Insights on Obesity in Children and Adults: Individualizing Management.

For the management of obesity in childhood and adolescence, nonoperative approaches have limited efficacy, including community-based and behavioral interventions and pharmacotherapy approved for use in adults. Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy are efficacious in reducing weight, body mass index, and comorbidities in adolescents. Understanding the phenotype associated with obesity provides an opportunity to individualize patients' treatments directed at the brain-gut axis.

Job Stress and Heart Rate Variability: Findings From the ELSA-Brasil Cohort.

Objective: Evidence suggests that exposure to psychosocial stress at work can inhibit vagal tonus, influencing the capacity to respond to environmental stimuli. We investigated whether job strain and low control and high demand at work, as separate measures, are associated with a reduction in heart rate variability (HRV).

Methods: This is a cross-sectional study with 9658 active workers at the baseline (2008-2010) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Chronic Megacolon Presenting in Adolescents or Adults: Clinical Manifestations, Diagnosis, and Genetic Associations.

Objective: Chronic megacolon is rarely encountered in clinical practice beyond infancy or early childhood. Most cases are sporadic, and some are familial megacolon and present during adolescence or adulthood. There is a need for diagnostic criteria and identifying genetic variants reported in non-Hirschsprung's megacolon.

Gastric accommodation measurements by single photon emission computed tomography and two-dimensional scintigraphy in diabetic patients with upper gastrointestinal symptoms.

Objective: To compare estimates of gastric accommodation (GA) with single photon emission computed tomography (SPECT) to measurements based on intragastric meal distribution immediately post-meal ingestion (IMD ).

Methods: We evaluated 108 diabetics with upper gastrointestinal (UGI) symptoms who had undergone gastric emptying of solids (GE) by scintigraphy and GA measurements by SPECT. Immediately after ingestion of a Tc-labeled egg meal (time 0), we estimated IMD as radioactive counts or area of the proximal half of the stomach on two-dimensional images.

Factor Structure and Psychometric Properties of the Peritraumatic and Posttraumatic Emotions Questionnaires Among Active Duty Military Personnel With Posttraumatic Stress Disorder.

The Peritraumatic Emotions Questionnaire (Peri-TEQ) and Posttraumatic Emotions Questionnaire (Post-TEQ) are self-report measures of emotions experienced during and after a traumatic event, respectively. The factor structure and psychometric properties of the Peri- and Post-TEQ were investigated among 474 military personnel with posttraumatic stress disorder (PTSD) following deployment. Exploratory factor analysis and confirmatory factor analysis were conducted to test the factor structure of the scales.

Audit of the diagnosis of rectal evacuation disorders in chronic constipation.

Background: Balloon expulsion test (BET) and high-resolution anorectal manometry (HRM) are used in diagnosis of rectal evacuation disorders (REDs); their performance characteristics are suboptimal.

Methods: We audited records of 449 consecutive patients with chronic constipation (CC). We documented anal sphincter tone and contraction, puborectalis tenderness, and perineal descent on digital rectal exam (DRE); maximum resting and squeeze pressures, and rectoanal pressure gradient on HRM; weight or time to balloon expulsion; colonic transit, and area of rectal area on radiograph (RASF).

Gastrointestinal hormones and regulation of gastric emptying.

Purpose Of Review: This review examines the hormonal regulation of gastric emptying, a topic of increasing relevance, given the fact that medications that are analogs of some of these hormones or act as agonists at the hormonal receptors, are used in clinical practice for optimizing metabolic control in the treatment of type 2 diabetes and in obesity.

Recent Findings: The major effects on gastric emptying result from actions of incretins, particularly gastric inhibitory polypeptide, glucagon-like peptide-1, and peptide tyrosine-tyrosine, the duodenal and pancreatic hormones, motilin, glucagon, and amylin, and the gastric orexigenic hormones, ghrelin and motilin. All of these hormones delay gastric emptying, except for ghrelin and motilin which accelerate gastric emptying.

