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This article is from Gastroenterology and Hepatology From Bed to Bench , volume 6 . Abstract Aim: For the purpose of cost modeling, the semi-parametric single-index two-part model was utilized in the paper. Furthermore, as functional gastrointestinal diseases which are well-known as common causes of illness among the society people in terms of both the number of patients and prevalence in a specific time interval, this research estimated the average cost of functional gastrointestinal diseases. Background: Health care policy-makers seek for real and accurate estimations of society's future medical costs. However, data dealt with in hygienic studies have characteristics which make their analysis complicated; distribution of cost data is highly skewed since many patients pay great costs. In addition, medical costs of many persons are zero in a specific time interval. Indeed, medical costs data are often right skewed, including remarkable number of zeros, and may be distributed non-homogeneously. Patients and methods: In modeling these costs by the semi-parametric single-index two-part model, parameters were determined by method of least squares; a result of this method was compared with the results yielded from two-part parametric model. Results: Average costs of functional gastrointestinal diseases and their standard deviation in semi-parametric and parametric methods were yielded as $72.69±108.96 (R2=0.38) and $75.93±122.29 (R2=0.33) respectively. Conclusion: Based on R2 index, the semi-parametric model is recognized as the best model. Totally, the two-part parametric regression model is a simple and available model which can be easily interpreted; on the other hand, though the single-index two-part semi-parametric model cannot be easily interpreted, it has considerable flexibility. The study goals can be indeed used as the main factor for choosing one of these two models.

This document outlines the protocol for a scoping review conducted as part of a PhD programme researching factors of importance for management of children with functional gastrointestinal disorders in general practice.

This article is from Biopsychosocial Medicine , volume 8 . Abstract This article reviews the effectiveness of Kampo (traditional Japanese herbal medicine) in the treatment of functional gastrointestinal disorders, especially functional dyspepsia (FD) and irritable bowel syndrome (IBS). The results of four randomized, controlled trials (RCTs) suggested the usefulness of rikkunshito in relieving the subjective symptoms of patients with FD. Rikkunshito significantly improved not only gastric symptoms, such as epigastiric discomfort, but also extra-gastric symptoms, such as general fatigue, when compared with control drugs. The therapeutic effects of rikkunshito were more evident when it was prescribed to patients with “kyosho”, i.e., low energy. Two RCTs suggested the efficacy of keishikashakuyakuto for IBS.Basic research studies have demonstrated that these Kampo medicines have multiple sites of action to improve subjective symptoms. For example, rikkunshito improves gastric motility dysfunction, including impaired adaptive relaxation and delayed gastric emptying, gastric hypersensitivity, and anorexia via facilitation of ghrelin secretion. It also exhibits anti-stress effects, i.e., it attenuates stress-induced exacerbation of gastric sensation and anorexia, as well as the hypothalamic-pituitary-adrenocortical axis and sympathetic activation. Keishikashakuyakuto exhibited not only an antispasmodic effect on intestinal smooth muscle, but also antidepressant-like effects. Case series suggest that other Kampo prescriptions are also effective for FD and IBS. However, further studies are necessary to evaluate their efficacy.

This article is from Biopsychosocial Medicine , volume 8 . Abstract This article reviews the effectiveness of Kampo (traditional Japanese herbal medicine) in the treatment of functional gastrointestinal disorders, especially functional dyspepsia (FD) and irritable bowel syndrome (IBS). The results of four randomized, controlled trials (RCTs) suggested the usefulness of rikkunshito in relieving the subjective symptoms of patients with FD. Rikkunshito significantly improved not only gastric symptoms, such as epigastiric discomfort, but also extra-gastric symptoms, such as general fatigue, when compared with control drugs. The therapeutic effects of rikkunshito were more evident when it was prescribed to patients with “kyosho”, i.e., low energy. Two RCTs suggested the efficacy of keishikashakuyakuto for IBS.Basic research studies have demonstrated that these Kampo medicines have multiple sites of action to improve subjective symptoms. For example, rikkunshito improves gastric motility dysfunction, including impaired adaptive relaxation and delayed gastric emptying, gastric hypersensitivity, and anorexia via facilitation of ghrelin secretion. It also exhibits anti-stress effects, i.e., it attenuates stress-induced exacerbation of gastric sensation and anorexia, as well as the hypothalamic-pituitary-adrenocortical axis and sympathetic activation. Keishikashakuyakuto exhibited not only an antispasmodic effect on intestinal smooth muscle, but also antidepressant-like effects. Case series suggest that other Kampo prescriptions are also effective for FD and IBS. However, further studies are necessary to evaluate their efficacy.

