Introduction

Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are disorders that affect approximately 20% of the population. One of the proposed pathophysiological mechanisms in these conditions is a loss of mucosal integrity, associated with low-grade inflammation and food-induced mast cell activation. To date, confocal laser endomicroscopy to monitor allergy-like reactions to luminal food protein application, or a wheal-and-flare-like reaction to submucosal injection of food proteins have experimentally been used to demonstrate allergy-like food responses in these patients. Compared to these complex methods, urinary histamine measurement may provide an elegant and non-invasive tool to detect such food reactions in FD and IBS. In this pilot project we assessed the ability to detect an increase of urinary histamine and n-methylhistamine after ingestion of food with different histamine content.

Aims & Methods

Healthy volunteers were recruited to ingest a histamine rich meal (HRM) or low histamine meal (LHM) on two different days with one week in between, in a cross over fashion. All volunteers filled out the upper gastrointestial ROME-IV diagnostic questionnaire to confirm the absence of disorders of gut-brain interaction. Volunteers came to the hospital fasted and received a standardized breakfast (pancake, brown sugar, water). After two hours participants were asked to empty the bladder before they consumed the study meal. After finishing the meal participants collected all urine and filled out symptom questionnaires of 10 gastrointestinal symptoms (VAS 0-4) for 4 hours. ELISA analysis of urinary histamine and n-methylhistamine were performed in accordance with the manufacturer’s instructions. Data are shown as mean ± standard deviation. Statistical tests were done using a paired T-test or two-way ANOVA with correction for multiple testing as appropriate.

Results

We recruited 10 healthy volunteers (70% female) with an average age of 23,8 ± 5,05 years and an average body mass index (BMI) of 21,3±1,55. All participants finished the whole meal. Urinary output was similar after the HRM and LHM (respectively 577±167 mL and 540±128 mL, p=0,605). There was no difference in urinary n-methylhistamine excretion between the HRM and LHM (respectively 34,5±8,8 µg/g creatinine vs 36,3±10,3 µg/g creatinine, p=0,779). Urinary excretion measures of histamine were below the detection limit in the majority of samples, excluding this aspect from statistical analysis. Overall symptom scores did not differ significantly after the HRM and the LHM. Only at 15 minutes postprandially, higher scores were found for postprandial fullness after the HRM (mean difference of 0,4 [95% CI 0,01 – 0,79], p=0,038).

Conclusion

In healthy volunteers administration of food with high histamine content compared to food with low histamine content does not increase urinary n-methylhistamine excretion. Ingestion of a histamine rich meal was associated with a transient postprandial increase of excessive postprandial fullness and did not induce a significant rise in postprandial symptoms.

References

1: Vanheel H, Vicario M, Vanuytsel T, Van Oudenhove L, Martinez C, Keita ÅV, Pardon N, Santos J, Söderholm JD, Tack J, Farré R. Impaired duodenal mucosal integrity and low-grade inflammation in functional dyspepsia. Gut. 2014 Feb;63(2):262-71.
2: McIntosh K, Reed DE, Schneider T, Dang F, Keshteli AH, De Palma G, Madsen K, Bercik P, Vanner S. FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial. Gut. 2017 Jul;66(7):1241-1251.

Introduction

Obesity and type 2 diabetes mellitus (T2DM) represent growing global health challenges, affecting millions of individuals worldwide. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as a cornerstone in the management of both conditions due to their metabolic benefits, including weight loss and glycemic control. European cohort studies have reported a high prevalence of gastrointestinal symptoms – including nausea, vomiting and early satiety among patients using GLP-1RAs. In parallel, increased rates of residual gastric content (RGC) during upper endoscopy have raised safety concerns, prompting reevaluation of pre-procedural fasting guidelines. However, data on the effects of GLP1-RA on the gastrointestinal (GI) tract in Asian patients is limited.

Aims & Methods

Our primary aim was to characterize a cohort of patients who received treatment with GLP1-RA in terms of their gastrointestinal side effects and presence of RGC during upper endoscopy. The secondary objective was to compare the afore-mentioned variables between 2 groups: oral versus subcutaneous mode of administration. We conducted a retrospective cross-sectional cohort study of 139 Asian adult patients with T2DM and/or obesity who were prescribed GLP-1RAs at a tertiary hospital between 01 January 2022 to 01 January 2023. Data collected included demographics, anthropometric measurements, co-morbidities, GI symptoms and upper endoscopy findings. Upper endoscopy images were analysed and adequacy of mucosal visibility was graded using the POLPREP scale. Patients were further stratified into two subgroups based on route of GLP-1RA administration: oral versus subcutaneous. Statistical analysis compared symptom prevalence and POLPREP scores across subgroups using chi square test, with p <0.05 considered statistically significant.

