Irritable bowel syndrome: more than abdominal pain and bowel habit abnormalities.

Background & Aims: Although irritable bowel syndrome (IBS) can be defined using few symptoms, principal symptoms alone may be inadequate in monitoring disorder severity. Secondary analysis of a published data set was performed to determine if more inclusive symptom measures would better reflect the burden of this disorder.

Methods: From a prospective naturalistic study of 213 patients meeting Rome II criteria, all the data were used from daily questionnaires recorded for 4 weeks, and repeated again after an interval of 4 weeks.

Recent advances in understanding depression in adults with diabetes.

The authors review the science linking depression with diabetes. Some recent heuristic research is identified that highlights progress in the field and is directing future research. Issues in the management of depression in diabetes are outlined, including interactions of depression and insulin resistance.

Gastric residual volume and aspiration in critically ill patients receiving gastric feedings.

Background: The helpfulness of bedside assessment of gastric residual volume in the prediction of aspiration has been questioned, as has the volume that signals increased risk of aspiration.

Objective: To describe the association between gastric residual volumes and aspiration of gastric contents.

Methods: In a prospective study of 206 critically ill patients receiving gastric tube feedings for 3 consecutive days, gastric residual volumes were measured with 60-mL syringes every 4 hours.

Development of esophageal peristalsis in preterm and term neonates.

Background & Aims: High-resolution manometry demonstrates a chain of 3 sequential pressure segments that represent esophageal peristalsis in children and adults. We performed high-resolution manometry in preterm and term neonates to determine the ontogenesis of esophageal motility with regard to this segmental architecture.

Methods: Sixteen preterm (gestational age 32.

Recent advances in understanding depression in adults with diabetes.

The authors review the science linking depression with diabetes. Some recent heuristic research is identified that highlights progress in the field and is directing future research. Issues in the management of depression in diabetes are outlined, including interactions of depression and insulin resistance.

Efficacy of sertraline in prevention of depression recurrence in older versus younger adults with diabetes.

Objective: Sertraline maintenance therapy effectively delays recurrence of major depressive disorder in adult diabetic patients when data are examined across all age-groups. A secondary analysis was performed to assess this effect in younger and older subsets of patients.

Research Design And Methods: Younger (aged <55 years, n = 85) and older (aged > or =55 years, n = 67) subsets were identified from a multicenter, double-blind, placebo-controlled, maintenance treatment trial of sertraline in diabetic participants who achieved depression recovery with open-label sertraline treatment.

Factors influencing glycemic control in type 2 diabetes during acute- and maintenance-phase treatment of major depressive disorder with bupropion.

Objective: Depression management in both short- and longer-term treatment studies has been associated with improvement in glycemic control. We used bupropion hydrochloride (Wellbutrin XL) to determine whether this improvement could be attributed to changes in anthropometrics or diabetes self-care.

Research Design And Methods: Ninety-three patients with type 2 diabetes and major depressive disorder (MDD) received bupropion hydrochloride in a two-phase, open-label treatment trial.

Predictors of premature antidepressant discontinuation in functional gastrointestinal disorders.

Objectives: To identify factors responsible for premature antidepressant discontinuation that would assist in designing management strategies for patients with functional gastrointestinal disorders. Antidepressants are being used increasingly to manage patients with functional gastrointestinal disorders; poor patient adherence to treatment regimens, particularly in the period shortly after antidepressant initiation, is common and interferes with success.

Methods: Clinical records were reviewed from 172 outpatients who attended a university-based practice and who had been prescribed antidepressants to manage their functional gastrointestinal symptoms.

Complications related to feeding tube placement.

Purpose Of Review: Blind placement of a feeding tube can result in serious complications. Given the widespread use of tube feedings, even a small percentage of such problems can affect a significant number of people. The purpose of this review is to describe recent reports of feeding tube placement problems and to examine possible solutions.

High somatic symptom burdens and functional gastrointestinal disorders.

Background & Aims: Unexplained, multi-system somatic symptoms and syndromes, the hallmark features of somatization, are prevalent in patients with functional gastrointestinal disorders (FGIDs). We studied outpatients attending a gastroenterology clinic to see whether current somatic symptom burdens (a somatization state measure) or number of prior functional diagnoses (a somatization trait measure) could predict the presence of an FGID over structural gastrointestinal disease, and whether the predictive value was dependent on comorbid depression or anxiety disorders.

Methods: Clinical data from 327 consecutive new referrals to an outpatient gastroenterology practice were reviewed, 187 with an FGID and 140 with a structural illness.

Tricyclic antidepressants for chronic vomiting in diabetic patients.

Chronic vomiting in diabetic patients often is unresponsive to prokinetic agents and poorly explained by delayed gastric emptying or neuropathy. This retrospective study examines clinical response to tricyclic antidepressants, a treatment of reported benefit in nondiabetic patients with unexplained vomiting syndromes. Outcomes were studied in 24 diabetic outpatients who had been treated with tricyclic antidepressants specifically for nausea and vomiting after an unsatisfactory response to prokinetic therapy.

Zonisamide or levetiracetam for adults with cyclic vomiting syndrome: a case series.

