201
|
McCulloch SM, Aziz I, Polster AV, Pischel AB, Stålsmeden H, Shafazand M, Block M, Byröd G, Lindkvist B, Törnblom H, Jonefjäll B, Simren M. The diagnostic value of a change in bowel habit for colorectal cancer within different age groups. United European Gastroenterol J 2019; 8:211-219. [PMID: 32213069 DOI: 10.1177/2050640619888040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Change in bowel habit as a sole alarm symptom for colorectal cancer is disputed. OBJECTIVE We investigated the diagnostic value of change in bowel habit for colorectal cancer, particularly as a single symptom and within different age groups. METHODS This retrospective cohort study examined colorectal cancer fast track referrals and outcomes across four Swedish hospitals (April 2016-May 2017). Entry criteria constituted one or more of three alarm features: anaemia, visible rectal bleeding, or change in bowel habit for more than 4 weeks in patients over 40 years of age. Patients were grouped as having only change in bowel habit, change in bowel habit plus anaemia/bleeding or anaemia/bleeding only. RESULTS Of 628 patients, 22% were diagnosed with colorectal cancer. There were no cases of colorectal cancer in the only change in bowel habit group under 55 years, while this was 6% for 55-64 years, 8% for 65-74 years and 14% for 75 years and older. Among subjects under 55 years, 2% with anaemia/bleeding had colorectal cancer, this increased to 34% for 55 years and older (P < 0.0001). Change in bowel habit plus anaemia/bleeding gave a colorectal cancer prevalence of 16% in under 55 years and increased to 30% for 55 years and older (P = 0.07). CONCLUSION Change in bowel habit as the only alarm feature has a low diagnostic yield for colorectal cancer in patients under 55 years.
Collapse
Affiliation(s)
- Sofia M McCulloch
- Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden
| | - Imran Aziz
- Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden
| | - Annikka V Polster
- Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden
| | | | | | | | - Mattias Block
- Sahlgrenska University Hospital, Östra Hospital, Gothenburg, Sweden
| | - Gunnar Byröd
- Sahlgrenska University Hospital, Mölndal Hospital, Mölndal, Sweden
| | - Björn Lindkvist
- Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Sahlgrenska Hospital, Gothenburg, Sweden
| | - Hans Törnblom
- Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Sahlgrenska Hospital, Gothenburg, Sweden
| | | | - Magnus Simren
- Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden.,Sahlgrenska University Hospital, Sahlgrenska Hospital, Gothenburg, Sweden
| |
Collapse
|
202
|
Nawawi KNM, Belov M, Goulding C. Low FODMAP diet significantly improves IBS symptoms: an Irish retrospective cohort study. Eur J Nutr 2019; 59:2237-2248. [PMID: 31520160 DOI: 10.1007/s00394-019-02074-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 08/02/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION There is growing evidence that a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) improves symptoms in irritable bowel syndrome (IBS) patients. We aimed to retrospectively investigate the effects of this diet in Irish IBS cohort over a 12-month follow-up period, including after re-introduction of the high FODMAP foods. METHODS All the tertiary referrals seen by an FODMAP-trained dietician were reviewed (2013-2016). Patients were evaluated for IBS symptoms by a questionnaire (four-point Likert scale). Subsequently, advice regarding the low FODMAP diet was given. Symptoms' response was assessed at 3-, 6-, and 12-month follow-up, by use of the same questionnaire. Re-introduction of high FODMAP foods was aimed to commence at the subsequent follow-up. RESULTS A total of 164 patients were identified. Thirty-seven patients were excluded due to failure to attend for follow-up. Hundred and twenty-seven patients (77% patients, of which 85% were female) completed the initial 3-month follow-up. Forty-five percent (74/164) and twenty-five percent (41/164) of the patients had continued follow-up at 6 and 12 months, respectively. Of the 127 patients who returned for follow-up, their commonest baseline symptoms were lethargy (92%), bloating (91%), flatulence (91%), and abdominal pain (89%). All symptoms were significantly improved at the initial follow-up (p < 0.0001 for all). Most patients (66%) were satisfied with their overall symptoms control. In patients who had a longer follow-up duration, all symptoms remained significantly improved compared to the baseline (p < 0.0001 for combined symptoms at 6 and 12 months). After re-introduction of the high FODMAP foods, all patients maintained their symptomatic response (n = 14/14 and n = 7/7 at 6- and 12-month follow-up, respectively). The best symptoms' improvement was seen in those who were fully adherent to the FODMAP diet. CONCLUSION In this Irish retrospective cohort study, the low FODMAP diet significantly improved all IBS symptoms at 3-, 6-, and 12-month follow-up. Following the re-introduction of the high FODMAP foods in a subgroup of patients, they were able to maintain their long-term symptomatic response up to 9 months. The low FODMAP diet might be continued for longer than 3 months; however, further studies are needed to assess the long-term safety of this diet.
Collapse
Affiliation(s)
- Khairul Najmi Muhammad Nawawi
- Gastroenterology Unit, Department of Medicine, University Hospital Galway, Galway, Ireland.,Gastroenterology Unit, Department of Medicine, Faculty of Medicine, The National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mary Belov
- Nutrition and Dietetic Department, University Hospital Galway, Galway, Ireland
| | - Carol Goulding
- Gastroenterology Unit, Department of Medicine, University Hospital Galway, Galway, Ireland.
| |
Collapse
|
203
|
Randomized clinical trial: the effect of probiotic Bacillus coagulans Unique IS2 vs. placebo on the symptoms management of irritable bowel syndrome in adults. Sci Rep 2019; 9:12210. [PMID: 31434935 PMCID: PMC6704184 DOI: 10.1038/s41598-019-48554-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 08/05/2019] [Indexed: 02/07/2023] Open
Abstract
The therapeutic effects of B. coagulans Unique IS2 have been well established in children with irritable bowel syndrome (IBS), but its efficacy in adults remain under reported. Thus, in this study the efficacy of B. coagulans Unique IS2 in the management of IBS symptoms in adults was investigated. Patients (n = 153) fulfilling Rome III criteria were provided placebo capsules for a 2 weeks run-in period. Only patients satisfying compliance criteria (n = 136) were randomized (double blind) to receive either B. coagulans Unique IS2 (2 billion CFU) or placebo capsules daily for 8 weeks. Reduction of abdominal discomfort/pain intensity and increase in complete spontaneous bowel movements were analyzed as primary end points. Other clinical symptoms of IBS and serum cytokines were also evaluated. B. coagulans Unique IS2 showed significant improvement in primary and secondary endpoints, as compared to placebo. Haematology of both the arms remained normal. No significant changes in pro- (IL-6, IL-12, TNF-α, INF- γ) and anti-inflammatory cytokine (IL-10) levels were detected at the end of B. coagulans treatment (8 weeks) as compared to placebo. B. coagulans was well tolerated with no severe adverse events to report. Overall, the results demonstrate that B. coagulans Unique IS2 is efficacious in the management of IBS symptoms in adults (18–60 years).
Collapse
|
204
|
A 5Ad Dietary Protocol for Functional Bowel Disorders. Nutrients 2019; 11:nu11081938. [PMID: 31426496 PMCID: PMC6722668 DOI: 10.3390/nu11081938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/10/2019] [Accepted: 08/15/2019] [Indexed: 02/06/2023] Open
Abstract
Functional bowel disorders (FBDs) affect around 20% of the population worldwide and are associated with reduced quality of life and high healthcare costs. Dietary therapies are frequently implemented to assist with symptom relief in these individuals, however, there are concerns regarding their complexity, restrictiveness, nutritional adequacy, and effectiveness. Thus, to overcome these limitations, a novel approach, the 5Ad Dietary Protocol, was designed and tested for its efficacy in reducing the severity of a range of gastrointestinal symptoms in 22 subjects with FBDs. The protocol was evaluated in a repeated measures MANOVA design (baseline week and intervention week). Measures of stool consistency and frequency were subtyped based on the subject baseline status. Significant improvements were seen in all abdominal symptom measures (p < 0.01). The effect was independent of body mass index (BMI), age, gender, physical activity level, and whether or not the subjects were formally diagnosed with irritable bowel syndrome (IBS) prior to participation. Stool consistency and frequency also improved in the respective contrasting subtypes. The 5Ad Dietary Protocol proved to be a promising universal approach for varying forms and severities of FBDs. The present study paves the way for future research encompassing a longer study duration and the exploration of underlying physiological mechanisms.
Collapse
|
205
|
Vlasova AV, Isakov VA, Pilipenko VI, Sheveleva SA, Markova YM, Polyanina AS, Maev IV. [Methanobrevibacter smithii in irritable bowel syndrome: a clinical and molecular study]. TERAPEVT ARKH 2019; 91:47-51. [PMID: 32598754 DOI: 10.26442/00403660.2019.08.000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
AIM To assess the role of Methanobrevibacter smithii in patients with irritable bowel syndrome associated with small intestinal bowel overgrowth. MATERIALS AND METHODS Sixty - seven patients with IBS according to Rome IV were enrolled into the study in whom hydrogen breath test was performed. Thirty - two healthy subjects with negative breath test was used as a control. All IBS symptoms assessed daily with 5 grade Lykert scale for 7 days, stool was assessed by Brystol stool scale. M. smithii was confirmed in stool samples by PCR. RESULTS AND DISCUSSION In 67 IBS patients CH4 overproduction was found in 32 (47.7%), H2 overproduction in 31 (46.2%) and normal values in 4 (5.9%) by hydrogen breath test. M. smithii was confirmed by stool PCR in all patients with CH4 overproduction. Severity and prevalence of main clinical features of IBS were similar in both SIBO groups but were significantly higher than in control (p.
Collapse
Affiliation(s)
- A V Vlasova
- Federal Research Centre of Nutrition, Biotechnology and Food Safety
| | - V A Isakov
- Federal Research Centre of Nutrition, Biotechnology and Food Safety
| | - V I Pilipenko
- Federal Research Centre of Nutrition, Biotechnology and Food Safety
| | - S A Sheveleva
- Federal Research Centre of Nutrition, Biotechnology and Food Safety
| | - Y M Markova
- Federal Research Centre of Nutrition, Biotechnology and Food Safety
| | - A S Polyanina
- Federal Research Centre of Nutrition, Biotechnology and Food Safety
| | - I V Maev
- Yevdokimov Moscow State University of Medicine and Dentistry
| |
Collapse
|
206
|
Diet in Irritable Bowel Syndrome (IBS): Interaction with Gut Microbiota and Gut Hormones. Nutrients 2019; 11:nu11081824. [PMID: 31394793 PMCID: PMC6723613 DOI: 10.3390/nu11081824] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 12/15/2022] Open
Abstract
Diet plays an important role not only in the pathophysiology of irritable bowel syndrome (IBS), but also as a tool that improves symptoms and quality of life. The effects of diet seem to be a result of an interaction with the gut bacteria and the gut endocrine cells. The density of gut endocrine cells is low in IBS patients, and it is believed that this abnormality is the direct cause of the symptoms seen in IBS patients. The low density of gut endocrine cells is probably caused by a low number of stem cells and low differentiation progeny toward endocrine cells. A low fermentable oligo-, di-, monosaccharide, and polyol (FODMAP) diet and fecal microbiota transplantation (FMT) restore the gut endocrine cells to the level of healthy subjects. It has been suggested that our diet acts as a prebiotic that favors the growth of a certain types of bacteria. Diet also acts as a substrate for gut bacteria fermentation, which results in several by-products. These by-products might act on the stem cells in such a way that the gut stem cells decrease, and consequently, endocrine cell numbers decrease. Changing to a low-FODMAP diet or changing the gut bacteria through FMT improves IBS symptoms and restores the density of endocrine cells.
Collapse
|
207
|
Serrano-Falcón B, Delgado-Aros S, Mearin F, Ciriza de los Ríos C, Serra J, Mínguez M, Montoro Huguet M, Perelló A, Santander C, Pérez Aisa Á, Bañón-Rodríguez I, Rey E. Clinical response to linaclotide at week 4 predicts sustained response in irritable bowel syndrome with constipation and improvements in digestive and extra-digestive symptoms. Therap Adv Gastroenterol 2019; 12:1756284819857358. [PMID: 31428193 PMCID: PMC6683318 DOI: 10.1177/1756284819857358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/24/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Linaclotide is approved for the treatment of moderate-to-severe irritable bowel syndrome (IBS) with constipation (IBS-C) in adults. This study aimed to assess factors predictive of a clinical response and improvements in non-IBS symptoms with linaclotide treatment in a Spanish patient population. METHODS In this open-label phase IIIb study, patients with moderate-to-severe IBS-C received linaclotide 290 μg once daily for 12 weeks. The primary endpoint was clinical response at week 12, defined as >30% reduction in IBS symptom severity score (IBS-SSS) or IBS-SSS <75 plus self-reported response of feeling 'better' or 'much better' versus the baseline. Digestive nonintestinal and extra-digestive symptom scores were assessed. Baseline characteristics and week 4 clinical response were assessed as predictors of week 12 clinical response. RESULTS A total of 96 patients were eligible; 91 were female and the mean age was 47.4 years. Mean (SD) baseline IBS-SSS was 371 (72.5). In the intention-to-treat and per-protocol populations, 22.9% and 31.7% were clinical responders at week 4, respectively, and 25.0% and 36.7% were clinical responders at week 12. Digestive nonintestinal and extra-digestive symptom scores were significantly improved at weeks 4 and 12. Baseline characteristic was not associated with week 12 clinical response; however, clinical response at week 4 was predictive of response at week 12 (OR: 6.5; 95%IC: 2.1-19.8). The most common adverse event was diarrhea inclusive of loose or watery stools (35.4%). CONCLUSIONS Linaclotide improves IBS-C symptoms, including digestive nonintestinal and extra-digestive symptoms. A clinical response at week 4 may predict response at week 12.
