|
1
|
Piovani D, Armuzzi A, Bonovas S. Association of Depression With Incident Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis. Inflamm Bowel Dis 2024; 30:573-584. [PMID: 37300511 PMCID: PMC10988103 DOI: 10.1093/ibd/izad109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Individuals with a history of depression/depressive symptoms are suspected to be at increased risk of incident inflammatory bowel diseases (IBDs). METHODS We systematically searched MEDLINE/PubMed, Embase, and Scopus databases for longitudinal studies examining the association between depression/depressive symptoms and subsequent new-onset IBD (ie, Crohn's disease and ulcerative colitis). We included studies in which the exposure was a confirmed diagnosis of depression/depressive symptoms measured through a validated scale. To limit concerns of diagnostic bias and reverse causality, and support temporality between exposure and outcomes, we synthesized estimates corresponding to the longest time lag reported. Two authors extracted study data independently and assessed each study's risk of bias. Maximally adjusted relative risk (RR) estimates were synthesized using random- and fixed-effects models. RESULTS Of 5307 records, 13 studies (8 cohort and 5 nested case-control studies; 9 million individuals) fulfilled the eligibility criteria. Depression was significantly associated with incident Crohn's disease (RRrandom, 1.17; 95% confidence interval, 1.02-1.34; 7 studies, 17 676 cases) and ulcerative colitis (RRrandom, 1.21; 95% confidence interval, 1.10-1.33; 6 studies, 28 165 cases). The primary studies considered pertinent confounders. Several years, on average, separated exposure and outcomes. No evidence of important heterogeneity or publication bias was found. Summary estimates were at low risk of bias, and results were confirmed in multiple sensitivity analyses. No firm conclusions could be drawn regarding a dilution of the association over time. CONCLUSIONS Individuals with a history of depression may show small-to-moderate increased risk of IBD even when depression is diagnosed several years before new-onset IBD. Further epidemiological and mechanistic studies should clarify whether these associations are causal.
Collapse
Affiliation(s)
- Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Alessandro Armuzzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Italy
| |
Collapse
|
|
2
|
Chiou GJ, Huang DS, Hu FR, Yang CM, Yang CH, Huang CW, Lin JW, Lin CW, Ho TC, Hsieh YT, Lai TT, Chen HM, Chen PL, Hsiao CK, Chen TC. Metabolic Syndromes as Important Comorbidities in Patients of Inherited Retinal Degenerations: Experiences from the Nationwide Health Database and a Large Hospital-Based Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2065. [PMID: 33672521 PMCID: PMC7923804 DOI: 10.3390/ijerph18042065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 01/05/2023]
Abstract
This study aimed to evaluate the medical and socioeconomic impacts of IRDs using the nationwide health database and a large hospital-based cohort. This retrospective cross-sectional cohort study used data from the nationwide National Health Insurance Research Database (NHIRD). All patients with IRD from January 2012 to December 2016 were selected from the NHIRD and matched with the general population at a ratio of 1:4. All variables, including comorbidities, medications, service utilization, and medical costs, within 1 year from the date of the IRD diagnosis, were analyzed. Disability data were retrieved from the Taiwan Inherited retinal degeneration Project (TIP), a medical center-based database. A total of 4447 and 17,788 subjects from the nationwide database were included in the IRD and control groups, respectively. The Charlson comorbidity index score was higher in the IRD group (0.74:0.52, p < 0.001). Yearly visits to the ophthalmology clinic were more frequent in the IRD group (6.80:1.06, p < 0.001), particularly to tertiary medical centers (p < 0.001). The IRD group showed greater odds ratios (OR) for metabolic syndrome-related comorbidities, including hypertension (OR = 1.18, 95% confidence interval (CI) 1.10 to 1.26) and diabetes (OR = 1.32, 95% CI 1.21 to 1.45), and double the average yearly medical cost (2104.3 vs. 1084.6 USD, p < 0.001) and ten times the yearly ophthalmology cost (369.1 vs. 36.1 USD, p < 0.001). The average disability level was 54.17% for all subjects. This study revealed the large medical and socioeconomic impacts of IRD on not only patients with IRD, but also their family members and the whole society.
Collapse
Affiliation(s)
- Guann-Jye Chiou
- Department of Medical Education, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Ding-Siang Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (D.-S.H.); (F.-R.H.); (C.-M.Y.); (C.-H.Y.); (C.-W.H.); (C.-W.L.); (T.-C.H.); (Y.-T.H.); (T.-T.L.)
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (D.-S.H.); (F.-R.H.); (C.-M.Y.); (C.-H.Y.); (C.-W.H.); (C.-W.L.); (T.-C.H.); (Y.-T.H.); (T.-T.L.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (D.-S.H.); (F.-R.H.); (C.-M.Y.); (C.-H.Y.); (C.-W.H.); (C.-W.L.); (T.-C.H.); (Y.-T.H.); (T.-T.L.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (D.-S.H.); (F.-R.H.); (C.-M.Y.); (C.-H.Y.); (C.-W.H.); (C.-W.L.); (T.-C.H.); (Y.-T.H.); (T.-T.L.)
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Ching-Wen Huang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (D.-S.H.); (F.-R.H.); (C.-M.Y.); (C.-H.Y.); (C.-W.H.); (C.-W.L.); (T.-C.H.); (Y.-T.H.); (T.-T.L.)
| | - Jou-Wei Lin
- Cardiovascular Center, National Taiwan University Hospital (Yun-Lin Branch), Yunlin 632, Taiwan;
| | - Chao-Wen Lin
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (D.-S.H.); (F.-R.H.); (C.-M.Y.); (C.-H.Y.); (C.-W.H.); (C.-W.L.); (T.-C.H.); (Y.-T.H.); (T.-T.L.)
| | - Tzyy-Chang Ho
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (D.-S.H.); (F.-R.H.); (C.-M.Y.); (C.-H.Y.); (C.-W.H.); (C.-W.L.); (T.-C.H.); (Y.-T.H.); (T.-T.L.)
| | - Yi-Ting Hsieh
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (D.-S.H.); (F.-R.H.); (C.-M.Y.); (C.-H.Y.); (C.-W.H.); (C.-W.L.); (T.-C.H.); (Y.-T.H.); (T.-T.L.)
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (D.-S.H.); (F.-R.H.); (C.-M.Y.); (C.-H.Y.); (C.-W.H.); (C.-W.L.); (T.-C.H.); (Y.-T.H.); (T.-T.L.)
| | - Ho-Min Chen
- Health Data Research Center, National Taiwan University, Taipei 100, Taiwan;
| | - Pei-Lung Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan;
- Graduate Institute of Medical Genomics and Proteomics, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Medical Genetics, National Taiwan University Hospital, Taipei 100, Taiwan
| | - Chuhsing Kate Hsiao
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei 100, Taiwan;
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei 100, Taiwan; (D.-S.H.); (F.-R.H.); (C.-M.Y.); (C.-H.Y.); (C.-W.H.); (C.-W.L.); (T.-C.H.); (Y.-T.H.); (T.-T.L.)
