1
|
Kim N. Sex- and Gender-related Issues of Gut Microbiota in Gastrointestinal Tract Diseases. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021. [DOI: 10.4166/kjg.2021.409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Mavroudis G, Simren M, Jonefjäll B, Öhman L, Strid H. Symptoms compatible with functional bowel disorders are common in patients with quiescent ulcerative colitis and influence the quality of life but not the course of the disease. Therap Adv Gastroenterol 2019; 12:1756284819827689. [PMID: 30815033 PMCID: PMC6383088 DOI: 10.1177/1756284819827689] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/19/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Whether patients with inactive ulcerative colitis (UC) have symptoms compatible with functional bowel disorders (FBDs) other than irritable bowel syndrome (IBS) is unclear. Our aim was to investigate the prevalence and burden of these symptoms and determine impact on the UC course. METHODS We used Mayo score, sigmoidoscopy and calprotectin (f-cal) to define remission in 293 UC patients. Presence of symptoms compatible with FBD, severity of gastrointestinal, extraintestinal and psychological symptoms, stress levels and quality of life (QoL) were measured with validated questionnaires. At 1 year later, remission was determined by modified Mayo score and f-cal in 171 of these patients. They completed the same questionnaires again. RESULTS A total of 18% of remission patients had symptoms compatible with FBD other than IBS, and 45% subthreshold symptoms compatible with FBD. The total burden of gastrointestinal symptoms in patients with symptoms compatible with FBD was higher than in patients without FBD (p < 0.001), which had negative impact on QoL (p = 0.02). These symptoms were not correlated with psychological distress, systemic immune activity or subclinical colonic inflammation and were not a risk factor for UC relapse during follow up. CONCLUSION Symptoms compatible with FBD other than IBS are common during UC remission influencing patients' QoL but not the UC course.
Collapse
Affiliation(s)
| | - Magnus Simren
- Sahlgrenska University Hospital, Department of
Internal Medicine, Gothenburg, Sweden,Institute of Medicine, Sahlgrenska Academy,
University of Gothenburg, Department of Internal Medicine and Clinical
Nutrition, Gothenburg, Sweden
| | - Börje Jonefjäll
- Institute of Medicine, Sahlgrenska Academy,
University of Gothenburg, Department of Internal Medicine and Clinical
Nutrition, Gothenburg, Sweden,Kungälv Hospital, Department of Internal
Medicine, Kungälv, Sweden
| | - Lena Öhman
- Institute of Medicine, Sahlgrenska Academy,
University of Gothenburg, Department of Internal Medicine and Clinical
Nutrition, Gothenburg, Sweden,Institute of Biomedicine, Sahlgrenska Academy,
University of Gothenburg, Department of Microbiology and Immunology,
Gothenburg, Sweden
| | - Hans Strid
- Institute of Medicine, Sahlgrenska Academy,
University of Gothenburg, Department of Internal Medicine and Clinical
Nutrition, Gothenburg, Sweden,Södra Älvsborg Hospital, Department of Internal
Medicine, Borås, Sweden
| |
Collapse
|
3
|
|
4
|
Park SH, Han KS, Kang CB. Relaxation Therapy for Irritable Bowel Syndrome: A Systematic Review. Asian Nurs Res (Korean Soc Nurs Sci) 2014. [DOI: 10.1016/j.anr.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
5
|
Veneziani S, Doria C, Falciati L, Castelli CC, Illic GF. Return to Competition in a Chronic Low Back Pain Runner: Beyond a Therapeutic Exercise Approach, a Case Report. Eur J Transl Myol 2014; 24:2221. [PMID: 26913133 PMCID: PMC4756742 DOI: 10.4081/ejtm.2014.2221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Chronic low back pain (CLBP) is a disabling condition affecting both quality of life and performance in athletes. Several approaches have been proposed in the field of physiotherapy, manual therapy, physical exercise and counseling. None apparently is outdoing the other with the exception of trunk stability exercises in specific conditions. The present paper describes a clinical success in managing a CLBP runner affected by MRI documented disk herniation via dietary change. Dietary changes allowed our patient that had failed with previous standard therapeutic approaches, to regain an optimal pain-free condition. We advance the hypothesis that a visceral-autonomic concomitant or primary disturbance possibly generating mild gastrointestinal discomfort in CLBP patients should be ruled out as a possible cause of pain and disability at the somato-motor level.
Collapse
Affiliation(s)
- Sergio Veneziani
- (1) Department of Neurosciences & Imaging, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy; (2) Orthopedics & Traumatology and Emergency&Urgency Departments, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Christian Doria
- (1) Department of Neurosciences & Imaging, University "G. D'Annunzio" Chieti-Pescara , Chieti, Italy
| | - Luca Falciati
- (3) Department of Clinical and Experimental Sciences, University of Brescia , Italy
| | - Claudio Carlo Castelli
- (2) Orthopedics & Traumatology and Emergency&Urgency Departments, "Papa Giovanni XXIII" Hospital , Bergamo, Italy
| | - Giorgio Fanò Illic
- (1) Department of Neurosciences & Imaging, University "G. D'Annunzio" Chieti-Pescara, Chieti, Italy; (4) A.S.I. Italian Space Agency, Rome, Italy
| |
Collapse
|
6
|
A clinical observation of irritable bowel syndrome treated by traditional Chinese spinal orthopedic manipulation. Complement Ther Med 2013; 21:613-7. [DOI: 10.1016/j.ctim.2013.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 08/20/2013] [Accepted: 09/15/2013] [Indexed: 11/22/2022] Open
|
7
|
Faresjö Å, Grodzinsky E, Hallert C, Timpka T. Patients with irritable bowel syndrome are more burdened by co-morbidity and worry about serious diseases than healthy controls--eight years follow-up of IBS patients in primary care. BMC Public Health 2013; 13:832. [PMID: 24025070 PMCID: PMC3847157 DOI: 10.1186/1471-2458-13-832] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 08/30/2013] [Indexed: 12/13/2022] Open
Abstract
Background Irritable Bowel Syndrome (IBS) is a hidden public health disease that affects up to 20% of the general population. Although co-morbidity can affect diagnose setting and treatment of the disease, there are few studies concerning diagnosed and registered co-morbidity for IBS patients in primary care. The aim of this study was to analyse co-morbidity among IBS-patients compared to age- and sex-matched controls from the general population using data from a county-wide computerized medical record system. Methods IBS cases were recruited from three Swedish primary health care centres during a five-years period and controls from the same corresponding geographical areas. Co-morbidity data for IBS-patients and morbidity data for controls were derived from a population-based Health Care Register (HCR) covering all diagnoses in primary as well as hospital care in the region. Odds Ratios with 95% confidence intervals for morbidity in gastro-intestinal and non-gastrointestinal diagnoses for cases with irritable bowel syndrome compared to controls were calculated separately for each gender and diagnosis. Results We identified more co-morbidity among IBS patients of both sexes, compared to matched controls in the general population. Patients with IBS were particularly more worried about having a serious disease than their control group. The risk among male IBS-cases to get this latter diagnose was three times higher compared to the male controls. Conclusions In this population based case–control study, the analysis of diagnoses from the HCR revealed a broad spectrum of common co-morbidity and significantly more physician-recorded diagnoses among IBS-patients in comparisons to the control group.