Background Interoception describes the inner sense of the body, and relates to sensing, interpretation and regulation of internal signals. Investigation of interoception and subject beliefs has recently been tested with a new approach of cardiac interoception by Legrand et al. Aberrant interoceptive abilities are suggested to play a role in development and maintenance of functional somatic disorders (FSD). Studies on adults with specific types of FSD such as functional neurological disorder and fibromyalgia syndrome have found that these patients have lower or impaired cardiac interoception compared to healthy controls. In contrast, a study on patients with somatoform disorders found no evidence for differences in cardiac interoception for these patients compared to healthy controls. However, the research within functional gastrointestinal disorders (FGID) is sparse, and our knowledge about the role of interoception in children and adolescents with this subtype of FSD even more limited. Aim The primary aim of this project is to investigate if interoception is altered in children and adolescents with FGID compared to healthy controls, using a psychophysical measure of cardiac interoception, i.e. the heart rate discrimination (HRD) task.

Management of Functional Gastrointestinal Disorders in Children

Management of Functional Gastrointestinal Disorders in Children

Functional gastrointestinal disorders (FGID) affect children worldwide, with a prevalence of 21-25%.[1-5] The disorders cannot be explained by organic, biochemical, or other psychiatric causes[6, 7] and are best understood as a dysregulation of the brain-gut axis influenced by biological and psychosocial factors.[8, 9] The disorders cause recurrent and debilitating gastrointestinal symptoms affecting the children´s everyday life by significantly interfering with school-, social- and leisure life,[7, 10] often leading to psychological distress.[6, 11, 12] Parents must balance the needs of the child with FGID and any siblings,[13] they may struggle to understand and manage the child’s pain,[14] and the high absenteeism from school often requires parental sick leave,[15] affecting their work life, making it difficult to manage the household and family life as such.[14, 16, 17] Cognitive Behavioural Therapy (CBT) has been proven effective in reducing FGID symptoms.[18-20] Internet-based CBT (I-CBT) is gaining traction, and recent studies have found it superior compared to conventional treatment.[15, 21] Parental involvement in the treatment is crucial, as the parents' behaviour with regard to the FGID symptoms, affects the child´s symptom perception.[22-24] However, a more explorative approach is needed to fully understand parents' perspectives, the possible challenges of the treatment, and the effects on their everyday lives.[14, 25] This in-depth knowledge can be of importance to further refine the treatment and guide the later implementation of the I-CBT program in a Danish clinical context.

Jawarish Shahi: A special dosage form of herbal formulations for functional gastrointestinal disorders in Unani medicineA comprehensive review 

This article is from Journal of Neurogastroenterology and Motility , volume 17 . Abstract The importance of health-related quality of life (HRQOL) continues to grow, as clinicians and clinical researchers have recognized the impact of the functional gastrointestinal disorders. Limited information is available on the performance of HRQOL questionnaires in Asia. Furthermore, the effect across different cultural settings of functional gastrointestinal disorders on HRQOL has been little studied in Eastern countries. We summarized recent studies on HRQOL in Korean patients with functional gastrointestinal disorders as well as other Asian literatures. Functional gastrointestinal disorders-related symptoms had a great effect on the HRQOL of Korean patients. These results and their considerable prevalence in Korea indicate that functional gastrointestinal disorders have a substantial social impact in this country.