Collapse
Affiliation(s)
- Blanca Serrano-Falcón
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | | | | | | | - Jordi Serra
- University Hospital German Trias i Pujol, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Badalona, Spain
| | - Miguel Mínguez
- Hospital Clínico de València, Universitat de València, València, Spain
| | | | | | - Cecilio Santander
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | | | - Enrique Rey
- Servicio de Aparato Digestivo, Hospital Clínico San Carlos, Universidad Complutense, Instituto de Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
| |
Collapse
|
208
|
Jiang Y, Greenwood-Van Meerveld B, Johnson AC, Travagli RA. Role of estrogen and stress on the brain-gut axis. Am J Physiol Gastrointest Liver Physiol 2019; 317:G203-G209. [PMID: 31241977 PMCID: PMC6734369 DOI: 10.1152/ajpgi.00144.2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 01/31/2023]
Abstract
Symptoms of functional gastrointestinal disorders (FGIDs), including fullness, bloating, abdominal pain, and altered gastrointestinal (GI) motility, present a significant clinical problem, with a reported prevalence of 25%-40% within the general population. More than 60% of those affected seek and require healthcare, and affected individuals report a significantly decreased quality of life. FGIDs are highly correlated with episodes of acute and chronic stress and are increased in prevalence and reported severity in women compared with men. Although there is evidence that sex and stress interact to exacerbate FGID symptoms, the physiological mechanisms that mediate these sex-dependent disparities are incompletely understood, although hormonal-related differences in GI motility and visceral sensitivity have been purported to play a significant role in the etiology. In this mini review, we will discuss brain-gut axis control of GI motility and sensitivity, the influence of estrogen on GI motility and sensitivity, and stress modulation of the brain-gut axis.
Collapse
Affiliation(s)
- Yanyan Jiang
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Beverley Greenwood-Van Meerveld
- Oklahoma Center for Neuroscience, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
- Veterans Affairs Health Care System, Oklahoma City, Oklahoma
| | - Anthony C Johnson
- Veterans Affairs Health Care System, Oklahoma City, Oklahoma
- Department of Neurology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - R Alberto Travagli
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| |
Collapse
|
209
|
McKinney P, Cox AM, Sbaffi L. Information Literacy in Food and Activity Tracking Among Parkrunners, People With Type 2 Diabetes, and People With Irritable Bowel Syndrome: Exploratory Study. J Med Internet Res 2019; 21:e13652. [PMID: 31373277 PMCID: PMC6744816 DOI: 10.2196/13652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/04/2019] [Accepted: 06/29/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The tracking, or logging, of food intake and physical activity is increasing among people, and as a result there is increasing evidence of a link to improvement in health and well-being. Crucial to the effective and safe use of logging is a user's information literacy. OBJECTIVE The aim of this study was to analyze food and activity tracking from an information literacy perspective. METHODS An online survey was distributed to three communities via parkrun, diabetes.co.uk and the Irritable Bowel Syndrome Network. RESULTS The data showed that there were clear differences in the logging practices of the members of the three different communities, as well as differences in motivations for tracking and the extent of sharing of said tracked data. Respondents showed a good understanding of the importance of information accuracy and were confident in their ability to understand tracked data, however, there were differences in the extent to which food and activity data were shared and also a lack of understanding of the potential reuse and sharing of data by third parties. CONCLUSIONS Information literacy in this context involves developing awareness of the issues of accurate information recording, and how tracked information can be applied to support specific health goals. Developing awareness of how and when to share data, as well as of data ownership and privacy, are also important aspects of information literacy.
Collapse
Affiliation(s)
- Pamela McKinney
- Information School, University of Sheffield, Sheffield, United Kingdom
| | - Andrew Martin Cox
- Information School, University of Sheffield, Sheffield, United Kingdom
| | - Laura Sbaffi
- Information School, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
210
|
Abstract
PURPOSE OF REVIEW Chronic diarrhea is a common problem in all age groups but is a particularly challenging diagnostic problem in the elderly, since many different conditions need to be considered. The purpose of this review is to discuss the evaluation of chronic diarrhea in older individuals. It highlights those conditions that seem to occur with increased frequency in the elderly, discusses the diagnostic tests that are of greatest value in sorting out these problems, and presents an approach to evaluation that is both practical and affordable. RECENT FINDINGS There appears to be little value in distinguishing irritable bowel syndrome with diarrhea (IBS-D) from functional diarrhea in most patients, including older individuals. Both conditions need a thoughtful analysis of potential causes that may lead to more focused treatment. Older individuals may be more at risk of having certain structural disorders, and these need to be considered when constructing a differential diagnosis. In addition, elderly patients may have atypical presentations of specific disorders that require an increased index of suspicion. Diagnostic tests generally seem to perform well in older patients but have not been validated in this cohort of patients. Although the pretest probabilities of certain diseases are different in the elderly, the conventional algorithm for assessment of chronic diarrhea should lead to a diagnosis in most cases. Better studies are needed to adequately quantitate the likelihood of different diagnoses and the operating characteristics of diagnostic tests in older patients with chronic diarrhea. Lacking that information, physicians can still do a good job of making a diagnosis in these patients by adopting a stepwise approach.
Collapse
|
211
|
He Z, Ye B, Ding Y, Jiang L. Characteristics of intestinal microflora involved insacral nerve stimulation affecting visceral hypersensitivity. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:2786-2792. [PMID: 31934114 PMCID: PMC6949583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study was to investigate the effect of intestinal flora-intestinal-brain on the visceral sensitivity of normal rat and visceral hypersensitivity model rats, and to explore the effect of intestinal flora-intestinal-brain axis on visceral hypersensitivity in rats. METHODS Sixty SD male newborn rats were randomly divided into 4 groups according to the random number table: group A, group B, group C, and group D, with 15 rats in each group. 15 sterile SD newborn rats, numbered E group. Group A: normal model group; group B, group C, group D, group E, all used acetogen enema sensitization method to establish a visceral hypersensitivity model. Group C was given the vancomycin antibiotic before the model group and in group D sacral nerve stimulation (SNS) was given after modeling. At the end of the treatment period, the visceral sensitivity, intestinal flora expression, expression of NGF, TrKA, NF-κB, TRPV1, pTRPV1, IL-1β, IL-10, IL-22, TNF-α, 5-HT, and γ-GABA were measured in each group. RESULTS (1) The VMR values of the sterile rat model group were significantly different from those of the model group and the SNS stimulation model group (P<0.01). The VMR values of the antibiotic model group were statistically significant compared with the SNS stimulation model group (P<0.01). (2) There was no bacterial growth in the sterile rat model group. The expression levels of the four bacterial groups were significantly different between the antibiotic model group and the SNS stimulation model group (P<0.01). (3) The expression of NGF and TrKA in the SNS stimulation model was higher than that in the antibiotic model group (P<0.05). The expression of NF-κB and pTRPV1 was lower than that in the model group (P<0.05). The NGF, TrKA, NF-κB, and pTRPV1 were hardly expressed, which was significantly lower than the other groups (P<0.05). (4) There was no significant difference in the content of each index between the normal model group and the antibiotic model group (P > 0.05), IL-10 and 5-HT levels in the normal model group, the sterile rat model group, and the antibiotic model. There was no significant difference between the group and the sterile rat model group (P > 0.05). The difference was statistically significant (P<0.01). CONCLUSION The neurotransmitter produced by the intestinal flora can bind to the receptor TrkA and the translocation channel TRPV1 of intestinal tissue and CNS tissue, causing intestinal sensitivity changes.
Collapse
Affiliation(s)
- Zhi He
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University Nanjing, China
| | - Bixing Ye
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University Nanjing, China
| | - Yu Ding
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University Nanjing, China
| | - Liuqin Jiang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University Nanjing, China
| |
Collapse
|
212
|
Sabaté JM, Rivière S, Jouet P, Gastaldi-Menager C, Fagot-Campagna A, Tuppin P. Healthcare use by 30,000 patients with irritable bowel syndrome (IBS) in France: a 5-year retrospective and one-year prospective national observational study. BMC Gastroenterol 2019; 19:111. [PMID: 31248366 PMCID: PMC6598248 DOI: 10.1186/s12876-019-1031-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/21/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) can be responsible for alteration in quality of life and economic burden. The aim of this study was to evaluate healthcare use related to this disorder in France. METHODS The French health data system was used to select adults covered by the general health scheme (87% of population) through their first IBS hospitalization in 2015. We studied the healthcare refunded during the previous 5 years, 1 year before and after hospitalization. RESULTS Among 43.7 million adults who used refunded healthcare in 2015, 29,509 patients were identified (0.07, 33% males, 67% females, mean age 52 years, 30% admitted through emergency room). During their hospitalization, 33% had upper endoscopy and 64% colonoscopy. Over the five previous years, 3% had at least one hospitalization with an IBS diagnosis, 58% had abdominal ultrasonography, 27% CT scan, 21% upper endoscopy, 13% colonoscopy and 83% a gastroenterologist visit. The year before, these rates were respectively: 0, 36, 16, 6, 4 and 78%. Some of those rates decreased the year after the hospitalization with respectively: 1, 27, 13, 5, 4 and 19%. The year before, 65% had at least one CRP dosage (13% three or more), 58% a TSH dosage (7%) and 8% a test for coeliac diseases (1%) and the year after: 44% (8%), 43% (5%) and 3% (0.3%). At least one refund of a drug used to treat IBS was found for 85% of patients 5 years before, 65% one year before and 51% one year after. CONCLUSION This first study using French health data system for healthcare consumption assessment in IBS points out the repetition of outpatient visits, examinations and in particular radiological examinations, without a strong decrease after hospitalization for IBS and gastroenterologist visit.
Collapse
Affiliation(s)
- Jean-Marc Sabaté
- Service de Gastroentérologie, Hôpital Avicenne AP-HP, INSERM U-987, 175 rue de Stalingrad, 93000, Bobigny, France
- Physiopathologie et Pharmacologie Clinique de la Douleur, Hôpital Ambroise Paré, 9 avenue Charles-de-Gaulle, 92104, Boulogne-Billancourt, France
| | - Sébastien Rivière
- Caisse nationale de l'Assurance maladie (CNAM) - Direction de la Stratégie des Études et des Statistiques, 26-50 avenue du Professeur André Lemierre, F-75986, Paris, Cedex 20, France
| | - Pauline Jouet
- Service de Gastroentérologie, Hôpital Ambroise Paré AP-HP, 9 avenue Charles-de-Gaulle, 92104, Boulogne-Billancourt, France
| | - Christelle Gastaldi-Menager
- Caisse nationale de l'Assurance maladie (CNAM) - Direction de la Stratégie des Études et des Statistiques, 26-50 avenue du Professeur André Lemierre, F-75986, Paris, Cedex 20, France
| | - Anne Fagot-Campagna
- Caisse nationale de l'Assurance maladie (CNAM) - Direction de la Stratégie des Études et des Statistiques, 26-50 avenue du Professeur André Lemierre, F-75986, Paris, Cedex 20, France
| | - Philippe Tuppin
- Caisse nationale de l'Assurance maladie (CNAM) - Direction de la Stratégie des Études et des Statistiques, 26-50 avenue du Professeur André Lemierre, F-75986, Paris, Cedex 20, France.
| |
Collapse
|
213
|
El-Salhy M, Hausken T, Hatlebakk JG. Increasing the Dose and/or Repeating Faecal Microbiota Transplantation (FMT) Increases the Response in Patients with Irritable Bowel Syndrome (IBS). Nutrients 2019; 11:E1415. [PMID: 31238507 PMCID: PMC6628324 DOI: 10.3390/nu11061415] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Faecal microbiome transplantation (FMT) appears to be an effective method for treating irritable bowel syndrome (IBS) patients. However, it is not clear if a high transplant dose and/or repeating FMT are/is needed to ensure a response. The present study was undertaken to clarify this matter. METHODS Ten IBS patients who did not respond to a 30-g transplant subsequently received a 60-g transplant into the duodenum via a gastroscope. The patients provided faecal samples before and 1 month after FMT. They completed five questionnaires measuring symptoms, fatigue and quality of life at baseline and then at 2 weeks, 1 month and 3 months after FMT. The dysbiosis index (DI) was measured using the GA-map Dysbiosis Test®. RESULTS Seven patients (70%) responded to the 60-g transplant, with significant clinical improvements in the abdominal symptoms, fatigue and quality of life in 57%, 80% and 67% of these patients. The 60-g transplant also reduced the DI. CONCLUSION FMT is an effective treatment for IBS. A high-dose transplant and/or repeated FMT increase the response rate and the intensity of the effects of FMT.
Collapse
Affiliation(s)
- Magdy El-Salhy
- Section for Gastroenterology, Department of Medicine, Stord Hospital, Box 4000, 54 09 Stord, Norway.
- Department of Clinical Medicine, University of Bergen, 5007 Bergen, Norway.
- National Centre for Functional Gastrointestinal Disorders, 5021 Bergen, Norway.
| | - Trygve Hausken
- Department of Clinical Medicine, University of Bergen, 5007 Bergen, Norway.
