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Lackner JM. Innovative cognitive behavioral therapies for irritable bowel syndrome: processes, predictors, platforms, and outcomes. Pain 2024; 165:1464-1471. [PMID: 38323654 DOI: 10.1097/j.pain.0000000000003186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/18/2023] [Indexed: 02/08/2024]
Affiliation(s)
- Jeffrey M Lackner
- Division of Behavioral Medicine, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States
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2
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Arabpour E, Alijanzadeh D, Sadeghi A, Khoshdel S, Hekmatdoost A, Kord-Varkaneh H, Abdehagh M. Gluten restriction in irritable bowel syndrome, yes or no?: a GRADE-assessed systematic review and meta-analysis. Front Nutr 2023; 10:1273629. [PMID: 38024368 PMCID: PMC10646307 DOI: 10.3389/fnut.2023.1273629] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background More than half of patients with irritable bowel syndrome (IBS) report aggravating their symptoms with certain foods. Currently, Low fermentable oligo-, di-, and monosaccharides and polyols diet (LFD) is the most accepted dietary intervention for IBS. Recent randomized controlled trials (RCTs) have been suggested that gluten restriction may reduce the symptoms of patients with IBS. However, the results from these studies are conflicting. This study filled this knowledge gap by evaluating the impact of the gluten-free diet (GFD) on IBS symptoms. Methods A systematic search was carried out in Pubmed/Medline, Cochrane CENTRAL, Scopus, and Web of Science up to April 2023. A random-effect model was applied to estimate the standardized mean difference (SMD) and 95% confidence interval (95% CI) for each outcome. Results A total of nine controlled trials were included in the meta-analysis. In contrast to gluten-containing diet, GFD was unable to reduce overall symptoms (SMD - 0.31; 95% CI -0.92, 0.31), bloating (SMD -0.37; 95% CI -1.03, 0.30), and quality of life (SMD -0.12, 95% CI -0.64, 0.39); but had a slight trend to reduce abdominal pain (SMD -0.68; 95% CI -1.36, -0.00). Also, LFD significantly reduced the IBS-Severity score system (SMD 0.66, 95% CI 0.31, 1.01) and improved quality of life (SMD -0.36, 95% CI -0.70, -0.01), compared to GFD. Conclusion A GFD is not robust enough to be routinely recommended for IBS patients, and its efficacy is significantly lower than that of an LFD. Only a certain subgroup of IBS patients may benefit from GFD; further studies are needed to target this subgroup.
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Affiliation(s)
- Erfan Arabpour
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Dorsa Alijanzadeh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Khoshdel
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology, Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Kord-Varkaneh
- Department of Nutrition, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Abdehagh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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3
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Hibberd TJ, Ramsay S, Spencer-Merris P, Dinning PG, Zagorodnyuk VP, Spencer NJ. Circadian rhythms in colonic function. Front Physiol 2023; 14:1239278. [PMID: 37711458 PMCID: PMC10498548 DOI: 10.3389/fphys.2023.1239278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/17/2023] [Indexed: 09/16/2023] Open
Abstract
A rhythmic expression of clock genes occurs within the cells of multiple organs and tissues throughout the body, termed "peripheral clocks." Peripheral clocks are subject to entrainment by a multitude of factors, many of which are directly or indirectly controlled by the light-entrainable clock located in the suprachiasmatic nucleus of the hypothalamus. Peripheral clocks occur in the gastrointestinal tract, notably the epithelia whose functions include regulation of absorption, permeability, and secretion of hormones; and in the myenteric plexus, which is the intrinsic neural network principally responsible for the coordination of muscular activity in the gut. This review focuses on the physiological circadian variation of major colonic functions and their entraining mechanisms, including colonic motility, absorption, hormone secretion, permeability, and pain signalling. Pathophysiological states such as irritable bowel syndrome and ulcerative colitis and their interactions with circadian rhythmicity are also described. Finally, the classic circadian hormone melatonin is discussed, which is expressed in the gut in greater quantities than the pineal gland, and whose exogenous use has been of therapeutic interest in treating colonic pathophysiological states, including those exacerbated by chronic circadian disruption.
