Irritable bowel syndrome (IBS) är en av våra vanligaste funktionella tarmsjukdomar med en prevalens på ca 10% värden över. Diagnosen ställs utifrån ROME-kriterierna vilka är ett symptombaserat diagnostiskt verktyg samt uteslutande av andra allvarliga tillstånd. Vidare kan IBS delas in i undergrupper beroende på avföringens konsistens mätt utifrån The Bristol stool form scale (BSFS). Patologin bakom sjukdomen är idag inte helt klarlagd men flera faktorer och mekanismer tros spela in. Däribland finns visceral hypersensitivitet och avvikande uttryck av smärtreglerande signalsubstanser, rubbningar i den gastrointestinala mikrobiotan, genetik, ökad inflammation, defekt mucosabarriär med ökad permeabilitet, psykosociala faktorer och kost. Behandling är främst inriktad på symptomlindring och att utbilda patienten i att hantera sjukdomen genom att undvika triggande faktorer som kan förvärra symptom. Probiotika är levande icke-patogena mikroorganismer som används i behandlande syfte. Några av de mest studerade släkterna av bakterier som används vid behandling av IBS är Lactobacillus och Bifidobacterium. Detta arbete syftade till att analysera effekten av probiotika i form av en kombination med dessa två släkten som symptomlindrande behandling vid IBS. Detta gjordes genom litteratursökning på databasen PubMed där fem artiklar filtrerades fram utifrån satta kriterier. Resultatet visade att probiotika innehållande Lactobaciullus och Bifidobacteirum har potential att förändra den gastrointestinala mikrobiotan. Man kunde också se att en ökad nivå Bifidobacteriumkorrelerade med sänkt symptomgrad och lägre nivå inflammatoriska markörer. Studierna visade också på sänkt tarmpermeabilitet efter intag av probiotika. Den generella symptombilden och allvarlighetsgraden av sjukdomen förbättrades och även flera specifika symptom. Trots det kunde en entydig och signifikant förbättring av livskvalitén inte fastställas. Dosen probiotika som användes var mellan 5-10 miljarder colony forming units (CFU) i alla utom en studie. Denna undersökte en betydligt högre dos om 52 miljarder CFU men gav trots det inte bättre resultat än övriga studier. Studiepopulationen var sammantaget enhetlig i de olika studierna och speglade också den vanligaste patientgruppen. Slutsatsen var att probiotika innehållande släkterna Bifidobacterium och Lactobacillus kan förbättra allvarlighetsgraden av IBS och ge en generell och specifik symptomlindring. / Irritable bowel syndrome (IBS) is one of the most common functional bowel disorders without any detectable biochemical or structural changes with a prevalence of about 10 % worldwide. The diagnosis is based on the ROME-criteria which is a symptom based diagnostic tool and also exclusion of other severe diseases. Further on, IBS can be divided into different subgroups based on stool texture evaluated by the Bristol stool form scale (BSFS).  The pathology behind IBS is not fully understood but several factors and mechanisms are thought to be involved. Amongst those are hypersensitivity in the gut and divergent pain transmission, disturbance in gut microbiota, genetics, increased inflammation, defective mucosal barrier function with increased permeability, psychosocial factors and diet. Treatment is mainly used to alleviate symptoms so as to help the patients to manage the disease by education and by avoiding the triggering factors that may exacerbate the symptoms.  Probiotics are living non-pathogen microorganisms, meaning they are not harmful, used to treat or favor the host. Some of the most studied genera of bacteria, both in general and used as treatment of IBS, are Lactobacillus and Bifidobacterium. These bacteria are often referred to as lactic acid bacteria due to their ability to metabolize specific carbohydrates and produce lactic acid.  This study aimed to investigate the effect of probiotics consisting of these two genera on symptom relief for patients with IBS. It was achieved by carrying out a literature review in the PubMed database. Five articles were found based on set criteria.  The results showed that probiotics based on Lactobacillus and Bifidobacterium have potential to alter the gut microbiota and that levels of Bifidobacterium corresponding to level of symptoms and inflammatory markers. Also, the intestinal permeability was lowered by probiotics administration. The overall symptoms and severity were decreased as well as several specific symptoms. Despite that, a significant increase in quality of life was not observed.  The dose used was between 5-10 billion colony forming units (CFU) in all but one study. This study used a much higher dose of 52 billion CFU and did also last a longer period of time but did not get better results than the other studies. The study population was in general similar in all studies and did also reflect the most common patient group based on prevalence.  In conclusion, probiotics consisting of Lactobacillus and Bifidobacterium can be used to improve severity of IBS and to relieve general and specific symptoms.

