Study Objective: To compare the rates and severity of hospital-acquired Clostridium difficile infection (CDI) among patients taking proton pump inhibitors (PPIs) versus those not taking PPIs. Design: Retrospective, single-center, cohort study. Setting: Tertiary community hospital with a teaching service. Patients: A total of 41,663 patients with CDI who were hospitalized between January 2013 and May 2014; of those, 17,471 patients (41.9%) had received at least one dose of a PPI (PPI group), and 24,192 patients (58.1%) had no PPI exposure (control group). Measurements and Main Results: A total of 348 patients had CDI during the study period, with 269 cases present on admission. Hospital-acquired CDI was defined as CDI diagnosis occurring on or after the third calendar day of admission. After excluding those patients with CDI on admission, 65 (0.38%) of 17,302 patients later developed CDI in the hospital in the PPI group compared with only 14 (0.058%) of 24,092 patients in the control group. Of these patients, 36 patients (0.21%) in the PPI group met the definition of severe CDI compared with 8 (0.03%) in the control group. This demonstrated an unadjusted relative risk (RR) of 6.46 (95% confidence interval [CI] 3.63–11.51, p<0.0001) of developing hospital-acquired CDI and an unadjusted RR of 6.27 (95% CI 2.91–13.48, p<0.0001) of developing severe CDI while taking a PPI. When evaluating only patients who developed severe-complicated CDI, there were 22 cases in the PPI group and 2 cases in the control group, demonstrating an unadjusted RR of 15.3 (95% CI 3.6–65.13, p=0.0002) of developing severe-complicated CDI. Confounding variables were similar between groups. Conclusion: PPI use was associated with an increase in both the rate and severity of hospital-acquired CDI.

Irritable bowel syndrome (IBS) is a functional bowel disorder with 6.5% worldwide prevalence that causes gas production, abdominal distension, and abdominal pain or discomfort. This systematic review describes efficacy of the Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols (FODMAP) diet (Low-FODMAP diet or LFD) to alleviate IBS symptoms using the PRISMA guidelines. Nine randomized controlled trials (RCT) and one non-RCT consecutive controlled study published between 2015 to 2019 were identified using PubMed and CENTRAL. Included studies involved adult IBS participants with symptoms of abdominal pain, constipation, and/or diarrhea. A total of 530 participants completed the interventions from the 10 studies included in the final systematic review with participants ranging from mean ages of 40.31±12.83 years. The LFD can be recommended to patients for its use with alleviating abdominal pain severity and quality of life; however, more research is needed to verify the efficacy of the LFD concerning stool frequency and consistency.

The parasitosis in the tropical countries like Ecuador, are found in the different population groups of all ages, sexes, social conditions, ethnic groups, especially in those without hygienic conditions, pertaining to different geographic zones and the prevalence varies in agreement with the ecology, the human factors and the social economic characteristics. The fecal contamination on land and water where an adequate disposition of excretes, the surrounding conditions, the deficient living conditions, the rural life, the absence of bathrooms, the custom to not use shoes and to have contact with the water. The deficiency of hygienic education, contamination of foods and human migration all favor intestinal parasites. The parasitic plague in Ecuador and especially in the province of Imbabura is not very well known, this is because of the little attention and economical means that are given to an investigation. This investigation clearly points out the different concepts, definitions, consequences, treatments and prophylaxis that the community should take into account. This investigative work was done in the rural area of the Imbabura province for the following ethnic groups: Indigenous, Black, and Mestizo, with children younger than five years old and it is directed to the health personnel, and students It is estimated that in the whole world more than 20 million people are infected by the "himenolepsis" parasite. The Intestinal parasite has a direct relation with the Nutritional state of any given country, as well as the basic services, like water, collection of trash, elimination of excretes, illiteracy, bad family hygiene habits, and a healthy environment. This is how 40 thousand children die of hunger in the world daily, the difference here is an American child eats 500 times more than third world child. The lack of interest by the governments both international and national in health Programs in rural zones, impedes a solution being found. 50% of investigations are dedicated to the advancements in military, which also influences the lack of water, 3 billion people in the world lack drinkable water. There are many forms of exposure to the parasite, including, ground (garbage or trash left on floor) or contaminated water, contaminated food, biting insects, domestic or wild animals which have the parasite, another person, and their clothes or bed sheets. The most common of these being contaminated water. There are many reasons these parasites are found in higher numbers in third world countries. The lack of healthiness in the rural population increases the intestinal parasite in children under five years old, the lack of knowledge by part of the mothers on the consequences of the intestinal parasites. Bad hygiene habits that the mothers have as well as the children under five years old in not washing their hands before eating and after using the restroom add to the rapid spread of the parasite. The nutritional state of the children greatly increases exposure, mostly concerning food preparation. The presence of intestinal parasites in the children under five years old does the same damage with no importance to age, race, or sex. The bad form in which excretes are eliminated in the town also contributes to parasite spreading. To fight against further parasite spreading it is advised that a program of investigation is applied with many disciplinary teams including: Doctors, Epidemists, Microbiologists, Anthropologist, Nutritionists, and nurses to study and help find solution for the well-being of the areas that most need it. To also help, it is advised that Nutritionists, Nurses, Doctors, and people who have direct knowledge of what is health, capacitate the leaders of the community and citizens on the basic hygiene norms, including preparation and manipulation of foods, consequences and ways to prevent parasites. This would help slow the rapid spread of parasites among youth as well as adults. Have meetings teaching proper use of bathrooms both private and public in rural areas, to avoid massive parasite contamination. It is important to teach families that they should treat the water before drinking it because water has a direct link with parasite spreading. Demand that government pay more attention to health issues in rural communities.