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Affiliation(s)
- Timothy J. Hibberd
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Stewart Ramsay
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | | | - Phil G. Dinning
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Colorectal Surgical Unit, Division of Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | | | - Nick J. Spencer
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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4
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Chang L, Cash BD, Lembo A, Kunkel DC, English BA, Lindstrom B, Gu G, Skare S, Gilder K, Turner S, Cataldi F, Lipkis D, Tack J. Efficacy and safety of olorinab, a full agonist of the cannabinoid receptor 2, for the treatment of abdominal pain in patients with irritable bowel syndrome: Results from a phase 2b randomized placebo-controlled trial (CAPTIVATE). Neurogastroenterol Motil 2023; 35:e14539. [PMID: 36740814 DOI: 10.1111/nmo.14539] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 12/19/2022] [Accepted: 01/11/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Olorinab is a highly selective, peripherally acting, full agonist of cannabinoid receptor 2. This study assessed the efficacy and safety of olorinab to treat abdominal pain in patients with irritable bowel syndrome with diarrhea (IBS-D) and constipation (IBS-C). METHODS CAPTIVATE was a phase 2b, randomized, double-blind, placebo-controlled, parallel-group trial. Eligible participants aged 18-70 years with IBS-C and IBS-D diagnosed per Rome IV received olorinab 10 mg, 25 mg, or 50 mg three times daily (TID) or placebo TID for 12 weeks. The primary endpoint was the change in patient-reported average abdominal pain score (AAPS) from baseline to Week 12. KEY RESULTS A total of 273 participants were randomized to receive olorinab 10 mg (n = 67), olorinab 25 mg (n = 67), olorinab 50 mg (n = 69), or placebo (n = 70). Although a treatment response was observed across all groups, the weekly change in average AAPS from baseline to Week 12 was not significantly different between placebo and any olorinab dose. In a prespecified subgroup analysis of participants with a baseline AAPS ≥6.5, olorinab 50 mg (n = 35) significantly improved AAPS compared with placebo (n = 30) (p = 0.014). Adverse event rates were comparable between olorinab and placebo and there were no reported serious adverse events or deaths. CONCLUSION AND INFERENCES Although olorinab was well-tolerated and improved weekly AAPS, the primary endpoint was not met. However, in participants with moderate-to-severe pain at baseline (AAPS ≥6.5), olorinab 50 mg significantly improved weekly AAPS compared with placebo. CLINICALTRIALS gov: NCT04043455.
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Affiliation(s)
- Lin Chang
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Brooks D Cash
- University of Texas Health Science Center Houston, Houston, Texas, USA
| | - Anthony Lembo
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - David C Kunkel
- University of California San Diego, La Jolla, California, USA
| | | | | | - Guibao Gu
- Arena Pharmaceuticals, Inc., San Diego, California, USA
| | - Sharon Skare
- Arena Pharmaceuticals, Inc., San Diego, California, USA
| | - Kye Gilder
- Arena Pharmaceuticals, Inc., San Diego, California, USA
| | | | - Fabio Cataldi
- Arena Pharmaceuticals, Inc., San Diego, California, USA
| | - Donald Lipkis
- Sharp Grossmont Hospital, San Diego, California, USA
| | - Jan Tack
- University Hospitals Leuven, Leuven, Belgium
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5
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Wu J, Wang C, Lv L. Diagnostic yield of colonoscopy for organic disease in irritable bowel syndrome and its risk factors: A meta-analysis. Neurogastroenterol Motil 2023; 35:e14481. [PMID: 36168183 DOI: 10.1111/nmo.14481] [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: 03/23/2022] [Revised: 07/27/2022] [Accepted: 09/16/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Colonoscopy is commonly performed in patients with irritable bowel syndrome (IBS) to rule out organic disease. We performed a meta-analysis to assess the prevalence of organic disease detected at colonoscopy in IBS and its potential risk factors. METHODS Medline, Embase, and Web of Science were searched through January 2022. Observational studies that reported diagnostic yield of colonoscopy for organic disease including colorectal cancer (CRC), inflammatory bowel disease (IBD), or microscopic colitis (MC) in adult IBS patients were eligible. Pooled prevalence and risk difference (RD) with 95% confidence intervals (CIs) were calculated. RESULTS Of 2490 citations identified, 12 studies were eligible containing 28,630 patients with IBS undergoing colonoscopy. Pooled prevalence of CRC, IBD, and MC in IBS was 0.78%, 4.48%, and 2.35%, respectively. No difference in the yield for CRC, IBD, and MC was seen between IBS and non-IBS patients. CRC was rare in IBS patients without alarm symptoms or younger than 40 years (<0.1%). Pooled Prevalence of CRC (2.47% vs. 0.11%; RD 2.57%, 95% CI 0.37%-4.78%) and IBD (8.86% vs. 4.25%; RD 10.75%, 95% CI 4.81%-16.68%) was significantly higher in IBS patients with alarm symptoms compared with those without. IBD and MC were more likely to be detected at colonoscopy in IBS-D compared with IBS-C. The prevalence of CRC and MC was higher in IBS patients with older age than younger age. CONCLUSION We provide the first pooled estimate of yield of colonoscopy in IBS and its risk factors, which may be used to inform clinical decision and support guidelines.
