recommend a non-transplant home parenteral nutrition approach (in the absence of liver disease). Parenteral nutrition is an intravenous feeding technique that delivers nutrition directly into the blood stream.
Source: Diamanti A, et al. J Ped Gastroenterol Nutr. April 2014.
Researchers are finding new serotonin drugs that may help treat a variety of functional gastrointestinal (GI) disorders with improved safety.
A new generation of 5-HT4 receptor agonists is useful in treating symptoms of functional constipation, and has an improved safety profile compared to older drugs in this class.
A relatively new serotonin drug to treat irritable bowel syndrome with diarrhea (IBS-D) is also being developed. The drug, ramosetron (a 5-HT3 receptor antagonist), has been associated with improved stool consistency in nearly 300 men with IBS-D in Japan. It appears to have an improved safety profile compared to other drugs in this class.
Source: Camilleri M. Neurogastroenterol Motil. August 2014.
In a review of records, researchers at Mayo Clinic found an increase over a 2-decade period in gastroesophageal reflux disease (GERD) diagnosis rates, but no increase in reported GERD symptoms. About 6 out of 10 persons reporting GERD symptoms received a GERD diagnosis while only about 1 out of 10 persons reporting functional dyspepsia (FD) symptoms received an FD diagnosis. Common symptoms of GERD – heartburn and/or acid regurgitation – are also reported in about one-third of people with FD. However, treatments differ for these 2 conditions and PPIs that treat GERD do not work for FD.
Source: Pleyer C, et al. Neurogastroenterol Motil. August 2014.
A study involving existing medical information collected from 16 different medical centers on 75 adults and 5 children concluded that fecal microbiota transplant (FMT) appears to be safe and effective for treating C. difficile infection in people who have weakened immune systems.
Up to 15–20% of cases of antibioticassociated recurrent diarrhea and colitis presented in hospitals are attributed to C. difficile infection. FMT helps restore the balance of beneficial microorganisms lost to antibiotic use, and is indicated for people who have not been helped by standard therapies for C. difficile. However, the use of this treatment among individuals with weakened immune systems has been limited due to concerns about safety.
Source: Kelly CR, et al. Am J Gastroenterol. July 2014.
Proton pump inhibitors (PPIs) reduce stomach acid production and are widely used to treat gastroesophageal reflux disease (GERD). However, in about 30% of patients PPIs do not adequately resolve symptoms.
Researchers looking at the occurrence of acid reflux events concluded that strategies which target the pool of acid (called the acid pocket) that floats on the top of ingested food after a meal may be effective for people with GERD who are not helped by PPIs alone.
Altering the size, position, and acidity of the acid pocket while using a PPI may add therapeutic benefit.
Source: Rohof WO, et al. Clin Gastroenterol Hepatol. July 2014.
In two large phase 3 studies, the drug naloxegol was assessed for safety and efficacy in the treatment of opioid-induced constipation in individuals taking opioids for non-cancer related pain. At daily doses of both 12.5 mg and 25 mg the drug was associated with a significant reduction in constipation symptoms. Side effects were more frequent at higher doses and most often included gastrointestinal (GI) effects (abdominal pain, diarrhea, nausea, and vomiting).
Naloxegol is a member of an emerging class of drugs (peripherally acting μ-opioid receptor antagonists) that decrease the GI side effects of opioids without reducing their painkilling effects.
Naloxegol is indicated for use by individuals suffering from opioid-induced constipation who have not responded satisfactorily to standard laxative therapy.
Source: Chey WD, et al. New Engl J Med. June 2014.
Results from a preliminary study of adolescents with irritable bowel syndrome (IBS) suggest that frequent bouts of restrictive eating – such as not eating when hungry or eliminating certain foods – are associated with abnormalities in gastric sensation and gut motility. These gastrointestinal symptoms have been noted in association with other conditions characterized by restrictive eating. Results of this study warrant further investigation.
Source: Van Tilberg MAL, et al. J Ped Gastroenterol Nutr. April 2014.
Fructose can trigger or worsen symptoms in irritable bowel syndrome (IBS). A new study investigated the prevalence of symptomatic fructose malabsorption in those with IBS and tested whether any patient characteristics can help to detect fructose malabsorption.
After ingesting 25g of fructose, fructose malabsorption was found in 22% of those studied. Symptoms indicating intolerance to fructose were found in 28% of sampled individuals, not all of whom demonstrated malabsorption. There were no differences in IBS subtype or clinical symptoms between those who did or did not have malabsorption. However, young males had a greater incidence of malabsorption. The authors recommend further studies to determine whether a low-fructose diet would help IBS patients who are intolerant to fructose, with and without malabsorption.
Source: Melchior C, et al. United European Gastroenterol J. April 2014.
Results of a new study indicate that ERCP and surgery (sphincterotomy) are not reliably effective treatments of pain resulting from sphincter of Oddi dysfunction (SOD). Because these procedures carry substantial risk, the authors do not recommend the continued use of ERCP and sphincterotomy for abdominal pain following cholecystectomy – removal of the gallbladder.
SOD describes a condition in which the sphincter of Oddi does not relax at the appropriate time, most often due to scarring or muscle spasm. The back-up of digestive juices that results can cause episodes of severe abdominal pain.
Source: Cotton PB, et al. JAMA. May 2014.
Researchers reviewing existing studies found an imbalance of certain cells (cytokines) involved in regulating inflammation and sensitization in people with irritable bowel syndrome (IBS) compared to people without IBS. Using a cytokine profile may eventually be one way to help individualize treatment for people with IBS.
Source: Bashashati M, et al. Neurogastroenterol Motil. May 5, 2014.
A retrospective database study of existing records has found that people with diagnoses of severe chronic constipation (CC) have a potentially higher risk of developing colorectal cancer and noncancerous (benign) colorectal tumors over time, compared to people without CC.
The study, which looked at medical record databases, reviewed data from over 100,000 patients (28,854 patients with CC and 86,562 without) for 2–5 years. In those with CC, 2.7% developed colorectal cancer vs. 1.7% of those without. For non-cancerous colorectal tumors, the proportion was 24.8% for those with CC and 11.9% for those without. The risks increased with the severity of the chronic constipation.
These findings demonstrate an association only – not a causation – between CC and the development of colorectal cancer and/or benign tumor. While further studies are needed to determine whether there is an underlying causal link, the authors recommend that doctors be aware of this potential association in order to monitor and treat their patients appropriately.
Source: Guérin A, et al. Aliment Pharmacol Ther. July 2014.
Recent findings suggest that symptoms existing outside the intestinal tract, such as reflux, joint pain, skin abnormalities, and psychological dysfunction, in association with childhood functional abdominal pain are significant predictors of the development of functional gastrointestinal disorders, particularly irritable bowel syndrome (IBS), in adulthood.
Source: Horst S, et al. Clin Castroenterol Hepatol. Apr 13, 2014.
A review of existing studies of inflammatory bowel disease (IBD) and of irritable bowel syndrome (IBS) found a number of shared factors contributing to both disorders. In some instances these shared factors may involve braingut dysfunction, genetics, abnormal microbiota, low-grade inflammation in some IBS patients, and IBS symptoms in some patients with IBD in remission.
Source: Barbara G, et al. Curr Opin Gastroenterol. May 7, 2014.
A study of 25 children with functional gastrointestinal (GI) disorders revealed that specific foods are perceived by children to worsen their GI symptoms. These most often included spicy foods, cow’s milk, and pizza. Common coping strategies identified were consuming smaller portions, modifying foods, and avoiding problem foods.
Source: Carlson M, et al. J Acad Nutr Diet. March, 2014.