- National Centre for Functional Gastrointestinal Disorders, 5021 Bergen, Norway.
| | - Jan Gunnar Hatlebakk
- Department of Clinical Medicine, University of Bergen, 5007 Bergen, Norway.
- National Centre for Functional Gastrointestinal Disorders, 5021 Bergen, Norway.
| |
Collapse
|
214
|
Mahmoudi L, Shafiekhani M, Dehghanpour H, Niknam R. Community pharmacists' knowledge, attitude, and practice of Irritable Bowel Syndrome (IBS): the impact of training courses. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:427-436. [PMID: 31417329 PMCID: PMC6592030 DOI: 10.2147/amep.s201904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 05/06/2019] [Indexed: 06/10/2023]
Abstract
Introduction: Irritable Bowel Syndrome (IBS) is a common chronic functional gastrointestinal disorder. Pharmacists have a vital role in patient education and in drug-therapy management for IBS. This survey is the first study in Iran, to evaluate knowledge, attitude, and practice (KAP) of community pharmacists on IBS, and the impact of training courses on the improvement of their skills. Objective and setting: This pre- and post-cross-sectional study was conducted to evaluate IBS-KAP amongst Community pharmacists in Shiraz, Iran. Methods: Pretested questionnaires were designed to assess professional characteristics and KAP components of the community pharmacists regarding IBS. All pharmacists from Shiraz were invited to participate in a 3-day training course on IBS. The participants were requested to complete the questionnaire before commencing the training course (pre-test), at the end of the 3-days course (post-test), and also 3 months after the course (follow-up test). Results: Correct answers to all parts increased after the training course, as well as in the follow-up stage, which was statistically significant in all three parts (P<0.05). The increases in correct answers were seen in the fields of attitude, practice, and knowledge. Conclusion: It seems that continuing IBS training courses are essential for pharmacists, regarding the fact that they can play an important role in assisting patients with IBS, as they are easily accessible healthcare professionals.
Collapse
Affiliation(s)
- Laleh Mahmoudi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Shafiekhani
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Dehghanpour
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
215
|
How Patients with IBS Use Low FODMAP Dietary Information Provided by General Practitioners and Gastroenterologists: A Qualitative Study. Nutrients 2019; 11:nu11061313. [PMID: 31212668 PMCID: PMC6627590 DOI: 10.3390/nu11061313] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 05/31/2019] [Accepted: 06/06/2019] [Indexed: 12/13/2022] Open
Abstract
There is a lack of dietitians trained to deliver the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet (LFD) for irritable bowel syndrome (IBS). Many patients receive nutritional information from general practitioners (GPs) or gastroenterologists (GEs). Since the LFD is dietitian-led, the aim of this research was to qualitatively explore the effects of GP- and GE-delivered LFD information, in IBS self-management. Semi-structured interviews were conducted in a purposive sample of 8 people with IBS (6 female), who used the LFD as their primary treatment. Interpretive Phenomenological Analysis (IPA) was used to develop themes on the lived experience of the participant’s use of LFD information from GPs and GEs. This information was perceived as trustworthy but simplistic; often just ”food lists” with little personalisation to meet individual needs and difficult to apply in ”real life”. The information required substantial interpretation and the familial and social effects of implementation were not addressed in the materials provided. Supplementary digital resources were regarded as more practical but the participants expressed concern in relation to the validity of these materials. The findings in this study support current clinical guidelines proposed by both the National Institute for Health and Care Excellence and the British Dietetic Association that the LFD should be considered a dietitian-led only intervention.
Collapse
|
216
|
Chong PP, Chin VK, Looi CY, Wong WF, Madhavan P, Yong VC. The Microbiome and Irritable Bowel Syndrome - A Review on the Pathophysiology, Current Research and Future Therapy. Front Microbiol 2019; 10:1136. [PMID: 31244784 PMCID: PMC6579922 DOI: 10.3389/fmicb.2019.01136] [Citation(s) in RCA: 160] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/06/2019] [Indexed: 11/16/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a functional disorder which affects a large proportion of the population globally. The precise etiology of IBS is still unknown, although consensus understanding proposes IBS to be of multifactorial origin with yet undefined subtypes. Genetic and epigenetic factors, stress-related nervous and endocrine systems, immune dysregulation and the brain-gut axis seem to be contributing factors that predispose individuals to IBS. In addition to food hypersensitivity, toxins and adverse life events, chronic infections and dysbiotic gut microbiota have been suggested to trigger IBS symptoms in tandem with the predisposing factors. This review will summarize the pathophysiology of IBS and the role of gut microbiota in relation to IBS. Current methodologies for microbiome studies in IBS such as genome sequencing, metagenomics, culturomics and animal models will be discussed. The myriad of therapy options such as immunoglobulins (immune-based therapy), probiotics and prebiotics, dietary modifications including FODMAP restriction diet and gluten-free diet, as well as fecal transplantation will be reviewed. Finally this review will highlight future directions in IBS therapy research, including identification of new molecular targets, application of 3-D gut model, gut-on-a-chip and personalized therapy.
Collapse
Affiliation(s)
- Pei Pei Chong
- School of Biosciences, Taylor's University, Subang Jaya, Malaysia
| | - Voon Kin Chin
- School of Biosciences, Taylor's University, Subang Jaya, Malaysia
| | - Chung Yeng Looi
- School of Biosciences, Taylor's University, Subang Jaya, Malaysia
| | - Won Fen Wong
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Priya Madhavan
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Voon Chen Yong
- School of Biosciences, Taylor's University, Subang Jaya, Malaysia
| |
Collapse
|
217
|
A Population Survey of Dietary Attitudes towards Gluten. Nutrients 2019; 11:nu11061276. [PMID: 31195638 PMCID: PMC6628309 DOI: 10.3390/nu11061276] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 02/06/2023] Open
Abstract
It is unclear how the prevalence of people who believe the gluten-free diet (GFD) to be generally healthy (“Lifestylers”) is impacting the overall rates of self-reported gluten sensitivity (GS). We repeated a population survey from 2012 in order to examine how attitudes towards GS have changed over time. Our survey (N = 1004) was administered in Sheffield (UK) in 2015, replicating the 2012 experiment. The questionnaire included a food frequency survey and assessed self-reported GS as well as associated variables (prevalence, current diet, pre-existing conditions, etc.). The overall rates of key variables and chi-squared analysis in comparison to the previous survey were as follows: self-reported GS was 32.8% (previously 12.9%, p < 0.001), pre-existing coeliac disease (CD) was 1.2% (previously 0.8%, p = 0.370), following a GFD was 3.7% (previously 3.7%, p = 0.997). Self-reported GS was positively associated with some pre-existing conditions, including anxiety, depression, chronic fatigue, headaches, and other food allergies/intolerances (including irritable bowel syndrome (IBS); chi-squared analyses, all p < 0.001). Over a 3-year period, the fraction of people who self-reported GS increased by over 250%. Despite this, arguably more meaningful indications of underlying physiological GS remained comparable. This research suggests that the public perception of gluten is causing a marked increase in the number of people who erroneously believe they are sensitive to it.
Collapse
|
218
|
Hasler WL, Levinthal DJ, Tarbell SE, Adams KA, Li BUK, Issenman RM, Sarosiek I, Jaradeh SS, Sharaf RN, Sultan S, Venkatesan T. Cyclic vomiting syndrome: Pathophysiology, comorbidities, and future research directions. Neurogastroenterol Motil 2019; 31 Suppl 2:e13607. [PMID: 31241816 PMCID: PMC6899706 DOI: 10.1111/nmo.13607] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 03/18/2019] [Indexed: 12/14/2022]
Abstract
Cyclic vomiting syndrome (CVS) is characterized by severe episodic emesis in adults and children. Cannabinoid hyperemesis syndrome is an increasingly recognized CVS-like illness that has been associated with chronic cannabis use. There are significant gaps in our understanding of the pathophysiology, clinical features, comorbidities, and effective management options of CVS. Recommendations for treating CVS are based on limited clinical data, as no placebo-controlled, randomized trials have yet been conducted. Diseases associated with CVS, including migraine, mitochondrial disorders, autonomic dysfunction, and psychiatric comorbidities, provide clues about pathophysiologic mechanisms and suggest potential therapies. We review our current understanding of CVS and propose future research directions with the aim of developing effective therapy. Establishing a multicenter, standardized registry of CVS patients could drive research on multiple fronts including developing CVS-specific outcome measures to broaden our understanding of clinical profiles, to serve as treatment end points in clinical trials, and to provide a platform for patient recruitment for randomized clinical trials. Such a robust database would also facilitate conduct of research that aims to determine the underlying pathophysiological mechanisms and genetic basis for CVS, as well as identifying potential biomarkers for the disorder. Soliciting government and industry support is crucial to establishing the necessary infrastructure and achieving these goals. Patient advocacy groups such as the Cyclic Vomiting Syndrome Association (CVSA), which partner with clinicians and researchers to disseminate new information, to promote ongoing interactions between patients, their families, clinicians, investigators, to support ongoing CVS research and education, must be an integral part of this endeavor.
Collapse
Affiliation(s)
- William L. Hasler
- Division of GastroenterologyUniversity of Michigan Health SystemAnn ArborMichigan
| | - David J. Levinthal
- Division of Gastroenterology, Hepatology and NutritionUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Sally E. Tarbell
- Department of Psychiatry and Behavioral SciencesNorthwestern Feinberg School of MedicineChicagoIllinois
| | | | - B U. K. Li
- Department of PediatricsMedical College of WisconsinMilwaukeeWisconsin
| | - Robert M. Issenman
- Division of Pediatric GastroenterologyMcMaster UniversityHamiltonOntarioCanada
| | - Irene Sarosiek
- Division of GastroenterologyTexas Tech University Health Sciences CenterEl PasoTexas
| | | | - Ravi N. Sharaf
- Division of GastroenterologyDepartment of Healthcare Policy and ResearchWeill Cornell Medical CenterNew YorkNew York,Department of MedicineWeill Cornell Medical CenterNew YorkNew York
| | | | - Thangam Venkatesan
- Division of Gastroenterology and HepatologyMedical College of WisconsinMilwaukeeWisconsin
| |
Collapse
|
219
|
Kesuma Y, Firmansyah A, Bardosono S, Sari IP, Kurniawan A. Blastocystis ST-1 is associated with Irritable Bowel Syndrome-diarrhoea (IBS-D) in Indonesian adolescences. Parasite Epidemiol Control 2019; 6:e00112. [PMID: 31528737 PMCID: PMC6742775 DOI: 10.1016/j.parepi.2019.e00112] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 12/14/2022] Open
Abstract
Objective IBS is a functional gastrointestinal disorder and commonly presents in children and adolescences, presented as diarrhoea, constipation or mixed type. Blastocystis is a common intestinal protozoa found worldwide, which pathogenicity is still controversial. This study aimed to identify the risk factors of IBS, the association between IBS types with Blastocystis subtypes and analyse Blastocystis pathogenicity. Design A comparative cross-sectional study was conducted among senior high school students. Rome III Criteria for IBS diagnosis, questionnaires on the risk factors of IBS and types of IBS were recorded. Students were further selected and classified into IBS and non-IBS groups to analyse the association between IBS, IBS types with Blastocystis infection and its subtypes. Direct microscopic stool examination to identify single Blastocystis infection was performed, followed by culture in Jones' medium, PCR, sequencing of 18S rRNA and phylogenetic analysis to determine Blastocystis subtype. Data was analysed using SPSS v22.0 and P value <0.05 was considered statistically significant (95% confidence intervals). Results IBS was found in 30.2% of 454 students, consisted of 33.3% IBS Diarrhoea, 27.7% IBS Mixed, 27.7% IBS Unclassified and 11.1% IBS Constipation. Major risk factors to IBS consisted of family history of recurrent abdominal pain, abuse, bullying and female gender in respective order (OR 3.6–2.1). Blastocystis ST-1 was significantly associated to IBS-D with 2.9 times risk factor. Conclusions Blastocystis infection is a risk factor to develop IBS-D type in adolescence; Blastocystis ST-1 can be regarded as a pathogenic subtype.
Collapse
Affiliation(s)
- Yudianita Kesuma
- Department of Pediatrics, Faculty of Medicine, Universitas Sriwijaya and Moh. Hoesin Hospital, Palembang, Indonesia
- Doctoral Study program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Agus Firmansyah
- Department of Pediatrics, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Saptawati Bardosono
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ika Puspa Sari
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Agnes Kurniawan
- Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Corresponding author at: Department of Parasitology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| |
Collapse
|
220
|
El-Salhy M, Gilja OH, Hatlebakk JG. Overlapping of irritable bowel syndrome with erosive esophagitis and the performance of Rome criteria in diagnosing IBS in a clinical setting. Mol Med Rep 2019; 20:787-794. [PMID: 31180516 PMCID: PMC6580027 DOI: 10.3892/mmr.2019.10284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 05/15/2019] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) overlap. It is not clear whether GERD is caused by non-erosive esophagitis, or erosive esophagitis. The Rome criteria are not widely used for the diagnosis of IBS in the clinic. In total, 1,489 IBS patients without red flags were included in the present retrospective study. They comprised of 1,331 females and 158 males with a mean age of 51 years. The diagnosis of IBS was verified by endoscopic and histopathological examinations. Whereas erosive esophagitis occurred in 97% of patients, only 66% had GERD symptoms. Endoscopy and histopathological examinations revealed that 1.4% of the IBS patients with diarrhea as the predominant symptom had other organic gastrointestinal diseases: 0.3% with celiac disease, 0.2% with Crohn's disease, 0.07% with ulcerative colitis, 0.6% with microscopic colitis, and 0.2% with colon cancer. Applying the Rome III criteria produced a sensitivity of 100% [95% confidence intervals (CI)=99.8–100.0%] a specificity of 98.7% (95% CI=98.0–99.2%), a positive likelihood ratio of 76.9%, and a negative likelihood ratio of 0%. IBS is associated with erosive esophagitis. Applying Rome III criteria without red flags and history, was effective in diagnosing IBS. Celiac disease and microscopic colitis should be considered as alternative diagnoses.
