Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study

Perceptions and Practices of Primary Care Providers in Europe and the US in the Diagnosis and Treatment of Irritable Bowel Syndrome: A Multinational Survey

BACKGROUND

The knowledge and proficiency of primary care practitioners (PCPs) in diagnosing and managing irritable bowel syndrome (IBS) remain generally low and variable internationally. This variability is partly due to a lack of familiarity with the Rome Foundation diagnostic criteria and treatment guidelines for this condition.

METHODS

We conducted an electronic survey of PCPs in the United States and nine European countries to assess their understanding of IBS pathophysiology; the use of Rome IV criteria in diagnosis, knowledge of and frequency in prescribing various recommended treatments; and the likelihood of referring patients with suspected IBS to subspecialists.

RESULTS

Most PCPs in the United States and Europe perceive IBS as a diagnosis of exclusion rather than a definitive diagnosis. They also believe IBS is underdiagnosed in primary care and challenging to diagnose confidently. The majority of PCPs consider diet as a crucial component of IBS management. Notably, US PCPs reported greater confidence than their European counterparts in recommending dietary interventions such as increased dietary fiber, a low FODMAP diet, and gluten restriction. Conversely, both groups exhibited moderate to high confidence in recommending over-the-counter treatments. European PCPs showed greater confidence in treating IBS with antispasmodics and secretagogues, while US PCPs expressed greater confidence in prescribing neuromodulators. Additionally, US PCPs were more likely to refer patients with suspected IBS to a gastroenterologist, whereas both US and European PCPs showed similar referral patterns to dietitians and referred very few patients to mental health providers. Both US and European PCPs reported that IBS is moderately to extremely difficult to treat effectively and emphasized the importance of a strong and longitudinal doctor-patient relationship in managing the condition.

CONCLUSION

Despite the Rome Foundation recommendations and criteria to support a positive diagnosis of IBS, most PCPs still rely on exclusionary investigations such as endoscopy and a serologic workup, while a significant percentage suggest referring patients to gastroenterologists.

Evaluation of Perceived Competence and Satisfaction in Neurogastroenterology and Motility Training During the Gastroenterology Fellowship in Spain

INTRODUCTION

We evaluated the level of achievement of the published recommendations of the European and American neurogastroenterology and motility (NGM) Societies, on the competence in managing NGM disorders in a European Country with regulated gastroenterology training program.

METHODS

We conducted a nationwide survey to gastroenterologists in Spain. Information regarding demographics, training center characteristics, NGM training, self-reported interest, satisfaction with the Tier 1 skills recommended by the ANMS-ESNM, and perceived competence in the diagnosis and management of diseases in the spectrum of NGM was obtained.

RESULTS

Surveys of 222 participants were analyzed (age 31 ± 3 years, 68% female, 77% specialists, 23% residents). During GI training, the average time spent on NGM was 4 (IQR 2-8) weeks, and 14% of participants reported they did not have any (0 weeks total) specific time dedicated to NGM in their training center. Ninety-two (41%) participants reported low satisfaction in the NGM skills obtained during training. There was a disparity in the skills acquired, being greatest for gastroesophageal reflux disease and lowest for colonic inertia (97% and 19% confident, respectively). Multiple regression analysis showed that the weeks of specific training in NGM was an independent factor associated with perceived satisfaction in the skills obtained (IC 95% 1.8-2.9, p < 0.001).

CONCLUSION

Our data reveal a relevant deficit in training on NGM during gastroenterology fellowships and highlight the urgent need to extend and standardize the time allocated to learning NGM in the training programs, as training time correlates with satisfaction in the skills obtained.

Epidemiology of Rome IV Fecal Incontinence in Japan: An Internet Survey of 9995 Individuals

BACKGROUND

Fecal incontinence (FI) is a debilitating condition defined as recurrent uncontrolled passage of fecal material according to Rome IV. Although FI greatly impacts patients' health-related quality of life (HRQOL), there have been few studies about the prevalence of FI in the Japanese general population. The aim of this study was to investigate the epidemiology of FI using Rome IV criteria in Japan.

METHODS

This was a cross-sectional internet survey for Japanese individuals aged 18 to 79 years using a questionnaire about demographics, comorbidities, lifestyle, abdominal symptoms, bowel habits, HRQOL, and disorders of gut-brain interaction according to Rome IV diagnostic criteria. Multivariate linear regression analysis identified factors associated with FI fulfilling Rome IV criteria (Rome IV FI).

RESULTS

Overall, 9995 subjects were analyzed. Of which, 9.5% of the participants had at least one episode of FI in the last 3 months, and the prevalence of Rome IV FI was 1.2%. HRQOL was significantly impaired in patients with Rome IV FI compared to continent individuals. Major functional bowel disorders overlapped with 39.5% of Rome IV FI where functional diarrhea (25.8%) was the most predominant. The overlap further impaired HRQOL in Rome IV FI patients. Alcohol consumption (odds ratio 1.82, 95% CI 1.24-2.66, p = 0.002) was independently related to Rome IV FI apart from gastroesophageal reflux disease, irritable bowel syndrome, functional abdominal bloating/distension, and functional diarrhea.

CONCLUSIONS

The prevalence of Rome IV FI was 1.2% in Japan. Further study is warranted to investigate the effect of lifestyle modification on the management of FI.

Sex Differences, Menses-Related Symptoms and Menopause in Disorders of Gut-Brain Interaction

BACKGROUND

Disorders of gut-brain interaction (DGBI) predominate in women, but little is known about sex differences in menses-related or menopause symptoms.

METHODS

Using data from the Rome Foundation Global Epidemiology Survey, we assessed Rome IV DGBI symptoms in individuals in 26 countries who met criteria for ≥ 1 of 5 DGBI: irritable bowel syndrome (IBS), functional dyspepsia (FD), functional constipation (FC), functional diarrhea (FDr), or functional bloating (FB). Participants included pre- and post-menopausal women with DGBI and age-matched men. Odds ratios estimated sex and age differences for symptom by sex or pre- vs. post-menopause in logistic regression; standardized mean difference (SMD) provided effect sizes.

KEY RESULTS

14,570 participants met criteria for ≥ 1 of the 5 DGBI. Women exceeded men in most symptoms. In FD, women stopped eating due to early satiety more than men (11.1 vs. 8.9 days/month, SMD 0.21). Symptoms were generally increased in premenopausal women and younger men compared to older counterparts; however, only premenopausal IBS, FD, and FC women reported increased constipation-associated symptoms. Compared to premenopausal women, postmenopausal women had increased accidental stool leakage in IBS and FDr, and increased digital manual maneuvers in FC (18% vs. 25% frequency, SMD -0.25). IBS and FD had the most menses-associated symptoms.

CONCLUSIONS AND INFERENCES

Women had higher symptom frequency across the 5 DGBI compared to men. Our findings suggest that premenopausal women have greater visceral perception than postmenopausal women, although increased outlet symptoms in postmenopausal women indicate greater anorectal/pelvic dysfunction. While age alone has some influence on symptoms, female sex hormones may also increase visceral perception.

Systematic Review: Integrated Models of Care for Managing Irritable Bowel Syndrome

BACKGROUND

Multidisciplinary integrated models of care show promise for improving symptoms and quality of life (QoL) in adults with irritable bowel syndrome (IBS).

AIMS

To describe and evaluate the characteristics of integrated models of care for IBS and identify how digital health is being used in these models of care.

METHODS

Four databases were searched to March 2024 for studies that included adults with IBS who participated in multidisciplinary integrated models of care that delivered non-pharmacological therapies. The template for intervention description and replication (TIDieR) checklist was used to appraise study quality and extract model of care characteristics, which were mapped against the Project INTEGRATE framework to establish topics.

RESULTS

Sixteen studies (6 randomized controlled trials, 2 quasi-experimental, 8 cohort studies) reported 14 integrated models of care including 2165 patients of which 918 were IBS patients. Integrated models of care led to improved IBS symptoms (n = 11/13 models of care) and QoL (n = 6/9 models of care). Studies showed moderate compliance with the TIDieR checklist. Five topics were established: clinicians involved, therapies provided, location and mode of delivery, coordinating clinical partnerships, and sharing visions and values of integrated care. Most commonly, a gastroenterologist coordinated care with a psychologist, dietitian, and/or nurse in tertiary care. Psychological, dietary, and physical therapies were provided by n = 11, n = 8, and n = 3 integrated models of care, respectively. Six models of care provided joint consultations or group sessions. Four models of care used digital health such as telephone coaching or online modules.

CONCLUSIONS

Integrated models of care for IBS exhibited diverse characteristics including the clinicians involved, the therapies provided and the mode of delivery of each therapy. There is a need to evaluate the use of digital health and the delivery of integrated models of care in primary care settings.

A service evaluation of FODMAP restriction, FODMAP reintroduction and long-term follow-up in the dietary management of irritable bowel syndrome

BACKGROUND

The dietary restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), called the low-FODMAP diet (LFD), is frequently used to manage irritable bowel syndrome (IBS). This service evaluation aimed to assess the long-term effectiveness of the LFD in managing IBS symptoms and whether symptom response and dietary adherence to the LFD were associated.

METHODS

This observational service evaluation collected data via questionnaires during clinical dietetic appointments for IBS management. Symptom severity was reported at baseline, short term (following FODMAP restriction) and long term (following FODMAP reintroduction). Additional data that captured experiences following the LFD were collected at long-term follow-up.

RESULTS

Of 184 patients, 14% reported satisfactory relief from global symptoms at baseline, which increased to 69% at short-term follow-up and 57% at long-term follow-up (p < 0.001). The most notable improvements in individual symptoms between baseline and long-term follow-up were abdominal bloating (72% baseline, 48% long term, p < 0.001), abdominal pain (61% baseline, 30% long term, p < 0.001) and flatulence (71% baseline, 40% long term, p < 0.001). High adherence with the LFD at short-term follow-up was not associated with long-term symptom improvement, but there was an association between long-term adherence and global symptom severity (p = 0.032). Completion of FODMAP reintroduction as per protocol was associated with long-term symptom improvement (p = 0.049).

CONCLUSIONS

The LFD is an effective treatment for managing IBS symptoms in the long term, particularly, when the diet is adhered to and reintroduction is completed as per dietetic education. Further randomised-controlled trials are required to explore the cause-and-effect relationship between LFD and IBS symptom management.

