No abstract available.
Gastric Emptying ; Proton Pump Inhibitors ; Proton Pumps ; Protons

No abstract available.
Esophagus

Functional gastrointestinal disorders (FGIDs), represented by functional dyspepsia (FD) and irritable bowel syndrome (IBS), are a group of disorders that include variable combinations of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. FGIDs account for a significant percentage of patients seen in primary care settings with abdominal symptoms. Although the definition of FGIDs can easily affect the prevalence, the prevalences of dyspepsia/FD and IBS diagnosed by the Rome III criteria in the general population are 5.3-20.4% and 1.1-29.2%, respectively. Recent reports of FD and IBS defined by the Rome III criteria indicated a female predominance. Regarding the subtype prevalence of FD, postprandial distress syndrome was more prevalent than epigastric pain syndrome (5.6-13.9% vs 0.9-9.5%). The subtype prevalence of IBS is characterized by male predominance for IBS with diarrhea and female predominance for IBS with constipation. Factors affecting the development of FGIDs such as epidemiological factors including genetic and environmental factors, are important. Gene polymorphisms are involved in the development of FGIDs. The prevalence differs among races and geographic areas. Foods may affect the development of FGIDs, but the causal relationships between food and FGIDs are not conclusive. The symptoms often regress and appear in the course of these entities. Building a favorable patient-doctor relationship is effective for controlling symptoms of FGIDs. Physicians should explain that FGIDs are highly prevalent conditions, impair the patients' quality of life even without evident underlying organic causes and are not life-threatening conditions to ensure patients' understanding.
Constipation ; Continental Population Groups ; Diarrhea ; Dyspepsia ; Epidemiology* ; Female ; Gastrointestinal Diseases* ; Humans ; Irritable Bowel Syndrome ; Japan* ; Male ; Prevalence ; Primary Health Care ; Quality of Life

BACKGROUND/AIMS: Epidemiological studies suggest that there is a considerable overlap between functional dyspepsia (FD) and irritable bowel syndrome (IBS). The aim of this study was to examine concurrent gastrointestinal symptoms in FD and IBS. METHODS: A total of 186 college students filled out a questionnaire regarding whether they had uninvestigated dyspepsia (UD, FD without endoscopic examination) and IBS based on Rome-II criteria. Gastrointestinal symptoms were measured using the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. RESULTS: A total of 181 students (98 males, mean age 24.6 years) completed both questionnaires. The prevalence of UD, IBS, and UD+IBS overlap was 12 (6.7%), 40 (22.1%), and 8 (4.4%), respectively. A significant UD+IBS overlap was observed (66.7% IBS in UD, 20.0% UD in IBS). Reflux scores of GSRS in either UD or IBS were significantly greater than in those without. Gastroesophageal reflux disease (GERD), defined as weekly occurring moderate symptoms of heartburn and/or acid regurgitation and evaluated using the GSRS, was found in 16 (8.8%) of the subjects. The prevalence of IBS was significantly higher in GERD patients than in non-GERD patients (50.0% vs 19.4%). CONCLUSIONS: The considerable overlap not only between UD and IBS, but also between GERD and IBS, suggests the involvement of common pathophysiological disturbances in the two conditions.
Dyspepsia ; Epidemiologic Studies ; Gastroesophageal Reflux ; Heartburn ; Humans ; Irritable Bowel Syndrome ; Male ; Prevalence ; Surveys and Questionnaires