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Affiliation(s)
- Jie Wu
- Department of Gastroenterology, Xiangya Hospital of Central South University, Changsha, China
| | - Chunlian Wang
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Liang Lv
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
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Carbone F, Van den Houte K, Besard L, Tack C, Arts J, Caenepeel P, Piessevaux H, Vandenberghe A, Matthys C, Biesiekierski J, Capiau L, Ceulemans S, Gernay O, Jones L, Maes S, Peetermans C, Raat W, Stubbe J, Van Boxstael R, Vandeput O, Van Steenbergen S, Van Oudenhove L, Vanuytsel T, Jones M, Tack J. Diet or medication in primary care patients with IBS: the DOMINO study - a randomised trial supported by the Belgian Health Care Knowledge Centre (KCE Trials Programme) and the Rome Foundation Research Institute. Gut 2022; 71:2226-2232. [PMID: 35483886 PMCID: PMC9554021 DOI: 10.1136/gutjnl-2021-325821] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/13/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND In Europe, IBS is commonly treated with musculotropic spasmolytics (eg, otilonium bromide, OB). In tertiary care, a low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet provides significant improvement. Yet, dietary treatment remains to be explored in primary care. We evaluated the effect of a smartphone FODMAP-lowering diet application versus OB on symptoms in primary care IBS. METHODS IBS patients, recruited by primary care physicians, were randomised to 8 weeks of OB (40 mg three times a day) or diet and followed for 24 weeks. We compared IBS Symptom Severity Score and the proportion of responders (improvement ≥50 points) in all patients and the subgroup fulfilling Rome IV criteria (Rome+). We also evaluated treatment efficacy, quality of life, anxiety, depression, somatic symptom severity (Patient Health Questionnaire (PHQ15, PHQ9)) and treatment adherence and analysed predictors of response. RESULTS 459 primary care IBS patients (41±15 years, 76% female, 70% Rome+) were randomised. The responder rate after 8 weeks was significantly higher with diet compared with OB (71% (155/218) vs 61% (133/217), p=0.03) and more pronounced in Rome+ (77% (118/153) vs 62% (98/158), p=0.004). Patients allocated to diet (199/212) were 94% adherent compared with 73% with OB (148/202) (p<0.001). The significantly higher response rate with diet was already observed after 4 weeks (62% (132/213) vs 51% (110/215), p=0.02) and a high symptom response persisted during follow-up. Predictors of response were female gender (OR=2.08, p=0.04) for diet and PHQ15 (OR=1.10, p=0.02) for OB. CONCLUSION In primary care IBS patients, a FODMAP-lowering diet application was superior to a spasmolytic agent in improving IBS symptoms. A FODMAP-lowering diet should be considered the first-line treatment for IBS in primary care. TRIAL REGISTRATION NUMBER NCT04270487.
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Affiliation(s)
- Florencia Carbone
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium
| | - Karen Van den Houte
- TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium
| | - Linde Besard
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Céline Tack
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Joris Arts
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,Gastroenterology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Philip Caenepeel
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,Gastroenterology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Hubert Piessevaux
- Department of Gastroenterology and Hepatology, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | | | - Christophe Matthys
- Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jessica Biesiekierski
- TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium.,Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Luc Capiau
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Steven Ceulemans
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Olivier Gernay
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Lydia Jones
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Sophie Maes
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Christian Peetermans
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Willem Raat
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jeroen Stubbe
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Rudy Van Boxstael
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | - Olivia Vandeput
- Primary care physician, Domino primary care physician study group, Leuven, Belgium
| | | | - Lukas Van Oudenhove
- TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium.,TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium
| | - Michael Jones
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jan Tack
- Department of Gastroenterology, KU Leuven University Hospitals Leuven, Leuven, Belgium .,TARGID (Translational Research Center for Gastrointestinal Disorders), KU Leuven, Leuven, Belgium.,Rome Foundation Research Institute, Raleigh, North Carolina, USA.,Rome Foundation, Raleigh, North Carolina, USA
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Müller-Lissner S, Andresen V, Corsetti M, Bustos Fernández L, Forestier S, Pace F, Valdovinos MA. Functional Abdominal Cramping Pain: Expert Practical Guidance. J Clin Gastroenterol 2022; 56:844-852. [PMID: 36149666 PMCID: PMC9553264 DOI: 10.1097/mcg.0000000000001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Functional abdominal cramping pain (FACP) is a common complaint, which may present either on its own or in association with a functional gastrointestinal disorder. It is likely caused by a variety of, probably partly unknown, etiologies. Effective management of FACP can be challenging owing to the lack of usable diagnostic tools and the availability of a diverse range of treatment approaches. Practical guidance for their selection and use is limited. The objective of this article is to present a working definition of FACP based on expert consensus, and to propose practical strategies for the diagnosis and management of this condition for physicians, pharmacists, and patients. A panel of experts on functional gastrointestinal disorders was convened to participate in workshop activities aimed at defining FACP and agreeing upon a recommended sequence of diagnostic criteria and management recommendations. The key principles forming the foundation of the definition of FACP and suggested management algorithms include the primacy of cramping pain as the distinguishing symptom; the importance of recognizing and acting upon alarm signals of potential structural disease; the recognition of known causes that might be addressed through lifestyle adjustment; and the central role of antispasmodics in the treatment of FACP. The proposed algorithm is intended to assist physicians in reaching a meaningful diagnostic endpoint based on patient-reported symptoms of FACP. We also discuss how this algorithm may be adapted for use by pharmacists and patients.