Collapse
Affiliation(s)
- Magdy El-Salhy
- Section for Gastroenterology, Department of Medicine, Stord Hospital, 5416 Stord, Norway
| | - Odd Helge Gilja
- Department of Clinical Medicine, University of Bergen, 5007 Bergen, Norway
| | | |
Collapse
|
221
|
Lin X, Liu X, Xu J, Cheng KK, Cao J, Liu T, Liu Q, Zhong H, Shen G, Dong J, Chang X. Metabolomics analysis of herb-partitioned moxibustion treatment on rats with diarrhea-predominant irritable bowel syndrome. Chin Med 2019; 14:18. [PMID: 31080495 PMCID: PMC6505125 DOI: 10.1186/s13020-019-0240-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/29/2019] [Indexed: 02/08/2023] Open
Abstract
Background Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder, which is commonly treated with antidiarrhoeal, antispasmodics, serotonergic agents or laxative agents. These treatments provide relief for IBS symptoms but may also lead to undesired side effects. Previously, herb-partitioned moxibustion (HPM) treatment has been demonstrated to be effective in ameliorating symptoms of IBS. However, the underlying mechanism of this beneficial treatment is yet to be established. The aim of the current study was to systematically assess the metabolic alterations in response to diarrhea-predominant IBS (IBS-D) and therapeutic effect of HPM. Methods Proton nuclear magnetic resonance spectroscopy (1H NMR)-based metabolomics approach was used to investigate fecal and serum metabolome of rat model of IBS-D with and without HPM treatment. Results The current results showed that IBS-induced metabolic alterations in fecal and serum sample include higher level of threonine and UDP-glucose together with lower levels of aspartate, ornithine, leucine, isoleucine, proline, 2-hydroxy butyrate, valine, lactate, ethanol, arginine, 2-oxoisovalerate and bile acids. These altered metabolites potentially involve in impaired gut secretory immune system and intestinal inflammation, malabsorption of nutrients, and disordered metabolism of bile acids. Notably, the HPM treatment was found able to normalize the Bristol stool forms scale scores, fecal water content, plasma endotoxin level, and a number of IBS-induced metabolic changes. Conclusions These findings may provide useful insight into the molecular basis of IBS and mechanism of the HPM intervention. Electronic supplementary material The online version of this article (10.1186/s13020-019-0240-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Xianwei Lin
- 1Department of Electronic Science, Fujian Provincial Key Laboratory for Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005 China
| | - Xia Liu
- 2College of Acupuncture and Moxibustion, Hunan University of Chinese Medicine, Changsha, 410208 China
| | - Jingjing Xu
- 1Department of Electronic Science, Fujian Provincial Key Laboratory for Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005 China
| | - Kian-Kai Cheng
- 3Innovation Centre in Agritechnology, Universiti Teknologi Malaysia, 84600 Muar, Johor Malaysia
| | - Jianan Cao
- 2College of Acupuncture and Moxibustion, Hunan University of Chinese Medicine, Changsha, 410208 China
| | - Tao Liu
- 2College of Acupuncture and Moxibustion, Hunan University of Chinese Medicine, Changsha, 410208 China
| | - Qiong Liu
- 2College of Acupuncture and Moxibustion, Hunan University of Chinese Medicine, Changsha, 410208 China
| | - Huan Zhong
- 2College of Acupuncture and Moxibustion, Hunan University of Chinese Medicine, Changsha, 410208 China
| | - Guiping Shen
- 1Department of Electronic Science, Fujian Provincial Key Laboratory for Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005 China
| | - Jiyang Dong
- 1Department of Electronic Science, Fujian Provincial Key Laboratory for Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005 China
| | - Xiaorong Chang
- 2College of Acupuncture and Moxibustion, Hunan University of Chinese Medicine, Changsha, 410208 China
| |
Collapse
|
222
|
Close association between abnormal expressed enzymes of energy metabolism and diarrhea-predominant irritable bowel syndrome. Chin Med J (Engl) 2019; 132:135-144. [PMID: 30614852 PMCID: PMC6365280 DOI: 10.1097/cm9.0000000000000003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Irritable bowel syndrome (IBS) is one of the most common functional intestinal diseases, but its pathogenesis is still unknown. The present study aimed to screen the differentially expressed proteins in the mucosa of colon between IBS with diarrhea (IBS-D) patients and the healthy controls. Methods: Forty-two IBS-D patients meeting the Rome III diagnostic criteria and 40 control subjects from July 2007 to June 2009 in Chinese PLA General Hospital were enrolled in the present study. We examined the protein expression profiles in mucosa of colon corresponding to IBS-D patients (n = 5) and controls (n = 5) using 2-dimensional gel electrophoresis (2-DE) and mass spectrometry (MS). Secondly, Western blot and immunohistochemical analysis were carried out to validate the screened proteins in 27 IBS-D patients and 27 controls. Thirdly, high-performance liquid chromatography (HPLC) was further carried out to determine ATP concentration in the mucosa of colon between 10 IBS-D patients and 8 controls. Comparisons between 2 groups were performed by Student's t-test or Mann-Whitney U-test. Results: Twelve differentially expressed proteins were screened out. The α-enolase (ENOA) in the sigmoid colon (0.917 ± 0.007 vs. 1.310 ± 0.100, t = 2.643, P = 0.017) and caecum (0.765 ± 0.060 vs. 1.212 ± 0.122, t = 2.225, P = 0.023), Isobutyryl-CoA dehydrogenase (ACAD8) in the sigmoid colon (1.127 ± 0.201 vs. 1.497 ± 0.392, t = 7.093, P = 0.008) of the IBS-D group were significantly lower while acetyl-CoA acetyltransferase (CT) in the caecum (2.453 ± 0.422 vs. 0.931 ± 0.652, t = 8.363, P = 0.015) and ATP synthase subunit d (ATP5H) in the sigmoid (0.843 ± 0.042 vs. 0.631 ± 0.042, t = 8.613,P = 0.007) of the IBS-D group was significantly higher, compared with the controls. The ATP concentration in the mucosa of the sigmoid colon in IBS-D group was significantly lower than that of control group (0.470 [0.180, 1.360] vs. 5.350 [2.230, 7.900], U = 55, P < 0.001). Conclusions: Many proteins related to energy metabolism presented differential expression patterns in the mucosa of colon of the IBS-D patients. The abnormalities in energy metabolism may be involved in the pathogenesis of IBS which deserves more studies to elucidate.
Collapse
|
223
|
Lacy BE, Harris LA, Chang L, Lucak S, Gutman C, Dove LS, Covington PS, Lembo A. Impact of patient and disease characteristics on the efficacy and safety of eluxadoline for IBS-D: a subgroup analysis of phase III trials. Therap Adv Gastroenterol 2019; 12:1756284819841290. [PMID: 31019552 PMCID: PMC6466471 DOI: 10.1177/1756284819841290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/14/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome with diarrhea (IBS-D) is a prevalent gastrointestinal (GI) disorder with a varied presentation, often overlapping with other GI and non-GI disorders. Eluxadoline is a locally active mixed µ- and κ-opioid receptor agonist and δ-opioid receptor antagonist approved for the treatment of IBS-D in adults. As IBS-D is a heterogeneous disease, factors such as patient demographics, symptom severity, and symptom pattern history can potentially inform treatment selection. METHODS Here, we report additional prospectively planned analyses of two large double-blind, placebo-controlled studies (IBS-3001 and IBS-3002) enrolling patients meeting Rome III criteria for IBS-D. Patients were randomized 1:1:1 to receive placebo or eluxadoline 75 mg or 100 mg twice daily. Efficacy (abdominal pain, stool consistency, and composite, simultaneous improvement in both) and safety were assessed for prospectively defined patient subgroups stratified by age, sex, race, presence of comorbidities, and baseline disease characteristics. RESULTS Across all age, sex, race, comorbidity, and disease characteristic subgroups, a greater proportion of patients were composite responders with both eluxadoline doses as compared with placebo, including patients with a history of depression or a history of gastroesophageal reflux disease. Among patients aged ⩾65 years, a greater proportion of patients receiving eluxadoline 75 mg were composite, abdominal pain, and stool consistency responders compared with those receiving 100 mg. The proportion of patients with at least one adverse event was slightly higher in patients aged ⩾65 years and also in female patients. CONCLUSIONS This analysis suggests that eluxadoline is effective in treating IBS-D across a range of commonly encountered patient types. In contrast to the overall population, patients aged ⩾65 years demonstrated a greater proportion of responders at the lower approved 75 mg eluxadoline dose.
Collapse
Affiliation(s)
- Brian E. Lacy
- Division of Gastroenterology and Hepatology,
Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | | | - Lin Chang
- University of California, Los Angeles, CA,
USA
| | - Susan Lucak
- Weill Cornell Medical Center, New York, NY,
USA
| | | | - Leonard S. Dove
- Former employees of Furiex Pharmaceuticals,
Inc., an affiliate of Allergan plc, Madison, NJ, USA
| | - Paul S. Covington
- Former employees of Furiex Pharmaceuticals,
Inc., an affiliate of Allergan plc, Madison, NJ, USA
| | - Anthony Lembo
- Beth Israel Deaconess Medical Center, Boston,
MA, USA
| |
Collapse
|
224
|
Zhang W, Wong CH, Chavannes M, Mohammadi T, Rosenfeld G. Cost-effectiveness of faecal calprotectin used in primary care in the diagnosis of inflammatory bowel disease. BMJ Open 2019; 9:e027043. [PMID: 30987989 PMCID: PMC6500206 DOI: 10.1136/bmjopen-2018-027043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Inflammatory bowel disease (IBD) is a chronic, autoimmune, gastrointestinal disorder. Canada has one of the highest prevalence and incidence rates of IBD in the world. Diagnosis is challenging due to the similarity of symptoms to functional gastrointestinal disorders. Faecalcalprotectin (FC) is a biomarker for active mucosal inflammation and has proven effective in the diagnosis of IBD. Our study objective was to assess the cost-effectiveness of adding an FC test compared with standard practice (blood test) in primary care among adult patients presenting with gastrointestinal symptoms. DESIGN We constructed a decision analytic tree with a 1-year time horizon. The cut-off level of 100 µg/g was used for FC testing. Probabilistic analyses were conducted for the base case and all scenarios. SETTING Canadian health sector perspective. POPULATION A hypothetical cohort of adult patients presenting with gastrointestinal symptoms in the primary care setting. INTERVENTIONS FC test compared with blood test. MAIN OUTCOME MEASURES Costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER) of FC test expressed as cost per QALY gained compared with blood test and time to IBD diagnosis. RESULTS FC testing is expected to cost more ($C295.1 vs $C273.9) than standard practice but yield little higher QALY (0.751vs0.750). The ICER of FC test was $C20 323 per QALY. Probabilistic analysis demonstrated that at a willingness-to-pay threshold of $C50 000 per QALY, there was 81.3% probability of FC test being cost-effective. The use of FC test in primary care reduced the time to IBD diagnosis by 40.0 days (95% CI 16.3 to 65.3 days), compared with blood testing alone. CONCLUSIONS Based on this analysis of short-term outcomes, screening adult patients in primary care using FC test at a cut-off level of 100 µg/g is expected to be cost-effective in Canada.
Collapse
Affiliation(s)
- Wei Zhang
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Chiew Hsia Wong
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mallory Chavannes
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, Canada
- Department of Pediatric, Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Los Angeles, University of Southern California, Los Angeles, USA
| | - Tima Mohammadi
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, Canada
| | - Greg Rosenfeld
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, Canada
| |
Collapse
|
225
|
Wylezinski LS, Gray JD, Polk JB, Harmata AJ, Spurlock CF. Illuminating an Invisible Epidemic: A Systemic Review of the Clinical and Economic Benefits of Early Diagnosis and Treatment in Inflammatory Disease and Related Syndromes. J Clin Med 2019; 8:E493. [PMID: 30979036 PMCID: PMC6518102 DOI: 10.3390/jcm8040493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 12/12/2022] Open
Abstract
Healthcare expenditures in the United States are growing at an alarming level with the Centers for Medicare and Medicaid Services (CMS) projecting that they will reach $5.7 trillion per year by 2026. Inflammatory diseases and related syndromes are growing in prevalence among Western societies. This growing population that affects close to 60 million people in the U.S. places a significant burden on the healthcare system. Characterized by relatively slow development, these diseases and syndromes prove challenging to diagnose, leading to delayed treatment against the backdrop of inevitable disability progression. Patients require healthcare attention but are initially hidden from clinician's view by the seemingly generalized, non-specific symptoms. It is imperative to identify and manage these underlying conditions to slow disease progression and reduce the likelihood that costly comorbidities will develop. Enhanced diagnostic criteria coupled with additional technological innovation to identify inflammatory conditions earlier is necessary and in the best interest of all healthcare stakeholders. The current total cost to the U.S. healthcare system is at least $90B dollars annually. Through unique analysis of financial cost drivers, this review identifies opportunities to improve clinical outcomes and help control these disease-related costs by 20% or more.