BACKGROUND/AIMS: Weekly granulocyte/monocyte adsorption (GMA) to deplete elevated and activated leucocytes should serve as a non-pharmacological intervention to induce remission in patients with ulcerative colitis (UC). This trial assessed the efficacy of monthly GMA as a maintenance therapy to suppress UC relapse. METHODS: Thirty-three corticosteroid refractory patients with active UC received 10 weekly GMA sessions as a remission induction therapy. They were then randomized to receive one GMA session every 4 weeks (True, n=11), extracorporeal circulation without the GMA column every 4 weeks (Sham, n=11), or no additional intervention (Control, n=11). The primary endpoint was the rate of avoiding relapse (AR) over 48 weeks. RESULTS: At week 48, the AR rates in the True, Sham, and Control groups were 40.0%, 9.1%, and 18.2%, respectively. All patients were steroid-free, but no statistically significant difference was seen among the three arms. However, in patients who could taper their prednisolone dose to <20 mg/day during the remission induction therapy, the AR in the True group was better than in the Sham (p<0.03) or Control (p<0.05) groups. CONCLUSIONS: Monthly GMA may potentially prevent UC relapse in patients who have achieved remission through weekly GMA, especially in patients on <20 mg/day PSL at the start of the maintenance therapy.
Adsorption ; Arm ; Blood Component Removal ; Colitis, Ulcerative ; Extracorporeal Circulation ; Humans ; Inflammatory Bowel Diseases ; Prednisolone ; Prospective Studies ; Recurrence ; Remission Induction ; Salicylamides ; Ulcer

No abstract available.
Esophagitis ; Humans

Noxious stimuli in the esophagus activate nociceptive receptors on esophageal mucosa, such as transient receptor potential, acid-sensing ion channel and the P2X family, a family of ligand-gated ion channels responsive to ATP, and this generates signals that are transmitted to the central nervous system via either spinal nerves or vagal nerves, resulting in esophageal sensation. Among the noxious stimuli, gastric acid and other gastric contents are clinically most important, causing typical reflux symptoms such as heartburn and regurgitation. A conventional acid penetration theory has been used to explain the mechanism of heartburn, but much recent evidence does not support this theory. Therefore, it may be necessary to approach the causes of heartburn symptoms from a new conceptual framework. Hypersensitivity of the esophagus, like that of other visceral organs, includes peripheral, central and probably psychosocial factor-mediated hypersensitivity, and is known to play crucial roles in the pathoegenesis of nonerosive reflux disease, functional heartburn and non-cardiac chest pain. There also are esophagitis patients who do not perceive typical symptoms. This condition is known as silent gastroesophageal reflux disease. Although the pathogenesis of silent gastroesophageal reflux disease is still not known, hyposensitivity to reflux of acid may possibly explain the condition.
Adenosine Triphosphate ; Central Nervous System ; Chest Pain ; Esophagitis ; Esophagus ; Gastric Acid ; Gastroesophageal Reflux ; Heartburn ; Humans ; Hypersensitivity ; Ion Channels ; Ligand-Gated Ion Channels ; Mucous Membrane ; Nociceptors ; Sensation ; Spinal Nerves

Background/Aims: Non-cardiac chest pain (NCCP) is defined as recurring angina-like retrosternal chest pain of non-cardiac origin. Information about the epidemiology of NCCP in Japan is lacking. We aim to determine the prevalence and characteristics of NCCP in the Japanese general population. Methods: Two internet-based surveys were conducted among the general population in March 2017. Questions investigated the characteristics of symptoms associated with chest pain and consultation behavior. Quality of life, anxiety, depression, and gastroesophageal reflux disease were analyzed. Results: Five percent of the survey respondents reported chest pain. Subjects with chest pain showed higher frequencies of anxiety and depression and lower quality of life. Among subjects with chest pain, approximately 30% had sought medical attention for their symptoms. Among all consulters, 70% were diagnosed with NCCP. Females were less likely to seek consultations for chest pain than males. Further, severity and frequency of chest pain, lower physical health component summary score, and more frequent gastroesophageal reflux disease were associated with consultation behavior. Subjects with NCCP and cardiac chest pain experienced similar impacts on quality of life, anxiety, and depression. Among subjects with NCCP, 82% visited a primary-care physician and 15% were diagnosed with reflux esophagitis. Conclusions The prevalence of chest pain in this sample of a Japanese general population was 5%. Among all subjects with chest pain, less than one-third consulted physicians, approximately 70% of whom were diagnosed with NCCP. Sex and both the severity and frequency of chest pain were associated with consultation behavior.