Search Results (105)

Background/Objectives: Irritable bowel syndrome (IBS) is a common disorder of brain–gut interaction characterized by abdominal pain and altered bowel habits. While stress and anxiety are known to exacerbate IBS symptoms, less is understood about how these factors interact on a daily timescale. This study aimed to clarify the relationship between daily stress and abdominal pain in IBS and to examine whether trait anxiety moderates this association. Methods: Forty-nine IBS patients completed daily assessments of stress and abdominal pain over a 14-day period. Participants rated abdominal pain three times daily and reported daily stress levels across seven life domains each evening. Trait anxiety was assessed at baseline using the STAI-T. Results: Hierarchical linear modeling was used to analyze within-person and between-person effects. An increase in between-person stress was associated with increased probability of abdominal pain among individuals with low-to-moderate trait anxiety, while this was not observed in patients with high trait anxiety. Even though within-person (day-to-day) stress variations had an impact on pain probability, the effects of between-person variations were multiple times greater. Conclusions: These findings suggest that the interplay between stress and anxiety in IBS might not be uniform. High trait anxiety may, under certain conditions, attenuate rather than amplify the link between stress and pain, possibly pointing to a more dynamic relationship. Full article

Gastroenteritis is commonly caused by viral etiologies. The inclusion of astrovirus on multiplex, syndromic gastrointestinal PCR panels allows for the detection and characterization of infected patients. This retrospective, observational, clinical study examines the epidemiology and clinical characteristics of astrovirus infections in adults from our institution in Washington D.C. (USA) over a seven-year period. Chart abstraction was performed to collect patient demographics, laboratory results, clinical presentation, and management. The overall positivity rate of astrovirus was 0.6%. Peak seasons were late winter to spring (February–April). The mean age was 32 years old (range: 18–52 years). All patients presented with gastroenteritis symptoms and were immunocompetent except one. Symptoms varied among diarrhea, abdominal pain, vomiting, and fever, but patients in age group 30–39 years experienced less vomiting (p = 0.01). Infected patients had an increase in monocytes and neutrophils and a decrease in lymphocytes (p < 0.001). Gastrointestinal co-infections were seen in 24% of our patients. In all patients, clinicians acknowledged the detection of astrovirus and discharged patients without further treatment. The median length of stay was 6 h, and no patients were admitted into the intensive care unit. We show that astrovirus infections in immunocompetent adults were associated with mild disease associated with specific cell counts and different symptoms correlated with age. Full article

Background/Objectives: With recent advancements in rectal cancer management leading to longer patient survival, the impact of various treatment approaches on patients’ quality of life (QOL) becomes an important focus of attention. While QOL studies exist for watch-and-wait after (chemo)radiation with/without local excision, data on health-related QOL (HRQOL) outcomes after contact X-ray brachytherapy (CXB) remain limited. This study evaluated functional and HRQOL outcomes in rectal cancer patients undergoing CXB and (chemo)radiation over one year. Methods: This prospective observational study (enrolment January–October 2023) with one-year follow-up assessed functional and HRQOL outcomes after CXB and (chemo)radiation using EORTC-QLQ-CR29, HADS, and EQ-5D-3L questionnaires. Longitudinal analyses were conducted using linear mixed-effects models, incorporating both fixed and random effects, following data processing based on relevant scoring manuals. Results: QOL was assessed in 53 patients who attended our centre for CXB for various clinical indications, with 51, 47, and 42 remaining at the end of treatment, 6-month, and 12-month follow-ups, respectively. Overall, symptom and functional scores from EORTC-QLQ-CR29 remained stable throughout the follow-up period. Significant improvements were observed in abdominal pain, flatulence, urinary frequency, and body weight at 12 months. HADS and EQ-5D-3L scores remained stable, while EQ-VAS scores showed improvement, indicating a good overall quality of life following CXB treatment. Conclusions: CXB treatment combined with (chemo)radiation maintained stable HRQOL, with some improvements in symptoms and QOL noted during the subsequent year. These findings will help rectal cancer patients understand the benefits and limitations of CXB as a treatment option. Full article