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan;
| |
Collapse
|
|
3
|
Sarjan HN, Divyashree S, Yajurvedi HN. The protective effect of the Vacha rhizome extract on chronic stress-induced immunodeficiency in rat. PHARMACEUTICAL BIOLOGY 2017; 55:1358-1367. [PMID: 28303736 PMCID: PMC6130551 DOI: 10.1080/13880209.2017.1301495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/27/2017] [Accepted: 02/28/2017] [Indexed: 06/06/2023]
Abstract
CONTEXT Chronic stress is an inevitable factor in the modern day society which affects cell mediated as well as humoral immunity. There is a need to prevent stress effects with traditionally used herbs. OBJECTIVE The present study was undertaken to investigate the immunoprotective effect of Vacha (Acorus calamus L. Acoraceae) rhizome under stressful condition. MATERIALS AND METHODS Soxlet extraction of Vacha rhizome was performed with increasing polarity of solvents, i.e., petroleum ether to ethanol. The extract was concentrated by distilling off the solvent in flash evaporator and dried in desiccators. The benzene extract was found to have anti-stress property in our earlier studies and hence it was used in the present experiment. Extract was administered every day for 4 weeks orally to adult female rats prior to exposure to stress, restraint (1 h) and forced swimming exercise (15 min). RESULTS Vacha rhizome extract significantly prevented the stress induced reduction in total and differential leukocytes count, immunoglobulin content, bone marrow cellularity and viability, lymphocytes counts in lymphoid organs, islands of white pulp of spleen (ED50 = 10 mg, p < 0.001) and a significant increase in circulating immune complexes and apoptotic index of lymphoid organs (ED50 = 10 mg, p < 0.001) compared to controls. DISCUSSION AND CONCLUSION The present study clearly indicates that Vacha extract not only prevents stress-induced suppression of immunity and structural involution of lymphoid organs, but also boosts immunity in normal rats. Therefore, it is suggested that Vacha extract administration maintains normal immunity despite the body experiencing stress.
Collapse
Affiliation(s)
- H. N. Sarjan
- Department of Zoology, University of Mysore, Manasagangotri, Mysore, India
| | - S. Divyashree
- Department of Zoology, University of Mysore, Manasagangotri, Mysore, India
| | - H. N. Yajurvedi
- Department of Zoology, University of Mysore, Manasagangotri, Mysore, India
| |
Collapse
|
|
4
|
Wong CM, Tsang H, Lai HK, Thach TQ, Thomas GN, Chan KP, Lee SY, Ayres JG, Lam TH, Leung WK. STROBE-Long-Term Exposure to Ambient Fine Particulate Air Pollution and Hospitalization Due to Peptic Ulcers. Medicine (Baltimore) 2016; 95:e3543. [PMID: 27149464 PMCID: PMC4863781 DOI: 10.1097/md.0000000000003543] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Little is known about the effect of air pollution on the gastrointestinal (GI) system. We investigated the association between long-term exposures to outdoor fine particles (PM2.5) and hospitalization for peptic ulcer diseases (PUDs) in a large cohort of Hong Kong Chinese elderly.A total of 66,820 subjects aged ≥65 years who were enrolled in all 18 Government Elderly Health Service centers of Hong Kong participated in the study voluntarily between 1998 and 2001. They were prospectively followed up for more than 10 years. Annual mean exposures to PM2.5 at residence of individuals were estimated by satellite data through linkage with address details including floor level. All hospital admission records of the subjects up to December 31, 2010 were retrieved from the central database of Hospital Authority. We used Cox regression to estimate the hazard ratio (HR) for PUD hospitalization associated with PM2.5 exposure after adjustment for individual and ecological covariates.A total of 60,273 subjects had completed baseline information including medical, socio-demographic, lifestyle, and anthropometric data at recruitment. During the follow-up period, 1991 (3.3%) subjects had been hospitalized for PUD. The adjusted HR for PUD hospitalization per 10 μg/m of PM2.5 was 1.18 (95% confidence interval: 1.02-1.36, P = 0.02). Further analysis showed that the associations with PM2.5 were significant for gastric ulcers (HR 1.29; 1.09-1.53, P = 0.003) but not for duodenal ulcers (HR 0.98; 0.78 to 1.22, P = 0.81).Long-term exposures to PM2.5 were associated with PUD hospitalization in elder population. The mechanism underlying the PM2.5 in the development of gastric ulcers warrants further research.
Collapse
Affiliation(s)
- Chit-Ming Wong
- From the School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Faculty of Medicine Building, Pokfulam (CMW, HT, HKL, TQT, KPC, THL); Institute of Applied Health Research, The University of Birmingham, Edgbaston, Birmingham, UK (GNT, JGA); Department of Health, Wu Chung House, Wan Chai (SYL); and Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong (WKL)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
5
|
Kaur B, Kaur G. Amelioration of Helicobacter pylori-Induced PUD by Probiotic Lactic Acid Bacteria. PROBIOTICS, PREBIOTICS, AND SYNBIOTICS 2016:865-895. [DOI: 10.1016/b978-0-12-802189-7.00067-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
|
|
6
|
|
|
7
|
Ingle AM, Verma AK, Tiwari R, Karthik K, Chakraborty S, Deb R, Rajagunalan S, Rathore R, Dhama K. Immunomodulators in day to day life: a review. Pak J Biol Sci 2013; 16:826-843. [PMID: 24498836 DOI: 10.3923/pjbs.2013.826.843] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
There are ongoing trends of immunomodulation to combat a vast range of human and animal diseases including the incurable diseases like viral diseases, cancers, autoimmune diseases and inflammatory conditions. Animate as well as non-animate factors, surrounding us are interacting with our immune system. A balanced diet should contain all essential components from energy to vitamin and trace minerals. Each of these constituent has a very special effect on the immune system starting from their development to active role in immunity therefore, the outcome of their deficiency often ends in disease. Edible items which we consume like various vegetables, spices, herbs, fruits etc., are also equally responsible in manipulation of our system either in positive or negative way. Water has biggest share in our body and acts as the main medium to support the activities of the different system of body without exception of immune system. Proper environmental temperature is essential to maintain body's functions and experiments carried out regarding the effect of temperature suggest that extremes of the temperature are often cause immunosuppression directly by acting on the cells of immunity or indirectly through inducing stress and thereby increasing production of catecholamine which are potent anti-immune molecules. Various pathogenic as well as non-pathogenic bacteria cause immune suppression and immune potentiation, respectively. Proper exercise hold a prime position in the healthy life as it supports immunity and keeps disease away. The present review deals with all these immunomodulators having both positive and negative impact on the health status of an individual.
Collapse
Affiliation(s)
- Abhijeet M Ingle
- Division of Bacteriology and Mycology, Indian Veterinary Research Institute, Izatnagar, Bareilly (UP)-243122, India
| | - Amit Kumar Verma
- Department of Veterinary Epidemiology and Preventive Medicine, Uttar Pradesh Pandit Deen Dayal Upadhayay Pashu Chikitsa Vigyan Viswavidyalaya Evum Go-Anusandhan Sansthan, Mathura-281001, India
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, Uttar Pradesh Pandit Deen Dayal Upadhayay Pashu Chikitsa Vigyan Viswavidyalaya Evum Go-Anusandhan Sansthan, Mathura-281001, India
| | - K Karthik
- Division of Bacteriology and Mycology, Indian Veterinary Research Institute, Izatnagar, Bareilly (UP)-243122, India
| | - Sandip Chakraborty
- Deaprtment of Animal Resource Development, Pt. Nehru Complex, Agartala, Tripura-799001, India
| | - Rajib Deb
- Animal Genetics and Breeding, Project Directorate on Cattle, Indian Council of Agricultural Research, Grass Farm Road, Meerut, (UP)-250001, India
| | - S Rajagunalan
- Division of Veterinary Public Health, Indian Veterinary Research Institute, Izatnagar, Bareilly (UP)-243122, India
| | - Rajesh Rathore
- Division of Bacteriology and Mycology, Indian Veterinary Research Institute, Izatnagar, Bareilly (UP)-243122, India
| | - Kuldeep Dhama
- Division of Pathology, Indian Veterinary Research Institute, Izatnagar, Bareilly (UP)-243122, India
| |
Collapse
|
|
8
|
Associations between DSM-IV mental disorders and onset of self-reported peptic ulcer in the World Mental Health Surveys. J Psychosom Res 2013; 75:121-7. [PMID: 23915767 PMCID: PMC3737596 DOI: 10.1016/j.jpsychores.2013.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 04/24/2013] [Accepted: 04/28/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Recent research demonstrating concurrent associations between mental disorders and peptic ulcers has renewed interest in links between psychological factors and ulcers. However, little is known about associations between temporally prior mental disorders and subsequent ulcer onset. Nor has the potentially confounding role of childhood adversities been explored. The objective of this study was to examine associations between a wide range of temporally prior DSM-IV mental disorders and subsequent onset of ulcer, without and with adjustment for mental disorder comorbidity and childhood adversities. METHODS Face-to-face household surveys conducted in 19 countries (n=52,095; person years=2,096,486). The Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Peptic ulcer onset was assessed in the same interview by self-report of physician's diagnosis and year of diagnosis. Survival analyses estimated associations between first onset of mental disorders and subsequent ulcer onset. RESULTS After comorbidity and sociodemographic adjustment, depression, social phobia, specific phobia, post-traumatic stress disorder, intermittent explosive disorder, alcohol and drug abuse disorders were significantly associated with ulcer onset (ORs 1.3-1.6). Increasing number of lifetime mental disorders was associated with ulcer onset in a dose-response fashion. These associations were only slightly attenuated by adjustment for childhood adversities. CONCLUSIONS A wide range of mental disorders were linked with the self-report of subsequent peptic ulcer onset. These associations require confirmation in prospective designs, but are suggestive of a role for mental disorders in contributing to ulcer vulnerability, possibly through abnormalities in the physiological stress response associated with mental disorders.
