Iron deficiency anemia (IDA) is the most common extraintestinal complication encountered in patients with Inflammatory Bowel Disease (IBD), and it is more prevalent in pediatric patients compared to adults (Rogler and Vavricka). The inflammation and blood loss from the disease impacts both the absorption and storage of iron in the body (Rogler and Vavricka). With the intent of establishing a standard of care for IDA treatment in patients with IBD, we conducted a prospective study of 104 consecutive pediatric patients to assess the safety and efficacy of intravenous (IV) iron therapy compared to oral therapy and no treatment, as well as the effects of iron therapy on patient quality of life. Efficacy was assessed by comparing the change in hemoglobin levels in the interval between admission to outpatient follow-up. The average time to the first ambulatory follow-up was 29.08 days. 69 patients received IV iron therapy, 17 patients received oral iron supplementation, and 18 patients had no treatment. Treatment with IV iron resulted in a statistically significant increase in hemoglobin levels (2.00 g/dL ± 1.57 g/dL, as mean ± standard deviation) from admission to the first follow-up ambulatory appointment (p < .0001). Patients receiving IV iron therapy also experienced a significantly greater mean increase in hemoglobin levels than those treated with oral iron (p = .0084) or no treatment (p = .0018). Further, patients treated with IV iron experienced a significant increase in their quality of life at follow-up compared to admission as measured by the Impact-III questionnaire (p = .0179). Our study illustrates the importance of screening pediatric patients with IBD for IDA and suggests that IV iron treatment is safe and more effective in raising hematologic and iron measures than orally- administered alternative options.

The role of histamine in chronic gastrointestinal diseases has been increasingly recognized in humans, but the role of histamine in the canine gastrointestinal tract has not been thoroughly investigated. The presence and distribution of all 4 histamine receptors (H1, H2, H3, and H4) in the stomach, duodenum, ileum, jejunum, and colon of healthy dogs were evaluated with a commonly employed immunohistochemistry technique using antibodies predicted to cross react with canine histamine receptors. All 4 histamine receptors were identified in the canine gastrointestinal tract, and differed in location and density within sections of the canine gastrointestinal tract. Antibody specificity was evaluated with Western blot. With the establishment of a method to study histamine receptors in the canine gastrointestinal tract, additional research to evaluate histamine receptors in dogs is warranted to further understand the pathophysiology and treatment of chronic canine enteropathies.

No description available.

Introduction: Irritable bowel syndrome (IBS) is characterized by gastrointestinal (GI) symptoms, and as a consequence of dysregulated communication via the gut-brain axis, is highly comorbid with mental illnesses such as anxiety and depression. With no known cure, IBS patients must manage their symptoms through lifestyle factors. Physical activity is one such lifestyle factor that reduces GI symptoms and improves mental health; however, it remains unclear whether physical activity buffers against the acute worsening of IBS symptoms following a stressor. Method: To investigate this, we evaluated the stress reactivity and recovery of 9 IBS patients and 13 healthy controls following exposure to acute stress. We exposed participants to an electronic Trier Social Stress Test (e-TSST) and measured changes in psychological stress (state anxiety), physiological stress (sympathovagal balance, where higher LF/HF ratio indicates greater stress system activation), and GI symptom severity before, during and every 20 minutes for one hour after. Physical activity was measured using the Stanford Seven-Day Physical Activity Recall questionnaire and quantified as weekly energy expenditure. Results: IBS patients had higher state anxiety (p = .05), LF/HF ratio (p = .01) and GI symptom severity (p = .01) than healthy controls. Although the e-TSST did not exacerbate these group differences, higher state anxiety at baseline (p = .03) and higher LF/HF ratio in response to an acute stressor (p < .001) were associated with more severe GI symptoms within the first 20 minutes following the e-TSST. Importantly, IBS patients who were more physically active experienced less severe GI symptoms during that same timeframe (p = .03). Conclusion: Physical activity may be a promising lifestyle factor for lessening GI symptom severity in response to an acute stressor. / Thesis / Master of Science in Kinesiology

A hollow viscus injury is an uncommon but potentially dangerous intra-abdominal injury that can result from blunt abdominal trauma. It can be misdiagnosed in patient, particularly when the patient has other concerning findings. Also, diagnosis can be increasingly difficult in a patient with a pre-existing ventral hernia and chronic abdominal pain. In this case we present a 66-year-old women, with a history of a large ventral hernia and chronic abdominal pain, who presented to the emergency department after a motor vehicle crash (MVC). Patient denied abdominal tenderness at the time of presentation and the initial computed tomography (CT) did not demonstrate any abnormal findings within the abdomen. Patient later began experiencing increased abdominal pain and presented with a small bowel perforation within the hernia that required a bowel resection and hernia repair. A review of the literature reveals that not only are hollow viscus injuries rare but there appears to be few documented cases of viscus injuries occurring within a existing ventral hernia.

