RESUMEN
Acute gastrointestinal injury (AGI) is common in mechanically ventilated (MV) patients, but the potential association between ventilatory pressure parameters and AGI grade and their impact on mortality remains unclear. This study aimed to explore the association between ventilatory pressure parameters and AGI grade, and their interaction on all-cause mortality in MV patients. This study was a secondary analysis of a multicenter, prospective, observational study that enrolled adult patients with an expected duration of mechanical ventilation ≥ 48 h from 14 general intensive care units in Zhejiang Province between March and August 2014. The AGI grade was assessed daily on the basis of gastrointestinal symptoms, intra-abdominal pressures, and feeding intolerance in the first week of admission to the ICU. This study included 331 patients (69.2% men; mean age, 64.6 ± 18.9 years). Multivariate regression analysis showed that plateau pressure (Pplat) (OR 1.044, 95% CI 1.009-1.081, P = 0.013), serum creatinine (OR 1.003, 95% CI 1.001-1.006, P = 0.042) and APACHE II score (OR 1.035, 95% CI 1.021-1.072, P = 0.045) were independently associated with global AGI grade III/IV within 7 days of ICU admission. Moreover, global AGI grade (HR 2.228, 95% CI 1.561-3.182, P < 0.001), serum creatinine (HR 1.002, 95% CI 1.001-1.003, P = 0.012) and APACHE II score (HR 1.039, 95% CI 1.015-1.063, P = 0.001) were independently associated with 60-day mortality. In addition, there were significant (Pint ≤ 0.028) interactions of Pplat and DP with AGI grade in relation to 60-days mortality, whereas no interaction (Pint = 0.061) between PEEP and AGI grade on 60-days mortality was observed. In the presence of Pplat ≥ 19 cmH2O, the patients with AGI grade III/IV had 60-day mortality rate of 72.2%, significantly higher than those with AGI grade I/II (48.7%, P = 0.018), whereas there were no significant differences (27.9% vs. 33.7%, P = 0.39) in 60-days mortality between AGI grade I/II and III/IV among the patients with Pplat < 19 cmH2O. In comparison with Pplat, DP had a similar interaction (Pint = 0.028) with AGI grade on 60-day mortality. Ventilatory pressure parameters (Pplat and DP) are independent risk factors of AGI grade III/IV. Pplat and DP interact with AGI grade on 60-days mortality, highlighting the importance of optimizing ventilatory pressure parameters to improve gastrointestinal function and survival outcomes of MV patients.Trial registration: ChiCTR-OCS-13003824.
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Unidades de Cuidados Intensivos , Respiración Artificial , Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios Prospectivos , APACHE , Enfermedades Gastrointestinales/mortalidad , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/fisiopatología , Anciano de 80 o más AñosRESUMEN
Parkinson's disease (PD) is typically a sporadic late-onset disorder, which has made it difficult to model in mice. Several transgenic mouse models bearing mutations in SNCA, which encodes alpha-Synuclein (α-Syn), have been made, but these lines do not express SNCA in a physiologically accurate spatiotemporal pattern, which limits the ability of the mice to recapitulate the features of human PD. Here, we generated knock-in mice bearing the G51D SNCA mutation. After establishing that their motor symptoms begin at 9 mo of age, we then sought earlier pathologies. We assessed the phosphorylation at Serine 129 of α-Syn in different tissues and detected phospho-α-Syn in the olfactory bulb and enteric nervous system at 3 mo of age. Olfactory deficit and impaired gut transit followed at 6 mo, preceding motor symptoms. The SncaG51D mice thus parallel the progression of human PD and will enable us to study PD pathogenesis and test future therapies.
