Abstract: The objectives of this study were to determine the clinical response to Enterra gastric electric stimulation (GES) in patients with refractory gastroparesis and to determine factors associated with a favorable response. Methods This study was conducted in patients undergoing Enterra GES for refractory gastroparesis. Symptoms were scored before and after GES implantation using the Gastroparesis Cardinal Symptom Index (GCSI) with additional questions about abdominal pain and global clinical response. Results During an 18-month period, 29 patients underwent GES implantation. Follow-up data were available for 28 patients, with average follow-up of 148 days. At follow-up, 14 of 28 patients felt improved, 8 remained the same, and 6 worsened. The overall GCSI significantly decreased with improvement in the nausea/vomiting subscore and the post-prandial subscore, but no improvement in the bloating subscore or abdominal pain. The decrease in GCSI was greater for diabetic patients than idiopathic patients. Patients with main symptom of nausea/vomiting had a greater improvement than patients with the main symptom of abdominal pain. Patients taking narcotic analgesics at the time of implant had a poorer response compared to patients who were not. Conclusions GES resulted in clinical improvement in 50% of patients with refractory gastroparesis. Three clinical parameters were associated with a favorable clinical response: (1) diabetic rather than idiopathic gastroparesis, (2) nausea/vomiting rather than abdominal pain as the primary symptom, and (3) independence from narcotic analgesics prior to stimulator implantation. Knowledge of these three factors may allow improved patient selection for GES.

Abstract: The aim of this study was to describe bowel problems, self-care practices, and information needs of patients who have recovered from the acute effects of sphincter-saving surgery for colorectal cancer. A retrospective, descriptive survey was conducted using a structured telephone interview and mailed questionnaires. The sample consisted of 101 patients who had undergone sphincter-saving surgery for colorectal cancer in the last 6 to 24 months. Most participants (71.3%) reported a change in bowel habits after surgery. The 6 most frequently reported gastrointestinal problems were incomplete evacuation (75.2%), excessive flatus (75.2%), urgency (73.3%), straining (61.4%), perianal soreness or itching (49.5%), and bloating (43.6%). Incontinence of feces (varying from smears to complete bowel action) was reported by 37.6% of participants. The most frequently reported information needs were related to diet (50.5%) and managing conditions such as diarrhea (31.7%), bloating/wind/gas (28.7%), pain (21.8%), and incomplete emptying of the bowel (18.8%). Patients who had recovered from the acute effects of sphincter-saving surgery for colorectal cancer reported a wide range of bowel problems and ongoing concerns about managing symptoms. Findings from this study provide valuable information to guide the development of educational resources to prevent or better manage bowel problems after surgery.

Abstract: Jejunoileal diverticulosis is a rare entity. Jejunoileal diverticulosis is not a disease that surgeons see often in clinical practice; however, it should remain on the differential diagnosis for any patient with an acute abdomen or gastrointestinal bleeding of unknown origin. It can present with a wide range of clinical scenarios and when patients experience chronic symptoms such as bloating, abdominal pain, nausea, bacterial overgrowth, or malabsorption, medical therapy is successful in most patients. However, when patients present with acute symptoms of bleeding, inflammation, perforation, or obstruction, surgical resection and primary anastomosis is often the treatment of choice. If patients are asymptomatic, they are better left alone, even when discovered incidentally in the operating room. In closing, the possibility of a patient having jejunal diverticular disease should be suspected whenever the symptoms of obscure abdominal pain, anemia, dilated jejunal loops on abdominal radiographs, a history of colonic diverticuli, and a history of acute appendicitis.

Abstract: Loperamide is an effective therapy for a variety of diarrheal syndromes, including acute, nonspecific (infectious) diarrhea; traveler's diarrhea; and chemotherapy-related and protease inhibitor?associated diarrhea. Loperamide is effective for the "gut-directed" symptom of diarrhea in patients with painless diarrhea or diarrhea-predominant irritable bowel syndrome. Loperamide and diphenoxylate are commonly used to treat diarrhea in numerous settings of inflammatory bowel disease. Loperamide has also been observed to increase anal sphincter tone, which may lead to improvement of fecal continence in patients with and without diarrhea. Loperamide is generally well tolerated at recommended nonprescription doses, with the most common side effects related to the impact on bowel motility (abdominal pain, distention, bloating, nausea, vomiting, and constipation).