Crohns sjukdom är en kronisk inflammatorisk sjukdom som påverkar hela gastrointestinala kanalen, från mun ner till ändtarmen. Sjukdomen är progressiv och innefattar olika skov av symptom, som till exempel diarré, magont, rektalblödning, viktminskning, feber och trötthet. Den exakta patofysiologiska orsaken är ej klargjord, men tros bero på olika faktorer som till exempel genetiska faktorer, miljöfaktorer samt immunologiska faktorer. Det är känt att individer med inflammatorisk tarmsjukdom (IBD) uttrycker en större population av mastceller och eosinofiler i tarmsubmukosa, och kan orsaka diverse symptom. Histamin-4 receptorer är G-proteinkopplade receptorer som har en nyckelroll i att förmedla inflammatoriska svar, och spelar en roll i immuncellsmigration till inflammerade vävnader. Syftet med projektet är att studera uttrycket av histaminreceptorn H4 på eosinofiler och mastceller i inflammerad tarmvävnad från patienter med Crohns sjukdom. Det medverkade 16 patienter, varav 8 hade Crohns sjukdom, och 8 var friska kontrollpatienter som opererats för tarmcancer. Uttrycket av eosinofiler, mastceller och Histamin-4 receptorer studerades med hjälp av immunohistokemisk metod. Resultatet visar statistisk signifikanta skillnader mellan patient och kontrollgruppen när det kommer till eosinofiler och mastceller, med ett p-värde &lt;0,05. Det uppvisades ingen signifikant skillnad mellan grupperna när det kom till icke inmärkta celler som uttrycker histamin-4 receptorer, eosinofiler som uttrycker receptorn samt mastceller som uttrycker receptorn. Sammanfattningsvis finns det ett behov att studera detta område igen, med större urval, och möjligtvis förbättrade metoder för att komma fram till säkerställda slutsatser. / Crohn's disease (CD) is a chronic inflammatory disease that affects the entire gastrointestinal tract, from the mouth down to the rectum. The disease is progressive and involves flare-ups of symptoms such as diarrhea, abdominal pain, rectal bleeding, weight loss, fever, and fatigue. The exact pathophysiological cause is unclear but is believed to be related to various factors, including genetic, environmental, and immunological factors. It is known that individuals with inflammatory bowel disease (IBD) express a higher population of mast cells and eosinophils in the intestinal submucosa, which can cause diverse symptoms. Histamine-4 receptors are G-protein-coupled receptors that play a key role in mediating inflammatory responses and are involved in immune cell migration to inflamed tissues. The aim of the project is to study the expression of the histamine receptor H4 on eosinophil granulocytes and mast cells in inflamed intestinal tissue from patients with CD. Sixteen patients participated, including 8 with CD and 8 control patients who underwent surgery for colon cancer. The expression of eosinophils, mast cells, and histamine-4 receptors was studied using immunohistochemical methods. The results show statistically significant differences between the patient and control groups in terms of the number of eosinophils and mast cells, with a p-value &lt;0.05. There was no significant difference between the groups in terms of un-stained cells expressing histamine-4 receptors, eosinophils and/or mast cells expressing the receptor. In conclusion, there is a need to further study this area with larger sample sizes and possibly improved methods to arrive at conclusive findings.

