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Deleemans JM, Gajtani Z, Baydoun M, Reimer RA, Piedalue KA, Carlson LE. The Use of Prebiotic and Probiotic Interventions for Treating Gastrointestinal and Psychosocial Health Symptoms in Cancer Patients and Survivors: A Systematic Review. Integr Cancer Ther 2021; 20:15347354211061733. [PMID: 34844479 PMCID: PMC8649088 DOI: 10.1177/15347354211061733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cancer treatments can cause significant gastrointestinal (GI) health issues, and negatively affect patient's psychosocial health and quality of life (QOL). Novel, integrative strategies using prebiotics and probiotics have been explored for treating adverse cancer treatment-related side effects. We evaluated the current literature for interventions using prebiotics or probiotics specifically to treat GI and psychosocial health issues in cancer patients and survivors. METHODS Five databases (PubMed, MEDLINE (Ovid), CINHAL, PsychINFO, Web of Science) were searched for studies with prebiotic or probiotic interventions where GI and/or psychosocial health outcomes were measured in adult cancer patients and survivors, and published before September 12th 2021. RESULTS Twelve studies (N = 974 participants) meeting the inclusion criteria were identified (randomized controlled trials [n = 10], single-group pre-post studies [n = 2]). Ten studies were conducted with patients on active cancer treatment, and 2 studies treated patients after anti-cancer therapies. Three studies used prebiotics, 7 studies used probiotics, and 2 studies used a combination therapy. The most commonly used probiotic strains were from the Lactobacillus genus. There was minimal evidence for prebiotics to improve GI or psychosocial health. Probiotics were associated with significant improvements in abdominal pain (n = 2), gas/bloating (n = 2), and especially diarrhea (n = 5), and with improvements in anxiety (n = 1), depression (n = 1), fatigue (n = 1), and QOL (n = 2). CONCLUSIONS Studies specifically examining effects of prebiotics and probiotics on GI and psychosocial health outcomes are scarce. Probiotic intervention may improve some GI symptoms in cancer patients, and QOL in survivors. Controlled trials that consistently include GI and psychosocial health outcomes are needed.
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Influence of Irritable Bowel Syndrome on Stress and Depressive Symptoms in Nurses: The Korea Nurses' Health Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312324. [PMID: 34886050 PMCID: PMC8657383 DOI: 10.3390/ijerph182312324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/20/2021] [Accepted: 11/21/2021] [Indexed: 11/23/2022]
Abstract
Despite the high risk of irritable bowel syndrome (IBS) and stress/depressive symptoms in nurses, limited research has examined the relationship between these conditions in female nurses. The purpose of this study was to determine the prevalence of IBS and the influence of IBS on stress and depressive symptoms in female nurses. We analyzed the data from the Korea Nurses’ Health Study. Among 7667 participants from the 7th survey conducted from December 2018 to September 2019, 178 nurses were identified as having IBS based on the Rome IV criteria. Using the propensity score matching, 712 were selected as a comparison group. Multivariate ordinal logistic regression analyses were conducted to examine the influence of IBS on stress and depressive symptoms. The prevalence of IBS was 2.3% and the prevalence of depressive symptoms among nurses with IBS was 13.5%. Female nurses with IBS were 2.214 times more likely to experience increased stress levels. However, when demographics, dietary habits, sleep quality, and depressive symptoms were considered, having IBS was no longer an influential factor for increased stress levels. When all the variables were considered, female nurses with IBS were still 2.205 times more likely to experience depressive symptoms. Adequate support is needed to relieve depressive symptoms in nurses with IBS.
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Yu S, Chun E, Ji Y, Lee YJ, Jin M. Effects of red ginseng on gut, microbiota, and brain in a mouse model of post-infectious irritable bowel syndrome. J Ginseng Res 2021; 45:706-716. [PMID: 34764725 PMCID: PMC8569328 DOI: 10.1016/j.jgr.2021.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 01/21/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023] Open
Abstract
Background Irritable bowel syndrome (IBS), the most common functional gastrointestinal disorder, is characterized by chronic abdominal pain and bowel habit changes. Although diverse complicated etiologies are involved in its pathogenesis, a dysregulated gut–brain axis may be an important factor. Red ginseng (RG), a traditional herbal medicine, is proven to have anti-inflammatory effects and improve brain function; however, these effects have not been investigated in IBS. Methods Three-day intracolonic zymosan injections were used to induce post-infectious human IBS-like symptoms in mice. The animals were randomized to receive either phosphate-buffered saline (CG) or RG (30/100/300 mg/kg) for 10 days. Amitriptyline and sulfasalazine were used as positive controls. Macroscopic scoring was performed on day 4. Visceral pain and anxiety-like behaviors were assessed by colorectal distension and elevated plus maze and open field tests, respectively, on day 10. Next-generation sequencing of gut microbiota was performed, and biomarkers involved in gut–brain axis responses were analyzed. Results Compared to CG, RG significantly decreased the macroscopic score, frequency of visceral pain, and anxiety-like behavior in the IBS mice. These effects were comparable to those after sulfasalazine and amitriptyline treatments. Moreover, RG significantly increased the proliferation of beneficial microbes, including Lactobacillus johnsonii, Lactobacillus reuteri, and Parabacteroides goldsteinii. RG significantly suppressed expression of IL-1β and c-fos in the gut and prefrontal cortex, respectively. Further, it restored the plasma levels of corticosterone to within the normal range, accompanied by an increase in adrenocorticotropic hormone. Conclusion RG may be a potential therapeutic option for the management of human IBS.
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Affiliation(s)
- Seonhye Yu
- Department of Microbiology, College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Eunho Chun
- Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, Republic of Korea
| | - Yeounjung Ji
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Republic of Korea
| | - Young Joo Lee
- Department of Bioscience and Biotechnology, Sejong University, Seoul, Republic of Korea
| | - Mirim Jin
- Department of Microbiology, College of Medicine, Gachon University, Incheon, Republic of Korea.,Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, Republic of Korea.,Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon, Republic of Korea
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Jones MP, Shah A, Walker MM, Koloski NA, Holtmann G, Talley NJ. Antibiotic use but not gastrointestinal infection frequently precedes first diagnosis of functional gastrointestinal disorders. United European Gastroenterol J 2021; 9:1074-1080. [PMID: 34653313 PMCID: PMC8598965 DOI: 10.1002/ueg2.12164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/27/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION While the etiopathogenesis of functional gastrointestinal disorders (FGIDs) is not completely understood, alterations of the intestinal microbiome have been observed. Antibiotics can induce dysbiosis, but whether antibiotics are a risk factor for the onset of FGIDs is uncertain. Antibiotics have been reported as both a risk factor for new onset FGID but also as a therapy for existing FGID. This study aimed to estimate the fraction of cases where antibiotics provoked the onset of FGID. METHOD Electronic medical records were obtained from general practices (primary care) in the United Kingdom. Dates of antibiotic prescription (AP) were compared with first date of FGID diagnosis and contrasted across three prevalent FGIDs and controls without gastrointestinal disorders. RESULTS There were 10,926 GI healthy controls, 4326 IBS alone, 3477 FD alone, 340 chronic constipation and 4402 with overlap of multiple conditions. Both the prevalence of AP and rate were higher in FGID patients and increased with diagnosis of multiple FGIDs. 7%-14% of FGID patients were prescribed their first recorded antibiotic in the 12 months prior to their first FGID diagnosis and 20%-33% were prescribed an antibiotic in the same period. Differences between FGID groups were not accounted for by social deprivation and only rate of AP was moderated by social deprivation. In contrast, only 5%-10% of patients ever had a gastrointestinal infection recorded and only 1.5%-3.5% prior to their first FGID diagnosis. CONCLUSION These data indicate that antibiotics are prescribed prior to FGID diagnosis in a significant minority of care-seeking FGID patients, opening the potential for this medication to contribute to the pathophysiology. APs appears to mostly be for non-gastrointestinal conditions.
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Affiliation(s)
- Michael P. Jones
- School of Psychological SciencesMacquarie UniversityNorth RydeNew South WalesAustralia
| | - Ayesha Shah
- Department of Gastroenterology and HepatologyPrincess Alexandra Hospital and Translational Research Institute (TRI)WoolloongabbaQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Marjorie M. Walker
- College of Health, Medicine and Well BeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Natasha A. Koloski
- Department of Gastroenterology and HepatologyPrincess Alexandra Hospital and Translational Research Institute (TRI)WoolloongabbaQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
- College of Health, Medicine and Well BeingUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Gerald Holtmann
- Department of Gastroenterology and HepatologyPrincess Alexandra Hospital and Translational Research Institute (TRI)WoolloongabbaQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Nicholas J. Talley
- College of Health, Medicine and Well BeingUniversity of NewcastleNewcastleNew South WalesAustralia
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Głąbska D, Kołota A, Lachowicz K, Skolmowska D, Stachoń M, Guzek D. Vitamin D Supplementation and Mental Health in Inflammatory Bowel Diseases and Irritable Bowel Syndrome Patients: A Systematic Review. Nutrients 2021; 13:nu13103662. [PMID: 34684663 PMCID: PMC8540769 DOI: 10.3390/nu13103662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 12/13/2022] Open
Abstract
Inflammatory bowel diseases (IBDs) and irritable bowel syndrome (IBS) are associated with decreased quality of life and mental health problems. Among various approaches to supportive therapy that aims to improve mental health in affected individuals, vitamin D supplementation is considered to be an effective method which may also be beneficial in alleviating the symptoms during the course of IBDs and IBS. The aim of the present study was to conduct a systematic review of the literature presenting the data regarding the influence of vitamin D supplementation on mental health in adults with inflammatory and functional bowel diseases, including IBDs and IBS. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (Registration number CRD42020155779). A systematic search of the PubMed and Web of Science databases was performed, and the intervention studies published until September 2021 were included. The human studies eligible to be included in the review should have described any intervention involving vitamin D as a supplement in a group of adult patients suffering from IBDs and/or IBS and should have assessed any component of mental health, but studies presenting the effects of combined supplementation of multiple nutrients were excluded. After eliminating the duplicates, a total of 8514 records were screened and assessed independently by two researchers. Further evaluation was carried out on the basis of title, abstract, and full text. Finally, 10 studies (four for IBDs and six for IBS) were selected for the current systematic review, and their quality was assessed using the Newcastle-Ottawa Scale (NOS). The studies analyzed the influence of various doses of vitamin D on bowel diseases, compared the results of vitamin D supplementation with placebo, or administered specific doses of vitamin D to obtain the required level in the blood. Supplementation was performed for at least 6 weeks. The analyzed mental health outcomes mainly included disease-specific quality of life/quality of life, anxiety, and depression. The majority of studies (including high-quality ones) confirmed the positive effect of vitamin D supplementation on the mental health of IBD and IBS patients, which was proven by all research works evaluating anxiety and depression and by the majority of research works evaluating quality of life. Although the studies followed different dosage regimens and supplementation protocols, the positive influence of vitamin D on mental health was found to be consistent. The number of studies on patients suffering from ulcerative colitis and the availability of trials randomized against the placebo group was low in the current review, which is considered to be a limitation of the present study and could also reflect the final outcome of the analysis. The conducted systematic review established the positive effect of vitamin D supplementation on the mental health of IBD and IBS patients, but this result requires further investigation, particularly in relation to other mental health outcomes.
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Affiliation(s)
- Dominika Głąbska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland; (A.K.); (K.L.); (D.S.); (M.S.)