Background/Objective: Among the inflammatory bowel illnesses, ulcerative colitis (UC) affects 5 million people worldwide. UC manifests as weight loss, rectal bleeding, persistent diarrhea, and abdominal pain. Experimental research focused into the potential benefits of atorvastatin for colitis, although the literature only has a small amount of clinical evidence. To examine atorvastatin’s protective effect in UC patients by assessing its impact on fecal myeloperoxidase, zonulin, and disease activity index (DAI). Methods: Two groups of patients with mild to moderate UC were randomly assigned. Over a six-month period, the control group (placebo group) received a placebo alongside mesalamine (1 g, three times daily [t.i.d.]). The atorvastatin group received atorvastatin (80 mg once daily) in addition to mesalamine (1 g t.i.d.). Disease severity was assessed by a gastroenterologist using the Disease Activity Index (DAI). Serum zonulin and fecal myeloperoxidase levels were measured before and after treatment to assess the biological efficacy of the interventions. Outcomes: Reduction in DAI and biomarker levels. Results: Both groups showed a significant decrease in DAI, zonulin, and fecal myeloperoxidase levels. However, the atorvastatin group (n = 23) demonstrated a significantly greater decrease in zonulin (p = 0.04), fecal myeloperoxidase (p = 0.03), and DAI (p = 0.001) compared to the placebo group (n = 24). In atorvastatin group, a significant correlation was observed between DAI and zonulin (p = 0.007, r = 0.4) and myeloperoxidase (p = 0.02, r = 0.36). Conclusions: The co-administration of atorvastatin may serve as a potential adjunct therapy for patients with UC. Full article

Background: Modified thoracoabdominal nerve block through a perichondrial approach (M-TAPA) and external oblique intercostal plane block (EOIB) provide abdominal analgesia by blocking thoracoabdominal nerves. Our aim was to compare the analgesic efficacy of M-TAPA vs. EOIB on the quality of recovery and pain scores in patients who underwent laparoscopic cholecystectomy surgery (LC). Methods: Patients with American Society of Anesthesiologists status I-II, aged between 18 and 65 years, and scheduled for elective LC under general anesthesia were enrolled in the study. The patients were randomized into two groups: Group M-TAPA (n = 30) and Group EOIB (n = 30). The blocks were performed with 40 mL 0.25% bupivacaine in total. The primary outcome of the study was the global quality of recovery score, and the secondary outcomes were the pain scores, rescue analgesic requirement, and adverse effects during the 24-h postoperative period. Results: The global quality of recovery scores at 24 h were similar in both groups. There was a reduction in the median static and dynamic numerical rating scale (NRS) in the first 2 h postoperatively for M-TAPA compared to the EOIB (p < 0.001). The need for rescue analgesia was significantly lower in the M-TAPA group compared to the EOIB group (p < 0.005). Conclusions: Opioid consumption was lower in the M-TAPA group, and the pain scores of the two groups were similar, with the exception of the first 2 h postoperatively. Both the M-TAPA block and EOIB are effective for analgesia following laparoscopic abdominal surgeries. Full article

Background: Caudal anesthesia is an important regional anesthetic technique in neonates. The placement of a catheter can provide excellent analgesia for a prolonged period; the role of adjuvants, in particular morphine, however, remains unclear. We aimed to describe our experience with caudal catheters for major surgery in neonates. Methods: We included all neonates who had a caudal catheter placed for major abdominal and thoracic surgery and explored postoperative pain management and catheter complications. This retrospective case series included neonates with caudal catheter placement from October 2012 to April 2018 at a tertiary university hospital. Results: A total of 33 caudal catheter placements in 32 neonates were included in this study, of which 28 (85%) were a laparotomy and 5 (15%) a thoracotomy. The mean catheter duration was 135 h with a postoperative failure rate of 3%. Patients who did not receive intravenous opioids postoperatively had a significantly shorter stay in the intensive care unit than those who did (341 h vs. 674 h, p = 0.01). All patients received continuous local anesthetics over the catheter, and 79% received additional intermittent epidural morphine postoperatively for a median period of 42 h. No infectious complications were reported. Conclusions: Caudal catheters are a valuable option for perioperative analgesia for major surgery in neonates. We found no serious catheter-related complication. Further research is needed to define the optimal approach and combination of different analgesic techniques. Full article