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Modelos Animales de Enfermedad , Técnicas de Sustitución del Gen , Enfermedad de Parkinson , alfa-Sinucleína , Animales , alfa-Sinucleína/metabolismo , alfa-Sinucleína/genética , Ratones , Enfermedad de Parkinson/genética , Enfermedad de Parkinson/metabolismo , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/patología , Ratones Transgénicos , Fosforilación , Trastornos del Olfato/genética , Trastornos del Olfato/metabolismo , Trastornos del Olfato/fisiopatología , Bulbo Olfatorio/metabolismo , Bulbo Olfatorio/patología , Enfermedades Gastrointestinales/genética , Enfermedades Gastrointestinales/metabolismo , Enfermedades Gastrointestinales/patología , Sistema Nervioso Entérico/metabolismo , Sistema Nervioso Entérico/fisiopatología , Humanos , MasculinoRESUMEN
Normal and optimal functioning of the gastrointestinal tract is paramount to ensure optimal nutrition through digestion, absorption and motility function. Disruptions in these functions can lead to adverse physiological symptoms, reduced quality of life and increased nutritional risk. When disruption or dysfunction of neuromuscular function occurs, motility disorders can be classified depending on whether coordination or strength/velocity of peristalsis are predominantly impacted. However, due to their nonspecific presenting symptoms and overlap with sensory disruption, they are frequently misdiagnosed as disorders of the gut-brain interaction. Motility disorders are a prevalent issue in the pediatric population, with management varying from medical therapy to psychological therapy, dietary manipulation, surgical intervention or a multimodal approach. This narrative review aims to discuss the dietary management of common pediatric motility disorders including gastroesophageal reflux, esophageal atresia, achalasia, gastroparesis, constipation, and the less common but most severe motility disorder, pediatric intestinal pseudo-obstruction.
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Enfermedades Gastrointestinales , Motilidad Gastrointestinal , Humanos , Motilidad Gastrointestinal/fisiología , Niño , Enfermedades Gastrointestinales/dietoterapia , Enfermedades Gastrointestinales/terapia , Enfermedades Gastrointestinales/fisiopatología , PreescolarRESUMEN
Endoscopic therapy has gone through three stages of development: intraluminal treatment, endoscopic tunneling technology, and endoscopic super minimally invasive surgery (ESMIS). Compared to the drawbacks of traditional surgical methods"organ resection and anatomical reconstruction", super minimally invasive surgery (SMIS) emphasizes the surgical concept of"curing diseases while preserving organs and functions". SMIS conducts treatment through four channels: natural cavity channel, tunnel channel, puncture channel, and multi cavity channel. It offers dozens of surgical methods for diagnosing and treating gastrointestinal diseases. At present, relatively sound implementation principles for ESMIS treatment have been established to ensure the safety and effectiveness of surgery, and to continuously expand other diagnostic and therapeutic fields.
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Procedimientos Quirúrgicos Mínimamente Invasivos , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Endoscopía/métodos , Enfermedades Gastrointestinales/cirugíaRESUMEN
Several international epidemiological studies have established a link between obesity and upper gastrointestinal cancer (UGC), but Chinese evidence is limited. This study aimed to determine the prevalence of obesity, especially central obesity, while investigating its association with upper gastrointestinal diseases in the high-risk population of Yangzhong, a typical high-risk area for UGC in southeastern China. We conducted a cross-sectional study from November 2017 to June 2021 involving 6736 residents aged 40-69. Multivariate logistic regression was used to assess independent factors influencing overweight/obesity and central obesity. We also analyzed the relationship between obesity and upper gastrointestinal diseases using multinomial logistic regression. The prevalence of overweight, obesity, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR)-central obesity were 40.6%, 12.0%, 49.9%, 79.4%, and 63.7%, respectively. Gender, age, smoking, tea consumption, sufficient vegetable, pickled food, spicy food, eating speed, physical activity, family history of cancer, and family history of common chronic disease were associated with overweight /obesity and central obesity. Besides, education and missing teeth were only associated with central obesity. General and central obesity were positively associated with UGC, while general obesity was negatively associated with UGC precancerous diseases. There were no significant associations between obesity and UGC precancerous lesions. Subgroup analyses showed that general and central obesity was positively associated with gastric cancer but not significantly associated with esophageal cancer. Obesity is negatively and positively associated with gastric and esophageal precancerous diseases, respectively. In conclusion, general and central obesity were at high levels in the target population in this study. Most included factors influenced overweight/obesity and central obesity simultaneously. Policymakers should urgently develop individualized measures to reduce local obesity levels according to obesity characteristics. Besides, obesity increases the risk of UGC but decreases the risk of UGC precancerous diseases, especially in the stomach. The effect of obesity on the precancerous diseases of the gastric and esophagus appears to be the opposite. No significant association between obesity and upper gastrointestinal precancerous lesions was found in the study. This finding still needs to be validated in cohort studies.