Collapse
Affiliation(s)
- Åshild Faresjö
- Department of Medicine and Health, Community Medicine, Linköping University, Linköping, Sweden.
| | | | | | | |
Collapse
|
8
|
Park JW, Cho YS, Lee SY, Kim ES, Cho H, Shin HE, Suh GI, Choi MG. Concomitant functional gastrointestinal symptoms influence psychological status in Korean migraine patients. Gut Liver 2013; 7:668-74. [PMID: 24312707 PMCID: PMC3848535 DOI: 10.5009/gnl.2013.7.6.668] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/22/2013] [Accepted: 02/08/2013] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Migraine is frequently accompanied by symptoms consistent with functional gastrointestinal disorders (FGIDs). This study evaluated the prevalence of functional gastrointestinal symptoms and assessed the symptoms' relationship with the concomitant functional symptoms of anxiety, depression, and headache-related disability. Methods This prospective study included 109 patients with migraine who were recruited from a headache clinic at a teaching hospital. The participants completed a self-administered survey that collected information on headache characteristics, functional gastrointestinal symptoms (using Rome III criteria to classify FGID), anxiety, depression, and headache-related disability. Results In total, 71% of patients met the Rome III criteria for at least one FGID. In patients with FGID, irritable bowel syndrome was the most common symptom (40.4%), followed by nausea and vomiting syndrome (24.8%) and functional dyspepsia (23.9%). Depression and anxiety scores were significantly higher in patients meeting the criteria for any FGID. The number of the symptoms consistent with FGID in individual patients correlated positively with depression and anxiety. Conclusions FGID symptoms defined by the Rome III criteria are highly prevalent in migraine. These symptoms correlate with psychological comorbidities, such as depression and anxiety.
Collapse
Affiliation(s)
- Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea College of Medicine, Uijeongbu, Korea
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Qu L, Xing L, Norman W, Chen H, Gao S. Irritable bowel syndrome treated by traditional Chinese spinal orthopedic manipulation. J TRADIT CHIN MED 2013; 32:565-70. [PMID: 23427390 DOI: 10.1016/s0254-6272(13)60072-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the clinical effect of traditional Chinese spinal orthopedic manipulation (TCSOM) in treating irritable bowel syndrome (IBS) compared with pinaverium bromide Dicetel (PBD), and to assess a possible cause for IBS. METHODS Two hundred ten IBS patients were randomly divided into the TCSOM group and the PBD group. All patients in the TCSOM group were treated with spinal manipulations 5 times. Pain intensity was assessed on a visual analogue scale and symptoms were evaluated based on bowel symptom scale (BSS) scores before and after treatment. A symptom improvement rating (SIR) was implemented to evaluate the effects of treatment, and to statistically compare the TCSOM and PBD groups. RESULTS Post-treatment subjective assessment for the TCSOM treatment group showed that 92 cases had excellent results, 10 cases had good results, 3 cases had fair results, and 0 cases had poor results. In the PBD group, 30 cases had excellent results, 41 cases had good results, 12 cases had fair results, and 22 cases had poor results. According to the SIR, which was based on the BSS, the TCSOM group included 92 cases with excellent results, 10 cases with good results and 3 cases with poor results. There were no adverse side effects from treatment. Based on the BSS, the PBD group had 30 cases with excellent results, 41 cases with good results, and 34 cases with poor results. We found that the symptom rating in the BSS in the TCSOM group showed a more significant improvement, such as a reduction in the severity and frequency of symptoms, compared with that in the PBD group (P < 0.001). CONCLUSION Displacement of intervertebral discs and/or vertebra in the thoracic or lumbar region appears to be a contributing factor in the symptoms of IBS. Correcting this displacement of intervertebral discs and/or vertebra to resolve the stimuli caused by pressure exerted on the nerves and vessels around the spine is an effective treatment for IBS.
Collapse
Affiliation(s)
- Liuxin Qu
- Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210009, China.
| | | | | | | | | |
Collapse
|
10
|
Osteopathy improves the severity of irritable bowel syndrome: a pilot randomized sham-controlled study. Eur J Gastroenterol Hepatol 2012; 24:944-9. [PMID: 22546751 DOI: 10.1097/meg.0b013e3283543eb7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Effective therapies for irritable bowel syndrome (IBS) are disappointing. Therefore, IBS patients have a growing interest for alternative medicines including osteopathy. AIM We aimed to evaluate the effect of osteopathy on the severity of IBS in a randomized sham-controlled trial. METHODS We prospectively assigned 30 patients with IBS (23F, 7M, mean age 45.8±16.4 years) fulfilling the Rome III criteria in a 2/1 ratio to receive either osteopathy or sham osteopathy. Two separate sessions were performed at a 7-day interval (days 0 and 7) with a further 3 weeks of follow-up (day 28). The primary outcome included at least a 25% improvement in the IBS severity score at day 7. The secondary outcomes included the impact of IBS on quality of life, psychological factors, and bowel habits. RESULTS The severity of IBS decreased in both groups at days 7 and 28. At day 7, this decrease was significantly more marked in patients receiving osteopathy compared with those receiving the sham procedure (-32.2±29.1 vs. -9.0±16.0, mean difference normalized to the baseline P=0.01). This difference did not persist at day 28 (P=0.4). Both anxiety and depression scores decreased without difference between groups. Stool frequency and consistency were not significantly modified. CONCLUSION Osteopathy improves the severity of IBS symptoms and its impact on quality of life. Osteopathy should therefore be considered for future research as an effective complementary alternative medicine in the management of IBS symptoms.