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Affiliation(s)
| | | | - Maura Corsetti
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust
- School of Medicine, University of Nottingham and Nottingham Digestive Diseases Centre, Translational Medical Science, University of Nottingham, Nottingham, UK
| | | | | | - Fabio Pace
- Bolognini Hospital, Seriate and University of Milan, Milan, Italy
| | - Miguel A. Valdovinos
- Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán,” Tlalpan, Mexico
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Thomas A, Thomas A, Butler-Sanchez M. Dietary Modification for the Restoration of Gut Microbiome and Management of Symptoms in Irritable Bowel Syndrome. Am J Lifestyle Med 2022; 16:608-621. [PMID: 36072680 PMCID: PMC9442469 DOI: 10.1177/15598276211012968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/13/2021] [Accepted: 04/08/2021] [Indexed: 08/27/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder leading to chronic debilitating issues. A healthy diet plays an integral role in maintaining the gut microbiota equilibrium, thus promoting digestive health. The structure and function of gut microbiota are affected by genetics and environmental factors, such as altered dietary habits, gastroenteritis, stress, increased use of alcohol and drugs, and medication use. Whereas there are various management approaches cited in the literature to manage symptoms of IBS, the purpose of this article is to focus on dietary options that will restore the gut microbiome and help in managing IBS symptoms. Some of the diets that are discussed in this article include a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, gluten-free/wheat-free diet, high-fiber diet, dietary and herbal supplements (psyllium, peppermint oil), and probiotics/prebiotics/synbiotics. The clinical practice guidelines recommended by the American College of Gastroenterology outlines evidence-based dietary recommendations for patients with IBS to manage symptoms. Recent advancements in the dietary management of IBS highlighting the use of a patient-centered, personalized nutrition approach along with lifestyle changes, pharmacological therapies, and psychosocial and behavioral interventions are also reviewed and discussed.
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Affiliation(s)
- Andrew Thomas
- Bharati Vidyapeeth Medical College, Pune,
India, and University of Illinois Health Sciences System, Chicago,
Illinois
| | - Annie Thomas
- Marcella Niehoff School of Nursing, Loyola
University Chicago, Illinois
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Ait Abdellah S, Gal C, Laterza L, Velenza V, Settanni CR, Napoli M, Schiavoni E, Mora V, Petito V, Gasbarrini A. Effect of a Multistrain Probiotic on Leaky Gut in Patients with Diarrhea-Predominant Irritable Bowel Syndrome: A Pilot Study. Dig Dis 2022; 41:489-499. [PMID: 36007493 PMCID: PMC10906476 DOI: 10.1159/000526712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND A probiotic mixture prevented epithelial barrier impairment in various experimental models. The objective was to evaluate its effects in patients suffering from IBS with diarrhea (IBS-D) with confirmed leaky gut. METHODS IBS-D patients with increased intestinal permeability measured by radionuclide tracers were enrolled in this pilot, open-label, prospective, interventional, single-center, Phase IV study. Patients received two capsules of a multistrain probiotic a day for 30 days and were evaluated by repeated intestinal permeability tests, the Bristol Stool Scale, and patient-perceived quality of life and satisfaction. RESULTS Of the 30 enrolled patients (mean age: 42.1 [SD: 13.1] years; female: 60%), 27 completed the study (full analysis set [FAS]), and 18 had no major protocol violation (per protocol set [PPS]). On D30, an improvement of intestinal permeability was observed in 81.5% of patients in FAS, normalization being observed in 37% of the participants (44% in PPS). The mean intestinal permeability was significantly decreased: baseline minus D30, 3.4 (95% CI: 1.7, 5.2); the IBS-QOL total score was significantly increased: D30 minus baseline, 8.0 (95% CI: 3.0, 12.9); and stool consistency was significantly improved. On D15 and D30, 96.3% of patients claimed that their IBS symptoms had been satisfactory alleviated, and a significant improvement was reported for the following VAS-IBS items: abdominal pain, diarrhea, and impact of gastrointestinal problems in daily life. Compliance and tolerance were satisfactory. CONCLUSION The multistrain probiotic tested may reduce intestinal permeability in a considerable proportion of patients and may improve abdominal pain, stool consistency, and quality of life. These results pave the way for larger, placebo-controlled clinical studies.
