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Chen F, Tan N, Chen S, Zhuang Q, Zhang M, Xiao Y. The Disease Spectrum and Natural History of Patients With Abdominal Bloating or Distension: A Longitudinal Study. J Neurogastroenterol Motil 2024; 30:64-72. [PMID: 38173159 PMCID: PMC10774809 DOI: 10.5056/jnm22197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/23/2023] [Accepted: 03/26/2023] [Indexed: 01/05/2024] Open
Abstract
Background/Aims Abdominal bloating or distension (AB/D) is a common complaint in the outpatient of gastroenterology department. Since the potential contributors are numerous and complex, a longitudinal study on the disease spectrum and natural history of patients was performed to better understand the key factors of AB/D. Methods Consecutive patients with the chief complaint of AB/D referred to the outpatient clinic were screened. Functional gastrointestinal disorders (FGIDs) were diagnosed according to Rome IV criteria. A 3-year follow-up was performed to seek for the changes in symptoms as well as disease spectrum. Results A total of 261 participants were enrolled and 139 completed the follow-up. Most patients suffered from moderate to severe symptoms more than 1 day per week. Common causes of AB/D were FGIDs (51.7%) and organic diseases (17.2%). The latter group was older with lower body mass index (BMI). Functional dyspepsia was the most common type of FGIDs in AB/D. The symptoms of 18.0% of participants failed to improve at the end of the 3-year follow-up, and those diagnosed with FGIDs were most likely to continue to suffer. Abdominal pain was a positive predictive factor for good prognosis in the FGIDs group. Besides, only 22.7% of participants had a consistent diagnosis of FGIDs during follow-up. Conclusions FGIDs are the most common diagnosis in patients with AB/D. Symptoms were especially hard to be improved. Classification diagnoses of FGIDs in AB/D patients fluctuated significantly over time.
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Affiliation(s)
- Fangfei Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Niandi Tan
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Songfeng Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qianjun Zhuang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mengyu Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yinglian Xiao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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2
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Zhao C, Zhou X, Shi X. The influence of Nav1.9 channels on intestinal hyperpathia and dysmotility. Channels (Austin) 2023; 17:2212350. [PMID: 37186898 DOI: 10.1080/19336950.2023.2212350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
The Nav1.9 channel is a voltage-gated sodium channel. It plays a vital role in the generation of pain and the formation of neuronal hyperexcitability after inflammation. It is highly expressed in small diameter neurons of dorsal root ganglions and Dogiel II neurons in enteric nervous system. The small diameter neurons in dorsal root ganglions are the primary sensory neurons of pain conduction. Nav1.9 channels also participate in regulating intestinal motility. Functional enhancements of Nav1.9 channels to a certain extent lead to hyperexcitability of small diameter dorsal root ganglion neurons. The hyperexcitability of the neurons can cause visceral hyperalgesia. Intestinofugal afferent neurons and intrinsic primary afferent neurons in enteric nervous system belong to Dogiel type II neurons. Their excitability can also be regulated by Nav1.9 channels. The hyperexcitability of intestinofugal afferent neurons abnormally activate entero-enteric inhibitory reflexes. The hyperexcitability of intrinsic primary afferent neurons disturb peristaltic waves by abnormally activating peristaltic reflexes. This review discusses the role of Nav1.9 channels in intestinal hyperpathia and dysmotility.
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Affiliation(s)
- Chenyu Zhao
- Department of Gastroenterology, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Gastroenterology, The Second Xiangya Hospital, Central South University, Changsha, China
- Department of Medical Genetics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xi Zhou
- The National & Local Joint Engineering Laboratory of Animal Peptide Drug Development, College of Life Sciences, Hunan Normal University, Changsha, Hunan, China
| | - Xiaoliu Shi
- Department of Medical Genetics, The Second Xiangya Hospital, Central South University, Changsha, China
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3
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Banibakhsh A, Sidhu D, Khan S, Haime H, Foster PA. Sex steroid metabolism and action in colon health and disease. J Steroid Biochem Mol Biol 2023; 233:106371. [PMID: 37516405 DOI: 10.1016/j.jsbmb.2023.106371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 07/31/2023]
Abstract
The colon is the largest hormonally active tissue in the human body. It has been known for over a hundred years that various hormones and bioactive peptides play important roles in colon function. More recently there is a growing interest in the role the sex steroids, oestrogens and androgens, may play in both normal colon physiology and colon pathophysiology. In this review, we examine the potential role oestrogens and androgens play in the colon. The metabolism and subsequent action of sex steroids in colonic tissue is discussed and how these hormones impact colon motility is investigated. Furthermore, we also determine how oestrogens and androgens influence colorectal cancer incidence and development and highlight potential new therapeutic targets for this malignancy. This review also examines how sex steroids potentially impact the severity and progression of other colon disease, such as diverticulitis, irritable bowel syndrome, and polyp formation.
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Affiliation(s)
- Afnan Banibakhsh
- Institute of Metabolism and Systems Research, Centre for Endocrinology, Diabetes, and Metabolism, University of Birmingham, Birmingham B15 2TT, UK
| | - Daljit Sidhu
- Institute of Metabolism and Systems Research, Centre for Endocrinology, Diabetes, and Metabolism, University of Birmingham, Birmingham B15 2TT, UK
| | - Sunera Khan
- Institute of Metabolism and Systems Research, Centre for Endocrinology, Diabetes, and Metabolism, University of Birmingham, Birmingham B15 2TT, UK
| | - Hope Haime
- Institute of Metabolism and Systems Research, Centre for Endocrinology, Diabetes, and Metabolism, University of Birmingham, Birmingham B15 2TT, UK
| | - Paul A Foster
- Institute of Metabolism and Systems Research, Centre for Endocrinology, Diabetes, and Metabolism, University of Birmingham, Birmingham B15 2TT, UK; Centre for Endocrinology, Diabetes, and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK.
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4
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Lu J, Chen Y, Shi L, Li X, Fei G, Li J, Yang A, Fang X. Cognition of abdominal pain and abdominal discomfort in Chinese patients with irritable bowel syndrome with diarrhea. Biopsychosoc Med 2023; 17:31. [PMID: 37684670 PMCID: PMC10486005 DOI: 10.1186/s13030-023-00286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 07/28/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND In Asia, the proportion of patients with irritable bowel syndrome (IBS) with abdominal discomfort alone is significantly higher than that in western countries. The purposes of this study are to understand the cognition of abdominal pain and abdominal discomfort in Chinese patients with IBS and to compare the clinical characteristics of patients with abdominal pain alone and with abdominal discomfort alone. METHODS Patients with IBS with diarrhea (IBS-D) who met the Rome III diagnostic criteria and had episodes of at least one day/week were consecutively enrolled. The cognition of abdominal pain and abdominal discomfort were investigated through face-to-face unstructured interview. Patients were divided into a pain group and a discomfort group according to the cognition interviews, then the characteristics and severity of symptoms (IBS symptom severity scale, IBS-SSS), IBS quality of life (IBS-QOL) and psychological state were compared between groups. RESULTS A total of 88 patients with IBS-D were enrolled. Most of the patients with self-reported abdominal pain described their pain as spasm/cramping; patients with self-reported abdominal discomfort had as many as 24 different descriptions of discomfort. Most patients having abdominal pain and discomfort could accurately distinguish the two symptoms. The degree of abdominal pain in the pain group was higher than abdominal discomfort in the discomfort group (P = 0.002). There was no significant difference in IBS-SSS, extra-intestinal pain, IBS-QOL, and psychological state between the two groups. CONCLUSIONS For Chinese patients with IBS-D, abdominal pain and abdominal discomfort are two different symptoms, but they have similar clinical features. TRIAL REGISTRATION ChiCTR, ChiCTR1900028082. Registered 11 December 2019 - Retrospectively registered, http://www.chictr.org.cn .
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Affiliation(s)
- Jia Lu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
- Department of Gastroenterology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan University, Zhengzhou, Henan, China
| | - Yang Chen
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Lili Shi
- Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoqing Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Guijun Fei
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Ji Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Aiming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Xiucai Fang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1# Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
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Sun S, Chen J, Li H, Lou Y, Chen L, Lv B. Patients' perspectives on irritable bowel syndrome: a qualitative analysis based on social media in China. Qual Life Res 2023; 32:2561-2571. [PMID: 37093542 PMCID: PMC10123591 DOI: 10.1007/s11136-023-03417-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
AIM To explore the perspectives, experience, and concerns of patients with irritable bowel syndrome (IBS) in China. METHODS We used data mining to investigate posts shared in Baidu Tieba concerned with IBS; we collected the data through the crawler code, and mined the cleaned data's themes based on Latent Dirichlet allocation (LDA) and the Grounded theory. RESULTS We found 5746 network posts related to IBS. LDA analysis generated 20 topics, and grounded theory analysis established eight topics. Combining the two methods, we finally arranged the topics according to five concepts: difficulty in obtaining disease information; serious psychosocial problems; dissatisfied with the treatment; lack of social support; and low quality of life. CONCLUSION Social media research improved patient-centric understanding of patients' experiences and perceptions. Our study may facilitate doctor-patient communication and assist in the formulation of medical policies.
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Affiliation(s)
- Shaopeng Sun
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiajia Chen
- Department of Anesthesiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Heng Li
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yijie Lou
- The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lixia Chen
- Nursing College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Bin Lv
- Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China.
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Huang KY, Wang FY, Lv M, Ma XX, Tang XD, Lv L. Irritable bowel syndrome: Epidemiology, overlap disorders, pathophysiology and treatment. World J Gastroenterol 2023; 29:4120-4135. [PMID: 37475846 PMCID: PMC10354571 DOI: 10.3748/wjg.v29.i26.4120] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/19/2023] [Accepted: 06/11/2023] [Indexed: 07/10/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common chronic gastrointestinal disease with a significant impact on patients' quality of life and a high socioeconomic burden. And the understanding of IBS has changed since the release of the Rome IV diagnosis in 2016. With the upcoming Rome V revision, it is necessary to review the results of IBS research in recent years. In this review of IBS, we can highlight future concerns by reviewing the results of IBS research on epidemiology, overlap disorders, pathophysiology, and treatment over the past decade and summarizing the latest research.
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Affiliation(s)
- Kai-Yue Huang
- Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- Institute of Digestive Diseases, Beijing Institute of Spleen and Stomach Disease of Traditional Chinese Medicine, Beijing 100091, China
| | - Feng-Yun Wang
- Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- Institute of Digestive Diseases, Beijing Institute of Spleen and Stomach Disease of Traditional Chinese Medicine, Beijing 100091, China
| | - Mi Lv
- Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- Institute of Digestive Diseases, Beijing Institute of Spleen and Stomach Disease of Traditional Chinese Medicine, Beijing 100091, China
| | - Xiang-Xue Ma
- Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- Institute of Digestive Diseases, Beijing Institute of Spleen and Stomach Disease of Traditional Chinese Medicine, Beijing 100091, China
| | - Xu-Dong Tang
- Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- Institute of Digestive Diseases, Beijing Institute of Spleen and Stomach Disease of Traditional Chinese Medicine, Beijing 100091, China
| | - Lin Lv
- Institute of Digestive Diseases, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing 100091, China
- Institute of Digestive Diseases, Beijing Institute of Spleen and Stomach Disease of Traditional Chinese Medicine, Beijing 100091, China
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7
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Konstantis G, Efstathiou S, Pourzitaki C, Kitsikidou E, Germanidis G, Chourdakis M. Efficacy and safety of probiotics in the treatment of irritable bowel syndrome: A systematic review and meta-analysis of randomised clinical trials using ROME IV criteria. Clin Nutr 2023; 42:800-809. [PMID: 37031468 DOI: 10.1016/j.clnu.2023.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/18/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder which affects a great number of patients globally. Clinical trials and meta-analyses have evaluated different therapies for IBS. Some of them have shown that probiotics play a significant role in the management of IBS-patients. Nevertheless, results are controversial, and the efficacy of the administration of probiotics remains to be confirmed, especially in regard to which type of probiotic-strains are beneficial. AIM The aim of the present meta-analysis is to assess the efficacy and safety of the administration of probiotics to IBS-patients with a diagnosis based on Rome IV criteria, which is performed for the first time. METHODS Electronic databases (Pubmed, Scopus and Cochrane) were searched until 26.01.2023 for randomized controlled trials (RCTs) studying the administration of probiotics in adult IBS-patients, who were categorized according to the Rome IV criteria. The risk of bias was assessed using the Cochrane Risk of Bias tool (ROB) 2.0. Weighted and standardized mean difference with the 95% confidence intervals were used for the synthesis of the results. Primary outcomes were the decrease of IBS-Symptom Severity Score (IBS-SSS) and decrease of abdominal pain. The secondary outcomes were the improvement in quality of life (QoL) and the decrease of bloating. Lastly, the adverse effects of probiotics were evaluated. The protocol of the study has been registered at protocols.io (DOI dx.doi.org/10.17504/protocols.io.14egn218yg5d/v1). RESULTS Six double-blind (N = 970) placebo-control RCTs fulfilled the inclusion criteria and overall, nine different strains of probiotics were examined. No significant reduction in IBS-SSS (WMD -43.2, 95% CI -87.5 to 1.0, I2 = 82.9%) was demonstrated, whereas a significant decrease regarding abdominal pain (SMD -0.94, 95% CI -1.53 to -0.35, I2 = 92,2) was shown. Furthermore, no correlation between improvement of QoL and the use of probiotics (SMD -0.64, 95% CI -1.27 to 0.00, I2 = 93,9%) was shown. However, probiotics were associated with a significant reduction in bloating (SMD -0.28, 95% CI -0.47 to -0.09, I2 = 36,0%). A qualitative synthesis was conducted about adverse events and showed that the use of probiotics' is safe without severe adverse events. CONCLUSIONS The administration of probiotics to IBS-patients demonstrated a positive effect on pain and bloating, but due to significant heterogeneity and confounding factors, that were not examined in the included studies, a definitive statement cannot be made. Moreover, probiotics did not lead to an improvement in other parameters. There is a need for larger RCTs in IBS-patients diagnosed according to Rome IV (not III) criteria and especially it is essential to be conducted RCTs which examine the administration of specific strains and have similar methodological characteristics.
