Duodenal aspiration/culture identifies 45% of patients with suspected SIBO. GBT has lower sensitivity but good specificity for detection of SIBO. There were no ethnic or gender differences in the prevalence of SIBO, but patients with SIBO were older. Because GBT is non-invasive, it should be considered first in patients with suspected SIBO.

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Small intestinal fungal overgrowth (SIFO) is characterized by the presence of excessive number of fungal organisms in the small intestine associated with gastrointestinal (GI) symptoms. Candidiasis is known to cause GI symptoms particularly in immunocompromised patients or those receiving steroids or antibiotics. However, only recently, there is emerging literature that an overgrowth of fungus in the small intestine of non-immunocompromised subjects may cause unexplained GI symptoms. Two recent studies showed that 26 % (24/94) and 25.3 % (38/150) of a series of patients with unexplained GI symptoms had SIFO. The most common symptoms observed in these patients were belching, bloating, indigestion, nausea, diarrhea, and gas. The underlying mechanism(s) that predisposes to SIFO is unclear but small intestinal dysmotility and use of proton pump inhibitors has been implicated. However, further studies are needed; both to confirm these observations and to examine the clinical relevance of fungal overgrowth, both in healthy subjects and in patients with otherwise unexplained GI symptoms. Importantly, whether eradication or its treatment leads to resolution of symptoms remains unclear; at present, a 2-3-week course of antifungal therapy is recommended and may be effective in improving symptoms, but evidence for eradication is lacking.

Assessment of transit through the gastrointestinal tract provides useful information regarding gut physiology and pathophysiology. Although several methods are available, each has distinct advantages and limitations. Recently, an ingestible wireless motility capsule (WMC), similar to capsule video endoscopy, has become available that offers a less-invasive, standardized, radiation-free and office-based test. The capsule has 3 sensors for measurement of pH, pressure and temperature, and collectively the information provided by these sensors is used to measure gastric emptying time, small bowel transit time, colonic transit time and whole gut transit time. Current approved indications for the test include the evaluation of gastric emptying in gastroparesis, colonic transit in constipation and evaluation of generalised dysmotility. Rare capsule retention and malfunction are known limitations and some patients may experience difficulty with swallowing the capsule. The use of WMC has been validated for the assessment of gastrointestinal transit. The normal range for transit time includes the following: gastric emptying (2-5 hours), small bowel transit (2-6 hours), colonic transit (10-59 hours) and whole gut transit (10-73 hours). Besides avoiding the use of multiple endoscopic, radiologic and functional gastrointestinal tests, WMC can provide new diagnoses, leads to a change in management decision and help to direct further focused work-ups in patients with suspected disordered motility. In conclusion, WMC represents a significant advance in the assessment of segmental and whole gut transit and motility, and could prove to be an indispensable diagnostic tool for gastrointestinal physicians worldwide.

The recent development of closely spaced circumferential solid state transducers has paved the way for novel technology that includes high resolution anorectal manometry and topography (HRAM) and 3-D high definition anorectal manometry (HDAM). These techniques are increasingly being used for the assessment of anorectal neuromuscular function. However, whether they constitute a diagnostic advantage or a mere refinement of an old technology is unknown. Unlike the traditional manometry that utilized 3 or 6 unidirectional sensors, the closely spaced circumferential arrangement facilitates superior spatiotemporal mapping of pressures at rest and during various dynamic maneuvers. HDAM can provide knowledge of the three muscles that govern the anal continence namely, the puborectalis, and the internal and external anal sphincters, and can show how they mediate the rectoanal inhibitory reflex and sensorimotor responses and the spatiotemporal orientation of these muscles. Also, anal sphincter defects can be mapped and readily detected using 3-D technology. Similarly, HRAM has facilitated confirmation and development of phenotypes of dyssynergic defecation. Recently, normative data have also been reported with HRAM and HDAM, together with the influence of age, gender, and test instructions. The greater yield of anatomical and functional information may supersede the limitations of costs, fragility, and shorter life-span associated with these new techniques. Thus, HDAM and HRAM are not just new gadgets but constitute a significant and novel diagnostic advance. However, more prospective studies are needed to better define anorectal disorders with these techniques and to confirm their superiority.