Collapse
|
|
9
|
Peptic ulcers after the Great East Japan earthquake and tsunami: possible existence of psychosocial stress ulcers in humans. J Gastroenterol 2013; 48:483-90. [PMID: 23053423 DOI: 10.1007/s00535-012-0681-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/03/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Societal stress derived from an event that affects the whole society, e. g., a natural disaster, provides a unique, indirect way of determining the relationship between psychological stress and peptic ulcer disease in humans. In this study, we investigated the changing patterns of the incidence of peptic ulcers before and after the Great East Japan earthquake, which occurred on 11 March, 2011. METHODS Clinical data of patients with peptic ulcers were retrospectively collected during the 3 months after the earthquake (2011) from 7 major hospitals in the middle of the stricken area, and were compared with the data for the same period of the previous year (2010). The eligible subjects were classified into four groups according to Helicobacter pylori infection status and intake of nonsteroidal anti-inflammatory drugs (NSAIDs). RESULTS The incidence of all types of peptic ulcers was 1.5-fold increased after the earthquake, and in particular, the incidence of hemorrhagic ulcers was 2.2-fold increased; the gastric ulcer/duodenal ulcer ratio in hemorrhagic ulcers was also significantly increased (p < 0.05). Regarding the etiology of the peptic ulcers, the proportion of non-H. pylori and non-NSAID ulcers was significantly increased, from 13 % in 2010 to 24 % in 2011 after the earthquake (p < 0.05). CONCLUSION In addition to the increased incidence of peptic ulcers, compositional changes in the disease were observed after the Great East Japan earthquake. The significant increase in the proportion of non-H. pylori and non-NSAID ulcers after the earthquake indicated that psychological stress alone induced peptic ulcers in humans independently of H. pylori infection and NSAID intake.
Collapse
|
|
10
|
Li XJ, He YL, Ma H, Liu ZN, Jia FJ, Zhang L, Zhang L. Prevalence of depressive and anxiety disorders in Chinese gastroenterological outpatients. World J Gastroenterol 2012; 18:2561-8. [PMID: 22654455 PMCID: PMC3360456 DOI: 10.3748/wjg.v18.i20.2561] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/20/2012] [Accepted: 03/09/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prevalence and physicians’ detection rate of depressive and anxiety disorders in gastrointestinal (GI) outpatients across China.
METHODS: A hospital-based cross-sectional survey was conducted in the GI outpatient departments of 13 general hospitals. A total of 1995 GI outpatients were recruited and screened with the Hospital Anxiety and Depression Scale (HADS). The physicians of the GI departments performed routine clinical diagnosis and management without knowing the HADS score results. Subjects with HADS scores ≥ 8 were subsequently interviewed by psychiatrists using the Mini International Neuropsychiatric Interview (MINI) to make further diagnoses.
RESULTS: There were 1059 patients with HADS score ≥ 8 and 674 (63.64%) of them undertook the MINI interview by psychiatrists. Based on the criteria of Diagnostic and Statistical Manual of Mental Disorders (4th edition), the adjusted current prevalence for depressive disorders, anxiety disorders, and comorbidity of both disorders in the GI outpatients was 14.39%, 9.42% and 4.66%, respectively. Prevalence of depressive disorders with suicidal problems [suicide attempt or suicide-related ideation prior or current; module C (suicide) of MINI score ≥ 1] was 5.84% in women and 1.64% in men. The GI physicians’ detection rate of depressive and anxiety disorders accounted for 4.14%.
CONCLUSION: While the prevalence of depressive and anxiety disorders is high in Chinese GI outpatients, the detection rate of depressive and anxiety disorders by physicians is low.
Collapse
|
|
11
|
Affiliation(s)
- Emeran A Mayer
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
| | | |
Collapse
|
|
12
|
Jeffery PL, McGuckin MA, Linden SK. Endocrine impact of Helicobacter pylori: Focus on ghrelin and ghrelin o-acyltransferase. World J Gastroenterol 2011; 17:1249-60. [PMID: 21455323 PMCID: PMC3068259 DOI: 10.3748/wjg.v17.i10.1249] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 12/21/2010] [Accepted: 12/28/2010] [Indexed: 02/06/2023] Open
Abstract
Ghrelin is predominantly produced by the gastric enteroendocrine cell compartment and is octanoylated by the recently discovered ghrelin o-acyltransferase (GOAT) before secretion into the bloodstream. This octanoylation is essential for many of the biological properties of ghrelin including appetite stimulation and anti-inflammatory properties as only the acylated form of ghrelin binds to the ghrelin receptor, the growth hormone secretagogue receptor (GHS-R). Given the gastric location of ghrelin production, it is perhaps not surprising that insult to the gastric mucosa affects circulating ghrelin levels in humans. Helicobacter pylori (H. pylori) infects more than fifty percent of the world’s population and once established within the gastric mucosa, can persist for life. Infection is associated with chronic gastritis, gastric atrophy and ulceration, reduced appetite and a lower body mass index (BMI). The large majority of studies investigating levels of circulating ghrelin and ghrelin expression in the stomach in patients with H. pylori infection indicate that the bacterium has a negative impact on ghrelin production and/or secretion. Eradication of infection restores ghrelin, improves appetite and increases BMI in some studies, however, a causative relationship between H. pylori-associated serum ghrelin decline and food intake and obesity has not been established. Most studies measure total ghrelin in the circulation although the measurement of the ratio of acyl/total ghrelin gives a clearer indication that the ghrelin acylation process is altered during infection and atrophy. GOAT is essential for the production of biologically-active, acyl ghrelin and the impact of H. pylori on GOAT expression and activity will be highly informative in the future.