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Affiliation(s)
- Georgios Konstantis
- Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Gastroenterology, Hepatology and Transplant Medicine, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Stylianos Efstathiou
- Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chryssa Pourzitaki
- Clinical Pharmacology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Elisavet Kitsikidou
- Department of Internal Medicine, Evangelical Hospital Dusseldorf, Dusseldorf, Germany
| | - Georgios Germanidis
- Division of Gastroenterology and Hepatology, 1st Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Chourdakis
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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8
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Ghoshal UC, Sachdeva S, Pratap N, Karyampudi A, Mustafa U, Abraham P, Bhatt CB, Chakravartty K, Chaudhuri S, Goyal O, Makharia GK, Panigrahi MK, Parida PK, Patwari S, Sainani R, Sadasivan S, Srinivas M, Upadhyay R, Venkataraman J. Indian consensus statements on irritable bowel syndrome in adults: A guideline by the Indian Neurogastroenterology and Motility Association and jointly supported by the Indian Society of Gastroenterology. Indian J Gastroenterol 2023; 42:249-273. [PMID: 36961659 PMCID: PMC10036984 DOI: 10.1007/s12664-022-01333-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 03/25/2023]
Abstract
The Indian Neurogastroenterology and Motility Association (INMA), earlier named the Indian Motility and Functional Diseases Association developed this evidence-based practice guidelines for the management of irritable bowel syndrome (IBS). A modified Delphi process was used to develop this consensus containing 28 statements, which were concerning diagnostic criteria, epidemiology, etiopathogenesis and comorbidities, investigations, lifestyle modifications and treatments. Owing to the Coronavirus disease-19 (COVID-19) pandemic, lockdowns and mobility restrictions, web-based meetings and electronic voting were the major tools used to develop this consensus. A statement was regarded as accepted when the sum of "completely accepted" and "accepted with minor reservation" voted responses were 80% or higher. Finally, the consensus was achieved on all 28 statements. The consensus team members are of the view that this work may find use in teaching, patient care, and research on IBS in India and other nations.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, 110 002, India
| | - Nitesh Pratap
- Department of Gastroenterology, KIMS Hospital, Secunderabad, 500 003, India
| | - Arun Karyampudi
- Department of Gastroenterology, GSL Medical College and General Hospital, Rajahmundry , 533 296, India
| | - Uzma Mustafa
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India
| | - Philip Abraham
- Department of Gastroenterology, P. D. Hinduja Hospital, Mumbai, 400 016, India
| | - Chetan B Bhatt
- Sir HN Reliance Foundation Hospital, Mumbai, 400 004, India
| | - Karmabir Chakravartty
- Department of Gastroenterology, Woodland Multispeciality Hospital, Kolkata, 700 027, India
| | - Sujit Chaudhuri
- Department of Gastroenterology, AMRI Hospitals, Salt Lake, Kolkata, 700 098, India
| | - Omesh Goyal
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India
| | - Govind K Makharia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, 751 019, India
| | - Prasanta Kumar Parida
- Department of Gastroenterology, SCB Medical College and Hospital, Cuttack, 753 001, India
| | | | - Rajesh Sainani
- Department of Gastroenterology, Jaslok Hospital, Mumbai, 400 026, India
| | - Shine Sadasivan
- Department of Gastroenterology, Amrita Institute of Medical Sciences, Kochi, 682 041, India
| | - M Srinivas
- Department of Gastroenterology, Gleneagles Global Health City, Chennai, 600 100, India
| | - Rajesh Upadhyay
- Department of Gastroenterology, Max Superspeciality Hospital, New Delhi, 110 017, India
| | - Jayanthi Venkataraman
- Department of Gastroenterology, Sri Ramachandra Institute of Higher Education and Research, Chennai, 600 116, India
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9
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Manabe N, Nakajima A, Odaka T, Haruma K. Daikenchuto significantly improves stool consistency and lower gastrointestinal symptoms in patients with chronic constipation. JGH OPEN 2023; 7:182-189. [PMID: 36968570 PMCID: PMC10037039 DOI: 10.1002/jgh3.12870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Abstract
Background and Aim A number of basic and clinical studies have confirmed that the traditional Japanese herbal medicine, Daikenchutou (DKT) has a pharmacological effect on cholinergic and serotonergic mechanisms with a favorable safety profile and an improving effect on lower gastrointestinal (GI) symptoms including abdominal pain or bloating. The purpose of this study is to evaluate the efficacy and safety of DKT on chronic constipation. Methods This multicenter, randomized, placebo-controlled, double-blinded clinical trial enrolled 67 patients with chronic constipation fulfilling Rome III criteria. After a 2-week observation period, 63 patients with persistent symptoms were finally randomized to a 4-week course of treatment with DKT or placebo. The primary endpoint consisted of a global assessment of overall treatment effect (OTE), while the secondary endpoints consisted of improvements in stool consistency, spontaneous bowel movements, lower GI symptoms related to constipation, and quality of life. Factors associated with OTE were also investigated. Results After 4 weeks administration of DKT, OTE was significantly higher than placebo. No side effects were observed. Significant improvement in stool consistency and lower GI symptoms was observed in the DKT group. The improvements in lower GI symptoms as well as stool consistency were associated with OTE. OTE was higher in patients with greater improvement in lower GI symptoms with mental component summary scores close to normal before treatment. Conclusion DKT was effective and safe in treating chronic constipation, especially in patients having symptoms related to constipation with no impaired mental component summary score.
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Affiliation(s)
- Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine Kawasaki Medical School Okayama Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Takeo Odaka
- Odaka Internal and Gastrointestinal Clinic Chiba Japan
| | - Ken Haruma
- Division of Gastroenterology, Department of Internal Medicine 2 Kawasaki Medical School Okayama Japan
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10
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Gwee KA, Lee YY, Suzuki H, Ghoshal UC, Holtmann G, Bai T, Barbara G, Chen MH, Chua ASB, Gibson PR, Hou X, Liu J, Nakajima A, Pratap N, Sachdeva S, Siah KTH, Soh AYS, Sugano K, Tack J, Tan VPY, Tang X, Walker M, Wu DC, Xiao YL, Zulkifli KK, Toh C. Asia-Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms. J Gastroenterol Hepatol 2023; 38:197-209. [PMID: 36321167 DOI: 10.1111/jgh.16046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/06/2022] [Accepted: 10/13/2022] [Indexed: 11/30/2022]
Abstract
Contemporary systems for the diagnosis and management gastrointestinal symptoms not attributable to organic diseases (Functional GI Disorders, FGID, now renamed Disorders of Gut-Brain Interaction, DGBI) seek to categorize patients into narrowly defined symptom-based sub-classes to enable targeted treatment of patient cohorts with similar underlying putative pathophysiology. However, an overlap of symptom categories frequently occurs and has a negative impact on treatment outcomes. There is a lack of guidance on their management. An Asian Pacific Association of Gastroenterology (APAGE) working group was set up to develop clinical practice guidelines for management of patients with functional dyspepsia (FD) who have an overlap with another functional gastrointestinal disorder: FD with gastroesophageal reflux (FD-GERD), epigastric pain syndrome with irritable bowel syndrome (EPS-IBS), postprandial distress syndrome with IBS (PDS-IBS), and FD-Constipation. We identified putative pathophysiology to provide a basis for treatment recommendations. A management algorithm is presented to guide primary and secondary care clinicians.
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Affiliation(s)
- Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and The Gastroenterology Group, Gleneagles Hospital, Singapore City, Singapore
| | - Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.,GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Uday Chand Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Gerald Holtmann
- Faculty of Medicine and Faculty of Health and Behavioural Sciences, Department of Gastroenterology and Hepatology, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Tao Bai
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Giovanni Barbara
- Department of Internal Medicine and Gastroenterology, and CRBA, University of Bologna, Bologna, Italy
| | - Min-Hu Chen
- Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | | | - Peter R Gibson
- Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinsong Liu
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Nitesh Pratap
- Krishna Institute of Medical Sciences, Secunderabad, India
| | - Sanjeev Sachdeva
- Department of Gastroenterology, GB Pant Hospital, New Delhi, India
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Alex Yu Sen Soh
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | | | - Jan Tack
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Victoria Ping Yi Tan
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Xudong Tang
- Institute of Gastroenterology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Marjorie Walker
- Anatomical Pathology College of Health, Medicine and Wellbeing, University of Newcastle, New South Wales, Australia
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine, and Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ying-Lian Xiao
- Division of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Khairil Khuzaini Zulkifli
- GI Function and Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia.,Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Clarissa Toh
- Stomach, Liver and Bowel Centre, Gleneagles Hospital, Singapore City, Singapore
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11
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LMWP (S3-3) from the Larvae of Musca domestica Alleviate D-IBS by Adjusting the Gut Microbiota. Molecules 2022; 27:molecules27144517. [PMID: 35889391 PMCID: PMC9324334 DOI: 10.3390/molecules27144517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/03/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022] Open
Abstract
Diarrhea-based Irritable Bowel Syndrome (D-IBS) and diarrhea are both associated with ecological imbalance of the gut microbiota. Low Molecular Weight Peptides (LMWP) from the larvae of Musca domestica have been shown to be effective in the treatment of diarrhea and regulation of gut microbiota. Meanwhile, the single polypeptide S3-3 was successfully isolated and identified from LMWP in our previous studies. It remains unclear exactly whether and how LMWP (S3-3) alleviate D-IBS through regulating gut microbiota. We evaluated the gut microbiota and pharmacology to determine the regulation of gut microbiota structure and the alleviating effect on D-IBS through LMWP (S3-3). The rates of loose stools, abdominal withdrawal reflex (AWR) and intestinal tract motility results revealed that LMWP (S3-3) from the larvae of Musca domestica had a regulating effect against diarrhea, visceral hypersensitivity and gastrointestinal (GI) dysfunction in D-IBS model mice. Additionally, 16S rRNA gene sequencing was utilized to examine the gut microbiota, which suggests that LMWP induce structural changes in the gut microbiota and alter the levels of the following gut microbiota: Bacteroidetes, Proteobacteria and Verrucomicrobia. LMWP putatively functioned through regulating 5-HT, SERT, 5-HT2AR, 5-HT3AR and 5-HT4R according to the results of ELISA, qRT-PCR and IHC. The findings of this study will contribute to further understanding how LMWP (S3-3) attenuate the effects of D-IBS on diarrhea, visceral hypersensitivity and GI dysfunction.