Collapse
|
11
|
Functional abdominal pain patient subtypes in childhood predict functional gastrointestinal disorders with chronic pain and psychiatric comorbidities in adolescence and adulthood. Pain 2012; 153:1798-1806. [PMID: 22721910 DOI: 10.1016/j.pain.2012.03.026] [Citation(s) in RCA: 158] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 03/19/2012] [Accepted: 03/26/2012] [Indexed: 12/12/2022]
Abstract
Although pediatric functional abdominal pain (FAP) has been linked to abdominal pain later in life, childhood predictors of long-term outcomes have not been identified. This study evaluated whether distinct FAP profiles based on patterns of pain and adaptation in childhood could be identified and whether these profiles predicted differences in clinical outcomes and central sensitization (wind-up) on average 9years later. In 843 pediatric FAP patients, cluster analysis was used to identify subgroups at initial FAP evaluation based on profiles of pain severity, gastrointestinal (GI) and non-GI symptoms, pain threat appraisal, pain coping efficacy, catastrophizing, negative affect, and activity impairment. Three profiles were identified: high pain dysfunctional, high pain adaptive, and low pain adaptive. Logistic regression analyses controlling for age and sex showed that, compared with pediatric patients with the low pain adaptive profile, those with the high pain dysfunctional profile were significantly more likely at long-term follow-up to meet criteria for pain-related functional gastrointestinal disorder (FGID) (odds ratio: 3.45, confidence interval: 1.95 to 6.11), FGID with comorbid nonabdominal chronic pain (odds ratio: 2.6, confidence interval: 1.45 to 4.66), and FGID with comorbid anxiety or depressive psychiatric disorder (odds ratio: 2.84, confidence interval: 1.35 to 6.00). Pediatric patients with the high pain adaptive profile had baseline pain severity comparable to that of the high pain dysfunctional profile, but had outcomes as favorable as the low pain adaptive profile. In laboratory pain testing at follow-up, high pain dysfunctional patients showed significantly greater thermal wind-up than low pain adaptive patients, suggesting that a subgroup of FAP patients has outcomes consistent with widespread effects of heightened central sensitization.
Collapse
|
12
|
Wilson IM, Kerr D, Lennon S. Do people with an ileostomy have a different back pain experience to those with a colostomy? A postal survey in Northern Ireland. Disabil Rehabil 2011; 32:1847-54. [PMID: 20331417 DOI: 10.3109/09638281003734490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The abdominal muscles play a vital role in lumbar stability. The stoma surgery creates a permanent flaw in the abdominal wall and this may increase the risk of low back pain for people with a stoma. PURPOSE To determine whether there was a difference in back pain experience between the two stoma groups: ileostomy and colostomy. METHOD A postal questionnaire sent to people in Northern Ireland with an ileostomy or colostomy. RESULT Over half (56.7%, n = 417) had back pain in the last 6 months and the primary perceived cause was the stoma surgery. There was a statistically significant deterioration in functional activities in those with back pain when 'today' was compared with 'before surgery'. Those with a colostomy had generally poorer outcomes in respect of pain and disability, than those with an ileostomy. CONCLUSION Low back pain in people with a stoma is a real and complex issue, especially as there are significant differences between those with an ileostomy when compared with people with a colostomy. Many factors are likely to contribute to a person developing low back pain, not least, the underlying reason for the surgery and the surgical procedure itself.
Collapse
Affiliation(s)
- Iseult M Wilson
- University of Ulster, School of Health Sciences, Newtownabbey BT37 OQB, United Kingdom.
| | | | | |
Collapse
|
13
|
Wang SJ, Chen PK, Fuh JL. Comorbidities of migraine. Front Neurol 2010; 1:16. [PMID: 21188255 PMCID: PMC3008936 DOI: 10.3389/fneur.2010.00016] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 06/28/2010] [Indexed: 12/18/2022] Open
Abstract
Migraine is a common neurological disorder and can be severely disabling during attacks. The highest prevalence occurs between the ages of 25 and 55 years, potentially the most productive period of life. Migraine leads to a burden not only for the individual, but also for the family and society in general. Prior studies have found that migraine occurs together with other illnesses at a greater coincidental rate than is seen in the general population. These occurrences are called “comorbidities,” which means that these disorders are interrelated with migraine. To delineate the comorbidities of migraine is important, because it can help improve treatment strategies and the understanding of the possible pathophysiology of migraine. The comorbid illnesses in patients with migraine include stroke, sub-clinical vascular brain lesions, coronary heart disease, hypertension, patent foramen ovale, psychiatric diseases (depression, anxiety, bipolar disorder, panic disorder, and suicide), restless legs syndrome, epilepsy and asthma. In this paper, we review the existing epidemiological and hospital-based studies, and illustrate the connections between these illnesses and migraine.