Oral Health Is Associated with Disorders of Gut-Brain Interaction in Adult Women

BACKGROUND

The disorders of gut-brain interaction (DGBI) form a heterogeneous group of gastrointestinal disorders that, to date, have no organic basis. The role of oral health in the development of these disorders has not been explored.

OBJECTIVE

The objective of this study was to examine the relationship between oral health and the DGBI.

METHODS

Data obtained from 166 women with (n = 113) and without fibromyalgia (n = 55) during a prospective observational study conducted in New Zealand during 2022 was evaluated for correlations between oral health measures (WHO oral health questionnaire), and the DGBI (Rome IV survey).

RESULTS

Of the 166 women enrolled in the study, 122 (73.5%) met criteria for at least one DGBI. Women who met criteria for any of the esophageal, gastroduodenal, bowel, and anorectal disorders had significantly lower oral health scores (p < 0.001). For 12 specific DGBI, oral health scores were significantly lower (p < 0.05). Oral health scores were inversely associated with the number of DGBI detected in each participant (ρ = - 0.590, p < 0.001, 95% CI [- 0.69, - 0.48]).

CONCLUSION

The results of this study suggest there is an association between the oral health and the presence, type, and number of DGBIs in women. Further research to examine the nature of this relationship is required.

Current state of the non-pharmacological management of irritable bowel syndrome: an up-to-date review of the literature

Irritable bowel syndrome (IBS) is a complex disorder of gut-brain interaction (DGBI) that is thought to affect a significant proportion of the population. As a result of the nature of IBS, it is hard to predict treatment efficacy as all individuals respond differently, and thus multidisciplinary treatment has become increasingly of interest as it targets multiple aspects of IBS at the same time. Here, we aim to review the literature of both multidisciplinary and single-discipline therapy for IBS. Ovid MEDLINE was utilised with a systematic search to find relevant randomised controlled trials. The population included adults with a Rome diagnosis of IBS and an intervention that was either multidisciplinary care, diet, psychotherapy, gut-directed hypnotherapy (GDH) or physiotherapy. Multidisciplinary care studies found an overall significant improvement, while dietary treatment was varied. A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols diet was the only one to improve symptoms, while gluten-free and fibre diets had mixed evidence for their efficacy. Novel diets, including a tritordeum-based diet and low tryptophan diet, significantly improved symptoms. Cognitive behavioural therapy was found to be efficacious when compared to controls, as was psychoeducation. GDH was also found to be efficacious, but 83.3% of studies examined a refractory IBS population. There is a lack of literature looking at how multidisciplinary care and different combinations of disciplines work to treat those with IBS in secondary care. Further studies are required for a greater understanding of how multidisciplinary care may be utilised to better manage IBS.

Patients with functional gastrointestinal disorders spend less time in tertiary care when managed by a single clinician: results of a multicentre audit in South Australia

BACKGROUND AND AIMS

Functional gastrointestinal disorders (FGIDs) impact quality of life and represent a significant burden on healthcare services. Guidelines recommend an early, positive diagnosis to reduce harmful over-investigation in FGID patients. The aim of this multicentre study was to evaluate FGID management against current guidelines.

METHODS

A multicentre, retrospective evaluation of patients with a primary diagnosis of FGID across two tertiary gastroenterology services over a 12-month period was performed. Time to diagnosis of a FGID, number of outpatient encounters, number and type of investigations performed and time to discharge from the outpatient service were assessed. Whether care was delivered by single or multiple clinicians was recorded. Statistical analysis was performed using Student's t test, logistic regression analysis and Kaplan-Meir curves.

RESULTS

Between June 2021 and June 2022, 275 individual patients were reviewed primarily for FGID. Median time to FGID diagnosis was 70 days (interquartile range (IQR): 0-175), over a median of four outpatient encounters (IQR: 3-6), with an overall time in service of 182 days (IQR: 105-344). When care was delivered by a single rather than multiple clinicians, patients were more likely to receive a FGID diagnosis early (hazard ratio (HR): 1.6, 95% confidence interval (CI): 1.25-2.04, P < 0.0001), be discharged sooner (HR: 1.83, 95% CI: 1.44-2.33, P < 0.0001), with a trend towards less harmful investigations (odds ratio: 1.79, 95% CI: 0.96-3.58, P = 0.08).

CONCLUSIONS

Consistent delivery of clinical care reduces healthcare utilisation in the management of FGIDs. Further studies are needed to identify optimal care models for managing outpatients with FGIDs.

Incidence and Clinical Course of Post-infectious Irritable Bowel Syndrome in Patients Admitted to University Hospitals: 1-year Prospective Follow-up Study

Background/Aims

Post-infectious irritable bowel syndrome (PI-IBS) is characterized by chronic gastrointestinal symptoms that arise following an episode of infectious enteritis. The incidence rates vary, ranging from 5% to 32% and the risk factors are not well known. We aim to investigate the incidence and risk factors of PI-IBS in enteritis patients admitted to university hospitals in Korea.

Methods

This multi-center prospective study was conducted in patients hospitalized for infectious enteritis. Each patient underwent 1 outpatient visit and 3 telephone surveys during the first year after discharge to determine if PI-IBS occurred within the follow-up period.

Results

In the 3-month survey, 7 out of 354 patients (2%) were diagnosed with PI-IBS, and after 1 year, only 1 patient met the criteria for IBS. No statistically significant difference was found between the PI-IBS group and the non-PI-IBS group in terms of age, sex, underlying diseases, medication history, gastrointestinal symptoms, enteritis location, causative strain, hospitalization and treatment periods, and laboratory findings. Female sex (P = 0.003), enteropathogenic Escherichia coli (EPEC) infection (P = 0.044), and a longer total treatment period (P = 0.018) were independent risk factors for diarrhea lasting ≥ 3 months after enteritis.

Conclusions

The incidence of PI-IBS in Korea was relatively low, and most cases improved over time. No risk factors associated with the development of PI-IBS were found. However, persistent diarrhea after enteritis was associated with female sex, EPEC infection, and severe or long-lasting enteritis. IBS symptoms may persist after severe enteritis but usually improve with time.

Serum salusin levels in diarrhea- and constipation-predominant irritable bowel syndrome

Objective

Inflammation and immunity play major roles in the etiopathogenesis of functional intestinal disorders. The salusins that were identified in this study are important because of their ease of collection, sensitivity and reliability. For that reason, the aim of this study was to analyze the importance of the levels of salusin in the blood, an inflammation-related parameter, in the diagnosis and prediction of irritable bowel disease.

Methodology

The study participants included 28 diagnosed with constipation-predominant IBS, 29 (34.1%) diagnosed with diarrhea-predominant IBS (D-IBS), and 28 (32.9%) controls. Enzyme-linked immune-sorbent assay (ELISA) method has been used for the measurement of salusin levels.

Results

Participants were 50 (58.8%) female and 35 (41.2%) male. The serum levels of salusin-α were substantially reduced in the diarrhea-predominant IBS group vs controls. There was also no major difference in the levels of salusin between the constipation-predominant-IBS and the diarrhea-predominant IBS group.

Conclusion

A major prognostic relationship was found between the level of salusins and the subgroup of D-IBS. It is well known that salusins have been related to inflammatory processes and oxidative injury in previous studies. The relationship between salusin and gastrointestinal diseases should be further investigated. Low-grade submucosal intestinal inflammation is also associated with irritable bowel syndrome. It is our belief that salusins may be useful in diagnosing, predicting or treating IBS.

Plasma levels of ghrelin, neuropeptide Y, and urocortin-1 in patients with different subtypes of functional dyspepsia

BACKGROUND

Functional dyspepsia (FD) is a common disease of the digestive system, and its burden on medical resources is increasing year by year. Brain-gut axis dysfunction is considered to be an important pathogenesis of the disease, and brain-gut peptide plays an important role in the regulation of the brain-gut axis. In this study, plasma levels of acyl ghrelin (AG), desacyl ghrelin (DAG), neuropeptide Y (NPY), and urocortin-1 (UCN-1) were measured, and generalized Anxiety Disorder Scale and Patient Health Questionnaire Depression Scale were used to assess the psychosocial status of patients to reveal their differences among different FD subtypes.

AIM

To determine the plasma levels of AG, DAG, NPY and UCN-1 in patients with different subtypes of FD, and to investigate the psychosocial status of patients with FD, in order to find effective theoretical support for clinical treatment.

METHODS

From February 2022 to March 2023, 53 patients with FD (all meeting Rome IV diagnostic criteria) were selected from the Department of Gastroenterology of the Second Hospital of Tianjin Medical University, including 19 cases in postprandial discomfort syndrome (PDS) group, 19 cases in overlap syndrome group, and 15 cases in epigastric pain syndrome (EPS) group. Fifteen healthy volunteers who underwent medical check-ups during the same time period were selected as a healthy control group. All study subjects were tested for plasma AG, DAG, NPY, and UCN-1 levels by enzyme-linked immunoassay, and four scales, namely, the Nepean Dyspepsia Symptom Index Rating Scale, Nepean Quality of Life Index Rating Scale, Generalized Anxiety Disorder Scale, and Patient Health Questionnaire Depression Scale, were used to assess the psychosocial status of the subjects.

RESULTS

The level of serum AG in the PDS group was lower than those of the control (P < 0.001), EPS (P < 0.001), and overlap syndrome groups (P = 0.030). The level of serum AG in the overlap syndrome group was lower than those of the control (P = 0.017) and EPS groups (P = 0.008). However, no significant difference was found in serum AG between the EPS and control groups (P = 0.684). The differences in plasma DAG levels were not significant between the PDS and control groups (P = 0.458), between the EPS and control groups (P = 0.638), between the overlap syndrome and control groups (P = 0.612), between the PDS and EPS groups (P = 0.170), between the PDS and overlap syndrome groups (P = 0.709), and between the EPS and overlap syndrome groups (P = 0.239). The level of serum NPY in the PDS group was lower than those of the control (P = 0.043), EPS (P = 0.044), and overlap syndrome groups (P = 0.049), but no significant difference was found between the EPS and control groups (P = 0.971), between the EPS and overlap syndrome groups (P = 0.929), and between the overlap syndrome and control groups (P = 0.929). The level of serum UCN-1 in the PDS group was higher than those of the control (P = 0.036), EPS (P = 0.015), and overlap syndrome groups (P = 0.045), but no significant difference was found between the the EPS and control groups (P = 0.978), between the EPS and overlap syndrome groups (P = 0.571), and between the overlap syndrome and control groups (P = 0.649). The difference in the levels of anxiety and depression was statistically different between the FD group and the control group (P < 0.001), but the difference was not statistically significant between any two of the FD subgroups (P = 0.471 for anxiety, P = 0.171 for depression).