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12
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Zeng HY, Bai T, Li SE, Zhang L, Song J, Liu JS, Hou XH. Exploration of "Zhang" in functional gastrointestinal disorders: A cross-cultural challenge in Chinese clinical setting. J Dig Dis 2022; 23:388-395. [PMID: 36111616 DOI: 10.1111/1751-2980.13121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/20/2022] [Accepted: 08/09/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In China, four symptoms of functional gastrointestinal disorders, postprandial fullness, early satiety, bloating, and abdominal distension are commonly and interchangeably expressed as a single chief complaint, "Zhang". In this study we aimed to explore the most efficient method of determining the characteristics of symptoms in such patients. METHODS Consecutive patients with the chief complaint of abdominal "Zhang" from December 2017 to June 2018 were included. Their symptom patterns were determined by face-to-face interviews. Patients with a single symptom (postprandial fullness, early satiety, bloating, or abdominal distension) completed the questionnaire assessing their understanding of the symptoms using three methods including concept terms, pictograms, and verbal descriptions. RESULTS A total of 230 patients (121 men, 109 women; mean age 43.7 ± 12.6 y) were included. Verbal descriptions were most applicable to identify patients' symptom patterns, followed by concept terms and pictograms. Early satiety was the most difficult to identify (20.9% agreement between patient's understanding and doctor's diagnosis by using concept term), whereas fullness and bloating had apparently higher recognition (70.7% and 72.1% by concept terms). Elder patients (>60 y) and those with more frequent symptom attacks (≥once daily) showed relatively poorer understanding of the symptoms. CONCLUSIONS Early satiety is poorly identified by patients. Existing pictograms fail to show comprehension-improving features in a Chinese cultural setting. Verbal descriptions may be the best option for diagnosing abdominal "Zhang". More caution is required during the inquiry of medical history from elder patients with frequent symptom attacks.
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Affiliation(s)
- Hao Yu Zeng
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Tao Bai
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Sai Er Li
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.,Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jun Song
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jin Song Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiao Hua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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13
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Yang W, Yang X, Cai X, Zhou Z, Yao H, Song X, Zhao T, Xiong P. The Prevalence of Irritable Bowel Syndrome Among Chinese University Students: A Systematic Review and Meta-Analysis. Front Public Health 2022; 10:864721. [PMID: 35493361 PMCID: PMC9051230 DOI: 10.3389/fpubh.2022.864721] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background Irritable bowel syndrome (IBS) has become a common public health issue among university students, impairing their physical and mental health. This meta-analysis aimed to examine the pooled prevalence of IBS and its associated factors among Chinese university students. Methods Databases of PubMed, EMBASE, MEDLINE (via EBSCO), CINAHL (via EBSCO), Wan Fang, CNKI and Weipu (via VIP) were systematically searched from inception date to May 31, 2021. Meta-analysis was performed using random-effects models. Meta-regression and subgroup analysis were used to detect the potential source of heterogeneity. Key Results A total of 22 cross-sectional studies (14 were in Chinese and 8 were in English) with 33,166 Chinese university students were included. The pooled prevalence of IBS was estimated as 11.89% (95% CI = 8.06%, 16.35%). The prevalence was 10.50% (95% CI = 6.80%, 15.87%) in Rome II criteria, 12.00% (95% CI = 8.23%, 17.17%) in Rome III criteria, and 3.66% (95% CI = 2.01%, 6.60%) in Rome IV criteria. The highest prevalence of IBS was 17.66% (95% CI = 7.37%, 36.64%) in North China, and the lowest was 3.18% (95% CI = 1.28%, 7.68%) in South China. Subgroup analyses indicated that gender, major, anxiety and depression symptoms, drinking and smoking behaviors were significantly associated with the prevalence of IBS. Meta-regression analyses suggested that region influenced prevalence estimates for IBS. Conclusions and Inferences This meta-analysis illustrated that IBS is very common in Chinese university students. Regular screening, effective prevention, and appropriate treatments should be implemented to reduce the risk of IBS in this population. More future studies should be conducted in Northeastern and Southwestern parts of China.
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Affiliation(s)
- Weixin Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xiao Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xianghao Cai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhuoren Zhou
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Huan Yao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xingrong Song
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tianyun Zhao
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Peng Xiong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
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14
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Colomier E, Melchior C, Algera JP, Hreinsson JP, Störsrud S, Törnblom H, Van Oudenhove L, Palsson OS, Bangdiwala SI, Sperber AD, Tack J, Simrén M. Global prevalence and burden of meal-related abdominal pain. BMC Med 2022; 20:71. [PMID: 35172840 PMCID: PMC8851773 DOI: 10.1186/s12916-022-02259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/13/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients with disorders of gut-brain interaction (DGBI) report meal intake to be associated with symptoms. DGBI patients with meal-related symptoms may have more severe symptoms overall and worse health outcomes, but this subgroup has not been well characterized. We aimed to describe the global prevalence of meal-related abdominal pain and characterize this subgroup. METHODS The data analyzed originated from the Internet survey component of the population-based Rome Foundation Global Epidemiology Study, completed in 26 countries (n = 54,127). Adult subjects were asked whether they had abdominal pain and how often this was meal-related. Respondents were categorized into "no," "occasional," and "frequent" meal-related abdominal pain groups based on 0%, 10-40%, and ≥50% of the pain episodes being meal-related, respectively. DGBI diagnoses, frequency of other GI symptoms, psychological distress, non-GI somatic symptoms, quality of life, and healthcare utilization were compared between groups. Mixed linear and ordinal regression was used to assess independent associations between psychological distress, non-GI somatic symptoms, quality of life, other GI symptoms, and meal-related abdominal pain. RESULTS Overall, 51.9% of the respondents reported abdominal pain in the last 3 months, and 11.0% belonged to the group with frequent meal-related abdominal pain, which included more females and younger subjects. DGBI diagnoses were more common in subjects with frequent meal-related abdominal pain, and the frequency of several GI symptoms was associated with having more frequent meal-related abdominal pain. Having meal-related abdominal pain more frequently was also associated with more severe psychological distress, non-GI somatic symptoms, and a poorer quality of life. The group with frequent meal-related abdominal pain also more often consulted a doctor for bowel problems compared to the other groups of meal-related abdominal pain. CONCLUSION Reporting frequent meal-related abdominal pain is common across the globe and associated with other GI and non-GI somatic symptoms, psychological distress, healthcare utilization, and a poorer quality of life. Individuals who frequently experience meal-related abdominal pain also more frequently fulfill the diagnostic criteria for DGBI. Assessing meal-related symptoms in all DGBI patients could be of major importance to improve and individualize symptom management.
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Affiliation(s)
- Esther Colomier
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.
| | - Chloé Melchior
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,INSERM UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy University, Rouen, France.,Rouen University Hospital, Gastroenterology Department and INSERM CIC-CRB 1404, F-76031, Rouen, France
| | - Joost P Algera
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jóhann P Hreinsson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stine Störsrud
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lukas Van Oudenhove
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for GI Disorders (TARGID), KU Leuven, Leuven, Belgium.,Cognitive & Affective Neuroscience Lab (CANlab), Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Olafur S Palsson
- Center for Functional GI and Motility Disorders, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ami D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jan Tack
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium
| | - Magnus Simrén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Center for Functional GI and Motility Disorders, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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15
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Quach DT, Vu KT, Vu KV. Prevalence, clinical characteristics, and management of irritable bowel syndrome in Vietnam: A scoping review. JGH Open 2021; 5:1227-1235. [PMID: 34816008 PMCID: PMC8593809 DOI: 10.1002/jgh3.12616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 12/17/2022]
Abstract
Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders worldwide. Its prevalence varies significantly from country to country, largely due to heterogeneity in the available data. Recent studies show that the prevalence of IBS in Asia is on the rise. However, there are very limited data regarding its prevalence in the Vietnamese population. This review aims to offer an overview of the prevalence and clinical characteristics of IBS in the Vietnamese population; and to discuss the current management of IBS in Vietnam-taking into account the available medical resources and the local spectrum of lower gastrointestinal disorders that may mimic IBS.
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Affiliation(s)
- Duc Trong Quach
- Department of Internal MedicineUniversity of Medicine and Pharmacy at Hochiminh CityHo Chi Minh CityVietnam
- Department of GastroenterologyNhan Dan Gia Dinh HospitalHo Chi Minh CityVietnam
| | | | - Khien Van Vu
- Department of Endoscopy108 Central HospitalHanoiVietnam
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16
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Quek SXZ, Loo EXL, Demutska A, Chua CE, Kew GS, Wong S, Lau HX, Low EXS, Loh TL, Lung OS, Hung ECW, Rahman MM, Ghoshal UC, Wong SH, Cheung CKY, Syam AF, Tan N, Xiao Y, Liu J, Lu F, Chen C, Lee YY, Maralit RM, Kim Y, Oshima T, Miwa H, Pang J, Siah KTH. Impact of the coronavirus disease 2019 pandemic on irritable bowel syndrome. J Gastroenterol Hepatol 2021; 36:2187-2197. [PMID: 33615534 PMCID: PMC8014795 DOI: 10.1111/jgh.15466] [Citation(s) in RCA: 9] [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: 09/30/2020] [Revised: 01/18/2021] [Accepted: 02/14/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Gastrointestinal manifestations of the coronavirus disease 2019 (COVID-19) pandemic may mimic irritable bowel syndrome (IBS), and social distancing measures may affect IBS patients negatively. We aimed to study the impact of COVID-19 on respondents with self-reported IBS. METHODS We conducted an anonymized survey from May to June 2020 in 33 countries. Knowledge, attitudes, and practices on personal hygiene and social distancing as well as psychological impact of COVID-19 were assessed. Statistical analysis was performed to determine differences in well-being and compliance to social distancing measures between respondents with and without self-reported IBS. Factors associated with improvement or worsening of IBS symptoms were evaluated. RESULTS Out of 2704 respondents, 2024 (74.9%) did not have IBS, 305 (11.3%) had self-reported IBS, and 374 (13.8%) did not know what IBS was. Self-reported IBS respondents reported significantly worse emotional, social, and psychological well-being compared with non-IBS respondents and were less compliant to social distancing measures (28.2% vs 35.3%, P = 0.029); 61.6% reported no change, 26.6% reported improvement, and 11.8% reported worsening IBS symptoms. Higher proportion of respondents with no change in IBS symptoms were willing to practice social distancing indefinitely versus those who deteriorated (74.9% vs 51.4%, P = 0.016). In multivariate analysis, willingness to continue social distancing for another 2-3 weeks (vs longer period) was significantly associated with higher odds of worsening IBS. CONCLUSION Our study showed that self-reported IBS respondents had worse well-being and compliance to social distancing measures than non-IBS respondents. Future research will focus on occupational stress and dietary changes during COVID-19 that may influence IBS.
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Affiliation(s)
- Sabrina Xin Zi Quek
- Department of Medicine, Yong Loo Lin School of MedicineNational University HospitalSingapore
| | - Evelyn Xiu Ling Loo
- Department of Paediatrics, Yong Loo Lin School of MedicineNational University of SingaporeSingapore,Singapore Institute for Clinical SciencesAgency for Science, Technology and ResearchSingapore
| | - Alla Demutska
- Department of Clinical PsychologyJames Cook UniversitySingapore
| | - Chun En Chua
- Department of Medicine, Yong Loo Lin School of MedicineNational University HospitalSingapore
| | - Guan Sen Kew
- Department of Medicine, Yong Loo Lin School of MedicineNational University HospitalSingapore,Division of Gastroenterology and Hepatology, Department of MedicineNational University HospitalSingapore
| | - Scott Wong
- Department of MedicineNg Teng Fong General HospitalSingapore
| | - Hui Xing Lau
- Singapore Institute for Clinical SciencesAgency for Science, Technology and ResearchSingapore
| | | | - Tze Liang Loh
- Department of Otorhinolarygology, Head and Neck SurgeryUniversiti Putra MalaysiaSeri KembanganMalaysia
| | - Ooi Shien Lung
- Department of AnaesthesiologyColumbia Asia HospitalMiriSarawakMalaysia
| | | | - M. Masudur Rahman
- Department of GastroenterologySheikh Russel National Gastroliver Institute and HospitalDhakaBangladesh
| | - Uday C Ghoshal
- Department of GastroenterologySanjay Gandhi Postgraduate Institute Medical ScienceLucknowIndia
| | - Sunny H Wong
- Department of Medicine and Therapeutics, Faculty of MedicineThe Chinese University of Hong KongShatinHong Kong
| | - Cynthia K Y Cheung
- State Key Laboratory of Pharmaceutical BiotechnologyThe University of Hong KongHong Kong,Department of MedicineThe University of Hong KongHong Kong
| | - Ari F Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of MedicineUniversity of Indonesia/Cipto Mangunkusumo HospitalJakartaIndonesia
| | - Niandi Tan
- Departments of Gastroenterology and HepatologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Yinglian Xiao
- Departments of Gastroenterology and HepatologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Jin‐Song Liu
- Department of GastroenterologyWuhan Union Hospital of Huazhong University of Science and TechnologyWuhanHubeiChina
| | - Fang Lu
- Xiyuan Hospital, China Academy of Chinese Medical SciencesBeijingChina
| | - Chien‐Lin Chen
- Department of MedicineBuddhist Tzu Chi Hospital and University School of MedicineHualienTaiwan
| | - Yeong Yeh Lee
- St George and Sutherland Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia,Gut Research Group, Faculty of MedicineUniversiti Kebangsaan MalaysiaKuala LumpurMalaysia
| | | | - Yong‐Sung Kim
- Wonkwang Digestive Disease Research Institute, Gut and Food HealthcareWonkwang University School of MedicineIksanSouth Korea
| | - Tadayuki Oshima
- Division of Gastroenterology and Hepatology, Department of Internal MedicineHyogo College of MedicineNishinomiyaHyogoJapan
| | - Hiroto Miwa
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore
| | - Junxiong Pang
- Saw Swee Hock School of Public HealthNational University of Singapore and National University Health SystemSingapore,Centre for Infectious Disease Epidemiology and ResearchNational University of SingaporeSingapore
| | - Kewin Tien Ho Siah
- Department of Medicine, Yong Loo Lin School of MedicineNational University HospitalSingapore,Division of Gastroenterology and Hepatology, Department of MedicineNational University HospitalSingapore
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17
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Yamada E, Tsunoda S, Mimura M, Akizuki M, Miyazawa Y, Yamazaki T, Nagano Y, Murakami R, Kitahara T, Wakasugi J, Ozawa Y, Komatsu T, Inamori M, Nagai K, Nakajima A. Positioning of Bristol Stool Form Scale type 3 in constipation treatment satisfaction: A multicenter study in Japan. J Gastroenterol Hepatol 2021; 36:2125-2130. [PMID: 33538361 DOI: 10.1111/jgh.15428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/14/2020] [Accepted: 01/31/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Many patients are not satisfied with chronic constipation (CC) treatments. The aim of this study was to identify factors linked to CC treatment satisfaction or dissatisfaction. METHODS Our study population included patients who received CC treatment at a clinic or hospital. CC was diagnosed by a physician based on the patient's complaint. Treatment satisfaction was evaluated using the 28th question of the Patient Assessment of Constipation Quality of Life questionnaire. RESULTS We conducted this study at 28 facilities. We included 167 patients (mean age 66.7 ± 15.2 years, male:female ratio is 1:3.07). Sixty-eight (40.7%) of patients were satisfied with their constipation treatment. Treatment dissatisfaction of CC was significantly associated with frequency of bowel movement <3/week (odds ratio [OR] = 0.376, 95% confidence interval [CI]: 0.156-0.904, P = 0.029) or Bristol Stool Form Scale (BSFS) type 3 (OR = 0.401, 95% CI: 0.170-0.946, P = 0.037). CONCLUSIONS Our study showed that CC patients with BSFS type3 were not satisfied with constipation treatment. In general, BSFS types 3-5 are defined as normal stools. Therefore, BSFS type 3 may be set as a treatment goal even though the patient is not satisfied. The pathophysiology of CC differs by region and patient background. Therefore, parameters used to define successful treatment will be different by patient or region. We should reconsider the positioning of BSFS type 3 to improve treatment satisfaction for CC.