Collapse
|
|
13
|
Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Br J Nutr 2010; 105:755-64. [PMID: 20974015 DOI: 10.1017/s0007114510004319] [Citation(s) in RCA: 927] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In a previous clinical study, a probiotic formulation (PF) consisting of Lactobacillus helveticus R0052 and Bifidobacterium longum R0175 (PF) decreased stress-induced gastrointestinal discomfort. Emerging evidence of a role for gut microbiota on central nervous system functions therefore suggests that oral intake of probiotics may have beneficial consequences on mood and psychological distress. The aim of the present study was to investigate the anxiolytic-like activity of PF in rats, and its possible effects on anxiety, depression, stress and coping strategies in healthy human volunteers. In the preclinical study, rats were daily administered PF for 2 weeks and subsequently tested in the conditioned defensive burying test, a screening model for anti-anxiety agents. In the clinical trial, volunteers participated in a double-blind, placebo-controlled, randomised parallel group study with PF administered for 30 d and assessed with the Hopkins Symptom Checklist (HSCL-90), the Hospital Anxiety and Depression Scale (HADS), the Perceived Stress Scale, the Coping Checklist (CCL) and 24 h urinary free cortisol (UFC). Daily subchronic administration of PF significantly reduced anxiety-like behaviour in rats (P < 0·05) and alleviated psychological distress in volunteers, as measured particularly by the HSCL-90 scale (global severity index, P < 0·05; somatisation, P < 0·05; depression, P < 0·05; and anger-hostility, P < 0·05), the HADS (HADS global score, P < 0·05; and HADS-anxiety, P < 0·06), and by the CCL (problem solving, P < 0·05) and the UFC level (P < 0·05). L. helveticus R0052 and B. longum R0175 taken in combination display anxiolytic-like activity in rats and beneficial psychological effects in healthy human volunteers.
Collapse
|
|
14
|
|
|
15
|
Lindén S, Semino-Mora C, Liu H, Rick J, Dubois A. Role of mucin Lewis status in resistance to Helicobacter pylori infection in pediatric patients. Helicobacter 2010; 15:251-8. [PMID: 20633185 PMCID: PMC3209514 DOI: 10.1111/j.1523-5378.2010.00765.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Helicobacter pylori causes gastritis, peptic ulcer and is a risk factor for adenocarcinoma and lymphoma of the stomach. Gastric mucins, carrying highly diverse carbohydrate structures, present functional binding sites for H. pylori and may play a role in pathogenesis. However, little information is available regarding gastric mucin in children with and without stomach diseases. MATERIALS AND METHODS Expression of mucins and glycosylation was studied by immunohistochemistry on gastric biopsies from 51 children with and without H. pylori infection and/or peptic ulcer disease. RESULTS In all children, MUC5AC was present in the surface epithelium and MUC6 in the glands. No MUC6 in the surface epithelium or MUC2 was detected in any section. The Le(b) and Le(a) blood group antigens were present in the surface epithelium of 80% and 29% of children, respectively. H. pylori load was higher in Le(b) negative children than in Le(b) positive individuals (mean +/- SEM 17.8 +/- 3.5 vs 10.8 +/- 1.5; p < 0.05), but there was no correlation between Le(a) or Le(b) status and gastritis, nodularity, and gastric or duodenal ulcer (DU). Expression of sialyl-Le(x) was associated with H. pylori infection, and DU. CONCLUSIONS Mucin expression and glycosylation is similar in children and adults. However, in contrast to adults, pediatric H. pylori infection is not accompanied by aberrant expression of MUC6 or MUC2. Furthermore, the lower H. pylori density in Le(b) positive children indicates that H. pylori is suppressed in the presence of gastric mucins decorated with Le(b), the binding site of the H. pylori BabA adhesin.
Collapse
Affiliation(s)
- Sara Lindén
- Mucosal Immunobiology and Vaccine Center, Sahlgrenska academy, Gothenburg University, Box 435, 405 30 Gothenburg, Sweden
| | - Cristina Semino-Mora
- Digestive Diseases Division, Department of Medicine, Uniformed Services of the Health Sciences, Bethesda, Maryland, USA
| | - Hui Liu
- Digestive Diseases Division, Department of Medicine, Uniformed Services of the Health Sciences, Bethesda, Maryland, USA
| | - James Rick
- Digestive Diseases Division, Department of Medicine, Uniformed Services of the Health Sciences, Bethesda, Maryland, USA
| | - Andre Dubois
- Digestive Diseases Division, Department of Medicine, Uniformed Services of the Health Sciences, Bethesda, Maryland, USA
| |
Collapse
|
|
16
|
Gustafson J, Welling D. “No Acid, No Ulcer”—100 Years Later: A Review of the History of Peptic Ulcer Disease. J Am Coll Surg 2010; 210:110-6. [DOI: 10.1016/j.jamcollsurg.2009.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 08/13/2009] [Accepted: 08/19/2009] [Indexed: 11/28/2022]
|
|
17
|
Bellinger DL, Millar BA, Perez S, Carter J, Wood C, ThyagaRajan S, Molinaro C, Lubahn C, Lorton D. Sympathetic modulation of immunity: relevance to disease. Cell Immunol 2008; 252:27-56. [PMID: 18308299 PMCID: PMC3551630 DOI: 10.1016/j.cellimm.2007.09.005] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Accepted: 09/01/2007] [Indexed: 02/05/2023]
Abstract
Optimal host defense against pathogens requires cross-talk between the nervous and immune systems. This paper reviews sympathetic-immune interaction, one major communication pathway, and its importance for health and disease. Sympathetic innervation of primary and secondary immune organs is described, as well as evidence for neurotransmission with cells of the immune system as targets. Most research thus far has focused on neural-immune modulation in secondary lymphoid organs, has revealed complex sympathetic modulation resulting in both potentiation and inhibition of immune functions. SNS-immune interaction may enhance immune readiness during disease- or injury-induced 'fight' responses. Research also indicate that dysregulation of the SNS can significantly affect the progression of immune-mediated diseases. However, a better understanding of neural-immune interactions is needed to develop strategies for treatment of immune-mediated diseases that are designed to return homeostasis and restore normal functioning neural-immune networks.
Collapse
Affiliation(s)
- Denise L Bellinger
- Department of Pathology & Human Anatomy, Loma Linda University School of Medicine, 11021 Campus Street, Alumni Hall 325, Loma Linda, CA 92352, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
18
|
Elenkov IJ. Neurohormonal-cytokine interactions: implications for inflammation, common human diseases and well-being. Neurochem Int 2007; 52:40-51. [PMID: 17716784 DOI: 10.1016/j.neuint.2007.06.037] [Citation(s) in RCA: 197] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Revised: 06/20/2007] [Accepted: 06/22/2007] [Indexed: 11/29/2022]
Abstract
The neuroendocrine system affects the immune system through the neuroendocrine humoral outflow via the pituitary, and through direct neuronal influences via the sympathetic, parasympathetic (cholinergic) and peptidergic/sensory innervation of peripheral tissues. Circulating hormones or locally released neurotransmitters and neuropeptides regulate major immune functions, such as antigen presentation, antibody production, lymphocyte activity, proliferation and traffic, and the secretion of cytokines including the selection of T helper (Th)1 or Th2 cytokine responses. During inflammation, the activation of the stress system, through induction of a Th2 shift protects the organism from systemic "overshooting" with Th1/pro-inflammatory cytokines. Under certain conditions, however, stress hormones, substance P, ATP and the activation of the corticotropin-releasing hormone/substance P-histamine axis may actually facilitate inflammation, through induction of interleukin (IL)-1, IL-6, IL-8, IL-18, tumor necrosis factor (TNF)-alpha and CRP production. Thus, a dysfunctional neuroendocrine-immune interface associated with abnormalities of the 'systemic anti-inflammatory feedback' and/or 'hyperactivity' of the local pro-inflammatory factors may play a role in the pathogenesis of atopic/allergic and autoimmune diseases, obesity, depression and atherosclerosis. Better understanding of the neuroendocrine control of inflammation may provide critical insights into mechanisms underlying a variety of common human immune-related diseases.