- Correspondence: ; Tel.: +48-22-593-71-26
| | - Aleksandra Kołota
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland; (A.K.); (K.L.); (D.S.); (M.S.)
| | - Katarzyna Lachowicz
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland; (A.K.); (K.L.); (D.S.); (M.S.)
| | - Dominika Skolmowska
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland; (A.K.); (K.L.); (D.S.); (M.S.)
| | - Małgorzata Stachoń
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland; (A.K.); (K.L.); (D.S.); (M.S.)
| | - Dominika Guzek
- Department of Food Market and Consumer Research, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159C Nowoursynowska Street, 02-776 Warsaw, Poland;
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Subjective Taste and Smell Changes in Conjunction with Anxiety and Depression Are Associated with Symptoms in Patients with Functional Constipation and Irritable Bowel Syndrome. Gastroenterol Res Pract 2021; 2021:5491188. [PMID: 34589124 PMCID: PMC8476287 DOI: 10.1155/2021/5491188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background Patients with functional constipation (FC) and irritable bowel syndrome (IBS) often report psychological abnormalities and decreased eating enjoyment. Several patients also complain of changes in the sense of smell and taste, but these are often disregarded clinically. Aims Therefore, there is a need to determine whether taste/smell disturbances and psychological abnormalities are present in patients with FC or IBS and whether these are related to the severity of lower gastrointestinal symptoms. Methods A total of 337 subjects were recruited, including FC (n = 115), IBS (n = 126), and healthy controls (n = 96). All participants completed questionnaires evaluating taste and smell (taste and smell survey (TSS)), Lower Gastrointestinal Symptoms Rating Scale (LGSRS), Hamilton anxiety scale (HAMA), and Hamilton depression scale (HAMD). TSS recorded information on the nature of taste and smell changes (TSCs) and the impact of these changes on the quality of life. LGSRS was used to assess the severity of lower gastrointestinal symptoms; HAMA and HAMD scales were used to reflect the psychosocial state. This study protocol was registered on the Chinese Clinical Trial Registry (No. ChiCTR-2100044643). Results Firstly, we found that taste and smell scores were higher in patients with IBS than in healthy controls. Secondly, for FC and IBS patients, LGSRS was significantly correlated with the taste score (Spearman′s rho = 0.832, P < 0.001). LGSRS was also significantly correlated with HAMA (Spearman′s rho = 0.357, P = 0.017) and HAMD (Spearman′s rho = 0.377, P = 0.012). In addition, the taste score was significantly correlated with HAMD (Spearman′s rho = 0.479, P = 0.001), while the smell score was also significantly correlated with HAMD (Spearman′s rho = 0.325, P = 0.031). Thirdly, 60.87% and 71.43% of patients complained of taste abnormality, while 65.22% and 71.43% had smell abnormality in the FC and IBS groups, respectively. Meanwhile, 47.83% and 47.62% of patients suffered from anxiety, while 43.48% and 57.14% suffered from depression in the FC and IBS groups, respectively. Finally, we found significant differences in the taste, smell, HAMD, and LGSRS scores between the female and male IBS groups (P < 0.050). Conclusions TSCs and psychological disorders are prominent in FC and IBS patients. Taste abnormalities, as well as anxiety and depression, are significantly correlated with LGSRS. Awareness of this high prevalence of taste/smell abnormalities and the psychological changes among patients with FC and IBS may help better predict and understand the severity of symptoms.
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57
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Koloski NA, Jones M, Walker MM, Keely S, Holtmann G, Talley NJ. Sleep disturbances in the irritable bowel syndrome and functional dyspepsia are independent of psychological distress: a population-based study of 1322 Australians. Aliment Pharmacol Ther 2021; 54:627-636. [PMID: 34247414 DOI: 10.1111/apt.16500] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/18/2021] [Accepted: 06/09/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Psychological distress, strongly associated with functional gastrointestinal disorders (FGIDS), likely plays a central role in the pathophysiology. The role of sleep disturbances in FGIDs is unclear, and an association with psychological factors is uncertain. AIM To determine whether sleep disturbances are associated with irritable bowel syndrome (IBS) and functional dyspepsia (FD) and if a potential association is explained by psychological distress. METHODS Adult sample randomly selected from a region in New South Wales, Australia in 2015 who returned a follow-up mail survey in 2018 (response rate, 60.5%) that contained questions on IBS, FD, sleep (MOS-Sleep Scale) and psychological distress (Kessler 6 scale). RESULTS Among this population, 10.4% (95% CI 8.8-12.2) and 17.9% (95% CI 15.9-20.1) met Rome III criteria for IBS and FD, respectively. The prevalence of any sleep disturbance at least most of the time was common, with a significantly higher prevalence in FGID (IBS and/or FD) compared with the remaining population (41.8% vs 32.2%, P = 0.003). The total sleep problem index was significantly higher for IBS (OR = 1.71 [95% CI 1.29-2.27], P < 0.0001) (IBS-diarrhoea predominant and IBS-mixed but not IBS-constipation) and FD (OR = 1.80 [1.43-2.26], P < 0.0001) (both epigastric pain syndrome and postprandial distress syndrome) even after adjusting for age, sex and psychological distress. CONCLUSION Both IBS and FD, and most of their major subtypes except IBS-C, are associated with a range of sleep disturbances. These sleep problems do not appear to be explained by psychological factors and may play an independent role in the pathophysiology.
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Affiliation(s)
- Natasha A Koloski
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Faculty of Health and Behavioural Sciences, University of Queensland, Herston, QLD, Australia
| | - Michael Jones
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Marjorie M Walker
- School of Medicine and Public Health, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, College of Health Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia
| | - Nicholas J Talley
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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Jagielski CH, Riehl ME. Behavioral Strategies for Irritable Bowel Syndrome: Brain-Gut or Gut-Brain? Gastroenterol Clin North Am 2021; 50:581-593. [PMID: 34304789 DOI: 10.1016/j.gtc.2021.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction (DGBI) that is associated with significant physical, emotional, and occupational burden. Factors such as early life stress, sleep disruption, maladaptive coping strategies, symptom hypervigilance, and visceral hypersensitivity negatively affect gut-brain communication and increase the likelihood of developing IBS or worsen IBS severity. Behavioral strategies, such as cognitive behavioral therapy, gut-directed hypnosis, and mindfulness-based treatments, have shown benefit in improving gastrointestinal (GI)-specific quality of life, as well as reducing GI symptoms. Partnering with a GI-specific mental health provider can assist gastroenterologists in providing comprehensive treatment of IBS and other DGBIs.
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Affiliation(s)
- Christina H Jagielski
- Internal Medicine-Gastroenterology, Michigan Medicine, 380 Parkland Plaza, Ann Arbor, MI 48103, USA.
| | - Megan E Riehl
- Internal Medicine-Gastroenterology, Michigan Medicine, 3912 Taubman Center, SPC 5362, Suite 3436, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5362, USA
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Aziz MNM, Kumar J, Muhammad Nawawi KN, Raja Ali RA, Mokhtar NM. Irritable Bowel Syndrome, Depression, and Neurodegeneration: A Bidirectional Communication from Gut to Brain. Nutrients 2021; 13:nu13093061. [PMID: 34578939 PMCID: PMC8468817 DOI: 10.3390/nu13093061] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 12/13/2022] Open
Abstract
Patients with irritable bowel syndrome (IBS) are increasingly presenting with a wide range of neuropsychiatric symptoms, such as deterioration in gastroenteric physiology, including visceral hypersensitivity, altered intestinal membrane permeability, and gastrointestinal motor dysfunction. Functional imaging of IBS patients has revealed several abnormalities in various brain regions, such as significant activation of amygdala, thinning of insular and anterior cingulate cortex, and increase in hypothalamic gray matter, which results in poor psychiatric and cognitive outcomes. Interrelations between the enteric and central events in IBS-related gastrointestinal, neurological, and psychiatric pathologies have compelled researchers to study the gut-brain axis-a bidirectional communication that maintains the homeostasis of the gastrointestinal and central nervous system with gut microbiota as the protagonist. Thus, it can be disrupted by any alteration owing to the gut dysbiosis or loss of diversity in microbial composition. Available evidence indicates that the use of probiotics as a part of a balanced diet is effective in the management of IBS and IBS-associated neurodegenerative and psychiatric comorbidities. In this review, we delineate the pathogenesis and complications of IBS from gastrointestinal and neuropsychiatric standpoints while also discussing the neurodegenerative events in enteric and central nervous systems of IBS patients and the therapeutic potential of gut microbiota-based therapy established on clinical and preclinical data.
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Affiliation(s)
- Muhammad Nazirul Mubin Aziz
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (M.N.M.A.); (J.K.)
| | - Jaya Kumar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (M.N.M.A.); (J.K.)
- Gut Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (K.N.M.N.); (R.A.R.A.)
| | - Khairul Najmi Muhammad Nawawi
- Gut Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (K.N.M.N.); (R.A.R.A.)
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Raja Affendi Raja Ali
- Gut Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (K.N.M.N.); (R.A.R.A.)
- Gastroenterology Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Norfilza M. Mokhtar
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (M.N.M.A.); (J.K.)
- Gut Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia; (K.N.M.N.); (R.A.R.A.)
- Correspondence:
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Liu G, Li S, Chen N, Zhao Z, Guo M, Liu H, Feng J, Zhang D, Yao Z, Hu B. Inter-hemispheric Functional Connections Are More Vulnerable to Attack Than Structural Connection in Patients With Irritable Bowel Syndrome. J Neurogastroenterol Motil 2021; 27:426-435. [PMID: 34210908 PMCID: PMC8266492 DOI: 10.5056/jnm20134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/14/2020] [Accepted: 09/20/2020] [Indexed: 12/12/2022] Open
Abstract
Background/Aims Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disease characterized by recurrent abdominal pain and bowel dysfunction. However, the majority of previous neuroimaging studies focus on brain structure and connections but seldom on the inter-hemispheric connectivity or structural asymmetry. This study uses multi-modal imaging to investigate the abnormal changes across the 2 cerebral hemispheres in patients with IBS. Methods Structural MRI, resting-state functional MRI, and diffusion tensor imaging were acquired from 34 patients with IBS and 33 healthy controls. The voxel-mirrored homotopic connectivity, fractional anisotropy, fiber length, fiber number, and asymmetry index were calculated and assessed for group differences. In addition, we assessed their relevance for the severity of IBS. Results Compared with healthy controls, the inter-hemispheric functional connectivity of patients with IBS showed higher levels in bilateral superior occipital gyrus, middle occipital gyrus, precuneus, posterior cingulate gyrus, and angular gyrus, but lower in supplementary motor area. The statistical results showed no significant difference in inter-hemispheric anatomical connections and structural asymmetry, however negative correlations between inter-hemispheric connectivity and the severity of IBS were found in some regions with significant difference. Conclusions The functional connections between cerebral hemispheres were more susceptible to IBS than anatomical connections, and brain structure is relatively stable. Besides, the brain areas affected by IBS were concentrated in default mode network and sensorimotor network.
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Affiliation(s)
- Guangyao Liu
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
| | - Shan Li
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Nan Chen
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Ziyang Zhao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Man Guo
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Hong Liu
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
| | - Jie Feng
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, China
| | - Dekui Zhang
- Department of Gastroenterology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhijun Yao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Bin Hu
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Lanzhou, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.,Joint Research Center for Cognitive Neurosensor Technology of Lanzhou University and Institute of Semiconductors, Chinese Academy of Sciences, Lanzhou, China.,Engineering Research Center of Open Source Software and Real-Time System (Lanzhou University), Ministry of Education, Lanzhou, China
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Pogodina AV, Romanitsa AI, Rychkova LV. Obesity and functional bowel disorders: are they linked? OBESITY AND METABOLISM 2021. [DOI: 10.14341/omet12706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Obesity and functional bowel disease (FBD) are affecting a large number of people worldwide. They have psychosocial consequences and associated with considerable healthcare resource use. The purpose of this review was a comprehensive study of the relationship between obesity and FBD, as well as mechanisms to explain this relationship. An analysis of the literature provides strong evidence of a link between obesity and diarrhea, but there is currently insufficient data to speak confidently about the link between obesity and irritable bowel syndrome. Most studies suggest that adult obesity is not associated or negatively associated with constipation. The association of obesity with diarrhea is most convincingly explained through diet, eating behavior, changes in the metabolism of bile acids, accelerated colonic transit, altered intestinal microbiota and associated inflammation and increased intestinal permeability. Medicines taken by patients, as well as non-alcoholic fatty liver disease, can play their own role.Planning and conducting studies, including longitudinal ones, based on valid diagnostic criteria and taking into account the widest possible range of confounders, will allow a deeper study of the problem of comorbidity of obesity and FBD. This will help optimize the treatment of these diseases.