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Affiliation(s)
- Eiji Yamada
- Gastroenterology Division, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | | | | | | | | | | | | | | | | | | | - Yukihiro Ozawa
- Department of Surgery, Miura City Hospital, Miura, Japan
| | - Tatsuji Komatsu
- Gastroenterology Division, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Masahiko Inamori
- Department of Medical Education, Yokohama City University School of Medicine, Yokohama, Japan
| | | | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
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18
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El-Salhy M, Patcharatrakul T, Gonlachanvit S. The role of diet in the pathophysiology and management of irritable bowel syndrome. Indian J Gastroenterol 2021; 40:111-119. [PMID: 33666892 PMCID: PMC8187226 DOI: 10.1007/s12664-020-01144-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/25/2020] [Indexed: 02/04/2023]
Abstract
Irritable bowel syndrome (IBS) is a chronic gastrointestinal (GI) disorder that reportedly affects 5% to 20% of the world population. The etiology of IBS is not completely understood, but diet appears to play an important role in its pathophysiology. Asian diets differ considerably from those in Western countries, which might explain differences in the prevalence, sex, and clinical presentation seen between patients with IBS in Asian and Western countries. Dietary regimes such as a low-fermentable oligo-, di-, monosaccharides, and polyols (FODMAP) diet and the modified National Institute for Health and Care Excellence (NICE) diet improve both symptoms and the quality of life in a considerable proportion of IBS patients. It has been speculated that diet is a prebiotic for the intestinal microbiota and favors the growth of certain bacteria. These bacteria ferment the dietary components, and the products of fermentation act upon intestinal stem cells to influence their differentiation into enteroendocrine cells. The resulting low density of enteroendocrine cells accompanied by low levels of certain hormones gives rise to intestinal dysmotility, visceral hypersensitivity, and abnormal secretion. This hypothesis is supported by the finding that changing to a low-FODMAP diet restores the density of GI cells to the levels in healthy subjects. These changes in gut endocrine cells caused by low-FODMAP diet are also accompanied by improvements in symptoms and the quality of life.
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Affiliation(s)
- Magdy El-Salhy
- Section for Gastroenterology, Department of Medicine, Stord Helse-Fonna Hospital, Stord, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tanisa Patcharatrakul
- grid.7922.e0000 0001 0244 7875Center of Excellence on Neurogastroenterology and Motility, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ,Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sutep Gonlachanvit
- grid.7922.e0000 0001 0244 7875Center of Excellence on Neurogastroenterology and Motility, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ,Division of Gastroenterology, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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19
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Black CJ, Ford AC. Global burden of irritable bowel syndrome: trends, predictions and risk factors. Nat Rev Gastroenterol Hepatol 2020; 17:473-486. [PMID: 32296140 DOI: 10.1038/s41575-020-0286-8] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 02/08/2023]
Abstract
Irritable bowel syndrome (IBS) is one of the most common disorders of gut-brain interaction worldwide, defined according to patterns of gastrointestinal symptoms as described by the Rome diagnostic criteria. However, these criteria, developed with reference to research conducted largely in Western populations, might be limited in their applicability to other countries and cultures. Epidemiological data show a wide variation in the prevalence of IBS globally and more rigorous studies are needed to accurately determine any differences that might exist between countries as well as the potential explanations. The effects of IBS on the individual, in terms of their quality of life, and on health-care delivery and society, in terms of economic costs, are considerable. Although the magnitude of these effects seems to be comparable between nations, their precise nature can vary based on the existence of societal and cultural differences. The pathophysiology of IBS is complex and incompletely understood; genetics, diet and the gut microbiome are all recognized risk factors, but the part they play might be influenced by geography and culture, and hence their relative importance might vary between countries. This Review aims to provide an overview of the burden of IBS in a global context, to discuss future implications for the care of people with IBS worldwide, and to identify key areas for further research.
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Affiliation(s)
- Christopher J Black
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK.,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK. .,Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.
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Probiotic treatment induced change of inflammation related metabolites in IBS-D patients/double-blind, randomized, placebo-controlled trial. Food Sci Biotechnol 2019; 29:837-844. [PMID: 32523793 DOI: 10.1007/s10068-019-00717-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023] Open
Abstract
There have been many studies suggesting that probiotics are effective in patients with diarrhea-predominant irritable bowel syndrome (IBS-D). However, its mechanism of action as well as prediction of response is still to be elucidated. In the present study, to find out metabolomic characteristics of probiotic effect in IBS-D, we compared IBS symptom changes and metabolomic characteristics in the subjects' urine samples between multi-strain probiotics (one strain of Lactobacillus sp. and four strains of Bifidobacterium sp.) group (n = 32) and placebo group (n = 31). After 8 weeks' administration (3 times/day), dissatisfaction in bowel habits and stool frequencies were significantly improved. Also, probiotics group had significantly changed seven metabolites including palmitic acid methyl ester (PAME) and 4,6-dihydroxyquinoline, 4-(2-aminophenyl)-2,4-dioxobutanoic acid (DOBA). According to IBS-SSS and IBS-QoL questionnaires, IBS-SSS responders showed higher PAME levels and IBS-QoL responders showed lower DOBA levels. This suggests potential role of these metabolites as a biomarker to predict probiotics effect in IBS-D patients.
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21
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Herndon CC, Wang YP, Lu CL. Targeting the gut microbiota for the treatment of irritable bowel syndrome. Kaohsiung J Med Sci 2019; 36:160-170. [PMID: 31782606 DOI: 10.1002/kjm2.12154] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/20/2019] [Indexed: 12/15/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that affects an estimated 11% of people across the world. IBS patients are one of the largest subgroups seen in gastroenterology clinics, exhibit a lesser quality of life, and take greater use of the healthcare system. The exact etiology of IBS remains uncertain. Alterations in the gut microbiome may characterize apotential mechanism in the pathogenesis of IBS. This hypothesis is paralleled by rodent models in which manipulation of the gut microbiota leads to disturbed physiological functions along the brain-gut axis. Recent research in IBS treatments has redirected its focus towards gu microbiome based therapeutics. In this review, we discuss potential roles of enteric bacteria in the pathogenesis of IBS and its comorbidities. We then explore the manipulation of the enteric microbiota by prebiotics, probiotics, antibiotics, dietary changes, and fecal microbiota transfer. We also discuss the positive and negative effects of these therapeutics on IBS symptoms.
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Affiliation(s)
- Charles C Herndon
- Gail and Gerald Oppenheimer Family Center for Neurobiology of Stress and Resilience, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Yen-Po Wang
- Institute of Brain Science, Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Liang Lu
- Institute of Brain Science, Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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22
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Wong KMF, Mak ADP, Yuen SY, Leung ONW, Ma DY, Chan Y, Cheong PK, Lui R, Wong SH, Wu JCY. Nature and specificity of altered cognitive functioning in IBS. Neurogastroenterol Motil 2019; 31:e13696. [PMID: 31389109 DOI: 10.1111/nmo.13696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is unknown whether cognitive dysfunction found in patients with irritable bowel syndrome (IBS) was attributable to the different subtypes, ongoing pathophysiological processes, trait characteristics, or psychiatric comorbidity. METHODS Forty Rome-III patients with IBS (20 diarrhea-predominant [IBS-D] and 20 constipation-predominant [IBS-C]) and 40 age-, sex-, education-matched healthy controls were systematically recruited and compared on their cognitive function with continuous performance test (CPT), Wisconsin Card Sorting Test (WCST) and emotional Stroop test. Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire-15 (PHQ-15) and a structured bowel symptom questionnaire were performed to measure anxiety, depressive, somatization, and bowel symptoms, respectively. Psychiatric diagnoses were ascertained with SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders). KEY RESULTS Patients with IBS showed significantly increased standard deviation of reaction time (SDRT) (P = .003) on CPT, increased failure to maintain set (FMS) (P=.002), and percentage of perseverative errors (P = .003) on WCST. SDRT did not correlate with illness chronicity or bowel symptoms. FMS correlated with bowel symptom severity. In logistic regression models controlled for BAI, BDI-II, and PHQ-15, SDRT (AOR = 1.08, P = .025), but not FMS (P = .25) or percentage of perseverative errors (P = .24), significantly differentiated IBS from controls. Cognitive function was not significantly different between IBS-C and IBS-D (P > .05), or between pure IBS (n = 22) and IBS with generalized anxiety disorder (GAD) (n = 17) (P > .05). CONCLUSIONS & INFERENCES Patients with IBS showed attentional and executive function impairment irrespective of subtypes but otherwise heterogeneous in terms of its state-trait correlations and overlap with anxiety comorbidity.
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Affiliation(s)
| | - Arthur Dun Ping Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Suet Ying Yuen
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Owen Ngo Wang Leung
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Duan Yang Ma
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Yawen Chan
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Pui Kuan Cheong
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Rashid Lui
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Sunny Hei Wong
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Justin Che-Yuen Wu
- Institute of Digestive Diseases, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR
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23
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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.
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24
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Gwee KA, Gonlachanvit S, Ghoshal UC, Chua ASB, Miwa H, Wu J, Bak YT, Lee OY, Lu CL, Park H, Chen M, Syam AF, Abraham P, Sollano J, Chang CS, Suzuki H, Fang X, Fukudo S, Choi MG, Hou X, Hongo M. Second Asian Consensus on Irritable Bowel Syndrome. J Neurogastroenterol Motil 2019; 25:343-362. [PMID: 31327218 PMCID: PMC6657923 DOI: 10.5056/jnm19041] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/13/2019] [Accepted: 06/24/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND/AIMS There has been major progress in our understanding of the irritable bowel syndrome (IBS), and novel treatment classes have emerged. The Rome IV guidelines were published in 2016 and together with the growing body of Asian data on IBS, we felt it is timely to update the Asian IBS Consensus. METHODS Key opinion leaders from Asian countries were organized into 4 teams to review 4 themes: symptoms and epidemiology, pathophysiology, diagnosis and investigations, and lifestyle modifications and treatments. The consensus development process was carried out by using a modified Delphi method. RESULTS Thirty-seven statements were developed. Asian data substantiate the current global viewpoint that IBS is a disorder of gut-brain interaction. Socio-cultural and environmental factors in Asia appear to influence the greater overlap between IBS and upper gastrointestinal symptoms. New classes of treatments comprising low fermentable oligo-, di-, monosacharides, and polyols diet, probiotics, non-absorbable antibiotics, and secretagogues have good evidence base for their efficacy. CONCLUSIONS Our consensus is that all patients with functional gastrointestinal disorders should be evaluated comprehensively with a view to holistic management. Physicians should be encouraged to take a positive attitude to the treatment outcomes for IBS patients.