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Affiliation(s)
| | | | - Lucrezia Laterza
- CEMAD, Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Venanzio Velenza
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carlo Romano Settanni
- CEMAD, Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marco Napoli
- CEMAD, Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Elisa Schiavoni
- CEMAD, Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vincenzina Mora
- CEMAD, Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Valentina Petito
- CEMAD, Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Gasbarrini
- CEMAD, Digestive Disease Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
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Ohlsson B. Extraintestinal manifestations in irritable bowel syndrome: A systematic review. Therap Adv Gastroenterol 2022; 15:17562848221114558. [PMID: 35967918 PMCID: PMC9373179 DOI: 10.1177/17562848221114558] [Citation(s) in RCA: 11] [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: 02/16/2022] [Accepted: 06/30/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is characterized by abdominal pain and altered bowel habits. Further, IBS patients experience a high degree of extraintestinal symptoms. OBJECTIVES The aim of this review was to describe the relation between IBS and extraintestinal manifestations and mechanisms and treatments of these extraintestinal manifestations. DESIGN The study was performed as a systematic review. DATA SOURCES AND METHODS Search terms including extraintestinal manifestations or somatization and IBS were used to scrutinize for publications in Pubmed. In total, 630 publications were identified and 80 were finally included in this review. RESULTS About 50% of all IBS patients have extraintestinal manifestations in addition to gastrointestinal symptoms. Somatic pain, fatigue, and sleeping disturbances are most common, and most often described in women. Both extraintestinal manifestations and psychological distress are associated with exaggerated gastrointestinal symptoms, impaired quality of life, and difficulties to treat IBS symptoms. The extraintestinal manifestations render an excess of healthcare costs. Varying etiology and pathophysiology to IBS are discussed, and many patients express a general hypersensitivity. Extraintestinal symptoms are seldom documented at clinical healthcare or included in the assessment of treatment outcomes. A good patient-physician relationship and strengthening of coping mechanisms have rendered less gastrointestinal symptoms, psychological distress, and somatization. Altered lifestyle habits may improve both gastrointestinal and extraintestinal symptoms. Pharmacological treatment, including antidepressant drugs, should be considered when lifestyle advice fails. Teamwork between different specialists and healthcare providers may be of importance in the wide range of symptoms and extraintestinal manifestations. CONCLUSION Extraintestinal manifestations are common in IBS patients and is associated with worse suffering and difficulties to treat symptoms. Evaluation and treatment of IBS patients should consider also extraintestinal manifestations and their treatment outcome. Establishment of good relationship, strengthening of coping mechanisms, and education in healthier lifestyle habits are crucial in the management of these patients.