CONCLUSION

Except between the EPS group and the healthy control group, the differences in plasma AG between any two of the other groups are statistically significant, suggesting that AG may be crucial in the pathogenesis of FD and its level can predict the clinical manifestations of FD. There is no significant difference in plasma DAG between any two of the groups, suggesting that DAG might not be involved in the pathogenesis of FD. Compared with the other three groups, the differences of plasma AG, NPY, and UCN-1 in the PDS group were statistically significant, suggesting that these three brain and intestinal peptides may be involved in the pathogenesis of PDS. FD patients are more likely to be complicated with anxiety and depression, and the more severe the dyspepsia symptoms of FD patients, the more serious the degree of anxiety and depression, and the greater the impact on the quality of life, suggesting that improving patients' emotional problems is very helpful to improve the long-term efficacy for FD.

Plasma levels of ghrelin, neuropeptide Y, and urocortin-1 in patients with different subtypes of functional dyspepsia

BACKGROUND

Functional dyspepsia (FD) is a common disease of the digestive system, and its burden on medical resources is increasing year by year. Brain-gut axis dysfunction is considered to be an important pathogenesis of the disease, and brain-gut peptide plays an important role in the regulation of the brain-gut axis. In this study, plasma levels of acyl ghrelin (AG), desacyl ghrelin (DAG), neuropeptide Y (NPY), and urocortin-1 (UCN-1) were measured, and generalized Anxiety Disorder Scale and Patient Health Questionnaire Depression Scale were used to assess the psychosocial status of patients to reveal their differences among different FD subtypes.

AIM

To determine the plasma levels of AG, DAG, NPY and UCN-1 in patients with different subtypes of FD, and to investigate the psychosocial status of patients with FD, in order to find effective theoretical support for clinical treatment.

METHODS

From February 2022 to March 2023, 53 patients with FD (all meeting Rome IV diagnostic criteria) were selected from the Department of Gastroenterology of the Second Hospital of Tianjin Medical University, including 19 cases in postprandial discomfort syndrome (PDS) group, 19 cases in overlap syndrome group, and 15 cases in epigastric pain syndrome (EPS) group. Fifteen healthy volunteers who underwent medical check-ups during the same time period were selected as a healthy control group. All study subjects were tested for plasma AG, DAG, NPY, and UCN-1 levels by enzyme-linked immunoassay, and four scales, namely, the Nepean Dyspepsia Symptom Index Rating Scale, Nepean Quality of Life Index Rating Scale, Generalized Anxiety Disorder Scale, and Patient Health Questionnaire Depression Scale, were used to assess the psychosocial status of the subjects.

RESULTS

The level of serum AG in the PDS group was lower than those of the control (P < 0.001), EPS (P < 0.001), and overlap syndrome groups (P = 0.030). The level of serum AG in the overlap syndrome group was lower than those of the control (P = 0.017) and EPS groups (P = 0.008). However, no significant difference was found in serum AG between the EPS and control groups (P = 0.684). The differences in plasma DAG levels were not significant between the PDS and control groups (P = 0.458), between the EPS and control groups (P = 0.638), between the overlap syndrome and control groups (P = 0.612), between the PDS and EPS groups (P = 0.170), between the PDS and overlap syndrome groups (P = 0.709), and between the EPS and overlap syndrome groups (P = 0.239). The level of serum NPY in the PDS group was lower than those of the control (P = 0.043), EPS (P = 0.044), and overlap syndrome groups (P = 0.049), but no significant difference was found between the EPS and control groups (P = 0.971), between the EPS and overlap syndrome groups (P = 0.929), and between the overlap syndrome and control groups (P = 0.929). The level of serum UCN-1 in the PDS group was higher than those of the control (P = 0.036), EPS (P = 0.015), and overlap syndrome groups (P = 0.045), but no significant difference was found between the the EPS and control groups (P = 0.978), between the EPS and overlap syndrome groups (P = 0.571), and between the overlap syndrome and control groups (P = 0.649). The difference in the levels of anxiety and depression was statistically different between the FD group and the control group (P < 0.001), but the difference was not statistically significant between any two of the FD subgroups (P = 0.471 for anxiety, P = 0.171 for depression).

CONCLUSION

Except between the EPS group and the healthy control group, the differences in plasma AG between any two of the other groups are statistically significant, suggesting that AG may be crucial in the pathogenesis of FD and its level can predict the clinical manifestations of FD. There is no significant difference in plasma DAG between any two of the groups, suggesting that DAG might not be involved in the pathogenesis of FD. Compared with the other three groups, the differences of plasma AG, NPY, and UCN-1 in the PDS group were statistically significant, suggesting that these three brain and intestinal peptides may be involved in the pathogenesis of PDS. FD patients are more likely to be complicated with anxiety and depression, and the more severe the dyspepsia symptoms of FD patients, the more serious the degree of anxiety and depression, and the greater the impact on the quality of life, suggesting that improving patients' emotional problems is very helpful to improve the long-term efficacy for FD.

Repackaging and Performance Analysis of Implantable Pressure Sensor

In recent years, repackaging technology has been widely used in miniaturized implantable pressure sensors. However, the current packaging structure still has significant problems regarding biocompatibility, environmental adaptability, and measurement accuracy, which greatly limits its application in vivo measurement systems. In this paper, we report a method for implantable pressure sensor repackaging based on silicone oil, polydimethylsiloxane (PDMS) film, and polymer (parylene) coating. A systematic investigation using finite element analysis is conducted to assess the impact of packaging components on sensor performance, providing a solid theoretical foundation for packaging optimization. Experimental results demonstrate that when the parylene coating thickness is below 30 µm, the sensors exhibit superior linearity, repeatability, and reliability, along with exceptional stability and dynamic response across clinically relevant pressure ranges. This research provides valuable insights into the packaging design of implantable pressure sensors, facilitating the development of more stable, reliable, and cost-effective sensors for in vivo measurement systems.

An evidence-based update on the diagnosis and management of irritable bowel syndrome

INTRODUCTION

Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction affecting 5% of the population. The cardinal symptoms are abdominal pain and altered stool form or frequency.

AREAS COVERED

Diagnosis and management of IBS. We searched the literature for diagnostic accuracy studies, randomized controlled trials, and meta-analyses. A positive diagnosis of IBS, alongside testing to exclude celiac disease, is recommended. Exhaustive investigation has a low yield. Patients should be offered traditional dietary advice. If response is incomplete, specialist dietetic guidance should be considered. Probiotics may be beneficial, but quality of evidence is poor. First-line treatment of constipation is with laxatives, with secretagogues used where these are ineffective. Anti-diarrheal drugs should be used first-line for diarrhea, with second-line drugs including 5-hydroxytryptamine-3 antagonists, eluxadoline, or rifaximin, where available. First-line treatment of abdominal pain should be with antispasmodics, with gut-brain neuromodulators prescribed second-line. Low-dose tricyclic antidepressants, such as amitriptyline, are preferred. Brain-gut behavioral therapies are effective and have evidence for efficacy in patients refractory to standard therapies.

EXPERT OPINION

Despite substantial advances, there remains scope for improvement in terms of both the diagnosis and management of IBS. Reinforcement of positive diagnostic strategies for the condition and novel treatment paradigms are required.

Very-Low-Absorbable Geraniol for the Treatment of Irritable Bowel Syndrome: A "Real-World" Open-Label Study on 1585 Patients

OBJECTIVE

The objective of this study was to evaluate the efficacy of a very-low-absorbable geraniol formulation, administered as a food supplement, in patients with irritable bowel syndrome (IBS) in a real-world setting in Italy.

METHODS

This open-label study was conducted in Italy on patients diagnosed with IBS and treated for 4 weeks with 240 mg/day of Palmarosa essential oil, absorbed on 960 mg of ginger root powder to obtain a very-low-absorbable geraniol formulation. Baseline characteristics, including demographic and symptoms were recorded using the IBS Severity Scoring System (IBS-SSS). After 28 ± 7 days, the patients were asked to complete the IBS-SSS questionnaire again. The primary objective was to confirm the effects of a very-low-absorbable geraniol formulation on self-reported symptoms of IBS and the quality of life of affected individuals. The secondary objective was to confirm the effect of the treatment on the different IBS subtypes.

RESULTS

A total of 1585 patients were included in the study, with a mean age of 44.8 years and 56.4% women. Following the 4-week supplementation period, significant decreases were observed in the patients' IBS-SSS (-67.9%) and all the primary IBS symptoms, such as abdominal distention (-82.3%), unsatisfaction with bowel habits (-46.2%), and interference with quality of life (QoL) (-64.9%) (all p < 0.01). The patients' stool type improved significantly. Treatment was effective in all IBS subtypes.

CONCLUSIONS

Treatment with very-low-adsorbable geraniol food supplement was associated with improvements in symptoms and bowel habits in all IBS subtypes in a real-world setting in Italy. These findings support the use of geraniol as an effective option for patients with IBS regardless of the disease subtype.

Successful Strategy in Creating Low-FODMAP Wholegrain Bread-Simple and Global

Fermentable oligo-, di-, and monosaccharides as well as polyols (FODMAPs) came into focus following recent clinical studies confirming that they worsen the symptoms of several gastrointestinal disorders suffered by 40% of the general population. Currently; only the low-FODMAP diet is a valuable strategy to help relieve IBS symptoms; however; it is only a temporary solution due to the nutritional deficiency caused by avoiding high-FODMAP foods. At the same time; bakery products are an important part of the human diet worldwide and the key contributors to the high intake of FODMAPs; especially in their wholegrain form. Previous research has shown that reducing FODMAPs content has negative effects on the structures of dough and bread; as well as on sensory quality. Our innovative low-FODMAP wholegrain bakery products provide a unique solution for achieving a high-dietary-fiber intake without compromising the sensory appeal. The novelty of our work is that these experiments were the first to be performed based on known but unexploited facts about the superiority of the baker's yeast enzymatic complex. A crucial reduction in FODMAP content (by more than 75%) was achieved via a simple alteration to the bread formulation (6% baker's yeast and the addition of baking powder) and key process parameter values (40 °C and 60 min dough fermentation time) in conventional breadmaking technology.

Prevalence and Clinical Impact of the London Classification: A Prospective, International, Multicenter Study From the Lower Gastrointestinal International Consortium (LoGIC)

INTRODUCTION

The London classification provides standardization for characterization of disorders of anorectal function, although prevalences and clinical impact of these disorders are unclear.