Abstract: INTRODUCTION To assess the frequency and causative role of Giardia lamblia infection in children with recurrent abdominal pain in our setup. METHODS Prospective observational study of 239 children with recurrent abdominal pain was conducted at Department of Paediatrics, Postgraduate Medical institute, Hayatabad Medical Complex, Peshawar, from November 2004 to July 2006. Inclusion criteria was children from 4 to 14 years having recurrent abdominal pain defined as greater than three episodes of abdominal pain, in the last 3 months severe enough to affect the daily activities of the child. Fresh stool specimen was collected from each child for laboratory examination. Those with negative results had two other samples taken at different times. Positive cases were treated with metronidazole or tinidazole. Stool examination was repeated 1 week after the end of the treatment, followed by evaluation of complaints for the next 6 months. RESULTS Seventy-four (30.96%) children were positive for giardiasis. Thirty-eight were positive in their first sample, while 27 and 9 were in their second and third samples respectively. Giardia cysts were positive in 93% and trophozoite in 7%. Mean age of positive cases was 86+/-47 months. The mean duration of pain was 158+/-64 days, with 42% having pain for more than 6 months. Abdominal cramps, nausea and vomiting, abdominal distension, flatulence/bloating, anorexia and weight loss were the main clinical symptoms observed. Poor health hygiene, poor toilet training, overcrowding, and low socioeconomic status were observed risk factors. Stools were negative for giardiasis one week after the end of treatment. Only 76% children returned for follow-up and all were free of any complaints. CONCLUSION A significant proportion of children with recurrent abdominal pain were infected with Giardia lamblia and this study supports its potential role in recurrent abdominal pain in children.

Abstract: Summary Background Lactase deficiency is a common condition responsible for various abdominal symptoms. Lactose hydrogen breath test is currently the gold standard in diagnosing lactose intolerance. Aim To assess sensitivity and specificity of symptoms developed after oral lactose challenge. Methods Intensity of nausea, abdominal pain, borborygmi, bloating and diarrhoea was recorded every 15 min up to 3 h after ingestion of 50 g lactose in patients with positive (i.e. breath H2-concentration ≥20 p.p.m. above baseline) and negative lactose hydrogen breath test. Results Between July 1999 and December 2005, 1127 patients (72% females) underwent lactose hydrogen breath test. A positive result was found in 376 (33%). Sensitivity of individual symptoms ranged from 39% (diarrhoea) to 70% (bloating) while specificity ranged from 69% (bloating) to 90% (diarrhoea). A positive lactose hydrogen breath test was found in 21% of patients with one symptom, 40% of patients with two symptoms, 44% of patients with three symptoms, 67% of patients with four symptoms and 82% of patients with five symptoms. Symptom intensity was significantly higher for each symptom in the positive group. Conclusion Evaluating symptoms developed after ingestion of 50 g lactose can be used as a simple screening test to select patients who need to be referred for lactose intolerance testing.