Collapse
Affiliation(s)
- Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital Taipei, Taiwan
| | | | | |
Collapse
|
14
|
Guo YJ, Ho CH, Chen SC, Yang SS, Chiu HM, Huang KH. Lower urinary tract symptoms in women with irritable bowel syndrome. Int J Urol 2010; 17:175-81. [DOI: 10.1111/j.1442-2042.2009.02442.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
15
|
Park JH, Byeon JS, Shin WG, Yoon YH, Cheon JH, Lee KJ, Park H. Diagnosis of Irritable Bowel Syndrome: a Systematic Review. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2010; 55:308-15. [DOI: 10.4166/kjg.2010.55.5.308] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jung Ho Park
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Woon-Geon Shin
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Young Hun Yoon
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Jae Lee
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Hyojin Park
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | |
Collapse
|
16
|
Im JP, Kim BG, Kim JW, Lee KL, Son H, Kim JS, Jung HC, Song IS. [Association of lower urinary tract symptoms with irritable bowel syndrome in adult men - an internet-based survey]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2009; 53:348-54. [PMID: 19556841 DOI: 10.4166/kjg.2009.53.6.348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Patients with irritable bowel syndrome (IBS) are more likely to experience certain urinary symptoms. The aims of this study were to investigate the association between lower urinary tract symptoms (LUTS) and IBS, and to determine their impact on the quality of life. METHODS E-mails were sent to 23,594 men who were registered at an internet survey company. Subjects were requested to fill out the questionnaires regarding IBS and LUTS assessed by the International Prostate Symptom Score (IPSS). RESULTS Among 601 subjects (mean age, 35.5+/-8.4) included in the final analysis, 118 (19.6%) fulfilled the Rome II criteria for the diagnosis of IBS. The total mean IPSS of IBS subjects was 9.6, which was significantly higher than the 7.0 of non-IBS subjects (p<0.01). When IPSS was subcategorized into mild, moderate, and severe symptom categories, the proportions with the moderate and severe symptoms among IBS subjects were 33.9% and 13.6% respectively, which were significantly higher than those of non-IBS subjects; (26.9 and 5.2%) (p<0.01). In multivariate analysis, statistically significant association was found between IBS and moderate to severe LUTS (OR, 1.91; 95% CI, 1.27-2.88). IBS subjects also showed a poorer quality of life score than non-IBS subjects (2.24 vs. 1.65, p< 0.001). CONCLUSIONS LUTS in adult men with IBS are more severe and have a more negative impact on the quality of life than in non-IBS subjects.
Collapse
Affiliation(s)
- Jong Pil Im
- Seoul National University Hospital Kangnam Center, Department of Internal Medicine, Seoul National University Boramae Hospital, Seoul, Korea
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Hershcovici T, Zimmerman J. Nondigestive symptoms in non-erosive reflux disease: nature, prevalence and relation to acid reflux. Aliment Pharmacol Ther 2008; 28:1127-33. [PMID: 18702676 DOI: 10.1111/j.1365-2036.2008.03830.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nondigestive symptoms are frequent in the irritable bowel syndrome (IBS). AIM To characterize nondigestive symptoms in non-erosive gastro-oesophageal reflux disease (NERD) patients, as features of IBS are common in patients with NERD. METHODS A prospective, case-control study. NERD was defined in patients with reflux symptoms, a normal oesophageal mucosa and oesophageal pH < 4 for > or = 5% of the time during 24-h pH monitoring. Nondigestive symptoms were scored on validated scales of somatic pain, urinary, sleep and neurasthenia. IBS was defined by the Rome I criteria. RESULTS pH-positive NERD patients (n = 326) scored significantly higher than controls (nonpatient hospital visitors; n = 174) on all scales. The scores of pain, sleep and neurasthenia were highly specific in the discrimination of NERD patients from controls. In patients, nondigestive symptoms were independently associated with age, reflux symptoms severity and IBS status, but not with oesophageal acid exposure. NERD patients who met diagnostic criteria for IBS (49%) scored significantly higher on all the nondigestive symptoms scales than those had not met [IBS(-)]. Yet, IBS(-) patients scored significantly higher than controls on all scales. CONCLUSIONS Nondigestive symptoms were highly prevalent in NERD patients and were specific in their discrimination from controls. Nondigestive symptoms correlated with reflux symptoms and were predicted by IBS status.
Collapse
Affiliation(s)
- T Hershcovici
- Gastroenterology Unit, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.
| | | |
Collapse
|
18
|
|
19
|
Poitras P, Gougeon A, Binn M, Bouin M. Extra digestive manifestations of irritable bowel syndrome: intolerance to drugs? Dig Dis Sci 2008; 53:2168-76. [PMID: 18095162 DOI: 10.1007/s10620-007-0123-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 11/09/2007] [Indexed: 12/28/2022]
Abstract
Patients with IBS frequently complain of medication side effects. The goals of this study were to assess the prevalence of drug intolerance as an extra GI manifestation in patients with IBS and to verify the association between drug intolerance and psychological comorbidity. Female patients followed in a tertiary care center completed questionnaires assessing the presence of drug intolerance as well as somatic and psychological extra GI conditions. IBS patients (Rome II criteria; n = 71) were compared to inflammatory bowel disease patients (IBD; n = 96) or to healthy controls (HC; n = 67). The relationship to psychological comorbidity was verified in two different paradigms: (1) by looking at the statistical correlation between drug intolerance and the psychological extra GI symptoms in our IBS patients, and (2) by comparing in a meta-analysis the side effects to placebo (the nocebo effect is presumably increased due to hypervigilance or amplification in psychological disorders) in IBS patients or in patients with comparable medical conditions included in various drug trials approved by Health Canada. Our results show that prevalence of drug intolerance was significantly more elevated in IBS (41% patients) than in HC (7%) or in IBD (27%); somatic and psychological extra GI symptoms were also markedly increased in IBS. In addition, drug intolerance in our IBS patients was significantly associated with somatic comorbidities such as fatigue or multiple symptoms (P < 0.001), but not with psychological factors such as depression, anxiety, mood instability, or sleep disorder. A meta-analysis revealed that the nocebo effect was not different in patients with IBS than in control patients. In conclusion, drug intolerance is a frequent extra GI manifestation of IBS that is not associated with psychological comorbidity; thus, a somatic origin must be explored.