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Affiliation(s)
- A. V. Pogodina
- Scientific Center for Family Health and Human Reproduction Problems
| | - A. I. Romanitsa
- Scientific Center for Family Health and Human Reproduction Problems
| | - L. V. Rychkova
- Scientific Center for Family Health and Human Reproduction Problems
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Kim JY, Lim MH. Psychological factors to predict chronic diarrhea and constipation in Korean high school students. Medicine (Baltimore) 2021; 100:e26442. [PMID: 34232176 PMCID: PMC8270581 DOI: 10.1097/md.0000000000026442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 05/19/2021] [Accepted: 06/05/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Chronic diarrhea and constipation are common in adolescents and are associated with depression and anxiety. However, the association was not reported in adolescents adjusted for other psychological factors (resilience, personality traits, perceived stress, and suicidal ideation). Therefore, we investigated the significant psychological factors predicting chronic diarrhea and constipation in adjusted individuals for co-variables.A total of 819 Korean high school students who completed bowel health and psychological questionnaires were enrolled in this study. Depression and anxiety were assessed using validated questionnaires. We used multivariate analyses, controlling for demographic, dietary, lifestyle, and psychological variables to predict chronic diarrhea and constipation.Chronic diarrhea and constipation were more common in individuals with depression (22.3% and 18.6%, respectively) than in individuals with no depression (7.0% and 10.9%, respectively). In addition, they were more prevalent in individuals with anxiety (24.5% and 18.6%, respectively) than in individuals with no anxiety (9.1% and 12.7%, respectively). Multivariate analyses showed that resilience (adjusted risk ratio [aRR] = 0.98, adjusted 95% confidence interval [CI] = 0.97-0.99), moderate (aRR = 6.77, adjusted 95% CI = 3.55-12.91), and severe depression (aRR = 7.42, adjusted 95% CI = 3.61-15.27) were associated with chronic diarrhea. Only mild depression was associated with chronic constipation (aRR = 2.14, adjusted 95% CI = 1.36-3.38). However, anxiety was not significantly associated with chronic diarrhea or constipation.Among the psychological factors predicting disordered bowel habits, resilience and moderate and severe depression were significant predictors of chronic diarrhea, but not anxiety. Furthermore, only mild depression was an independent predictor of chronic constipation.
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Affiliation(s)
- Ji Young Kim
- Department of Psychology, Graduate School of Dankook University
| | - Myung Ho Lim
- Department of Psychology and Psychotherapy, College of Health Science
- Environmental Health Center, Dankook Medical Hospital, Dankook University, Cheonan, Korea
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Dao VH, Hoang LB, Trinh TO, Tran TTT, Dao VL. Psychobiotics for Patients with Chronic Gastrointestinal Disorders Having Anxiety or Depression Symptoms. J Multidiscip Healthc 2021; 14:1395-1402. [PMID: 34140777 PMCID: PMC8203266 DOI: 10.2147/jmdh.s312316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Using psychobiotics to modify the gut microbiome has been shown to improve the anxiety and depression situation of patients with chronic gastrointestinal (GI) symptoms. This study evaluated changes in depression, anxiety, GI symptomss and side effects when patients used a multispecies probiotics product. PATIENTS AND METHODS A single-center uncontrolled trial was conducted in patients with chronic GI symptoms, anxiety and depression who used a multispecies probiotics product. The patients were screened for anxiety and depression symptoms using the Hospital Anxiety and Depression Scale (HADS). Those who had a component score of 8 or higher were given the multispecies probiotics product for 2 months and followed up after 1 and 2 months. All data are collected and managed in a case report form. RESULTS Eighty-three patients were enrolled, with a mean age (SD) of 43.9 (12.3) years; 73.5% of the patients were female. Of these patients, 8 met the Rome IV criteria for irritable bowel syndrome. The HADS scores displayed significant improvement at follow-up. The mean (SD) total HADS scores were 20.0 (6.3), 7.2 (5.4), and 4.9 (5.1) at baseline, 1 month, and 2 months, respectively. Quality of life also improved significantly. A small proportion (<5%) of patients developed mild symptoms, including fullness, diarrhea, and sleep complaints. CONCLUSION After 2 months using the probiotic product, the symptoms of anxiety and depression improved significantly. Mild gastrointestinal or constitutional symptoms developed in some patients.
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Affiliation(s)
- Viet Hang Dao
- Internal Medicine Faculty, Hanoi Medical University, Hanoi, Vietnam
- Research and Training Management Unit, Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
| | - Long Bao Hoang
- Research and Training Management Unit, Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
| | - Thi Oanh Trinh
- Research and Training Management Unit, Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
| | - Thi Thu Trang Tran
- Research and Training Management Unit, Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
| | - Van Long Dao
- Internal Medicine Faculty, Hanoi Medical University, Hanoi, Vietnam
- Research and Training Management Unit, Institute of Gastroenterology and Hepatology, Hanoi, Vietnam
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64
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Kerr KL, Ralph-Nearman C, Colaizzi JM, DeVille DC, Breslin FJ, Aupperle RL, Paulus MP, Morris AS. Gastric symptoms and low perceived maternal warmth are associated with eating disorder symptoms in young adolescent girls. Int J Eat Disord 2021; 54:1009-1018. [PMID: 33836108 PMCID: PMC9945938 DOI: 10.1002/eat.23516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/03/2021] [Accepted: 03/23/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study sought to determine whether gastric symptoms are associated with later eating disorder (ED) symptoms during early adolescence, and whether this relationship is moderated by parental warmth/acceptance and/or the child's sex. METHOD Longitudinal data from the Adolescent Brain Cognitive DevelopmentSM Study were utilized. Participants ages 9-10 years old (N = 4,950; 2,370 female) completed measures at baseline and 1 year later (Y1). At baseline, gastric symptoms were measured by parent-reported items from the Child Behavior Checklist (CBCL), and perceived parental acceptance was measured by youth report on the Children's Report of Parent Behavior Inventory (CRPBI) Acceptance subscale separately for mothers and fathers. ED symptoms at Y1 were assessed by parent report on a computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Linear mixed-effects models were conducted separately for maternal and paternal acceptance to test relationships among variables. RESULTS A three-way interaction between baseline gastric symptoms, sex, and maternal acceptance predicted Y1 ED symptoms (𝛽 = 0.08; p < .01). Post-hoc analyses revealed that the interaction between gastric symptoms and maternal acceptance was significant for girls only (𝛽 = -0.06, p < .01), such that low maternal acceptance was associated with a stronger relationship between baseline gastric symptoms and Y1 ED symptoms. No statistically significant main effects or interactions were found in the model for paternal acceptance. DISCUSSION Gastric symptoms and low perceived maternal acceptance may interact to result in heightened risk for EDs in young adolescent girls.
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Affiliation(s)
- Kara L. Kerr
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma
| | - Christina Ralph-Nearman
- Department of Psychological and Brain Sciences, The University of Louisville, Louisville, Kentucky,Laureate Institute for Brain Research, Tulsa, Oklahoma
| | | | - Danielle C. DeVille
- Laureate Institute for Brain Research, Tulsa, Oklahoma,Department of Psychology, The University of Tulsa, Tulsa, Oklahoma
| | | | - Robin L. Aupperle
- Laureate Institute for Brain Research, Tulsa, Oklahoma,Department of Community Medicine, The University of Tulsa, Tulsa, Oklahoma
| | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma,Department of Community Medicine, The University of Tulsa, Tulsa, Oklahoma,Department of Psychiatry, University of California, San Diego, California
| | - Amanda Sheffield Morris
- Laureate Institute for Brain Research, Tulsa, Oklahoma,Department of Human Development and Family Science, Oklahoma State University, Stillwater, Oklahoma
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Selim A, Saad Salem S, Albasher N, Bakrmom G, Alanzi S, Jradi H. Irritable Bowel Syndrome and Coping Strategies: A Cross-sectional Study for Identifying Psychological Alarms and Factors Related to Coping in Riyadh, Saudi Arabia. Clin Nurs Res 2021; 31:144-154. [PMID: 34056933 DOI: 10.1177/10547738211020437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Psychological alarms including severity of pain, functional impairment, depression, and impaired coping strategies have been correlated with (IBS); however, these attributes, particularly coping strategies, have not been well studied. The aim of this study was to assess psychological alarms, life stressors, and coping strategies of adults diagnosed with IBS. A total of 806 participants completed a self-administered survey consisting of socio-demographic data and life stressors, the Rome IV criteria to diagnose IBS, the Psychological Alarm Questionnaire, and the Coping Strategies Questionnaire (CSQ 24). IBS diagnosis was established among 372 (46.15%) participants. Anxiety (OR = 1.81; 95% CI: 1.35-2.45), severe pain (OR = 1.92; 95% CI: 1.42-2.63), financial life stressors (OR = 1.98; 95% CI: 1.33-2.40), and coping strategies such as reinterpretation (OR = 1.92; 95% CI: 1.39-2.68) and diversion (OR = 2.01; 95% CI: 1.05-3.89) were all significantly and independently associated with IBS diagnosis. Giving the chronic nature of IBS, future research should focus on coping as a potential treatment goal for IBS patients.
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Affiliation(s)
- Abeer Selim
- Faculty of Nursing, Psychiatric and Mental Health Nursing Department, Mansoura University, Mansoura, Egypt
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi
| | - Samah Saad Salem
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi
- Faculty of Nursing, Medical-Surgical Nursing Department, Cairo University, Egypt
| | - Noura Albasher
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ghadah Bakrmom
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Samar Alanzi
- Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hoda Jradi
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Li J, He P, Lu X, Guo Y, Liu M, Li G, Ding J. A Resting-state Functional Magnetic Resonance Imaging Study of Whole-brain Functional Connectivity of Voxel Levels in Patients With Irritable Bowel Syndrome With Depressive Symptoms. J Neurogastroenterol Motil 2021; 27:248-256. [PMID: 33795543 PMCID: PMC8026363 DOI: 10.5056/jnm20209] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/11/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims Depressive symptom is one of the most common symptoms in patients with irritable bowel syndrome (IBS), but its pathogenetic mechanisms remain unclear. As a voxel-level graph theory analysis method, degree centrality (DC) can provide a new perspective for exploring the abnormalities of whole-brain functional network of IBS with depressive symptoms (DEP-IBS). Methods DC, voxel-wise image and clinical symptoms correlation and seed-based functional connectivity (FC) analyses were performed in 28 DEP-IBS patients, 21 IBS without depressive symptoms (nDEP-IBS) patients and 36 matched healthy controls (HC) to reveal the abnormalities of whole brain FC in DEP-IBS. Results Compared to nDEP-IBS patients and HC, DEP-IBS patients showed significant decrease of DC in the left insula and increase of DC in the left precentral gyrus. The DC's z-scores of the left insula negatively correlated with depression severity in DEP-IBS patients. Compared to nDEP-IBS patients, DEP-IBS patients showed increased left insula-related FC in the left inferior parietal lobule and right inferior occipital gyrus, and decreased left insula-related FC in the left precentral gyrus, right supplementary motor area (SMA), and postcentral gyrus. In DEP-IBS patients, abstracted clusters' mean FC in the right SMA negatively correlated with depressive symptoms. Conclusions DEP-IBS patients have abnormal FC in brain regions associated with the fronto-limbic and sensorimotor networks, especially insula and SMA, which explains the vicious circle between negative emotion and gastrointestinal symptoms in IBS. Identification of such alterations may facilitate earlier and more accurate diagnosis of depression in IBS, and development of effective treatment strategies.
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Affiliation(s)
- Jie Li
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Ping He
- Department of Orthodontics, Hangzhou Stomatological Hospital, Hangzhou, Zhejiang, China
| | - Xingqi Lu
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yun Guo
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Min Liu
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Guoxiong Li
- Department of Gastroenterology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jianping Ding
- Department of Radiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
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Risks of Major Mental Disorders and Irritable Bowel Syndrome among the Offspring of Parents with Irritable Bowel Syndrome: A Nationwide Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094679. [PMID: 33924787 PMCID: PMC8124475 DOI: 10.3390/ijerph18094679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 12/12/2022]
Abstract
Irritable bowel syndrome (IBS) is a functional bowel disorder that is highly comorbid with mental disorders. However, few studies have examined the risk of attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder, major depressive disorder (MDD), and schizophrenia in the offspring of parents with IBS. We used nationally representative cross-sectional survey data to analyze cross-generational transmission patterns of both IBS and major mental disorders. Odds ratio (OR) was calculated by using logistic regression models with adjustment for potential confounding factors. Offspring of parents with IBS were more likely to develop IBS themselves (OR = 2.41, 95% confidence interval (CI), 2.09–2.78), ADHD (OR = 1.33, 95% CI, 1.08–1.62), and MDD (OR = 1.32, 95% CI, 1.04–1.68) than the controls. Data stratification by parental sex revealed that paternal IBS increased risk of ADHD (OR = 1.34, 95% CI, 1.01–1.77) in the offspring, while maternal IBS increased the risk of MDD (OR = 1.51, 95% CI, 1.11–2.06). This is the first study to reveal parental IBS is associated with IBS, ADHD, and MDD among offspring, suggesting the necessity for early implementation of prevention strategies for at-risk children.