INTRODUCTION: Inflammatory bowel disease (IBD) is a complex, chronic, autoimmune disease of the gastrointestinal tract. Reactive oxygen species (ROS), a product of active leukocytes, have been implicated in the pathogenesis of IBD. The ability to reliably measure ROS in blood, urine, and stool samples could represent a new approach to assessing disease activity and response to therapy in pediatric patients with IBD. OBJECTIVES: To assess the relationship between redox measurements and clinical disease activity in pediatric patients with IBD. METHODS: Biological specimens, including stool, urine, blood plasma, and intestinal aspirates, were collected from patients at Boston Children’s Hospital. Each sample’s oxidation-reduction potential was measured by two oxidation-reduction potential probes (an Arrowdox probe and a Mettler Toledo probe). Probes were directly immersed into the sample, returning a millivolt measurement of oxidation-reduction potential. Linear regression was performed to explore the relationship between patient-reported outcome measures (PROMs) and redox measurements of biological specimens. Patients were also stratified by disease severity, and ANOVA testing was performed to test for differences in oxidation-reduction potential observed in patients with remittent, mild, moderate, and severe disease activity. RESULTS: Redox values in stool, urine, plasma, and intestinal aspirate did not significantly correlate with PROMs or differ significantly among groups categorized by disease severity. CONCLUSIONS: Measurements of oxidation-reduction potential from stool, urine, plasma, and intestinal aspirate do not appear to be useful for assessing disease severity in pediatric patients with inflammatory bowel disease.

Non-alcoholic fatty liver disease (NAFLD) is a liver disorder linked to obesity that is rapidly increasing in incidence worldwide. It is a disorder that ranges in severity; from a benign condition of hepatic steatosis to a potentially deadly one resulting in cirrhosis and hepatocellular carcinoma. It is currently known that NAFLD is strongly associated with various aspects of metabolic syndrome: insulin resistance, elevated triglyceride levels, obesity, and type two diabetes mellitus. The multifactorial pathogenesis of NAFLD is still uncertain and closer attention is needed on the effect of one’s diet on NAFLD. In this study, we directly compare a westernized diet containing high levels of fat and fructose to a diet high in fat and containing cholate using mouse models in order to determine the role of each dietary factor in the incidence and severity of the different stages of NAFLD. We will evaluate the severity of hepatic steatosis and hepatocellular damage via hematoxylin and eosin (H&E) stained liver tissue and the severity of hepatic fibrosis via trichrome-stained liver tissue. Our hypothesis is that mice on the fructose-based diet are expected to have higher levels of hepatic steatosis and hepatocellular damage relative to mice on the cholate-based diet while mice on the cholate-based diet are expected to have higher levels of hepatic fibrosis relative to the fructose-based diet. The results of this study will aid in elucidating and strengthening the connection between one’s diet and the prevalence and severity of NAFLD.

Gastroesophageal reflux disease (GERD), or acid reflux, affects 6-9 million people in the United States. It is characterized by a reflux of gastric acid and bile salts from the stomach into the esophagus, causing injuries to the esophagus known as Barrett's esophagus (BE). BE is the main risk factor for the development of esophageal adenocarcinoma (EAC), a devastating cancer in the esophagus whose molecular roots remain poorly understood. In recent years, evidence points to the esophageal epithelium itself as responsible for causing and promoting inflammation upon injury by gastric reflux, namely via an increase in inflammatory cytokine secretion. This project was focused on a cytokine of interest, Activin A, which is known for its importance during embryogenesis and stem cell differentiation. It has recently been studied for its role in inflammation and tumor formation, but not in the case of esophageal diseases. Here, we demonstrate that Activin A signaling in esophageal epithelial cells is heavily upregulated shortly after exposure to bile salts and acid. We show evidence that this upregulation causes an increase in cell migration upon a reconstituted extracellular matrix. We also provide further evidence that bile and acid injury causes epithelial cells to secrete cytokines, which drive inflammation. We show that the upregulated Activin A secretion and signaling plays an important role in promoting this inflammatory state. Finally, we provide evidence that bile salts and acid exposure, as well as increased Activin A signaling, causes esophageal epithelial cells to upregulate stem cell and transdifferentiation markers, supporting the latest theories on the origin of Barrett' esophagus stem cells as well as paligenosis.

No description available.