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Obesidad , Humanos , Persona de Mediana Edad , Masculino , Femenino , China/epidemiología , Adulto , Prevalencia , Anciano , Obesidad/epidemiología , Estudios Transversales , Factores de Riesgo , Enfermedades Gastrointestinales/epidemiología , Obesidad Abdominal/epidemiología , Sobrepeso/epidemiología , Circunferencia de la CinturaRESUMEN
BACKGROUND: The association between education, intelligence, and cognition with digestive tract diseases has been established. However, the specific contribution of each factor in the pathogenesis of these diseases are still uncertain. METHOD: This study employed multivariable Mendelian randomization (MR) to assess the independent effects of education, intelligence, and cognition on gastrointestinal conditions in the FinnGen and UK Biobank European-ancestry populations. A two-step MR approach was employed to assess the mediating effects of the association. RESULTS: Meta-analysis of MR estimates from FinnGen and UK Biobank showed that 1- SD (4.2 years) higher education was causally associated with lower risks of gastroesophageal reflux (OR: 0.58; 95% CI: 0.50, 0.66), peptic ulcer (OR: 0.57; 95% CI: 0.47, 0.69), irritable bowel syndrome (OR: 0.70; 95% CI: 0.56, 0.87), diverticular disease (OR: 0.69; 95% CI: 0.61, 0.78), cholelithiasis (OR: 0.68; 95% CI: 0.59, 0.79) and acute pancreatitis (OR: 0.54; 95% CI: 0.41, 0.72), independently of intelligence and cognition. These causal associations were mediating by body mass index (3.7-22.3%), waist-to-hip ratio (8.3-11.9%), body fat percentage (4.1-39.8%), fasting insulin (1.4-5.5%) and major depression (6.0-12.4%). CONCLUSION: Our findings demonstrate a causal and independent association between education and six common digestive tract diseases. Additionally, our study highlights five mediators as crucial targets for preventing digestive tract diseases associated with lower education levels.
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Escolaridad , Análisis de la Aleatorización Mendeliana , Humanos , Inteligencia/genética , Cognición , Enfermedades del Sistema Digestivo/genética , Masculino , Femenino , Persona de Mediana Edad , Causalidad , Enfermedades Gastrointestinales/genética , Factores de RiesgoRESUMEN
BACKGROUND: Radiotherapy (RT) is effective for cervical cancer but causes late side effects (SE) to nearby organs. These late SE occur more than 3 months after RT and are rated by clinical findings to determine their severity. While imaging studies describe late gastrointestinal (GI) SE, none demonstrate the correlation between the findings and the toxicity grading. In this study, we demonstrated the late GI toxicity prevalence, CT findings, and their correlation. METHODS: We retrospectively studied uterine cervical cancer patients treated with RT between 2015 and 2018. Patient characteristics and treatment(s) were obtained from the hospital's databases. Late RTOG/EORTC GI SE and CT images were obtained during the follow-up. Post-RT GI changes were reviewed from CT images using pre-defined criteria. Risk ratios (RR) were calculated for CT findings, and multivariable log binomial regression determined adjusted RRs. RESULTS: This study included 153 patients, with a median age of 57 years (IQR 49-65). The prevalence of ≥ grade 2 RTOG/EORTC late GI SE was 33 (27.5%). CT findings showed 91 patients (59.48%) with enhanced bowel wall (BW) thickening, 3 (1.96%) with bowel obstruction, 7 (4.58%) with bowel perforation, 6 (3.92%) with fistula, 0 (0%) with bowel ischemia, and 0 (0%) with GI bleeding. Adjusted RRs showed that enhanced BW thickening (RR 9.77, 95% CI 2.64-36.07, p = 0.001), bowel obstruction (RR 5.05, 95% CI 2.30-11.09, p < 0.001), and bowel perforation (RR 3.82, 95% CI 1.96-7.44, p < 0.001) associated with higher late GI toxicity grades. CONCLUSIONS: Our study shows CT findings correlate with grade 2-4 late GI toxicity. Future research should validate and refine these findings with different imaging and toxicity grading systems to assess their potential predictive value.