Characterization of Upper Gastrointestinal Symptoms, Gastric Motor Functions, and Associations in Patients with Diabetes at a Referral Center.

Objectives: Our aim was to characterize upper gastrointestinal (UGI) symptoms and associations in individuals with diabetes mellitus (DM) who had undergone evaluation of gastric emptying (GE) and accommodation (GA) at a referral center.

Methods: From the Mayo Clinic Rochester electronic medical records of adults with diabetes types 1 and 2 (DM1 and DM2) evaluated between January 1997 and December 2015, we extracted demographics, UGI symptoms, current medications, treatments for diabetes, GE solids by scintigraphy, GA by single photon emission computed tomography (SPECT), and diabetes complications. We compared subgroups with delayed (GE at 2 h <25% or GE at 4 h <75%), rapid (GE at 1 h > 35%), and normal GE, as well as reduced (<428 mL) and normal GA.

Malignancy and Meckel's diverticulum: A systematic literature review and 14-year experience at a tertiary referral center.

Background: Meckel's diverticulum is present in about 2% of the population. The literature reports 3.2% incidence of tumors within Meckel's diverticulum; the tumors are predominantly benign.

Sugar-Sweetened Soft Drinks and Fructose Consumption Are Associated with Hyperuricemia: Cross-Sectional Analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

The secular trend of hyperuricemia coincides with the substantial increase in the consumption of sugar-sweetened beverages. Our aim was to evaluate the association between the consumption of soft drinks, dietary fructose and unsweetened, non-processed fruit juices with hyperuricemia in a cross-sectional analysis of baseline data (2008⁻2010; = 7173) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The explanatory variables were the consumption of soft drinks, fruit juice, and fructose using a validated semi-quantitative food frequency questionnaire.

Combination Therapies for Obesity.

The objective of this review is to examine advances in the development of combination therapies for the treatment of obesity beyond diet or lifestyle interventions. Experimental combination pharmacotherapies include combinations of pramlintide and phentermine as well as amylin and bupropion-naltrexone. Incretin and pancreatic hormones generally inhibit upper gastrointestinal motor functions, and combinations showing efficacy in obesity are coadministration of glucagon-like peptide-1 (GLP-1) with glucagon, a unimolecular dual incretin of PEGylated GLP-1/GIP coagonist, the combination of GLP-1 and PYY, and, in proof of concept studies, combined infusions of GLP-1, peptide YY, and oxyntomodulin.

Analysis of Fecal Primary Bile Acids Detects Increased Stool Weight and Colonic Transit in Patients With Chronic Functional Diarrhea.

Background & Aims: Patients with bile acid diarrhea (BAD) are identified based on increased levels of BAs in fecal samples collected over a 48-hr period while on a 100-gram fat diet (48-hr BA), retention of Se-labeled homocholic acid taurine, or serum levels of C4 or FGF19. BAD increases fecal weight and colonic transit. We investigated whether results of tests for BAD associate with increased fecal weight and more rapid colonic transit over a 24- or 48-hr period in patients with irritable bowel syndrome with diarrhea (IBS-D).

Association between delayed gastric emptying and upper gastrointestinal symptoms: a systematic review and meta-analysis.

Background: The relationship between delayed gastric emptying and upper GI symptoms (UGI Sx) is controversial.

Objective: To assess association between gastric emptying and UGI Sx, independent of treatment.

Design: We performed a systematic review and meta-analysis of the literature from 2007 to 2017, review of references and additional papers identified by content expert.

Dietary Selenium Intake and Subclinical Hypothyroidism: A Cross-Sectional Analysis of the ELSA-Brasil Study.

Selenium (Se) participates in several enzymatic reactions necessary for regulating the homeostasis of thyroid hormones. We aimed to analyze the association between dietary Se intake and subclinical hypothyroidism. Baseline data from the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto-ELSA-Brasil) in Brazil were analyzed, with a final sample size of 14,283 employees of both sexes aged 35⁻74 years.