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Affiliation(s)
- Kok Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, and Gleneagles Hospital,
Singapore
| | - Sutep Gonlachanvit
- Center of Excellence on Neurogastroenterology and Motility, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok,
Thailand
- Correspondence: Sutep Gonlachanvit, MD, Center of Excellence on Neurogastroenterology and Motility, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand, Tel: +66-2-256-4265, Fax: +66-2-252-7839, E-mail:
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow,
India
| | | | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Hyogo,
Japan
| | - Justin Wu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, New Territories,
Hong Kong
| | - Young-Tae Bak
- Department of Internal Medicine, Korea University College of Medicine, Seoul,
Korea
| | - Oh Young Lee
- Department of Gastroenterology, College of Medicine, Hanyang University, Seoul,
Korea
| | - Ching-Liang Lu
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei,
Taiwan
| | - Hyojin Park
- Division of Gastroenterology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou,
China
| | - Ari F Syam
- Division of Gastroenterology, Departement of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta,
Indonesia
| | - Philip Abraham
- Division of Gastroenterology, P D Hinduja Hospital, Mumbai,
India
| | - Jose Sollano
- Department of Internal Medicine, Division of Gastroenterology, University of Santo Tomas, Manila,
Philippine
| | - Chi-Sen Chang
- Taichung Veterans General Hospital, Taiwan Boulevard, Taichung City,
Taiwan
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Kanagawa,
Japan
| | - Xiucai Fang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing,
China
| | - Shin Fukudo
- Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Aoba Sendai,
Japan
| | - Myung-Gyu Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Xiaohua Hou
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan,
China
| | - Michio Hongo
- Department of Medicine, Kurokawa General Hospital, Kurokawa, Miyagi,
Japan
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25
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Nahar L, Paul S, Chattopadhyay A, Koley M, Saha S. An open-label randomized pragmatic non-inferiority pilot trial to compare the effectiveness of Dysentery compound with individualized homeopathic medicines in irritable bowel syndrome. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2019; 16:/j/jcim.ahead-of-print/jcim-2018-0217/jcim-2018-0217.xml. [PMID: 31199766 DOI: 10.1515/jcim-2018-0217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/24/2019] [Indexed: 12/12/2022]
Abstract
Background Irritable Bowel Syndrome (IBS) is a prevalent gastro-intestinal disorder characterized by recurrent abdominal pain, bloating, altered bowel function and myriad of gastro-intestinal symptoms. Dysentery compound (DC), a 'bowel nosode', is one of the homeopathic medicines to treat IBS, but remained under-researched. We hypothesized that DC would be non-inferior to individualized homeopathy (IH) in treatment of IBS. Method An open, randomized (1:1), parallel arms, pragmatic, non-inferiority, pilot trial was conducted to compare the effectiveness of DC with IH medicines in 60 IBS patients. IBS Quality of Life (IBS-QOL) questionnaire was used as the outcome measure; assessed at baseline and after 3 months. Comparative analysis was carried out on the primary outcome to detect non-inferiority by one-tailed t test at alpha=5% with a prefixed margin (Δ) of 1.0 based on assumption. Results Six subjects dropped out. Groups were comparable at baseline (all p>0.01). Though intra-group changes were higher favoring IH over DC, group differences were statistically non-significant (all p>0.01). Non-inferiority was not demonstrated by DC against IH over 3 months (mean difference= -3.3, SE=5.2, lower 95% confidence limit -11.9, t= -0.453, p=0.674). No adverse events were reported from either group. Conclusion Non-inferiority of DC against IH in treatment of IBS was not demonstrated though it appeared as safe; still, being a pilot trial, no definite conclusion could be drawn. Further exploration of both efficacy and effectiveness of either of the therapies is necessary by adequately powered trials and independent replications. Trial registration: CTRI/2017/05/008480; UTN: U1111-1196-1004.
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Affiliation(s)
- Laijun Nahar
- National Institute of Homoeopathy, Homoeopathic Materia Medica, Block GE, Sector III, Salt Lake Kolkata, India
| | - Swapan Paul
- National Institute of Homoeopathy, Homoeopathic Materia Medica, Block GE, Sector III, Salt Lake Kolkata, India
| | - Abhijit Chattopadhyay
- National Institute of Homoeopathy, Homoeopathic Materia Medica, Block GE, Sector III, Salt Lake Kolkata, India
| | - Munmun Koley
- Independent Researcher, Champsara, Baidyabati Hooghly, India
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26
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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.
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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
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27
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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.
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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
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Ghoshal UC, Rahman MM. Post-infection irritable bowel syndrome in the tropical and subtropical regions: Vibrio cholerae is a new cause of this well-known condition. Indian J Gastroenterol 2019; 38:87-94. [PMID: 31073702 DOI: 10.1007/s12664-019-00959-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014, India.
| | - M Masudur Rahman
- Department of Gastroenterology, Sheikh Russel Gastroliver Institute and Hospital, Dhaka, Bangladesh
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29
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Hudon Thibeault AA, Sanderson JT, Vaillancourt C. Serotonin-estrogen interactions: What can we learn from pregnancy? Biochimie 2019; 161:88-108. [PMID: 30946949 DOI: 10.1016/j.biochi.2019.03.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/28/2019] [Indexed: 02/07/2023]
Abstract
We have reviewed the scientific literature related to four diseases in which to serotonin (5-HT) is involved in the etiology, herein named 5-HT-linked diseases, and whose prevalence is influenced by estrogenic status: depression, migraine, irritable bowel syndrome and eating disorders. These diseases all have in common a sex-dimorphic prevalence, with women more frequently affected than men. The co-occurrence between these 5-HT-linked diseases suggests that they have common physiopathological mechanisms. In most 5-HT-linked diseases (except for anorexia nervosa and irritable bowel syndrome), a decrease in the serotonergic tone is observed and estrogens are thought to contribute to the improvement of symptoms by stimulating the serotonergic system. Human pregnancy is characterized by a unique 5-HT and estrogen synthesis by the placenta. Pregnancy-specific disorders, such as hyperemesis gravidarum, gestational diabetes mellitus and pre-eclampsia, are associated with a hyperserotonergic state and decreased estrogen levels. Fetal programming of 5-HT-linked diseases is a complex phenomenon that involves notably fetal-sex differences, which suggest the implication of sex steroids. From a mechanistic point of view, we hypothesize that estrogens regulate the serotonergic system, resulting in a protective effect against 5-HT-linked diseases, but that, in turn, 5-HT affects estrogen synthesis in an attempt to retrieve homeostasis. These two processes (5-HT and estrogen biosynthesis) are crucial for successful pregnancy outcomes, and thus, a disruption of this 5-HT-estrogen relationship may explain pregnancy-specific pathologies or pregnancy complications associated with 5-HT-linked diseases.
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Affiliation(s)
- Andrée-Anne Hudon Thibeault
- INRS-Institut Armand-Frappier, 531, boulevard des Prairies, Laval, QC, H7V 1B7, Canada; Center for Interdisciplinary Research on Well-Being, Health, Society and Environment (Cinbiose), Université du Québec à Montréal, C.P.8888, succ. Centre-Ville, Montréal, QC, H3C 3P8, Canada.
| | - J Thomas Sanderson
- INRS-Institut Armand-Frappier, 531, boulevard des Prairies, Laval, QC, H7V 1B7, Canada.
| | - Cathy Vaillancourt
- INRS-Institut Armand-Frappier, 531, boulevard des Prairies, Laval, QC, H7V 1B7, Canada; Center for Interdisciplinary Research on Well-Being, Health, Society and Environment (Cinbiose), Université du Québec à Montréal, C.P.8888, succ. Centre-Ville, Montréal, QC, H3C 3P8, Canada.
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30
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Parida PK, Mishra D, Pati GK, Nath P, Dash KR, Behera SK, Parida S, Khatua CR, Panigrahi S, Mahapatra A, Khuntia HK, Singh SP. A prospective study on incidence, risk factors, and validation of a risk score for post-infection irritable bowel syndrome in coastal eastern India. Indian J Gastroenterol 2019; 38:134-142. [PMID: 30949908 DOI: 10.1007/s12664-019-00943-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/24/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Post-infection irritable bowel syndrome (PI-IBS) can occur following acute gastroenteritis (AGE). This study was designed to evaluate the incidence and risk factors of PI-IBS following AGE and to validate a PI-IBS risk score. METHODS This prospective study was performed between September 2014 and October 2016 on AGE patients by documenting their AGE severity and following up after 3 and 6 months to study the development of IBS (ROME III criteria). The risk score was calculated for all the subjects, and its discrimination ability was tested. RESULTS Out of 136 hospitalized AGE patients, 35 developed PI-IBS after 6 months. The factors associated with PI-IBS were younger age, longer duration of AGE, anxiety, depression, abdominal pain, bloody stool, vomiting, fever, family history of IBS, and positive stool culture (univariate analysis); however, on multivariate analysis, younger age (adjusted odds ratio [AOR] 0.5; p 0.03), prolonged duration of AGE (AOR 8.6; p 0.01), and abdominal cramps (AOR 2.1; p 0.02) were the independent factors influencing its occurrence. PI-IBS occurred even after infection with Vibrio cholerae. The PI-IBS risk score was significantly higher in patients who developed PI-IBS (72.4 ± 14.48 vs. 31.56 ± 20.4, p-value < 0.001); score > 50 had a sensitivity and specificity of 91.4% and 84.2%, respectively. CONCLUSION One fourth of AGE patients developed PI-IBS after 6 months. Factors influencing its development were younger age, long duration of AGE, and abdominal pain. The PI-IBS risk score had good predictive accuracy in our population.
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Affiliation(s)
| | - Debakanta Mishra
- Department of Gastroenterology, S C B Medical College, Cuttack, 753 007, India
| | - Girish Kumar Pati
- Department of Gastroenterology, Institute of Medical Sciences and SUM Hospital, K8 Kalinga Nagar, Shampur, Bhubaneswar, 751 003, India
| | - Preetam Nath
- Department of Gastroenterology, Kalinga Institute of Medical Science, KIIT Road, Patia, Bhubaneswar, 751 024, India
| | | | - Sambit Kumar Behera
- Department of Gastroenterology, S C B Medical College, Cuttack, 753 007, India
| | - Suryakanta Parida
- Department of Gastroenterology, S C B Medical College, Cuttack, 753 007, India
| | | | - Subhendu Panigrahi
- Department of Gastroenterology, S C B Medical College, Cuttack, 753 007, India
| | - Amarendra Mahapatra
- Regional Medical Research Centre (RMRC), Chandrasekharpur, Bhubaneswar, 751 023, India
| | - Hemant Kumar Khuntia
- Regional Medical Research Centre (RMRC), Chandrasekharpur, Bhubaneswar, 751 023, India
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Bai T, Wang WF, Zhang L, Wang H, Qian W, Song J, Hou XH. Positive endoscopic and ultrasonographic findings in patients with symptom-diagnosed functional gastrointestinal disorder: Data from a Chinese cross-sectional study. J Dig Dis 2018; 19:759-765. [PMID: 30520233 DOI: 10.1111/1751-2980.12693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 03/15/2018] [Accepted: 11/22/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Few studies have systematically assessed symptom-based diagnoses of functional gastrointestinal disorders (FGID) in China. This study aimed to evaluate the positive endoscopic and ultrasonographic findings in patients with symptom-based FGID. METHODS Adult patients with gastrointestinal symptoms but not red flag symptoms who were empirically diagnosed with FGID underwent an upper or lower gastrointestinal endoscopy. An abdominal ultrasonography was also performed to screen for potential organic diseases. Patients' data were collected and the Rome III questionnaire was used for symptom-based assessment. RESULTS Positive endoscopic and ultrasonographic findings were detected in 31.8%, 26.2% and 9.9% of patients with esophageal, gastroduodenal and intestinal disorders, respectively. Among patients diagnosed with FGID using the questionnaire, the rates of positive endoscopic and ultrasonographic findings were higher in patients with upper gastrointestinal symptoms than in those with lower gastrointestinal symptoms. Moreover, patients elder than 34.5 years with upper gastrointestinal symptoms and those elder than 47.5 years with lower gastrointestinal symptoms were more likely to have positive endoscopic and ultrasonographic findings. CONCLUSIONS The Rome III questionnaire is a valuable diagnostic tool for screening FGID in China. However, the rates of positive endoscopic and ultrasonographic findings vary depending on the location of symptoms. Endoscopy and ultrasonography have irreplaceable value, especially for investigating upper gastrointestinal symptoms.