Background & Aims: Management of cyclic vomiting syndrome in adults is limited by the small number of effective medications for maintenance therapy. The clinical response to treatment with 2 newer antiepileptic drugs was evaluated retrospectively to see whether they might have a prophylactic role in this syndrome.

Methods: Outpatient records from 20 adult patients with cyclic vomiting syndrome attending a university-based practice were reviewed.

Endoscopic removal of the wireless pH monitoring capsule in patients with severe discomfort.

Background: Few patients have significant symptoms during wireless esophageal pH monitoring, and the capsule typically sloughs spontaneously. Severe discomfort during monitoring can occur that requires endoscopic dislodgement of the capsule.

Objective: To determine the frequency with which endoscopic capsule dislodgement is required and the outcomes of the intervention.

Esophageal motor disorders.

Refinements continue in the measurement, display, and interpretation of pressure events that serve as signatures of esophageal motor disorders, and esophageal manometry retains its position as the diagnostic gold standard. The focus of attention remains with achalasia, not because of pathophysiologic developments or changing prevalence, but in response to the growing interest in minimally invasive surgery and its success. Some controversy remains regarding the role of preoperative motility assessments in patients undergoing antireflux surgery, as peristaltic features do not solely predict outcome.

Depression, anxiety, and nonalcoholic steatohepatitis.

Objective: Nonalcoholic steatohepatitis (NASH) is a morbid liver disease with limited treatment. Depression and anxiety have been associated recently with insulin resistance and inflammatory states, factors that are relevant to the development of NASH. We hypothesized that depression and anxiety would be more prevalent in NASH patients and predict more severe histological findings on liver biopsy.

Functional abdominal pain syndrome.

Functional abdominal pain syndrome (FAPS) differs from the other functional bowel disorders; it is less common, symptoms largely are unrelated to food intake and defecation, and it has higher comorbidity with psychiatric disorders. The etiology and pathophysiology are incompletely understood. Because FAPS likely represents a heterogeneous group of disorders, peripheral neuropathic pain mechanisms, alterations in endogenous pain modulation systems, or both may be involved in any one patient.

Functional esophageal disorders.

Functional esophageal disorders represent processes accompanied by typical esophageal symptoms (heartburn, chest pain, dysphagia, globus) that are not explained by structural disorders, histopathology-based motor disturbances, or gastroesophageal reflux disease. Gastroesophageal reflux disease is the preferred diagnosis when reflux esophagitis or excessive esophageal acid exposure is present or when symptoms are closely related to acid reflux events or respond to antireflux therapy. A singular, well-defined pathogenetic mechanism is unavailable for any of these disorders; combinations of sensory and motor abnormalities involving both central and peripheral neural dysfunction have been invoked for some.

Sertraline for prevention of depression recurrence in diabetes mellitus: a randomized, double-blind, placebo-controlled trial.

Context: In patients with diabetes mellitus, depression is a prevalent and recurrent problem that adversely affects the medical prognosis.

Objective: To determine whether maintenance therapy with sertraline hydrochloride prevents recurrence of major depression in patients with diabetes.

Design: A randomized, double-blind, placebo-controlled, maintenance treatment trial.

Wireless pH monitoring in patients with non-cardiac chest pain.

Objectives: Gastroesophageal reflux disease (GERD) is an important cause of non-cardiac chest pain (NCCP), and its detection can require ambulatory pH monitoring. The purpose of this study was to determine the advantages of a wireless ambulatory pH monitoring system and 2 days of recording in diagnosing GERD in NCCP patients.

Methods: Results from ambulatory pH studies using the BRAVO capsule were reviewed from 62 subjects referred for evaluation of NCCP after non-diagnostic response to proton pump inhibitor therapy.

Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes, and risk factors.

Objectives: To describe the frequency of pepsin-positive tracheal secretions (a proxy for the aspiration of gastric contents), outcomes associated with aspiration (including a positive Clinical Pulmonary Infection Score [a proxy for pneumonia] and use of hospital resources), and risk factors associated with aspiration and pneumonia in a population of critically ill tube-fed patients.

Design: Prospective descriptive study conducted over a 2-yr period.

Setting: Five intensive care units in a university-affiliated medical center with level I trauma status.

Management of esophageal symptoms following fundoplication.

Laparoscopic antireflux surgery has emerged as a widely used and effective management option for the properly selected patient with gastroesophageal reflux disease. Poor symptomatic outcomes occur even in the best of hands, the most common being recurrent or persistent heartburn (or atypical symptoms) and dysphagia. When heartburn predominates, the initial management step is an anatomical and physiologic evaluation to determine whether acid reflux is controlled and if the postoperative neoanatomy is appropriate.

Verification of inefficacy of the glucose method in detecting aspiration associated with tube feedings.

While some authors believe that testing for glucose in suctioned tracheal secretions can be used to detect aspiration of glucose-containing formula, others disagree. Previous evaluative studies of the glucose method's efficacy have lacked adequate statistical power and a gold standard for aspiration. In this animal study, a gold standard for aspiration was used and possessed sufficient statistical power to address the glucose method's sensitivity and specificity.