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Structural relationship model of type D personality and depression with the mediating role of cognitive distortions and family functioning in irritable bowel syndrome patients and healthy people: A multi-group analysis. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01755-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Alnoman A, Badeghiesh AM, Baghlaf HA, Dahan MH. Pregnancy, delivery, and neonatal outcomes among women with irritable bowel syndrome (IBS) an evaluation of over 9 million deliveries. J Matern Fetal Neonatal Med 2021; 35:5935-5942. [PMID: 33823718 DOI: 10.1080/14767058.2021.1903421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Evaluate the associations between irritable bowel syndrome (IBS) and pregnancy, delivery, and neonatal outcomes, using a population database cohort. METHODS We conducted a retrospective analysis utilizing the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database over 11 years from 2004 to 2014. A delivery cohort was created using ICD-9 codes. ICD-9 code 564.1 was used to extract the cases of IBS. Pregnant women with IBS (study group) were compared to pregnant women without IBS (control). A multivariate logistic regression model was used to adjust for statistically significant variables (p value <.05). RESULTS There were a total of 9,096,788 deliveries during the study period. Of those, 8962 pregnant women were found to have IBS. The prevalence of IBS increased from 47.96 to 172.68 per 100,000 women during the study period. Compared to the control group, women with IBS were more likely to be Caucasian, older, have higher incomes and private insurance plans (p < .0001, in all cases). In addition, they were more likely to be obese, smokers, hypertensive, IVF pregnancies, have multiple gestations, thyroid disorders, chronic interstitial cystitis, fibromyalgia and have psychiatric disorders (p < .0001 in all cases). Women with IBS were more likely to experience pregnancy-induced hypertension (aOR 1.11, 95% CI 1.02-1.21), preeclampsia (aOR 1.23, 95% CI 1.09-1.38), deep venous thrombosis (aOR 2.26, 95% CI 1.12-4.57), and gestational diabetes (aOR 1.1, 95% CI 1.002-1.22) compared to the non-IBS group. Congenital anomalies were encountered in 1.7% of the IBS group compared to 0.4% in the control group (aOR 2.57, 95% CI 2.13-3.09). CONCLUSION When controlling for confounding effects, IBS is associated with an increased risk for preeclampsia, DVT and increased risk for congenital malformation.
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Affiliation(s)
- Abdullah Alnoman
- Department of Obstetrics and Gynaecology, McGill University, Montreal, Canada.,Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad M Badeghiesh
- Department of Obstetrics and Gynaecology, McGill University, Montreal, Canada.,Department of Obstetrics and Gynecology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Haitham A Baghlaf
- Division of Maternal-Fetal Medicine, Obstetrics & Gynaecology Department, University of Toronto, Toronto, Canada.,Department of Obstetrics and Gynecology, University of Tabuk, Tabuk, Saudi Arabia
| | - Michael H Dahan
- Division of Reproductive Endocrinology and Infertility, MUHC Reproductive Center, McGill University, Montreal, Canada
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Cumulative Effect of Psychological Alterations on Gastrointestinal Symptom Severity in Irritable Bowel Syndrome. Am J Gastroenterol 2021; 116:769-779. [PMID: 33982947 DOI: 10.14309/ajg.0000000000001038] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Psychological alterations are common and considered important for symptom generation in irritable bowel syndrome (IBS). However, the possible cumulative effect of having multiple psychological alterations on gastrointestinal (GI) symptom severity in IBS is largely unknown. METHODS Patients with IBS (Rome IV) completed validated questionnaires assessing GI symptoms (Gastrointestinal Symptom Rating Scale, IBS version and IBS Severity Scoring System), personality traits (Big Five), posttraumatic stress and psychological alterations, anxiety (Generalized Anxiety Disorder 7-item scale and State-Trait Anxiety Inventory), depression (Patient Health Questionnaire, 9-item version), fatigue (Multidimensional Fatigue Inventory), pain catastrophizing, somatization (Patient Health Questionnaire, 12-item version), stress (Perceived Stress Scale), and GI-specific anxiety (Visceral Sensitivity Index). Of the 18 possible psychological factors, those with significant associations with GI symptom severity, corrected for multiple comparisons, were identified. The associations between increasing number of psychological alterations (validated cutoff values or uppermost tertile) and the severity of GI symptoms were analyzed with linear trend analyses. RESULTS In total, 106 patients with IBS (Rome IV criteria) were included (72 [68%] women, median age of 35 [interquartile range: 26-45] years). Psychological alterations were common and overlap among these factors were frequently seen. Five psychological factors (physical fatigue, GI-specific anxiety, perceived stress, pain catastrophizing, and trait anxiety) demonstrated significant, noncollinear associations with GI symptom severity. With increasing number of these psychological alterations, a gradual increase was seen in the overall severity of GI symptoms (Gastrointestinal Symptom Rating Scale, IBS version: partial η = 0.268, P < 0.001; IBS Severity Scoring System: partial η = 0.219, P < 0.001, both large effect sizes). DISCUSSION Distinct associations were seen between the severity of GI symptoms and individual, as well as an increasing number of psychological alterations. This highlights the importance of understanding different psychological alterations for the disease burden in IBS (visual abstract, Supplementary Digital Content 1, http://links.lww.com/AJG/B756).
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Reicher-Atir R, Avnat-Becker L, Levy S, Sperber AD, Dickman R. Psychological defense mechanisms and use of corporeal discourse: a comparison between patients with irritable bowel syndrome, medical personnel and healthy volunteers. Eur J Gastroenterol Hepatol 2021; 33:514-521. [PMID: 32956177 DOI: 10.1097/meg.0000000000001940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of this study was to compare the use of psychological defense mechanisms and corporeal discourse among patients with irritable bowel syndrome (IBS), medical personnel and healthy volunteers. METHODS All participants completed an identical battery of questionnaires: a demographic questionnaire, the Corporeal Discourse Questionnaire, the Defense Style Questionnaire and a Visual Analogue Scale for situational anxiety and depression. Patients and medical personnel were recruited from the Rabin Medical Center, a tertiary university-affiliated hospital. Findings were analyzed according to the study variables and compared among the groups. RESULTS Questionnaires were completed by 40 patients with IBS, 39 medical personnel and 40 healthy volunteers. Correlations between the study variables within the entire study group (all study participants, N = 119) revealed that corporeal discourse was found to be significantly correlated with the immature and neurotic class of defense mechanisms (r = 0.41, P < 0.01 and r = 0.20, P < 0.05, respectively), depression (r = 0.46, P < 0.05) and anxiety (r = 0.46, P < 0.05). Differences between IBS and the other two groups were significant for corporeal discourse, depression, anxiety and use of immature defense mechanisms. Posthoc analyses showed that medical personnel differed from IBS patients in all of these measures. Healthy volunteers had an inconsistent pattern of differences from the other two groups. CONCLUSION Maturity level of defense mechanisms and the tendency to use corporeal discourse are expressed among IBS patients in a diverse and unique manner. These findings may indicate additional psychological mechanisms that could explain the use of somatic complaints in IBS and support the implementation of tailored psychological interventions.
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Affiliation(s)
- Rebecca Reicher-Atir
- Statistics Education Unit, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo
| | - Lee Avnat-Becker
- Statistics Education Unit, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo
| | - Sigal Levy
- Statistics Education Unit, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo
| | - Ami D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lee SM, Kim N, Yoon H, Kim YS, Choi SI, Park JH, Lee DH. Compositional and Functional Changes in the Gut Microbiota in Irritable Bowel Syndrome Patients. Gut Liver 2021; 15:253-261. [PMID: 32457278 PMCID: PMC7960967 DOI: 10.5009/gnl19379] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/29/2020] [Accepted: 03/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background/Aims This study aimed to characterize the changes in the gut microbiota of irritable bowel syndrome (IBS) patients and to investigate the consequent alterations in bacterial functions. Methods We performed 16S rRNA metagenomic sequencing and a phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt) analyses using fecal samples from control (n=12) and diarrhea-dominant IBS patients (n=7). Results The samples were clustered by the principal coordinates analysis depending on the presence of IBS (p=0.003). In the IBS patients, the abundances of Acidaminococcaceae, Sutterellaceae, and Desulfovibrionaceae were significantly increased, while those of Enterococcaceae, Leuconostocaceae, Clostridiaceae, Peptostreptococcaceae, and Lachnospiraceae were significantly decreased. The PICRUSt results indicated that two orthologues involved in secondary bile acid biosynthesis were significantly decreased in IBS patients. Modules involved in multidrug resistance, lipopolysaccharide biosynthesis, the reductive citrate cycle, and the citrate cycle were significantly increased in the IBS patients. In contrast, modules involved in cationic antimicrobial peptide resistance, and some transport systems were more abundant in controls than in IBS patients. Conclusions Changes in the gut microbiota composition in IBS patients lead to alterations in bacterial functions, such as bile acid transformation and the induction of inflammation, which is a known pathophysiological mechanism of IBS.
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Affiliation(s)
- Sun Min Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong Sung Kim
- Digestive Disease Research Institute, Wonkwang University, Iksan, Korea.,DCNbio, Seongnam, Korea
| | - Soo In Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Hyun Park
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Rijnaarts I, Witteman BJM, Zoetendal EG, Govers C, de Wit NJW, de Roos NM. Subtypes and Severity of Irritable Bowel Syndrome Are Not Related to Patients' Self-Reported Dietary Triggers: Results From an Online Survey in Dutch Adults. J Acad Nutr Diet 2021; 121:1750-1762.e8. [PMID: 33674208 DOI: 10.1016/j.jand.2021.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 01/07/2021] [Accepted: 01/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Diet plays an important role in symptom management of irritable bowel syndrome (IBS). However, current diet therapies are not optimal nor successful for everyone. OBJECTIVE To investigate whether subgroups based on IBS subtypes or severity identify different self-reported dietary triggers, and whether these are associated with severity and psychological factors. DESIGN Online cross-sectional survey PARTICIPANTS: Patients with IBS (n = 1601) who fulfilled the Rome IV criteria or had an IBS diagnosis. MAIN OUTCOMES Self-reported response to 44 preselected dietary triggers, IBS quality of life, and anxiety and depression. Subgroups were based on subtypes or severity. STATISTICAL ANALYSIS Response to dietary triggers was analyzed using multiple correspondence analysis. Moreover, a food score was calculated to quantify the number and severity of responses to dietary triggers. RESULTS Response to greasy foods, onions, cabbage, and spicy and fried foods were mentioned most often (ranging between 55% and 65%). Response to dietary triggers differed between subtypes and severity groups, but absolute differences were small. Multiple correspondence analysis did not reveal clustering between dietary triggers, and ellipses for the subtypes overlapped. Some clustering was seen when ellipses were drawn for severity, which indicates that severity explained a fraction of the variation in response to dietary triggers, and subtypes did not. The food score was not significantly different between subtypes but was significantly higher with higher levels of severity (mild = 20.9 ± 17, moderate = 29.2 ± 19, severe = 37.9 ± 20, P < .001), having depressive (no = 31.4 ± 20, yes = 37.4 ± 20, P < .001) or anxious symptoms (no = 30.7 ± 20, yes = 35.2 ± 20, P < .001), and lower quality of life (lower quality of life = 38.5 ± 19, higher quality of life = 26.5 ± 19, P < .001). CONCLUSION Patients with different IBS subtypes or IBS severity do not identify different self-reported dietary triggers. Patients with more severe IBS and who experience anxiety or depression tend to have severe responses to more dietary triggers. IBS severity seems a better classifier than Rome IV criteria regarding diet. Dietary treatment needs to be individualized under guidance of a dietitian.
