Irritable bowel syndrome, gastro-oesophageal reflux disease and dyspepsia: overlap analysis using loglinear models. Arab J Gastroenterol. 2012;13:20-23. [PMID: 22560820 DOI: 10.1016/j.ajg.2012.02.005]

Postprandial effect of gastrointestinal hormones and gastric activity in patients with irritable bowel syndrome

Altered gut regulation, including motor and secretory mechanisms, is characteristic of irritable bowel syndrome (IBS). The severity of postprandial symptoms in IBS patients is associated with discomfort and pain; gas-related symptoms such as bloating and abdominal distension; and abnormal colonic motility. The aim of this study was to assess the postprandial response, i.e., gut peptide secretion and gastric myoelectric activity, in patients with constipation-predominant IBS. The study was conducted on 42 IBS patients (14 males, 28 females, mean age 45.1 ± 15.3 years) and 42 healthy participants (16 males, 26 females, mean age 41.1 ± 8.7 years). The study assessed plasma gut peptide levels (gastrin, CCK-Cholecystokinin, VIP-Vasoactive Intestinal Peptide, ghrelin, insulin) and gastric myoelectric activity obtained from electrogastrography (EGG) in the preprandial and postprandial period (meal-oral nutritional supplement 300 kcal/300 ml). Mean preprandial gastrin and insulin levels were significantly elevated in IBS patients compared to the control group (gastrin: 72.27 ± 26.89 vs. 12.27 ± 4.91 pg/ml; p < 0.00001 and insulin: 15.31 ± 12.92 vs. 8.04 ± 3.21 IU/ml; p = 0.0001), while VIP and ghrelin levels were decreased in IBS patients (VIP: 6.69 ± 4.68 vs. 27.26 ± 21.51 ng/ml; p = 0.0001 and ghrelin: 176.01 ± 88.47 vs. 250.24 ± 84.55 pg/ml; p < 0.0001). A nonsignificant change in the CCK level was observed. IBS patients showed significant changes in postprandial hormone levels compared to the preprandial state-specifically, there were increases in gastrin (p = 0.000), CCK (p < 0.0001), VIP (p < 0.0001), ghrelin (p = 0.000) and insulin (p < 0.0001). Patients with IBS showed reduced preprandial and postprandial normogastria (59.8 ± 22.0 vs. 66.3 ± 20.2%) compared to control values (83.19 ± 16.7%; p < 0.0001 vs. 86.1 ± 9.4%; p < 0.0001). In response to the meal, we did not observe an increase in the percentage of normogastria or the average percentage slow-wave coupling (APSWC) in IBS patients. The postprandial to preprandial power ratio (PR) indicates alterations in gastric contractions; in controls, PR = 2.7, whereas in IBS patients, PR = 1.7, which was significantly lower (p = 0.00009). This ratio reflects a decrease in gastric contractility. Disturbances in the postprandial concentration of gut peptides (gastrin, insulin and ghrelin) in plasma may contribute to abnormal gastric function and consequently intestinal motility, which are manifested in the intensification of clinical symptoms, such as visceral hypersensitivity or irregular bowel movements in IBS patients.

Gastroesophageal reflux disease incidence among male patients with irritable bowel syndrome: A single-center cross-sectional study in southern Iran

Background and Aim

Gastrointestinal reflux disease (GERD) and irritable bowel syndrome (IBS) are among the most common gastrointestinal disorders in which the overlap of these diseases and their syndromes has been frequently reported. In this study, we aimed to evaluate GERD incidence among IBS patients and the related risk factors.

Methods

Male patients aged 18-60 years with an impression of IBS and referred to the gastrointestinal clinic from March 2019 to 2020 in Shiraz, Iran, were included in this study.

Results

Among the 163 enrolled patients with an average age of 31.53 ± 9.38 years, 64 (39.3%) were diagnosed with GERD. Based on statistical analysis, there was a significant association between GERD and the IBS patients' age (P = 0.006), smoking (P = 0.011), and alcohol consumption (P = 0.043). Also, GERD among IBS patients was significantly associated with the type of IBS (P < 0.001), with IBS-D having the lowest incidence (19.4%) and IBS-M the highest incidence of GERD (66.7%). Based on multivariate analysis, smoking had a reverse and significant correlation with lower incidence of GERD (OR = -1.364; P = 0.002).

Conclusion

Our results demonstrate that among male IBS patients, younger age, smoking, and alcohol consumption were among the risk factors for GERD. These findings may provide further insight into the best approach to treating these diseases.