Abstract: Gastroparesis presents with symptoms of gastric retention and nongastrointestinal manifestations, with objective evidence of delayed gastric emptying in the absence of mechanical obstruction. Diabetic, idiopathic, and postsurgical gastroparesis are the most common forms, although many other conditions are associated with symptomatic delayed gastric emptying (Table 1). Gastroparesis is estimated to affect up to 4% of the US population[1] and may produce either mild, intermittent symptoms of nausea, early satiety, and postprandial fullness with little impairment of daily function, or relentless vomiting with total disability and frequent hospitalizations. A recent report estimated that inpatient costs for patients with severe gastroparesis approach $7000/month.[2] Table 1 Etiologies of Gastroparesis Clinical Manifestations Gastroparesis presents with a constellation of symptoms. In one study, nausea was reported by 93% of patients whereas early satiety and vomiting were noted by 86% and 68%, respectively.[3] In another series, nausea, vomiting, bloating, and early satiety were reported by 92%, 84%, 75%, and 60% of patients, respectively.[4] Many patients in both case series (89% and 46%) also reported abdominal pain (Table 2). Others experience heartburn from acid reflux into the esophagus that is facilitated by fundic distention which increases the rate of transient lower esophageal sphincter relaxations.[5] Although some gastroparetics with frequent vomiting lose weight and develop malnutrition, most patients were overweight or obese in one series, indicating that the disorder does not necessarily restrict food intake.[6] Phytobezoars are organized concretions of indigestible food residue that are retained within the stomach. These may increase gastroparesis symptoms or produce a palpable epigastric mass, gastric ulceration, small intestinal obstruction, or gastric perforation.[7] Bezoars are eliminated by endoscopic disruption and lavage, enzymatic digestion (papain, cellulose, or N-acetylcysteine), and dietary exclusion of high-residue foods. Variably delayed gastric emptying may cause unpredictable food delivery in diabetics with gastroparesis, affecting glycemic control and increasing risks of both severe hypo- and hyperglycemia.[8] Table 2 Characteristics of Pain in 28 Gastroparesis Patients[3] Quantification of the severity and nature of gastroparesis symptoms has been facilitated by the introduction of validated surveys. The most widely used questionnaire for this purpose is the Gastroparesis Cardinal Symptom Index (GCSI), a symptom score validated in 7 university-based clinical practices in the United States that correlates well with patient and physician ratings of gastric symptom severity.[9] The GCSI comprises 3 subscales (postprandial fullness/early satiety, nausea/vomiting, and bloating) and represents a subset of the comprehensive Patient Assessment of Gastrointestinal Symptoms (PAGI-SYM) survey.[10] The Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life (PAGI-QOL) survey quantifies quality of life in dysmotility syndromes such as gastroparesis.[11] Using these questionnaires, investigators have begun to stratify patients with gastroparesis into different subgroups on the basis of symptom severity and predominant symptom profiles. Although these surveys currently are most useful for research trials, in the near future they may serve a clinical role similar to the Rome criteria for functional gastrointestinal disorders in terms of helping healthcare providers to select symptom-based management approaches.

Abstract: Background Persistent gastrointestinal (GI) symptoms after travel abroad may be common. It remains unclear how often subjects who developed new GI symptoms while abroad have persistent symptoms on return. The objective of this retrospective study was to evaluate the prevalence of persistent GI symptoms in a healthy cohort of travelers. Methods One hundred and eight consecutive patients, mostly returned missionaries, attending the University of Utah International Travel Clinic for any reason (but mostly GI symptoms) had data recorded about their bowel habits before, during, and after travel abroad. All subjects had standard hematological, biochemical, and microbiological tests to exclude known causes of their symptoms. Endoscopic procedures were performed when considered necessary by the treating physician. Diarrhea, constipation, irritable bowel syndrome (IBS), bloating, and dyspepsia were defined according to the Rome II Criteria. Results Eighty three (82% men and 18% women, median age 21 years) completed the survey with 68 subjects completing the questionnaire about bowel habits before and during travel. Among the respondents, 55 (82.1%) did not have any symptoms before travel. During travel, 41 (63%) developed new onset diarrhea; 6 (9%) developed constipation; 16 (24%) IBS, 29 (45%) bloating; and 11 (16%) dyspepsia. Of those who developed symptoms during travel, 27 (68%) had persistent diarrhea, 3 (50%) had persistent constipation, 10 (63%) had persistent IBS, 12 (43%) had persistent bloating and 8 (73%) had persistent dyspepsia. The presence of bowel symptoms during and after travel was not associated with age, gender, travel destination, or duration of travel. Conclusions: This study suggests that new onset of diarrhea, IBS, constipation, and dyspepsia are common among subjects traveling abroad. Gastrointestinal symptoms that develop during travel abroad usually persist on return.

