Antonia Perelló

Pathogenic mechanisms of postinfectious functional gastrointestinal disorders: Results 3 years after gastroenteritis

Objective. Functional gastrointestinal disorders (FGID) may appear after acute gastroenteritis. The aim of this study was to evaluate the possible mechanisms (inflammation, visceral hypersensitivity, psychological and immunogenetic factors) related to the development of postinfectious (PI) FGID 3 years after a Salmonella outbreak. Material andmethods. Biopsies of the antrum, and right- and left colon from 16 PI-FGID patients, 8 PI control patients, and 18 healthy controls (H-controls) were processed for immunohistochemistry, cytokines, and mast-cell electron microscopy. DNA was typed for cytokine gene polymorphisms. Visceral sensitivity (satiety test and rectal barostat) and psychological factors (SCL-90 and vital events) were assessed. Results. The number of mast cells and T lymphocytes was similar among the groups in all locations. Mast cells within 5 µm of nerve fibers of both PI groups were increased compared to H-controls: (stomach: 5.6±1.2 versus 6.6±1.5 versus 2.5±1.1; right colon: 9.7±1.3 versus 8.0±1.3 versus 4.1±1.7; left colon: 8.9±0.9 versus 8.5±1.8 versus 2.2±2.0 per field) (p<0.05). No differences in the production of IL-1β, IL-1ra, IL-6, and IL-10 or in their genotypes were found. PI-FGID patients showed a lower pain threshold to rectal distention (29±2 versus 37± 2 mmHg; p<0.05). Scores for anxiety (0.63±0.11 versus 0.28±0.14) and somatization (1.01±0.15 versus 0.45±0.15) were higher in PI-FGID patients than in PI controls (p<0.05). The number of stressful life events was not significantly different between both PI groups. Conclusions. Three years after salmonellosis, PI-FGID patients showed no evidence of inflammation in the gastric or colonic mucosa, but visceral sensitivity and anxiety/somatization levels were increased. The close anatomical mast cell-nerve fibers relation does not seem to be related to the FGID but to the infection itself.

Prevalence of Functional Gastrointestinal Disorders in Women Who Report Domestic Violence to the Police

BACKGROUND & AIMS Retrospective studies found an association between past sexual, physical, or psychological abuse and functional gastrointestinal disorders (FGIDs). However, there are no studies evaluating such an association concurrently with the ongoing abuse. Our aim was to investigate the prevalence of the main FGIDs, functional dyspepsia and irritable bowel syndrome, in 70 women reporting a situation of domestic violence to the police and to evaluate the level of psychological distress and its relationship with the presence of FGID. METHODS Through an interview between a social worker and the woman reporting abuse, digestive symptoms, psychological status, and type of abuse were recorded. These data were matched against police records. Functional dyspepsia and irritable bowel syndrome were diagnosed according to Rome II criteria. RESULTS Seventy-one percent of the women had an FGID: 67% functional dyspepsia, 47% irritable bowel syndrome, and 43% both. In two thirds of the cases, FGID onset occurred simultaneously with or soon after abuse onset. Only 34% of the women had sought medical attention for FGID symptoms. No differences were found between women with or without FGID regarding age and type or duration of abuse; psychological distress tended to be more severe in the group of women with FGIDs. CONCLUSIONS Most women who suffer domestic violence (reported to the police) have functional dyspepsia and/or irritable bowel syndrome and also have elevated psychological distress. This has important implications, not only for comprehensive health care of women in a situation of abuse, but also for medical treatment of women with FGIDs.

A novel thymidine phosphorylase mutation in a Spanish MNGIE patient.

A 29-year-old Spanish man presented with chronic intestinal pseudo-obstruction, progressive external ophthalmoplegia, peripheral neuropathy, and diffuse leukoencephalopathy. This combination of clinical features is characteristic of mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). Genetic analysis revealed a novel 18-base pair (bp) duplication (5044-5061 dup) in exon 8 of the thymidine phosphorylase (TP) gene. The mutation is predicted to produce a 6 amino acid insertion in the alpha-beta-domain of the protein. This 18-bp insertion in the thymidine phosphorylase gene is the first duplication mutation identified in MNGIE.

Síndrome del intestino irritable y enfermedad inflamatoria intestinal: ¿alguna conexión?