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74
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Ancona A, Petito C, Iavarone I, Petito V, Galasso L, Leonetti A, Turchini L, Belella D, Ferrarrese D, Addolorato G, Armuzzi A, Gasbarrini A, Scaldaferri F. The gut-brain axis in irritable bowel syndrome and inflammatory bowel disease. Dig Liver Dis 2021; 53:298-305. [PMID: 33303315 DOI: 10.1016/j.dld.2020.11.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 02/06/2023]
Abstract
Research increasingly demonstrates the bidirectional communication between gut microbiota and the brain, enhancing the role of gut microbiota modulation in the treatment of central nervous system (CNS) disorders. The first five years of life are extremely important as it affects the development of gut microbiota, immune system and, consequently, the onset of psychometric alterations, particularly in genetically predisposed individuals. In this review, we focus on the link between specific microbial genera, gastrointestinal (GI) disorders, anxiety and depression and on the effects of different therapeutic strategies for mood disorders on gut microbiota.
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Affiliation(s)
- Angela Ancona
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Roma, Italia
| | - Claudia Petito
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Unità Operativa Semplice di Psicologia Clinica Ospedaliera, 00168 Roma, Italia
| | - Irene Iavarone
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Roma, Italia
| | - Valentina Petito
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, 00168 Roma, Italia.
| | - Linda Galasso
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Roma, Italia
| | - Alessia Leonetti
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Roma, Italia
| | - Laura Turchini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Roma, Italia
| | - Daniela Belella
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Unità Operativa Semplice di Psicologia Clinica Ospedaliera, 00168 Roma, Italia
| | - Daniele Ferrarrese
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Unità Operativa Semplice di Psicologia Clinica Ospedaliera, 00168 Roma, Italia
| | - Giovanni Addolorato
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Roma, Italia; Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, 00168 Roma, Italia
| | - Alessandro Armuzzi
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Roma, Italia; Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, 00168 Roma, Italia
| | - Antonio Gasbarrini
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Roma, Italia; Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, 00168 Roma, Italia
| | - Franco Scaldaferri
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Dipartimento di Scienze Mediche e Chirurgiche, 00168 Roma, Italia; Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Dipartimento di Medicina e Chirurgia Traslazionale, 00168 Roma, Italia
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Davarinejad O, RostamiParsa F, Radmehr F, Farnia V, Alikhani M. The prevalence of obsessive-compulsive disorder in patients with irritable bowel syndrome: A cross-sectional study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:50. [PMID: 34084797 PMCID: PMC8057190 DOI: 10.4103/jehp.jehp_812_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/15/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases, and obsessive-compulsive disorder (OCD) is one of the main causes of this disease. The present study was aimed to investigate the prevalence of OCD in patients with IBS. MATERIALS AND METHODS The present research is a cross-sectional survey study. The research sample included 120 patients with IBS who referred to Imam Reza Hospital and gastrointestinal clinics in Kermanshah (Iran) in the 3 months of April, May, July in 2019 that were selected using the census sampling method, and demographic information, clinical and medical records were collected. Data analysis was performed using frequency, percentage, and Chi-square. RESULTS Among the patients who were studied, 58 of them (48.3%) were women and 62 (51.7%) were men, the results showed that the prevalence of OCD in patients with IBS was 14.96 and the symptoms of washing, checking, skepticism and slowness-repetition had the highest prevalence, respectively. These symptoms were more common in women than in men. There was also a significant relation between OCD prevalence in patients with IBS and with female gender, age-range 30-21 years, single, and history of OCD in the patient's immediate family and close relatives (P < 0.05), but there was no significant relationship between OCD prevalence in patients with IBS and level of education, occupation, income status, and place of residence. CONCLUSION Due to the high prevalence of OCD in patients with IBS, the interaction of gastroenterologists and psychiatrists to treat irritable bowel syndrome is very important.
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Affiliation(s)
- Omran Davarinejad
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh RostamiParsa
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farnaz Radmehr
- Clinical Research Development Center, Imam Khomeini and Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Vahid Farnia
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Alikhani
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
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76
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Li H, Chen Y, Hu Z, Jiang J, Ye J, Zhou Y, Yu Z, Tang H. Effectiveness of acupuncture for anxiety and depression in irritable bowel syndrome: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24958. [PMID: 33663136 PMCID: PMC7909111 DOI: 10.1097/md.0000000000024958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is the most commonly gastrointestinal diseases. The Rome Foundation's global study on 33 countries shows the total prevalence of IBS under the Rome IV Diagnostic Criteria was 3.8%. It is well established that people with IBS have higher levels of anxiety and depression. The impact of the acupuncture associated with anxiety and depression has been widely studied in Western countries. Acupuncture may be a promising choice for the treatment of anxiety and depression in IBS. METHODS RCTs of acupuncture for depression and anxiety in IBS will be searched in the relevant database, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP database). The studies of electronic searches will be exported to EndNote V.9.1 software. We will run meta-analyses using the Review Manager (RevMan) V.5.3 software. Any disagreement will be solved in consultation with a third reviewer. RESULTS Our study aims to explore the efficacy of acupuncture for depression and anxiety in IBS and to provide up-to-date evidence for clinical of IBS. CONCLUSION This study will perform a comprehensive systematic review and meta-analysis on the efficacy of acupuncture for depression and anxiety in IBS, making up for the lack of relevant evidence of the clinical use of acupuncture. INPLASY REGISTRATION NUMBER INPLASY 202120014.
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Affiliation(s)
- Huaiyu Li
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Yun Chen
- First Affiliated Hospital of Gannan Medical University, Ganzhou
| | - Ziyi Hu
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, P.R. China
| | - Jiawang Jiang
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Jing Ye
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Yuliang Zhou
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Zhiying Yu
- Jiangxi University of Traditional Chinese Medicine, Nanchang
| | - Haiyi Tang
- Jiangxi University of Traditional Chinese Medicine, Nanchang
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77
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Ejdemyr I, Hedström F, Gruber M, Nordin S. Somatic symptoms of helplessness and hopelessness. Scand J Psychol 2021; 62:393-400. [PMID: 33615490 DOI: 10.1111/sjop.12713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 01/04/2021] [Indexed: 01/01/2023]
Abstract
Helplessness and hopelessness are transdiagnostic and aggravating factors of mental ill health, but their relation with somatization is not well documented. The main objectives were to identify somatic symptoms that are particularly associated with helplessness, referred to as somatic symptoms of helplessness (SS-He), and hopelessness, referred to as somatic symptoms of hopelessness (SS-Ho), determine increased risk of helplessness and hopelessness if having these symptoms and a certain number of these symptoms, and determine sensitivity and specificity in identifying helplessness and hopelessness based on number of these symptoms in a general Swedish sample. Population-based data from validated questionnaire instruments were used from 3,210 participants who constituted case groups of helplessness and hopelessness, and corresponding reference groups. Among 15 common somatic symptoms, five SS-He (e.g., feeling tired/having low energy) and five SS-Ho (e.g., dizziness) were identified, showing increased risk of helplessness and hopelessness that ranged from the factor 1.73 to 2.58 and from 1.44 to 1.92, respectively, which decreased considerably when controlled for depression and anxiety. The risk of helplessness increased by the factor 1.49 for each additional SS-He, and by 1.38 for each SS-Ho. A cutoff of two/three or more SS-He showed a sensitivity of 81.7/63.7% and a specificity of 40.6/61.4% in identifying helplessness, and 77.4/54.6% and 40.4/66.1%, respectively, in identifying hopelessness based on two/three or more SS-Ho. Primary care clinicians may consider further investigation of helplessness and hopelessness as well as depression and anxiety if presenting with these symptoms.
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Affiliation(s)
- Ivan Ejdemyr
- Department of Psychology, Umeå University, Umeå, Sweden
| | | | | | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
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78
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Norlin AK, Walter S, Icenhour A, Keita ÅV, Elsenbruch S, Bednarska O, Jones MP, Simon R, Engström M. Fatigue in irritable bowel syndrome is associated with plasma levels of TNF-α and mesocorticolimbic connectivity. Brain Behav Immun 2021; 92:211-222. [PMID: 33249172 DOI: 10.1016/j.bbi.2020.11.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 10/17/2020] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a symptom-based disorder of gut-brain interactions generating abdominal pain. It is also associated with a vulnerability to develop extraintestinal symptoms, with fatigue often reported as one of the most disturbing. Fatigue is related to brain function and inflammation in several disorders, however, the mechanisms of such relations in IBS remain elusive. This study aimed to elucidate fatigue and its association with a resting state network of mesocorticolimbic regions of known importance in fatigue, and to explore the possible role of circulating TNF-α levels in IBS and healthy controls (HC). Resting state functional magnetic resonance imaging (fMRI) was conducted in 88 IBS patients and 47 HC of similar age and gender to investigate functional connectivity between mesocorticolimbic regions. Further, fatigue impact on daily life and plasma levels of the proinflammatory cytokine tumor necrosis factor-α (TNF-α), of known relevance to immune activation in IBS, were also measured. The selected mesocorticolimbic regions indeed formed a functionally connected network in all participants. The nucleus accumbens (NAc), in particular, exhibited functional connectivity to all other regions of interest. In IBS, fatigue impact on daily life was negatively correlated with the connectivity between NAc and dorsolateral prefrontal cortex bilaterally (left p = 0.019; right p = 0.038, corrected for multiple comparisons), while in HC, fatigue impact on daily life was positively correlated to the connectivity between the right NAc and anterior middle insula in both hemispheres (left p = 0.009; right p = 0.011). We found significantly higher levels of TNF-α in IBS patients compared to HC (p = 0.001) as well as a positive correlation between TNF-α and fatigue impact on daily life in IBS patients (rho = 0.25, p = 0.02) but not in HC (rho = -0.13, p = 0.37). There was no association between functional connectivity in the mesocorticolimbic network and plasma levels of TNF-α in either group In summary, this novel multimodal study provides the first evidence that the vulnerability to fatigue in IBS is associated with connectivity within a mesocorticolimbic network as well as immune activation. These findings warrant further investigation, both peripherally and potentially with measurements of central immune activation as well.
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Affiliation(s)
- Anna-Karin Norlin
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Susanna Walter
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Adriane Icenhour
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping Sweden; Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Åsa V Keita
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Bochum, Germany
| | - Olga Bednarska
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Michael P Jones
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Rozalyn Simon
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping Sweden
| | - Maria Engström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping Sweden
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79
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Gut-Brain-Microbiota Axis: Antibiotics and Functional Gastrointestinal Disorders. Nutrients 2021; 13:nu13020389. [PMID: 33513791 PMCID: PMC7910879 DOI: 10.3390/nu13020389] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 02/07/2023] Open
Abstract
Gut microbiota composition and function are major areas of research for functional gastrointestinal disorders. There is a connection between gastrointestinal tract and central nervous system and this is mediated by neurotransmitters, inflammatory cytokines, the vagus nerve and the hypothalamic-pituitary-adrenal axis. Functional gastrointestinal disorders are prevalent diseases affecting more than one third of the population. The etiology of these disorders is not clarified. Visceral hyperalgesia is the main hypothesis for explaining clinical symptoms, however gut-brain axis disorder is a new terminology for functional disorders. In this review, microbiota-gut-brain axis connection pathways and related disorders are discussed. Antibiotics are widely used in developed countries and recent evidence indicates antibiotic-induced dysbiosis as an important factor for functional disorders. Antibiotics exert negative effects on gut microbiota composition and functions. Antibiotic-induced dysbiosis is a major factor for occurrence of post-infectious irritable bowel syndrome. Cognitive and mood disorders are also frequent in functional gastrointestinal disorders. Animal and human trials show strong evidence for the causal relationship between gut microbiota and brain functions. Therapeutic implications of these newly defined pathogenic pathways are also discussed.
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80
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Orock A, Yuan T, Greenwood-Van Meerveld B. Importance of Non-pharmacological Approaches for Treating Irritable Bowel Syndrome: Mechanisms and Clinical Relevance. FRONTIERS IN PAIN RESEARCH 2021; 1:609292. [PMID: 35295688 PMCID: PMC8915633 DOI: 10.3389/fpain.2020.609292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
Chronic visceral pain represents a major unmet clinical need with the severity of pain ranging from mild to so severe as to prevent individuals from participating in day-to-day activities and detrimentally affecting their quality of life. Although chronic visceral pain can be multifactorial with many different biological and psychological systems contributing to the onset and severity of symptoms, one of the major triggers for visceral pain is the exposure to emotional and physical stress. Chronic visceral pain that is worsened by stress is a hallmark feature of functional gastrointestinal disorders such as irritable bowel syndrome (IBS). Current pharmacological interventions for patients with chronic visceral pain generally lack efficacy and many are fraught with unwanted side effects. Cognitive behavioral therapy (CBT) has emerged as a psychotherapy that shows efficacy at ameliorating stress-induced chronic visceral pain; however, the molecular mechanisms underlying CBT remain incompletely understood. Preclinical studies in experimental models of stress-induced visceral pain employing environmental enrichment (EE) as an animal model surrogate for CBT are unraveling the mechanism by which environmental signals can lead to long-lasting changes in gene expression and behavior. Evidence suggests that EE signaling interacts with stress and nociceptive signaling. This review will (1) critically evaluate the behavioral and molecular changes that lead to chronic pain in IBS, (2) summarize the pharmacological and non-pharmacological approaches used to treat IBS patients, and (3) provide experimental evidence supporting the potential mechanisms by which CBT ameliorates stress-induced visceral pain.