Abstract: OBJECTIVES: This report is a preliminary comparative study of irritable bowel syndrome symptoms in eight countries, USA, Mexico, Canada, England, Italy, Israel, India, and China We also assessed global symptom patterns and correlations and relationships to several psychosocial variables METHODS: Two hundred and thirty-nine participants completed a bowel symptom scale composed of four symptoms, abdominal pain or discomfort, bloating, diarrhea, and constipation as well as two psychosocial questionnaires, quality of relationship and attribution of symptoms to physical or emotional factors RESULTS: Pain score in Italy, with the least urban population, was significantly higher than six of the seven other countries whereas it was lowest in India and England Bloating was highest in Italy and constipation was highest in Mexico, both significantly higher than five other countries Diarrhea was higher in China than five other countries All significance values were P<005 Globally, diarrhea was less common than constipation, P<0001 and bloating significantly correlated with constipation as well with pain, P<005 Composite analysis of psychosocial variables and symptoms indicated that family conflict correlated directly, P<005, whereas family support correlated indirectly, P<001, with pain and bloating Pain, bloating and diarrhea were significantly attributed to physical etiology, P<001, whereas only diarrhea was attributed to emotional cause, P<005 CONCLUSION: This study suggests that there are significant variations in irritable bowel syndrome symptoms in different geographic locations around the world Various hypotheses that may explain our data such as cultural beliefs, gut contamination, urban and rural location, dietary practice, and psychosocial factors should be further investigated

Abstract: Background The prevalence of gastrointestinal (Gl) symptoms is increased in diabetes, but their natural history is understood poorly and any impact of glycemic control is controversial. We aimed to quantify changes in Gl symptom status and glycemic control among a population sample of patients with diabetes. Methods Data on 10 chronic Gl symptom complexes were obtained from a validated questionnaire at baseline and after 12 months. Changes in acute and chronic glycemic control were classified as always adequate, variable (deteriorated or improved), or always inadequate; acute glycemic control was assessed by fasting plasma glucose and chronic glycemic control by a validated self-report 5-point graded scale. Results Baseline and follow-up data were available in 136 individuals with diabetes (mean age 59 years; 66% males; 95% type 2). The most prevalent Gl symptom complexes were abdominal bloating/distension (35%), ulcer-like dyspepsia (35%), and irritable bowel syndrome (27%). Overall, between 7 and 24% reported a change in Gl symptoms with the largest change in irritable bowel syndrome (24%), bloating/distension (22%), and ulcer-like dyspepsia (21%). Those who had a change in abdominal bloating (either loss or gain) over 12 months were more likely to have increased their mean fasting plasma glucose (P<0.05). Contrary to expectations, consistently poor self-reported glycemic control was only weakly associated with less persistent abdominal pain (r= -0.2, P=0.03), diarrhea (r= -0.22, P=0.01), and abdominal bloating (r= -0.2, P=0.03). Acute glycemic control was not significantly related to any Gl symptoms. Conclusion We were unable to demonstrate any association between worsening Gl symptoms and glycemic control.

Abstract: Functional bowel disorders (FBDs) are common disorders that are characterized by various combinations of abdominal pain and/or discomfort, bloating and changes in bowel habits At present, diagnosing FBDs often incurs considerable health-care costs, partly because unnecessary investigations are performed Patients are currently diagnosed as having an FBD on the basis of a combination of typical symptoms, normal physical examination and the absence of alarm features indicative of an organic gastrointestinal disease Basic laboratory investigations, such as a complete blood count, measurement of the erythrocyte sedimentation rate and serological tests for celiac disease, are useful in the initial evaluation No further investigations are needed for most patients who have typical symptoms and no alarm symptoms The most important alarm symptoms include signs of gastrointestinal bleeding, symptom onset above 50 years of age, a family history of colorectal cancer, documented weight loss and nocturnal symptoms The presence of alarm symptoms obviously does not exclude an FBD, but further investigation is needed before confirmation of the diagnosis For patients with predominant and severe diarrhea, a more thorough diagnostic work-up should normally be considered, including colonoscopy with colonic biopsies and a test for bile-acid malabsorption