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Traumatismos por Radiación , Tomografía Computarizada por Rayos X , Neoplasias del Cuello Uterino , Humanos , Femenino , Neoplasias del Cuello Uterino/radioterapia , Neoplasias del Cuello Uterino/diagnóstico por imagen , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Traumatismos por Radiación/diagnóstico por imagen , Traumatismos por Radiación/etiología , Tracto Gastrointestinal/efectos de la radiación , Tracto Gastrointestinal/diagnóstico por imagen , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/diagnóstico por imagen , Análisis de RegresiónRESUMEN
OBJECTIVE: The use of non-pharmacological preventive measures during the COVID-19 pandemic has helped to reduce the incidence of multiple airborne or contact diseases. The objective of this paper was to evaluate the impact that all preventive measures have had on the transmission of different microorganisms, both by respiratory and contact transmission. METHODS: We compared the incidence of different infectious episodes coded with the CIAP-2 code (International Classification of Primary Care second edition of the WONCA International Classification Committee) collected from the computerized history of primary care, both with respiratory tract and digestive tract involvement, in the period from March 2018 to February 2020 (pre-pandemic period) and from March 2020 to February 2022 (pandemic period). The data corresponded to the entire region, with an estimated average population for the four years of 650,000 people. The statistical treatment of the data consisted of a descriptive analysis with the calculation of absolute values and percentages. Rates were calculated and compared using data provided by the National Institute of Statistics as a denominator. The P was obtained by statistical comparison by the exact method. A comparison of rates was made. RESULTS: The incidence in the number of CIAP-2 episodes studied, both corresponding to respiratory and gastrointestinal pathologies, comparing the period March 2018-February 2020 with the period March 2020-February 2022 decreased by 65.81%, from 534,439 cases to 182,707. CONCLUSIONS: The preventive measures applied during the pandemic produce a significant decrease in pathology involving the respiratory or the digestive tract.
OBJETIVO: El uso de medidas preventivas no farmacológicas durante la pandemia de la COVID-19 ayudó a reducir la incidencia de múltiples enfermedades de transmisión aérea o por contacto. El objetivo de este trabajo fue evaluar el impacto que habían tenido todas las medidas preventivas en la transmisión de diferentes microorganismos, tanto por transmisión respiratoria como por contacto. METODOS: Comparamos la incidencia de diferentes episodios infecciosos codificados con el código CIAP-2 (Clasificación Internacional de Atención Primaria, segunda edición, del Comité de Clasificación Internacional WONCA-World Organization of Family Doctors) recogidos de la historia informatizada de Atención Primaria, tanto con afectación del tracto respiratorio como del tracto digestivo, en el período de marzo de 2018 a febrero de 2020 (período prepandemia) y de marzo de 2020 a febrero de 2022 (período de pandemia). Los datos correspondieron a toda la región, con una población media estimada para los cuatro años de 650.000 personas. El tratamiento estadístico de los datos consistió en un análisis descriptivo con el cálculo de valores absolutos y porcentajes. Se calcularon y compararon tasas tomando como denominador los datos proporcionados por el Instituto Nacional de Estadística. La P fue obtenida mediante comparación estadística por el método exacto. Se realizó una comparación de tasas. RESULTADOS: La incidencia en el número de episodios CIAP-2 estudiados, tanto correspondientes a patología respiratoria como gastrointestinal, comparando el periodo de marzo de 2018-febrero de 2020 con el periodo marzo de 2020-febrero de 2022, disminuyó en un 65,81%, pasando de 534.439 casos a 182.707. CONCLUSIONES: Las medidas preventivas aplicadas durante la pandemia producen una disminución significativa de la patología del tracto respiratorio o digestivo.
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COVID-19 , Enfermedades Gastrointestinales , Humanos , Incidencia , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/prevención & control , COVID-19/prevención & control , COVID-19/epidemiología , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/prevención & control , España/epidemiología , Adulto , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/prevención & control , Persona de Mediana Edad , Masculino , FemeninoRESUMEN
Activating enhancer-binding protein 2 (AP-2) is a family of transcription factors (TFs) that play crucial roles in regulating embryonic and oncogenic development. In addition to splice isoforms, five major family members encoded by the TFAP2A/B/C/D/E genes have been identified in humans, i.e., AP-2α/ß/γ/δ/ε. In general, the first three TFs have been studied more thoroughly than AP-2δ or AP-2ε. Currently, there is a relatively limited body of literature focusing on the AP-2 family in the context of gastroenterological research, and a comprehensive overview of the existing knowledge and recommendations for further research directions is lacking. Herein, we have collected available gastroenterological data on AP-2 TFs, discussed the latest medical applications of each family member, and proposed potential future directions. Research on AP-2 in gastrointestinal tumors has predominantly been focused on the two best-described family members, AP-2α and AP-2γ. Surprisingly, research in the past decade has highlighted the importance of AP-2ε in the drug resistance of gastric cancer (GC) and colorectal cancer (CRC). While numerous questions about gastroenterological disorders await elucidation, the available data undoubtedly open avenues for anti-cancer targeted therapy and overcoming chemotherapy resistance. In addition to gastrointestinal cancers, AP-2 family members (primarily AP-2ß and marginally AP-2γ) have been associated with other health issues such as obesity, type 2 diabetes, liver dysfunction, and pseudo-obstruction. On the other hand, AP-2δ has been poorly investigated in gastroenterological disorders, necessitating further research to delineate its role. In conclusion, despite the limited attention given to AP-2 in gastroenterology research, pivotal functions of these transcription factors have started to emerge and warrant further exploration in the future.