Introduction Ehlers-Danlos syndrome (EDS), specifically the hypermobility type (hEDS), is associated with a variety of gastrointestinal (GI) conditions. This study aims to evaluate the prevalence of and factors associated with gut dysmotility in patients with hEDS. Methods This is a retrospective study of hEDS patients conducted at the Cleveland Clinic's Center for Personalized Genetic Healthcare between January 2007 and December 2017. Demographics, GI motility testing, endoscopic, and imaging data were extracted from the patients' charts. Results A total of 218 patients with hEDS were identified. Among them, 136 (62.3%) patients had at least one GI symptom at the time of EDS diagnosis. Motility testing was performed and reported in 42 (19.2%) patients. Out of them, five (11.9%) had esophageal dysmotility, 18 (42.8%) had gastroparesis, five (11.9%) had small bowel/colon altered transit time, and four (9.5%) had global dysmotility. In univariable analysis, patients with postural orthostatic tachycardia syndrome (POTS) [odds ratio (OR): 8.88, 95% CI: 3.69-24.9, p<0.0001], fibromyalgia (OR: 4.43, 95% CI: 2.04-10.1, p=0.0002), history of irritable bowel syndrome (OR: 5.01, 95% CI: 2.31-11.2, p<0.0001), and gastroesophageal reflux disease (OR: 3.33, 95% CI: 1.55-7.44, p=0.002) were more likely to be diagnosed with GI dysmotility. On multivariable analysis, only POTS (OR: 5.74, 95% CI: 2.25-16.7, p=0.0005) was significantly associated with an increased likelihood of GI dysmotility. Conclusions This study suggests that GI symptoms are relatively common among patients with hEDS. Of the patients tested for dysmotility, 76.2% were found to have some form of dysmotility. POTS was found to be an independent predictive factor for GI dysmotility.

Bakgrund: Postoperativ smärta och illamående så kallad postoperative nausea and vomiting (PONV) är bland de vanligaste postoperativa komplikationerna och är kopplat till fördröjd återhämtning med ökad komplikationsrisk. Individuella- och processrelaterade faktorer påverkar förekomst av postoperativ smärta och PONV. Tarmopererade patienter skattar jämförelsevis hög postoperativ smärta. Anestesisjuksköterskan har ett stort ansvar att tillgodose god smärtlindring och postoperativ omvårdnad. Syfte: Beskriva fördelning av postoperativ smärta, PONV, patientkaraktäristika i förhållande till kön hos tarmopererade patienter. Även att identifiera könsskillnader relaterat till postoperativ smärta och PONV samt samband mellan postoperativ smärta, PONV, patientkaraktäristika och processdata. Metod: En retrospektiv studie med kvantitativ ansats, patientdata från Svenskt Perioperativt Register (SPOR) användes. Patienter som genomgick operation på tunn- och tjocktarm (KVÅ-kod JF) på ett länssjukhus i Sverige åren 2019 och 2022 inkluderades, totalt 420 patienter. Data redovisades med deskriptiv och analytisk statistik. Resultat: Flera signifikanta samband påvisades; högre ålder korrelerade med lägre skattad postoperativ smärta och längre operationstid korrelerade med högre skattad postoperativ smärta. Patienter med generell anestesi utan tillägg av regional anestesi, elektiv operation och PONV skattade högre postoperativ smärta. Resultatet visade en signifikant könsskillnad, kvinnor drabbades i större utsträckning av PONV än män. Slutsats: Dessa samband och skillnader belyser att postoperativ smärta är komplext. Fler studier bör utföras i syfte att klargöra riskfaktorer för postoperativ smärta och PONV, och för att förstå underliggande mekanismer. Det är viktigt att vårdpersonal i ett tidigt skede förebygger, identifierar och behandlar postoperativ smärta och PONV utifrån patientens bakgrund och kända riskfaktorer. För att detta ska ske måste en individbaserad strategi utarbetas, för god behandling och återhämtning. / Background: Postoperative pain and postoperative nausea and vomiting (PONV) are among the most common postoperative complications and is associated with prolonged recovery. Individual and surgery-related predictors affect the prevalence of postoperative pain and PONV. Patients who underwent bowel surgery rated postoperative pain comparatively high. The anesthetic nurse has a responsibility in providing effective pain treatment and qualitative postoperative care. Purpose: To describe the distribution of postoperative pain, PONV, patient characteristics in relation to gender among patients undergoing bowel surgery. Also, to identify gender differences related to postoperative pain and PONV, but also correlations between postoperative pain, PONV, patient characteristics and surgery related factors. Methods: A retrospective register study with a quantitative approach, data from the Swedish Perioperative Registry (SPOR) were used. Patients included underwent bowel surgery in an operating ward at a county hospital in Sweden by 2019 or 2022, resulting in 420 patients. Data was performed with descriptive and analytic statistics. Findings: Findings demonstrated several significant correlations; higher age correlated with lower postoperative pain and longer duration of surgery correlated with higher postoperative pain. Patients with general anesthesia without complementary regional anesthesia, elective operation or PONV rated higher postoperative pain. Findings demonstrated a significant difference in gender, women tended to experience PONV more frequently than men. Conclusion: Findings illustrate the complexity of postoperative pain. More studies must be done to clarify risk factors for postoperative pain and PONV and understanding their underlying mechanisms. It’s essential that caregivers prevent, identify, and treat postoperative pain and PONV based on patient background and known risk factors. An individual-based strategy needs to be developed; to provide effective treatment and recovery.