This article is from Journal of Neurogastroenterology and Motility , volume 19 . Abstract Background/Aims: A self-report questionnaire is frequently used to measure symptoms reliably and to distinguish patients with functional gastrointestinal disorders (FGIDs) from those with other conditions. We produced and validated a cross-cultural adaptation of the Rome III questionnaire for diagnosis of FGIDs in Korea. Methods: The Korean version of the Rome III (Rome III-K) questionnaire was developed through structural translational processes. Subsequently, reliability was measured by a test-retest procedure. Convergent validity was evaluated by comparing self-reported questionnaire data with the subsequent completion of the questionnaire by the physician based on an interview and with the clinical diagnosis. Concurrent validation using the validated Korean version of the Short Form-36 Health Survey (SF-36) was adopted to demonstrate discriminant validity. Results: A total of 306 subjects were studied. Test-retest reliability was good, with a median Cronbach's α value of 0.83 (range, 0.71-0.97). The degree of agreement between patient-administered and physician-administered questionnaires to diagnose FGIDs was excellent; the κ index was 0.949 for irritable bowel syndrome, 0.883 for functional dyspepsia and 0.927 for functional heartburn. The physician's clinical diagnosis of functional dyspepsia showed the most marked discrepancy with that based on the self-administered questionnaire. Almost all SF-36 domains were impaired in participants diagnosed with one of these FGIDs according to the Rome III-K. Conclusions: We developed the Rome III-K questionnaire though structural translational processes, and it revealed good test-retest reliability and satisfactory construct validity. These results suggest that this instrument will be useful for clinical and research assessments in the Korean population.

This article is from BMC Gastroenterology , volume 13 . Abstract Background: Gastrointestinal (GI) symptoms are common in patients with eating disorders. The aim of this study was to determine, using factor analysis, whether these GI symptom factors (clusters) in eating disorder patients hold true to the Rome II classification of functional gastrointestinal disorders (FGIDs). Methods: Inpatients in a specialised eating disorder unit completed the Rome II questionnaire. Data from 185 patients were analysed using factor analysis of 17 questions cited as present in 30% to 70% of the patients. Results: Five factors emerged accounting for 68% of the variance and these were termed: ‘oesophageal discomfort’, ‘bowel dysfunction’, ‘abdominal discomfort’, ‘pelvic floor dysfunction’, and ‘self-induced vomiting’. These factors are significantly related to the Rome II FGID categories of functional oesophageal, bowel and anorectal disorders, and to the specific FGIDs of IBS, functional abdominal bloating, functional constipation and pelvic floor dyssynergia. Both heartburn and chest pain were included in the oesophageal discomfort factor. The ‘pelvic floor dysfunction’ factor was distinct from functional constipation. Conclusions: The GI symptoms common in eating disorder patients very likely represent the same FGIDs that occur in non-ED patients. Symptoms of pelvic floor dysfunction in the absence of functional constipation, however, are prominent in eating disorder patients. Further investigation of the items comprising the ‘pelvic floor dysfunction’ factor in other patient populations may yield useful results.

This article is from BMC Gastroenterology , volume 13 . Abstract Background: Gastrointestinal (GI) symptoms are common in patients with eating disorders. The aim of this study was to determine, using factor analysis, whether these GI symptom factors (clusters) in eating disorder patients hold true to the Rome II classification of functional gastrointestinal disorders (FGIDs). Methods: Inpatients in a specialised eating disorder unit completed the Rome II questionnaire. Data from 185 patients were analysed using factor analysis of 17 questions cited as present in 30% to 70% of the patients. Results: Five factors emerged accounting for 68% of the variance and these were termed: ‘oesophageal discomfort’, ‘bowel dysfunction’, ‘abdominal discomfort’, ‘pelvic floor dysfunction’, and ‘self-induced vomiting’. These factors are significantly related to the Rome II FGID categories of functional oesophageal, bowel and anorectal disorders, and to the specific FGIDs of IBS, functional abdominal bloating, functional constipation and pelvic floor dyssynergia. Both heartburn and chest pain were included in the oesophageal discomfort factor. The ‘pelvic floor dysfunction’ factor was distinct from functional constipation. Conclusions: The GI symptoms common in eating disorder patients very likely represent the same FGIDs that occur in non-ED patients. Symptoms of pelvic floor dysfunction in the absence of functional constipation, however, are prominent in eating disorder patients. Further investigation of the items comprising the ‘pelvic floor dysfunction’ factor in other patient populations may yield useful results.