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Factor de Transcripción AP-2 , Humanos , Factor de Transcripción AP-2/metabolismo , Factor de Transcripción AP-2/genética , Enfermedades Gastrointestinales/genética , Enfermedades Gastrointestinales/metabolismo , AnimalesRESUMEN
OBJECTIVE: Considerable disparities exist in access to gastrointestinal (GI) care and digestive outcomes across gender, racial, and socioeconomic groups. We evaluated (1) whether adults with chronic GI symptoms from diverse demographic groups would use a digital digestive care programme and (2) the effects of participation on GI symptom severity and other patient-reported outcomes. METHODS: Access to a digital digestive chronic care programme was provided to participants regardless of prior digestive diagnoses or symptoms for 90 days. The intervention included GI symptom tracking, personalised medical nutrition therapy, GI-specific health coaching, and targeted education on common GI symptoms. We assigned a Social Vulnerability Index (SVI) score to each participant according to their home address and compared baseline and end-intervention symptoms and other patient-reported outcomes by gender, race/ethnicity, and SVI. RESULTS: Of the 1936 participants, mean age was 43.1 years; 67% identified as white/Caucasian, 11% Asian/Pacific Islander, 6% Hispanic/Latinx, 7% black/African American, and 7% of multiple races. Participants of all demographic groups used the app symptom logging, reviewed educational materials, and interacted with their care team and reported similar statistically significant improvements in GI symptoms (by the end of the intervention, 85% improved, p<0.05). Participants reported feeling greater control of their health (83%), better able to manage their digestive symptoms (83%), increased happiness (76%), and greater productivity at work (54%), with black/African Americans and Native Americans most likely to report these changes. CONCLUSION: We conclude that a digital GI disease management programme may be of value in reducing disparities in access to GI care.
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Enfermedades Gastrointestinales , Poblaciones Vulnerables , Humanos , Masculino , Femenino , Adulto , Poblaciones Vulnerables/estadística & datos numéricos , Enfermedad Crónica , Persona de Mediana Edad , Enfermedades Gastrointestinales/terapia , Disparidades en Atención de Salud/estadística & datos numéricos , Manejo de la Enfermedad , Etnicidad/estadística & datos numéricos , Telemedicina , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Grupos Raciales/estadística & datos numéricosRESUMEN
The rise in food intolerances and celiac disease, along with advanced diagnostic techniques, has prompted health professionals to seek effective and economical testing methods. This study evaluates combining genetic tests with routine carbohydrate-absorption breath tests to classify patients with chronic gastrointestinal disorders into therapeutic groups, enhancing dietary management and improving gut health and quality of life. Forty-nine patients with suspected carbohydrate intolerance underwent genetic testing for lactase non-persistence, hereditary fructose intolerance, and celiac disease risk. Simultaneously, breath tests assessed lactose and fructose absorption. The lactase non-persistence genotype appeared in 36.7% of cases, with one hereditary fructose-intolerance case in a heterozygous condition. Celiac disease risk markers (HLA-DQ2/8 haplotypes) were found in 49.0% of the population. Secondary lactose and/or fructose malabsorption was present in 67.3% of patients, with 66.1% of lactase non-persistence individuals showing secondary lactose malabsorption. Fructose malabsorption was prevalent in 45.8% of patients at risk for celiac disease. Two main treatment groups were defined based on genetic results, indicating primary and irreversible gastrointestinal disorder causes, followed by a sub-classification using breath test results. Genetic testing is a valuable tool for designing dietary management plans, avoiding unnecessary diet restrictions, and reducing recovery times.
