No abstract available.

BACKGROUND/AIMS: The correlation between the Bristol stool form scale (BSFS) and colonic transit time (CTT) has been reported in Western populations. Our study aims to study the relationship between BSFS, stool frequency, and CTT in Eastern patients with chronic constipation. METHODS: A total of 144 chronic functional constipation patients underwent colonic transit study by using radio-opaque markers, anorectal manometry, and balloon expulsion test. Stool diary including stool forms and frequency was recorded. Delayed CTT was defined as the retention of more than 20.0% of radio-opaque markers in the colon on day 5. RESULTS: Twenty-five patients (17.4%) had delayed colonic transit. Mean 5-day BSFS (OR, 0.51; 95% CI, 0.34–0.79; P = 0.021) and stool frequency (OR, 0.60; 95% CI, 0.44–0.83; P = 0.002) were independently associated with delayed CTT by logistic regression analysis. Mean 5-day BSFS (area under the curve [AUC], 0.73; 95% CI, 0.62–0.84; P < 0.001) and stool frequency (AUC, 0.75; 95% CI, 0.63–0.87; P < 0.001) fairly predicted delayed CTT. The optimal mean 5-day BSFS of ≤ 3 provided 68.0% sensitivity, 69.7% specificity, and 69.4% accuracy, and the optimal stool frequency ≤ 2 bowel movements in 5 days provided 64.0% sensitivity, 83.1% specificity, and 84.0% accuracy for predicting delayed CTT. CONCLUSIONS: Both stool form and frequency were significantly associated with delayed CTT. Stool frequency ≤ 2 and BSFS 1–3 rather than BSFS 1–2 that was used in the Westerners could be used as surrogate for delayed CTT in Eastern patients with constipation.
Colon* ; Constipation ; Humans ; Logistic Models ; Manometry ; Sensitivity and Specificity

BACKGROUND/AIMS: Technetium-99m ((99m)Tc)-pertechnetate single photon emission computed tomography (SPECT) allows non-invasive measurement of gastric accommodation (GA) and has been reported to provide the results comparable to the gold standard barostat. The reproducibility of the test when it is performed at different time of the day is not known. The aim of this study was to assess the reproducibility of GA measurement by (99m)Tc-pertechnetate SPECT at the same and different time of the day. METHODS: Three GA studies were performed in each of 20 healthy volunteers (9 males, age 35 +/- 9 years), 2 studies in the morning and 1 study in the afternoon. Each study was performed on separate days at least 3 days apart, in random order. The fasting gastric scintigraphy images were acquired using SPECT at 30 minutes after iv (99m)Tc-pertechnetate. Then, the scintigraphic images were acquired 50 minutes after liquid meal (250 mL, Ensure(R)) ingestions. Gastric volumes were calculated from transaxial gastric images using Image J software. The GA was defined as the maximum postprandial gastric volume minus fasting gastric volume. RESULTS: GA measurement by SPECT show good reproducibility at both the same and different time of the day. The intraclass correlation coefficients of GA results for the same time, the first different time and the second different time studies were 0.681, 0.630 and 0.774, respectively, and the intra-subject coefficients of variation were 13.9%, 14.1% and 8.7%, respectively. CONCLUSIONS: GA measurement by (99m)Tc-pertechnetate SPECT shows good reproducibility at both the same and different time of the day. This result suggests that the schedule time does not appear to extremely affect the gastric accommodation value.
Appointments and Schedules ; Fasting ; Humans ; Male ; Meals ; Time and Motion Studies ; Tomography, Emission-Computed, Single-Photon