METHODS

An international research consortium was established, including 5 specialist centers. Prospective data were collected in consecutive adults referred for refractory chronic constipation (CC), fecal incontinence (FI), or coexistent CC/FI over 18 months. Patients completed a standardized clinical questionnaire and underwent anorectal physiology tests, which were performed and interpreted using uniform methodology. The prevalence of the London classification was compared between symptom groups (CC, FI, and coexistent CC/FI), equipment types, and sites. Clinical impact was assessed using Cleveland Clinic Constipation and St. Marks Incontinence Scores.

RESULTS

Of 1,012 included patients (85.6% women), 30.5% had self-reported CC, 33.2% had FI, and 36.3% had coexistent CC/FI. Rectoanal areflexia was uncommon (3.1%). Disorders of anal tone/contractility (CC: 45.0%; FI: 68.5%; coexistent CC/FI: 63.8%; P < 0.0001) and disorders of rectal sensation (major findings: rectal hyposensitivity, CC: 10.0%; FI: 5.0%; coexistent CC/FI: 11.1%; P = 0.018; rectal hypersensitivity, CC: 3.8%; FI: 9.0%; coexistent CC/FI: 4.9%; P = 0.025) varied between the symptom groups and were associated with symptom severity. Most disorders of rectoanal coordination were found in similar proportions across the symptom groups and were not associated with the severity of CC (median Cleveland Clinic Constipation Score 10-14 in all groups). Prevalences of some disorders differed between equipment types (specifically balloon expulsion test).

DISCUSSION

This prospective multicenter study provides information on the prevalence and clinical impact of the London classification and will guide refinement of the current London classification.

Cerebral cortex changes in FD, IBS, and GERD: A Mendelian randomization study

BACKGROUND

Prospective and cross-sectional studies have reported an association between functional gastrointestinal disorders and anxiety and depression. However, the causal relationship remains uncertain. To clarify this, we utilized Mendelian randomization (MR) to assess the causal effects of common gastrointestinal disorders on cortical structures.

METHODS

Genome-wide association study (GWAS) data was gathered for functional dyspepsia (FD), irritable bowel syndrome (IBS), and gastroesophageal reflux disease (GERD) from European populations numbering 329,262, 16,792, and 602,604, respectively. GWAS cerebral cortical architecture data for cortical thickness (TH) and surface area (SA) were obtained from 51,665 MRI scans. MR was used to analyze the casual relationship between FD, IBS, GERD, and cortical structures. Inverse-variance weighted, weighted median, and MR-Egger tests were performed as assessment indicators. We also evaluated heterogeneity and pleiotropy.

RESULTS

FD significantly decreases the TH in the rostral anterior cingulate cortex (βTH = -0.022 mm; 95%CI: -0.035 mm to -0.009 mm2; PTH = 6.89 × 10-4), and IBS significantly decreases the SA of the pars triangularis (βSA = -21.91 mm2; 95%CI: -32.99 mm to -10.83 mm2; PSA = 1.06 × 10-4), precuneus (βSA = -47.53 mm2; 95%CI: -73.57 mm to-21.48 mm2; PSA = 3.48 × 10-4) and superior frontal regions (βSA = -78.70 mm2; 95%CI: -122.61 mm to -34.78 mm2; PSA = 4.4 × 10-4). At the local functional level, GERD significantly increases the SA of the inferior temporal region (βSA = -113.58 mm2, 95%CI: -113.58 mm to -39.01 mm2, PSA = 6.05 × 10-5).

CONCLUSIONS

FD, IBS and GERD can affect the cerebral cortex architecture through the brain-gut axis, potentially increasing the risks of mental illness and cognitive impairment.

Acute stress triggers sex-dependent rapid alterations in the human small intestine microbiota composition

Background/aims

Digestive disorders of gut-brain interaction (DGBI) are very common, predominant in females, and usually associated with intestinal barrier dysfunction, dysbiosis, and stress. We previously found that females have increased susceptibility to intestinal barrier dysfunction in response to acute stress. However, whether this is associated with changes in the small bowel microbiota remains unknown. We have evaluated changes in the small intestinal microbiota in response to acute stress to better understand stress-induced intestinal barrier dysfunction.

Methods

Jejunal biopsies were obtained at baseline and 90 min after cold pain or sham stress. Autonomic (blood pressure and heart rate), hormonal (plasma cortisol and adrenocorticotropic hormone) and psychological (Subjective Stress Rating Scale) responses to cold pain and sham stress were monitored. Microbial DNA from the biopsies was analyzed using a 16S metabarcoding approach before and after cold pain stress and sham stress. Differences in diversity and relative abundance of microbial taxa were examined.

Results

Cold pain stress was associated with a significant decrease in alpha diversity (P = 0.015), which was more pronounced in females, along with significant sex differences in the abundance of specific taxa and the overall microbiota composition. Microbiota alterations significantly correlated with changes in psychological responses, hormones, and gene expression in the intestinal mucosal. Cold pain stress was also associated with activation of autonomic, hormonal and psychological response, with no differences between sexes.

Conclusions

Acute stress elicits rapid alterations in bacterial composition in the jejunum of healthy subjects and these changes are more pronounced in females. Our results may contribute to the understanding of female predominance in DGBI.

Impact of Microbiota on Irritable Bowel Syndrome Pathogenesis and Management: A Narrative Review

Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder, affecting 3-5% of the global population and significantly impacting patients' quality of life and healthcare resources. Alongside physical symptoms such as abdominal pain and altered bowel habits, many individuals experience psychological comorbidities, including anxiety and depression. Recent research has highlighted the critical role of the gut microbiota in IBS, with dysbiosis, characterized by an imbalance in microbial diversity, frequently observed in patients. The gut-brain axis, a bidirectional communication network between the gut and central nervous system, plays a central role in the development of IBS symptoms. Although interventions such as probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT) have demonstrated potential in modulating the gut microbiota and alleviating symptoms, their efficacy remains an area of ongoing investigation. This review examines the interactions between the gut microbiota, immune system, and brain, emphasizing the need for personalized therapeutic strategies. Future research should aim to identify reliable microbiota-based biomarkers for IBS and refine microbiome-targeted therapies to enhance patient outcomes.

The burden of irritable bowel syndrome and functional dyspepsia in Poland: a cross-sectional study from West Pomeranian Voivodship

BACKGROUND

Functional gastrointestinal disorders (FGIDs), now known as disorders of gut-brain interaction (DGBIs), such as Irritable Bowel Syndrome (IBS) and Functional Dyspepsia (FD), significantly impact global health, reducing quality of life and burdening healthcare systems. This study addresses the epidemiological gap in Poland, focusing on the West Pomeranian Voivodeship.

METHODS

We conducted a cross-sectional study of 2070 Caucasian patients (58.2% female, mean age 57.5 ± 15.1 years) undergoing gastrointestinal endoscopic examinations at Pomeranian Medical University from 2021 to 2023. Data were collected using Rome IV diagnostic questionnaires and correlated with gastroduodenoscopy and colonoscopy findings. Exclusion criteria were age under 18, pregnancy, Crohn's disease, ulcerative colitis, severe comorbidities, cancer, immunosuppressive therapy, ileostomy/colostomy, incomplete questionnaires, or lack of consent.

RESULTS

Using Rome IV criteria, IBS was diagnosed in 436 participants (21.1%) and FD in 248 participants (12.0%). Post-endoscopic evaluation revised FD diagnoses to 184 individuals (8.9%). Females had a higher prevalence of IBS and FD (OR 1.64 and 1.61, respectively). No significant association was found between higher BMI and increased risk of IBS and FD. Hypertension and diabetes prevalence were 35.1% and 13.0%, respectively. Individuals with a history of COVID-19 had a higher risk of developing IBS (OR 1.47, P = 0.050).

CONCLUSIONS

Our study provides crucial epidemiological data on IBS and FD in Poland, emphasizing the importance of endoscopic evaluations. Our findings highlight the need for regional studies to understand local DGBI prevalence, aiding targeted healthcare strategies.

Complex and Bidirectional Interplay Between Marital Quality, Catastrophizing, Psychological Dysfunction, and Quality of Life in Married Malay Women With Disorder of Gut-Brain Interactions

BACKGROUND

Disorders of gut-brain interactions (DGBI) affect more women, and marital quality may have been a factor that explains clinical manifestations of DGBI-however, the mechanism is unclear. This study aimed to elucidate supported relationships between DGBI with marital quality and clinical attributes in married Malay women.

METHODS

This cross-sectional study involved married Malay women with functional dyspepsia (FD), irritable bowel syndrome (IBS), and FD-IBS overlap per Rome IV criteria. Multivariate analysis of variance (MANOVA) and Pearson correlation analysis were performed to determine the association between DGBI, marital quality, and clinical attributes of catastrophizing, psychological dysfunction, and quality of life. Path analysis models were developed, tested, and fitted to elucidate relationships that satisfied significance testing and fit indices (termed supported relationship).

KEY RESULTS

Of 1130 screened participants, 513 were analyzed. The prevalence of FD, IBS, and FD-IBS overlap was 33.9% (n = 174), 29.5% (n = 151), and 36.6% (n = 188), respectively. Of 17 variables in MANOVA, significant differences in variables were observed for FD vs. FD-IBS overlap (10), IBS versus FD (10), and IBS versus FD-IBS overlap (5). Pearson correlation matrices found significant correlations for 15 of 17 variables. After testing and fitting, the third path model (Model 3) was deemed the final model. Model 3 suggested that relationships between DGBI and marital and clinical attributes were complex and bidirectional. The number of supported relationships were 50, 43, and 39 for FD-IBS overlap, FD, and IBS, respectively.

CONCLUSIONS AND INFERENCES

Relationships between DGBI, marital quality, and clinical attributes among married Malay women are complex and bidirectional.

Developing and evaluating a gamified self-management application for inflammatory bowel disease using the ADDIE model and Sukr framework

BACKGROUND

The prevalence and chronic nature of Inflammatory Bowel Diseases (IBD) is a significant global concern. As the essential part of treatments approach, patient adherence to treatment protocols and self-management practices are crucial to = IBD management. Healthcare initiatives focused on chronic conditions are strongly needed to consider various aspects of gamification and how it can positively affect self-management.

AIM

The current cognitive study aims to develop a mobile application to integrate the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) instructional design model and elaborate on a gamification design based on the reputable Sukr Wheel framework.