In pediatric pelvic health, sensory processing is not often considered as a significant factor. The current gold standard for addressing bowel and bladder dysfunction is urotherapy and medication. Urotherapy encompasses education regarding the anatomy and function, behavior modifications including fluid intake, removing or managing bowel and bladder irritants, diet changes, timed or scheduled voids, toilet postures and avoidance of holding maneuvers, manual therapy, and biofeedback. These forms of treatment have shown a roughly 50% success rate six months to several years after treatment is concluded (Pijpers et al., 2010 and Noordhoff et al., 2018). While the previously mentioned treatment methods are often necessary and appropriate, they fail to consider the central role that sensory processing, sensory integration, and emotional regulation play in basic biological functions and homeostasis. This doctoral project involved the creation and piloting of the Sensory Modulation – Bowel and Bladder Questionnaire (SM-BBQ) questionnaire to help diagnose children who have bowel or bladder dysfunction due to sensory under-responsivity. Results demonstrated a strong positive correlation between children who leaked both urine and stool and demonstrated hypo-responsiveness on the Sensory Processing Measure -2 (SPM-2) and their SM-BBQ scores. Significant findings were also noted between the SPM-2 scale scores and scores on both the SM-BBQ. In contemplating how these findings fit with Ayres Sensory Integration theory, perception and threshold may be more relevant than responsivity, as most participants were noted to be hypo- and hyper- responsive to input. A larger scale follow-up study will need to be conducted to ensure that the SM-BBQ is a reliable and valid measure for identifying children with toileting dysfunction related to sensory perception and helping those families to find appropriate services. / 2025-05-08T00:00:00Z