Chronic refractory gastrointestinal (GI) motility disorders are a significant burden on the healthcare system, acting as a large public health issue with significant impact on the quality of life in both the pediatric and adult population. Control systems of gastrointestinal motility are complex and involve coordination of smooth muscle contraction and relaxation, which the autonomic nervous system is largely responsible for. Gaps in the diagnosis process, such as overlooking autonomic function, has left patients with diminished quality of life and limited treatment options. Many patients in the clinic have experienced injury within the spinal cord and we hypothesized that GI symptoms might be related to spinal injury causing disruption of sensory and/or motor nerves of the autonomic nervous system. Our objective became to better understand the specific location and nature of spinal injuries and GI symptoms, as completed through the development of a self-report questionnaire. Main findings suggest symptoms indicative of T3-T9 and T10-L2 spinal pathology. COVID-19 did not allow for in-clinic neuromodulation with autonomic assessments, resulting in experiments remotely assessing at-home neuromodulation treatment for GI symptoms with suspected spinal autonomic dysfunction. At-home neuromodulation was not suitable for many patients, but those who were able to manage it showed highly promising results. After years of suffering, transcutaneous electrical nerve stimulation alleviated symptoms, particularly postprandial abdominal pain, constipation, vomiting and nausea. I discuss what we learned to set us up for successful at-home treatment, and we will use all information to design randomized controlled trials to prove the benefit of TENS. The present work offers significant information on the relationship of thoracolumbar spinal pathology and complex GI symptoms, which is now used in the clinic in the diagnosis process of GI dysmotility. In addition, we have learned how to conduct at-home treatment using TENS, which allows us to execute future studies. / Thesis / Master of Science (MSc) / There are gaps in the diagnosis process of complex gastrointestinal (GI) dysmotility disorders, including lack of testing of autonomic function, leaving patients suffering with diminished quality of life with unsuccessful treatment attempts. As many patients also experience injury or conditions of the spine, I have hypothesized that GI symptoms may be related to spinal injury-induced dysfunction of the autonomic nervous system. Experimental models aim to understand the location and nature of spinal pathology with GI symptoms for future diagnoses, as well as potential treatment options such as neuromodulation. Findings of this thesis suggest symptoms indicative of particular thoracolumbar spinal pathology and promising results of transcutaneous electrical nerve stimulation (TENS) to alleviate GI symptoms, including T3-T9 and T10-L2 spinal pathology-related postprandial abdominal pain, constipation, nausea, and vomiting. This work offers information for the diagnostic process of GI dysmotility and the future design of clinical trials of neuromodulation therapies.

Bakgrund: Inflammatorisk tarmsjukdom (IBD) är en kronisk inflammation i mag – tarmkanalen. Den autoimmuna tarmsjukdomen kännetecknas främst av Crohns sjukdom (CD) och Ulcerös Kolit (UC). Sjukdomarna fortlöper i skov med många individuella symtom, behov och mediciner, omväxlande med remission (besvärsfria perioder). Syfte: Att beskriva personers upplevelser av att leva med inflammatorisk tarmsjukdom. Metod: Litteraturöversikt med kvalitativ design och ett induktivt förhållningssätt. Artikelsökningen utfördes i två databaser: Cinahl och Medline. Tretton vetenskapliga artiklar med kvalitativ design analyserades i fem steg utifrån Fribergs beskrivning av analysmodell och valdes till resultatet. Resultat: Resultatet redovisas med följande teman: Livsförändringar vid IBD diagnos, Påverkan på det sociala livet och Att hantera IBD. Personer med IBD upplever att sjukdomen påverkar deras liv i stor utsträckning. Den fysiska, psykiska och sociala hälsan förändras både negativt och positivt, men attityden gentemot sjukdomen är en del av acceptansen för att uppnå välbefinnande i livet. Slutsats: Personerna med IBD navigerar genom livet med begränsningar och bristande förståelse från omgivningen. Förbättringar inom vården är avgörande för att hjälpa personer med IBD att hantera livet som kroniskt sjuk. / Background: Inflammatory bowel disease (IBD) is a chronic inflammation of the gastrointestinal tract. The autoimmune intestinal disease is mainly characterized by Crohn´s disease (CD) and Ulcerative Colitis (UC). The diseases continue in relapses with individual symptoms, needs and medications, alternating with remission (periods without symptoms).  Aim: To describe people´s experiences of living with inflammatory bowel disease. Method: Literature review with a qualitative design and an inductive approach. The article searches were performed in two databases: Cinahl and Medline. Thirteen scientific articles with a qualitative design were analyzed in five steps based on Friberg´s description of the analysis model and were selected as the result.  Results: The results are presented with the following themes: Life changes at IBD diagnosis, Impact on social life and To handle IBD. People with IBD experience that the disease largely affects their lives. The physical, mental and social health changes both negatively and positively, but the attitude towards the disease is a part of the acceptance to achieve well – being in life.  Conclusion: People with IBD navigate through life with limitations and a lack of understanding from those around them. Improvements in health care are crucial to helping persons with IBD to cope with life as a chronically ill person.