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Chen J, Zhang Y, Barandouzi ZA, Lee J, Zhao T, Xu W, Chen MH, Feng B, Starkweather A, Cong X. The effect of self-management online modules plus nurse-led support on pain and quality of life among young adults with irritable bowel syndrome: A randomized controlled trial. Int J Nurs Stud 2022; 132:104278. [PMID: 35640500 PMCID: PMC10588769 DOI: 10.1016/j.ijnurstu.2022.104278] [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] [Received: 02/24/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Irritable bowel syndrome is a chronic pain condition that needs life-long self-management. However, the effect of self-management among young adults with irritable bowel syndrome is limited. OBJECTIVES This study aimed to examine the effect of a nurse-led self-management program on pain, symptoms, and quality of life among young adults with irritable bowel syndrome. DESIGN A randomized controlled trial. SETTINGS AND PARTICIPANTS Eighty young adults with irritable bowel syndrome recruited from two campuses of a public university and two gastrointestinal clinics were randomly assigned into a self-management online education and learning modules alone group (Online Modules, n = 41) or a nurse-led one-to-one consultation plus self-management online education and learning modules group (Nurse-Led Online Modules, n = 39). Twenty-one healthy controls were also recruited from these two campuses. METHODS Both the intervention groups received ten online modules after baseline data collection. Participants in the Nurse-Led Online Modules group received additional three nurse-led one-to-one consultations at baseline, 6- and 12-week follow-ups. Self-reported pain, symptoms, quality of life, self-efficacy for managing chronic disease, and coping were measured at baseline, and 6- and 12-week follow-ups among the participants with irritable bowel syndrome. The healthy controls completed data collection of pain and symptoms at baseline and the 12-week follow-up. The intervention effects across study time points and the comparisons between the two interventional groups were analyzed using linear mixed models. A longitudinal mediation analysis was also conducted to explore the mediation effects of self-management mechanisms of the interventions. RESULTS Both the intervention groups showed significant interventional effects on decreasing pain intensity and pain interference and increasing quality of life at the 12-week follow-up (all p < 0.05). At the 12-week follow-up, the Nurse-Led Online Modules significantly reduced anxiety (p = 0.016) and had a significant greater improvement in quality of life than the Online Modules (p = 0.040). Increased self-efficacy mediated the intervention effect of the Nurse-Led Online Modules group on reducing pain interference and improving quality of life, while the effect of the Online Modules was mediated through decreasing inefficient coping strategy-catastrophizing. CONCLUSIONS This study showed that both the pain self-management online education and nurse-led intervention were effective for alleviating pain and improving quality of life among young adults with irritable bowel syndrome by targeting the self-management process. The nurse-led intervention had a better outcome than the online education alone in improving quality of life. REGISTRATION NUMBER NCT03332537.
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Affiliation(s)
- Jie Chen
- University of Connecticut, School of Nursing, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269-4026, United States of America; Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, 655 W. Lombard St., Baltimore, MD 21201, United States of America.
| | - Yiming Zhang
- University of Connecticut, Department of Statistics, 215 Glenbrook Road, U-4120, Storrs, CT 06269-4120, United States of America.
| | - Zahra Amirkhanzadeh Barandouzi
- University of Connecticut, School of Nursing, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269-4026, United States of America; Emory University, School of Nursing, 1520 Clifton Rd, Atlanta, GA 30322, United States of America.
| | - Joochul Lee
- University of Connecticut, Department of Statistics, 215 Glenbrook Road, U-4120, Storrs, CT 06269-4120, United States of America.
| | - Tingting Zhao
- University of Connecticut, School of Nursing, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269-4026, United States of America.
| | - Wanli Xu
- University of Connecticut, School of Nursing, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269-4026, United States of America.
| | - Ming-Hui Chen
- University of Connecticut, Department of Statistics, 215 Glenbrook Road, U-4120, Storrs, CT 06269-4120, United States of America.
| | - Bin Feng
- University of Connecticut, Department of Biomedical Engineering, 260 Glenbrook Road, U-3247, Storrs, CT 06269-3247, United States of America.
| | - Angela Starkweather
- University of Connecticut, School of Nursing, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269-4026, United States of America.
| | - Xiaomei Cong
- University of Connecticut, School of Nursing, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269-4026, United States of America.