BACKGROUND/AIMS: To evaluate the value of a 2-week high dose proton pump inhibitor (PPI) treatment on patients with overlapping non-erosive gastroesophageal reflux disease (NERD) and functional dyspepsia (FD). METHODS: Sixty overlapping NERD and FD patients with symptom onset > 3 months prior underwent 24-hour esophageal pH monitoring studies. All patients received rabeprazole 20 mg b.i.d. for 2 weeks. The reflux and dyspeptic symptoms were evaluated using a symptom questionnaire with 4-point Likert scales before and at the end of treatment. A positive PPI test was defined as score improvement in > or = 50% from the baseline in the typical reflux symptoms. RESULTS: The prevalence of each reflux and dyspeptic symptom did not differ significantly between patients with positive and negative pH tests. After the PPI treatment, epigastric burning, acid regurgitation, heartburn, nausea, vomiting and chest discomfort scores were significantly improved compared to pretreatment values (P < 0.05), whereas postprandial abdominal fullness, early satiation, belching and food regurgitation were not. The proportion of patients who responded to the PPI treatment did not differ significantly between patients with positive and negative pH tests. The sensitivity, specificity, PPV, NPV and accuracy of 2-week high dose rabeprazole treatment for diagnosing gastroesophageal reflux disease were 47%, 38%, 50%, 35% and 43%, respectively. CONCLUSIONS: The two-week high dose PPI treatment was not effective for early satiation, postprandial abdominal fullness, regurgitation or belching symptoms in patients with overlapping NERD and FD. Acid exposure in the distal esophagus could not predict the response of symptoms to PPI. In addition, the 2-week PPI test provided limited value for gastroesophageal reflux disease diagnosis in patients with overlapping NERD and FD.
2-Pyridinylmethylsulfinylbenzimidazoles ; Burns ; Dyspepsia ; Eructation ; Esophageal pH Monitoring ; Esophagus ; Gastroesophageal Reflux ; Heartburn ; Humans ; Hydrogen-Ion Concentration ; Nausea ; Prevalence ; Proton Pump Inhibitors ; Proton Pumps ; Protons ; Surveys and Questionnaires ; Satiation ; Sensitivity and Specificity ; Thorax ; Vomiting ; Weights and Measures

Antroduodenal manometry is one of the methods to evaluate stomach and duodenal motility. This test is a valuable diagnostic tool for gastrointestinal motility disorders especially small intestinal pseudo-obstruction which is difficult to make definite diagnosis by clinical manifestations or radiologic findings. Manometric findings that have no evidence of mechanical obstruction and suggestive of pseudo-obstruction with neuropathy or myopathy can avoid unnecessary surgery and the treatment can be directly targeted. Moreover, among patients who have clinically suspected small intestinal pseudo-obstruction but with normal manometric findings, the alternative diagnosis including psychiatric disorder or other organic disease should be considered. The application of this test to the patients with functional gastrointestinal symptoms especially to find the association of motor abnormalities to the symptom has less impressive yield. Antroduodenal manometry is now readily available only in some tertiary care centers. The aim of this review is to describe the antroduodenal manometry technique, interpretation and clinical utility.
Gastrointestinal Motility ; Humans ; Intestinal Pseudo-Obstruction ; Manometry ; Muscular Diseases ; Stomach ; Tertiary Care Centers ; Unnecessary Procedures

Rice- and chili-containing foods are common in Asia. Studies suggest that rice is completely absorbed in the small bowel, produces little intestinal gas and has a low allergenicity. Several clinical studies have demonstrated that rice-based meals are well tolerated and may improve gastrointestinal symptoms in functional gastrointestinal disorders (FGID). Chili is a spicy ingredient commonly use throughout Asia. The active component of chili is capsaicin. Capsaicin can mediate a painful, burning sensation in the human gut via the transient receptor potential vanilloid-1 (TRPV1). Recently, the TRPV1 expressing sensory fibers have been reported to increase in the gastrointestinal tract of patients with FGID and visceral hypersensitivity. Acute exposure to capsaicin or chili can aggravate abdominal pain and burning in dyspepsia and IBS patients. Whereas, chronic ingestion of natural capsaicin agonist or chili has been shown to decrease dyspeptic and gastroesophageal reflux disease (GERD) symptoms. The high prevalence of spicy food in Asia may modify gastrointestinal burning symptoms in patients with FGID. Studies in Asia demonstrated a low prevalence of heartburn symptoms in GERD patients in several Asian countries. In conclusion rice is well tolerated and should be advocated as the carbohydrate source of choice for patients with FGID. Although, acute chili ingestion can aggravate abdominal pain and burning symptoms in FGID, chronic ingestion of chili was found to improve functional dyspepsia and GERD symptoms in small randomized, controlled studies.
Abdominal Pain ; Asia ; Asian Continental Ancestry Group ; Burns ; Capsaicin ; Capsicum ; Diet ; Dyspepsia ; Eating ; Gastroesophageal Reflux ; Gastrointestinal Diseases ; Gastrointestinal Tract ; Heartburn ; Humans ; Hypersensitivity ; Meals ; Prevalence ; Sensation ; TRPV Cation Channels