Collapse
Affiliation(s)
- Ilia J Elenkov
- Institute of Neurobiology and Molecular Medicine, Italian National Research Council, Via Fosso del Cavaliere 100, 00133 Rome, Italy.
| |
Collapse
|
|
19
|
Slade T. The descriptive epidemiology of internalizing and externalizing psychiatric dimensions. Soc Psychiatry Psychiatr Epidemiol 2007; 42:554-60. [PMID: 17516015 DOI: 10.1007/s00127-007-0200-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2007] [Indexed: 01/22/2023]
Abstract
BACKGROUND There is a growing recognition that comorbidity among individual mental disorders is best explained by the broad, psychiatric dimensions of internalization (sub-divided into distress and fear) and externalization. The aims of the current study were to examine the descriptive epidemiology of these psychiatric dimensions. METHODS Continuous measures of distress, fear and externalization dimensions were obtained from principal components analysis of 11 common ICD-10 mental disorders in a large (N = 10,641) community sample. The relationships between these three dimensions and sociodemographic, physical illness and personality disorder characteristics were determined using multivariate linear regression analyses. RESULTS The results suggest that the distress dimension is more strongly related to disadvantageous sociodemographic characteristics and physical health conditions than either the fear or externalizing dimensions. The results also demonstrate some specificity in profiles particularly with regard to the personality disorders. CONCLUSIONS Greater emphasis should be placed on continuous psychiatric dimensions that are thought to underlie the expression of putatively independent mental disorders.
Collapse
Affiliation(s)
- Tim Slade
- School of Psychiatry, University of New South Wales at St Vincent's Hospital, 299 Forbes Street, Darlinghurst (NSW), 2010 Australia.
| |
Collapse
|
|
20
|
Elenkov IJ. Effects of Catecholamines on the Immune Response. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/s1567-7443(07)00210-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
|
|
21
|
|
|
22
|
Calcagni E, Elenkov I. Stress system activity, innate and T helper cytokines, and susceptibility to immune-related diseases. Ann N Y Acad Sci 2006; 1069:62-76. [PMID: 16855135 DOI: 10.1196/annals.1351.006] [Citation(s) in RCA: 260] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Associations between stress and health outcomes have now been carefully documented, but the mechanisms by which stress specifically influences disease susceptibility and outcome remain poorly understood. Recent evidence indicates that glucocorticoids (GCs) and catecholamines (CAs), the major stress hormones, inhibit systemically IL-12, TNF-alpha, and INF-gamma, but upregulate IL-10, IL-4, and TGF-beta production. Thus, during an immune and inflammatory response, the activation of the stress system, through induction of a Th2 shift may protect the organism from systemic "overshooting" with T helper lymphocyte 1 (Th1)/proinflammatory cytokines. In certain local responses and under certain conditions, however, stress hormones may actually facilitate inflammation, through induction of IL-1, IL-6, IL-8, IL-18, TNF-alpha, and CRP production, and through activation of the corticotropin-releasing hormone (CRH)/substance P(SP)-histamine axis. Autoimmunity, chronic infections, major depression, and atherosclerosis are characterized by a dysregulation of the pro/anti-inflammatory and Th1/Th2 cytokine balance. Thus, hyperactive or hypoactive stress system, and a dysfunctional neuroendocrine-immune interface associated with abnormalities of the "systemic anti-inflammatory feedback" and/or "hyperactivity" of the local proinflammatory factors may contribute to the pathogenesis of these diseases. Conditions that are associated with significant changes in stress system activity, such as acute or chronic stress, cessation of chronic stress, pregnancy and the postpartum period, or rheumatoid arthritis (RA) through modulation of the systemic or local pro/anti-inflammatory and Th1/Th2 cytokine balance, may suppress or potentiate disease activity and/or progression. Thus, stress hormones-induced inhibition or upregulation of innate and Th cytokine production may represent an important mechanism by which stress affects disease susceptibility, activity, and outcome of various immune-related diseases.
Collapse
Affiliation(s)
- Emanuele Calcagni
- Laboratory of Neuro-Endocrine-Immunology, San Raffaele Research Center, via della Pisana 235, 00163 Rome, Italy
| | | |
Collapse
|
|
23
|
Bellinger DL, Millar BA, Perez S, Carter J, Wood C, ThyagaRajan S, Molinaro C, Lubahn C, Lorton D. Innervation of lymphoid organs: Clinical implications. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.cnr.2006.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
|
24
|
Affiliation(s)
- Sean P Harbison
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
|
25
|
Elenkov IJ, Iezzoni DG, Daly A, Harris AG, Chrousos GP. Cytokine dysregulation, inflammation and well-being. Neuroimmunomodulation 2005; 12:255-69. [PMID: 16166805 DOI: 10.1159/000087104] [Citation(s) in RCA: 336] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 04/07/2005] [Indexed: 12/15/2022] Open
Abstract
Cytokines mediate and control immune and inflammatory responses. Complex interactions exist between cytokines, inflammation and the adaptive responses in maintaining homeostasis, health, and well-being. Like the stress response, the inflammatory reaction is crucial for survival and is meant to be tailored to the stimulus and time. A full-fledged systemic inflammatory reaction results in stimulation of four major programs: the acute-phase reaction, the sickness syndrome, the pain program, and the stress response, mediated by the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Common human diseases such as atopy/allergy, autoimmunity, chronic infections and sepsis are characterized by a dysregulation of the pro- versus anti-inflammatory and T helper (Th)1 versus Th2 cytokine balance. Recent evidence also indicates the involvement of pro-inflammatory cytokines in the pathogenesis of atherosclerosis and major depression, and conditions such as visceral-type obesity, metabolic syndrome and sleep disturbances. During inflammation, the activation of the stress system, through induction of a Th2 shift, protects the organism from systemic 'overshooting' with Th1/pro-inflammatory cytokines. Under certain conditions, however, stress hormones may actually facilitate inflammation through induction of interleukin (IL)-1, IL-6, IL-8, IL-18, tumor necrosis factor-alpha and C-reactive protein production and through activation of the corticotropin-releasing hormone/substance P-histamine axis. Thus, a dysfunctional neuroendocrine-immune interface associated with abnormalities of the 'systemic anti-inflammatory feedback' and/or 'hyperactivity' of the local pro-inflammatory factors may play a role in the pathogenesis of atopic/allergic and autoimmune diseases, obesity, depression, and atherosclerosis. These abnormalities and the failure of the adaptive systems to resolve inflammation affect the well-being of the individual, including behavioral parameters, quality of life and sleep, as well as indices of metabolic and cardiovascular health. These hypotheses require further investigation, but the answers should provide critical insights into mechanisms underlying a variety of common human immune-related diseases.
Collapse
Affiliation(s)
- Ilia J Elenkov
- Division of Rheumatology, Immunology and Allergy, Georgetown University Medical Center, Washington, D.C., USA
| | | | | | | | | |
Collapse
|
|
26
|
Abstract
Evidence accumulated over the last 5-10 years indicates that glucocorticoids (GCs) inhibit the production of interleukin (IL)-12, interferon (IFN)-gamma, IFN-alpha, and tumor necrosis factor (TNF)-alpha by antigen-presenting cells (APCs) and T helper (Th)1 cells, but upregulate the production of IL-4, IL-10, and IL-13 by Th2 cells. Through this mechanism increased levels of GCs may systemically cause a selective suppression of the Th1-cellular immunity axis, and a shift toward Th2-mediated humoral immunity, rather than generalized immunosuppression. During an immune response and inflammation, the activation of the stress system, and thus increased levels of systemic GCs through induction of a Th2 shift, may actually protect the organism from systemic "overshooting" with Th1/pro-inflammatory cytokines and other products of activated macrophages with tissue-damaging potential. However, conditions associated with significant changes of GCs levels, such as acute or chronic stress or cessation of chronic stress, severe exercise, and pregnancy and postpartum, through modulation of the Th1/Th2 balance may affect the susceptibility to or the course of infections as well as autoimmune and atopic/allergic diseases.
