Irritable bowel syndrome

Frequency of small intestinal bacterial overgrowth in patients with irritable bowel syndrome and chronic non-specific diarrhea

INTRODUCTION

Small intestinal bacterial overgrowth (SIBO) occurs in varying frequency in irritable bowel syndrome (IBS). We studied the frequency of SIBO in IBS and chronic non-specific diarrhea (CNSD).

METHODS

129 patients with IBS (Manning's criteria), 73 with CNSD (>/= 4 weeks diarrhea with two of these tests normal [urine D-xylose, fecal fat and duodenal biopsy]) and 51 healthy controls (HC) were evaluated for SIBO using glucose hydrogen breath test (GHBT). Diarrhea-predominant IBS (D-IBS) was grouped into CNSD. Rise in breath hydrogen 12 ppm above basal following 100 g glucose was diagnostic of SIBO.

RESULTS

Of 129 patients with IBS, 7 were constipation (C-IBS), and 122 were of indeterminate type (I-IBS). Patients with IBS were younger than HC and CNSD (IBS vs. HC: 36.6 yr +/- 11.4 vs. 44.1 yr +/- 13.6, p = 0.001; IBS vs. CNSD: 36.6 yr +/- 11.4 vs. 42 yr +/- 14.5, p = 0.003). Patients with CNSD were comparable to HC in age (42 yr +/- 14.5 vs. 44.1 yr +/- 13.6, p = ns). Patients with IBS were more often male than HC [108/129 (83.7%) vs. 34/51 (66.7%) p = 0.02]; gender of CNSD and HC was comparable [male 39/73 (53.4%) vs. 34/51 (66.7%) p = ns]. SIBO was commoner in CNSD than HC [16 (21.9%) vs. 1 (2%), p = 0.003], but was comparable in IBS and HC [11 (8.5%) vs. 1 (2%), p = 0.18]. Patients with CNSD more often had SIBO than IBS [16 (21.9%) vs. 11 (8.5%), p = 0.007].

CONCLUSIONS

SIBO was more common in CNSD including D-IBS than other types of IBS and HC.

Patients with irritable bowel syndrome in primary care appear not to be heavy healthcare utilizers

BACKGROUND

Irritable bowel syndrome is a frequently diagnosed gastrointestinal condition in general practice. Managing this chronic condition requires a co-ordinated effort between patient and doctor.

AIM

To explore the patterns of treatment and healthcare utilization of irritable bowel syndrome cases in a Swedish primary care setting.

METHODS

All cases with a registered diagnosis of irritable bowel syndrome were identified retrospectively for a 5-year period through computerized medical records at three primary healthcare centres in Sweden. Documentation of diagnosis, healthcare visits, treatments, investigations, medications, referrals, laboratory tests, mental and demographic data were retrieved from the records.

RESULTS

Of all 723 irritable bowel syndrome patients identified, only 37% had a follow-up appointment to their General Practitioner during the study period. For 80%, the General Practitioner initiated some treatment during the initial consultation and 75% were prescribed medication. Fibre and bulking laxatives and acid-suppressive drugs were the most common medication. Almost a quarter was referred for complementary investigations at hospital, only 8.9% of the irritable bowel syndrome patients were referred to a specialist investigation. Laboratory investigations varied and were ordered more frequently (P = 0.05) for men.

CONCLUSIONS

Irritable bowel syndrome patients appear not to be heavy utilizers of primary care and, of those who attend, the majority are managed by their General Practitioner.

Performance of the EQ-5D in patients with irritable bowel syndrome

OBJECTIVE

The EQ-5D is a standardized, nondisease-specific instrument for evaluating patients' preference-based valuations of health-related quality of life (HRQoL). This study's purpose was to determine the psychometric properties of EQ-5D in patients with irritable bowel syndrome (IBS).

METHODS

Data from four European IBS studies were assessed: UK (n = 161 and n = 297), Spain (n = 503), and Germany (n = 100). The EQ-5D is a five-item health state descriptive system used to develop health states (EQ-5D(INDEX)) and a visual analog scale (VAS) (0-100 from worst to best imaginable health state, EQ-5D(VAS)). Measures used with the EQ-5D included the SF-36, Irritable Bowel Syndrome--Quality of Life (IBS-QOL), and both subjective and clinical global assessments of IBS. Convergent validity was assessed using SF-36 and IBS-QOL data, discriminant validity using global ratings of IBS severity, and responsiveness by subjective and physician assessment of condition.