BACKGROUND/AIMS: Whether, chronic chili ingestion can desensitize transient receptor potential vanilloid type 1 receptors in gastrointestinal (GI) tract leading to decrease GI symptoms and sensation in diarrhea-predominant irritable bowel syndrome (IBS-D) patients has not been well explored. The aim of this study was to determine the effects of 6-week chili treatment on postprandial GI symptoms and rectal sensation in response to balloon distention in IBS-D patients. METHODS: Sixteen IBS-D patients received placebo or chili capsules before meals 3 times/day for 6 weeks in a randomized, double-blinded, crossover fashion with 4-week washout period. Postprandial GI symptoms were evaluated. All patients underwent a rectal barostat study to evaluate rectal sensory threshold at the end of each treatment. RESULTS: The maximum postprandial abdominal burning scores were similar between both treatments at baseline (1.4 [0.0-2.0] vs. 1.1 [0.0-2.8], P > 0.05) but were significantly decreased after chili (0.0 [0.0-0.5] vs. 0.3 [0.0-1.6], P < 0.05) at the end of treatment. The chili treatment significantly increased sensory threshold for the first rectal sensation (median [interquartile range]:16 [12-16] mmHg vs. 8 [8-16] mmHg, P < 0.05) however, there was no significant effect on rectal compliance (7.3 +/- 1.0 vs. 7.1 +/- 1.8 mL/mmHg). Other postprandial GI symptoms did not vary significantly between both treatments at baseline and the end of treatment. CONCLUSIONS: In IBS-D patients, 6-week chili ingestion significantly decreased postprandial abdominal burning and increased the rectal sensory threshold. These findings suggest a desensitization effect of chili ingestion on transient receptor potential vanilloid type 1 receptors in the proximal gut and rectum.
Burns ; Capsaicin ; Capsules ; Compliance ; Cross-Over Studies* ; Eating ; Gastrointestinal Tract ; Humans ; Irritable Bowel Syndrome* ; Meals ; Rectum ; Sensation* ; Sensory Thresholds

Background/Aims: A high prevalence of GERD has been reported in patients with supragastric belching. We aim to evaluate reflux characteristics and explore the temporal relationship between supragastric belches (SGBs) and reflux episodes in GERD patients with excessive belching. Methods: Twenty-four hour esophageal pH-impedance monitoring was analyzed. Reflux episodes were classified into: refluxes preceded by SGBs, followed by SGBs, and lone refluxes. Reflux characteristics were compared between patients with pH-positive (pH+) and pH-negative (pH–). Results: Forty-six patients (34 Female, age 47 ± 13 years) were included. Fifteen patients (32.6%) had pH+. Almost half (48.1 ± 21.0%) of refluxes were preceded by SGBs. The number of SGBs significantly correlated with the number of reflux episodes preceded by SGBs (r = 0.43, P < 0.05) and % time pH < 4 at the distal esophagus (r = 0.41, P < 0.05). Patients with pH+ had significantly more SGBs and reflux episodes preceded by SGBs/day than pH– patients (P < 0.05). The difference in the number of refluxes between pH+ and pH– patients was caused by reflux episodes preceded by SGBs, but not lone refluxes and refluxes followed by SGBs. The proportion of SGBs followed by reflux/total SGBs was similar between patients with pH+ and pH– (P > 0.05). Reflux episodes preceded by SGBs and followed by SGBs extended more proximal and had longer bolus and acid contact time than lone refluxes (P < 0.05). Conclusions In patients with GERD and SGB, the number of SGBs positively correlates with the number of reflux episodes preceded by SGBs. Identifying and managing SGB may be beneficial and more likely to improve GERD.