METHODS

The current study uses the ADDIE approach to integrate behavior change strategies derived from the self-management theory using the Sukr Wheel gamification (My IBD Buddy) framework on the Android platform.

RESULTS

The final evaluation was conducted over 14 days. User satisfaction comprised 22 participants aged 20 to 64, all diagnosed with inflammatory bowel diseases. System usability was measured on a scale ranging from 50 to 100. The average usability score for the entire user group was 80.68, indicating a "good" level of satisfaction among the program users based on the ranking scale.

CONCLUSION

"My IBD Buddy" mobile application, equipped with gamification for IBD patients, enhances self-efficacy and self-management.

Efficacy of fermented foods in irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials

Objective

Fermented foods (FFs) may theoretically benefit irritable bowel syndrome (IBS) symptoms, but the role of FFs for IBS patients in the real world is inconsistent and has not been systematically assessed. We performed a systematic review and meta-analysis to examine this issue.

Methods

PubMed, MEDLINE, Embase and Cochrane Library databases were searched up to August 2024. Randomized controlled trials (RCTs) investigating the efficacy of FFs in IBS were eligible for the analysis. Two authors independently screened studies and extracted data. Data were pooled using relative risk (RR) of dichotomous data and standardized mean difference (SMD) for continuous data.

Results

A total of 16 RCTs with 1,264 IBS patients were included. There were 12 RCTs involving 975 patients providing primary outcomes which was defined as symptom relief. The proportion of symptom relief was associated with the administration of FFs (RR 1.22, 95% CI 1.04-1.42, p = 0.01, I 2 = 0%). For secondary outcomes, FFs also exerted a beneficial effect on global symptoms scores (SMD = -0.15; 95% CI -0.29 to -0.02, p = 0.02, I 2 = 46%), but no significant improvement on abdominal pain scores and bloating scores. Subgroup analysis showed that fermented milk had a beneficial effect on symptom relief (RR 1.19, 95% CI 1.01 to 1.39, p = 0.04, I 2 = 0%).

Conclusion

Fermented foods, especially fermented milk with probiotics properties, appear to be efficacious in irritable bowel syndrome. However, given the limitations of current evidence, this conclusion should be interpreted with caution.

Systematic Review Registration

This study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42024576608.

Stress triggers irritable bowel syndrome with diarrhea through a spermidine-mediated decline in type I interferon

Irritable bowel syndrome with diarrhea (IBS-D) is a common and chronic gastrointestinal disorder that is characterized by abdominal discomfort and occasional diarrhea. The pathogenesis of IBS-D is thought to be related to a combination of factors, including psychological stress, abnormal muscle contractions, and inflammation and disorder of the gut microbiome. However, there is still a lack of comprehensive analysis of the logical regulatory correlation among these factors. In this study, we found that stress induced hyperproduction of xanthine and altered the abundance and metabolic characteristics of Lactobacillus murinus in the gut. Lactobacillus murinus-derived spermidine suppressed the basal expression of type I interferon (IFN)-α in plasmacytoid dendritic cells by inhibiting the K63-linked polyubiquitination of TRAF3. The reduction in IFN-α unrestricted the contractile function of colonic smooth muscle cells, resulting in an increase in bowel movement. Our findings provided a theoretical basis for the pathological mechanism of, and new drug targets for, stress-exposed IBS-D.

The relationship between adverse childhood experiences and disorders of the gut-brain interaction

OBJECTIVES

Disorders of the gut-brain interaction (DGBI) arise from a complex interplay of psychosocial factors, altered physiology, and early life factors. In adults, adverse childhood experiences (ACEs) have been associated with DGBI. While both ACEs and DGBI are prevalent among children, the relationship between ACEs and DGBI in childhood is not well understood.

METHODS

Retrospective review of patients aged 3-18 years with ACE scores documented between October 1, 2019 and April 30, 2022 who were divided into three comparison groups: (1) not referred to pediatric gastroenterology (GI); (2) referred to GI and diagnosed with a DGBI; and (3) referred to GI and not diagnosed with a DGBI.

RESULTS

Of 29,490 patients with ACE scores documented during the study period, 897 completed a GI consultation. Four hundred and one (44.7%) were diagnosed with a DGBI. With each additional adverse experience, patients were 1.09 times more likely to have a DGBI diagnosis (95% confidence interval [CI] = 1.056-1.163; p ≤ 0.001). An anxiety diagnosis mediated 73% of this relationship (p = 0.012).

CONCLUSIONS

Among patients receiving pediatric GI specialty care, higher ACE scores were associated with a higher likelihood of a DGBI diagnosis. Anxiety largely mediates this relationship, suggesting potential avenues for targeted, multidisciplinary interventions in both primary and specialty care settings.

Neurogastroenterology and motility disorders in patients with cirrhosis

Neurogastroenterology and motility disorders are complex gastrointestinal conditions that are prevalent worldwide, particularly affecting women and younger individuals. These conditions significantly impact the quality of life of people suffering from them. There is increasing evidence linking these disorders to cirrhosis, with a higher prevalence compared to the general population. However, the link between neurogastroenterology and motility disorders and cirrhosis remains unclear due to undefined mechanisms. In addition, managing these conditions in cirrhosis is often limited by the adverse effects of drugs commonly used for these disorders, presenting a significant clinical challenge in the routine management of patients with cirrhosis. This review delves into this connection, exploring potential pathophysiological links and clinical interventions between neurogastroenterology disorders and cirrhosis.

Quality and quantity of carbohydrates, faecal short-chain fatty acids and gastrointestinal symptoms - results from a randomised, controlled trial (CARBFUNC)

BACKGROUND & AIMS

Diet is a key determinant of gastrointestinal (GI) health, in part in association with microbiota-derived short-chain fatty acids (SCFAs). However, we need more knowledge of the relative impact of dietary carbohydrate amount and quality on GI symptoms, GI-associated quality of life (QoL) and faecal SCFAs.

METHODS

193 males and females with obesity were randomly allocated to follow one of three isocaloric, iso-proteinic dietary patterns (2000 kcal/day for females, 2500 kcal/day for males): a higher-carbohydrate lower-fat diet with refined carbohydrate sources (acellular diet, A-HCLF, comparator arm), a higher-carbohydrate lower-fat diet with minimally refined carbohydrate sources (intact cellular structures, cellular diet, C-HCLF), or a low-carbohydrate high-fat diet (LCHF), all low in added sugars. Secondary outcomes of this randomised controlled trial (CARBFUNC) were assessed, i.e., changes in abdominal symptoms (irritable bowel syndrome severity scoring system (IBS-SSS)), reflux symptoms (gastro-oesophageal reflux disease questionnaire (GerdQ)), GI-related QoL (Short-Form Nepean Dyspepsia Index (SF-NDI)) and fatigue (Fatigue Impact Scale), and faecal SCFAs concentrations after following the diets for 3 and 12 months. Group differences were analysed by constrained linear mixed effect modelling (cLMM).

RESULTS

118 and 57 participants completed 3 and 12 months of the dietary intervention, respectively, with no significant group differences in weight loss at 12 months (5-7%). At 12 months, the mean daily fibre intake was 34 ± 7 g/day, 41 ± 14.3 g/day, and 18.5 ± 6 g/day on the A-HCLF, C-HCLF and LCHF diet, respectively, compared to 21 ± 7, 21 ± 7 and 20 ± 6 g/day at baseline. We observed no significant between-group difference in IBS-SSS sum score after 3 and 12 months. We found significant improvement in GerdQ score (change score [95 % CI]: -0.62 [-1.18, -0.048], p = 0.034), and SF-NDI sum score (-1.88 [-3.22, -0.52], p = 0.007) after 3 months on the LCHF diet compared to the A-HCLF diet, and GerdQ remained significant at 12 months (-1.03 [-1.88, -0.19], p = 0.017). Compared to the A-HCLF diet, the concentration of faecal butyric acid increased significantly more after 3 months on the C-HCLF diet (4.97 [1.71, 8.23] p = 0.003) and faecal acetic acid decreased more (-6.41 [-12.8, -0.047]. p = 0.048) on the LCHF diet. At 12 months the greater reduction in faecal acetic acid on the LCHF diet remained significant (-9.82 [-19.0, -0.67], p = 0.036), along with significantly greater reductions also in total SCFAs (-21.3 [-38.0, -4.56], p = 0.013), propionic (-4.42 [-7.79, -1.05], p = 0.010), and butyric acid (-5.05 [-9.60, -0.51], p = 0.030).

CONCLUSION

In this sample of adults with obesity and mild GI symptoms at baseline, modest improvements were observed only for the LCHF diet in QoL (at 3 months) and reflux symptoms (at 3 and 12 months), which was significantly different from the acellular carbohydrate diet, and independent of total fibre intake. Concomitantly, compared to the acellular carbohydrate diet, the cellular diet significantly increased the faecal concentration of butyric acid, whereas the LCHF diet lowered acetic acid after 3 months and all the major SCFAs after 12 months.

CLINICAL TRIALS IDENTIFIER

NCT03401970. https://clinicaltrials.gov/ct2/show/NCT03401970.

Relationship Between High Frequency Component of Heart Rate Variability and Delta EEG Power During Sleep in Women With Irritable Bowel Syndrome Compared to Healthy Women

OBJECTIVE

To explore the relationship between the high frequency (HF) heart rate variability (HRV) and electroencephalogram (EEG) delta band power in women with irritable bowel syndrome (IBS) versus healthy control women.

MATERIALS AND METHODS

Twenty women with IBS and twenty healthy controls were studied over three consecutive nights using polysomnography in a sleep laboratory. To avoid the first night effect, only second-night data were analyzed. Power spectral analysis was applied to HRV and EEG recordings. The linear system coherence/phase analysis assessed the relationship between normalized HF power of HRV and normalized delta band power of EEG during the first four NREM-REM sleep cycles.

RESULTS

Women with IBS exhibited a significantly higher percentage of NREM sleep, higher normalized HF, lower normalized low frequency (LF) and decreased LF/HF ratio of HRV in the first four NREM-REM sleep cycles compared to controls. Additionally, their normalized delta band power was significantly lower in these sleep cycles and over the whole night. The phase shift between HF and delta band power was significantly longer in the IBS group. While the coherence between normalized HF and normalized delta band power was lower in the IBS group, the difference was not statistically significant.

CONCLUSIONS

The coherence/phase analysis showed a dysregulated interaction between autonomic and central nervous systems in women with IBS, manifested by increased lag time between cardiac and EEG delta band power compared to healthy controls. Whether this dysregulation contributes to the pathophysiology of IBS remains to be determined.