Collapse
Affiliation(s)
- Pierre Poitras
- Centre de Recherche, Centre Hospitalier de l'Université de Montréal-Hôpital Saint-Luc, Montréal, Québec, Canada.
| | | | | | | |
Collapse
|
20
|
Riedl A, Schmidtmann M, Stengel A, Goebel M, Wisser AS, Klapp BF, Mönnikes H. Somatic comorbidities of irritable bowel syndrome: a systematic analysis. J Psychosom Res 2008; 64:573-82. [PMID: 18501257 DOI: 10.1016/j.jpsychores.2008.02.021] [Citation(s) in RCA: 169] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 02/05/2008] [Accepted: 02/07/2008] [Indexed: 02/07/2023]
Abstract
OBJECTIVE A large number of irritable bowel syndrome (IBS) patients are additionally afflicted with other somatic intestinal and/or extraintestinal comorbidities. The occurrence of one or more comorbidities is correlated with enhanced medical help seeking, worse prognosis, and higher rates of anxiety and depression-all resulting in a reduced quality of life. The aims of this study were, firstly, to review the literature on comorbidities of IBS and to assess gastrointestinal and extraintestinal comorbidities, and, secondly, to evaluate explanatory hypotheses and possible common pathophysiological mechanisms. METHODS We systematically reviewed the scientific literature in the past 25 years, as cited in MEDLINE. RESULTS IBS patients present with a twofold increase in somatic comorbidities compared to controls, possibly caused by common pathophysiological mechanisms. Nevertheless, to date, there has been no convincing evidence for a consolidated underlying pathophysiology or somatization. Gastrointestinal disorders, such as functional dyspepsia, gastroesophageal reflux disease, functional constipation, and anal incontinence, occur in almost half of the patients. In a broad variety of extraintestinal comorbidities, fibromyalgia, chronic fatigue syndrome, and chronic pelvic pain are best documented and appear in up to 65%. CONCLUSION The knowledge and structured assessment of comorbid somatic symptoms might allow to identify subgroups of IBS patients with special characteristics and lead to adaptation of the therapeutic concept.
Collapse
Affiliation(s)
- Andrea Riedl
- Division of Hepatology, Gastroenterology, and Endocrinology, Department of Medicine, Charité-University Medical Center, Campus Virchow, Berlin, Germany
| | | | | | | | | | | | | |
Collapse
|
21
|
Bassett JT, Cash BD. A review of irritable bowel syndrome and an update on therapeutic approaches. Expert Opin Pharmacother 2008; 9:1129-43. [DOI: 10.1517/14656566.9.7.1129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
22
|
Usai P, Manca R, Cuomo R, Lai MA, Boi MF. Effect of gluten-free diet and co-morbidity of irritable bowel syndrome-type symptoms on health-related quality of life in adult coeliac patients. Dig Liver Dis 2007; 39:824-8. [PMID: 17644056 DOI: 10.1016/j.dld.2007.05.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 05/03/2007] [Accepted: 05/21/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND Both coeliac disease and irritable bowel syndrome show impaired health-related quality of life, however, the impact of irritable bowel syndrome-type symptoms on health-related quality of life in coeliac disease is unclear. AIM To evaluate the effect of gluten-free diet adherence and irritable bowel syndrome-type symptoms co-morbidity on health-related quality of life in adult coeliac disease patients. PATIENTS AND METHODS A total of 1130 adults were enrolled in the study comprising 1001 controls from the general population and 129 diagnosed coeliac disease patients from the University Clinic in Cagliari. Irritable bowel syndrome-type symptoms and health-related quality of life were assessed using the Rome II and the SF-36 questionnaires, respectively. RESULTS Irritable bowel syndrome-type symptoms prevalence in controls was 10.1% (102/1001) and 55% (71/129) in the coeliac disease patients. Irritable bowel syndrome-type symptom controls and coeliac disease patients both presented significantly lower health-related quality of life (p<or=0.05) compared to healthy controls. Strict diet coeliac disease patients, compared to partial diet patients, showed significantly (p<or=0.05) better scores in all domains, except physical functioning, physical-role and bodily pain. The lowest scores were found in partial diet coeliac disease patients with irritable bowel syndrome-type symptoms. CONCLUSIONS The present results confirm the burden of irritable bowel syndrome-type symptoms and coeliac disease on health-related quality of life. Moreover, these data show that health-related quality of life in coeliac disease is impaired by poor compliance and by co-morbidity with irritable bowel syndrome-type symptoms.
Collapse
Affiliation(s)
- P Usai
- Gastroenterology Unit, University of Cagliari, S.S. 554 Bivio per Sestu, 09042 Monserrato (CA), Italy.
| | | | | | | | | |
Collapse
|
23
|
Piche T, Huet PM, Gelsi E, Barjoan EM, Cherick F, Caroli-Bosc FX, Hébuterne X, Tran A. Fatigue in irritable bowel syndrome: characterization and putative role of leptin. Eur J Gastroenterol Hepatol 2007; 19:237-43. [PMID: 17301651 DOI: 10.1097/01.meg.0000252627.50302.b4] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Fatigue has received little attention in the irritable bowel syndrome. Emerging evidence exists that leptin may be involved in the pathogenesis of fatigue in several conditions. We aimed to evaluate the occurrence of fatigue and its characteristics in irritable bowel syndrome and to analyze the relationship between fatigue and leptin. METHODS We enrolled 51 consecutive irritable bowel syndrome patients and 22 healthy controls without fatigue. None of them were depressed. The Fatigue Impact Scale was used to evaluate fatigue. RESULTS In all, 62.7% of irritable bowel syndrome patients verbally expressed fatigue and rated more than 4 on the visual analog scale. The total score of fatigue was significantly higher in irritable bowel syndrome than in controls. In irritable bowel syndrome patients, but not in controls, a significant association was found between the total score of fatigue and leptin and this association was more pronounced in 32 irritable bowel syndrome patients who verbally expressed fatigue (r=0.60; P=0.0003). In irritable bowel syndrome, leptin correlated with fatigue independently from age, sex, fat mass and body mass index. CONCLUSIONS Our study shows that fatigue occurs in 62.7% of irritable bowel syndrome patients when systematically asked for. Fatigue influences all three domains of the Fatigue Impact Scale in irritable bowel syndrome, the most being the physical and the psychosocial domains. Fatigue is associated with circulating leptin levels independently from age, sex, fat mass and body mass index in irritable bowel syndrome. The metabolic sequence involved in the occurrence of fatigue remains to be determined.