Background/Aims: An increase in postprandial intestinal gas plays a role in bloating symptoms. We aim to study the utility of spot breath hydrogen (H 2 ) level in predicting the response to a low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAPs) diet. Methods: Patients with functional gastrointestinal disorders diagnosed by Rome IV criteria with bothersome bloating for > 6 months were prospectively enrolled. Patients completed 7-day food diaries and collected a breath sample 2 hours after their usual lunch at baselineand 4 weeks after low FODMAPs dietary advice by a dietitian. The responder was defined as an improvement of ≥ 30% bloatingscores in the fourth week. Results: Thirty-eight patients (32 female, 52.6 ± 13.8 years; 22 irritable bowel syndrome) completed the study. Twenty-one patients (55%) were classified as responders. Baseline global gastrointestinal symptoms, bloating, abdominal pain scores, and numbers of high FODMAPs items were similar between responders and non-responders. Both groups significantly decreased high FODMAPs items intake with similar numbers at the follow-up. The area under the curve for predicting low FODMAPs responsiveness using baseline H2 levels was 0.692 (95%CI, 0.51-0.86; P < 0.05), with the best cutoff at 8 parts per million (sensitivity 66.7%, specificity 82.4%). 66% of responders had baseline H2 level > 8 parts per million vs 17% of non-responders (P < 0.05). The baseline spot hydrogen level in responders was 9.5 (3.3-17.3) vs 4.5 (3.3-6.3) in non-responders (P< 0.05). Conclusions A higher baseline breath hydrogen level was associated with bloating improvement after low FODMAPs dietary advice. A spot breath test after lunch, a simple point-of-care test, is possibly helpful in managing patients with bloating.

BAome III criteria. METHODS: After EAR3Q was developed by Asian experts by cCKGROUND/AIMS: The development-processes by regional socio-cultural adaptation of an Enhanced Asian Rome III questionnaire (EAR3Q), a cultural adaptation of the Rome III diagnostic questionnaire (R3DQ), and its translation-validation in Asian languages are presented. As English is not the first language for most Asians, translation-validation of EAR3Q is essential. Hence, we aimed to culturally adapt the R3DQ to develop EAR3Q and linguistically validate it to show that the EAR3Q is able to allocate diagnosis according to Ronsensus, it was translated into Chinese, Hindi-Telugu, Indonesian, Korean, and Thai, following Rome Foundation guidelines; these were then validated on native subjects (healthy [n = 60], and patients with irritable bowel syndrome [n = 59], functional dyspepsia [n = 53] and functional constipation [n = 61]) diagnosed by clinicians using Rome III criteria, negative alarm features and investigations. RESULTS: Experts noted words for constipation, bloating, fullness and heartburn, posed difficulty. The English back-translated questionnaires demonstrated concordance with the original EAR3Q. Sensitivity and specificity of the questionnaires were high enough to diagnose respective functional gastrointestinal disorders (gold standard: clinical diagnoses) in most except Korean and Indonesian languages. Questionnaires often uncovered overlapping functional gastrointestinal disorders. Test-retest agreement (kappa) values of the translated questionnaires were high (0.700-1.000) except in Korean (0.300-0.500) and Indonesian (0.100-0.400) languages at the initial and 2-week follow-up visit. CONCLUSIONS: Though Chinese, Hindi and Telugu translations were performed well, Korean and Indonesian versions were not. Questionnaires often uncovered overlapping FGIDs, which were quite common.
Asia ; Asian Continental Ancestry Group* ; Constipation ; Diagnosis* ; Dyspepsia ; Follow-Up Studies ; Gastrointestinal Diseases ; Heartburn ; Humans ; Irritable Bowel Syndrome ; Surveys and Questionnaires* ; Sensitivity and Specificity ; Translations