Gastroesophageal reflux disease, functional dyspepsia and irritable bowel syndrome: common overlapping gastrointestinal disorders

Several studies have indicated an overlap between gastroesophageal reflux disease (GERD) and various functional gastrointestinal disorders (FGIDs). The overlapping conditions reported have mainly been functional dyspepsia (FD) and irritable bowel syndrome (IBS). The available literature is frequently based on symptomatic questionnaires or endoscopic procedures to diagnose GERD. Rarely, among patients with heartburn, pathophysiological evaluations have been considered to differentiate those with proven GERD from those without. Moreover, both GERD and IBS or FD showed enormous heterogeneity in terms of the criteria and diagnostic procedures used. The GERD-IBS overlap ranges from 3-79% in questionnaire-based studies and from 10-74% when GERD has been diagnosed endoscopically. The prevalence of functional dyspepsia (after normal upper endoscopy) is 12-15% and an overlap with GERD has been reported frequently. Only a few studies have considered a potential overlap between functional heartburn (FH) and IBS using a 24-h pH-metry or impedance-pH evaluation. Similar data has been reported for an overlap between FH and FD. Recently, a revision of the Rome criteria for esophageal FGIDs identified both FH and hypersensitive esophagus (HE) as potential functional esophageal disorders. This might increase the potential overlap between different FGIDs, with FH and HE rather than with GERD. The aim of the present review article was to appraise and discuss the current evidence supporting the possible concomitance of GERD with IBS and FD in the same patients and to evaluate how various GERD treatments could impact on the quality of life of these patients.

Quantitation of Colonic Cells as Severity Markers in Patients with Irritable Bowel Syndrome

Background:

Irritable bowel syndrome (IBS) is the most common gastrointestinal syndrome. Routine histopathology and immunohistochemistry (IHC) evaluations have shown an increase in the number of different inflammatory cells in the colon of IBS patients. In this study, we have compared the number of intraepithelial lymphocytes (IELs), eosinophils, mast cells and CD3+ T cells, in IBS patients and normal subjects.

Materials and Methods:

In 2016, seventynine patients with IBS and seventy-nine healthy subjects who underwent colonoscopy for other non-specific causes and with no pathologic findings, were enrolled in this cross-sectional study. Biopsy specimens obtained from the colon were stained, using IHC methods to determine the number of IELs, eosinophils, mast cells and CD3+ T cells. Quantitative and qualitative variables were compared between the two groups, using a Chi-square test and Student’s t-test.

Results:

Seventy-nine patients with IBS, 79.7% females with a mean age of 42.5±14.6 years, were recruited, as the case group, and seventy-nine individuals, 51.9% females with a mean age of 39.7±18.9 years, were enrolled as controls. The average number of IELs per high power fields (hpf) was found to be higher in the IBS group, and this difference was statistically significant (32.8±11.8 vs. 28.6±12.9; P=0.034). Also, the mean count/hpf of CD3+ T lymphocytes (23.1±7.9 vs. 20.2±8.1; P=0.024) and mast cells (7.6±3.1 vs. 6.6±3.0; P=0.041) were significantly higher in the IBS group, compared to the control group. The number of eosinophils was higher in the IBS group, but the differences were not statistically significant (P=0.066).

Conclusion:

According to the results, we suggest that analysis of immune cells and IELs in intestinal biopsies might be an appropriate method for diagnosis of IBS.

Gastrointestinal symptoms associated with gastroesophageal reflux disease, and their relapses after treatment with proton pump inhibitors: A systematic review

Gastroesophageal reflux disease (GERD) is a common functional gastrointestinal disorder with significant effects on the quality of life. The burden of GERD is soaring in Asia. Preventing symptom relapse is a therapeutic goal in GERD patients. Since proton pump inhibitors (PPI) are the first-line treatment of GERD, drug failure has become a major problem in the treatment procedure. We reviewed the literature in order to find articles related to comorbidities and symptoms affecting GERD from 1980 to 2015 via PubMed and Google Scholar using keywords such as ‘Gastroesophageal reflux disease’, ‘Gastrointestinal symptoms’ and Boolean operators (such as AND, OR, NOT). Due to the cost of PPI therapy and the high rate of GERD relapse after PPI therapy, demand for continuing this type of treatment is decreasing. Thus, we need to discover new approaches to treat the disease and also investigate the relationship between the treatment of GERD and its comorbidities and symptoms such as functional constipation.

Reduction in duodenal endocrine cells in irritable bowel syndrome is associated with stem cell abnormalities

AIM: To determine whether the decreased density of duodenal endocrine cells in irritable bowel syndrome (IBS) is associated with abnormalities in stem cell differentiation.