Abstract: Ovarian cancer is usually diagnosed after it has spread and is difficult to cure. Most of attempts to identify early symptoms have lacked control group or have been based on interviews. We examined early symptoms of ovarian cancer in young women and compared with a matched control group. Symptoms recorded in medical files of 100 women aged 15-35 years with ovarian cancer who were referred to Vali-Asr hospital between 1995 and 2005. Symptoms of cases were compared with 100 matched controls during 2 years before diagnosis. More cases (95%) than controls (28%) complained of at least one symptom up to 2 years before diagnosis, most of these symptoms were abdominal. Others included urinary symptoms, infertility and abnormal vaginal bleeding. The most common symptoms among cases were: unusual abdominal or lower back pain 52%, unusual bloating, fullness and pressure in the abdomen 37%, gastro-intestinal problems 36%. In total, 11%, 3% and 12% of controls reported these symptoms respectively, resulting in odds ratios of 8.7, 18.9 and 4.1 respectively for these symptoms. Unusual abdominal or lower back pain, fullness and pressure, gastrointestinal, urinary problems and infertility should make women and physicians more aware of changes associated with ovarian cancer.

Abstract: Gastroparesis is a chronic disorder of gastric motility that is characterized by delayed emptying of either solids or liquids from the stomach in the absence of any mechanical obstruction. Nausea, vomiting, early satiety and bloating are some of the manifestations of gastroparesis. Idiopathic, diabetes mellitus and postsurgical states account for the majority of cases. Gastroparesis is a difficult condition to treat. Prokinetic drugs like metoclopramide and erythromycin form the mainstay of therapy but are less than ideal. Some patients may benefit from endoscopic botolinium toxin injection. Gastric electrical stimulation, though promising, is not ready for prime time yet.

Abstract: Defects of the mitochondrial genome (mtDNA) are increasingly recognized as common causes of neurologic syndromes.1 One of the most common pathogenic mtDNA mutations is the m.3243A>G in the MTTL1 gene. In addition to numerous neurologic features this mutation can also give rise to gastrointestinal symptoms including bloating, dysphagia, recurrent vomiting and anorexia, chronic diarrhea, and gastrointestinal pseudo-obstruction.2–4 To gain insight into the pathophysiology of gastrointestinal symptoms associated with the m.3243A>G mtDNA mutation, we investigated the degree of respiratory chain deficiency and the level of m.3243A>G mutation in individual areas from the gastrointestinal tract of two patients in whom gastrointestinal symptoms were both prominent and difficult to manage. ### Case report. Patient 1 developed many features of the mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS) syndrome including strokelike episodes, encephalopathy, myopathy, and lactic acidosis. In addition, she had a long history of digestive problems dating back to childhood. She had a small appetite even as a child and felt full even with small portions. During her teenage years constipation became more marked, as well as a feeling of bloating after even a small meal. In later life she developed severe constipation requiring regular enemas and laxatives. She died at age 32 years. Patient 2, who died at age 59 years, was the maternal aunt of Patient 1. She had a …