Collapse
Affiliation(s)
- Ilia J Elenkov
- Clinical Neuroendocrinology Branch, National Institute of Mental Health, National Institutes of Health, Building 10, Room 2D46, 10 Center Drive, Bethesda, MD 20892, USA.
| |
Collapse
|
|
27
|
Abstract
Ambulatory medicine is a frequent clinical setting where practitioners can effectively apply Mind-body interventions ranging from basic stress management therapies to the sophisticated biomedical instrumentation of clinical biofeedback. Given the rather extensive and growing body of clinical research in this area, the intent of this article is to provide an evidence-based assessment of the evidence underlying the clinical efficiency of such interventions. Such an evidence-based approach can help ambulatory care providers to identify those Mind-body interventions with specific clinical indication so that they can be utilized both safely and effectively in ambulatory medicine.
Collapse
Affiliation(s)
- Kenneth R Pelletier
- Department of Medicine, UCLA Geffen School of Medicine, University of California in Los Angeles, Calif, USA.
| |
Collapse
|
|
28
|
Elenkov IJ. Systemic stress-induced Th2 shift and its clinical implications. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2003; 52:163-86. [PMID: 12498104 DOI: 10.1016/s0074-7742(02)52009-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Ilia J Elenkov
- Division of Rheumatology, Immunology, and Allergy, Georgetown University Medical Center, Washington, D.C. 20007, USA
| |
Collapse
|
|
29
|
Abstract
Helicobacter pylori (H. pylori) infection is widely accepted as the most important factor in the pathogenesis of duodenal ulcer. However, in parallel with more effective eradication of H. pylori, the prevalence of H. pylori is changing, and H. pylori-negative peptic ulcer disease appears to be increasing. When making a diagnosis of H. pylori-negative peptic ulcer disease, it is essential to avoid misclassification because of inaccurate diagnosis. In addition, secondary causes may need to be excluded with appropriate investigations. In the absence of H. pylori, nonsteroidal anti-inflammatory drug usage is the most common cause of peptic ulcer; surreptitious nonsteroidal anti-inflammatory drug usage is a cause of unexplained ulcer disease in up to 60% of patients. Hypersecretory syndromes such as Zollinger-Ellison syndrome, although rare, need to be excluded. Once all known etiological factors are excluded, there remains a group of patients with so-called "idiopathic ulcers." The interplay of etiological factors in the pathogenesis of idiopathic peptic ulcer disease is poorly defined but may include a genetic predisposition, altered acid secretion, rapid gastric emptying, defective mucosal defense mechanisms, psychological stress, and smoking. The management of idiopathic peptic ulcers is not defined; they appear to be more resistant to standard therapy, can be associated with more frequent complications, and those that relapse may require long-term maintenance therapy.
Collapse
Affiliation(s)
- Carolyn Quan
- Department of Medicine, University of Sydney, Nepean Hospital, Penrith, Australia
| | | |
Collapse
|
|
30
|
Pawlik T, Konturek PC, Konturek JW, Konturek SJ, Brzozowski T, Cześnikiewicz M, Plonka M, Bielanski W, Areny H. Impact of Helicobacter pylori and nonsteroidal anti-inflammatory drugs on gastric ulcerogenesis in experimental animals and in humans. Eur J Pharmacol 2002; 449:1-15. [PMID: 12163100 DOI: 10.1016/s0014-2999(02)01909-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Helicobacter pylori (H. pylori) and nonsteroidal anti-inflammatory drugs (NSAID) are the most common pathogens in the gastroduodenal mucosa in animals and humans, but their relationship in ulcerogenesis has been little studied. According to some authors, H. pylori infection in humans does not act synergistically with NSAID on ulcer healing, therefore, there is no need to eradicate the germ. This notion is supported by the finding that the eradication of H. pylori does not affect NSAID-induced gastropathy treated with omeprazole and that H. pylori infection induces a strong cyclooxygenase-2 expression resulting in excessive biosynthesis of gastroprotective prostaglandins, which should in turn counteract NSAID-induced gastropathy and heal the existing ulcer. Other investigators claim that H. pylori infection acts synergistically with NSAID on ulcer development, therefore, H. pylori should be eradicated, particularly at the start of long-term NSAID therapy. Maastricht 2-2000 consensus also recommends eradication prior to NSAID treatment, but this eradication does not appear to accelerate ulcer healing or to prevent the recurrent ulcers in NSAID users. Our studies in almost 6,000 dyspeptic patients undergoing upper endoscopy and [(13)C]-urea breath test (UBT) revealed that about 70% of these patients are H. pylori (+) and about 30.6% of these develop gastroduodenal ulcers. Of these ulcers, over 70% were H. pylori (+) positive, 12% NSAID (+), 8% were both H. pylori (+) and NSAID (+), while 22% ulcers were H. pylori (-) and NSAID (-) or "idiopathic" ulcers. Basically, our results support Hawkey's concept and this also agrees with our findings in the rat model showing that: (1) there is no synergistic interaction between H. pylori infection and NSAID on gastric ulcer development, (2) H. pylori and NSAID are independent risk factors for peptic ulceration, and (3) NSAID therapy in H. pylori positive patients attenuates the ulcer development possibly due to direct inhibitory action of these drugs on H. pylori.
Collapse
Affiliation(s)
- Teresa Pawlik
- Department of Physiology, University Medical College, Ul. Grzegorzecka St. 16, 31-531, Cracow, Poland
| | | | | | | | | | | | | | | | | |
Collapse
|
|
31
|
Abstract
OBJECTIVE Although psychological modulation of immune function is now a well-established phenomenon, much of the relevant literature has been published within the last decade. This article speculates on future directions for psychoneuroimmunology research, after reviewing the history of the field. METHODS This review focuses on human psychoneuroimmunology studies published since 1939, particularly those that have appeared in Psychosomatic Medicine. Studies were clustered according to key themes, including stressor duration and characteristics (laboratory stressors, time-limited naturalistic stressors, or chronic stress), as well as the influences of psychopathology, personality, and interpersonal relationships; the responsiveness of the immune system to behavioral interventions is also addressed. Additionally, we describe trends in populations studied and the changing nature of immunological assessments. The final section focuses on health outcomes and future directions for the field. RESULTS There are now sufficient data to conclude that immune modulation by psychosocial stressors or interventions can lead to actual health changes, with the strongest direct evidence to date in infectious disease and wound healing. Furthermore, recent medical literature has highlighted a spectrum of diseases whose onset and course may be influenced by proinflammatory cytokines, from cardiovascular disease to frailty and functional decline; proinflammatory cytokine production can be directly stimulated by negative emotions and stressful experiences and indirectly stimulated by chronic or recurring infections. Accordingly, distress-related immune dysregulation may be one core mechanism behind a diverse set of health risks associated with negative emotions. CONCLUSIONS We suggest that psychoneuroimmunology may have broad implications for the basic biological sciences and medicine.