BackgroundThe present study aimed to identify factors affecting vaccination against influenza among health professionals.MethodsWe used a multi-centre cross-sectional design to conduct an online self-administered questionnaire with physicians and nurses at state and foundation university hospitals in the south-east of Turkey, between 1 January 2015 and 1 February 2015. The five participating hospitals provided staff email address lists filtered for physicians and nurses. The questionnaire comprised multiple choice questions covering demographic data, knowledge sources, and Likert-type items on factors affecting vaccination against influenza. The target response rate was 20 %.ResultsIn total, 642 (22 %) of 2870 health professionals (1220 physicians and 1650 nurses) responded to the questionnaire. Participants’ mean age was 29.6 ± 9.2 years (range 17–62 years); 177 (28.2 %) were physicians and 448 (71.3 %) were nurses. The rate of regular vaccination was 9.2 % (15.2 % for physicians and 8.2 % for nurses). Increasing age, longer work duration in health services, being male, being a physician, working in an internal medicine department, having a chronic disease, and living with a person over 65 years old significantly increased vaccination compliance (p < 0.05). We found differences between vaccine compliant and non-compliant groups for expected benefit from vaccination, social influences, and personal efficacy (p < 0.05). Univariate analysis showed differences between the groups in perceptions of personal risks, side effects, and efficacy of the vaccine (p < 0.05). Multivariate analysis found that important factors influencing vaccination behavior were work place, colleagues’ opinions, having a chronic disease, belief that vaccination was effective, and belief that flu can be prevented by natural ways.ConclusionNumerous factors influence health professionals’ decisions about influenza vaccination. Strategies to increase the ratio of vaccination among physicians and nurses should consider all of these factors to increase the likelihood of success.

SUMMARY Background Fiber supplements are useful, but whether a plum-derived mixed fiber that contains both soluble and insoluble fiber improves constipation is unknown. Aim We investigated the efficacy and tolerability of mixed fiber versus psyllium in a randomized double blind controlled trial. Methods Constipated patients (Rome III) received mixed fiber or psyllium, 5g bid, for 4 weeks. Daily symptoms and stool habit were assessed using stool diary. Subjects with ≥1 complete spontaneous bowel movement (CSBM)/week above baseline for ≥ 2/4 weeks were considered responders. Secondary outcome measures included stool consistency, bowel satisfaction, straining, gas, bloating, taste, dissolvability and Quality of Life (QOL). Results 72 subjects (MF=40; psyllium=32) were enrolled and 2 from psyllium group withdrew. The mean CSBM/week increased with both mixed fiber (p<0.0001) and psyllium (p=0.0002) without group difference. There were 30 (75%) responders with mixed fiber and 24 (75%) with psyllium (p=0.9). Stool consistency increased (p=0.04), straining (p=0.006), and bloating scores decreased (p=0.02) without group differences. Significantly more patients reported improvement in flatulence (53% vs. 25%, p=0.01) and felt that mixed fiber dissolved better (p=0.02) compared to psyllium. QOL improved (p=0.0125) with both treatments without group differences. Conclusions Mixed fiber and psyllium were equally efficacious in improving constipation and QOL. Mixed fiber was more effective in relieving flatulence, bloating and dissolved better. Mixed fiber is effective and well tolerated. Clinical Trial No: NCT01288508

Carvacrol and thymol, both used as flavor agents in cosmetic and food products, have prooxidant and antioxidant activities. To clarify the mechanisms of their cytotoxicity and the factors affecting their antioxidant/prooxidant activities, we investigated cell membrane and DNA damage induced by carvacrol and thymol in parental and drug-resistant human lung cancer cell lines. After 24 and 48 hour incubation periods, the cytotoxicity of carvacrol (IC 50 380 and 244 µM) was found to be higher than that of thymol (IC 50 497 and 266 µM) in parental cells. However, thymol showed higher cytotoxic effects in drug resistant H1299 cells for three incubation periods. Also, carvacrol and thymol, at higher concentrations, increased malondealdehyde (MDA) levels causing membrane damage and 8-hydroxy deoxyguanozine (8-OHdG) levels, causing DNA damage to both parental and drug resistant cells. On the other hand, carvacrol and thymol protected the cells against H 2 O 2-induced cytotoxicity, and membrane and DNA damage when the cells were preincubated with these two compounds at lower concentration (