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Nunan D, Cai T, Gardener AD, Ordóñez-Mena JM, Roberts NW, Thomas ET, Mahtani KR. Physical activity for treatment of irritable bowel syndrome. Cochrane Database Syst Rev 2022; 6:CD011497. [PMID: 35766861 PMCID: PMC9243367 DOI: 10.1002/14651858.cd011497.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Current recommendations for people with irritable bowel syndrome (IBS) to partake in physical activity are based on low-level evidence, do not incorporate evidence from all available randomised controlled trials (RCTs) and provide little information regarding potential adverse effects. OBJECTIVES To assess the benefits and harms of physical activity interventions in adults diagnosed with irritable bowel syndrome and to explore possible effect moderators including type, setting and nature of physical activity interventions. SEARCH METHODS We searched nine electronic databases including CENTRAL, MEDLINE and Embase to 5 November 2021. We handsearched reference lists and sought unpublished studies through trial registries. SELECTION CRITERIA We included RCTs involving adults (aged 18 years or older) diagnosed with IBS and conducted in any setting comparing a physical activity intervention with no intervention, usual care or wait-list control group or another physical activity intervention group and assessing a validated measure of symptoms, quality of life or bowel movement. DATA COLLECTION AND ANALYSIS At least two review authors independently selected studies for inclusion, extracted study data, and performed risk of bias and GRADE assessments to assess the certainty of evidence. We pooled studies that evaluated similar outcomes using a random-effects meta-analysis, and synthesised data from other studies narratively. MAIN RESULTS We included 11 RCTs with data for 622 participants. Most (10/11) were set in high- or middle- to high-income countries, with five involving supervised physical activity, three unsupervised activity and three a mix of supervised and unsupervised activity. No trial was at low risk of bias. Four trials specified a minimally important difference for at least one assessed outcome measure. Data for 10 trials were obtained from published journal articles, with data for one obtained from an unpublished Masters degree thesis. Irritable bowel syndrome symptoms Six RCTs assessed the effectiveness of a physical activity intervention compared with usual care on global symptoms of IBS. Meta-analysis of five studies showed an observed improvement in reported symptoms following physical activity (standardised mean difference (SMD) -0.93, 95% confidence interval (CI) -1.44 to -0.42; 185 participants). We rated the certainty of evidence for this outcome as very low due to unclear and high risk of bias, inconsistency and imprecision from sparse data. This means physical activity may improve IBS symptoms but the evidence is very uncertain. The results of the remaining study supported the meta-analysis but were at unclear risk of bias and sample size was small. Two studies assessed the effectiveness of a yoga intervention compared with a walking intervention on global IBS symptoms. Meta-analysis of these two studies found no conclusive evidence of an effect of yoga compared with walking on IBS symptoms (SMD -1.16, 95% CI -3.93 to 1.62; 124 participants). We rated the certainty of evidence as very low, meaning the evidence is very uncertain about the effect of yoga interventions compared with walking interventions on IBS symptoms. Two studies assessed the effectiveness of a physical activity intervention (yoga) compared with medication. One reported no observed difference in global IBS symptoms, though CIs were wide, suggesting uncertainty in the observed estimates and risk of bias was high (MD -1.20, 95% CI -2.65 to 0.25; 21 participants). We excluded IBS symptom data for the remaining study as it used a non-validated method. One study compared a yoga intervention with a dietary intervention and reported an observed improvement in symptoms with both interventions but neither intervention was superior to the other. Quality of life Five RCTs assessed the impact of physical activity on self-reported quality of life compared with usual care. Meta-analysis of data from four studies found no improvement in quality of life following a physical activity intervention (SMD 1.17, 95% CI -0.30 to 2.64; 134 participants; very low certainty due to risk of bias, inconsistency and imprecision). We rated the certainty of evidence as very low, meaning the evidence is very uncertain about the effect of physical activity interventions on quality-of-life outcomes in people with IBS. One study assessed the impact on quality of life of a yoga intervention compared with walking and observed an improvement in the yoga group (MD 53.45, 95% CI 38.85 to 68.05; 97 participants ). One study reported no observed difference in quality of life between a yoga and a dietary intervention. Abdominal pain Two trials assessed the impact of physical activity compared with usual care on reported abdominal pain. Meta-analysis found no improvement in abdominal pain with physical activity compared with usual care (SMD 0.01, 95% CI -0.48 to 0.50; 64 participants). We rated the certainty of the evidence as very low due to risk of bias and imprecision, meaning the evidence is very uncertain about the effect of physical activity interventions on abdominal pain in people with IBS. One study assessing the impact of a yoga intervention compared with walking advice reported no observed differences between groups on abdominal pain. One study comparing a yoga intervention with a dietary intervention found neither intervention had a more beneficial impact than the other and both interventions did not conclusively reduce abdominal pain. There was insufficient evidence to adequately assess adverse effects associated with physical activity due to a lack of reporting in trials. One study reported a musculoskeletal injury in a yoga intervention group but this did not result in withdrawal from the study. AUTHORS' CONCLUSIONS Findings from a small body of evidence suggest that physical activity comprising of yoga, treadmill exercise or support to increase physical activity may improve symptoms but not quality of life or abdominal pain in people diagnosed with IBS but we have little confidence in these conclusions due to the very low certainty of evidence. The numbers of reported adverse events were low and the certainty of these findings was very low for all comparisons, so no conclusions can be drawn. Discussions with patients considering physical activity as part of symptom management should address the uncertainty in the evidence to ensure fully informed decisions. If deemed sufficiently important to patients and healthcare providers, higher quality research is needed to enable more certain conclusions.