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Affiliation(s)
- Albert Orock
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Tian Yuan
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Beverley Greenwood-Van Meerveld
- Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Oklahoma City VA Health Care System, Oklahoma City, OK, United States
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- *Correspondence: Beverley Greenwood-Van Meerveld
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81
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Park HH, Kim JH, Yoon D, Lee H, Shin JY. Gender differences in the adverse events associated with cardiovascular drugs in a spontaneous reporting system in South Korea. Int J Clin Pharm 2021; 43:1036-1044. [PMID: 33439426 DOI: 10.1007/s11096-020-01212-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
Background Studies on disease-related gender differences in pharmacodynamics and pharmacokinetics are prevalent; however, gender differences in the drug-related adverse events have not been systemically described. Objective To explore gender differences in the adverse events associated with cardiovascular drugs using a spontaneous reporting system. Setting This study was conducted using the Korea adverse event reporting system and national health insurance databases. Methods The number of reported adverse events was divided by the number of patients diagnosed with cardiovascular diseases (Korean Standard Classification of Disease, 7th Revision, I05-I70) and prescribed cardiovascular drugs. We calculated adverse event reporting rates per 100,000 persons and the reporting ratio for women, compared with men. Main outcome measures Reporting ratios across the groups of adverse events and cardiovascular drugs. Results We identified 27,533 adverse events associated with cardiovascular drugs and 9,413,666 patients with cardiovascular disease. Compared with men, reporting ratios of women were higher in the following categories: Overall (1.09, 95% CI, 1.06-1.11), beta blockers (1.20, 95% CI, 1.05-1.39), and calcium channel blockers (1.14, 95% CI, 1.03-1.27). For the adverse events, the reporting ratio was 1.34 (95% CI, 1.14-1.58) for musculoskeletal disorders and 2.54 (95% CI, 2.10-3.07) for oedema in women. Conclusion Our findings on differential adverse events reporting rates associated with the cardiovascular drugs between women and men provide an evidence on possible gender differences in wide range of pharmacotherapy. A clear understanding of the relationship between drug-induced adverse events and gender will aid in the development of therapeutic interventions being tailored to the individual patients.
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Affiliation(s)
- Han-Heui Park
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-guGyeong gi-do, Suwon, Republic of Korea
| | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-guGyeong gi-do, Suwon, Republic of Korea
| | - Dongwon Yoon
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-guGyeong gi-do, Suwon, Republic of Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-guGyeong gi-do, Suwon, Republic of Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-guGyeong gi-do, Suwon, Republic of Korea. .,Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
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The effect on gastrointestinal system functions, pain and anxiety of acupressure applied following laparoscopic cholecystectomy operation: A randomised, placebo-controlled study. Complement Ther Clin Pract 2021; 43:101304. [PMID: 33540298 DOI: 10.1016/j.ctcp.2021.101304] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/31/2022]
Abstract
The aim of this randomised, placebo-controlled, 3-way blinded study was to determine the effect on GIS symptoms, pain and anxiety of acupressure applied for a total of 12 min, as 3 min at each of the ST25, CV12, TH6, and HT7 acupuncture points, at 0, 4 and 8 h after laparoscopic cholecystectomy operation. The research data were collected using a patient data collection form, the Numeric Pain Intensity Scale and the State-Trait Anxiety Inventory. The patients were evaluated in respect of the time to first flatus and defecation, pain and the State-Trait Anxiety points at 0, 4, and 8 h postoperatively. The application of acupressure was determined to have signficantly reduced acute postoperative pain and shortened the time to defecation (p < 0.05). The application of acupressure can be recommended in the nursing interventions following laparoscopic cholecystectomy to reduce acute pain and shorten the time to defecation.
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83
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Hu Z, Li M, Yao L, Wang Y, Wang E, Yuan J, Wang F, Yang K, Bian Z, Zhong LLD. The level and prevalence of depression and anxiety among patients with different subtypes of irritable bowel syndrome: a network meta-analysis. BMC Gastroenterol 2021; 21:23. [PMID: 33413140 PMCID: PMC7791666 DOI: 10.1186/s12876-020-01593-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 12/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a very common functional bowel disorder. However, the difference of depression and anxiety comorbidities among different IBS subtypes is still not well evaluated. This study aims to investigate the difference in the level and prevalence of depression and anxiety among healthy controls and patients with different subtypes of IBS. METHODS PubMed, EMBASE and the Cochrane library were searched systematically until August 17, 2020. Studies that investigated depression and/or anxiety levels or prevalence among different IBS-subtype patients measured at baseline or the same point were included. Network meta-analysis was conducted to analyze standardized mean difference (SMD) of anxiety and depression levels, and single arm meta-analysis was performed for prevalence of anxiety and depression among different IBS subtypes. RESULTS Eighteen studies involving 7095 participants were included. Network meta-analyses results showed healthy controls had a lower level of depression than IBS with mixed symptoms of constipation and diarrhea (IBS-M) [SMD = - 1.57; 95% confidence interval (CI) - 2.21, - 0.92], IBS with constipation (IBS-C) (SMD = - 1.53; 95% CI - 2.13, - 0.93) and IBS with diarrhea (IBS-D)(SMD = - 1.41; 95% CI - 1.97, - 0.85), while no significant difference was found between IBS unclassified (IBS-U) and healthy controls (SMD = - 0.58; 95% CI - 2.15, 1.00). There was also no significant difference in the level of depression among different IBS subtypes patients. The results of anxiety were similar to depression. Ranking probability showed that IBS-M was associated with the highest level of depression and anxiety symptoms, followed by IBS-C/IBS-D and IBS-U. Single-arm meta-analysis showed IBS-C had the highest prevalence of depression (38%) and anxiety (40%), followed by IBS-D, IBS-M and IBS-U. CONCLUSION The results indicated that IBS-M was more likely to be associated with a higher level of depression and anxiety, and the prevalence of depression and anxiety in IBS-C was highest. The psychological screening and appropriate psychotherapy are needed for patients with IBS-C, IBS-D and IBS-M instead of IBS-U.
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Affiliation(s)
- Zhichao Hu
- Hong Kong Chinese Medicine Clinical Study Center, School of Chinese Medicine, Hong Kong Baptist University, 7 Baptist University Road, Kowloon, 999077, Hong Kong SAR, China
| | - Meixuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Yinshu Wang
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Enkang Wang
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Jianye Yuan
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Fengyun Wang
- Xiyuan Hospital, China Academy of Chinese Medicinal Sciences, Beijing, 100091, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China
| | - Zhaoxiang Bian
- Hong Kong Chinese Medicine Clinical Study Center, School of Chinese Medicine, Hong Kong Baptist University, 7 Baptist University Road, Kowloon, 999077, Hong Kong SAR, China.
| | - Linda L D Zhong
- Hong Kong Chinese Medicine Clinical Study Center, School of Chinese Medicine, Hong Kong Baptist University, 7 Baptist University Road, Kowloon, 999077, Hong Kong SAR, China.
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Abstract
PURPOSE OF REVIEW Irritable bowel syndrome (IBS) is a very common disorder whose clinical presentation varies considerably between patients as well as within the same individual over time. Many of its symptoms, such as pain, diarrhea, constipation and bloating, may be manifestations of a host of other gastrointestinal diseases; some accompanied by increased mortality. This presents the clinician with a real dilemma: how to sensibly investigate the patient in which one suspects IBS but there is a nagging doubt that 'it could be something else'? Could one miss 'something serious'? This short review attempts to provide both an evidence-based response to these vexing questions and a practical guide to detecting alternative diagnoses in the subject with IBS-type symptoms. RECENT FINDINGS Clinical features, patient demographics and the clinical context can help to significantly narrow the differential diagnosis of the individual with IBS-type symptoms and may permit a positive diagnosis of IBS. The advent of noninvasive serological and stool tests has greatly facilitated differentiation from celiac disease and inflammatory bowel disease, respectively. In the older, female diarrhea sufferer microscopic colitis should be considered. The role of bile acid diarrhea in the individual with diarrhea-predominant IBS is emphasized; the status of small intestinal bacterial overgrowth in IBS remain uncertain. SUMMARY Attention to detail in the clinical evaluation of the individual with IBS-like symptoms will facilitate a selective and targeted approach to investigation. Wherever indicated, widely available serological and fecal tests will serve to bolster the diagnosis by excluding other options. Proceeding to more invasive testing should be dictated by clinical presentation and scenario with the threshold for intervention being generally lower among those with prominent diarrhea.
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85
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Chey WD, Keefer L, Whelan K, Gibson PR. Behavioral and Diet Therapies in Integrated Care for Patients With Irritable Bowel Syndrome. Gastroenterology 2021; 160:47-62. [PMID: 33091411 DOI: 10.1053/j.gastro.2020.06.099] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/08/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023]
Abstract
Irritable bowel syndrome (IBS) is a common, symptom-based condition that has negative effects on quality of life and costs health care systems billions of dollars each year. Until recently, management of IBS has focused on over-the-counter and prescription medications that reduce symptoms in fewer than one-half of patients. Patients have increasingly sought natural solutions for their IBS symptoms. However, behavioral techniques and dietary modifications can be effective in treatment of IBS. Behavioral interventions include gastrointestinal-focused cognitive behavioral therapy and gut-directed hypnotherapy to modify interactions between the gut and the brain. In this pathway, benign sensations from the gut induce maladaptive cognitive or affective processes that amplify symptom perception. Symptoms occur in response to cognitive and affective factors that trigger fear of symptoms or lack of acceptance of disease, or from stressors in the external environment. Among the many dietary interventions used to treat patients with IBS, a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols is the most commonly recommended by health care providers and has the most evidence for efficacy. Patient with IBS who choose to follow a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols should be aware of its 3 phases: restriction, reintroduction, and personalization. Management of IBS should include an integrated care model in which behavioral interventions, dietary modification, and medications are considered as equal partners. This approach offers the greatest likelihood for success in management of patients with IBS.
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Affiliation(s)
- William D Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan.
| | | | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, United Kingdom
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Faecal microbiota transplantation alleviates symptoms of depression in individuals with irritable bowel syndrome: A case series. MEDICINE IN MICROECOLOGY 2020. [DOI: 10.1016/j.medmic.2020.100029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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87
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Lee SY, Ryu HS, Choi SC, Jang SH. A Study of Psychological Factors Associated with Functional Gastrointestinal Disorders and Use of Health Care. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:580-586. [PMID: 33124590 PMCID: PMC7609222 DOI: 10.9758/cpn.2020.18.4.580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/13/2022]
Abstract
Objective The purpose of this study was to analyze the symptoms of depression, anxiety, and childhood trauma in functional gastrointestinal disorder (FGID) patients who visited the brain-gut axis clinic. Methods The study participants included 99 individuals who were diagnosed with FGID by gastroenterologists, 88 individuals who had no FGID but showed symptoms of FGID based on the Rome criteria, and 79 individuals who did not show any symptoms or were diagnosed with FGID. Symptoms of depression, anxiety, and childhood trauma were evaluated by the Korean version of Beck-depression inventory-II (K-BDI-II), Korean version of Beck anxiety inventory (K-BAI), and Korean version of childhood trauma questionnaire (K-CTQ), respectively. Results The BDI score, BAI score, and CTQ score were significantly different between the groups. The group also had higher odds for developing anxiety as compared to the control group (odds ratio [OR] = 10.215, 95% confidence intervals [CI] 2.49−41.76). Additionally, the FGID group had higher odds for developing symptoms of depression (OR = 5.554, 95% CI 2.06−14.97) and experiencing physical violence (OR = 3.128, 95% CI 1.53−6.38) than the non-FGID group. Conclusion This study showed that FGID patients were more likely to have symptoms of depression, severe anxiety, and childhood trauma, which were the risk factors of FGID.