Abstract: Background: Tegaserod is increasingly prescribed by pediatric gastroenterologists even though there are few published data concerning its use in children. The aim of this study was to describe the authors' experience with tegaserod in children. Patients and Methods : Patients treated with tegaserod from 2004 through 2006 were included in this study. Defecation and fecal incontinence frequency and global assessment of relief of symptoms were assessed. Results: Seventy-two patients (44 girls) ranging in age from 1.1 to 18.3 years constitute the patient sample of this report. The median age was 10 years and the median follow-up after initiation of tegaserod treatment was 11.3 months (range 2.3-45.2 months). Indications to prescribe tegaserod were constipation (58%) and a variety of other conditions including functional dyspepsia or inflammatory bowel disease (42%). Defecation frequency increased after tegaserod use (1 vs 7/week, P <0.001) and presence of fecal incontinence decreased (47% vs 23%, P <0.001) in the constipation group. Parents rated relief of constipation as moderate or significant in 71% of cases in the constipation group. In the group with other indications to start tegaserod therapy, moderate or significant relief of abdominal pain and bloating was noted in 64% and 68% of patients, respectively. The median dose of tegaserod prescribed was 0.22 mg.kg(-1).day(-1) (range 0.05-0.87 mg.kg(-1).day(-1)). Adverse events were observed in 32% of the patients. The most common side effects were self-limiting diarrhea (20%) and abdominal pain (8%). Only one patient discontinued tegaserod because of side effects; this patient experienced pain at his cecostomy site. Conclusions: Tegaserod seems to relieve a variety of functional gastrointestinal symptoms in children. Further randomized controlled studies are needed to support the specific pediatric target of prescribing tegaserod

Abstract: Children’s diets contain increased amounts of sweeteners such as fructose. Fructose is present in fruit, honey and some vegetables, and fructose corn syrup is increasingly being consumed as a sweetener in various products including soda-pop.1 Unabsorbed fructose may be fermented in the colon and creates an osmotic load, drawing fluid into the gut lumen and is the basis for recommendations that toddlers with chronic non-specific diarrhoea reduce their intake of apple juice. The abdominal pain, bloating and alteration of bowel habits associated with dietary fructose intolerance are under-recognised in adult patients diagnosed with irritable bowel syndrome.2 3 However, the production of …

Abstract: Lactose malabsorption is a syndrome producing constellation of symptoms, including abdominal pain, bloating, flatulence, diarrhea, and sometimes nausea and/or vomiting. Primary causes of lactose malabsorption due to loss of intestinal lactase activity include genetic/racial lactase nonpersistence, congenital lactase deficiency, and developmental lactase deficiency. Secondary lactose malabsorption can be caused by any disorder that injures the small intestinal mucosa, such as viral gastroenteritis, celiac disease, allergic (eosinophilic) gastroenteritis, and radiation enteritis. The diagnosis depends on careful clinical evaluation and is customarily confirmed with a lactose breath hydrogen test. As the symptoms are nonspecific, many adults diagnosed with lactose malabsorption actually have irritable bowel syndrome. Treatment consists of a trial of eliminating lactose-containing dairy foods, with supplementation of alternative calcium and protein sources. Commercial enzyme products containing β-galactosidases can be prescribed to help patients digest dietary lactose. Long-term lactose restriction usually is not necessary and can lead to reduced bone mineral density.

Abstract: In 2007, Goldstein et al. sought to determine the economic burden attributed to the management of postoperative ileus (POI) associated with abdominal surgery in the U.S. Their study revealed an annual national hospital cost of $1.46 billion for both the index hospitalization and any readmissions within 30 days.1 POI is one of the expected complications of major abdominal surgery. It can occur with other procedures, including extra-peritoneal, gynecological, joint replacement, and cardiovascular surgeries,1,2 and it is the most common cause of delayed hospital discharge after abdominal surgery.2,3 POI is the impairment of gastrointestinal (GI) motility after intra-abdominal surgery or other non-abdominal procedures. It affects all segments of the GI tract and may last from five to six days or even longer, and it has the potential to delay GI recovery and hospital discharge until its resolution. POI is characterized by abdominal distention and bloating, nausea, vomiting, pain, accumulation of gas and fluids in the bowel, and delayed passage of flatus and defecation (Table 1). It is the result of a multifactorial process that includes inhibitory sympathetic input and the release of hormones, neurotransmitters, and other mediators (e.g., endogenous opioids). Table 1 Clinical Features and Consequences of Postoperative Ileus