Background: Crohn’s disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBDs) characterized by various clinical symptoms including abdominal pain, diarrhea, fatigue, and extraintestinal manifestations, which negatively affect a patient’s quality of life. Both mainly occur in adolescence and young adulthood and therefore affect women in their sexually active period. The aim of this study was to assess the effect of IBD on female sexuality and attitudes towards contraception. Methods: A prospective cross-sectional survey study was conducted at the Medical University of Vienna, Austria. Data were collected using a self-designed questionnaire, which included questions on demographics, gynecological patient history, contraceptive choices, and fertility, as well as the Female Sexual Functionality Index (FSFI). Results: A total of 83 female patients with IBD (CD: n = 47, UC: n = 36) and 340 healthy control participants between the ages of 18 and 50 years were investigated. Demographic parameters did not differ between the groups; however, mean FSFI scores were significantly lower in the patient group (p < 0.001). Significantly fewer patients in the IBD group used contraception (p = 0.008). No significant differences regarding conception rates and infertility rates were noted between patients with IBD and control participants (p = 0.533 and p = 0.506, respectively). Conclusions: Female sexuality is significantly impaired in patients with IBD. Women with IBD do not receive sufficient information regarding contraception and should be screened for sexual dysfunction to optimize their quality of life. Full article

Background: Urinary tract infections (UTIs) are among the most prevalent bacterial infections affecting millions of people worldwide each year. They are characterized by the presence of pathogenic microorganisms in the urinary system, leading to symptoms such as frequent urination, burning sensations during urination, and lower abdominal pain. While UTIs can affect individuals of all ages and genders, they are particularly common in women due to anatomical factors. A significant concern regarding UTIs is their tendency to recur, with some patients experiencing multiple episodes within a year. Methods: This study included 674 female patients that were admitted into “Dr. Carol Davila” Central Military Emergency University Hospital in Bucharest over a period of 3 years. Results: Of the 674 women with urinary tract infection, 435 (79.3%) had more than one positive culture, and 239 (35.4%) experienced at least one recurrent urinary tract infection 6–12 months after the initial diagnosis. The mean age of women with urinary tract infection was 63 (±15.61 years). Recurrent urinary tract infections were most prevalent in those aged 65–80 years (52%). Escherichia coli was detected in 71% of the positive cultures. Conclusions: The high prevalence of UTIs among women is a significant public health concern that warrants attention. Women are particularly susceptible to UTIs due to various anatomical and physiological factors. This increased vulnerability underscores the importance of understanding the current epidemiological landscape of UTIs to develop effective preventive strategies. Full article

Background/Objectives: Natural compounds represent novel promising alternative treatments for functional gastrointestinal disorders. This multicenter, double-blind, randomized, placebo-controlled, crossover study aimed to evaluate the efficacy and safety of xyloglucan, pea protein, and chia seed powder (XP + CS) in irritable bowel syndrome with constipation (IBS-C). Methods: Sixty patients received twice-daily XP + CS or placebo for 28 days. Following a 28-day washout period, patients switched to the alternative treatment for another 28 days. Efficacy was evaluated using the Bristol Stool Form Scale; a seven-point Likert scale for abdominal pain, bloating, and discomfort; a Visual Analogue Scale for IBS symptom severity; the quality of life (QoL)-IBS questionnaire; Sickness Impact Profile (SIP) score; and serum zonulin concentrations. Adverse events were monitored throughout the study. Results: Compared to the placebo, XP + CS significantly improved stool consistency (p = 0.04 and p < 0.001 at days 15 and 28, respectively), IBS symptoms (p < 0.001 at day 15), QoL (p < 0.001 from day 15 on), and nearly all SIP domains (p < 0.001 at all time-points). Additionally, XP + CS treatment restored serum zonulin concentrations to within normal ranges by day 15. No serious adverse events were reported. Conclusions: This study provides evidence supporting the efficacy and safety of XP + CS in managing IBS-C symptoms. Full article

Objectives: To analyze the clinical characteristics, trends in hospitalization, and healthcare resource utilization of pediatric patients with fecal impaction. Methods: We utilized the Healthcare Cost and Utilization Project (HCUP) databases, including the National Inpatient Sample (NIS) and the Kids Inpatient Database (KID) datasets from 2011 to 2019, to include all hospitalizations of patients up to 18 years of age with a primary diagnosis of (1) fecal impaction or (2) a primary diagnosis of abdominal pain or constipation with a secondary diagnosis of fecal impaction. The study analyzed various comorbid factors and clinical characteristics of these patients. For healthcare resource utilization, we analyzed the length of hospital stays and total hospital charges, adjusted for inflation. Results: A total of 23,570 admissions due to fecal impactions in children between the years 2011 and 2019 were analyzed, contributing to 0.18% of the total pediatric admissions. Hospitalization rates nearly doubled from 2011 (0.15%) to 2019 (0.29%). The mean hospitalization charges also trended upwards from 15,234 USD in 2011 to 22,487 USD in 2019. The inflation-adjusted annual rate of increase in hospital charges during this period was 5.9% per year. Aggressive fecal disimpaction procedures (either manual or surgical) were performed in approximately 3% of these admissions. Multivariate regression showed that older children (13–18 years of age) were more likely to require aggressive disimpaction. Female children, those with Hispanic ethnicity, and those with obesity were less likely to be associated with the need for disimpaction. Conclusions: Hospitalizations for fecal impaction have increased significantly over the past decade, creating a substantial burden on healthcare resources. Our study highlights the importance of aggressive outpatient management strategies with close follow-up for fecal impactions, which will potentially minimize these hospitalizations. Full article