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Affiliation(s)
- Sang-Yeol Lee
- Department of Psychiatry, Wonkwang University School of Medicine, Iksan, Korea
| | - Han-Seung Ryu
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Suck-Chei Choi
- Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Seung-Ho Jang
- Department of Psychiatry, Wonkwang University School of Medicine, Iksan, Korea
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88
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Söderquist F, Syk M, Just D, Kurbalija Novicic Z, Rasmusson AJ, Hellström PM, Ramklint M, Cunningham JL. A cross-sectional study of gastrointestinal symptoms, depressive symptoms and trait anxiety in young adults. BMC Psychiatry 2020; 20:535. [PMID: 33176747 PMCID: PMC7661167 DOI: 10.1186/s12888-020-02940-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND >Patients with functional gastrointestinal disorders have a high psychiatric co-morbidity. This study aimed to investigate and characterise gastrointestinal symptoms in relation to depressive symptoms and trait anxiety in a well-defined population of young adult psychiatric outpatients and healthy controls. METHODS Gastrointestinal symptoms were assessed with the Gastrointestinal Symptom Rating Scale for Irritable Bowel Syndrome (GSRS-IBS). Depressive symptoms were assessed with the Montgomery-Åsberg Depression Rating Scale- Self assessment (MADRS-S). Trait anxiety was estimated with three of the Swedish universities of Personality (SSP) scales: Somatic trait anxiety, Psychic trait anxiety and Stress susceptibility. Self-ratings were collected from 491 young adult psychiatric outpatients and 85 healthy controls. Gastrointestinal symptom severity was compared between patients with and without current psychotropic medication and controls. Associations between gastrointestinal symptoms, depressive symptoms and trait anxiety were assessed using Spearman's coefficients and generalized linear models adjusting for possible confounders (sex, body mass index, bulimia nervosa). RESULTS Patients, with and without current psychotropic medication, reported significantly more gastrointestinal symptoms than controls. In the generalized linear models, total MADRS-S score (p < 0.001), Somatic trait anxiety (p < 0.001), Psychic trait anxiety (p = 0.002) and Stress susceptibility (p = 0.002) were independent predictors of the total GSRS-IBS score. Further exploratory analysis using unsupervised learning revealed a diverse spectrum of symptoms that clustered into six groups. CONCLUSION Gastrointestinal symptoms are both highly prevalent and diverse in young adult psychiatric outpatients, regardless of current psychotropic medication. Depressive symptom severity and degree of trait anxiety are independently related to the total gastrointestinal symptom burden.
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Affiliation(s)
- Fanny Söderquist
- Department of Neuroscience, Psychiatry Uppsala University, Uppsala, Sweden
| | - Mikaela Syk
- Department of Neuroscience, Psychiatry Uppsala University, Uppsala, Sweden
| | - David Just
- Department of Neuroscience, Psychiatry Uppsala University, Uppsala, Sweden
| | | | - Annica J Rasmusson
- Department of Neuroscience, Psychiatry Uppsala University, Uppsala, Sweden
| | - Per M Hellström
- Department of Medical Sciences, Gastroenterology/Hepatology, Uppsala University, Uppsala, Sweden
| | - Mia Ramklint
- Department of Neuroscience, Psychiatry Uppsala University, Uppsala, Sweden
| | - Janet L Cunningham
- Department of Neuroscience, Psychiatry Uppsala University, Uppsala, Sweden.
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Koloski N, Holtmann G, Talley NJ. Is there a causal link between psychological disorders and functional gastrointestinal disorders? Expert Rev Gastroenterol Hepatol 2020; 14:1047-1059. [PMID: 32715790 DOI: 10.1080/17474124.2020.1801414] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Psychological distress is associated with functional gastrointestinal disorders (FGIDs) including irritable bowel syndrome (IBS) and functional dyspepsia (FD) but only evidence from prospective longitudinal and treatment studies can indicate whether the link between FGIDs and psychological distress is causal. Emerging evidence suggests underlying biological mechanisms may explain the association of psychological distress with FGIDs. AREAS COVERED This review critically evaluates whether anxiety and/or depression and FGIDs are causally related including evidence for a temporal sequence, strength and specificity of the association, biological gradient, and biological plausibility. EXPERT OPINION Accumulating evidence suggests that psychological factors are causal for symptoms in a subset of FGID patients and not explained by health care seeking behavior (brain-gut disorder). In other cases, psychological factors may arise secondary to intestinal disease (gut-brain disorder). Prospective population-based studies are needed in FGIDs other than IBS and FD to determine if a similar brain-gut and gut-brain syndrome exists. Treatment studies have not phenotyped FGIDs according to brain-gut versus gut-brain origins which may be important in understanding true treatment efficacy. Future research needs to unravel biological mechanisms that may explain the link between psychological factors and FGIDs but promising data in the area of the brain-gut-immune-microbe axis is emerging.
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Affiliation(s)
- Natasha Koloski
- Faculty of Health and Medicine, University of Newcastle , Callaghan, Australia
- Australian Gastrointestinal Research Alliance (AGIRA)
- Department of Gastroenterology, Princess Alexandra Hospital , Woolloongabba, Australia
- School of Medicine, University of Queensland , St Lucia, Australia
| | - Gerald Holtmann
- Australian Gastrointestinal Research Alliance (AGIRA)
- Department of Gastroenterology, Princess Alexandra Hospital , Woolloongabba, Australia
- School of Medicine, University of Queensland , St Lucia, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle , Callaghan, Australia
- Australian Gastrointestinal Research Alliance (AGIRA)
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90
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Moayyedi P, MacQueen G, Bernstein CN, Vanner S, Bercik P, Madsen KL, Surette M, Rioux JD, Dieleman LA, Verdú E, de Souza RJ, Otley A, Targownik L, Lavis J, Cunningham J, Marshall DA, Zelinsky S, Fernandes A. IMAGINE Network's Mind And Gut Interactions Cohort (MAGIC) Study: a protocol for a prospective observational multicentre cohort study in inflammatory bowel disease and irritable bowel syndrome. BMJ Open 2020; 10:e041733. [PMID: 33087380 PMCID: PMC7580069 DOI: 10.1136/bmjopen-2020-041733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Gut microbiome and diet may be important in irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and comorbid psychiatric conditions, but the mechanisms are unclear. We will create a large cohort of patients with IBS, IBD and healthy controls, and follow them over time, collecting dietary and mental health information and biological samples, to assess their gastrointestinal (GI) and psychological symptoms in association with their diet, gut microbiome and metabolome. METHODS AND ANALYSIS This 5-year observational prospective cohort study is recruiting 8000 participants from 15 Canadian centres. Persons with IBS who are 13 years of age and older or IBD ≥5 years will be recruited. Healthy controls will be recruited from the general public and from friends or relatives of those with IBD or IBS who do not have GI symptoms. Participants answer surveys and provide blood, urine and stool samples annually. Surveys assess disease activity, quality of life, physical pain, lifestyle factors, psychological status and diet. The main outcomes evaluated will be the association between the diet, inflammatory, genetic, microbiome and metabolomic profiles in those with IBD and IBS compared with healthy controls using multivariate logistic regression. We will also compare these profiles in those with active versus quiescent disease and those with and without psychological comorbidity. ETHICS AND DISSEMINATION Approval has been obtained from the institutional review boards of all centres taking part in the study. We will develop evidence-based knowledge translation initiatives for patients, clinicians and policymakers to disseminate results to relevant stakeholders.Trial registration number: NCT03131414.
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Affiliation(s)
- Paul Moayyedi
- Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | | | | | - Premysl Bercik
- Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Karen L Madsen
- Medicine, University of Alberta, Edmonton, Ontario, Canada
| | - Michael Surette
- McMaster University Faculty of Health Sciences, Hamilton, Alberta, Canada
| | - John D Rioux
- Universite de Montreal, Montreal, Ontario, Canada
| | - Levinus A Dieleman
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Elena Verdú
- Division of Gastroenterology, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Clinical Epidemiology and Biostatistics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | | | - John Lavis
- McMaster University Faculty of Health Sciences, Hamilton, Alberta, Canada
| | - Jennifer Cunningham
- Population Health Research Institute, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Sandra Zelinsky
- PaCER Innovates, University of Calgary, Calgary, Alberta, Canada
| | - Aida Fernandes
- Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Supraspinal Mechanisms of Intestinal Hypersensitivity. Cell Mol Neurobiol 2020; 42:389-417. [PMID: 33030712 DOI: 10.1007/s10571-020-00967-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/22/2020] [Indexed: 12/13/2022]
Abstract
Gut inflammation or injury causes intestinal hypersensitivity (IHS) and hyperalgesia, which can persist after the initiating pathology resolves, are often referred to somatic regions and exacerbated by psychological stress, anxiety or depression, suggesting the involvement of both the spinal cord and the brain. The supraspinal mechanisms of IHS remain to be fully elucidated, however, over the last decades the series of intestinal pathology-associated neuroplastic changes in the brain has been revealed, being potentially responsible for the phenomenon. This paper reviews current clinical and experimental data, including the authors' own findings, on these functional, structural, and neurochemical/molecular changes within cortical, subcortical and brainstem regions processing and modulating sensory signals from the gut. As concluded in the review, IHS can develop and maintain due to the bowel inflammation/injury-induced persistent hyperexcitability of viscerosensory brainstem and thalamic nuclei and sensitization of hypothalamic, amygdala, hippocampal, anterior insular, and anterior cingulate cortical areas implicated in the neuroendocrine, emotional and cognitive modulation of visceral sensation and pain. An additional contribution may come from the pathology-triggered dysfunction of the brainstem structures inhibiting nociception. The mechanism underlying IHS-associated regional hyperexcitability is enhanced NMDA-, AMPA- and group I metabotropic receptor-mediated glutamatergic neurotransmission in association with altered neuropeptide Y, corticotropin-releasing factor, and cannabinoid 1 receptor signaling. These alterations are at least partially mediated by brain microglia and local production of cytokines, especially tumor necrosis factor α. Studying the IHS-related brain neuroplasticity in greater depth may enable the development of new therapeutic approaches against chronic abdominal pain in inflammatory bowel disease.
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92
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Lu J, Shi L, Huang D, Fan W, Li X, Zhu L, Wei J, Fang X. Depression and Structural Factors Are Associated With Symptoms in Patients of Irritable Bowel Syndrome With Diarrhea. J Neurogastroenterol Motil 2020; 26:505-513. [PMID: 32675388 PMCID: PMC7547200 DOI: 10.5056/jnm19166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 04/28/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims A strong correlation between depression and irritable bowel syndrome with diarrhea (IBS-D) has been identified. The aim of this study is to identify the correlations among depression, structural factors, gastrointestinal (GI) and extra-GI symptoms, and efficacy of neuromodulators in patients with IBS-D. Methods Patients meeting the Rome III Diagnostic Criteria for IBS-D were enrolled. The intestinal symptoms and psychological states were evaluated using IBS-specific symptom questionnaires and Hamilton Depression Rating Scale. Results In total, 410 patients with IBS-D were enrolled, 28.8% (118/410) had comorbid depression. Patients with depression did not readily experience improvement in abdominal pain/discomfort after defecation, and had a higher prevalence of passing mucus, overlapping functional dyspepsia, and extra-GI symptoms. The structural factor “mental disorders” significantly correlated with main bowel symptom score and degree of pre-defecation abdominal pain/discomfort. No structural factor significantly correlated with bowel movements or stool form. Patients who had passing mucus, overlapping functional dyspepsia and extra-GI painful symptoms have higher score of “anxiety/somatization.” Patients with sexual dysfunction have higher score of “retardation symptoms.” In total, 28.3% of patients with IBS-D were prescribed neuromodulators. Baseline scores of “anxiety/somatization” and “retardation symptoms” positively correlated with improvement of diarrhea after paroxetine, and “sleep disturbances” positively correlated with improvement of abdominal pain/discomfort and diarrhea after mirtazapine. Conclusions Comorbid depression and higher scores of structural factors might aggravate GI and extra-GI symptoms other than bowel movements and stool form. Structural factors of Hamilton Depression Rating Scale correlated with efficacy of paroxetine and mirtazapine in patients with IBS-D.