A systematic review of preclinical studies targeted toward the management of co-existing functional gastrointestinal disorders, stress, and gut dysbiosis

Modern dietary habits and stressed lifestyle have escalated the tendency to develop functional gastrointestinal disorders (FGIDs) through alteration in the gut-brain-microbiome axis. Clinical practices use symptomatic treatments, neglect root causes, and prolong distress in patients. The past decade has seen the evolution of various interventions to attenuate FGIDs. But clinical translation of such studies is very rare mostly due to lack of awareness. The aim of this review is to meticulously integrate different studies and bridge this knowledge gap. Literature between 2013 and 2023 was retrieved from PubMed, ProQuest, and Web of Science. The data was extracted based on the PRISMA guidelines and using the SYRCLE's risk of bias and the Cochrane Risk of Bias tools, quality assessment was performed. The review has highlighted molecular insights into the coexistence of FGIDs, stress, and gut dysbiosis. Furthermore, novel interventions focusing on diet, probiotics, herbal formulations, and phytoconstituents were explored which mostly had a multitargeted approach for the management of the diseases. Scientific literature implied positive interactions between the interventions and the gut microbiome by increasing the relative abundance of beneficial bacteria and reducing stress-related hormones. Moreover, the interventions reduced intestinal inflammation and regulated the expression of epithelial tight junction proteins in different in vivo models. This systematic review delves deep into the preclinical interventions to manage coexisting FGIDs, stress, and gut dysbiosis. However, in most of the discussed studies, long-term risks and toxicity profile of the interventions are lacking. So, it is necessary to highlight them for improved clinical outcomes.

A prospective analysis of clinical and parasitological outcomes after treatment or a wait-and-see approach of Dientamoeba fragilis infection in an adult general practice population

PURPOSE

Dientamoeba fragilis is a protozoan frequently encountered in stool samples globally. It is debated whether Dientamoeba fragilis carries pathogenic capacities. This study prospectively analyses clinical and parasitological outcomes after treatment or a wait-and-see approach of Dientamoeba fragilis infection in a general practice adult population.

METHODS

In this prospective observational cohort study 113 adult patients with a positive Polymerase Chain Reaction (PCR) test result for D. fragilis (T0) in a primary care setting, were followed-up longitudinally with a control PCR-test and microscopic stool examination at 30 days (T1) and 90 days (T2) after inclusion. Standardized patient-reported questionnaires including treatment details and the adjusted Irritable Bowel Syndrome-Severity Score (IBS-SS) were retrieved at T0, T1 and T2.

RESULTS

Parasitology and questionnaires were retrieved from 87 participants at T0 and T1, and 74 at T2. Treated patients(n = 64) more often tested PCR negative at T1 (64.1% vs. 16.4%, p < 0.001) and T2 (67.3% vs. 5.3%, p < 0.001) compared to untreated patients. No difference in decline in IBS-SS was seen comparing the treatment and non-treatment groups at T1 (p = 0.403) or T2 (p = 1.00).

CONCLUSION

A short and long term increased parasitological clearance is shown with treatment of clioquinol or metronidazole compared with no treatment. A clear and significant correlation between parasitological cure and decline of clinical complaints as reported by the participants could not be established.

Review: Food-induced mucosal alterations visualized using endomicroscopy

Confocal laser endomicroscopy (CLE) is a novel technique allowing real time in vivo microscopy during standard endoscopy. Recently, acute mucosal alterations after food administration visualized by CLE have been linked to symptoms in irritable bowel syndrome (IBS). Interestingly, the observed reactions occurred in subjects without demonstrable allergic sensitization to food-this is in line with mechanistic research showing local but not systemic allergic sensitization to foods in an animal model for IBS. Here, European experts conducting CLE with food administration provide a narrative review of the available literature and propose practical guidance on the use of this technique. CLE allows physicians to observe acute mucosal reactions after the application of food to the duodenal mucosa in patients with functional gastrointestinal disorders. Some open-label interventions show a symptomatic benefit when patients exclude the nutrient that triggered an acute mucosal reaction. However, many technical, mechanistic, and clinical questions remain unanswered to date. Technically, the interobserver variability and learning curve requires systematic evaluation and criteria or cutoffs for alterations require validation. Mechanistic studies are needed to enhance our understanding of the mechanisms underlying observed alterations. Finally, rigorous blinded controlled studies are needed to assess a link of these observed alterations with symptom generation. CLE offers a platform allowing scientific insights related to food induced acute mucosal alterations. However, many questions remain unanswered, and more research is warranted to understand the role of acute mucosal alterations visualized upon food administration in IBS pathophysiology and treatment.

Biofeedback efficacy for outlet dysfunction constipation: Clinical outcomes and predictors of response by a limited approach

BACKGROUND

Functional defecation disorders (FDD) are a common etiology of refractory chronic constipation (CC). FDD diagnosis (dyssynergic defecation [DD] and inadequate defecatory propulsion [IDP]), requires diagnostic tests including anorectal manometry (ARM) and balloon expulsion test (BET). Biofeedback (BF) is the treatment of choice for DD. The aims of our study were to evaluate: the outcome of BF in a group of constipated patients with defecatory disorders of any etiology; the efficacy of two simple diagnostic tools in predicting BF outcome in the short-term.

METHODS

One hundred and thirty-one refractory CC patients failing the BET underwent BF therapy. Before BF, all patients underwent the following: ARM. Straining questionnaire. The answers were: "belly muscles"; "anal muscles"; "both"; "Don't know/No answer." Digital rectal examination augmented by abdominal palpation on straining (augmented-DRE). The BF therapist was blinded to ARM, straining questionnaire, and augmented-DRE results.

KEY RESULTS

Eighty-one patients responded to BF. Gender, age, and IBS-C showed no significant impact on BF response. Both DD and IDP responded equally to BF, while the rate of response in patients with isolated structural pelvic floor abnormalities was lower (p < 0.001). The answer "anal muscles" to straining questionnaire showed a strong association with BF response (p < 0.001). A lack in abdominal contraction and in anal relaxation on augmented-DRE were strongly associated with BF response (p < 0.01). Absence of manual maneuvers to facilitate defecation was associated with BF response (p < 0.001).

CONCLUSIONS & INFERENCES

BF is the therapy of choice for refractory constipation due to FDD of any etiology, inducing both clinical and anorectal physiology improvement in the short term. Comorbid IBS-C did not affect outcome while symptomatic isolated pelvic floor abnormalities appeared refractory to behavior treatment. The straining questionnaire and augmented-DRE outcomes showed a strong correlation with BF response and can be implemented in clinical practice to improve the management of constipated patients by prompting early referral to BF.

Fibromyalgia severity and symptoms are associated with the disorders of gut-brain interaction

INTRODUCTION

Fibromyalgia remains an idiopathic common disorder characterised by widespread pain with no universally accepted treatment. Irritable bowel syndrome is prevalent among women living with fibromyalgia. The prevalence of other disorders of gut-brain interaction (DGBI) and associations with fibromyalgia symptoms and severity is unknown.

OBJECTIVES

To evaluate the prevalence of the range of DGBI and associations with the symptoms and severity of fibromyalgia in women.

METHODS

A prospective observational study was conducted in New Zealand in 2022. A comprehensive survey included validated measures to identify DGBI (Rome IV) and items assessing the severity of fibromyalgia and pain symptoms, sleep quality, quality of life, mental health and migraine. Analysis was conducted employing Spearman's rho, Mann-Whitney U, Kruskal-Wallis and chi-square tests.

RESULTS

A total of 111 adult women with fibromyalgia enrolled in the study. Of these, 98 (93%) met the criteria for at least one DGBI, and 67 (68%) satisfied criteria for more than one. All groups of DGBI, and 11 specific DGBI were significantly associated with measures of pain, fibromyalgia severity, sleep problems and migraine (p < 0.05). Severity of pain and symptoms associated with fibromyalgia, including sleep problems, were also significantly associated with the functional bowel disorder severity index.

CONCLUSION

This study demonstrated that the prevalence of DGBI in women with fibromyalgia extends beyond irritable bowel syndrome. Presence of multiple DGBI correlates with pain, severity indices of fibromyalgia and sleep problems. Further research is required to examine the aetiology of DGBI in this population.

SIGNIFICANCE STATEMENT

This observational study has identified important relationships between the broader DGBI, fibromyalgia pain and associated symptoms, particularly migraine and sleep disturbance. Notable correlations between the severity indices of each are demonstrated, suggesting that improvements in one domain may reduce pain and improve overall well-being. These findings highlight the importance of addressing each clinical feature of the condition when supporting patients with fibromyalgia.

Prevalence of functional diarrhea in children and adolescents

BACKGROUND

Functional diarrhea (FDr) is a common disorder in toddlers and adults. In children, the Rome criteria define FDr as a disorder of children younger than 5 years old exclusively. However, in clinical practice, school-aged children and adolescents sometimes consult for symptoms that mimic the diagnosis of FDr. We conducted a study aimed at assessing the prevalence of FDr in school-aged children and adolescents.

METHODS

A cross-sectional study was conducted in children aged 8-18 years from two schools in Colombia. Children completed self-report validated questionnaires to diagnose disorders of gut-brain interaction (DGBI) per Rome IV (QPGS-IV) for their age group and the questions related to FDr from the Rome IV questionnaire for infants and toddlers.

KEY RESULTS

After excluding children with organic diseases and IBS-D, 981 participants were included (female 53.8%, White 24.7%, Indigenous 10.9%, mixed race 52.6%). Of the 981 participants, 325 (33.1%) had a DGBI. Of these, 17 children (5.2%) were diagnosed with FDr (3 participants 8-12 years; 14 participants 13-18 years). FDr was more prevalent among White children compared to non-White children (mixed race, Black, and Indigenous) (p = 0.01).

CONCLUSION & INFERENCES

Despite the absence of FDr in the Rome IV criteria for children and adolescents, 1.7% of children aged 8-18 years likely have FDr. This study suggests that FDr does occur in children and adolescents. If confirmed in future studies, the diagnosis of FDr should be considered for inclusion in future editions of the Rome criteria for children of all ages.

Validating Simple Modifications to the Rome IV Criteria for the Diagnosis of Irritable Bowel Syndrome in Secondary Care

BACKGROUND

The Rome IV criteria for irritable bowel syndrome (IBS) may be too restrictive for clinical practice and research.