Collapse
Affiliation(s)
- Lukasz S Wylezinski
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- IQuity, Inc., Nashville, TN 37203, USA.
| | | | | | | | - Charles F Spurlock
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
- IQuity, Inc., Nashville, TN 37203, USA.
| |
Collapse
|
226
|
Moayyedi P, Andrews CN, MacQueen G, Korownyk C, Marsiglio M, Graff L, Kvern B, Lazarescu A, Liu L, Paterson WG, Sidani S, Vanner S. Canadian Association of Gastroenterology Clinical Practice Guideline for the Management of Irritable Bowel Syndrome (IBS). J Can Assoc Gastroenterol 2019; 2:6-29. [PMID: 31294724 PMCID: PMC6507291 DOI: 10.1093/jcag/gwy071] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/04/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND & AIMS Irritable bowel syndrome (IBS) is one of the most common gastrointestinal (GI) disorders, affecting about 10% of the general population globally. The aim of this consensus was to develop guidelines for the management of IBS. METHODS A systematic literature search identified studies on the management of IBS. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an iterative online platform and then finalized and voted on by a multidisciplinary group of clinicians and a patient. RESULTS Consensus was reached on 28 of 31 statements. Irritable bowel syndrome is diagnosed based on symptoms; serological testing is suggested to exclude celiac disease, but routine testing for C-reactive protein (CRP), fecal calprotectin or food allergies is not recommended. A trial of a low fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAP) diet is suggested, while a gluten-free diet is not. Psyllium, but not wheat bran, supplementation may help reduce symptoms. Alternative therapies such as peppermint oil and probiotics are suggested, while herbal therapies and acupuncture are not. Cognitive behavioural therapy and hypnotherapy are suggested psychological therapies. Among the suggested or recommended pharmacological therapies are antispasmodics, certain antidepressants, eluxadoline, lubiprostone, and linaclotide. Loperamide, cholestyramine and osmotic laxatives are not recommended for overall IBS symptoms. The nature of the IBS symptoms (diarrhea-predominant or constipation-predominant) should be considered in the choice of pharmacological treatments. CONCLUSIONS Patients with IBS may benefit from a multipronged, individualized approach to treatment, including dietary modifications, psychological and pharmacological therapies.
Collapse
Affiliation(s)
- Paul Moayyedi
- Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
| | | | - Glenda MacQueen
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Christina Korownyk
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lesley Graff
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brent Kvern
- Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adriana Lazarescu
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - Louis Liu
- Division of Gastroenterology, University of Toronto, Toronto, Ontario, Canada
| | - William G Paterson
- Division of Gastroenterology, Queen’s University, Kingston, Ontario, Canada
| | - Sacha Sidani
- Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Vanner
- Division of Gastroenterology, Queen’s University, Kingston, Ontario, Canada
| |
Collapse
|
227
|
Şahin-Eryılmaz G, Başak K, Çakır-Madenci Ö, Koç H, Tüzün S, Dolapçıoğlu C, Ahıshalı E, Dabak MR. Relationship between irritable bowel syndrome and plasma and tissue ghrelin levels. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 29:631-635. [PMID: 30289393 DOI: 10.5152/tjg.2018.17593] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS This study aimed to evaluate the relationship between irritable bowel syndrome (IBS) and plasma and tissue ghrelin levels. MATERIALS AND METHODS Patients who had undergone gastroscopy procedure for any reason previously were enrolled in the study. Among these, patients with IBS symptoms were evaluated according to the Roma III criteria. The healthy control group comprised patients with no IBS symptom and had undergone gastroscopy procedure for another reason. The plasma ghrelin level and tissue ghrelin level obtained by immunohistochemical examination of biopsy specimens taken from the gastric antrum and corpus were evaluated in all participants. RESULTS The mean age of 90 participants was 43.64}12.64 years. The median value of the plasma ghrelin level was 3.29 (1.2-12.7) in the diarrhea group (IBS-D), 1.49 (0.82-7.08) in the constipation group (IBS-C), and 1.5 (0.2-3.7) in the control group. The plasma ghrelin levels between the groups were found to be significantly higher in IBS-D than in IBS-C and the control groups (p=0.001 and p=0.001, respectively). On comparing antral mucosal gland biopsy outcomes among the groups, staining intensity score was found to be significantly high in IBS-C as compared with the control group, whereas no significant difference was observed between IBS-D and the control groups (p=0.020 and p=0.429, respectively). CONCLUSION The plasma ghrelin level in IBS-D and the staining intensity in the antral mucosal gland in IBS-C were found to be significantly higher. In addition, there was no difference between the groups in terms of ghrelin staining intensity in the gastric corpus.
Collapse
Affiliation(s)
| | - Kayhan Başak
- Department of Medical Pathology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | | | - Hacer Koç
- Department of Medical Biochemistry, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Sabah Tüzün
- Department of Family Medicine, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Can Dolapçıoğlu
- Department of Gastroenterology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Emel Ahıshalı
- Department of Gastroenterology, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Reşat Dabak
- Department of Family Medicine, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| |
Collapse
|
228
|
Laatikainen R, Jalanka J, Loponen J, Hongisto SM, Hillilä M, Koskenpato J, Korpela R, Salonen A. Randomised clinical trial: effect of low-FODMAP rye bread versus regular rye bread on the intestinal microbiota of irritable bowel syndrome patients: association with individual symptom variation. BMC Nutr 2019; 5:12. [PMID: 32153925 PMCID: PMC7050854 DOI: 10.1186/s40795-019-0278-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 02/06/2019] [Indexed: 12/17/2022] Open
Abstract
Background A low intake of Fermentable, Oligo-, Di-, Mono-saccharides and Polyols (FODMAPs) is effective in the symptom control of irritable bowel syndrome (IBS) patients but may exert negative effects on the intestinal microbiota. The microbial effects of increasing regular or non-FODMAP fibre sources are largely unknown. Furthermore, it is not known if the baseline microbiota composition is associated with individual symptom control during the consumption of different rye products in IBS patients. Our objective was to evaluate whether increased consumption of low-FODMAP rye bread or regular rye bread for 4 weeks would alter the intestinal microbiota composition of IBS patients following their habitual diet, and whether these changes associate to symptoms and/or the baseline microbiota. Methods The study was conducted as a randomized double blind controlled cross-over study (n = 50). Microbiota was analysed by 16S rRNA gene sequencing and associated with gastrointestinal symptoms. Both microbial changes and their associations to symptoms were secondary outcomes. Results The consumption of the test breads did not alter microbiota diversity. Compared to baseline, consumption of the low FODMAP rye bread decreased the abundance of Bacteroides, Flavonifractor, Holdemania, Parasutterella and Klebsiella and showed a trend towards increased bifidobacteria, whereas the regular rye bread decreased the abundance of Flavonifractor. When comparing between the two test breads, Klebsiella was decreased after low-FODMAP rye bread intake. Patients whose symptoms decreased during the low-FODMAP rye bread displayed more Blautia and less Barnesiella at baseline. Conclusions Consumption of low-FODMAP rye bread had modest, potentially beneficial effects on patients’ microbiota while increasing their intake of fibre substantially. The baseline microbiota composition was associated with the variable degrees of symptom relief experienced by the patients. Consumption of a low-FODMAP rye bread might be one way to increase dietary fibre intake and improve the mild dysbiosis often observed among patients with IBS. Trial registration ClinicalTrials.gov: NCT02161120. Retrospectively registered 11 June 2014. Electronic supplementary material The online version of this article (10.1186/s40795-019-0278-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Reijo Laatikainen
- 1Faculty of Medicine, Pharmacology, Medical Nutrition Physiology, University of Helsinki, Helsinki, Finland.,2Aava Medical Centre, Helsinki, Finland.,Booston Oy Ltd, Viikinkaari 6, 00790 Helsinki, Finland
| | - Jonna Jalanka
- 3Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | | | - Markku Hillilä
- 5Clinic of Gastroenterology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Riitta Korpela
- 3Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anne Salonen
- 3Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
229
|
Oliveira JP, Ferreira S. Multiple phenotypic domains of Fabry disease and their relevance for establishing genotype- phenotype correlations. APPLICATION OF CLINICAL GENETICS 2019; 12:35-50. [PMID: 30881085 PMCID: PMC6407513 DOI: 10.2147/tacg.s146022] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fabry disease (FD) is a rare X-linked glycosphingolipidosis resulting from deficient α-galactosidase A (AGAL) activity, caused by pathogenic mutations in the GLA gene. In males, the multisystemic involvement and the severity of tissue injury are critically dependent on the level of AGAL residual enzyme activity (REA) and on the metabolic load of the disease, but organ susceptibility to damage varies widely, with heart appearing as the most vulnerable to storage pathology, even with relatively high REA. The expression of FD can be conceived as a multidomain phenotype, where each of the component domains is the laboratory or clinical expression of the causative GLA mutation along a complex pathophysiologic cascade pathway. The AGAL enzyme activity is the most clinically useful marker of the protein phenotype. The metabolic phenotype and the pathologic phenotype are diverse expressions of the storage pathology, respectively, assessed by biochemical and histological/ultrastructural methods. The storage phenotypes are the direct consequences of enzyme deficiency and hence, together with the enzymatic phenotype, constitute the more specific diagnostic markers of FD. In the pathophysiology cascade, the clinical phenotypes are most distantly linked to the underlying genetic causation, being critically influenced by the patients’ gender and age, and modulated by the effects of variation in other genetic loci, of polygenic inheritance and of environmental risk factors. A major challenge in the clinical phenotyping of patients with FD is the differential diagnosis between its nonspecific, later-onset complications, particularly the cerebrovascular, cardiac and renal, and similar chronic illnesses that are common in the general population. Comprehensive phenotyping, whenever possible performed in hemizygous males, is therefore crucial for grading the severity of pathogenic GLA variants, to clarify the phenotypic correlations of hypomorphic alleles, to define benign polymorphisms, as well as to establish the pathogenicity of variants of uncertain significance.
Collapse
Affiliation(s)
- João Paulo Oliveira
- Department of Genetics, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal, .,Service of Medical Genetics, São João University Hospital Centre, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal.,i3S - Institute for Research and Innovation in Health / [Instituto de Investigação e Inovação em Saúde], University of Porto, 4200-135 Porto, Portugal,
| | - Susana Ferreira
- Department of Genetics, Faculty of Medicine, University of Porto, Alameda Hernâni Monteiro, 4200-319 Porto, Portugal, .,i3S - Institute for Research and Innovation in Health / [Instituto de Investigação e Inovação em Saúde], University of Porto, 4200-135 Porto, Portugal,
| |
Collapse
|
230
|
Chung CF, Wang Q, Schroeder J, Cole A, Zia J, Fogarty J, Munson SA. Identifying and Planning for Individualized Change: Patient-Provider Collaboration Using Lightweight Food Diaries in Healthy Eating and Irritable Bowel Syndrome. PROCEEDINGS OF THE ACM ON INTERACTIVE, MOBILE, WEARABLE AND UBIQUITOUS TECHNOLOGIES 2019; 3:7. [PMID: 31080941 PMCID: PMC6504841 DOI: 10.1145/3314394] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/01/2019] [Indexed: 12/20/2022]
Abstract
Identifying and planning strategies that support a healthy lifestyle or manage a chronic disease often require patient-provider collaboration. For example, people with healthy eating goals often share everyday food, exercise, or sleep data with health coaches or nutritionists to find opportunities for change, and patients with irritable bowel syndrome (IBS) often gather food and symptom data as part of working with providers to diagnose and manage symptoms. However, a lack of effective support often prevents health experts from reviewing large amounts of data in time-constrained visits, prevents focusing on individual goals, and prevents generating correct, individualized, and actionable recommendations. To examine how to design photo-based diaries to help people and health experts exchange knowledge and focus on collaboration goals when reviewing the data together, we designed and developed Foodprint, a photo-based food diary. Foodprint includes three components: (1) A mobile app supporting lightweight data collection, (2) a web app with photo-based visualization and quantitative visualizations supporting collaborative reflection, and (3) a pre-visit note communicating an individual's expectations and questions to experts. We deployed Foodprint in two studies: (1) with 17 people with healthy eating goals and 7 health experts, and (2) with 16 IBS patients and 8 health experts. Building upon the lens of boundary negotiating artifacts and findings from two field studies, our research contributes design principles to (1) prepare individuals to collect data relevant to their health goals and for collaboration, (2) help health experts focus on an individual's eating context, experiences, and goals in collaborative review, and (3) support individuals and experts to develop individualized, actionable plans and strategies.