Abstract: Irritable bowel syndrome (IBS) is a functional bowel disorder in which abdominal pain or discomfort is associated with a change in bowel habit, or with features of disordered defecation. Patients and doctors in primary care generally agree on IBS symptomatology and consider pain and bloating as its main features. Consultation behaviour is mainly driven by the severity of IBS symptomatology, rather than by its impact on quality of life or psychological distress. Irritable bowel syndrome is associated with a high prevalence of comorbidity. Before the diagnosis the comorbidity levels are comparable to the prevalence in a random sample of patients from primary care. Somatic comorbidity is a common feature in the year of IBS diagnosis and drops afterwards, while functional and psychiatric disorders remain prevalent. These patients might need targeted treatment approaches. The subjective measurement “adequate relief of abdominal pain and discomfort” is currently the best choice for the outcome assessment in IBS research. In addition, an integrated IBS symptom scale may be used as a secondary outcome measure, of which the IBS symptom severity scale (IBS SSS) is presently the best available instrument. Finally, the IBS quality of life score (IBS-QOL) is the preferred scale to asses changes in health-related quality of life. Based on recruitment analysis of this randomised controlled trial (RCT) we conclude that patients randomised in IBS research do differ from eligible IBS patients with respect to type and intensity of symptoms and disease history, which might influence the applicability of the trial results. Therapy with soluble and insoluble fibre confer distinct effects in IBS; long-term psylium (soluble fibre) is more effective than placebo in reducing IBS symptoms. In contrast, bran, an insoluble fibre, showed no favourable outcome compared to placebo. Psyllium seems the preferred treatment in IBS patients.

Abstract: Irritable bowel syndrome (IBS) is a chronic, highly prevalent gastrointestinal motility disorder characterized by abdominal discomfort/pain associated with altered bowel habits such as diarrhea or constipation or both. Current therapy for the constipation-predominant form (IBS-C) comprises fiber or osmotic or stimulant laxatives. However, these may exacerbate the condition or cause electrolyte disturbances. Lubiprostone is a novel selective chloride channel-2 activator that increases fluid secretion in the intestinal apical cell membrane, increasing gut motility and frequency of stool passage, and alleviating abdominal discomfort/pain. Lubiprostone has very low systemic bioavailability and cannot be quantitated in blood, but its active metabolite, M3, has been pharmacokinetically profiled. Lubiprostone reaches peak plasma concentrations within approximately 1 h and has a half-life of 0.9-1.4 h. Despite this short half-life, lubiprostone can be administered orally twice daily. Its efficacy in IBS-C has been demonstrated in two phase III studies; spontaneous bowel movement frequency increased and stool consistency improved, whereas straining, bloating and severity of constipation decreased. The beneficial effects continued for up to 4 weeks after cessation of lubiprostone. Lubiprostone was well tolerated in the long-term, with nausea and diarrhea being the commonest adverse events. Further studies are ongoing in opioid-induced bowel dysfunction.

Abstract: Celiac disease and lactose intolerance are both relatively frequent diseases with symptoms occurring after ingestion of certain food components In celiac disease wheat gluten and related proteins of other cereals induce an inflammatory disease of the small intestine in predisposed individuals, leading to gastrointestinal and extraintestinal symptoms Moreover, there is an association with many other diseases and besides classic symptoms (diarrhea, weight loss, malabsorption) atypical courses with less or lacking gastrointestinal symptoms exist The prevalence is about 1 : 100 (Europe, USA) and higher than supposed earlier Diagnostic criteria include serologic tests (tissue transglutaminase antibody, endomysial antibody) and characteristic small bowel histology (lymphocytic infiltration, villous atrophy) Therapy is a strict and lifelong gluten-free diet Rarely, refractory disease or lack of compliance are associated with increased risk of malignancy and worse prognosis Lactose intolerance is attributed to low intestinal lactase levels, due to reduced genetic expression or mucosal injury and consequent intolerance to dairy products The frequency is varying in different ethnic groups, occurring in 10-15% of Northern European people Intensity of clinical symptoms (diarrhea, abdominal pain, bloating) depends on the amount of ingested lactose and individual activity of intestinal lactase The capacity of lactose malabsorption can be measured using the noninvasive lactose breath hydrogen test The treatment is based on a reduced dietary lactose intake or in case of secondary form treatment of the underlying disease