AIMS

To validate the Rome IV criteria and study the diagnostic performance of simple modifications to them.

METHODS

We collected symptom data from consecutive adults with suspected IBS seen in a single clinic. We used a reference standard to confirm IBS (presence of lower abdominal pain associated with altered stool form or frequency; no evidence of organic gastrointestinal disease after limited investigation). We applied Rome IV criteria, but also two modifications. First, we re-incorporated abdominal discomfort but kept symptom frequency required for both abdominal pain and discomfort to at least 1 day per week. Second, we included only abdominal pain but relaxed symptom frequency back to 3 days per month. We calculated sensitivity, specificity and positive and negative likelihood ratios (LRs), with 95% confidence intervals (CIs), for each diagnostic criterion.

RESULTS

We recruited 170 patients (76.5% female, mean age 37.9 years). Sensitivity and specificity of the Rome IV criteria were 82.1% and 85.1%, respectively; positive and negative LRs were 5.51 (95% CI 2.95-11.3) and 0.21 (95% CI 0.14-0.31), respectively. Modifying the criteria by relaxing the frequency of abdominal pain to 3 days per month led to the best performance [sensitivity 90.2%, specificity 85.1%, positive LR 6.06 (95% CI 3.25-12.2), and negative LR 0.11 (95% CI 0.07-0.19)].

CONCLUSIONS

The Rome IV criteria performed well in diagnosing IBS. A simple modification relaxing the required frequency of abdominal pain improved their performance.

Factors Associated With Abdominal Pain in Patients With Active and Quiescent Ulcerative Colitis: A Multicohort Study

BACKGROUND

Abdominal pain can be an overlooked symptom in patients with ulcerative colitis (UC).

AIMS

The aim of this study was to investigate the prevalence and factors associated with abdominal pain in active and quiescent UC.

METHODS

Three study cohorts of adult UC patients were used. Cross-sectional cohorts I and II included 130 (46 active) and 288 (156 active) patients. Longitudinal cohort III included 83 patients with active disease at diagnosis that reached deep remission during follow-up. The Gastrointestinal Symptom Rating Scale was used to assess abdominal pain and other validated questionnaires to assess psychological distress, fatigue and quality of life (QoL).

RESULTS

In the two cross-sectional cohorts, 63% and 58% of the active vs. 54% and 33% of the quiescent UC patients reported abdominal pain (both p ≤ 0.02). In the longitudinal cohort, 71% had abdominal pain at diagnosis vs. 46% when in remission (p < 0.001). In multivariable models, symptoms of anxiety were associated with higher abdominal pain levels in both cross-sectional cohorts (OR 1.75 [IQR 1.11-2.76] and OR 1.99 [1.45-2.73]), whereas in cohort II, active disease (OR 2.68 [1.61-4.45]) and female sex (OR 2.03 [1.21-3.41]) were also associated with pain. QoL was negatively correlated with higher levels of abdominal pain, both in active and quiescent disease.

CONCLUSIONS

Abdominal pain in UC is prevalent and associated with lower QoL in both active and quiescent disease. Associated factors are active disease, female sex and psychological symptoms, especially anxiety. We suggest considering a holistic approach when treating UC patients with abdominal pain.

Management of Refractory Functional Gastrointestinal Disorders: What Role Should Psychiatrists Have?

Currently, it has been stated that psychiatric and psychological problems are equally paramount aspects of the clinical modulation and manifestation of both the central nervous and digestive systems, which could be used to restore balance. The present narrative review aims to provide an elaborate description of the bio-psycho-social facets of refractory functional gastrointestinal disorders, psychiatrists' role, specific psychiatric approach, and the latest psychiatric and psychological perspectives on practical therapeutic management. In this respect, "psyche," "psychiatry," "psychology," "psychiatrist," "psychotropic," and "refractory functional gastrointestinal disorders" (as the keywords) were searched in relevant English publications from January 1, 1950, to March 1, 2024, in the PubMed, Web of Science, Scopus, EMBASE, Cochrane Library, and Google Scholar databases. Eventually, the narrative technique was adopted to reach a compelling story with a high level of cohesion through material synthesis. The current literature recognizes the brain-gut axis modulation as a therapeutic target for refractory functional gastrointestinal disorders and the bio-psycho-social model as an integrated framework to explain disease pathogenesis. The results also reveal some evidence to affirm the benefits of psychotropic medications and psychological therapies in refractory functional gastrointestinal disorders, even when psychiatric symptoms were absent. It seems that psychiatrists are required to pay higher levels of attention to both the assessment and treatment of patients with refractory functional gastrointestinal disorders, accompanied by educating and training practitioners who take care of these patients.

Rome IV Functional Defecation Disorder: Time for a Change in Symptom Criteria for Improved Clinical Relevance?

INTRODUCTION

Defecatory disorders are common affecting up to 8% of the population. Rome IV diagnostic criteria are used to define this condition and, therefore, select patients for the gold standard therapy, anorectal biofeedback. The aim of this study was to test the current Rome IV Functional Defecation Disorder (FDD) criteria in a real-world population by using the response to biofeedback as a validation tool.

METHODS

A total of 485 patients (female 437, mean age 50 ± 17.6 years) with defecatory symptoms presenting to a neurogastroenterology clinic underwent anorectal biofeedback therapy regardless of whether they met formal Rome IV FDD criteria or not. Patients were assessed extensively with the Rome questionnaire, constipation questionnaire, and visual analog scales for satisfaction, control, quality of life, and anorectal manometry.

RESULTS

Rome IV FDD was no better at predicting response to biofeedback compared with non-Rome IV FDD ( P = NS). Digitation ( P = 0.043) and increasing cumulative number of defecatory symptoms ( P = 0.038) were correlated with improvement in biofeedback (≥2-point increase in bowel satisfaction). Those with abnormal physiology only responded well to biofeedback (83% response rate), but this was not statistically different from no Rome IV physiology patients (73%). There was a trend for increasing cumulative number of abnormal physiology factors to correlate with biofeedback ( P = 0.086).

DISCUSSION

Rome IV symptom criteria need revision to include more defecatory symptoms, include all subtypes of irritable bowel syndrome, and be inclusive of those with either loose stools or more frequent stools such as those previously labeled with "pseudodiarrhea" or "hyperdefecation." Continuing to include physiology criteria in the Rome diagnosis of FDD seems valid.

Meta-analysis of gut microbiota alterations in patients with irritable bowel syndrome

Introduction

Irritable bowel syndrome (IBS) is a common chronic disorder of gastrointestinal function with a high prevalence worldwide. Due to its complex pathogenesis and heterogeneity, there is urrently no consensus in IBS research.

Methods

We collected and uniformly reanalyzed 1167 fecal 16S rRNA gene sequencing samples (623 from IBS patients and 544 from healthy subjects) from 9 studies. Using both a random effects (RE) model and a fixed effects (FE) model, we calculated the odds ratios for metrics including bacterial alpha diversity, beta diversity, common genera and pathways between the IBS and control groups.

Results

Significantly lower alpha-diversity indexes were observed in IBS patients by random effects model. Twenty-six bacterial genera and twelve predicted pathways were identified with significant odds ratios and classification potentials for IBS patients. Based on these feature, we used transfer learning to enhance the predictive capabilities of our model, which improved model performance by approximately 10%. Moreover, through correlation network analysis, we found that Ruminococcaceae and Christensenellaceae were negatively correlated with vitamin B6 metabolism, which was decreased in the patients with IBS. Ruminococcaceae was also negatively correlated with tyrosine metabolism, which was decreased in the patients with IBS.

Discussion

This study revealed the dysbiosis of fecal bacterial diversity, composition, and predicted pathways of patients with IBS by meta-analysis and identified universal biomarkers for IBS prediction and therapeutic targets.

The Role of Gut Microbiome in Irritable Bowel Syndrome: Implications for Clinical Therapeutics

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID) characterized by chronic or recurrent gastrointestinal symptoms without organic changes, and it is also a common disorder of gut-brain interaction (DGBIs).. The symptoms of IBS not only affect the quality of life for individual patients but also place a significant burden on global healthcare systems. The lack of established and universally applicable biomarkers for IBS, along with the substantial variability in symptoms and progression, presents challenges in developing effective clinical treatments. In recent years, preclinical and clinical studies have linked the pathogenesis of IBS to alterations in the composition and function of the intestinal microbiota. Within the complex microbial community of the gut, intricate metabolic and spatial interactions occur among its members and between microbes and their hosts. Amid the multifaceted pathophysiology of IBS, the role of intestinal microenvironment factors in symptom development has become more apparent. This review aims to delve into the changes in the composition and structure of the gut microbiome in individuals with IBS. It explores how diet-mediated alterations in intestinal microbes and their byproducts play a role in regulating the pathogenesis of IBS by influencing the "brain-gut" axis, intestinal barrier function, immune responses, and more. By doing so, this review seeks to lay a theoretical foundation for advancing the development of clinical therapeutics for IBS.

Acupuncture and electroacupuncture for cyclic vomiting syndrome with tachygastria in an adult: A case report

RATIONALE

Cyclic vomiting syndrome (CVS) is characterized by recurrent episodes of acute vomiting lasting <1 week, occurring independently and chronically. Management typically involves lifestyle interventions, supportive care, and preventative medication. In rare cases, CVS persists for decades in adults, requiring a multidisciplinary approach to improve symptoms and quality of life.

PATIENT CONCERNS

A 30-year-old male patient presented with a 7-year history of recurrent nausea and vomiting, which initially began in 2017. The episodes occurred without identifiable triggers such as alcohol or overeating, increasing in frequency from once every 4 months to 2 months. He expressed fear of severe deterioration, impacting his ability to eat freely, work, and enjoy his hobbies.

DIAGNOSES

He was diagnosed with CVS based on the Rome criteria. Cutaneous electrogastrography showed postprandial power decrease and tachygastria.

INTERVENTIONS

Regular acupuncture treatments, including electroacupuncture at ST36 with 3 Hz, were administered twice a week for 3 weeks, followed by weekly sessions for 5 additional weeks.

OUTCOMES

Over 11 treatment sessions across 8 weeks, no nausea or vomiting was observed. The visual analog scale (VAS) score for subjective gastrointestinal discomfort decreased from 67 to 0 after 4 weeks. The Nausea Severity Scale (NSS) score dropped from 14 to 0 after 4 weeks. The Functional Dyspepsia-related QoL score decreased from 16 to 0 after 8 weeks. The Nepean Dyspepsia Index-Korean version decreased from 80 to 8 after 8 weeks. Furthermore, the patient expressed high satisfaction with the treatment, and no adverse events were observed.