METHODS: The study sample comprised 203 patients with IBS (180 females and 23 males with a mean age of 36 years) and a control group of 86 healthy subjects without gastrointestinal complaints (77 females and 9 males with a mean age of 38 years). The patients included 80 with mostly diarrhoea (IBS-D), 47 with both diarrhoea and constipation (IBS-M), and 76 with mostly constipation (IBS-C). Both the patients and controls underwent gastroscopy and four biopsy samples were taken from the descending part of the duodenum, proximal to the papilla of Vater. The biopsy samples were sectioned and immunostained for Musashi 1 (Msi-1), neurogenin 3 (NEUROG3), secretin, cholecystokinin (CCK), gastric inhibitory peptide (GIP), somatostatin and serotonin. Immunostaining was performed with an ultraView Universal DAB Detection Kit (v1.02.0018, Venata Medical Systems, Basal, Switzerland) using the BenchMark Ultra immunohistochemistry/in situ hybridization staining module (Venata Medical Systems). Endocrine cell densities were quantified by computerized image analysis using the Olympus cellSens imaging program.

RESULTS: The densities of Msi-1 and NEUROG3 cells were significantly lower in IBS patients, regardless of the subtype, than in the controls (77 ± 17 vs 8 ± 2; P = 0.0001, and 351 ± 33 vs 103 ± 22; P = 0.00002, respectively). Furthermore, the densities of secretin, and CCK cells were significantly lower in patients with diarrhoea as the predominant IBS symptom (IBS-D) than in the controls (161 ± 11 vs 88 ± 8; P = 0.00007, and 325 ± 41 vs 118 ± 10; P = 0.00006, respectively), but not in patients with constipation as the predominant IBS symptom (IBS-C) or those with both diarrhoea and constipation (IBS-M). The GIP cell density was significantly reduced in both IBS-D (152 ± 12 vs 82 ± 7; P = 0.00003), and IBS-C (152 ± 12 vs 107 ± 8; P = 0.01), but not in IBS-M. The densities of somatostatin cells in the controls and the IBS-total, IBS-D, IBS-M and IBS-C patients were 81 ± 8, 28 ± 3, 20 ± 4, 37 ± 5 and 28 ± 4 cells/mm² epithelium, respectively. The density of somatostatin cells was lower in IBS-total, IBS-D, IBS-M and IBS-C patients than in the controls (P = 0.00009, 0.00006, 0.009 and 0.00008, respectively). The density of serotonin cells did not differ between IBS patients and controls.

CONCLUSION: The reduction in duodenal endocrine cells in IBS patients found in this study is probably attributable to the reduction in cells expressing Msi-1 and NEUROG3.

Overlap of gastroesophageal reflux disease and functional bowel disorders in the general Chinese rural population

OBJECTIVE

This study aimed to investigate the prevalence of the overlap between gastroesophageal reflux disease (GERD) and functional bowel disorders (FBD) in the general population in rural areas in China.

METHODS

A population-based cross-sectional study was conducted in six villages in Nanmazhuang area in Lankao County (Henan Province, China) from December 2010 to October 2011. The GERD questionnaire (GerdQ) and Rome III criteria were used for the diagnosis of GERD and FBD and to determine the prevalence of GERD-FBD overlap.

RESULTS

The response rate to the questionnaires of the patients was 91.5%. In all, 2950 of 3700 residents with a mean age of 42.4 ± 16.8 years were included. Among them, 4.8% were diagnosed with GERD and 4.6% with FBD. The proportion of respondents with FBD was significantly higher in the GERD group than that in the non-GERD group (25.53% vs 3.60%, P < 0.05). The prevalence of GERD in the FBD group was significantly higher than that in the non-FBD group (26.28% vs 3.73%, P < 0.05). The prevalence of GERD-FBD overlap in the general rural population was 1.22%. Logistic regression analysis indicated that anxiety was an independent predictor for the GERD-FBD overlap in GERD and FBD (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.09 and OR 1.06, 95% CI 1.02-1.10, respectively).

CONCLUSION

GERD-FBD overlap is more common than expected by chance in the general rural population, and anxiety is significantly related to the overlap.

The spectra, symptom profiles and overlap of Rome III functional gastrointestinal disorders in a tertiary center in South China

OBJECTIVE

Most previous studies exploring the overlap of functional gastrointestinal disorders (FGID) focus on the overlap between functional dyspepsia (FD) and irritable bowel syndrome (IBS). In this study, we aimed to explore the spectra, symptom profiles and overlap of all FGID using the validated Chinese version of the Rome III questionnaire.