Collapse
Affiliation(s)
- Chia-Fang Chung
- Informatics, Indiana University Bloomington, Bloomington, IN, 47405, USA
| | - Qiaosi Wang
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Jessica Schroeder
- Paul G. Allen School of Computer Science & Engineering, DUB Group, University of Washington, Seattle, WA, 98195, USA
| | - Allison Cole
- Family Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Jasmine Zia
- Division of Gastroenterology, University of Washington, Seattle, WA, 98195, USA
| | - James Fogarty
- Paul G. Allen School of Computer Science & Engineering, DUB Group, University of Washington, Seattle, WA, 98195, USA
| | - Sean A Munson
- Human Centered Design & Engineering, DUB Group, University of Washington, Seattle, WA, 98195, USA
| |
Collapse
|
231
|
Internet-Delivered Cognitive Behavior Therapy for Young Taiwanese Female Nursing Students with Irritable Bowel Syndrome-A Cluster Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050708. [PMID: 30818837 PMCID: PMC6427663 DOI: 10.3390/ijerph16050708] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
Abstract
Irritable Bowel Syndrome (IBS) is prevalent within the general population. Studies have shown that stress and anxiety co-exist with IBS. Young Taiwanese women commonly exhibit physical and psychological health problems caused by academic stress. The purpose of our current study was to evaluate the efficacy of short-term Internet-delivered cognitive-behavioral therapy (ICBT) on female nursing students in practicum. We performed a cluster randomized controlled trial comprised of 160 participants who met the inclusion criteria, which were divided into three groups: (1) ICBT, (2) expressive writing (EW), and (3) wait-list control. Treatment interventions lasted for 6 weeks. Levels of anxiety, depression, and IBS symptoms were assessed at four time points, baseline assessment at T0, 2 weeks after T0 (T1), at the end of practicum (T2), and at 3-month follow-up (T3). The results showed that ICBT and EW groups exhibited a significant, yet small, reduction in anxiety and depression at T2 and T3 compared to the wait-list control group. The EW group exhibited significantly greater reduction in anxiety and depression compared to the ICBT group at T2. However, the ICBT group demonstrated greater improvements in alleviating anxiety and depression at T3 compared to the EW group. These data indicate that ICBT and EW groups exhibited small effects on anxiety and depression reduction at T2 and T3 compared to the wait-list control group, with no effects on IBS symptoms in young Taiwanese female nursing students.
Collapse
|
232
|
Mascarenhas-Saraiva MJ, Mascarenhas-Saraiva M. Effectiveness and tolerability of linaclotide in the treatment of IBS-C in a "real-life" setting: Results from a Portuguese single-center study. Neurogastroenterol Motil 2019; 31:e13508. [PMID: 30569519 DOI: 10.1111/nmo.13508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 10/08/2018] [Accepted: 10/16/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although linaclotide has been approved to treat moderate to severe IBS-C, no data are available on its effectiveness and tolerability in patients in a real-life setting. METHODS A prospective single-center study of the effectiveness and tolerability of linaclotide was carried out on patients (n = 40) with moderate to severe IBS-C, all fulfilling the Rome IV criteria. Clinical information was recorded using a dietary questionnaire at baseline, and 3 and 6 months after initiating treatment. The end-points to measure effectiveness included abdominal pain and bloating (11-NRS), the number of bowel movements and patient satisfaction. Tolerability was assessed through the frequency of adverse events. KEY RESULTS In terms of efficacy, an improvement in abdominal pain and in the intensity of bloating was evident in the cohort after 6 months of linaclotide therapy. The proportion of patients with moderate or severe symptoms of bloating fell from 93.3% to 33.3% and those with pain from 93.4% to 20%. Weekly bowel movements also improved and accordingly, 97% of the patients were moderately or very satisfied with the treatment. At the end of the study, diarrhea was the most frequent adverse event (10%), although it was considered mild in 66.7% of these subjects and moderate in 33.3%. A lack of efficacy (n = 3) and excessive diarrhea (n = 7) were motives for discontinuing the treatment. CONCLUSIONS AND INFERENCES Linaclotide proved to be a safe and effective drug to reduce the main symptoms of IBS-C in everyday clinical practice, with an improvement comparable to that seen in clinical trials.
Collapse
|
233
|
Nybacka S, Störsrud S, Liljebo T, Le Nevé B, Törnblom H, Simrén M, Winkvist A. Within- and Between-Subject Variation in Dietary Intake of Fermentable Oligo-, Di-, Monosaccharides, and Polyols Among Patients with Irritable Bowel Syndrome. Curr Dev Nutr 2019; 3:nzy101. [PMID: 30838348 PMCID: PMC6396026 DOI: 10.1093/cdn/nzy101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/12/2018] [Accepted: 12/17/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A diet low in fermentable carbohydrates, fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) is a promising treatment option for patients with irritable bowel syndrome (IBS). In order to correctly estimate and study the intake of FODMAPs, information about within- and between-subject variations in intakes is needed, but is currently lacking. OBJECTIVES The aim was to characterize the variation in FODMAP intake among patients with IBS and to calculate how many days of observations are required to capture absolute intakes as well as to rank individuals. METHODS Food intake was recorded during 4 consecutive days, and intakes of energy and FODMAPs were calculated. The coefficient of variation within subjects (CVw), coefficient of variation between subjects (CVb), number of days required to estimate an individual's intake, and number of observations required to correctly rank individuals into quartiles of consumption were calculated. RESULTS Diet records were provided from 151 women and 46 men with IBS. The reported mean energy intake was 2039 ± 502 kcal among women and 2385 ± 573 kcal among men, and the median FODMAP intakes were 18.7 g (range 3.7-73.4) and 22.8 g (range 3.6-165.7), respectively. The ratio of CVw/CVb for total FODMAP intake was 0.83 for women and 0.67 for men, and below 1 for all FODMAPs. To capture intake of FODMAPs at the individual level, 19 d of observations are required. Ranking individuals within a group would require 2-6 d of observations. CONCLUSION There is more variation between subjects than within subjects regarding FODMAP intake. To correctly estimate an individual's absolute intake of FODMAPs, the number of days of diet records required exceeds what is reasonable for a participant to accomplish. However, ranking individuals into quartiles of FODMAP consumption can be achieved using a 4-d food record. This trial was registered at www.clinicaltrials.gov as NCT02107625 and NCT01252550.
Collapse
Affiliation(s)
- Sanna Nybacka
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stine Störsrud
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Hans Törnblom
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Simrén
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
234
|
Hitschfeld M, Tovar E, Gupta S, Bik EM, Palmer C, Hoaglin MC, Almonacid DE, Richman J, Apte ZS. The role of a sequencing-based clinical intestinal screening test in patients at high-risk for Clostridium difficile and other pathogens: a case report. J Med Case Rep 2019; 13:9. [PMID: 30642394 PMCID: PMC6332561 DOI: 10.1186/s13256-018-1919-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/07/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hospitalization and antibiotic treatment can put patients at high risk for Clostridium difficile infection, where a disturbance of the gut microbiome allows for Clostridium difficile proliferation and associated symptoms, including mild, moderate, or severe diarrhea. Clostridium difficile infection is challenging to treat, often recurrent, and leads to almost 30,000 annual deaths in the USA alone. Here we present a case where SmartGut™, an at-home, self-administered sequencing-based clinical intestinal screening test, was used to identify the presence of Clostridium difficile in a patient with worsening diarrhea. Identification of this pathogen and subsequent treatment led to a significant improvement in symptoms. CASE PRESENTATION The patient is a 29-year-old white woman with a history of severe irritable bowel syndrome with diarrhea, hemorrhoidectomy, and anal sphincterotomy complicated by a perianal fistula and perirectal abscesses that required extended courses of broad-spectrum antibiotics. In June 2016, she developed intermittent Clostridium difficile infections, which required continued antibiotic use. Months later she used an at-home, self-administered, intestinal microbial test, the first of which was negative for the presence of Clostridium difficile, but it detected the relative abundance of microbes associated with irritable bowel syndrome outside the healthy reference ranges. In the subsequent 2 months after the negative Clostridium difficile result, her gastrointestinal symptoms worsened dramatically. A second microbiome test resulted in a positive Clostridium difficile finding and continued abnormal microbial parameters, which led the treating physician to refer her to a gastroenterologist. Additional testing confirmed the presence of Clostridium difficile with a toxin-positive strain. She received treatment immediately and her gastrointestinal symptoms improved significantly over the next week. CONCLUSIONS This case report suggests that more frequent DNA testing for Clostridium difficile infections may be indicated in patients that are at high-risk for Clostridium difficile infection, especially for patients with irritable bowel syndrome, and those who undergo gastrointestinal surgery and/or an extended antibiotic treatment. This report also shows that such testing could be effectively performed using at-home, self-administered sequencing-based clinical intestinal microbial screening tests. Further research is needed to investigate whether the observations reported here extrapolate to a larger cohort of patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Zachary S. Apte
- uBiome, San Francisco, CA USA
- University of California San Francisco, San Francisco, CA USA
| |
Collapse
|
235
|
El-Ayache N, Galligan JJ. 5-HT 3 receptor signaling in serotonin transporter-knockout rats: a female sex-specific animal model of visceral hypersensitivity. Am J Physiol Gastrointest Liver Physiol 2019; 316:G132-G143. [PMID: 30359082 PMCID: PMC6383387 DOI: 10.1152/ajpgi.00131.2018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The irritable bowel syndrome (IBS) is a functional gastrointestinal motor and visceral sensation disorder that is more common in women than men. Female serotonin transporter (SERT)-gene knockout (KO) rats exhibit hypersensitivity to colorectal balloon distention (CRD) that mimics colonic hypersensitivity occurring in female IBS patients. Alosetron (5-HT3 receptor antagonist) is used to treat diarrhea-predominant IBS in female patients. Other 5-HT3 receptor antagonists are ineffective at treating IBS symptoms. The visceromotor response (VMR) to CRD in SERT-KO and wild-type (WT) rats was measured following subcutaneous (sc), intracerobroventricular (icv), or intrathecal (it) treatment with 5-HT3 receptor antagonists and an agonist. Alosetron (sc) and granisetron (antagonists) caused a paradoxical increase in the VMR to CRD in SERT-KO female rats. Alosetron (sc) increased the VMR to CRD in WT male rats. Alosetron (it) increased the VMR to CRD in SERT-KO female rats only, and the 5-HT3 receptor agonist SR-52772 increased the VMR to CRD in SERT-KO male rats. Depletion of spinal 5-HT using 5,7-dihydroxytryptamine prevented the increase in VMR to CRD in SERT-KO female and male rats treated it with alosetron and SR-52772, respectively. Alosetron (icv) did not affect the VMR to CRD in WT or KO female rats, but it increased the VMR in male SERT-KO but not WT male rats. These data suggest that 5-HT3 receptor signaling at the dorsal spinal cord mediates visceral hypersensitivity in female SERT-KO rats. Such differences could facilitate development of sex-specific drug treatments for visceral pain. NEW & NOTEWORTHY We studied a model of female sex-specific visceral hypersensitivity using rats that had a loss of function of the serotonin transporter (SERT) caused by gene truncation. Female SERT-KO rats exhibited visceral hypersensitivity in response to colorectal balloon distention. We found that increased 5-HT signaling at dorsal spine 5-HT3 receptors was responsible for visceral hypersensitivity in female but not male SERT-KO rats.
Collapse
Affiliation(s)
- Nadine El-Ayache
- 1Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan
| | - James J. Galligan
- 1Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan,2Neuroscience Program, Michigan State University, East Lansing, Michigan
| |
Collapse
|
236
|
Hasan SS, Pearson JS, morris J, Whorwell PJ. SKYPE HYPNOTHERAPY FOR IRRITABLE BOWEL SYNDROME: Effectiveness and Comparison with Face-to-Face Treatment. Int J Clin Exp Hypn 2019; 67:69-80. [PMID: 30702396 PMCID: PMC6538308 DOI: 10.1080/00207144.2019.1553766] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/03/2018] [Indexed: 12/14/2022]
Abstract
Gut-focused hypnotherapy is an effective treatment for irritable bowel syndrome but is not widely available. This study assessed whether providing hypnotherapy by Skype might partially overcome this problem. Using a 50-point or more reduction in the IBS Symptom Severity Score as the primary outcome measure, 65% of subjects responded to Skype hypnotherapy with all other outcomes significantly improving. The primary outcome figure for face-to-face hypnotherapy was 76%. When other outcome scores for Skype and face-to-face treatment were compared, the mean changes were these: symptom severity (-94.1 vs. -129.2), noncolonic score (-52.3 vs. -64.8), quality of life (+56.4 vs. +66.2), anxiety (-3.3 vs. -3.0), depression (-1.7 vs. -2.5), and a 30% or more pain reduction (44% vs. 62%). Skype hypnotherapy is effective but slightly less so than face-to-face treatment. However, many patients would have been unable to access treatment without the Skype option.