Collapse
|
|
32
|
Xia HH, Wong BC, Wong KW, Wong SY, Wong WM, Lai KC, Hu WH, Chan CK, Lam SK. Clinical and endoscopic characteristics of non-Helicobacter pylori, non-NSAID duodenal ulcers: a long-term prospective study. Aliment Pharmacol Ther 2001; 15:1875-1882. [PMID: 11736717 DOI: 10.1046/j.1365-2036.2001.01115.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The proportion of duodenal ulcers not associated with Helicobacter pylori infection or the use of non-steroidal anti-inflammatory drugs (NSAIDs) is increasing. AIM To identify the clinical and endoscopic characteristics of non-H. pylori, non-NSAID duodenal ulcers. METHODS Clinical and endoscopic data and H. pylori status were prospectively collected from consecutive patients who underwent upper endoscopy from 1997 to 1999. Patients with duodenal ulcers were identified, and those with non-H. pylori, non-NSAID duodenal ulcers were analysed further. RESULTS A total of 11 717 upper endoscopies were performed in 8344 patients. Of these, 1153 (14%) had duodenal ulcers. Of 599 patients with active ulcers and known H. pylori status, 104 (17%) had ulcers not associated with H. pylori or the use of NSAIDs, 393 (66%) had ulcers associated with H. pylori alone, 51 (8.5%) had ulcers associated with the use of NSAIDs alone and 51 (8.5%) had ulcers associated with both. Multivariate logistic regression analysis revealed that the presence of concomitant diseases (odds ratio=15.0; 95% confidence interval, 8.64-25.9; P < 0.001) and the absence of epigastric pain/discomfort (odds ratio=0.52; 95% confidence interval, 0.29-0.91; P=0.022) were independent predictors for non-H. pylori, non-NSAID duodenal ulcers. CONCLUSIONS Non-H. pylori, non-NSAID duodenal ulcers exhibit certain distinct clinical and endoscopic characteristics. The presence of concomitant diseases is an important predictive factor.
Collapse
Affiliation(s)
- H H Xia
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
| | | | | | | | | | | | | | | | | |
Collapse
|
|
33
|
Abstract
This review focuses on the pathway leading from the marital relationship to physical health. Evidence from 64 articles published in the past decade, particularly marital interaction studies, suggests that marital functioning is consequential for health; negative dimensions of marital functioning have indirect influences on health outcomes through depression and health habits, and direct influences on cardiovascular, endocrine, immune, neurosensory, and other physiological mechanisms. Moreover, individual difference variables such as trait hostility augment the impact of marital processes on biological systems. Emerging themes in the past decade include the importance of differentiating positive and negative dimensions of marital functioning, the explanatory power of behavioral data, and gender differences in the pathways from the marital relationship to physiological functioning. Contemporary models of gender that emphasize self-processes, traits, and roles furnish alternative perspectives on the differential costs and benefits of marriage for men's and women's health.
Collapse
Affiliation(s)
- J K Kiecolt-Glaser
- Department of Psychiatry, Ohio State University College of Medicine, 1670 Upham Drive, Columbus, Ohio 43210, USA.
| | | |
Collapse
|
|
34
|
Abstract
Dyspepsia with or without nausea is common during pregnancy. Known ulcer disease, gastritis, and GERD may improve during pregnancy. Many women have a stoic and long-suffering posture during pregnancy owing to an unrealistic expectation concerning the teratogenicity of commonly used drugs. It is appropriate in medicine to alleviate pain and suffering when possible, and many drugs can be used safely and effectively to control upper gastrointestinal tract symptoms. When symptoms are persistent into the late second trimester, refractory to pharmacologic treatment, or severe, H. pylori infection, complications of ulcer disease, and underlying cancer should be suspected and sequentially ruled out. More timely treatment and work-up of nonobstetric disease during pregnancy is expected to lower perinatal complications.
Collapse
Affiliation(s)
- S L Winbery
- Department of Emergency Medicine, University of Tennessee Medical Group, Memphis, Tennessee, USA
| | | |
Collapse
|
|
35
|
Richter L, Richter DM. Exposure to parental tobacco and alcohol use: effects on children's health and development. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2001; 71:182-203. [PMID: 11347360 DOI: 10.1037/0002-9432.71.2.182] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This review examines three ways in which parental tobacco and alcohol use compromises the physical and mental health of children: 1) direct exposure to the substances; 2) living with parents who may become ill from using these substances; and 3) children's modeling of parental substance use. Implications for prevention, intervention, and public education are discussed, and a reframing of the national dialogue on youth substance abuse is called for.
Collapse
Affiliation(s)
- L Richter
- National Center on Addiction and Substance Abuse, Columbia University, New York, USA.
| | | |
Collapse
|
|
36
|
Crawley J, Frank L, Joshua-Gotlib S, Flynn J, Frank S, Wiklund I. Measuring change in quality of life in response to Helicobacter pylori eradication in peptic ulcer disease: the QOLRAD. Dig Dis Sci 2001; 46:571-80. [PMID: 11318535 DOI: 10.1023/a:1005655317121] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study was designed to determine if a new condition-specific quality of life measure, the Quality Of Life in Reflux And Dyspepsia (QOLRAD), was responsive to clinical change over a four-week period when evaluating peptic ulcer disease patients undergoing Helicobacter pylori (Hp) eradication. A secondary aim was to evaluate QOLRAD's psychometric performance. Hp-positive patients with peptic ulcer disease were recruited from primary care and gastroenterology clinics (N = 155). QOLRAD scores improved significantly (P < 0.0001) and mean total score increase was 1.07 points on a 7-point scale among 111 subjects who responded to Hp eradication. Effect sizes were moderate for responders (0.64) and low for nonresponders (0.36). Score changes below 0.60 were associated with the smallest improvement in patient and physician condition rating; scores above 1.2 were associated with the greatest improvement. The QOLRAD demonstrates reliability and validity. Changes in QOLRAD score can be meaningfully related to clinical changes, aiding evaluation of health-related quality of life in peptic ulcer disease.
Collapse
Affiliation(s)
- J Crawley
- AstraZeneca, Wayne, Pennsylvania, USA
| | | | | | | | | | | |
Collapse
|
|
37
|
Knapp S, Keller PA. Professional associations' strategies for revitalizing professional psychology. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2001. [DOI: 10.1037/0735-7028.32.1.71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
|
38
|
Abstract
Night work and rotating shift work disrupt the circadian timing system. This disruption may produce significant deleterious symptoms in some workers. Certain medical conditions may be aggravated by shift-work scheduling, and shift workers are at increased risk of experiencing cardiovascular, gastrointestinal, and reproductive dysfunction. Vulnerable individuals may develop clinical depression when working shifts. Primary care practitioners may intervene by providing medical surveillance and educational programs for shift-working patients and their families.
Collapse
Affiliation(s)
- A J Scott
- Department of Environmental and Occupational Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, USA
| |
Collapse
|
|
39
|
Xia HH, Phung N, Kalantar JS, Talley NJ. Demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative peptic ulcer disease. Med J Aust 2000; 173:515-519. [PMID: 11194733 DOI: 10.5694/j.1326-5377.2000.tb139318.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To identify demographic and endoscopic characteristics of patients with Helicobacter pylori positive and negative chronic peptic ulcer disease. DESIGN Cross-sectional study of peptic ulcer disease in prospectively recruited PATIENTS undergoing gastroscopy. PATIENTS 277 consecutive patients referred for gastroscopy in 1996-1998. MAIN OUTCOME MEASURES Rapid urease test, culture and histological examination for H. pylori infection; anti-H. pylori IgG antibodies in serum; demographic data, intake of non-steroidal anti-inflammatory drugs (NSAIDs) in the preceding 3 months, and size, number and location of ulcers. RESULTS 54 patients (19%) had evidence of peptic ulcer disease (34 gastric ulcer, 14 duodenal ulcer and 6 both gastric and duodenal ulcer); 45 had active chronic peptic ulcer disease and were analysed in detail. H. pylori was present in 25 (56%) of these patients; 10 (22%) had used NSAIDs and 7 of the NSAID group also had H. pylori infection. Of the patients with gastric ulcers, those with non-H. pylori, non-NSAID ulcers were significantly younger than both those with H. pylori-associated ulcers (mean age, 48 v. 65 years, P = 0.02) and those with NSAID-associated ulcers (mean age, 48 v 68 years, P = 0.02). The average size and number of gastric ulcers did not differ between patients with and without H. pylori infection. Of patients with duodenal ulcers, those with H. pylori infection had significantly fewer ulcers (1.1 v. 1.8, P = 0.04), although ulcer size was similar in the infected and uninfected groups. CONCLUSIONS Gastric ulcers may now be more common than duodenal ulcers. Gastric ulcers associated with H. pylori infection and/or NSAID use occurred mostly in older people, while non-H. pylori, non-NSAID gastric ulcers were more common in younger patients. In the duodenum, single ulcers were associated with H. pylori infection, and multiple ulcers were more frequent in the non-H. pylori, non-NSAID group.