Norovirus Gastroenteritis Leading to Partial Small Bowel Obstruction David Berry DO, Arthur Cecchini DO, Koushik Sanku MD, Bhavesh Gajjar MD Berrydw@etsu.edu, Cecchini@etsu.edu, Sankuk@etsu.edu, Gajjarb@etsu.edu Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University BACKGROUND Acute gastroenteritis (AGE) is a common problem in both inpatient and outpatient settings. Most cases are viral in origin, with norovirus being the most cited. Typical symptoms include low-grade fever, chills, nausea, vomiting, and abdominal discomfort. The physical examination is usually unremarkable, but abdominal tenderness or signs of volume depletion may be present in severe disease. Most patients have spontaneous remission within a few days and do not require hospitalization or diagnostic evaluation. Laboratory evaluation is often helpful in severe disease, immunocompromised patients, or when bloody or mucoid diarrhea is present. Polymerase chain reaction (PCR) gastrointestinal multiplex testing is often the preferred evaluation as it has a high sensitivity, specificity, and turnaround time when compared to traditional stool studies of enzyme-immunoassay studies. Treatment is often supportive, but specific bacterial and parasitic pathogens should prompt treatment with antimicrobial therapy. CASE PRESENTATION This case presents a 47-year-old male with no known previous medical history or history of intraabdominal surgeries. He presented with four days of progressive nausea, vomiting, diarrhea, and abdominal discomfort. The physical examination revealed a distended and tender abdomen. The metabolic panel did not show any electrolyte derangements. Computed tomography with intravenous contrast revealed partial small bowel obstruction versus less likely ileus. Gastrointestinal pathogen PCR returned positive for norovirus. The patient was given intravenous fluid, nausea control, and pain control, his diet was advanced, and his symptoms subsequently resolved. We believe this case to be unusual, as most cases of viral gastroenteritis are uncomplicated, and this patient presented with radiographic evidence of ileus versus partial small bowel obstruction. PCR testing revealed positivity for norovirus. He had no previous abdominal surgeries or family history of early intestinal malignancies, and the symptoms spontaneously resolved with several days of conservative management, making another etiology much less likely. CONCLUSION AGE is a common diagnosis seen in the primary care clinic, and most patients have an uneventful recovery. However, suspicion of partial obstruction or intestinal ileus should arise when severe abdominal pain and prolonged vomiting are present.

Background: Irritable Bowel Syndrome (IBS) is a common disorder in which the main symptoms are abdominal pain or discomfort combined with diarrhoea and/or constipation. Personal petitionary prayer – asking God for help and support when facing problems in life – is among the most common forms of prayer and can be viewed as a coping strategy when managing health problems. Previous research on the effects of personal petitionary prayer has showed conflicting findings and there are indications that prayer can be associated with more problems when facing stressful somatic problems such as chronic pain in Swedish settings rather than the opposite and expected benefits from praying. The present master-thesis was informed by the coping theory by Lazarus and Folkman (1984) and a theoretical perspective of prayer as a religious coping strategy. Aims: The aim was to investigate associations between personal petitionary prayer as a coping strategy and IBS symptoms, quality of life and anxiety. A second aim was to investigate if use of prayer would change 10 weeks later and if IBS symptoms at baseline could predict prayer assessed 10 weeks later.   Methods: The data in this master-thesis were collected in association with a treatment trial on internet-delivered cognitive behaviour therapy for IBS (Ljótsson et al., 2010). Data were derived from all 85 self-selected participants who had been included in the treatment trial. The three-item self-report measure of prayer which is  part of  the Coping Strategies Questionnaire for pain was used. I also included data on self-report measures of IBS symptoms and IBS-related quality of life and anxiety, and finally a measure of symptoms of depression. The sample included were mainly women (85%), with some form of higher education (64%) and finally fairly young (Mean age 34.6 years). Data on prayer have not been published before. 10 week follow-up data were available for 37 participants.  Results: Statistically significant cross-sectional correlations were found between the prayer scale score and IBS-related quality of life (r =-.44, p&lt;.01) and with gastrointestinal symptom-specific anxiety (r=.42, p&lt;.01), which indicates that more use of prayer is associated with  lower quality of life and more anxiety symptoms. Regression analyses entering prayer in competition with the other variables as predictors showed that prayer was more consistently associated with IBS-related quality of life which also predicted prayer. Use of prayer did not change over the 10-week period and prayer at 10 weeks could not be predicted. Interpretation: In line with some previous research personal petitionary prayer can be associated with more rather than less problems with health. It is important to note that personal prayer is one form of prayer and that long term effects may show different results. Finally, the role of religious affiliation and cultural aspects need to be considered in future research.

Diet is a key factor in the development and progression of Inflammatory Bowel Disease (IBD). A variety of diets have been studied with IBD patients. This cross-sectional survey identified current healthcare practitioner views on different diets and their efficacy with IBD patients. Diets were rated on awareness, compliance, and contributors to success by participants (n = 181). Frequencies were conducted, and ANOVA with Duncan pairwise comparison or chi-square analysis were used to determine significant differences. Most participants (96%) and 98% of registered dietitians (RD) considered using diet to help treat IBD patients. RDs perceived the low fiber or low residue diet easiest for patient compliance (4.2 ± 1.0, P < .05), and the specific carbohydrate diet hardest for patient compliance (2.4 ± 1.4). Initial and follow up consultations with a RD significantly contributed to patient success across all diets, and greater involvement from the RD may solve issues with compliance.

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