Collapse
Affiliation(s)
- Thierry Piche
- Department of Hepatogastroenterology, CHU, Nice, France.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Ladep NG, Obindo TJ, Audu MD, Okeke EN, Malu AO. Depression in patients with irritable bowel syndrome in Jos, Nigeria. World J Gastroenterol 2006; 12:7844-7. [PMID: 17203531 PMCID: PMC4087553 DOI: 10.3748/wjg.v12.i48.7844] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the brain-gut interaction and the effect of behavioral or psychiatric conditions on irritable bowel syndrome (IBS) in an African population.
METHODS: IBS was diagnosed using the Rome II diagnostic criteria. The entry of each patient was confirmed following detailed explanations of the questions. Four hundred and eighteen patients were studied. Subjects satisfying the Rome II criteria for IBS were physically examined and stool microscopy was done to identify the presence of “alarm factors”. Depression was diagnosed using the symptom-check list adapted from the Research Diagnostic Criteria (DSM-IV) of the American Psychiatric Association.
RESULTS: Seventy-five (56.8%) of the 132 IBS patients were depressed whereas only 54 (20.1%) of the 268 non-IBS patients were depressed. There was a significant relationship between IBS and depression (χ2 = 54.29, Odds ratio = 5.21, 56.8 ± 8.4 vs 20.1 ± 5.2, P = 0.001). Even though constipation predominant IBS patients were more likely to be depressed, no significant relationship was found between the subtype of IBS and depression (χ2 = 0.02, OR = 0.95, P = 0.68).
CONCLUSION: IBS is significantly associated with major depression but not gender and bowel subtypes of the patients. Patients with IBS need to be evaluated for depression due to the highly significant relationship between the two conditions.
Collapse
Affiliation(s)
- Nimzing-G Ladep
- Department of Medicine, Faculty of Medical Sciences, University of Jos, Nigeria.
| | | | | | | | | |
Collapse
|
25
|
Whorwell PJ, Altringer L, Morel J, Bond Y, Charbonneau D, O'Mahony L, Kiely B, Shanahan F, Quigley EMM. Efficacy of an encapsulated probiotic Bifidobacterium infantis 35624 in women with irritable bowel syndrome. Am J Gastroenterol 2006; 101:1581-90. [PMID: 16863564 DOI: 10.1111/j.1572-0241.2006.00734.x] [Citation(s) in RCA: 497] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Probiotic bacteria exhibit a variety of properties, including immunomodulatory activity, which are unique to a particular strain. Thus, not all species will necessarily have the same therapeutic potential in a particular condition. We have preliminary evidence that Bifidobacterium infantis 35624 may have utility in irritable bowel syndrome (IBS). OBJECTIVES This study was designed to confirm the efficacy of the probiotic bacteria B. infantis 35624 in a large-scale, multicenter, clinical trial of women with IBS. A second objective of the study was to determine the optimal dosage of probiotic for administration in an encapsulated formulation. METHODS After a 2-wk baseline, 362 primary care IBS patients, with any bowel habit subtype, were randomized to either placebo or freeze-dried, encapsulated B. infantis at a dose of 1 x 10(6), 1 x 10(8), or 1 x 10(10), cfu/mL for 4 wk. IBS symptoms were monitored daily and scored on to a 6-point Likert scale with the primary outcome variable being abdominal pain or discomfort. A composite symptom score, the subject's global assessment of IBS symptom relief, and measures of quality of life (using the IBS-QOL instrument) were also recorded. RESULTS B. infantis 35624 at a dose of 1 x 10(8) cfu was significantly superior to placebo and all other bifidobacterium doses for the primary efficacy variable of abdominal pain as well as the composite score and scores for bloating, bowel dysfunction, incomplete evacuation, straining, and the passage of gas at the end of the 4-wk study. The improvement in global symptom assessment exceeded placebo by more than 20% (p < 0.02). Two other doses of probiotic (1 x 10(6) and 1 x 10(10)) were not significantly different from placebo; of these, the 1 x 10(10) dose was associated with significant formulation problems. No significant adverse events were recorded. CONCLUSIONS B. infantis 35624 is a probiotic that specifically relieves many of the symptoms of IBS. At a dosage level of 1 x 10(8) cfu, it can be delivered by a capsule making it stable, convenient to administer, and amenable to widespread use. The lack of benefits observed with the other dosage levels of the probiotic highlight the need for clinical data in the final dosage form and dose of probiotic before these products should be used in practice.
Collapse
Affiliation(s)
- Peter J Whorwell
- Department of Medicine, University of Manchester, Manchester, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Mearin F, Badía X, Balboa A, Benavent J, Caballero AM, Domínguez-Muñoz E, Garrigues V, Piqué JM, Roset M, Cucala M, Figueras M. Predictive factors of irritable bowel syndrome improvement: 1-year prospective evaluation in 400 patients. Aliment Pharmacol Ther 2006; 23:815-26. [PMID: 16556184 DOI: 10.1111/j.1365-2036.2006.02828.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The natural history of the irritable bowel syndrome is poorly understood. AIM To assess the clinical course of the irritable bowel syndrome and the factors that might predict it. METHODS An observational prospective study, involving 400 irritable bowel syndrome patients meeting Rome II criteria. Symptoms were recorded in a diary over four non-consecutive months (1, 4, 7 and 10). Demographic data, associated disorders, psychological status and health-related quality of life were obtained. RESULTS At 1-year follow-up, half of the patients and half of their physicians considered irritable bowel syndrome to have improved, but improvement was minor. Diary data showed that, according to the type of symptom, improvement was small and quite different: diarrhoea in 19% of patients, abdominal pain frequency in 26%, constipation in 33% and abdominal pain intensity in 60%. Factors related to improvement at one year were: severe symptoms and poor health-related quality of life at first visit, irritable bowel syndrome-constipation, good improvement at 3 months, anxiety/depression, stress, symptoms related to meals and absence of comorbidity. By multivariate logistic regression, predictors were: severe basal symptoms and good improvement at 3 months (OR:CI 95%, 1.32:1.09-1.59 and 4.44:2.81-7.05). CONCLUSIONS At 1-year follow-up, half the patients and their physicians considered the irritable bowel syndrome to have had some improvement but, symptom diaries demonstrated that improvement was small and heterogeneous. Severe basal symptoms and improvement at 3 months were related to better prognosis.