BACKGROUND: Vitamin D deficiency and insufficiency are rising healthcare concerns in the United States (US) and worldwide. The latest data collected by the National Health and Nutrition Examination Surveys (NHANES) between 2002-2006 showed that approximately one third of Americans over one-year-old were vitamin D deficient (serum 25-hydroxy vitamin D (25-OHD) < 12 ng/mL) or insufficient (serum 25-OHD < 20 ng/mL) (Looker et al., 2011). Environmental exposures, acute or chronic disease, and genetics can exacerbate vitamin D deficiency. People with malabsorptive disorders such as Inflammatory Bowel Disease (IBD) are at an even greater risk of becoming vitamin D deficient. Pediatric patients with IBD are particularly vulnerable to the short and long-term effects of vitamin D deficiency, given the prominent role played by this agent on skeletal development. More recent data have demonstrated that vitamin D also plays an important role in maintaining and regulating the immune system. For this reason, investigators have been interested in a better understanding of the relationship between vitamin D and inflammation. Vitamin D may prove to be an important adjunct therapy for people suffering from IBD and other autoinflammatory diseases. OBJECTIVES: Many patients and medical providers understand the importance that vitamin D has in a growing child’s skeletal development. However, compliance with daily supplementation remains low. The design of this study allows patients to receive high-dose vitamin D supplementation during scheduled biologic infusions. The goal is to assess the safety and efficacy of high-dose interval vitamin D therapy. The secondary goal of this study will be to determine if optimal vitamin D levels impact the inflammation observed in the gastrointestinal (GI) tract of patients with IBD. METHODS: 60 patients with IBD, between 5-25 years of age, who received regularly scheduled infliximab or vedolizumab infusions, and had serum 25-OHD levels below 30 ng/mL were recruited for the study. These patients were screened for the exclusion criteria, including underlying liver or kidney disease. Enrolled participants were given eight high-dose oral vitamin D3 supplements during scheduled infliximab or vedolizumab infusions for 8-16 months. Serum 25-OHD levels, urine calcium and creatinine levels, and research blood samples were collected at baseline, midpoint, and final visits. Questionnaires were also dispensed to patients to measure quality of life (QoL). This data was collected and analyzed to assess the safety and efficacy of high-dose interval vitamin D supplementation in pediatric patients with IBD. RESULTS: The data from this study showed statistical significance in the change of serum-25OHD level from baseline to midpoint and final visits. The mean increase from baseline to midpoint was 15.71±10.1 ng/mL for the 30 participants who had completed 3 study doses (2,500 mCg or 5,000 mCg) (mean±95% CI). The mean increase from baseline to final visit was 18.1±11.67 ng/mL for the 19 participants who completed all 7 study doses (2,500 mCg or 5,000 mCg) (mean±95% CI). A single factor ANOVA test confirmed statistical significance with p < 0.0001. Urine calcium and creatinine levels did not have a statistically significant change from baseline to final visit for the 12 participants who had completed both samples. Lastly, IMPACT-III QoL scores were not significantly different from baseline. However, there was an overall increase in the mean scores in all 6 subcategories of the survey. As more participants complete the study, the statistical significance and the validity of results will likely be strengthened. CONCLUSION: High-dose interval vitamin D supplementation was a safe and effective way to achieve serum 25-OHD levels to an optimal range (i.e., 40-60 ng/mL) in pediatric patients and young adult patients with IBD. The data suggests that three doses of high-dose vitamin D may be sufficient to bring levels to an optimal and stable plateau. Patient compliance with supplementation was 100% in this study, because of provider-observed ingestion of vitamin D. Patients also noted that this was their preferred method of supplementation. The safety and efficacy results of this study serve as a framework for developing a more standard approach to vitamin D supplementation for our patients with IBD. Future studies may benefit from expanding this method of delivery to patients who have other inflammatory diseases that require both regular oral vitamin D therapy and in person visits for treatments (i.e., intravenous (IV) medication).

The use of computed tomography in patients with gastrointestinal disease is increasing. However, the triple-phase computed tomographic angiographic appearance of the canine small intestine and the effects that phase of contrast enhancement and plane of reconstruction have on the appearance of the small intestine have not been fully evaluated. The purposes of this study were to investigate these effects on the appearance of the small intestinal wall. The minimal and maximal small intestinal diameter, wall thickness, number of wall layers identified, and degree of mucosal enhancement were recorded. The plane of reconstruction did not have any significant effects on wall thickness, diameter, degree of mucosal enhancement, or number of wall layers identified. There was a positive association between body weight and intestinal diameter. The arterial phase demonstrated the greatest mucosal enhancement and number of wall layers identified. The transverse plane was subjectively the most useful for evaluation of the small intestines.

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.

Small bowel cancer (SBC) is the malignancy with the highest standardized incidence ratio in Lynch syndrome (LS) patients. Of all SBCs, about 50% are duodenal cancers (DCs), therefore being accessible by esophago-gastro-duodenoscopy (EGD) for surveillance. We asked whether early detection of DC is possible for LS patients undergoing surveillance by EGD and if surveillance should be limited to specific subgroups. Data for LS patients with DC were retrieved from the registry of the German Consortium for Familial Intestinal Cancer. Patients undergoing active surveillance by EGDs (surveillance group) were compared to those who did not (nonsurveillance group) regarding tumor stage at diagnosis. Union for International Cancer Control stages I-IIA were defined as early stage disease and IIB-IV as advanced stage disease. Statistical analysis was performed using Fisher's exact test. Among 2015 patients with pathogenic variants in any mismatch-repair-gene, 47 patients with 49 DCs were identified. In 10% of cases, patients were under 35 years at diagnosis; family and personal tumor history did not correlate with DC diagnosis. Pathogenic germline variants in MSH6, PMS2 or EPCAM were present in 10% of patients. Statistical analysis could be performed on 13 DC patients in the surveillance group and 14 in the nonsurveillance group. Early detection was possible for 71% of patients in the surveillance group and 29% of patients in the nonsurveillance group (P = .021). Early detection of DC by EGD in LS patients is feasible regardless of family history, mutational status and should start no later than 25 years of age.

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