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Affiliation(s)
- Tao Bai
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wen Feng Wang
- Department of Gastroenterology, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, Guangdong Province, China
| | - Lei Zhang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Huan Wang
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wei Qian
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Jun Song
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiao Hua Hou
- Division of Gastroenterology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Chuah KH, Mahadeva S. Cultural Factors Influencing Functional Gastrointestinal Disorders in the East. J Neurogastroenterol Motil 2018; 24:536-543. [PMID: 30153722 PMCID: PMC6175561 DOI: 10.5056/jnm18064] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/16/2018] [Accepted: 07/21/2018] [Indexed: 01/06/2023] Open
Abstract
Culture forms an integral aspect of environmental factors which influences disease presentation and clinical outcomes in functionalgastrointestinal disorders (FGIDs). In this review, the role of culture in FGIDs in the East is briefly explored with regards to symptompresentation and diagnostic issues, lifestyle and cultural habits, epidemiology, and healthcare seeking behavior. In both functionaldyspepsia and irritable bowel syndrome, symptom presentation and disease sub-typing in Asians are known to differ from their Western counterparts, possibly relating to cultural dietary practices and from cultural perception of symptoms. Dietary patterns, together with defecating practices are explored as factors contributing to a lower prevalence of constipation in the East. An urban-rural difference in the prevalence of FGIDs in Asia is attributed to a change in dietary patterns in rapidly developing urban communities, together with an increased level of psychological morbidity. Lastly, cultural attitudes towards traditional/local remedies, variation in healthcare systems, anxiety regarding organic disease, and religious practices have been shown to influence healthcare seeking behavior among FGID patients in the East.
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Affiliation(s)
- Kee-Huat Chuah
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur,
Malaysia
| | - Sanjiv Mahadeva
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur,
Malaysia
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Li J, Cui H, Cai Y, Lin J, Song X, Zhou Z, Xiong W, Zhou H, Bian Y, Wang L. Tong-Xie-Yao-Fang Regulates 5-HT Level in Diarrhea Predominant Irritable Bowel Syndrome Through Gut Microbiota Modulation. Front Pharmacol 2018; 9:1110. [PMID: 30323765 PMCID: PMC6172324 DOI: 10.3389/fphar.2018.01110] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/10/2018] [Indexed: 12/15/2022] Open
Abstract
Tong-Xie-Yao-Fang (TXYF) has been widely used for the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D) in traditional Chinese medicine. However, its mechanism of action in the treatment of IBS-D remains to be fully understood. Recent reports have shown that Clostridium species in the gut can induce 5-HT production in the colon, which then contributes to IBS-D. Due to the wide use of TXYF in the clinical treatment of IBS-D and the close relationship between gut microbiota and IBS-D, we hypothesize that TXYF treats IBS-D by modulating gut microbiota and regulating colonic 5-HT levels. In this study, variation analysis of 16S rRNA was conducted to evaluate changes in the distribution of gut microbiota in IBS-D model rats after TXYF treatment. Moreover, we investigated whether TXYF could affect colonic 5-HT levels in IBS-D model rats. We then performed fecal transplantation experiments to confirm the effects of TXYF on gut microbiota and 5-HT levels. We found that TXYF treatment can ameliorate IBS-D and regulate 5-HT levels in colon tissue homogenates. TXYF treatment also affected the diversity of gut microbiota and altered the relative abundance of Akkermansia and Clostridium sensu stricto 1 in gut flora populations. Finally, we showed that fecal transplantation from TXYF-treated rats could relieve IBS-D and regulate 5-HT levels in colon tissue homogenates. In conclusion, the present study demonstrates that TXYF treatment diminishes colonic 5-HT levels and alleviates the symptoms of IBS-D by favorably affecting microbiota levels in gut flora communities.
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Affiliation(s)
- Junchen Li
- Integrative Medicine Institute, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Huantian Cui
- Integrative Medicine Institute, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuzi Cai
- Integrative Medicine Institute, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jin Lin
- Integrative Medicine Institute, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xin Song
- Integrative Medicine Institute, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zijun Zhou
- Integrative Medicine Institute, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Wantao Xiong
- Integrative Medicine Institute, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Huifang Zhou
- Integrative Medicine Institute, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuhong Bian
- Integrative Medicine Institute, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Li Wang
- Preparation Department, Tianjin Second People’s Hospital, Tianjin, China
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Rahman MM, Ghoshal UC, Sultana S, Kibria MG, Sultana N, Khan ZA, Ahmed F, Hasan M, Ahmed T, Sarker SA. Long-Term Gastrointestinal Consequences are Frequent Following Sporadic Acute Infectious Diarrhea in a Tropical Country: A Prospective Cohort Study. Am J Gastroenterol 2018; 113:1363-1375. [PMID: 30171215 DOI: 10.1038/s41395-018-0208-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 06/07/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Postinfection irritable bowel syndrome (PI-IBS) and functional dyspepsia (PI-FD), though reported from the temperate countries, have not been studied in the tropics; PI-malabsorption syndrome (MAS), which mimics PI-IBS, is reported from the tropics. No report till date on PI-IBS excluded PI-MAS. We studied: (i) the frequency of continuing bowel dysfunction after acute gastroenteritis (AG), (ii) its predictors, and (iii) PI-MAS among patients with PI-IBS. METHODS 345 consecutive subjects each, with AG and age- and gender-matched healthy controls were followed up 3-monthly for 12 months using a translated-validated questionnaire and functional gastrointestinal disorders (FGIDs) were diagnosed by Rome III criteria. Symptom duration >3 months but <6 months was diagnosed as chronic bowel dysfunction (CBD) and dyspeptic symptoms, respectively. MAS was diagnosed if 2/3 tests (D-xylose H2 breath test, Sudan III-stained stool microscopy, and duodenal histology) were abnormal. Fecal microbiological studies were performed in 245/345 (71%) patients. RESULTS AG patients more often developed PI-IBS and PI-FD than controls (16.5 vs. 2.6% and 7.4 vs. 0.6%, respectively; p<0.001). Presence of FD was a risk factor for PI-IBS and IBS for PI-FD. On multivariate analysis, dyspeptic symptoms, CBD, and weight loss were the risk factors for PI-FGIDs. The frequency of PI-IBS following Vibrio cholera and other bacterial infection was comparable. Malabsorption was present among 2/23 (9%) patients with PI-IBS. CONCLUSION FGIDs are common after AG; dyspeptic symptoms, CBD, and weight loss were risk factors for PI-FGIDs. Vibrio cholerae infection caused PI-FGID, which was never reported. About 9 % patients fulfilling the criteria for PI-IBS had PI-MAS.
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Affiliation(s)
- Masudur M Rahman
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal
| | - Uday Chand Ghoshal
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal
| | - Shamima Sultana
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal
| | - Md Golam Kibria
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal
| | - Nigar Sultana
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal
| | - Zeenat Arefin Khan
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal
| | - Faruque Ahmed
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal
| | - Mahmud Hasan
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal
| | - Tahmeed Ahmed
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal
| | - Shafiqul Alam Sarker
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Department of Gastroenterology, Sanjay Gandhi Postgraduate institute of Medical sciences, Lucknow, india. Nutrition and clinical service division, international center for diarrheal disease Research, dhaka, Bangladesh. Gastroliver Foundation, dhaka, Bangladesh. These authors contributed equally: M. Masudur rahman, uday c. ghoshal
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Aziz I, Törnblom H, Palsson OS, Whitehead WE, Simrén M. How the Change in IBS Criteria From Rome III to Rome IV Impacts on Clinical Characteristics and Key Pathophysiological Factors. Am J Gastroenterol 2018; 113:1017-1025. [PMID: 29880963 DOI: 10.1038/s41395-018-0074-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/13/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The diagnostic criteria for irritable bowel syndrome (IBS) have recently been updated from Rome III to Rome IV. Whereas in Rome III a diagnosis of IBS entailed chronic abdominal pain or discomfort at least 3 days per month, in Rome IV the term discomfort has been removed and the frequency of abdominal pain increased to at least 1 day per week. We examined how this change in IBS criteria impacts on clinical characteristics and pathophysiological factors. METHODS A total of 542 Swedish subjects with Rome III IBS completed a baseline questionnaire enquiring for the number of abdominal pain days in the last 10 days; this was subsequently used as a surrogate marker to identify Rome IV IBS, in that (a) those with 0 or 1 day of pain were classed as Rome IV-negative, and (b) those with ≥2 days of pain were classed as Rome IV-positive. Comparisons were made between Rome IV-positive and -negative IBS groups for demographics, IBS subtype, gastrointestinal and psychological symptoms, somatisation, fatigue, disease-specific quality of life, rectal sensitivity, and oro-anal transit time. RESULTS Overall, 85% of Rome III IBS patients fulfilled the Rome IV criteria for IBS, but 15% did not. Rome IV-positive subjects were significantly more likely to be female, have poorer quality of life, greater pain severity, bloating, somatisation, fatigue, and rectal sensitivity than Rome IV-negative subjects. There were no differences in severity of anxiety or depression, IBS subtypes, bowel habit dissatisfaction, or oro-anal transit time. Finally, increasing number of pain days correlated positively with symptoms and visceral hypersensitivity. CONCLUSIONS Most Rome III-positive IBS patients seeking healthcare fulfil the Rome IV IBS criteria. They constitute a more severe group than those who lose their IBS diagnosis.
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Affiliation(s)
- Imran Aziz
- 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, Chapel Hill, NC, USA
| | - Hans Törnblom
- 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, Chapel Hill, NC, USA
| | - Olafur S Palsson
- 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, Chapel Hill, NC, USA
| | - William E Whitehead
- 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, Chapel Hill, NC, USA
| | - 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, Chapel Hill, NC, USA.,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, Chapel Hill, NC, USA
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36
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Siah KTH, Gong X, Yang XJ, Whitehead WE, Chen M, Hou X, Pratap N, Ghoshal UC, Syam AF, Abdullah M, Choi MG, Bak YT, Lu CL, Gonlachanvit S, Boon CS, Fang F, Cheong PK, Wu JCY, Gwee KA. Rome Foundation-Asian working team report: Asian functional gastrointestinal disorder symptom clusters. Gut 2018; 67:1071-1077. [PMID: 28592440 DOI: 10.1136/gutjnl-2016-312852] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 03/29/2017] [Accepted: 04/24/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Functional gastrointestinal disorders (FGIDs) are diagnosed by the presence of a characteristic set of symptoms. However, the current criteria-based diagnostic approach is to some extent subjective and largely derived from observations in English-speaking Western patients. We aimed to identify latent symptom clusters in Asian patients with FGID. DESIGN 1805 consecutive unselected patients with FGID who presented for primary or secondary care to 11 centres across Asia completed a cultural and linguistic adaptation of the Rome III Diagnostic Questionnaire that was translated to the local languages. Principal components factor analysis with varimax rotation was used to identify symptom clusters. RESULTS Nine symptom clusters were identified, consisting of two oesophageal factors (F6: globus, odynophagia and dysphagia; F9: chest pain and heartburn), two gastroduodenal factors (F5: bloating, fullness, belching and flatulence; F8 regurgitation, nausea and vomiting), three bowel factors (F2: abdominal pain and diarrhoea; F3: meal-related bowel symptoms; F7: upper abdominal pain and constipation) and two anorectal factors (F1: anorectal pain and constipation; F4: diarrhoea, urgency and incontinence). CONCLUSION We found that the broad categorisation used both in clinical practice and in the Rome system, that is, broad anatomical divisions, and certain diagnoses with long historical records, that is, IBS with diarrhoea, and chronic constipation, are still valid in our Asian societies. In addition, we found a bowel symptom cluster with meal trigger and a gas cluster that suggests a different emphasis in our populations. Future studies to compare a non-Asian cohort and to match to putative pathophysiology will help to verify our findings.