Background/Objectives: Postoperative ileus, the temporary cessation of gastrointestinal motility leading to accumulation of fluid and gas in the bowel, is a common complication following posterior spine fusion (PSF) in patients with neuromuscular scoliosis (NMS). Abdominal radiographs (KUBs) are often ordered to differentiate between ileus and mechanical obstruction but expose patients to radiation, add cost, and may lead to unnecessary work up. The aim of this study was to determine how often KUBs led to a change in treatment after PSF in patients with NMS. Methods: A retrospective review was conducted of NMS patients with ≥2-year follow-up treated with PSF between January 2014 and December 2019 at a tertiary pediatric hospital. Results: Of the 133 patients (age 13.7, SD 2.6 years; preoperative curve magnitude 82.8, SD 23.0 degrees; follow-up 44.7, SD 15.4 months), 22.6% (30/133) underwent KUB imaging due to abdominal pain, distension, or delayed return of bowel function. In total, 93.3% (28/30) of the KUB imaging was consistent with ileus. One KUB study resulted in a gastroenterology consultation and bowel cleanout, and one raised concerns regarding possible pneumatosis of the colon, prompting a pediatric surgery consultation and exploratory laparotomy which was unremarkable. Conclusions: KUBs were performed in nearly 25% of NMS patients during the acute postoperative period, but rarely provided useful diagnostic information leading to changes in management. In the presence of postoperative abdominal distension, feeding intolerance, and delayed return of bowel function, we advocate for continuing conservative measures until bowel function returns, reserving abdominal radiographs for patients with a worsening exam despite bowel rest or additional causes for concern. Full article

Background and Clinical Significance: Retrorectal cystic hamartomas (“Tailgut cysts”) are rare developmental cysts that appear in the retrorectal space, arising from aberrant remnants of the post-anal primitive gut in case of an incomplete embryogenetic involution. Case Presentation: We present the case of a 30-year-old woman with a history of chronic lower abdominal pain. Other digestive symptoms, like rectal fullness, constipation, pain on defecation, rectal bleeding or genitourinary obstruction symptoms, were not associated. During a period of 3 years, she underwent several surgical procedures for ovarian cysts, without relieving the symptomatology. A computed tomography (CT) scan showed a presacral tumor with a right pararectal development. A surgical resection of the lesion using an anterior approach was performed, with the final pathological diagnosis of a retrorectal cystic hamartoma (“tailgut cyst”). Conclusions: This case underlines the fact that retrorectal masses can be challenging to diagnose, and tailgut cysts must be taken into consideration in cases of perirectal tumors in patients with a history of multiple failed procedures and surgeries. Full article

Background/Objectives: In Italy, the prevalence of celiac disease (CeD) among children exceeds 1.5% and has steadily increased with a linear trend over the past 25 years. The clinical presentation is heterogenous and a change in onset symptoms has been described in recent years. The aim of the study is to describe the pattern of clinical presentation of CeD during the last 12 years in a single Italian center. Methods: We retrospectively enrolled all children diagnosed with CeD at Bambino Gesù Children Hospital, Rome between 1 March 2011 and 22 June 2023. To investigate the changes in pattern of clinical presentation, we divided the patient population into three groups of approximately 4 years each (respectively: 49, 48 and 48 months). Patients who previously received a CeD diagnosis in other centers were excluded. Results: Overall, 4478 patients were diagnosed with CeD at our center. 1082 were excluded, leaving 3396 available for analysis. We divided the study cohort into three groups: group 1 (n = 909), group 2 (n = 1103), and group 3 (n = 1384). Diagnoses of CeD increased by 17.5%. The trend of the non-classic form shows a significative increase (p = 0.000064), showing a high prevalence of bloating and abdominal pain and a significant reduction in celiac crisis (p < 0.0001). Conclusions: Annual diagnoses of CeD increased during the study period, and the clinical presentation has changed in recent years, showing an increase in the non-classic form and a reduction in more severe forms of celiac crisis. Full article