Results

A total of 139 patients were analysed. 19.4% of patients had GLP-1RA prescribed for T2DM, 21.6% for Obesity, and 58.8% for both. The most commonly prescribed GLP-1RA was Liraglutide (33.8%) followed by oral Semaglutide (28.1%). Majority of patients (66.9%) did not have any GI side effects. The most commonly reported GI symptoms were abdominal bloating (15.8%), nausea (7.9%) and early satiety (4.3%). 13.7% of patients underwent upper endoscopy with 89.5% having a POLPREP score of 3 with no significant complications reported. None of the patients withheld GLP-1RA prior to endoscopy. Upon stratifying patients based on route of administration, analysis revealed that patients on oral GLP-1RAs were more likely to report nausea compared to those on subcutaneous formulations (15.8% vs 5.0%, p=0.03). There were no significant differences in the other GI symptoms or POLPREP scores.

Conclusion

Based on our Asian cohort, these findings suggest that GLP-1RAs have an acceptable GI symptom profile with a potential route-dependent difference in symptomatology. In addition, discontinuing these drugs prior to upper endoscopy may be unnecessary.

References

1. Camilleri et al. Effects of GLP-1 and other Gut Hormone Receptors on the Gastrointestinal tract and implications in clinical practice. Am J Gastroenterol 2024;119:1028-1037
2. Nadeem et al. Effects of glucagon-like peptide-1 receptor agonists on upper endoscopy in diabetic and nondiabetic patients. Gastrointestinal Endoscopy 2024.
3. Jalleh et al. Gastrointestinal effects of GLP-1 receptor agonists: mechanisms, management, and future directions. Lancet Gastroenterol Hepatol 2024;9:957-64
4. Facciorusso et al. Effects of Glucagon-like peptide-1 receptor agonists on upper gastrointestinal endoscopy: A meta-analysis. Clinical Gastroenterol and Hepatol 2024.
5. Romańczyk et al. Scoring system assessing mucosal visibility of upper gastrointestinal tract: The POLPREP scale. J Gastroenterol Hepatol 2022 Jan;37(1):164-168.

Disclosure

Nothing to disclose

Introduction

Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction affecting 5 to 10% of the population, combining chronic abdominal pain and altered bowel transit. Its varied and complex mechanisms make management difficult and can be responsible for impaired quality of life. Patient education is recommended for managing chronic diseases. As part of a patient education program, the first step is to assess patients' knowledge and needs by conducting a shared educational assessment. Experiments conducted in various countries have shown that therapeutic patient education (TPE) can be effective, reducing severity, improving quality of life, and reducing care seeking. These studies have also shown that patients often have a lack of knowledge and/or misconceptions about IBS (1).

Aims & Methods

This study aimed to assess the baseline knowledge level of patients enrolled in a patient education program. Patients with IBS were selected for participation in a TPE program following a multidisciplinary day hospital for IBS. All patients had to have seen a general practitioner and/or a gastroenterologist outside the team without sufficient improvement in their condition. The TPE was based on a document developed in collaboration with a patient organisation (APSSII). This program was divided into five 1-hour sessions (training and discussion time) conducted by different professionals (neurogastroenterologists, clinical psychologist, dietitian) covering the following points:
1) understanding my illness (epidemiology, diagnosis, mechanisms),
2) talking about my illness and expressing my needs (interaction with loved ones, work, doctor, school, rights and support);
3) organizing my daily life, improving my quality of life (impact of IBS on QoL, work, exercise, intimate life);
4) taking advantage of different treatments and care options (placebo, adverse effects, symptomatic and long-term treatment, alternative treatments);
5) the role of eating and diets (balanced diet, lactose-free, gluten-free, low-FODMAP, food allergies, risks of diets). Before the start of each session, questionnaires testing participants' knowledge on the session topic were completed.

Results

From November 2023 to September 2024, 135 questionnaires completed by 43 patients with IBS were included. 70% were women, mean age 45 ± 18 years, subtypes based on IBS transit: IBS-C 55%, IBS-D 33%, IBS-M 12%, with a mean severity (IBS-SSS) of 331 ± 72 points, EQ5D health score of 50 ± 21. Among the most common misconceptions, 25% believed that a diagnosis by endoscopy was possible, 48% believed the disease could be complicated by IBD, and 13% by colon cancer. Regarding treatments, 11% of patients believed that the placebo effect only concerned medications, 58% believed that faecal microbiota transplantation could currently be offered in clinical routine for IBS care, 78% believed that hypnotherapy was only effective if you believe in it, and 68% believed that multi-strain probiotics were more effective than single-strain ones.

Conclusion

This study, conducted in France on patients with moderate or severe forms of IBS, shows a highly variable level of knowledge about their disease depending on the questions, with some significant misconceptions that need to be addressed. These results justify the implementation of therapeutic education for these patients. A study is underway to verify the improvement in patients' knowledge and the existence of a positive impact of this strategy on symptom severity and quality of life.

References

(1) Halpert et al. What Patients Know About Irritable Bowel Syndrome (IBS) and What They Would Like to Know. National Survey on Patient Educational Needs in IBS and Development and Validation of the Patient Educational Needs Questionnaire (PEQ). Am J Gastroenterol 2007; 102:1972-82.

Disclosure

Nothing to disclose