RESULTS

Moderate-to-high associations (r >or= 0.33) were seen between the EQ-5D(VAS) and the SF-36 and IBS-QOL subscales. Mean response scores to EQ-5D(INDEX) dimensions and the EQ-5D(VAS) score were significantly better for control patients than for patients with IBS (all P < 0.01). The EQ-5D(VAS) was able to discriminate between levels of pain severity (quartiles, P < 0.001; mild/moderate/severe, P < 0.05) and general health severity (mild/moderate/severe, P < 0.001). The EQ-5D(VAS) and the EQ-5D(INDEX) were responsive in patients using both a self-perceived (Subject's Global Assessment) and physician-rated (Clinic Global Assessment) improvement.

CONCLUSIONS

The EQ-5D performs well in comparison to general and disease-specific outcomes. It is a valid and responsive measure that can be used to generate preference-based valuations of HRQoL in patients with IBS and useful for comparisons in clinical and cost-effectiveness studies.

Ultrasound examination of the sigmoid colon: possible new diagnostic tool for irritable bowel syndrome

OBJECTIVE

Irritable bowel syndrome (IBS) affects about 10% of the population, and is primarily a disease of women. It may cause chronic pelvic pain. As yet there is no imaging test to aid in diagnosis, which relies upon history. We aimed to determine whether transvaginal sonographic investigation of the sigmoid colon could aid in the diagnosis of IBS.

METHOD

Transvaginal ultrasound was used in 175 female patients undergoing pelvic ultrasound studies for a variety of reasons, none specifically for bowel complaints. We measured the wall of the sigmoid colon and then obtained the history of positive or negative for IBS.

RESULTS

The majority of those 27 reporting a history of IBS had thickening of the wall of the sigmoid colon. A cut-off of 3.0 mm gave a sensitivity for this group of patients of 70%, specificity of 95%, positive predictive value of 73% and negative predictive value of 95%.

CONCLUSION

Transvaginal ultrasound may be useful in identifying patients at risk for IBS. Consideration of colon wall measurement during pelvic ultrasound should be studied, as IBS may be a cause of chronic pelvic pain.

Rationale for using serotonergic agents to treat irritable bowel syndrome

PURPOSE

The role of serotonin in gastrointestinal (GI)-tract functioning, the pharmacologic rationale for using serotonergic agents in the treatment of irritable bowel syndrome (IBS), and clinical experience with novel serotonergic agents are described.

SUMMARY

IBS is a common multisymptom disorder that is associated with a high socioeconomic burden. The goal of treatment is to provide rapid and sustained global relief of the multiple symptoms of IBS with a single, effective, well-tolerated agent. Traditional treatment options target single symptoms, and many patients are dissatisfied with the level of relief achieved and adverse effects. Research has revealed that serotonin is involved in three major actions in the gut: (1) mediating intestinal motility, (2) mediating intestinal secretion in the GI tract, and (3) modulating perception in the bowels. Serotonin is also a vital link in the brain-gut axis. Alterations in key elements of serotonin signaling have been demonstrated in patients with IBS. Tegaserod, a selective serotonin type 4 (5-HT(4))-receptor partial agonist, is indicated for use in women with IBS whose primary bowel symptom is constipation. Alosetron, a 5-HT(3)-receptor antagonist, is indicated for use in women with severe diarrhea-predominant IBS in whom traditional therapies have failed. The clinical usefulness of several other serotonergic agents for IBS is being investigated.

CONCLUSION

The use of serotonergic agents in patients with IBS is based on the critical role that serotonin plays in the maintenance of normal gut function and brain-gut communication. Pharmacologic therapies targeting specific serotonin receptors represent an important step in the management of IBS.

Epidemiological features of irritable bowel syndrome in a Turkish urban society

BACKGROUND AND AIM

Irritable bowel syndrome (IBS) is a widespread functional bowel disorder and its prevalence in Western societies ranges from 3-20%. The present study aimed to determine the prevalence of IBS in eastern Turkey, particularly in urban parts of Elazig where 250 000 people live.

METHODS

Of the 18 primary care centers, four were randomly selected for this study. All individuals (aged >17 years) living around the service area of these health centers were included. A total of 1900 subjects were randomly selected using the personal health records from the primary care centers. The total number of subjects that could be contacted was 1766. A questionnaire with multiple choice questions was applied to the subjects by medical students using the face-to-face technique. Prevalence of IBS and distribution of symptoms were evaluated by the Rome II criteria.

RESULTS

Of the 1766 subjects, 45.4% were male and 54.6% were female. Prevalence of IBS was 5% in males, 7.4% in females and 6.3% overall. The percentage of subjects with IBS in the 17-30 years age group was 26.2%; 52.3% in the 30-50 years age group and 21.6% in the above 50 years age group. Prevalence of IBS was highest (10.2%) in persons who were illiterate and lowest (3.0%) in university graduates. A positive correlation was determined between low economical status and prevalence of IBS (P < 0.05).

CONCLUSION

Although IBS is widely present in Turkey, its prevalence is lower than that reported in Western communities. In the region where this study was carried out, IBS was more prevalent in females and in individuals with low educational and economical status.