Functional gastrointestinal disorders (FGDs) are recognized sequelae of infectious gastroenteritis (IGE). Within the active duty military population, a group with kn own high IGE rates, the population based incidence, risk factors, and attributable burden of care referable to FGD after IGE are poorly defined.

Gulf War illness (GWI) is a chronic, multi-symptom disorder with no treatment. Exposure to anti-cholinergic drugs such as pyridostigmine bromide (PB) contributed to the development of GWI, but the mechanisms that connect the acute effects of PB with chronic dysfunction in multiple systems remain unclear. Gastrointestinal problems are frequent and debilitating chronic symptoms experienced by Gulf War veterans. The overall objective of this proposal is to understand how PB contributes to the development of functional gastrointestinal disorders in Gulf War illness. Given that the enteric nervous system (ENS) regulates gut functions, we hypothesize that that PB disrupts gut functions by creating persistent neuroinflammation within the ENS. The major activities in this reporting period include in vivo and in vitro studies to understand the acute effects of PB on the ENS, the neural control of gut functions, and the inflammatory response within the gut.

Gulf War illness (GWI) is a chronic, multi-symptom disorder with no treatment. Exposure to anti-cholinergic drugs such as pyridostigmine bromide (PB) contributed to the development of GWI, but the mechanisms that connect the acute effects of PB with chronic dysfunction in multiple systems remain unclear. Gastrointestinal problems are frequent and debilitating chronic symptoms experienced by Gulf War veterans. The overall objective of this proposal is to understand how PB contributes to the development of functional gastrointestinal disorders in Gulf War illness. Given that the enteric nervous system (ENS) regulates gut functions, we hypothesize that that PB disrupts gut functions by creating persistent neuroinflammation within the ENS. The major activities in this reporting period include in vivo and in vitro studies to understand the acute effects of PB on the ENS, the neural control of gut functions, and the inflammatory response within the gut.

This article is from Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association , volume 18 . Abstract Functional gastrointestinal disorders (FGIDs) are a group of conditions characterized by the dysfunction of the gastrointestinal (GI) tract. Although the specific pathogenesis of FGIDs is unclear, several theories have been proposed to explain the symptoms. Abnormal GI motility and visceral hypersensitivity have always been considered to be the main physiopathologic basis of FGIDs, and FGIDs related to psychomental disorders have also caused a major social concern. In recent years, a growing number of researches have proved that cytokines have a significant influence on GI motility, and the role of cytokines in FGIDs has aroused more and more attention. In this article, we discuss the interaction between immunoinflammation and FGIDs, and make an overview of current studies.

This article is from Journal of Neurogastroenterology and Motility , volume 17 . Abstract Background/Aims: Rome criteria classifying functional gastrointestinal disorder (FGID) were updated. The aims of this study were to assess the spectra of FGID and to evaluate the applicability of Rome III criteria in Korea. Methods: New patients who visited 2 primary clinics and 2 tertiary care hospitals were consecutively invited to complete questionnaires. These consisted of questionnaires for FGID based on Rome III criteria and symptom checklist-90-revised for somatization, depression and anxiety. Results: A total of 786 patients was participated. Among them, FGID was observed in 49.7%. In the patients with FGID, functional dyspepsia was most common (46.0%) followed by irritable bowel syndrome (IBS, 40.2%). Functional dyspepsia was most common both in the primary care clinics and tertiary care hospitals. Postprandial distress syndrome was the most common subtype and the frequency of epigastric pain syndrome was low. There were few responders for constipation as Bristol types 1 and 2 and for diarrhea as types 6 and 7 in subtype classification using the Bristol Stool Form Scale. Thereby, unspecified IBS defined by stool form was unexpectedly common in 43.9% of IBS, whereas unspedified IBS defined by Rome III definition was 5.1%. Patients with overlap FGIDs had higher score of anxiety, depression or somatization. Conclusions: FGIDs were common both in primary care clinics and tertiary care hospitals of Korea. Overlap FGIDs is still common by Rome III criteria, which may limits its wide application.