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Affiliation(s)
- Jia Lu
- Departments of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lili Shi
- Departments of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Huang
- Department of Gastroenterology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Wenjuan Fan
- Departments of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoqing Li
- Departments of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liming Zhu
- Departments of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wei
- Departments of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiucai Fang
- Departments of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Bistoletti M, Bosi A, Banfi D, Giaroni C, Baj A. The microbiota-gut-brain axis: Focus on the fundamental communication pathways. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2020; 176:43-110. [PMID: 33814115 DOI: 10.1016/bs.pmbts.2020.08.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Michela Bistoletti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Annalisa Bosi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Davide Banfi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Cristina Giaroni
- Department of Medicine and Surgery, University of Insubria, Varese, Italy.
| | - Andreina Baj
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Imipramine improves visceral sensation and gut barrier in rat models of irritable bowel syndrome. Eur J Pharmacol 2020; 887:173565. [PMID: 32946869 DOI: 10.1016/j.ejphar.2020.173565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022]
Abstract
An impaired gut barrier, possibly leading to visceral hypersensitivity has been recently recognized to be one of the pivotal pathophysiology of irritable bowel syndrome (IBS). We previously showed that lipopolysaccharide (LPS), corticotropin-releasing factor (CRF), and repeated water avoidance stress (WAS) induce visceral hypersensitivity and colonic hyperpermeability via pro-inflammatory cytokine signaling (rat IBS models). Although the precise mechanisms of action are unclear, imipramine, a tricyclic antidepressant, improves IBS symptoms, and also has anticytokine properties. In this study, we hypothesized that imipramine improves the gut barrier to ameliorate IBS symptoms. To test this hypothesis, we determined its effects on visceral hypersensitivity and colonic hyperpermeability in rat IBS models. The visceral pain threshold in response to colonic balloon distention was electrophysiologically estimated by abdominal muscle contractions, and colonic permeability was measured by quantifying the absorbed Evans blue in colonic tissue in vivo. Subcutaneous imipramine injection (7, 20, 50 mg/kg) dose-dependently inhibited LPS-induced (1 mg/kg, subcutaneously) visceral hypersensitivity and colonic hyperpermeability. Imipramine also blocked these gastrointestinal (GI) changes induced by CRF (50 μg/kg, intraperitoneally) or repeated WAS (1 h daily for 3 days). Yohimbine (an α2-adrenoceptors antagonist), sulpiride (a dopamine D2 receptor antagonist), and naloxone hydrochloride (an opioid receptor antagonist) reversed these effects of imipramine in the LPS model. Therefore, imipramine may block GI changes in IBS via α2-adrenoceptors, dopamine D2, and opioid signaling. The improvement in the gut barrier resulting in inhibition of visceral pain is considered a valid mechanism of imipramine to ameliorate IBS symptoms.
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Shortcomings of Trials Assessing Antidepressants in the Management of Irritable Bowel Syndrome: A Critical Review. J Clin Med 2020; 9:jcm9092933. [PMID: 32932856 PMCID: PMC7564007 DOI: 10.3390/jcm9092933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 12/12/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a common disorder requiring complex, multidisciplinary management. Antidepressants are commonly used and recommended in guidelines for the treatment of patients with IBS. We assessed randomized controlled trials (RCTs) on antidepressants in patients with IBS, with specific attention to study design and data quality/reporting characteristics. Following a comprehensive search, data and RCT characteristics were systematically summarized. Fragility index, representing the number of positive “events” that the study relies on for its significance, was calculated. Eighteen RCTs were included. Overall, tricyclic antidepressants (TCAs), but not selective serotonin reuptake inhibitors (SSRIs), appeared to be efficacious in IBS. Eight studies reported on adverse events (AEs), which were significantly greater in patients receiving antidepressants versus placebo. The median (mean) fragility index of TCA trials was 0 (1.5). RCTs with positive results had significantly lower placebo rates (20.8%) versus negative studies (45.7%; p < 0.0001). RCTs exhibited limitations related to study design (sample size and blinding), data analysis (outcomes and placebo response), and data reporting (selective reporting of AEs and publication bias). Careful consideration of limitations of RCTs on antidepressants in IBS is warranted to formulate a safe and beneficial treatment regimen for patients with IBS.
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Talley NJ, Holtmann GJ, Jones M, Koloski NA, Walker MM, Burns G, Potter MDE, Shah A, Keely S. Zonulin in serum as a biomarker fails to identify the IBS, functional dyspepsia and non-coeliac wheat sensitivity. Gut 2020; 69:1-3. [PMID: 31563879 DOI: 10.1136/gutjnl-2019-318664] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/13/2019] [Accepted: 08/31/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Gerald J Holtmann
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Michael Jones
- Department of Psychology, Macquarie University, Ryde, New South Wales, Australia
| | - Natasha A Koloski
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Marjorie M Walker
- Anatomical Pathology, University of Newcastle, Newcastle, New South Wales, Australia
| | - Grace Burns
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,School of Biomedical Science and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
| | - Michael D E Potter
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Ayesha Shah
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Simon Keely
- School of Biomedical Science and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia.,Gastrointestinal Research Group, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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97
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Mokhtar NM, Bahrudin MF, Abd Ghani N, Abdul Rani R, Raja Ali RA. Prevalence of Subthreshold Depression Among Constipation-Predominant Irritable Bowel Syndrome Patients. Front Psychol 2020; 11:1936. [PMID: 32849137 PMCID: PMC7423989 DOI: 10.3389/fpsyg.2020.01936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/13/2020] [Indexed: 12/12/2022] Open
Abstract
Patients suffering from irritable bowel syndrome (IBS) may have some form of affective disorders that may worsen their symptoms. Lack of screening among IBS patients is one of the reasons for depression unawareness among healthcare providers. The present study was conducted to evaluate the prevalence of depression among patients with constipation-predominant IBS (IBS-C). A total of 240 IBS patients who fulfilled Rome III criteria were enrolled. The psychiatric assessment was evaluated using the Center for Epidemiologic Studies Depression Scale Revised (CESD-R). Twenty items in CESD-R scale measured symptoms of depression in nine separate groups. Patients were categorized into five different subgroups: major depressive episode, probable major depressive episode, possible major depressive episode, subthreshold depressive symptoms, and without clinical significance of depression. Out of the 240 patients with IBS-C, the majority (n = 161, 67.1%) had no clinical significance of depression. Seventy seven (32.1%) had subthreshold depression and only two (0.83%) patients were regarded as having probable a major depressive episode. No patient was categorized into a major or possible major depressive episode. The prevalence of subthreshold depression was the highest among female (72.3%) patients with 51.1% being single, 44.7% were married, and 4.3% were divorcees. When stratified according to ethnicity, subthreshold depression was highly prevalent among Malays (76.6%), followed by Chinese (19.2%), and Indians (2.1%). A high percentage of the patients were found to be non-smokers (93.6%) and had lower income of less than RM 5000 (USD 1250) per month (89.4%). The moderately high prevalence of subthreshold depression among patients with IBS, justifies psychological evaluation in all patients with functional gastrointestinal disorders.
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Affiliation(s)
- Norfilza Mohd Mokhtar
- GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Fyzal Bahrudin
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nazierah Abd Ghani
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rafiz Abdul Rani
- Gastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Raja Affendi Raja Ali
- GUT Research Group, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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98
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Yildiz A, Kizil E, Yildiz A. Quality of life and psychometric evaluation of patients diagnosed with irritable bowel syndrome: an observational cohort study. SAO PAULO MED J 2020; 138:282-286. [PMID: 32556060 PMCID: PMC9673838 DOI: 10.1590/1516-3180.2019.0527.r1.16042020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Very few data are available for evaluating health-related quality of life among people with irritable bowel syndrome (IBS) and even fewer data are available in relation to anxiety and depression status among these patients. OBJECTIVES To evaluate the quality of life, anxiety and depression status of patients with IBS. DESIGN AND SETTING Observational cohort study conducted in a tertiary-care university hospital. METHODS Patients who had recently been diagnosed with IBS and who had been followed up for IBS-specific treatment for at least three months were included. A quality of life (QoL) survey, the Beck Anxiety Index (BAI) and the Hamilton Depression Index (HAM-D) were applied to the patients. RESULTS In total, 274 patients with IBS were included in the study cohort. These patients presented very high baseline scores for anxiety and depression, and very poor QoL results. CONCLUSION Our study showed that IBS had a very high impact on these patients, regarding their anxiety and depression levels, alongside very poor results relating to quality of life.
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Affiliation(s)
- Alp Yildiz
- MD. General Surgeon, Department of General Surgery, Yenimahalle Training and Research Hospital, Yildirim Beyazıt University, Ankara, Turkey.
| | - Emre Kizil
- MD. Psychiatrist, Private Emre Kizil Psychiatry Clinic, Cankaya, Ankara, Turkey.
| | - Aybala Yildiz
- MD, PhD. Associate Professor, Department of General Surgery, Yenimahalle Training and Research Hospital, Yildirim Beyazıt University, Ankara, Turkey.
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99
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Effects of a high fat diet on gut microbiome dysbiosis in a mouse model of Gulf War Illness. Sci Rep 2020; 10:9529. [PMID: 32533086 PMCID: PMC7293234 DOI: 10.1038/s41598-020-66833-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023] Open
Abstract
Gulf War Illness (GWI) is a chronic health condition that appeared in Veterans after returning home from the Gulf War. The primary symptoms linked to deployment are posttraumatic stress disorder, mood disorders, GI problems and chronic fatigue. At first glance, these symptoms are difficult to ascribe to a single pathological mechanism. However, it is now clear that each symptom can be linked individually to alterations in the gut microbiome. The primary objective of the present study was to determine if gut microbiome dysbiosis was evident in a mouse model of GWl. Because the majority of Gulf War Veterans are overweight, a second objective was to determine if a high fat diet (HF) would alter GWI outcomes. We found that the taxonomic structure of the gut microbiome was significantly altered in the GWI model and after HF exposure. Their combined effects were significantly different from either treatment alone. Most treatment-induced changes occurred at the level of phylum in Firmicutes and Bacteroidetes. If mice fed HF were returned to a normal diet, the gut microbiome recovered toward normal levels in both controls and GWI agent-treated mice. These results add support to the hypotheses that dysbiosis in the gut microbiome plays a role in GWI and that life-style risk factors such as an unhealthy diet can accentuate the effects of GWI by impacting the gut microbiome. The reversibility of the effect of HF on the gut microbiome suggests new avenues for treating GWI through dietary intervention.
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100
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Bosi A, Banfi D, Bistoletti M, Giaroni C, Baj A. Tryptophan Metabolites Along the Microbiota-Gut-Brain Axis: An Interkingdom Communication System Influencing the Gut in Health and Disease. Int J Tryptophan Res 2020; 13:1178646920928984. [PMID: 32577079 PMCID: PMC7290275 DOI: 10.1177/1178646920928984] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/02/2020] [Indexed: 12/12/2022] Open
Abstract
The ‘microbiota-gut-brain axis’ plays a fundamental role in maintaining host homeostasis, and different immune, hormonal, and neuronal signals participate to this interkingdom communication system between eukaryota and prokaryota. The essential aminoacid tryptophan, as a precursor of several molecules acting at the interface between the host and the microbiota, is fundamental in the modulation of this bidirectional communication axis. In the gut, tryptophan undergoes 3 major metabolic pathways, the 5-HT, kynurenine, and AhR ligand pathways, which may be directly or indirectly controlled by the saprophytic flora. The importance of tryptophan metabolites in the modulation of the gastrointestinal tract is suggested by several preclinical and clinical studies; however, a thorough revision of the available literature has not been accomplished yet. Thus, this review attempts to cover the major aspects on the role of tryptophan metabolites in host-microbiota cross-talk underlaying regulation of gut functions in health conditions and during disease states, with particular attention to 2 major gastrointestinal diseases, such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), both characterized by psychiatric disorders. Research in this area opens the possibility to target tryptophan metabolism to ameliorate the knowledge on the pathogenesis of both diseases, as well as to discover new therapeutic strategies based either on conventional pharmacological approaches or on the use of pre- and probiotics to manipulate the microbial flora.
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Affiliation(s)
- Annalisa Bosi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Davide Banfi
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Michela Bistoletti
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Cristina Giaroni
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Andreina Baj
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
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