Background/Objectives: Acute intermittent porphyria (AIP) is a metabolic disease characterised by neurovisceral crises with episodes of acute abdominal pain alongside life-altering, and often hidden, chronic symptoms. The elimination of precipitating factors, hemin therapy, and pain relief are strategies used to treat porphyria symptoms, but are often reserved for patients suffering recurrent, acute attacks. Givosiran (siRNA) is an emerging AIP therapy capable of silencing delta-aminolevulinic acid synthase-1 (ALAS1) and, in turn, reducing the accumulation of delta-aminolevulinic acid (ALA) and porphobilinogen (PBG) that precede porphyria symptoms. The aim of this study was to investigate the efficacy and safety of givosiran administration in patients with both acute and chronic AIP burden, who were poorly responsive to current therapies, using a personalised medicine approach. Methods: Real-world data were collected in consecutive patients treated with givosiran at an accredited German Porphyria Clinical Center. Biochemical, clinical, and HR-QoL outcomes were monitored alongside adverse events (AEs). Results: Twenty-eight patients treated between 2018 and 2024 were sub-categorised into groups corresponding to Ipnet terms 13 ‘Sporadic Attacks, 5 ‘Symptomatic High Excretors’, 5 ‘Prophylactic Heme’, and 5 “Recurrent Attacks’. The mean time from diagnosis to treatment was 9.2 years (range in months 1–324), and the mean duration of treatment was 30 months (range 3–68). After 6 months of monthly givosiran injection (2.5 mg/kg), all patients’ ALA levels reached <2ULN, and 60% of patients attained PBG levels < 2ULN (p < 0.001). These biochemical responses were not different between sub-groups (p > 0.05). Clinically, 75% of patients’ chronic and acute porphyria symptoms improved. The total patient populations’ annualised attack ratio (AAR) improved; Historical AAR: 2.9 (0–12.0) vs. Givo AAR: 0.45 (0–3.0) (p < 0.01). During follow-up, nine patients experienced minor breakthrough episodes. Of these, three patients required hemin infusion. An association between clinical success and a shorter interim period between diagnosis and treatment was evident (r = −0.522, p = 0.0061). All patients’ indices of HR-QoL improved under givosiran, including mental health (38%, p < 0.0001) and pain (38%, p < 0.0001). Patient-reported health (givosiran 77.9% vs. baseline 37.1%, p < 0.0001) and clinical outcome scores (86.9%: good–very good) were also positive. Two patients withdrew from treatment <6 months, citing fatigue, which was a common side effect. A mild elevation in liver enzymes (AST and/or ALT < 1.5ULN, 15.4%) and reduced glomerular filtration rates (GFR, 11.5%) were also evident, but no life-threatening adverse events (AEs) were attributed to givosiran treatment. Conclusions: Givosiran is effective in preventing severe acute attacks and reducing the chronic health burden in patients with acute intermittent porphyria. Importantly, HR-QoL improved in patients suffering chronic AIP burden with few incidences of historical attacks. All patients experienced substantially improved mental health, ease of living, and self-perceived health. Full article

This study aimed to describe an ultrasound-guided technique for implanting catheters for local anesthetic administration into the quadratus lumborum (QL) inter-fascial plane in canine cadavers and assessing the spread along the vertebral bodies (VBs) by computed tomography (CT). Phase 1: eight canine cadavers received one catheter per hemiabdomen, followed by injection of contrast media solution [low volume (L_V) 0.3 mL kg⁻¹ or high volume (H_V) 0.6 mL kg⁻¹]. Phase 2: postoperative pain of five dogs was managed by injecting 0.3 mL kg⁻¹ of ropivacaine 0.5% through QL catheters every eight hours, up to 72 h after abdominal surgery. Pain was assessed using the Short Form of the Glasgow Composite Measure Pain Scale, and methadone 0.2 mg kg⁻¹ was administered intravenously when the pain score was ≥6. The number of VBs stained by the contrast solution between the QL and psoas minor muscles was significantly higher in group H_V than group L_V. The catheter tip was visualized in the retroperitoneal space in 1/16 and 2/10 hemiabdomens in phases 1 and 2, respectively. Rescue analgesia was required in 3/5 dogs during the postoperative period. The QL catheter placement technique appears feasible and may be included in a multimodal analgesic approach for dogs undergoing abdominal surgeries. Full article