Collapse
Affiliation(s)
- F Mearin
- Institute of Functional and Motor Digestive Disorders, Centro Médico Teknon, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Piche T, Huet PM, Tran A. Treatment of fatigue in hepatogastroenterology: fact or fiction? GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2005; 29:561-3. [PMID: 15980751 DOI: 10.1016/s0399-8320(05)82129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
|
28
|
Vandvik PO, Wilhelmsen I, Ihlebaek C, Farup PG. Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications. Aliment Pharmacol Ther 2004; 20:1195-203. [PMID: 15569123 DOI: 10.1111/j.1365-2036.2004.02250.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Somatic comorbid symptoms might identify irritable bowel syndrome patients with different aetiologies and needs of treatment. AIMS To measure comorbid symptoms in patients with irritable bowel syndrome in general practice, and to explore characteristics of patients with low, intermediate and high somatic comorbidity. METHODS Prospective study of 208 of 278 consecutive patients with irritable bowel syndrome (Rome II) in nine general practices. Questionnaires assessed 22 comorbid symptoms (subjective health complaint inventory), psychosocial factors including psychological distress (Symptom Check list-10) and quality of life (Short form-12). Subjective health complaint data from 1240 adults (controls) constituted a reference material. Patients with low, intermediate and high somatic comorbidity were identified by a somatic comorbidity score (17 subjective health complaint items). Health care seeking was assessed after 6-9 months. RESULTS Patients with irritable bowel syndrome (67% females, mean age 50, s.d. 16) reported 20 of 22 comorbid symptoms significantly more frequent than controls (odds ratios = 2-7, P < 0.001). The somatic comorbidity score correlated with psychological distress (R = 0.46, P < 0.001). Patients with high somatic comorbidity reported higher levels of mood disorder, health anxiety, neuroticism, adverse life events and reduced quality of life and increased health care seeking when compared to those with low and intermediate somatic comorbidity (P-values < 0.05). CONCLUSIONS Our findings support the hypothesis that structured assessment of comorbid somatic symptoms might identify subgroups with different aetiology and needs of treatment.
Collapse
Affiliation(s)
- P O Vandvik
- Department of Medicine, Innlandet Hospital Health Authority, Gjøvik, Norway.
| | | | | | | |
Collapse
|
29
|
|
30
|
Abstract
PURPOSE The aims of this review are 1) to consider the hypothesis that interstitial cystitis (IC) is not a single disease entity in all patients by reviewing the evidence for the presence of IC subtypes and for the comorbidity of various unexplained clinical conditions in some patients with IC, and 2) to describe recent results obtained in humans and in cats with severe feline IC (FIC) that suggest the presence of an underlying neuroendocrine abnormality. MATERIALS AND METHODS The IC literature concerning comorbidity with other disorders was reviewed and these findings were compared with those of investigators studying the comorbid disorders and comparable data on cats with FIC. RESULTS A significant overlap of symptoms exists among a number of unexplained clinical conditions and a common stress response pattern of increased sympathetic nervous system function in the absence of comparable activation of the hypothalamic-pituitary-adrenal axis occurs in a subset of patients with many of these conditions. A comparable pattern exists in cats with FIC, which also includes increased corticotropin releasing factor activity and decreased adrenocortical reserve. CONCLUSIONS Further investigation of the stress response system of patients with IC seems merited, which may provide novel approaches to therapy in some patients.
Collapse
Affiliation(s)
- C A Tony Buffington
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
31
|
Abstract
Irritable bowel syndrome (IBS) represents one of the most common reasons for primary care visits and consultation with a gastroenterologist. It is characterized by abdominal discomfort, bloating and disturbed defecation in the absence of any identifiable physical, radiologic or laboratory abnormalities indicative of organic gastrointestinal disease. IBS is a costly disorder, responsible for significant direct and indirect costs to patients and society. Much of the cost attributed to IBS arises from the time and resources used to establish the diagnosis. Historically IBS has been viewed by many as a diagnosis of exclusion rather than as a primary diagnosis, and many patients with typical symptoms will undergo an extensive array of diagnostic tests and procedures prior to the eventual diagnosis of IBS. Recent reviews addressing the management of such patients have cast doubt on the necessity for this degree of testing. Current best evidence does not support the routine use of blood tests, stool studies, breath tests, abdominal imaging or lower endoscopy in order to exclude organic gastrointestinal disease in patients with typical IBS symptoms without alarm features. Serological testing for celiac sprue in this population may eventually prove useful but validation of studies indicating an increased prevalence of this disease in patients with suspected IBS is needed. The development and refinement of symptom-based criteria defining the clinical syndrome of IBS has greatly facilitated the diagnosis of this condition, which can be confidently diagnosed through the identification of typical symptoms, normal physical examination and the exclusion of alarm features. The presence of alarm features or persistent non-response to symptom-directed therapies should prompt a more detailed diagnostic evaluation dictated by the patient's predominant symptoms.