Fresh fruit consumption and risk of incident albuminuria among rural Chinese adults: A village-based prospective cohort study.

Background: Recent studies showed that increased fresh fruit consumption is significantly associated with lower risks of diabetes, hypertension, and cardiovascular disease (CVD); other studies suggested that albuminuria is associated with diabetes, hypertension, and CVD. Therefore, we hypothesized that lower fresh fruit consumption is associated with higher risk of incident albuminuria among Chinese adults in rural areas, where fresh fruit consumption level is very low and prevalence of albuminuria is high.

Methods: We tested the hypothesis in a village-based cohort study of 3574 participants aged ≥ 30 years from the Handan Eye Study conducted from 2006 to 2013.

Comparison of pH and motility of the small intestine of healthy subjects and patients with symptomatic constipation using the wireless motility capsule.

Gastrointestinal luminal pH shows a rise from the duodenum to the terminal ileum in healthy individuals. Our objectives were to compare the pH in the proximal small intestine (SI) (first 60 min of small intestinal transit) lumen of human volunteers and patients with symptomatic constipation; to quantify contractile pressure profiles of the proximal SI, and to assess the relationship between luminally-recorded contractile pressure and small intestinal transit times (SITT) of a non-disintegrating capsule that measures pH and pressure activity (wireless motility capsule). We used previously acquired records from 39 healthy subjects and 41 patients with symptomatic constipation.

Update on Bile Acid Malabsorption: Finally Ready for Prime Time?

Purpose Of Review: To provide an update on the prevalence, pathophysiology, disease associations, and treatment options for bile acid malabsorption (BAM).

Recent Findings: •Molecular mechanisms-BAs prevent water reabsorption and increase water secretion by intracellular mediators, increasing aquaporin channels and intracellular permeability. •Inflammatory bowel disease-new molecular mechanisms of BAM are identified in patients without ileal disease, including changes in expression of ileal BA transporter and nuclear receptors involved in BA homeostasis.

Guanylate cyclase-C as a therapeutic target in gastrointestinal disorders.

Functional gastrointestinal disorders (FGIDs) and IBDs are two of the most prevalent disorders of the GI tract and consume a significant proportion of healthcare resources. Recent studies have shown that membrane-bound guanylate cyclase-C (GC-C) receptors lining the GI tract may serve as novel therapeutic targets in the treatment of FGIDs and IBDs. GC-C receptor activation by its endogenous paracrine hormones uroguanylin and guanylin, and the resulting intracellular production of its downstream effector cyclic GMP, occurs in a pH-dependent manner and modulates key physiological functions.

Allelic variant in the glucagon-like peptide 1 receptor gene associated with greater effect of liraglutide and exenatide on gastric emptying: A pilot pharmacogenetics study.

Background: Weight loss in response to the long-acting GLP-1 receptor (GLP1R) analog, liraglutide, is correlated with delay in gastric-emptying (GE). The aim of this pilot study was to assess whether specific genetic variants in GLP1R or TCF7L2 are associated with delayed GE and weight loss in obese patients treated with liraglutide or the short-acting GLP-1 agonist, exenatide.

Methods: We evaluated in obese individuals the associations of genetic variations of GLP1R (rs6923761) and TCF7L2 (rs7903146) on GE T and weight from two trials that evaluated separately exenatide, 5 μg BID for 30 days, or liraglutide, 3 mg daily for 5 weeks.

Toward an effective peripheral visceral analgesic: responding to the national opioid crisis.

This minireiew summarizes recent new developments in visceral analgesics. This promising field is important, as a new approach to address abdominal pain with peripheral visceral analgesics is considered a key approach to addressing the current opioid crisis. Some of the novel compounds address peripheral pain mechanisms through modulation of opioid receptors via biased ligands, nociceptin/orphanin FQ opioid peptide (NOP) receptor, or dual action on NOP and μ-opioid receptor, buprenorphine and morphiceptin analogs.