Diagnosis and Treatment of Rumination Syndrome.

http://www.thelancet.com/article/S0140673622015458/pdf

Effect of statin therapy on muscle symptoms: an individual participant data meta-analysis of large-scale, randomised, double-blind trials

Rumination syndrome is a functional gastrointestinal disorder characterized by effortless, postprandial regurgitation. Duodenal eosinophilia has been described in patients with functional dyspepsia. Because of the significant symptomatic overlap between functional dyspepsia and rumination syndrome, we hypothesized that histological changes might exist among patients with rumination syndrome. We included patients with rumination syndrome in whom we had obtained duodenal biopsies and compared these with controls. Digital images of biopsy specimens were analyzed for routine pathology and eosinophil counts by a pathologist blinded to the case–control status. The 22 patients with rumination syndrome had a mean age of 39.2 years (range 21–71) and 77% were female. The 10 controls had a mean age of 34.3 (range 27–69) and 80% were female. There was a significant increase in the mean eosinophil count among the patients with rumination syndrome compared to controls, 26 per mm2 (range 16–42) versus 18 per mm2 (range 10–28), p = 0.006. Intraepithelial lymphocyte counts were significantly higher in rumination patients (mean 15/100 enterocytes, range 8–29) versus controls (mean 11/100 enterocytes, range 11–18), p = 0.02. Patients with rumination syndrome have subtle duodenal pathology with eosinophilia and increased intraepithelial lymphocyte counts compared to controls.

Duodenal Pathology in Patients with Rumination Syndrome: Duodenal Eosinophilia and Increased Intraepithelial Lymphocytes.

It is estimated that 2.6 million deaths worldwide can be attributed to hypercholesterolemia. The main reason for non-adherence to statin therapy are the statin-associated muscle symptoms (including nocebo/drucebo effect). In this case, apart from ezetimibe, nutraceuticals are prescribed. We aimed to assess the comparative efficacy of different nutraceuticals in terms of lowering low density lipoprotein cholesterol (LDL-C) and improving lipid profile. Electronic and hand searches were performed until February 2021. The inclusion criteria were the following: (1) randomized trial with any of the reportedly LDL-C lowering nutraceutical: artichoke, berberine, bergamot, garlic, green tea extract, plant sterols/stanols, policosanols, red yeast rice (RYR), silymarin or spirulina. (2) outcome either LDL-C (primary outcome), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) or serum triglycerides (TG). Random effects network meta-analysis (NMA) was performed to rank the effect of each intervention using frequentist approach. Finally, a total of 131 trials enrolling 13,062 participants were included. All analysed nutraceuticals except for policosanols were more effective in lowering LDL-C (-1.21 [-46.8 mg/dL] to -0.17 [-6.6 mg/dL] mmol/l reduction) and TC (-1.75 [-67.7 mg/dL] to -0.18 [7 mg/dL] mmol/l reduction) than placebo/no intervention. The most effective approaches in terms of LDL-C- and TC-lowering were bergamot and RYR (-1.21 [-46.8 mg/dl] and -0.94 [-36.4 mg/dl] mmol/l) reduction respectively. In conclusion, bergamot and RYR appear to be the most effective nutraceuticals in terms of LDL-C and TC reduction. Evidence for bergamot effect was based on relatively small study group and may require further investigations. Policosanols have no effect on the lipid profile. 

A network meta-analysis on the comparative effect of nutraceuticals on lipid profile in adults.

Research indicates that regurgitation and reingestion (R/R) is a relatively common behaviour in zoo‐housed great apes, with most studies to date carried out on Western lowland gorillas Gorilla gorilla gorilla and Chimpanzees Pan troglodytes. R/R is an abnormal behaviour because great apes are not anatomically adapted to regurgitate their food as part of their normal feeding processes, and because this behaviour has not been observed in members of the species living freely in the wild, in conditions that would allow a full behavioural range. In this article, an overview is given of the published literature on R/R in great apes, which suggests that this behaviour is probably multifactorial and may be linked to inappropriate feeding environments (e.g. in terms of nutritional composition of the diet and/or presentation of food), and possibly also social and other factors. A similar behaviour to R/R, known as rumination disorder, can occur in humans (another great ape species), in whom it is classified as a feeding and eating disorder, and there are potential consequences to people's physical health as a result of oral acid. There have been no known studies to date to identify whether or not similar health consequences can occur in non‐human great apes, but the regurgitant has been found to be significantly more acidic in gorillas than the food they ingested originally, meaning it is potentially injurious in non‐human great apes. There is much that is not yet known about R/R and how to reduce or eliminate it when it does occur. The research indicates that there are a range of factors involved and these can vary by individual animal. More research into this behaviour is clearly needed to ensure that zoos and sanctuaries are providing the best possible care for these animals, and some suggestions for future research directions are included in this review.

/pdf/regurgitation-and-reingestion-r-r-in-great-apes-a-review-of-1ezj69u99k.pdf

‘Regurgitation and reingestion’ (R/R) in great apes: A review of current knowledge

Statin intolerance is a clinical syndrome whereby adverse effects (AEs) associated with statin therapy [most commonly statin‐associated muscle symptoms (SAMS)] result in the discontinuation of therapy and consequently increase the risk of adverse cardiovascular outcomes. However, complete statin intolerance occurs in only a small minority of treated patients (estimated prevalence of only 3–5%). Many perceived AEs are misattributed (e.g. physical musculoskeletal injury and inflammatory myopathies), and subjective symptoms occur as a result of the fact that patients expect them to do so when taking medicines (the nocebo/drucebo effect)—what might be truth even for over 50% of all patients with muscle weakness/pain. Clear guidance is necessary to enable the optimal management of plasma in real‐world clinical practice in patients who experience subjective AEs. In this Position Paper of the International Lipid Expert Panel (ILEP), we present a step‐by‐step patient‐centred approach to the identification and management of SAMS with a particular focus on strategies to prevent and manage the nocebo/drucebo effect and to improve long‐term compliance with lipid‐lowering therapy.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/jcsm.12960

Step‐by‐step diagnosis and management of the nocebo/drucebo effect in statin‐associated muscle symptoms patients: a position paper from the International Lipid Expert Panel (ILEP)

Rumination syndrome is the effortless regurgitation of recently ingested food with subsequent reswallowing or spitting out. Dental erosion (DE) affects 2% to 5% of the population. DE is defined as loss of tooth structure by a chemical process that does not involve bacteria. Our objective was

Julio Acosta

Papers

Step‐by‐step diagnosis and management of the nocebo/drucebo effect in statin‐associated muscle symptoms patients: a position paper from the International Lipid Expert Panel (ILEP)

Rumination Syndrome and Dental Erosions in Children.