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Affiliation(s)
- Kewin Tien Ho Siah
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore.,Department of Internal Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xiaorong Gong
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yet-Sen University, Guangzhou, China
| | - Xi Jessie Yang
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - William E Whitehead
- Centre for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yet-Sen University, Guangzhou, China
| | - Xiaohua Hou
- Department of Gastroenterology and Hepatology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nitesh Pratap
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ari F Syam
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Murdani Abdullah
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Myung-Gyu Choi
- Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Tae Bak
- Department of Gastroenterology, Korea University Guro Hospital, Seoul, South Korea
| | - Ching-Liang Lu
- Division of Gastroenterology, Taipei Veterans General Hospital, National Yang-Ming University Taipei, Taiwan National Yang-Ming University Taipei, Taipei, Taiwan
| | - Sutep Gonlachanvit
- Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
| | | | - Fan Fang
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Pui Kuan Cheong
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Justin C Y Wu
- Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Kok-Ann Gwee
- Department of Internal Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Liu ZY, Gua XX, Zhang RG, Wang XX, Ai J, Wang WF, Yang YS. Association of mitochondrial displacement loop polymorphisms with diarrhea-predominant irritable bowel syndrome: A preliminary study. J Dig Dis 2018; 19:295-300. [PMID: 29633533 DOI: 10.1111/1751-2980.12597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate whether single nucleotide polymorphisms (SNPs) in the mitochondrial displacement loop (D-loop) were associated with irritable bowel syndrome (IBS). METHODS Altogether 40 participants were recruited and classified into three groups, including 20 that fulfilled the Rome III criteria for diarrhea-predominant IBS (IBS-D), 10 with constipation-predominant IBS (IBS-C), and 10 healthy volunteers (controls). DNA was extracted from biopsy specimens of the colon obtained during routine colonoscopies. The mitochondrial D-loop was sequenced and variants were identified in comparison with the reference sequence from GenBank. We searched GenBank and MITOMAP to determine whether a variant could be considered an SNP. RESULTS No significant differences in sex, age and body mass index were found among the three groups. The average numbers of SNPs in the IBS-D, IBS-C and control groups were 12.2 ± 2.7, 9.8 ± 1.8 and 9.9 ± 2.1, respectively. The frequency of SNPs was significantly higher in the IBS-D group than in the IBS-C group and controls (P < 0.05). No significant difference was found between the latter two groups. Each SNP was compared among the three groups and the frequency of 199C was found to be significantly higher in the control group than in the IBS-D group (P = 0.03), but no significant difference in its frequency was found between the IBS-C group and controls. CONCLUSIONS Patients with IBS-D have a higher incidence of SNPs in the mitochondrial D-loop than controls. The genotype 199C may be associated with a lower risk of IBS-D.
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Affiliation(s)
- Zi Yu Liu
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xia Xu Gua
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Rong Gui Zhang
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiao Xiao Wang
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Ai
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Wei Feng Wang
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing, China.,Division of Gastroenterology and Hepatology, Shenzhen University Health Science Center, Shenzhen, Guangdong Province, China
| | - Yun Sheng Yang
- Department of Gastroenterology and Hepatology, Chinese People's Liberation Army General Hospital, Beijing, China
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38
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Singh P, Surana R, Soni S, Agnihotri A, Ahuja V, Makharia GK, Staller K, Kuo B. Cross cultural comparison of constipation profiles at tertiary care centers between India and USA. Neurogastroenterol Motil 2018; 30. [PMID: 29521026 DOI: 10.1111/nmo.13324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite potential differences in patient perception of chronic constipation (CC) in geographically and culturally distinct regions, head-to-head studies comparing the clinical profile, constipation severity, impact on quality of life (QOL) and economic impact are lacking. METHODS We conducted a cross-sectional cohort study of patients presenting with CC to tertiary care centers in the USA and India. Standardized instruments were used to assess constipation subtype, disease severity, disease-specific QOL, somatization, and psychiatric comorbidities. We used multivariable linear regression to determine the predictors of QOL and number of healthcare visits. KEY RESULTS Sixty-six and 98 patients with CC were enrolled in the USA and India, respectively. Indian patients with CC had significantly more frequent bowel movements/week compared to their USA counterparts (Median 5 vs 3, P < .0001). The proportion of patients with Bristol stool form scale type 1 and 2 was significantly higher in the USA compared to India (65.5% vs 48%, P = .04). Higher depression score (P = .001), more severe constipation symptoms (P = .001) and site of the study being USA (P = .008) independently predicted worse QOL. Indian patients (P < .001) and worse QOL (P = .02) were independent predictors of number of healthcare visits in the last 12 months. CONCLUSIONS AND INFERENCES Indian patients with CC have more frequent and softer bowel movements compared to those in the USA suggesting significant differences in perception of CC in different geographic and cultural settings. QOL and economic impact related to constipation varies with geographic/cultural setting irrespective of other clinical and psychosomatic features.
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Affiliation(s)
- P Singh
- Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
| | - R Surana
- Division of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - S Soni
- Division of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - A Agnihotri
- Division of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - V Ahuja
- Division of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - G K Makharia
- Division of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India
| | - K Staller
- Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
| | - B Kuo
- Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, Boston, MA, USA
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39
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Abstract
Breath hydrogen tests are popular, noninvasive tests for the assessment of carbohydrate fermentation in patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD). There is limited information regarding the utility of breath hydrogen and methane tests in IBS and FD patients in East and Southeast Asia. This review aims to summarize current literature about common indications of breath testing in this region, the genesis of functional gastrointestinal symptoms by provocative breath testing and provide suggestions for correct use. The most common testing indication is the assessment of lactose intolerance, followed by small intestinal bacterial overgrowth (SIBO) and differentiation of intestinal gas profiles in research setting. Studies in this region not only documented a high prevalence of lactose malabsorption but a population, both healthy and IBS, that is highly symptomatic to typical lactose intakes. Breath hydrogen assessment of other fermentable carbohydrates (FODMAPs) are fairly uncommon, whereas methane breath testing is almost nonexistent. Cumulative hydrogen production following lactulose was also not excessive in IBS patients compared with controls. The evidence however, for the detection of SIBO suggests limited reliability in the use of lactulose or glucose breath testing alone and inconclusive data on its correlation with symptoms. Conversely, little has been carried out in FD. In conclusion, breath testing should be limited in the predicting patients with SIBO for directing clinical management but can be considered in the objective assessment of lactose malabsorption within a low FODMAP diet. Recommendations to improve the interpretation of breath testing in research were also provided.
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Hewawasam SP, Iacovou M, Muir JG, Gibson PR. Dietary practices and FODMAPs in South Asia: Applicability of the low FODMAP diet to patients with irritable bowel syndrome. J Gastroenterol Hepatol 2018; 33:365-374. [PMID: 28700090 DOI: 10.1111/jgh.13885] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022]
Abstract
The low Fermentable Oligosaccharides, Disaccharides, and Monosaccharides And Polyols (FODMAP) diet has been described, evaluated, and found efficacious for the treatment of patients with irritable bowel syndrome primarily in Western countries. The aim of this review was to address the applicability of this diet to South Asia. The high prevalence of irritable bowel syndrome in South Asia and its associated effects of quality of life and economics warrant the introduction of efficacious therapies. The considerable heterogeneity of dietary patterns and methods of food preparation across South Asian countries and a paucity of food analysis limit precision in defining foods that are high or low in FODMAPs. Spices and condiments are commonly consumed and mostly have a low FODMAP content. However, major high FODMAP sources are frequently used and include onion, garlic, shallots, legumes/pulses, and wheat-based products, as well as coconut and milk products, offering an opportunity for dietary management to reduce the symptom load. The feasibility of instituting a restrictive diet in which foods with a high FODMAP content are replaced by foods low in FODMAPs must be addressed as a substantial proportion of the nutritional intake including energy, proteins, and micronutrients, is often obtained from FODMAP-rich food. Furthermore, limited knowledge of health professionals together with a paucity of dietitians further challenge the practicality of introducing the diet. Thus, while the use of the low FODMAP diet in South Asia may be more limited than in westernized countries, it does offer potential therapeutic opportunities, the efficacy, and impact of which require further investigation.
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Affiliation(s)
- Samapriya P Hewawasam
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Marina Iacovou
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Jane G Muir
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Monash University and Alfred Health, Melbourne, Victoria, Australia
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Gwee KA, Ghoshal UC, Chen M. Irritable bowel syndrome in Asia: Pathogenesis, natural history, epidemiology, and management. J Gastroenterol Hepatol 2018; 33:99-110. [PMID: 28901578 DOI: 10.1111/jgh.13987] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/15/2017] [Accepted: 09/07/2017] [Indexed: 12/14/2022]
Abstract
Historically, the epidemiology of gastrointestinal diseases in Asia was different from that in Western countries. Early studies suggested a low prevalence of irritable bowel syndrome (IBS) in Asia. As the diagnosis of IBS is symptom-based and as symptom perception, expression, and interpretation are influenced by sociocultural perspectives including language, the presentation of IBS is expected to vary in different communities. Furthermore, the pathogenesis is multifactorial with psychosocial (stress, illness, behavior, and diet) and biological (infection, gut microbiota, and immune activation) variables interacting, and so, the present study can anticipate that the development of IBS will vary in different environments. In recognition of this aspect of functional gastrointestinal disorders, the recently published Rome IV documents have provided greater focus on cross-cultural factors. In this review, the present study seeks to highlight Asian perspectives by identifying historical trends and recent publications from the region and comparing these with the observations from Western societies.
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Affiliation(s)
- Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Uday Chand Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Minhu Chen
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Ghoshal UC, Gwee KA, Holtmann G, Li Y, Park SJ, Simadibrata M, Sugano K, Wu K, Quigley EMM, Cohen H. The role of the microbiome and the use of probiotics in gastrointestinal disorders in adults in the Asia-Pacific region - background and recommendations of a regional consensus meeting. J Gastroenterol Hepatol 2018; 33:57-69. [PMID: 28589613 DOI: 10.1111/jgh.13840] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/28/2017] [Accepted: 05/30/2017] [Indexed: 12/11/2022]
Abstract
The Asia-Pacific region is diverse, with regard to ethnicity, culture, and economic development incorporating some of the world's least and most developed nations. Gastrointestinal diseases are common in the Asia-Pacific region, and their prevalence, presentation, and management vary considerably within the region. There is growing evidence for an important role for the human gut microbiota in gastrointestinal health. As a consequence, geographic variations in the composition of the gut microbiota may contribute to variations in both the prevalence and response to therapy of specific diseases. Probiotics have been proposed as a valuable option in the prevention and treatment of a number of gastrointestinal illnesses, but the quality of available evidence to support their efficacy is variable. A meeting of international experts in adult and pediatric gastroenterology was held at the Sorbonne University, Paris, France, on April 11 and 12, 2016, to discuss current evidence supporting the use of probiotics in gastrointestinal disorders in the Asia-Pacific region. This article provides an overview of the discussions held at this meeting and recommends the formation of an Asia-Pacific Consortium on Gut Microbiota similar to those established in Europe and North America.
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Affiliation(s)
- Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kok-Ann Gwee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital Brisbane, University of Queensland, Brisbane, Queensland, Australia
| | - Yanmei Li
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
| | - Soo Jung Park
- Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Marcellus Simadibrata
- Faculty of Medicine, University of Indonesia and Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,RSUPN Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Kentaro Sugano
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kaichun Wu
- Fourth Military Medical University, Xi'an, China
| | - Eamonn M M Quigley
- Division of Gastroenterology and Hepatology, Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, Texas, USA
| | - Henry Cohen
- Clínica de Gastroenterología, Facultad de Medicina, Montevideo, Uruguay
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Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the evidence supporting the use of recently developed pharmacological treatments for IBS together with new evidence supporting more traditional therapies in order to understand where the new agents are best used in the treatment pathway. RECENT FINDINGS There is evidence to support the use of traditional treatments such as antispasmodics, antidepressants and dietary alteration in IBS. New therapeutic agents such as Linaclotide, Lubiprostone, Plecanatide, Rifaxamin and Eluxadoline are all more effective than placebo in treating symptoms of IBS with Tenapanor being a promising new agent. The majority of patients, however, treated with these medications remain symptomatic and they are not suitable for use in all patients. SUMMARY Traditional treatments such as antispasmodics, antidepressants, dietary and lifestyle modifications retain their importance in the treatment of IBS with the newer agents to be considered wherever these treatments are ineffective or poorly tolerated.