Collapse
Affiliation(s)
- B D Cash
- Division of Gastroenterology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | |
Collapse
|
32
|
Extraintestinal symptoms in irritable bowel syndrome and inflammatory bowel diseases: nature, severity, and relationship to gastrointestinal symptoms. Dig Dis Sci 2003. [PMID: 12741465 DOI: 10.1016/s0016-5085(01)83160-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Patients suffering from the irritable bowel syndrome (IBS) tend to have extraintestinal symptoms. The purposes of this study were to compare the nature and severity of these symptoms in IBS patients in relation to patients with inflammatory bowel disease (IBD) and to nonpatients and to clarify the relationship between intestinal and extraintestinal symptoms. A consecutive group of male patients and a control group of age-matched male subjects were studied. Symptoms were graded for severity using a validated, self-administered inventory. There were 53 IBS patients, 55 IBD patients (32 Crohn's disease), and 56 controls. IBS patients scored significantly higher than IBD patients on constipation, dyspepsia, and reflux scales. Musculoskeletal symptoms, neurasthenia, and sleep scores were similar in IBS and IBD patients, and both groups scored significantly higher than the controls. The scores of urinary, thoracic, and oral symptoms were similar in IBD patients and in controls. However, IBS patients scored significantly higher than both groups on all these scales. Reflux symptoms were the most powerful predictors of extraintestinal symptoms, both in IBS and in IBD. Diarrhea was predictive of extraintestinal symptoms only in IBD. In conclusion, IBS patients experienced extraintestinal symptoms to the same extent, or even more than patients with IBD. However, the relationship between intestinal and extraintestinal symptoms differed in the two conditions.
Collapse
|
33
|
Abstract
Bloating is a frequently reported symptom in functional bowel disorders. It usually occurs in combination with other symptoms, but may also occur in isolation. The severity of bloating tends to worsen during the course of the day and improves overnight. Although frequently considered to be a subjective phenomenon, recent studies have shown that bloating is associated with a measurable increase in abdominal girth. The pathophysiology of bloating remains elusive, but the evidence supports a sensorimotor dysfunction of the bowel. The possible mechanisms include abnormal gas trapping, fluid retention, food intolerance and altered gut microbial flora. Further studies are needed to define the sensorimotor abnormalities associated with bloating, which might be segmental and transient rather than generalized and persistent. The lack of understanding of this symptom is paralleled by a limited availability of therapeutic options. Conventional medications used in functional bowel disorders are not helpful and may indeed worsen the symptoms. In future, new drugs with activity against serotonin and kappa receptors, or novel approaches such as the use of exclusion diets, probiotics and hypnotherapy, may prove to be useful.
Collapse
Affiliation(s)
- S Zar
- OGEM Department, St George's Hospital Medical School, London, UK
| | | | | |
Collapse
|
34
|
Whitehead WE, Palsson O, Jones KR. Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications? Gastroenterology 2002; 122:1140-56. [PMID: 11910364 DOI: 10.1053/gast.2002.32392] [Citation(s) in RCA: 743] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Comorbid or extraintestinal symptoms occur frequently with irritable bowel syndrome and account for up to three fourths of excess health care visits. This challenges the assumption that irritable bowel is a distinct disorder. The aims of this study were to (1) assess comorbidity in 3 areas: gastrointestinal disorders, psychiatric disorders, and nongastrointestinal somatic disorders; and (2) evaluate explanatory hypotheses. METHODS The scientific literature since 1966 in all languages cited in Medline was systematically reviewed. RESULTS Comorbidity with other functional gastrointestinal disorders is high and may be caused by shared pathophysiological mechanisms such as visceral hypersensitivity. Psychiatric disorders, especially major depression, anxiety, and somatoform disorders, occur in up to 94%. The nongastrointestinal nonpsychiatric disorders with the best-documented association are fibromyalgia (median of 49% have IBS), chronic fatigue syndrome (51%), temporomandibular joint disorder (64%), and chronic pelvic pain (50%). CONCLUSIONS Multivariate statistical analyses suggest that these are distinct disorders and not manifestations of a common somatization disorder, but their strong comorbidity suggests a common feature important to their expression, which is most likely psychological. Some models explain the comorbidity of irritable bowel with other disorders by suggesting that each disorder is the manifestation of varying combinations of interacting physiological and psychological factors. An alternative hypothesis is that the irritable bowel diagnosis is applied to a heterogeneous group of patients, some of whom have a predominantly psychological etiology, whereas others have a predominantly biological etiology, and that the presence of multiple comorbid disorders is a marker for psychological influences on etiology.
Collapse
Affiliation(s)
- William E Whitehead
- Division of Digestive Diseases and Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
| | | | | |
Collapse
|
35
|
Abstract
Chest pain of esophageal origin or noncardiac chest pain is reported by at least a fifth of the general population. Recent literature focused on further understanding mechanisms of chest pain in subset of patients with functional chest pain of presumed esophageal origin. Studies have demonstrated concurrent visceral and somatic pain hypersensitivity, and amplified secondary allodynia, in patients with noncardiac chest pain (NCCP), suggesting central sensitization. Other studies have demonstrated abnormal cerebral processing of intraesophageal stimuli. However, gastroesophageal reflux disease (GERD) has remained the most common esophageal cause of NCCP. The introduction of the proton pump inhibitor test, a highly sensitive and cost-effective diagnostic strategy, simplified our diagnostic approach toward patients with GERD-related NCCP. For patients with positive proton-pump-inhibitor test results, long-term treatment with antireflux medication is warranted. For patients with non-GERD-related NCCP, pain modulators remain the cornerstone of therapy.
Collapse
Affiliation(s)
- R Fass
- Section of Gastroenterology, Department of Medicine, Southern Arizona Veterans Affairs Health Care System, and University of Arizona Health Sciences Center, Tucson, Arizona 85723, USA.
| | | | | |
Collapse
|
36
|
Affiliation(s)
- B J Horwitz
- Gastroenterology Section and the Functional Gastrointestinal Diseases Center, Temple University School of Medicine, Philadelphia, PA, USA
| | | |
Collapse
|
37
|
Abstract
Several unexplained clinical conditions frequently coexist with fibromyalgia; these include chronic fatigue syndrome, irritable bowel syndrome, temporomandibular disorder, tension and migraine headaches, and others. However, only recently have studies directly compared the physiological parameters of these conditions (eg, fibromyalgia vs irritable bowel syndrome) to elucidate underlying pathogenic mechanisms. This review summarizes data from comparative studies and discusses their implications for future research.
Collapse
Affiliation(s)
- L A Aaron
- Department of Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359780, Seattle, WA 98104, USA.
| | | |
Collapse
|