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Pruebas Respiratorias , Enfermedad Celíaca , Intolerancia a la Fructosa , Enfermedades Gastrointestinales , Pruebas Genéticas , Lactasa , Intolerancia a la Lactosa , Humanos , Femenino , Masculino , Adulto , Enfermedad Celíaca/dietoterapia , Enfermedad Celíaca/genética , Persona de Mediana Edad , Pruebas Respiratorias/métodos , Pruebas Genéticas/métodos , Intolerancia a la Fructosa/genética , Intolerancia a la Fructosa/dietoterapia , Intolerancia a la Fructosa/diagnóstico , Enfermedades Gastrointestinales/dietoterapia , Enfermedades Gastrointestinales/genética , Enfermedades Gastrointestinales/diagnóstico , Intolerancia a la Lactosa/genética , Intolerancia a la Lactosa/dietoterapia , Intolerancia a la Lactosa/diagnóstico , Enfermedad Crónica , Lactasa/genética , Lactasa/deficiencia , Lactasa/metabolismo , Anciano , Intolerancia Alimentaria/genética , Adulto Joven , Adolescente , FructosaRESUMEN
Electronic noses (eNoses) are electronic bionic olfactory systems that use sensor arrays to produce response patterns to different odors, thereby enabling the identification of various scents. Gastrointestinal diseases have a high incidence rate and occur in 9 out of 10 people in China. Gastrointestinal diseases are characterized by a long course of symptoms and are associated with treatment difficulties and recurrence. This review offers a comprehensive overview of volatile organic compounds, with a specific emphasis on those detected via the eNose system. Furthermore, this review describes the application of bionic eNose technology in the diagnosis and screening of gastrointestinal diseases based on recent local and international research progress and advancements. Moreover, the prospects of bionic eNose technology in the field of gastrointestinal disease diagnostics are discussed.
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Nariz Electrónica , Enfermedades Gastrointestinales , Compuestos Orgánicos Volátiles , Humanos , Enfermedades Gastrointestinales/diagnóstico , Compuestos Orgánicos Volátiles/análisisRESUMEN
Functional gastrointestinal disorders (FGIDs) are common in young adults, particularly women, who tend to develop multiple FGIDs over time. This study aimed to investigate the prevalence of multiple concurrent FGIDs among female university students and identify differences in dietary habits, academic stress, and quality of life (QOL) based on the number of concurrent FGIDs. This secondary analysis included data from 406 female participants, originally collected through an online survey from two universities in one city in Korea. The online survey was accessible only after participants were verified as students through their online community. Concurrent FGID was present in 25.8 percent (n = 16) of the participants with FGIDs (n = 62), with the most common being irritable bowel syndrome + functional dyspepsia overlap (43.8 percent, 7/16). Participants with multiple concurrent FGIDs consumed fewer grains and vegetables, while significantly more of them consumed instant food, fast food, milk, and tea/coffee. They experienced significantly higher academic stress and lower QOL than those without the disease. Female university students with concurrent FGIDs tend to have unhealthy dietary habits, and concurrent FGIDs negatively affect academic stress and QOL. Therefore, female university students should undergo early-stage screening for FGIDs, and a comprehensive program should address their dietary habits and stress-coping skills.
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Conducta Alimentaria , Enfermedades Gastrointestinales , Calidad de Vida , Estrés Psicológico , Estudiantes , Humanos , Femenino , Estudiantes/estadística & datos numéricos , Estudiantes/psicología , República de Corea/epidemiología , Universidades , Enfermedades Gastrointestinales/epidemiología , Adulto Joven , Prevalencia , Estrés Psicológico/epidemiología , Encuestas y Cuestionarios , Adulto , Síndrome del Colon Irritable/epidemiología , Síndrome del Colon Irritable/psicología , Estudios Transversales , Dispepsia/epidemiología , AdolescenteRESUMEN
Immune-mediated gastrointestinal (GI) diseases, including achalasia, celiac disease, and inflammatory bowel diseases, pose significant challenges in diagnosis and management due to their complex etiology and diverse clinical manifestations. While genetic predispositions and environmental factors have been extensively studied in the context of these conditions, the role of viral infections and virome dysbiosis remains a subject of growing interest. This review aims to elucidate the involvement of viral infections in the pathogenesis of immune-mediated GI diseases, focusing on achalasia and celiac disease, as well as the virome dysbiosis in IBD. Recent evidence suggests that viral pathogens, ranging from common respiratory viruses to enteroviruses and herpesviruses, may trigger or exacerbate achalasia and celiac disease by disrupting immune homeostasis in the GI tract. Furthermore, alterations in the microbiota and, specifically, in the virome composition and viral-host interactions have been implicated in perpetuating chronic intestinal inflammation in IBD. By synthesizing current knowledge on viral contributions to immune-mediated GI diseases, this review aims to provide insights into the complex interplay between viral infections, host genetics, and virome dysbiosis, shedding light on novel therapeutic strategies aimed at mitigating the burden of these debilitating conditions on patients' health and quality of life.
