Abstract: Our aim was to evaluate the response to intraluminal gas in irritable bowel syndrome and to determine whether this response was consequent upon disordered motility or altered perception. We evaluated 10 patients who satisfied the clinical criteria for the diagnosis of irritable bowel syndrome and 10 healthy controls. An eight-lumen perfused catheter assembly was positioned to monitor motor activity in the duodenum and proximal jejunum; a separate side port in the distal duodenum permitted gas infusion. Subjects recorded symptoms of abdominal pain, bloating, and nausea throughout the study, using a visual analog scale. Following an overnight fast and a 60-min basal recording period in the fasted state, subjects ate a standard meal; 60 min later, “sham” gas was administered for 20 min, followed by the actual infusion of nitrogen gas at 40 ml/min. Subjects were randomized to receive atropine (7 µg/kg) or placebo intravenously during the period of actual gas infusion. Patients with irritable bowel syndrome described more pain (score, mean±se, control versus irritable bowel: 0.22±0.16 vs 1.65±0.5,P<0.01) and nausea (0.25±0.21 vs 1.45±0.64,P<0.04) during sham gas; motility indices were similar in both groups. During active gas, irritable bowel syndrome patients reported more pain (0.40±0.39 vs 2.94±1.16,P<0.03); motility indices at all sites were similar in both groups. Symptom severity in irritable bowel syndrome subjects randomized to receive atropine was similar to control subjects during active gas infusion; motility indices were similar. We conclude that irritable bowel syndrome patients are more sensitive to intraluminal gas. This does not appear related to an exaggerated motor response, but may reflect heightened central perception.

Abstract: This study compared daily gastrointestinal symptoms and stool characteristics across two menstrual cycles, and recalled bowel symptoms and psychological distress in women with irritable bowel syndrome (IBS,N=22), IBS nonpatients (IBS-NP,N=22), and controls (N =25). Daily reports of abdominal pain, bloating, intestinal gas, constipation, and diarrhea did not differ significantly between the IBS and IBS-NP groups but both groups reported significantly higher symptoms than the control group. Stool consistencies was significantly looser in the IBS group relative to the control group. Menstrual cycle effects on symptoms were noted in all the groups. There were no significant differences in psychological distress between women with IBS, and IBS-NP, but both groups reported significantly higher global distress than the control group. The lack of difference between the IBS and IBS-NP groups in contrast to the results of others, can be understood in terms of differences in recruitment strategies.

Abstract: Our objectives were to evaluate children with recurrent abdominal pain for lactose maldigestion and to assess factors which might predict lactose absorption status. One hundred thirty-seven children were referred for specialty evaluation of recurrent abdominal pain of at least three months' duration. Study subjects were evaluated by history and physical examination, dietary interviews, hematologic and biochemical laboratory testing, stool parasite examination, and radiologic or endoscopic structural examinations, as indicated. Lactose hydrogen breath testing was performed after challenge with 1 g/kg lactose (10% aqueous solution). There were 53 males and 84 females, whose ages ranged from 6 to 18 years (9.64 ±2.9; mean±sd). Lactose maldigestion was detected in 33/137 patients (24%). The prevalence of abdominal pain, bloating, gas, flatulence, diarrhea, and constipation was similar in children with or without lactose maldigestion. The perception of symptoms related to the ingestion of dairy products was similar in both groups. No other clinical parameter predicted lactose maldigestion. However, children with lactose maldigestion had overall clinical improvement with a lactose-restricted diet. Clinical evaluation alone cannot adequately predict the presence of lactose maldigestion in children. Formal evaluation for lactose maldigestion using breath hydrogen testing methods should be considered in children with recurrent abdominal pain.

Abstract: Many physicians consider gallstones to be a cause of vague upper abdominal discomfort. However, both dyspepsia and gallstones are common conditions in the general population, and the relationship between the two has continued to generate controversy. In this editorial, I review the evidence for and against a relationship between gallstones and dyspepsia. The data suggest that upper abdominal discomfort, heartburn, bloating, and other vague symptoms are not related to gallstones and the routine ordering of an ultrasound in the patient with dyspepsia is not warranted.

Abstract: Gastrointestinal motor dysfunction, intestinal pseudo-obstruction syndromes, and hollow visceral neuropathy and myopathy were previously considered functional bowel diseases but are now recognized to be organic disorders They may alter the muscle of the intestinal wall or the nerves of the myenteric plexus, or both Their symptoms of chronic unexplained abdominal pain, abdominal distention and bloating, early satiety, nausea, vomiting, and alternating diarrhea and constipation are the most common and perhaps the most difficult problems encountered by gastroenterologists New intestinal recording devices assess motility and allow objective classification of neuromuscular disease, permitting accurate diagnosis and better treatment

Abstract: SummaryA structured questionnaire was employed to compare symptomatology between patients with newly diagnosed endometriosis and a control group. A number of symptoms, including constipation, diarrhoea, nocturnal micturition, bloating and lethargy, not classically associated with endometriosis, were more common in the cases than controls. This information may facilitate treatment of some patients by expiditing diagnostic laparoscopy.