Collapse
Affiliation(s)
- Shariq S. Hasan
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester, UK
| | - James S. Pearson
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester, UK
| | - Julie morris
- Neurogastroenterology Unit, Wythenshawe Hospital, Manchester, UK
| | | |
Collapse
|
237
|
Qin L, Qin J, Yang Q, Lv X, Huang L. Efficacy and safety of pinaverium bromide combined with flupentixol-melitracen for diarrhea-type irritable bowel syndrome: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14064. [PMID: 30633208 PMCID: PMC6336559 DOI: 10.1097/md.0000000000014064] [Citation(s) in RCA: 5] [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] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There are many trials on the combination of Pinaverium bromide (PB) and Flupentixol-melitracen (FM) in the treatment of diarrhea-type irritable bowel syndrome (IBS-D), but the sample sizes are small, and the research conclusions are inconsistent. Thus, a meta-analysis was performed, aiming to evaluate the efficacy and safety of this combination therapy in patients with IBS-D. METHODS A systematic literature search was conducted in 7 databases covering the period up to July 2018 to identify randomized controlled trials (RCTs) of PB combined with FM versus PB alone for IBS-D. The primary outcome was the total symptom relief rate. The other outcomes were the adverse events rate, HAMA/SAS score, and HAMD/SDS score. The methodological quality of the RCTs was assessed independently using 6 criteria according to the Cochrane Collaboration. All data were analyzed using Review Manager 5.3. RESULTS Fifteen RCTs with 1487 participants were identified from 2005 to 2018. Compared with PB alone, 15 RCTs showed significant effects of PB plus FM in terms of improved symptom relief in patients with IBS-D (n = 1487, OR = 5.17, 95%CI, 3.79-7.07, P < .00001). Eleven RCTs reported adverse effects in both the PB plus FM and PB groups, there was no statistically significant difference in the adverse events rate between the 2 groups (n = 1207, OR = 2.91, 95%CI, 0.91-9.28, P = 0.07). Two RCTs and 3 RCTs reported HAMA and HAMD scores respectively, and 3 RCTs reported both SAS and SDS scores. After treatment, the above scores in the PB plus FM group were significantly lower than the PB group (all P < .01). However, the trials were deemed to have a medium risk of bias. CONCLUSIONS The efficacy of PB combined with FM is superior to PB alone in the treatment of IBS-D, and it is safe for clinical use. However, the conclusions still need to be verified by conducting more large-scale and high-quality RCTs.
Collapse
Affiliation(s)
- Lifeng Qin
- Department of Gastroenterology, First Affiliated Hospital of Guangxi Medical University
- Department of infectious diseases, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinmei Qin
- Department of infectious diseases, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qian Yang
- Department of infectious diseases, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaoping Lv
- Department of Gastroenterology, First Affiliated Hospital of Guangxi Medical University
| | - Liyi Huang
- Department of infectious diseases, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
238
|
Azami M, Badfar G, Abangah G, Mahmoudi L. Celiac disease in Iranian irritable bowel syndrome patients; a systematic review and meta-analysis. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2019; 12:85-97. [PMID: 31191832 PMCID: PMC6536022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/18/2018] [Indexed: 11/09/2022]
Abstract
AIM The present study was conducted to evaluate the prevalence, clinical symptoms and pathological findings of celiac disease (CD) in irritable bowel syndrome (IBS) patients in Iran. BACKGROUND Several studies show high prevalence of CD in IBS patients, but the results are contradictory. METHODS The present study was conducted based on MOOSE protocol and results were reported according to PRISMA guideline. The search was done using international online databases (Scopus, PubMed, Science Direct, Cochrane Library, Embase, and Web of Science), national databases and Google Scholar search engine. RESULTS The pooled prevalence of CD in 2,367 Iranian IBS patients was estimated to be 6.13% (95%CI: 4.11-9.05). The prevalence of CD in men and women with IBS was 4.28% (95% CI: 2.45-7.37) and 7.19% (95% CI: 4.51-11.28), respectively. The serological prevalence of anti tTG-IgA (11 studies with 2901 IBS patients) and AGA-IgG (4 studies with 936 IBS patients) was estimated to be 5.35% (95%CI: 3.60-7.89) and 6.35% (95%CI: 2.05-18.03), respectively. The clinical symptoms of CD among IBS patients included predominant diarrhea (47.87% [95%CI: 22.46-74.43]), predominant constipation (17.34% [95%CI: 9.17-30.35]), and alternative diarrhea and constipation (27.84% [95%CI: 11.57-53.23]). According to pathological findings based on marsh classification, the prevalence of CD at stages 1, 2 and 3 were 30.89% (95%CI: 13.25-56.68), 36.56% (95%CI: 21.74-54.45) and 52.87% (95%CI: 14.48-88.13), respectively. CONCLUSION In the present meta-analysis, we observed a high prevalence for CD among Iranian IBS patients, which is higher than global estimates. Examination of all IBS patients in terms of CD seems to be necessary, but cost-effectiveness should be considered.
Collapse
Affiliation(s)
- Milad Azami
- Medical Student, Student Research Committee, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Gholamreza Badfar
- Assistant Professor, Department of Pediatrics, Behbahan School of Medicine, Ahvaz jundishapour university of Medical science, Behbahan, Iran
| | - Ghobad Abangah
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Leily Mahmoudi
- Faculty of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| |
Collapse
|
239
|
Declining Rates of Referral for Irritable Bowel Syndrome Without Constipation at a Tertiary Care Center. Dig Dis Sci 2019; 64:182-188. [PMID: 30324554 DOI: 10.1007/s10620-018-5302-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/24/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common chronic disorder of the gastrointestinal tract. Several treatments have been developed, including rifaximin for the treatment of IBS without constipation (non-IBS-C), but no studies have evaluated the effect of these therapies on patient referral rates to tertiary care gastroenterology clinics. AIM To assess referral patterns for IBS patients at a tertiary motility clinic over a 10-year period. METHODS Data from consecutive patients referred to the clinic during 2006-2016 were analyzed. Trends in the proportion of referrals and prior rifaximin use in IBS-C versus non-IBS-C groups were compared. RESULTS A total of 814 adult patients were referred to a single physician panel for IBS-related symptoms. Of these, 776 were included in the study [528 females (68%), average age 45.7 ± 15.9 years), comprising 431 IBS-C (55.5%) and 345 non-IBS-C (44.5%) patients. The proportion of non-IBS-C referrals declined significantly from 53.0% in 2006 to 27.3% in 2016 (Chi-square, p < 0.0001, Cochran-Armitage trend test p = 0.0001), and the proportion of IBS-C referrals increased significantly from 46.9% in 2006 to 72.7% in 2016 (Chi-square, p < 0.0001, Cochran-Armitage trend test p = 0.0004). Non-IBS-C referrals with prior rifaximin use significantly increased from 22.7% in 2006 to 66.7% in 2016 (Cochran-Armitage trend test, p = 0.008). CONCLUSIONS The results indicate a significantly declining tertiary care referral rate for non-IBS-C over the past decade. While not directly linked, there has been an increase in rifaximin use in the same population during the same time interval.
Collapse
|
240
|
Alharbi SH, Alateeq FA, Alshammari KI, Alshammri ASS, Alabdali NAN, Alsulaiman MAS, Algothi SMI, Altoraifi AS, Almutairi MQ, Ahmed HG. Irritable Bowel Syndrome and Dietary Habits in Northern Saudi Arabia. Health (London) 2019. [DOI: 10.4236/health.2019.113025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
241
|
Dong Y, Baumeister D, Berens S, Eich W, Tesarz J. High Rates of Non-Response Across Treatment Attempts in Chronic Irritable Bowel Syndrome: Results From a Follow-Up Study in Tertiary Care. Front Psychiatry 2019; 10:714. [PMID: 31681031 PMCID: PMC6797829 DOI: 10.3389/fpsyt.2019.00714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/05/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: Despite a wealth of treatment options for irritable bowel syndrome (IBS), data on the subjective experience of treatments in ongoing clinical practice are sparse. This follow-up study assessed the individual usage of treatment modalities by IBS patients over time and investigated the patients' subjective experience of therapeutic impact. Methods: The study was conducted at the Specialty Clinic for Functional Gastrointestinal Disorders of the Heidelberg University Hospital. All patients who fulfilled the Rome III criteria for IBS and treated in our outpatient clinic between January 2012 and December 2016 were invited to the assessment. The primary outcome variables were individual usage of treatment modalities and the Patient Global Impression of Change (PGIC) with treatments. Results: Three hundred and sixty-six patients fulfilled the Rome III criteria for IBS and thus were eligible for this study. Two hundred and seven patients dropped out from the study. The study could include 159 patients (43.7 ± 17.1 years; 71.1% female). The mean time since the first visit to the clinic was 2.8 ± 1.3 years (median 3.0 years). The mean time of symptom duration was 14.1 ± 11.1 years (median 10 years). The average number of treatment attempts was 12, ranging from 2 to 39). With respect to the subjective experience of therapeutic impact, there were no significant differences in the PGIC scores among different treatments (p = 0.183). The rates of non-response rates (minimally improved, no change, or minimally worse) ranged from 63.0% to 83.9%. The PGIC score was correlated negatively with the mean number of treatment attempts (r = -0.316, p < 0.01). The mean number of treatment attempts was correlated negatively with quality of life (r = -0.262, p < 0.01). Conclusion: A multidisciplinary treatment approach of IBS is characterized by high rates of non-response and a high number of frustrating treatment attempts. The connection between the various treatment attempts and the frustrating subjective experience of therapeutic impact puts a substantial burden on IBS patients.
Collapse
Affiliation(s)
- Yuanjun Dong
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - David Baumeister
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabrina Berens
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
242
|
Cojocariu R, Ciobica A, Balmus IM, Guenne S, Trifan A, Stanciu C, Hrițcu L, Lefter R. Antioxidant Capacity and Behavioral Relevance of a Polyphenolic Extract of Chrysanthellum americanum in a Rat Model of Irritable Bowel Syndrome. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:3492767. [PMID: 31485290 PMCID: PMC6710773 DOI: 10.1155/2019/3492767] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/12/2019] [Accepted: 07/25/2019] [Indexed: 02/08/2023]
Abstract
Chrysanthellum americanum L. (Vatke) is a medicinal plant from the Compositae family used in west-African traditional medicine, known for its flavonoid and saponin richness and for its strong antioxidant potential. In the present study, we assessed the effects of Chrysanthellum americanum polyphenolic extract in the psychological stress-induced rat model of irritable bowel syndrome (IBS), a chronic functional digestive tract disorder marked by immune and inflammatory-related disturbances of central nervous and peripheral intestinal systems, which is often associated with mood disorders including depression and anxiety. Consequently, memory impairment, anxiety and depression behavioral indicators, and cerebral oxidative stress biomarker dynamics were evaluated in a multifactorial heterotypic stress-exposed IBS rats after 6-day gavage with polyphenolic C. americanum extract (100 mg/kg body weight). Y-maze, elevated plus maze, and forced swimming tests were used for assessing behavioral responses. Administration of the extract exhibited significant anxiolytic and antidepressant-like effects coupled with significantly increased temporal lobe antioxidant enzyme specific activity (superoxide dismutase and glutathione peroxidase) and decreased malondialdehyde levels, a well-known lipid peroxidation marker. Furthermore, linear regression statistical analyses showed significant correlations between the oxidative stress parameters and behavioral tests. In conclusion, our results suggest that the administration of Chrysanthellum americanum polyphenolic extract could ameliorate mood and cognitive disturbances related to stress-induced in an IBS rat model. This could be also related to cerebral oxidative stress status attenuation.
Collapse
Affiliation(s)
- Roxana Cojocariu
- 1Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, 11th Carol I Avenue, 700506 Iasi, Romania
| | - Alin Ciobica
- 2Department of Research, Faculty of Biology, Alexandru Ioan Cuza University, 11th Carol I Avenue, 700506 Iasi, Romania
| | - Ioana-Miruna Balmus
- 2Department of Research, Faculty of Biology, Alexandru Ioan Cuza University, 11th Carol I Avenue, 700506 Iasi, Romania
| | - Samson Guenne
- 3Laboratory of Applied Biochemistry and Chemistry, University Joseph KI-ZERBO, 03 BP 7021 Ouagadougou 03, Burkina Faso
| | - Anca Trifan
- 4“Grigore T. Popa” University of Medicine and Pharmacy, 16th Universitatii Street, 700115 Iasi, Romania
| | - Carol Stanciu
- 5Center of Biomedical Research, Romanian Academy, 8th Carol I Avenue, 700506 Iasi, Romania
| | - Luminita Hrițcu
- 6Faculty of Veterinary Medicine, University of Agricultural Sciencies and Veterinary Medicine “”Ion Ionescu de la Brad” of Iasi, 3rd Mihail Sadoveanu Alley, Iasi 700490, Romania
| | - Radu Lefter
- 5Center of Biomedical Research, Romanian Academy, 8th Carol I Avenue, 700506 Iasi, Romania
| |
Collapse
|
243
|
Rizzello F, Ricci C, Scandella M, Cavazza E, Giovanardi E, Valerii MC, Campieri M, Comparone A, De Fazio L, Candela M, Turroni S, Spisni E. Dietary geraniol ameliorates intestinal dysbiosis and relieves symptoms in irritable bowel syndrome patients: a pilot study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:338. [PMID: 30567535 PMCID: PMC6299992 DOI: 10.1186/s12906-018-2403-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/06/2018] [Indexed: 12/31/2022]
Abstract
Background (Trans)-3,7-Dimethyl-2,6-octadien-1-ol, commonly called geraniol (Ge-OH), is an acyclic monoterpene alcohol with well-known anti-inflammatory and antimicrobial properties. Ge-OH is a non-toxic compound classified as Generally Recognized As Safe (GRAS) by the US Food and Drug Administration and the European Food Security Agency. Methods Ge-OH was orally administered at a maximum daily dose of 8 mg kg(− 1) body weight for four weeks in a delayed release formulation capable of reaching the colon. Fecal microbiota and blood cytokines were analyzed before and after Ge-OH treatment, as well as IBS symptomatology by using Visual Analogue Scale (VAS-IBS). Results The results show that orally administered Ge-OH is a powerful modulator of the intestinal microbial ecosystem, capable of leading to increased relative abundances of Collinsella and especially Faecalibacterium, a well-known health-promoting butyrate producer consistently found to be decreased in IBS patients. Moreover, Ge-OH strongly improved the clinical symptoms of colitis by significantly reducing the score recorded by the VAS-IBS questionnaire. Clinical improvement was associated with a significant reduction in the circulating MIP-1β, a chemokine found to be increased in several IBS patients. Conclusion Ge-OH could be a powerful component for food supplement targeted to the treatment of IBS patients. Trial registration ISRCTN47041881, retrospectively registered on 19th July 2018.