METHODS

Consecutive newly diagnosed FGID patients who were admitted to the Outpatient Gastroenterology Clinic from 10 May to 10 September 2012 were recruited in the study. All the patients complained of gastrointestinal (GI) symptoms for at least 3 months with a symptom onset of at least 6 months before diagnosis after excluded organic diseases. Patients who met the inclusion criteria were asked to complete the scoring algorithm for the Rome III integrated questionnaire.

RESULTS

Among 350 eligible patients, 302 (86.3%) returned completed questionnaires. A total of six major domains including 17 disorders were diagnosed. The four most prevalent FGID were FD (54.6%), IBS (40.7%), unspecified functional bowel disorder (13.9%) and functional constipation (12.6%). The three most prevalent symptoms in FGID were abdominal pain (66.2%), loose stool (58.3%) and abdominal bloating/distension (56.3%). Of the 302 patients, 152 (50.3%) had one to five overlapping FGID. Only functional bloating had no overlap. Six patients had five overlapping FGID simultaneously. In all, 63 patients had overlapping FD and IBS.

CONCLUSIONS

This study provided the detailed spectra and symptom profiles for all FGID. Overlapping FGID are common in China.

Stomach antral endocrine cells in patients with irritable bowel syndrome

To the best of our knowledge, stomach antral endocrine cells have not previously been investigated in patients with irritable bowel syndrome (IBS). Thus, in the present study, 76 patients with IBS were examined (designated as IBS-total). Diarrhoea was the predominant symptom in 26 of these patients (IBS-D), while in 21 patients, the predominant symptoms were both diarrhoea and constipation (IBS-M) and in 29 patients the predominant symptom was constipation (IBS-C). Forty-three healthy subjects were enrolled as the controls. Stomach antral biopsy samples obtained from all of the subjects were immunostained using the avidin-biotin-complex method for serotonin, gastrin, somatostatin and serotonin transporter (SERT). The immunopositive cell densities and immunoreactivity intensities were determined by computer-aided image analysis. The density of the serotonin-immunoreactive cells was significantly decreased in the IBS-M patients and increased in the IBS-C patients relative to the controls. The immunoreactivity intensity did not differ significantly between the controls and IBS-total. The density of the gastrin-immunoreactive cells was significantly greater in the IBS-D, IBS-M and IBS-C patients than in the controls. The immunoreactivity intensity of gastrin was significantly greater in the IBS-D patients than in the controls. The density of the somatostatin-immunoreactive cells cells was significantly lower in the IBS-total, IBS-D, IBS-M and IBS-C patients than in the controls. The immunoreactivity intensities of both somatostatin and SERT did not differ significantly between the controls and IBS-total. The increase in gastrin cell density and the decrease in somatostatin cell density in all IBS subtypes may cause high levels of gastric secretion, which may in turn contribute to the high incidence of dyspepsia and gastro-oesophageal reflux observed in patients with IBS.

Comparison of light and electron microscopy in measurement of esophageal intercellular space in children

OBJECTIVES

A good objective marker of esophageal mucosal damage from gastroesophageal reflux disease (GERD) is lacking in children. Increased esophageal epithelial intercellular (EEIC) space measured using electron microscopy (EM) has been proposed as a surrogate of esophageal mucosal damage in adults with GERD. The aim of the present study was to compare EEIC space measured using EM and light microscopy (LM) in children with nonerosive reflux disease (NERD) with asymptomatic controls.

METHODS

Distal esophageal mucosal biopsy was used to measure EEIC space using EM in 35 NERD subjects and 8 controls. In a subset of these patients we used phase contrast LM to measure EEIC space area (26 NERD subjects and 8 controls).

RESULTS

The median (range) EEIC space measured using EM in the NERD group was 1.15 (0.74-1.64) μm compared with 0.93 (0.67-1.11) μm in the control group (P = 0.002). The median (range) EEIC space measured using LM was 14.4% (9.6%-26.3%) in the NERD group and 9.6% (8.5%-17.2%) in controls (P = 0.003). Using a cutoff value of 1.02 μm for normal EEIC space measured by EM, we obtained 73% sensitivity and 75% specificity to distinguish the NERD group from the control group, and using a cutoff value of 11.1% for EEIC space measured by LM, we obtained 96% sensitivity and 75% specificity.

CONCLUSIONS

EEIC space is increased in children with NERD compared with that in controls, suggesting that changes in EEIC space can be a useful marker of esophageal mucosal injury in children with NERD. Our results suggest that the accuracy of EM and LM to evaluate EEIC space changes in NERD is comparable, and LM may be a more cost-effective option.