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Disbiosis , Virosis , Humanos , Disbiosis/inmunología , Virosis/inmunología , Virosis/complicaciones , Virosis/virología , Enfermedades Gastrointestinales/virología , Enfermedades Gastrointestinales/inmunología , Enfermedades Gastrointestinales/etiología , Enfermedades Inflamatorias del Intestino/inmunología , Enfermedades Inflamatorias del Intestino/virología , Animales , Microbioma Gastrointestinal/inmunología , Virus/inmunología , Virus/patogenicidad , Enfermedad Celíaca/virología , Enfermedad Celíaca/inmunología , ViromaRESUMEN
BACKGROUND: The delivery of safe drinking water has high public health relevance, as reflected in the Sustainable Development Goals (SDG6). Several precautionary actions have reduced the burden associated with infectious diseases in high-income countries; however, pollution in source waters, inadequate disinfection, and premise plumbing, along with an increased awareness that intrusion in the drinking water distribution system, represents risk factors for gastrointestinal illness linked to consume of drinking water. Sporadic cases of waterborne infections are expected to be underreported since a sick person is less likely to seek healthcare for a self-limiting gastrointestinal infection. Hence, knowledge on the true burden of waterborne diseases is scarce. The primary aim with the present study was to estimate the risk of gastrointestinal illness associated with drinking tap water in Norway. METHODS: We conducted a 12-month prospective cohort study where participants were recruited by telephone interview after invitation based on randomised selection. A start up e-survey were followed by 12 monthly SMS questionnaires to gather information on participants characteristics and drinking tap water (number of 0.2L glasses per day), incidence, duration and symptoms associated with gastrointestinal illness. Associations between the exposure of drinking tap water and the outcome of risk of acute gastrointestinal illness (AGI) were analysed with linear mixed effects models. Age, sex, education level and size of the drinking water supply were identified as potential confounders and included in the adjusted model. RESULTS: In total, 9,946 persons participated in this cohort study, accounting for 11.5% of all invited participants. According to the data per person and month (99,446 monthly submissions), AGI was reported for 5,508 person-months (5.5 per 100 person-months). Severe AGI was reported in 819 person-months (0.8 per 100 person-months). Our study estimates that 2-4% of AGI in Norway is attributable to drinking tap water. CONCLUSIONS: This is the largest cohort study in Norway estimating the burden of self-reported gastrointestinal infections linked to the amount of tap water drunk in Norway. The data indicate that waterborne AGI is not currently a burden in Norway, but the findings need to be used with caution. The importance of continued efforts and investments in the maintenance of drinking water supplies in Norway to address the low burden of sporadic waterborne cases and to prevent future outbreaks needs to be emphasised.
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Agua Potable , Enfermedades Gastrointestinales , Humanos , Noruega/epidemiología , Masculino , Femenino , Estudios Prospectivos , Adulto , Persona de Mediana Edad , Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/etiología , Adulto Joven , Anciano , Adolescente , Medición de Riesgo , Factores de Riesgo , Enfermedades Transmitidas por el Agua/epidemiología , Encuestas y Cuestionarios , Abastecimiento de AguaRESUMEN
Contenxt: The focus on gastrointestinal (GI) health has been increasing due to a growing awareness of its pivotal role in overall well-being. Current trends in addressing GI health aim to optimize gut-microbiome composition, understand the bidirectional communication between the gut and the brain, and use functional diagnostic testing to aid in diagnosis and guide treatments for GI disorders. Objective: The study intended to examine advances in microbiome research, including advancements in technology, and to investigate methods of noninvasive diagnostics, the importance of the gut-brain axis (GBA) and the oral cavity, the types of beneficial microorganisms, and the prevalence of functional GI disorders (FGIDs). Setting: The study took place at Biocidin Botanicals in Watsonville CA, USA. Results: Recent research has illuminated the critical role that gut health plays in human physiology and disease. Also, the oral cavity is emerging as a vital microbial reservoir affecting both GI and systemic health. Dietary patterns and lifestyle choices exert profound effects on the gut microbiota and host metabolism, emphasizing the importance of holistic approaches to GI care. FGIDs impose significant burdens on patients' quality of life and the healthcare systems. Integrating stress management strategies and supporting healthy lifestyle choices are essential for managing FGIDs effectively. Conclusions: Functional foods, prebiotics, probiotics, and postbiotics offer promising avenues for optimizing GI health and mitigating disease risk.