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Bortolotti M. Letter: the neglected analgesic properties of red pepper in the clinical management of the irritable bowel syndrome pain. Aliment Pharmacol Ther 2018; 47:153-154. [PMID: 29226399 DOI: 10.1111/apt.14417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- M Bortolotti
- Department of Gastroenterology and Internal Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Ghoshal UC, Sachdeva S, Pratap N, Verma A, Karyampudi A, Misra A, Abraham P, Bhatia SJ, Bhat N, Chandra A, Chakravartty K, Chaudhuri S, Chandrasekar TS, Gupta A, Goenka M, Goyal O, Makharia G, Mohan Prasad VG, Anupama NK, Paliwal M, Ramakrishna BS, Reddy DN, Ray G, Shukla A, Sainani R, Sadasivan S, Singh SP, Upadhyay R, Venkataraman J. Indian consensus on chronic constipation in adults: A joint position statement of the Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology. Indian J Gastroenterol 2018; 37:526-544. [PMID: 30617919 PMCID: PMC6339668 DOI: 10.1007/s12664-018-0894-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
The Indian Motility and Functional Diseases Association and the Indian Society of Gastroenterology developed this evidence-based practice guideline for management of chronic constipation. A modified Delphi process was used to develop this consensus containing 29 statements, which were generated by electronic voting iteration as well as face to face meeting and review of the supporting literature primarily from India. These statements include 9 on epidemiology, clinical presentation, and diagnostic criteria; 8 on pathophysiology; and the remaining 12 on investigations and treatment. When the proportion of those who voted either to accept completely or with minor reservation was 80% or higher, the statement was regarded as accepted. The members of the consensus team believe that this would be useful for teaching, clinical practice, and research on chronic constipation in India and in other countries with similar spectrum of the disorders.
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Affiliation(s)
- Uday C. Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | | | | | - Abhai Verma
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | - Arun Karyampudi
- Asian Institute of Gastroenterology, Hyderabad, 500 082 India
| | - Asha Misra
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | - Philip Abraham
- P D Hinduja Hospital and MRC, and Hinduja Heathcare Surgical, Mumbai, 400 016 India
| | | | - Naresh Bhat
- Aster CMI Hospital, Bangalore, 560 092 India
| | | | | | - Sujit Chaudhuri
- Advanced Medicare Research Institute, Salt Lake, Kolkata, 700 091 India
| | - T. S. Chandrasekar
- Department of Gastroenterology, Medindia Hospitals, Nungambakkam, Chennai, 600 034 India
| | - Ashok Gupta
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226 014 India
| | - Mahesh Goenka
- Appollo Gleneagles Hospitals, Kolkata, 700 054 India
| | - Omesh Goyal
- Dayanand Medical College, Ludhiana, 141 001 India
| | - Govind Makharia
- All India Institute of Medical Sciences, New Delhi, 110 029 India
| | | | | | | | | | - D. N. Reddy
- Asian Institute of Gastroenterology, Hyderabad, 500 082 India
| | - Gautam Ray
- B R Singh Railway Hospital, Kolkata, 700 014 India
| | - Akash Shukla
- Lokmanya Tilak Municipal General Hospital and Medical College, Sion, Mumbai, 400 022 India
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El-Salhy M, Patcharatrakul T, Hatlebakk JG, Hausken T, Gilja OH, Gonlachanvit S. Enteroendocrine, Musashi 1 and neurogenin 3 cells in the large intestine of Thai and Norwegian patients with irritable bowel syndrome. Scand J Gastroenterol 2017; 52:1331-1339. [PMID: 28853300 DOI: 10.1080/00365521.2017.1371793] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The prevalence, gender distribution and clinical presentation of IBS differ between Asian and Western countries. This study aimed at studying and comparing enteroendocrine, Musashi 1 (Msi 1) and neurogenin 3 (neurog 3) cells in Thai and Norwegian IBS patients. MATERIAL AND METHODS Thirty Thai and 61 Norwegian IBS patients as well as 20 Thai and 24 Norwegian controls were included. Biopsy samples were taken from each of the sigmoid colon and the rectum during a standard colonoscopy. The samples were immunostained for serotonin, peptide YY, oxyntomodulin, pancreatic polypeptide, somatostatin, Msi 1 and neurog 3. The densities of immunoreactive cells were determined with computerized image analysis. RESULTS The densities of several enteroendocrine cell types were altered in both the colon and rectum of both Thai and Norwegian IBS patients. Some of these changes were similar in Thai and Norwegian IBS patients, while others differed. CONCLUSIONS The findings of abnormal densities of the enteroendocrine cells in Thai patients support the notion that enteroendocrine cells are involved in the pathophysiology of IBS. The present observations highlight that IBS differs in Asian and Western countries, and show that the changes in large-intestine enteroendocrine cells in Thai and Norwegian IBS patients might be caused by different mechanisms.
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Affiliation(s)
- Magdy El-Salhy
- a Department of Medicine, Section for Gastroenterology , Stord Helse-Fonna Hospital , Stord , Norway.,b Department of Clinical Medicine , University of Bergen , Bergen , Norway.,c Department of Medicine, National Centre for Functional Gastrointestinal Disorders , Haukeland University Hospital , Bergen , Norway
| | - Tanisa Patcharatrakul
- d Department of Medicine, GI Motility Research Unit, Division of Gastroenterology, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand.,e King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok , Thailand
| | - Jan Gunnar Hatlebakk
- b Department of Clinical Medicine , University of Bergen , Bergen , Norway.,c Department of Medicine, National Centre for Functional Gastrointestinal Disorders , Haukeland University Hospital , Bergen , Norway
| | - Trygve Hausken
- b Department of Clinical Medicine , University of Bergen , Bergen , Norway.,c Department of Medicine, National Centre for Functional Gastrointestinal Disorders , Haukeland University Hospital , Bergen , Norway.,e King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok , Thailand
| | - Odd Helge Gilja
- b Department of Clinical Medicine , University of Bergen , Bergen , Norway.,c Department of Medicine, National Centre for Functional Gastrointestinal Disorders , Haukeland University Hospital , Bergen , Norway.,f Department of Medicine , National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital , Bergen , Norway
| | - Sutep Gonlachanvit
- d Department of Medicine, GI Motility Research Unit, Division of Gastroenterology, Faculty of Medicine , Chulalongkorn University , Bangkok , Thailand.,e King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok , Thailand
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Rahman MM, Mahadeva S, Ghoshal UC. Epidemiological and clinical perspectives on irritable bowel syndrome in India, Bangladesh and Malaysia: A review. World J Gastroenterol 2017; 23:6788-6801. [PMID: 29085223 PMCID: PMC5645613 DOI: 10.3748/wjg.v23.i37.6788] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/23/2017] [Accepted: 09/13/2017] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder, common in clinic and in the community. It has a significant impact on both society and patients' quality of life. The epidemiology, clinical presentation, and management of IBS may vary in different geographical regions due to differences in diet, gastrointestinal infection, socio-cultural and psycho-social factors, religious and illness beliefs, symptom perception and reporting. Although previous reviews and consensus reports on IBS in Asia have been published, Asia is quite diverse socio-demographically. In this context, India, Bangladesh and Malaysia share some similarities, including: (1) large proportion of the population living in rural areas; (2) rapid development and associated lifestyle changes in urban areas; and (3) dietary, cultural and religious practices. The present review explores the clinical and epidemiological data on IBS from these three major nations in South and South-East Asia. In-depth review of the literature revealed important differences between IBS in the East, as revealed by studies from these three countries, and the West; these include a predominantly rural profile, differences in bowel habit and symptom profile, raising concern with regards to diagnostic criteria and subtyping of IBS, higher dietary fiber consumption, frequent lactose malabsorption, parasitosis, and possible overlap between post-infectious IBS and tropical sprue. Moreover, the current perception on difference in prevalence of the disorder in these countries, as compared to the West, might be related to variation in survey methods.
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Affiliation(s)
- M Masudur Rahman
- Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka 1000, Bangladesh
| | - Sanjiv Mahadeva
- Division of Gastroenterology, Department of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Uday C Ghoshal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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El-Salhy M, Patcharatrakul T, Hatlebakk JG, Hausken T, Gilja OH, Gonlachanvit S. Chromogranin A cell density in the large intestine of Asian and European patients with irritable bowel syndrome. Scand J Gastroenterol 2017; 52:691-697. [PMID: 28346031 DOI: 10.1080/00365521.2017.1305123] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Patients with irritable bowel syndrome (IBS) in Asia show distinctive differences from those in the western world. The gastrointestinal endocrine cells appear to play an important role in the pathophysiology of IBS. The present study aimed at studying the density of chromogranin A (CgA) cells in the large intestine of Thai and Norwegian IBS patients. METHODS Thirty Thai IBS patients and 20 control subjects, and 47 Norwegian IBS patients and 20 control subjects were included. A standard colonoscopy was performed in both the patients and controls, and biopsy samples were taken from the colon and the rectum. The biopsy samples were stained with hematoxylin-eosin and immunostained for CgA. The density of CgA cells was determined by computerized image analysis. RESULTS In the colon and rectum, the CgA cell densities were far higher in both IBS and healthy Thai subjects than in Norwegians. The colonic CgA cell density was lower in Norwegian IBS patients than in controls, but did not differ between Thai IBS patients and controls. In the rectum, the CgA cell densities in both Thai and Norwegian patients did not differ from those of controls. CONCLUSIONS The higher densities of CgA cells in Thai subjects than Norwegians may be explained by a higher exposure to infections at childhood and the development of a broad immune tolerance, by differences in the intestinal microbiota, and/or differing diet habits. The normal CgA cell density in Thai IBS patients in contrast to that of Norwegians may be due to differences in pathophysiology.
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Affiliation(s)
- Magdy El-Salhy
- a Department of Medicine, Section for Gastroenterology , Stord Helse-Fonna Hospital , Stord , Norway.,b Department of Clinical Medicine , University of Bergen , Bergen , Norway.,c Department of Medicine , National Centre for Functional Gastrointestinal Disorders, Haukeland University Hospital , Bergen , Norway
| | - Tanisa Patcharatrakul
- d Division of Gastroenterology, Department of Medicine Faculty of Medicine , GI Motility Research Unit, Chulalongkorn University , Bangkok , Thailand.,e Thai Red Cross Society , King Chulalongkorn Memorial Hospital , Bangkok , Thailand
| | - Jan Gunnar Hatlebakk
- b Department of Clinical Medicine , University of Bergen , Bergen , Norway.,c Department of Medicine , National Centre for Functional Gastrointestinal Disorders, Haukeland University Hospital , Bergen , Norway
| | - Trygve Hausken
- b Department of Clinical Medicine , University of Bergen , Bergen , Norway.,c Department of Medicine , National Centre for Functional Gastrointestinal Disorders, Haukeland University Hospital , Bergen , Norway.,e Thai Red Cross Society , King Chulalongkorn Memorial Hospital , Bangkok , Thailand
| | - Odd Helge Gilja
- b Department of Clinical Medicine , University of Bergen , Bergen , Norway.,c Department of Medicine , National Centre for Functional Gastrointestinal Disorders, Haukeland University Hospital , Bergen , Norway.,f Department of Medicine , National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital , Bergen , Norway
| | - Sutep Gonlachanvit
- d Division of Gastroenterology, Department of Medicine Faculty of Medicine , GI Motility Research Unit, Chulalongkorn University , Bangkok , Thailand.,e Thai Red Cross Society , King Chulalongkorn Memorial Hospital , Bangkok , Thailand
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Abstract
PURPOSE OF REVIEW Post-infectious irritable bowel syndrome (PI-IBS) is characterized by persistent abdominal pain and diarrhea, typically following an episode of infectious gastroenteritis. The mechanisms that underlie IBS-D remain elusive, but PI-IBS provides a mechanistic model of this disorder. This review provides an up-to-date appraisal of the pathophysiology, clinical features, and management approaches for PI-IBS. RECENT FINDINGS Disordered immune reactions and release of cytokines with resultant gut inflammation and dysfunction appear to be key features of PI-IBS. Disordered brain-gut-microbiota interactions, type of infecting agent, and host-genetic susceptibility are risk factors but also are reasons for the varying spectrum of clinical severity. Although prognosis is generally good, symptoms and inflammation may persist for a long time. Symptomatic relief with antidiarrheals, antispasmodics, 5HT3 antagonists, mesalamine, probiotics, and low-dose antidepressants remain the primary approaches, but in some difficult cases, a combination of drugs that target the pathophysiology may be helpful. PI-IBS has many overlapping features with IBS-D and shares similar pathophysiology and management approaches.
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Affiliation(s)
- Yeong Yeh Lee
- School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | - Satish S C Rao
- Section of Gastroenterology/Hepatology, Department of Internal Medicine, Medical College of Georgia, AD 2226, Digestive Health Center, Augusta University, 1481 Laney-Walker Blvd, Augusta, GA, 30912, USA.
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Ling Y, Yuan L, Haifeng Z, Xiaopeng M, Chunhui B, Huangan W, Chen Z, Guanghong D, Li Q, Shuang Z. Effect of warming moxibustion Tianshu (ST 25, bilateral) and Qihai (CV 6) for the treatment of diarrhea-dominant irritable bowel syndrome: a patient-blinded pilot trial with orthogonal design. J TRADIT CHIN MED 2017. [DOI: 10.1016/s0254-6272(17)30161-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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