Collapse
Affiliation(s)
- H H Xia
- Department of Medicine, University of Sydney, Nepean Hospital, Sydney, NSW
| | | | | | | |
Collapse
|
|
40
|
Cheng Y, Macera CA, Davis DR, Blair SN. Physical activity and peptic ulcers. Does physical activity reduce the risk of developing peptic ulcers? West J Med 2000; 173:101-7. [PMID: 10924430 PMCID: PMC1071012 DOI: 10.1136/ewjm.173.2.101] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although Helicobacter pylori has been identified as a major cause of chronic gastritis, not all infected patients develop ulcers, suggesting that other factors such as lifestyle may be critical to the development of ulcer disease. OBJECTIVE To investigate the role physical activity may play in the incidence of peptic ulcer disease. METHODS The participants were men (n = 8,529) and women (n = 2,884) who attended the Cooper Institute for Aerobics Research, Dallas, Texas, between 1970 and 1990. The presence of gastric or duodenal ulcer disease diagnosed by a physician was determined from a mail survey in 1990. Participants were classified into 3 physical activity groups according to information provided at the baseline clinic visit (before 1990): active, those who walked or ran 10 miles or more a week; moderately active, those who walked or ran less than 10 miles a week or did another regular activity; and the referent group consisting of those who reported no regular physical activity. RESULTS With the use of gender-specific proportional hazards regression models that could be adjusted for age, smoking, alcohol use, body mass index, and self-reported tension, active men had a significantly reduced risk for duodenal ulcers (relative hazard [95% confidence interval] for the active group, 0.38 [0.15-0.94], and 0.54 [0.30-0.96] for the moderately active group). No association was found between physical activity and gastric ulcers for men or for either type of ulcer for women. CONCLUSION Physical activity may provide a nonpharmacologic method of reducing the incidence of duodenal ulcers among men.
Collapse
Affiliation(s)
- Y Cheng
- School of Public Health, University of South Carolina, Columbia, USA
| | | | | | | |
Collapse
|
|
41
|
Wise TN. Consultation liaison psychiatry and psychosomatics: strange bedfellows. PSYCHOTHERAPY AND PSYCHOSOMATICS 2000; 69:181-3. [PMID: 10867585 DOI: 10.1159/000012392] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
|
42
|
Overmier JB, Murison R. Anxiety and helplessness in the face of stress predisposes, precipitates, and sustains gastric ulceration. Behav Brain Res 2000; 110:161-74. [PMID: 10802312 DOI: 10.1016/s0166-4328(99)00193-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
When an organism is subjected to stress, gastric ulcers or ulcerations commonly develop but the vulnerability to and amount of pathology induced varies considerably between individuals. The role of psychological factors in determining the occurrence and severity of these ulcerations is amply demonstrated in the studies reviewed here. The present paper (a) gives a brief history of the search for the causes of gastric ulcer, (b) provides a review of our own research which reveals that vulnerability to gastric ulceration is modulated by psychologically meaningful experiences, and (c) offers a multifactorial perspective on the causes of gastric ulceration and the future of research on it.
Collapse
Affiliation(s)
- J B Overmier
- Department of Psychology, University of Minnesota, 75 East River Road, Minneapolis MN, USA
| | | |
Collapse
|
|
43
|
Cheng Y, Macera CA, Davis DR, Blair SN. Does physical activity reduce the risk of developing peptic ulcers? Br J Sports Med 2000; 34:116-21. [PMID: 10786867 PMCID: PMC1724173 DOI: 10.1136/bjsm.34.2.116] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although Helicobacter pylori has been identified as a major cause of chronic gastritis, not all infected patients develop ulcers, suggesting that other factors such as lifestyle may be critical to the development of ulcer disease. AIM To investigate the role physical activity may play in the incidence of peptic ulcer disease. METHODS The subjects were men (8529) and women (2884) who attended the Cooper Clinic in Dallas between 1970 and 1990. The presence of gastric or duodenal ulcer disease diagnosed by a doctor was determined from a mail survey in 1990. Subjects were classified into three physical activity groups according to information provided at the baseline clinic visit (before 1990): active, those who walked or ran 10 miles or more a week; moderately active, those who walked or ran less than 10 miles a week or did another regular activity; the referent group consisting of those who reported no regular physical activity. RESULTS With the use of gender specific proportional hazards regression models that could be adjusted for age, smoking, alcohol use, body mass index, and self reported tension, active men were found to have a significant reduction in risk for duodenal ulcers (relative hazard (95% confidence interval) for the active group was 0.38 (0.15 to 0.94) and 0.54 (0.30 to 0.96) for the moderately active group). No association was found between physical activity and gastric ulcers for men or for either type of ulcer for women. CONCLUSIONS Physical activity may provide a non-pharmacological method of reducing the incidence of duodenal ulcers among men.
Collapse
Affiliation(s)
- Y Cheng
- School of Public Health, University of South Carolina, Columbia, USA
| | | | | | | |
Collapse
|
|
44
|
Abstract
OBJECTIVE Research on ulcer psychosomatics has plummeted since the early 1970s, to the applause of many who argue that ulcer is simply an infectious disease. The purpose of this article is to discuss the relevance of ulcer psychogenesis in the age of Helicobacter pylori. METHODS A critical literature review was conducted. RESULTS There is a substantial and methodologically sound body of prospective studies linking stress with the onset and course of peptic ulcer. Psychosocial factors can be estimated to contribute to 30% to 65% of ulcers, whether related to nonsteroidal antiinflammatory drugs, H. pylori, or neither. The observed association between stress and ulcer is accounted for, in part, by recall bias, misreported diagnoses, and confounding by low socioeconomic status (a source of stress and of ulcer risk factors, such as H. pylori and on-the-job exertion) and by distressing medical conditions (which lead to use of nonsteroidal antiinflammatory drugs). Of the residual, true association, a substantial proportion is accounted for by mediation by health risk behaviors, such as smoking, sleeplessness, irregular meals, heavy drinking, and, again, nonsteroidal antiinflammatory drugs. The remainder results from psychophysiologic mechanisms that probably include increased duodenal acid load, the effects of hypothalamic-pituitary-adrenal axis activation on healing, altered blood flow, and impairment of gastroduodenal mucosal defenses. CONCLUSIONS Peptic ulcer is a valuable model for understanding the interactions among psychosocial, socioeconomic, behavioral, and infectious factors in causing disease. The discovery of H. pylori may serve, paradoxically, as a stimulus to researchers for whom the concepts of psychology and infection are not necessarily a contradiction in terms.
Collapse
Affiliation(s)
- S Levenstein
- Gastroenterology Department, San Camillo-Forlanini Hospital, Rome, Italy.
| |
Collapse
|