Asunto(s)
Enfermedades Gastrointestinales , Microbioma Gastrointestinal , Humanos , Enfermedades Gastrointestinales/terapia , Probióticos/uso terapéutico , Eje Cerebro-Intestino/fisiología , PrebióticosRESUMEN
Benign and malignant diseases of the upper gastrointestinal tract show gender-specific differences. The frequent gastroesophageal reflux disease is a prime example: men have an erosive reflux disease more often than women and are also younger at the time of onset. The rate of progression to a metaplastic Barrett's esophagus is also higher in men. In the case of achalasia, there are indications that surgical treatment by laparoscopic Heller's myotomy and semifundoplication 180° according to Dor leads to a markedly better improvement in the symptoms in women compared to men, although they showed a more pronounced dilation of the tubular esophagus. The female hormone status influences the localization and histopathology of adenocarcinoma of the esophagogastric junction and gastric carcinoma. Premenopausal and postmenopausal carcinomas differ significantly in women. In addition, high microsatellite instability (MSI high) is more frequent in women and is associated with a generally significantly better prognosis. The MSI high gastric carcinomas of women show better survival than MSI high carcinomas of men. The future inclusion of gender-specific aspects in studies of the upper gastrointestinal tract is desirable in order to generate adequate data and to enable differentiated treatment stratification in the future.
Asunto(s)
Esófago de Barrett , Humanos , Femenino , Masculino , Factores Sexuales , Esófago de Barrett/patología , Esófago de Barrett/diagnóstico , Esófago de Barrett/terapia , Reflujo Gastroesofágico/patología , Reflujo Gastroesofágico/diagnóstico , Neoplasias Gástricas/patología , Neoplasias Gástricas/genética , Neoplasias Gástricas/cirugía , Acalasia del Esófago/patología , Acalasia del Esófago/genética , Acalasia del Esófago/diagnóstico , Acalasia del Esófago/fisiopatología , Acalasia del Esófago/cirugía , Tracto Gastrointestinal Superior/patología , Enfermedades Gastrointestinales/patología , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/genética , Inestabilidad de Microsatélites , Adenocarcinoma/patología , Adenocarcinoma/genética , Adenocarcinoma/cirugíaRESUMEN
INTRODUCTION: Air pollution and transportation noise pollution has been linked to gastrointestinal (GI) diseases, but their relationship remains unclear. METHODS: We extracted the significantly modulated genes and CpG sites related to air pollution (PM2.5, PM10, and NOx) and transportation noise pollution (aircraft, railway, and traffic road noise) from previous published studies. Genome-wide methylation analysis and colocalization analysis with these CpG sites and GWAS data of GI diseases were performed to disentangle the relationship between pollution-related blood DNA methylation (DNAm) alterations and GI diseases risk. Summary-based Mendelian randomization (SMR) analysis assessed the impact of pollution-related genes on GI diseases risk across methylation, gene expression, and protein levels. Enrichment analysis investigated the implicated biological pathways and immune cell types. RESULTS: DNAm at cg00227781 [CD300A] (modulated by NOx exposure) and cg19215199 [ZMIZ1] (modulated by PM2.5 exposure) was significantly linked to increased noninfective enteritis and colitis risk, while cg08500171 [BAT2] (modulated by NOx exposure) is significantly associated with an increased gastroesophageal reflux disease (GERD) risk. Colocalization analysis provides strong evidence supporting a shared causal variant between these associations. Multi-omics levels SMR analysis revealed that pollution-modulated lower DNAm at 5 specific CpG sites were associated with increased expression of 4 genes (IL21R, EVPL, SYNGR1, and WDR46), subsequently increasing the risk of GERD, ulcerative colitis, and gastric ulcer. 7 circulating proteins coded by pollution-modulated genes were observed to be associated with 6 GI diseases risk. Enrichment analysis implicates immune and inflammatory responses, MAPK signaling, and telomere maintenance in these pollution-induced effects. CONCLUSION: We identified potential links between air and transportation noise pollution-related gene methylation, expression, and protein abundance with GI diseases risk, possibly revealing new therapeutic targets.