Abstract: Background. Ingestion of a large dose of the milk sugar lactose — for example, the 50-g load in 1 liter of milk — causes symptoms such as abdominal pain, di- arrhea, bloating, and flatulence in the majority of people with lactose malabsorption. It is uncertain whether the in- gestion of more common doses of lactose, such as the amount in 240 ml (8 oz) of milk, causes symptoms. Some people insist that even smaller quantities of milk, such as the amount used with cereal or coffee, cause severe gas- trointestinal distress. Methods. In a randomized, double-blind, crossover trial, we evaluated gastrointestinal symptoms in 30 peo- ple (mean age, 29.4 years; range, 18 to 50) who report- ed severe lactose intolerance and said they consistently had symptoms after ingesting less than 240 ml of milk. The ability to digest lactose was assessed by measuring the subjects' end-alveolar hydrogen concentration after they ingested 15 g of lactose in 250 ml of water. Sub- jects then received either 240 ml of lactose-hydrolyzed milk containing 2 percent fat or 240 ml of milk containing 2 percent fat and sweetened with aspartame to approx- imate the taste of lactose-hydrolyzed milk; each type of milk was administered daily with breakfast for a one-week period. Using a standardized scale, subjects rated the occurrence and severity of bloating, abdominal pain, diarrhea, and flatus and recorded each passage of flatus. Results. Twenty-one participants were classified as having lactose malabsorption and nine as being able to absorb lactose. During the study periods, gastrointestinal symptoms were minimal (mean symptom-severity scores for bloating, abdominal pain, diarrhea, and flatus between 0.1 and 1.2 (1 indicated trivial symptoms; and 2, mild symptoms)). When the periods were compared, there were no statistically significant differences in the severity of these four gastrointestinal symptoms. For the lactose- malabsorption group, the mean ( � SEM) difference in ep- isodes of flatus per day was 2.5 � 1.1 (95 percent confi- dence interval, 0.2 to 4.8). Daily dietary records indicated a high degree of compliance, with no additional sources of lactose reported. Conclusions. People who identify themselves as se- verely lactose-intolerant may mistakenly attribute a vari- ety of abdominal symptoms to lactose intolerance. When lactose intake is limited to the equivalent of 240 ml of milk or less a day, symptoms are likely to be negligible and the use of lactose-digestive aids unnecessary. (N Engl J Med 1995;333:1-4.)

Abstract: Patients are often referred for evaluation of a wide range of GI complaints including dysphagia, abdominal pain, bloating, nausea, constipation or diarrhoea Many are diagnosed with 'functional' disease when endoscopy or conventional radiological studies fail to identify an anatomic cause for the patient's symptoms In such cases nuclear medicine offers non-invasive methods for objectively demonstrating disease involving different areas of the gastrointestinal tract Increasingly scintigraphy is playing a primary role in the evaluation of patients with suspected acute cholecystitis, active gastrointestinal bleeding, gastroparesis, and small and large bowel motility disorders In addition, it supplements other studies when results are inconclusive in diagnosing oesophageal dysmotility, gastro-oesophageal reflux, acalculous cholecystitis, and postoperative complications of gastrointestinal surgery

Abstract: The efficacy and safety of the peripheral kappa agonist fedotozine was evaluated in a double-blind, multicenter study involving 238 patients with the irritable bowel syndrome. After a two-week washout, patients were assigned to one of four groups to receive either placebo or fedotozine three times a day at doses of 3.5, 15, or 30 mg for six weeks. Patient assessment of mean symptom intensity indicated that the 30-mg dose of fedotozine was superior to placebo in relieving maximal daily abdominal pain (P=0.01), mean daily pain (P=0.007), and abdominal bloating (P=0.02). Changes in bowel function and defecation disorders could not be evaluated reliably. According to the investigators, the highest dose of fedotozine markedly reduced overall disease severity (P=0.003) and the pain component of the symptomatic profile (P=0.009). Clinical and laboratory safety was very good. Fedotozine 30 mg three times a day therefore appears to be effective and safe in the treatment of the abdominal pain and bloating associated with IBS.

Abstract: The effects of fundic mobilization in Nissen fundoplication on belching ability, abdominal gas volume, bloating and flatus were assessed in a prospective, randomized study of 25 patients with refractory gastro-oesophageal reflux disease. Reflux was cured regardless of fundic mobilization. Subjective ability to belch was restored to preoperative in 73% of the patients with fundic mobilization, compared to 50% without. About 10% in both groups totally lost their ability to belch. Disturbance from flatus increased postoperatively slightly in both groups, but from bloating it remained the same or even diminished. The residual intra-abdominal radioactivity (median (interquartile range)) after provoked belching was preoperatively 8.9% (4.4–12.0) with and 13.2% (6.8–15.2) without fundic mobilization, compared to 36.7% (31.1–40.9) of the controls (P < 0.05). After fundoplication this residual activity was normalized in both study groups. Disturbance from postoperative bloating or flatus were not related to the ab...