Collapse
|
244
|
Wang X, Qi Q, Wang Y, Wu H, Jin X, Yao H, Jin D, Liu Y, Wang C. Gut microbiota was modulated by moxibustion stimulation in rats with irritable bowel syndrome. Chin Med 2018; 13:63. [PMID: 30574173 PMCID: PMC6299671 DOI: 10.1186/s13020-018-0220-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022] Open
Abstract
Background The pathogenesis of irritable bowel syndrome (IBS) is closely related to intestinal dysbacteriosis and can be controlled by moxibustion treatment. However, the mechanism underlying the therapeutic value of moxibustion in IBS treatment remains unknown. Methods An IBS rat model was established by colorectal distention (CRD) stimulus and mustard oil clyster. Sixty-five male rats were randomly divided into six groups: normal, IBS model, moxibustion, electroacupuncture (EA), Bifid-triple Viable Capsule (BTVC) and Pinaverium Bromide (PB) groups. The moxibustion group was treated with mild moxibustion at the bilateral Tianshu (ST25) and Shangjuxu (ST37) for 10 min/day for 7 days, the EA group was given EA at ST25 and ST37 once daily for 7 days, while the BTVC group and PB groups received Bifid-triple Viable Capsule and Pinaverium Bromide solution (at the proportion of 1:0.018) respectively by gavage once daily for 7 days. After the treatment, abdominal withdrawal reflex (AWR) scores were determined based on CRD stimulus, gut microbiota profiling was conducted by 16S rRNA high-throughput sequencing. Results Irritable bowel syndrome model rats had significantly increased AWR scores at all intensities (20, 40, 60 and 80 mmHg) compared with the normal group. Moxibustion treatment significantly reduced AWR scores compared with the IBS model group at all intensities. Across all groups the most abundant phyla were Bacteroidetes and Firmicutes followed by Proteobacteria and Candidatus Saccharibacteria. At genus level IBS model rats had a higher abundance of Prevotella, Bacteroides and Clostridium XI and a lower abundance of Lactobacillus and Clostridium XIVa compared with normal rats. These changes in microbiota profiles could however be reversed by moxibustion treatment. Alpha diversity was decreased in IBS model rats compared with normal rats, yet significantly increased in moxibustion- and PB-treated rats compared with IBS rats. Conclusion Our findings suggest that moxibustion treats IBS by modulating the gut microbiota.
Collapse
Affiliation(s)
- Xiaomei Wang
- 1Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, 650 South Wanping Road, Xuhui District, Shanghai, 200030 China.,2Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030 China
| | - Qin Qi
- 3Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437 China
| | - Yuanyuan Wang
- 3Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437 China
| | - Huangan Wu
- 1Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, 650 South Wanping Road, Xuhui District, Shanghai, 200030 China.,2Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030 China
| | - Xiaoming Jin
- 4Stark Neurosciences Research Institute & Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Huan Yao
- 5Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Duiyin Jin
- 3Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437 China
| | - Yanan Liu
- 3Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437 China
| | - Cun Wang
- 3Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437 China
| |
Collapse
|
245
|
Noorbakhsh H, Yavarmanesh M, Mortazavi SA, Adibi P, Moazzami AA. Metabolomics analysis revealed metabolic changes in patients with diarrhea-predominant irritable bowel syndrome and metabolic responses to a synbiotic yogurt intervention. Eur J Nutr 2018; 58:3109-3119. [PMID: 30392136 DOI: 10.1007/s00394-018-1855-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE Irritable bowel syndrome is a gastrointestinal disorder which can influence human metabolism. It has been demonstrated that probiotics are beneficial in controlling IBS. Thus, the main objective of the present study was to determine metabolic changes in response to diarrhea predominant irritable bowel syndrome (IBS-D) and to investigate the metabolic effects of a synbiotic intervention on serum, urine, and stool samples from IBS-D patients and healthy controls using proton nuclear magnetic resonance (1HNMR). METHODS A 1HNMR-based metabolomics study was conducted on urine and serum metabolites from 16 healthy and eight IBS-D participants at baseline and after 4 weeks of a synbiotic yogurt intervention. RESULTS At the baseline, serum acetoacetate, myo-inositol, and sarcosine concentrations were higher and threonine and methionine concentrations were lower in the IBS-D cohort than the control group. Moreover, Indoxyl-sulfate concentration of urine was lower and dimethylamine and taurine were higher in the IBS-D group. After intervention, serum concentration of ketone bodies decreased, choline, phenylalanine, and branched-chain amino acids increased in IBS-D group. Metabolomics analysis indicated a shift in one-carbon metabolism. Thus, the level of serum homocysteine was determined and found to be higher in the IBS-D cohort at baseline, and then decreased after the intervention. CONCLUSION IBS causes a shift in one-carbon metabolism and these changes can be reversed by a synbiotic intervention. An increase in the number of fecal Lactobacilli and an improvement in the health status of IBS-D patients were also observed in response to intervention.
Collapse
Affiliation(s)
- Hamid Noorbakhsh
- Department of Food Science and Technology, Collage of Agriculture, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Masoud Yavarmanesh
- Department of Food Science and Technology, Collage of Agriculture, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Seyed Ali Mortazavi
- Department of Food Science and Technology, Collage of Agriculture, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Peyman Adibi
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali A Moazzami
- Department of Molecular Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| |
Collapse
|
246
|
Cong X, Perry M, Bernier KM, Young EE, Starkweather A. Effects of Self-Management Interventions in Patients With Irritable Bowel Syndrome: Systematic Review. West J Nurs Res 2018; 40:1698-1720. [PMID: 28854852 PMCID: PMC5794643 DOI: 10.1177/0193945917727705] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Irritable bowel syndrome (IBS) is a prevalent and costly condition, with expenditures exceeding US$21 billion annually. As there is no known cure for IBS, treatment is focused on symptom self-management strategies. The purpose of this systematic review was to investigate the efficacy and overall effect of self-management interventions for patients with IBS. Of the 64 publications that were identified, 20 were included in the systematic review. Self-management interventions were found in diverse formats, including web-based, self-training booklets, individual and/or group interventions with health care providers, and cognitive-behavioral therapy or exercise-based interventions. Different symptom measures were used across the studies, whereas measurement of quality of life was more standardized. Overall, there is robust evidence supporting self-management interventions for improving short-term symptom management and improving quality of life, whereas longer term outcomes are variable. Further studies are needed to use standardized symptom measures and tailor interventions for pediatric populations, and tracking longer term outcomes.
Collapse
Affiliation(s)
- Xiaomei Cong
- 1 University of Connecticut, Storrs, CT, USA
- 2 University of Connecticut, Farmington, CT, USA
| | | | | | | | | |
Collapse
|
247
|
Yu ES, Priyadharsini S S Y, Venkatesan T. Migraine, Cyclic Vomiting Syndrome, and Other Gastrointestinal Disorders. ACTA ACUST UNITED AC 2018; 16:511-527. [PMID: 30361855 DOI: 10.1007/s11938-018-0202-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder characterized by episodic nausea and vomiting and is diagnosed using Rome IV criteria. CVS is being recognized more frequently in adults with a prevalence of 2%. It is associated with several functional disorders like autonomic dysfunction, anxiety, and depression, but the strongest association is with migraine. We will elucidate the close relationship between migraine and CVS and briefly discuss its association with other gastrointestinal disorders. RECENT FINDINGS We highlight similarities in pathophysiology, clinical presentation, and response to medications between CVS and migraine (tricyclic antidepressants, triptans, antiepileptics). We also discuss novel therapies like CGRP inhibitors which are effective in migraine and have potential for adaptation in patients with CVS. Using migraine as a template should enable investigators to elucidate the mechanisms underlying this disorder, develop novel therapies, and direct future research in CVS.
Collapse
Affiliation(s)
- Elliot S Yu
- Department of Internal Medicine, The Hub for Collaborative Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Yasodara Priyadharsini S S
- Division of Gastroenterology and Hepatology, The Hub for Collaborative Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Thangam Venkatesan
- Division of Gastroenterology and Hepatology, The Hub for Collaborative Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| |
Collapse
|
248
|
Codoñer-Franch P, Gombert M. Circadian rhythms in the pathogenesis of gastrointestinal diseases. World J Gastroenterol 2018; 24:4297-4303. [PMID: 30344415 PMCID: PMC6189841 DOI: 10.3748/wjg.v24.i38.4297] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/31/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Abstract
The etiology of digestive pathologies such as irritable bowel syndrome (IBS), inflammatory bowel diseases (IBD) and cancer is not yet fully understood. In recent years, several studies have evidenced circadian variations in mechanisms involved in digestive health. In situations of disturbed circadian rhythms (chronodisruption) where the central clock and the peripheral clocks receive incoherent signals, the synchronicity is lost producing implications for health. This lack of coordination could alter the tissue function and cause long term damage to the organs. Life habits such as sleep, physical exercise, social interaction, and feeding times are determinants for stability and integrity of circadian rhythms. In recent years, experimental and clinical studies have consistently evidenced that the alteration of circadian rhythms is associated with the development of digestive pathologies mainly linked to dismotility or changes in microbiota composition. Likewise, it seems reasonable to deep into the importance of chronodisruption as a factor that may participate in the development of pathologies such as IBS, IBD and digestive cancers. Moreover, life habits respecting circadian rhythms should be promoted for the prevention of these diseases. Further studies will allow us a better understanding of the mechanisms acting at molecular level, and the development of new therapeutic targets.
Collapse
Affiliation(s)
- Pilar Codoñer-Franch
- Department of Pediatrics, Obstetrics and Ginecology, University of Valencia, Valencia 46010, Spain
- Department of Pediatrics, Dr. Peset University Hospital, Valencia 46017, Spain
| | - Marie Gombert
- Department of Pediatrics, Obstetrics and Ginecology, University of Valencia, Valencia 46010, Spain
- Department of Biotechnology, University of La Rochelle, La Rochelle 17000, France
| |
Collapse
|
249
|
Abstract
BACKGROUND Visceral pain is a complex and heterogeneous disorder, which can range from the mild discomfort of indigestion to the agonizing pain of renal colic. Regulation of visceral pain involves the spinal cord as well as higher order brain structures. Recent findings have linked the microbiota to gastrointestinal disorders characterized by abdominal pain suggesting the ability of microbes to modulate visceral hypersensitivity and nociception to pain. MAIN BODY In this review we describe the neuroanatomical basis of visceral pain signaling and the existing evidence of its manipulation exerted by the gut microbiota. We included an updated overview of the potential therapeutic effects of dietary intervention, specifically probiotics and prebiotics, in alleviating hypersensitivity to visceral pain stimuli. CONCLUSIONS The gut microbiota dramatically impacts normal visceral pain sensation and affects the mechanisms mediating visceral nociception. Furthermore, manipulation of the gut microbiota using prebiotics and probiotics plays a potential role in the regulation of visceral pain disorders.
Collapse
Affiliation(s)
- Matteo M Pusceddu
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California Davis, One Shield Avenue, Davis, CA, USA.
| | - Melanie G Gareau
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California Davis, One Shield Avenue, Davis, CA, USA.
| |
Collapse
|
250
|
White JP, Xiong S, Malvin NP, Khoury-Hanold W, Heuckeroth RO, Stappenbeck TS, Diamond MS. Intestinal Dysmotility Syndromes following Systemic Infection by Flaviviruses. Cell 2018; 175:1198-1212.e12. [PMID: 30293866 DOI: 10.1016/j.cell.2018.08.069] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/07/2018] [Accepted: 08/29/2018] [Indexed: 02/07/2023]
Abstract
Although chronic gastrointestinal dysmotility syndromes are a common worldwide health problem, underlying causes for these disorders are poorly understood. We show that flavivirus infection of enteric neurons leads to acute neuronal injury and cell death, inflammation, bowel dilation, and slowing of intestinal transit in mice. Flavivirus-primed CD8+ T cells promote these phenotypes, as their absence diminished enteric neuron injury and intestinal transit delays, and their adoptive transfer reestablished dysmotility after flavivirus infection. Remarkably, mice surviving acute flavivirus infection developed chronic gastrointestinal dysmotility that was exacerbated by immunization with an unrelated alphavirus vaccine or exposure to a non-infectious inflammatory stimulus. This model of chronic post-infectious gastrointestinal dysmotility in mice suggests that viral infections with tropism for enteric neurons and the ensuing immune response might contribute to the development of bowel motility disorders in humans. These results suggest an opportunity for unique approaches to diagnosis and therapy of gastrointestinal dysmotility syndromes.
Collapse
Affiliation(s)
- James P White
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Shanshan Xiong
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nicole P Malvin
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - Robert O Heuckeroth
- Department of Pediatrics, the Children's Hospital of Philadelphia Research Institute, the Perelman School of Medicine at the University of Pennsylvania, Abramson Research Center, Philadelphia, PA 19104, USA
| | - Thaddeus S Stappenbeck
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Michael S Diamond
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110, USA; The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, MO 63110, USA.
| |
Collapse
|