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders and is that with the greatest socioeconomic impact worldwide. Diagnosis of IBS is based on clinical criteria that have been modified over time, the Rome II criteria being those that are currently followed. Some of the symptoms of IBS are similar to those in patients with inflammatory bowel disease (IBD), which can hamper or delay diagnosis. The use of inflammatory markers in stools (such as calprotectin) may help to distinguish between these two entities. A possible connection between IBS and IBD could be based on five points: (i) both disorders have similar symptoms; (ii) symptoms often overlap in the same patients; (iii) IBS and IBD have a common familial aggregation; (iv) some predisposing factors, such as a history of acute gastroenteritis, play a role in both disorders, and (v) importantly, signs of microinflammation are found in the bowels of patients with IBS. With regard to this latter point, an increase in inflammatory cells has been found in the intestinal mucosa of patients with IBS and, more specifically, mastocytes have been found to be increased in the jejunum and colon while CD3 and CD25 intraepithelial lymphocytes have be observed to be increased in the colon. Moreover, activated mastocytes are increased near to nerve endings in patients with IBS and this finding has been correlated with the intensity of both intestinal symptoms (abdominal pain) and psychological symptoms (depression and fatigue). A good model of microinflammation is post-infectious IBS, since the timing of the onset of the infectious process is known. In patients with post-infectious IBS, an increase in intraepithelial lymphocytes and enterochromaffin cells is initially found, which is reduced over time; consequently, although the symptoms of IBS persist, after 3 years no differences are detected in the number of inflammatory cells between IBS patients and controls. Among the various factors that can favor the development of IBS in these patients, two host-dependent mechanisms are most closely implicated in the physiopathology of IBS: polymorphism of the genes codifying pro- or anti-inflammatory cytokines and psychological factors such as anxiety, depression, somatization and neuroticism at the time of the acute infection. In view of all of the above, the similarities between IBS and IBD are probably more than mere coincidence and may reflect distinct manifestations of a broad spectrum of inflammation in the colon.

Calidad de vida en los pacientes con síndrome del intestino irritable

La prevalencia del síndrome del intestino irritable (SII) es muy elevada, lo que tiene una gran repercusión sanitaria, social y económica. El número de consultas médicas, de pruebas diagnósticas (en este caso no diagnósticas) y de prescripciones terapéuticas es muy grande, con el consiguiente gasto de recursos. Supone, además, una de las primeras causas de absentismo laboral. Por otra parte, si bien el SII no pone en riesgo la vida del paciente, sí condiciona de forma considerable su calidad. La prevalencia del SII oscila entre un 5 y un 20% dependiendo de la población estudiada y los criterios diagnósticos empleados1,2. Recientemente se ha publicado un estudio que utilizó un mismo cuestionario para valorar la prevalencia y diversos aspectos clínicos de este síndrome en 8 países europeos: Alemania, Italia, Francia, Bélgica, Países Bajos, Reino Unido, Suiza y España3. Las prevalencias totales fueron desde el 6,7 al 12%, siendo más altas en Reino Unido, Francia e Italia y más bajas en Países Bajos, Bélgica y España. En nuestro país la prevalencia global (agrupando a los sujetos diagnosticados formalmente y a los sujetos sin este diagnóstico) fue del 7,3%. Las personas con SII perdieron más días de trabajo por enfermedad (5,2 frente a 2,1 días). Más del 40% refería un impacto importante en sus actividades sociales (salir a comer, hacer viajes largos o acudir a lugares no conocidos). Un 36% de las personas con SII reconocía que éste afectaba a sus relaciones físicas o sexuales, y un 35% que afectaba a sus relaciones familiares. Desde hace mucho tiempo se ha dicho que sólo la tercera parte de los sujetos con SII buscan atención médica. Estos datos procedían de investigaciones en Estados Unidos4, pero datos obtenidos de la población española demuestran que en nuestro medio más de las dos terceras partes de personas con SII acuden al médico5. Los motivos por los que unas personas buscan asistencia sanitaria y otras no lo hacen no están del todo claros. Algunos estudios parecen indicar que la razón fundamental es la intensidad de las molestias, mientras que en otros son los factores psicosociales los determinantes. Otro de los factores que sin duda influyen en la decisión de consultar al médico es la facilidad de acceso y gratuidad del sistema sanitario en el que se encuentra el paciente. Así, en España el 58% de los sujetos con SII con estreñimiento y el 67% de los que presentan SII con diarrea buscan atención sanitaria6.

Helicobacter pylori infection does not protect against eosinophilic esophagitis: results from a large multicenter case-control study

OBJECTIVES: Rising trends in eosinophilic esophagitis (EoE) have been repeatedly linked to declining Helicobacter pylori (H. pylori) infection, mostly in retrospective studies. We aimed to prospectively evaluate this inverse association. METHODS: Prospective case‐control study conducted in 23 centers. Children and adults naïve to eradication therapy for H. pylori were included. Cases were EoE patients, whereas controls were defined by esophageal symptoms and <5 eos/HPF on esophageal biopsies. H. pylori status was diagnosed by non‐invasive (excluding serology) or invasive testing off proton pump inhibitor (PPI) therapy for 2 weeks. Atopy was defined by the presence of IgE‐mediated conditions diagnosed by an allergist. RESULTS: 808 individuals, including 404 cases and 404 controls (170 children) were enrolled. Overall H. pylori prevalence was 38% (45% children vs. 37% adults, p 0.009) and was not different between cases and controls (37% vs. 40%, p 0.3; odds ratio (OR) 0.97; 95% confidence interval (CI) 0.73‐1.30), neither in children (42% vs. 46%, p 0.1) nor in adults (36% vs. 38%, p 0.4). Atopy (OR 0.85; 95%CI 0.75‐0.98) and allergic rhinitis (OR 0.81; 95%CI 0.68‐0.98) showed a borderline inverse association with H. pylori infection in EoE patients. This trend was not confirmed for asthma or food allergy. CONCLUSIONS: H. pylori infection was not inversely associated with EoE, neither in children nor in adults. A borderline inverse association was confirmed for atopy and allergic rhinitis, but not asthma of food allergy. Our findings question a true protective role of H. pylori infection against allergic disorders, including EoE.