LESSONS

Acupuncture offers a significant and safe approach to relieving symptoms and enhancing the quality of life for patients with nausea and vomiting. Although this is a single case report, the findings suggest that acupuncture can improve treatment compliance and manage symptoms in adults with CVS. Further research, including clinical trials, is required to confirm these findings and understand the underlying mechanisms.

A two-phase transfer learning framework for gastrointestinal diseases classification

Gastrointestinal (GI) disorders are common and often debilitating health issues that affect a significant portion of the population. Recent advancements in artificial intelligence, particularly computer vision algorithms, have shown great potential in detecting and classifying medical images. These algorithms utilize deep convolutional neural network architectures to learn complex spatial features in images and make predictions for similar unseen images. The proposed study aims to assist gastroenterologists in making more efficient and accurate diagnoses of GI patients by utilizing its two-phase transfer learning framework to identify GI diseases from endoscopic images. Three pre-trained image classification models, namely Xception, InceptionResNetV2, and VGG16, are fine-tuned on publicly available datasets of annotated endoscopic images of the GI tract. Additionally, two custom convolutional neural networks are constructed and fully trained for comparative analysis of their performance. Four different classification tasks are examined based on the endoscopic image categories. The proposed architecture employing InceptionResNetV2 achieves the most consistent and generalized performance across most classification tasks, yielding accuracy scores of 85.7% for general classification of GI tract (eight-category classification), 97.6% for three-diseases classification, 99.5% for polyp identification (binary classification), and 74.2% for binary classification of esophagitis severity on unseen endoscopic images. The results indicate the effectiveness of the two-phase transfer learning framework for clinical use to enhance the identification of GI diseases, aiding in their early diagnosis and treatment.

Tenapanor Improves Abdominal Symptoms Irrespective of Changes in Complete Spontaneous Bowel Movement Frequency in Adults with Irritable Bowel Syndrome with Constipation

INTRODUCTION

Tenapanor is a first-in-class, minimally absorbed intestinal sodium/hydrogen exchanger isoform 3 inhibitor approved by the US Food and Drug Administration for adults with irritable bowel syndrome with constipation (IBS-C). Pooled data from the phase 2b (NCT01923428) and phase 3 T3MPO-1 (NCT02621892) and T3MPO-2 (NCT02686138) studies examined the effects of tenapanor on abdominal symptoms independent of tenapanor's effect on complete spontaneous bowel movement (CSBM) frequency in adults with IBS-C.

METHODS

This post hoc analysis was performed for patients with no CSBMs in ≥6 of the first 12 weeks of treatment (no-CSBM subgroup). The three-item abdominal score (AS3; the average of weekly abdominal pain, bloating, and discomfort scores) measured abdominal symptom response in tenapanor versus placebo. The overall change from baseline and response rate (improvement of ≥2 points or a reduction of ≥30%) in AS3 and individual abdominal scores during the 12 weeks were assessed.

RESULTS

In the pooled safety analysis set (N = 1,382), 641 patients were classified as no-CSBM patients and 640 were included in the efficacy analysis. Among the no-CSBM subgroup, tenapanor-treated patients experienced a greater improvement in AS3 in week 12 versus placebo-treated patients (least squares mean change, -1.74 vs. -1.29; p = 0.007), and the AS3 responder rate was higher for tenapanor (40.2% vs. 29.6%; p = 0.008). Similar improvements were displayed across individual abdominal symptom scores. Diarrhea was the most common adverse event in tenapanor-treated patients.

CONCLUSION

Tenapanor was observed to improve abdominal symptoms independent of its effect on bowel symptoms in adults with IBS-C.

INTRODUCTION

Tenapanor is a first-in-class, minimally absorbed intestinal sodium/hydrogen exchanger isoform 3 inhibitor approved by the US Food and Drug Administration for adults with irritable bowel syndrome with constipation (IBS-C). Pooled data from the phase 2b (NCT01923428) and phase 3 T3MPO-1 (NCT02621892) and T3MPO-2 (NCT02686138) studies examined the effects of tenapanor on abdominal symptoms independent of tenapanor's effect on complete spontaneous bowel movement (CSBM) frequency in adults with IBS-C.

METHODS

This post hoc analysis was performed for patients with no CSBMs in ≥6 of the first 12 weeks of treatment (no-CSBM subgroup). The three-item abdominal score (AS3; the average of weekly abdominal pain, bloating, and discomfort scores) measured abdominal symptom response in tenapanor versus placebo. The overall change from baseline and response rate (improvement of ≥2 points or a reduction of ≥30%) in AS3 and individual abdominal scores during the 12 weeks were assessed.

RESULTS

In the pooled safety analysis set (N = 1,382), 641 patients were classified as no-CSBM patients and 640 were included in the efficacy analysis. Among the no-CSBM subgroup, tenapanor-treated patients experienced a greater improvement in AS3 in week 12 versus placebo-treated patients (least squares mean change, -1.74 vs. -1.29; p = 0.007), and the AS3 responder rate was higher for tenapanor (40.2% vs. 29.6%; p = 0.008). Similar improvements were displayed across individual abdominal symptom scores. Diarrhea was the most common adverse event in tenapanor-treated patients.

CONCLUSION

Tenapanor was observed to improve abdominal symptoms independent of its effect on bowel symptoms in adults with IBS-C.

Evaluating the relationship between dietary flavonoids intake and constipation incidence in the general US population

BACKGROUND

Dietary adjustment has consistently been regarded as an effective and health way for both the prevention and treatment of constipation. Several researches suggest a significant correlation between dietary flavonoids intake and gut microbiota, while the relationship between dietary flavonoids and constipation has not been reported. The objective of this study is to investigate the relationship between flavonoids intake and constipation.

METHODS

This cross-sectional analysis was based on data from the National Health and Nutrition Examination Survey (NHANES) collected from 2007 to 2010. The dietary flavonoid and subclasses intake value were obtained from the United States Department of Food and Nutrient Database for Dietary Studies (FNDDS), while constipation was defined using the stool consistency or frequency. Relationships between total and six main flavonoid subclasses intake constipation were investigated using weighted logistic regression approach.

RESULTS

The study revealed a negative association between isoflavones, anthocyanidins, flavanones, flavones, flavonols, and total flavonoid intake and constipation, with significant p-trends of < 0.05. Following multivariate adjustment, decreased odds of constipation could still be observed in the highest quartiles of anthocyanidins compared with those in the reference quartiles (p-value = 0.03). Ln-transformed anthocyanidins exhibited a statistically significant nonlinear association with constipation, displaying an inverted U-shaped pattern. When anthocyanidins intake exceeded 0.92 mg, the rate of constipation trended downward with increases in anthocyanidins intake.

CONCLUSIONS

Our study demonstrated that higher dietary flavonoids intake can reduce the incidence of constipation in the adult US population. In addition, the negative association between anthocyanin intake and constipation was more stable compared to other subclasses.

Prevalence and predictors of functional gastrointestinal disorder among the undergraduate students of Bangladesh

OBJECTIVE

This study aimed to address this knowledge gap by investigating FGID prevalence and its predictors among undergraduate students in Bangladesh.

DESIGN

This cross-sectional study was conducted between 01 August 2023 and 31 January 2024 among 1,019 undergraduate students. Data were collected using a web-based survey containing questions on socio-demographics, the Rome IV questionnaire, the insomnia severity index, the perceived stress scale 4, the patient health questionnaire, and the smartphone addiction scale. Descriptive statistics, the chi-square test, the t-test, and the multivariable logistic regression model were used to report our study findings.

RESULTS

The overall prevalence of FGID was 38.24%, with functional constipation being the most common subtype (18.24%). The multivariate analysis revealed that college canteen meal (AOR: 1.593, CI: 1.068, 2.376), occasionally and regularly delayed meal (AOR: 1.663, CI: 1.031, 2.682; AOR: 1.872, CI: 1.061, 3.301), physical inactivity (AOR:0.41, CI: 1.061, 3.301), family history of FGID and GI disease (AOR: 4.7, CI: 2.55, 8.66; AOR: 2.42, CI: 1.47, 3.96), history of abdominal surgery (AOR: 2, CI: 1.08, 3.72), psychological trauma (AOR: 1.64, CI: 1.04, 2.57), dairy-product consumption (AOR: 1.64, CI: 1.04, 2.59), >3 meals/day (AOR: 1.89, CI: 1.2, 2.98), insomnia (AOR: 1.98, CI: 0.73, 5.40), and depression (AOR: 7.02, CI: 2.74, 17.98) were significantly associated with FGID.

CONCLUSION

The burden of FGIDs among Bangladeshi students is concerning. This study found significant factors contributing to their prevalence, including meal source and number of daily meals, delayed meals, family history of disease, physical activity, abdominal surgery, history of psychological trauma, depression, and insomnia. This study recommends further exploration and holistic healthcare approaches to better the well-being of young adults dealing with FGIDs.

Optimization of protocols for immunohistochemical assessment of enteric nervous system in formalin fixed human tissue

Gastrointestinal (GI) motility is regulated in a large part by the cells of the enteric nervous system (ENS), suggesting that ENS dysfunctions either associate with, or drive GI dysmotility in patients. However, except for select diseases such as Hirschsprung's Disease or Achalasia that show a significant loss of all neurons or a subset of neurons, our understanding of human ENS histopathology is extremely limited. Recent endoscopic advances allow biopsying patient's full thickness gut tissues, which makes capturing ENS tissues simpler than biopsying other neuronal tissues, such as the brain. Yet, our understanding of ENS aberrations observed in GI dysmotility patients lags behind our understanding of central nervous system aberrations observed in patients with neurological disease. Paucity of optimized methods for histopathological assessment of ENS in pathological specimens represent an important bottleneck in ascertaining how the ENS is altered in diverse GI dysmotility conditions. While recent studies have interrogated ENS structure in surgically resected whole mount human gut, most pathological specimens are banked as formalin fixed paraffin embedded (FFPE) tissue blocks - suggesting that methods to interrogate ENS in FFPE tissue blocks would provide the biggest impetus for ENS histopathology in a clinical setting. In this report, we present optimized methods for immunohistochemical interrogation of the human ENS tissue on the basis of >25 important protein markers that include proteins expressed by all neurons, subset of neurons, hormones, and neurotransmitter receptors. This report provides a resource which will help pathologists and investigators assess ENS aberrations in patients with various GI dysmotility conditions.