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Affiliation(s)
- David Nunan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ting Cai
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nia W Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Elizabeth T Thomas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal R Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Melchior C, Algera J, Colomier E, Törnblom H, Simrén M. Irritable bowel syndrome with food-related symptoms: Future directions in the clinical management. United European Gastroenterol J 2022; 10:594-600. [PMID: 35727703 PMCID: PMC9278572 DOI: 10.1002/ueg2.12265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/25/2022] [Indexed: 11/08/2022] Open
Abstract
The majority of patients with irritable bowel syndrome (IBS) experiences food-related symptoms, which are associated with high symptom burden, reduced quality of life, increased healthcare consumption and reduced intake of certain nutrients. In this review we aimed to describe a clinically useful approach for physicians, by presenting the latest progress in knowledge and its translation to management in IBS patients with food-related symptoms, as well as the underlying mechanisms involved. The research tools currently available that can be used in the future for a better characterization of this subgroup of patients are also discussed. Working towards this approach could lead to a more individualised work-up and management of IBS patients with food-related symptoms.
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Affiliation(s)
- 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, Rouen, France
| | - Joost Algera
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Esther Colomier
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Translational Research for Gastrointestinal Disorders, University Hospital KU Leuven, University of Leuven, Leuven, Belgium
| | - Hans Törnblom
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Simrén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina, USA
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Effectiveness and Safety of Probiotics for Patients with Constipation-Predominant Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of 10 Randomized Controlled Trials. Nutrients 2022; 14:nu14122482. [PMID: 35745212 PMCID: PMC9231226 DOI: 10.3390/nu14122482] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/05/2022] [Accepted: 06/12/2022] [Indexed: 12/13/2022] Open
Abstract
To perform a systematic review and meta-analysis to evaluate the effectiveness and safety of probiotics in the treatment of constipation-predominant irritable bowel syndrome (IBS-C), we searched for randomized controlled trials (RCTs) comparing probiotic care versus placebos for patients with IBS-C in five comprehensive databases (March 2022). The risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool. RevMan 5.3 was used to perform a meta-analysis on stool consistency, abdominal pain, bloating, quality of life (QoL), fecal Bifidobacterium and Lactobacillus counts, and adverse events. The GRADE approach was used to evaluate the certainty of the evidence. Ten RCTs involving 757 patients were included. Only three studies were rated as having a low risk of bias. The meta-analysis results show that, compared to the placebo, probiotics significantly improved stool consistency (MD = 0.72, 95% CI (0.18, 1.26), p < 0.05, low quality) and increased the number of fecal Bifidobacteria (MD = 1.75, 95% CI (1.51, 2.00), p < 0.05, low quality) and Lactobacillus (MD = 1.69, 95% CI (1.48, 1.89), p < 0.05, low quality), while no significant differences were found in abdominal pain scores, bloating scores, QoL scores, or the incidence of adverse events (p > 0.05). The low-to-very low certainty evidence suggests that probiotics might improve the stool consistency of patients with IBS-C and increase the number of Bifidobacteria and Lactobacilli in feces with good safety. However, more high-quality studies with large samples are needed to verify the findings.
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Alexandru BA, Rat LA, Moldovan AF, Mihancea P, Mariș L. An Open-Label Trial Study of Quality-of-Life Assessment in Irritable Bowel Syndrome and Their Treatment. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060763. [PMID: 35744026 PMCID: PMC9230795 DOI: 10.3390/medicina58060763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/16/2022]
Abstract
Background and objectives: Irritable bowel syndrome (IBS) does not only have a complex pathophysiological evolution with central and peripheral mechanisms. This study aimed to monitor the neuropsychiatric part of IBS and its management, following the quality of life of patients with IBS. Materials and Methods: Participants numbering 145 were investigated in this study for 6 months and were divided into four groups, namely the control group with a symptomatic period of less than 6 months (n = 34), the group with irritable bowel syndrome (IBS; n = 58), IBS and neuropsychiatric treatment (n = 32), and IBS with probiotic treatment (n = 22). Clinical and paraclinical analyses as well as quality of life were monitored by domestic and international psychological questionnaires. Results: It was observed that, in patients with pro-longed symptoms, neuropsychiatric impairment occurred more frequently, and both clinical and paraclinical analyses improved significantly (p < 0.05) more so in those with complex allopathic treatment and in those with probiotic treatment. There were no significant differences between the two research groups. Conclusions: It has been shown that the neuropsychological component of IBS plays an important role in its treatment, and modern probation therapy can achieve similar results to those of neuropsychiatry. This also requires further studies to ensure the best combination in the approach to IBS.
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Affiliation(s)
- Bogdana Ariana Alexandru
- Faculty of Medicine and Pharmacy, Medicine Department, University of Oradea, 410068 Oradea, Romania; (B.A.A.); (A.F.M.)
| | - Lavinia Alina Rat
- Faculty of Medicine and Pharmacy, Doctoral School, University of Oradea, 1 December Square, 410068 Oradea, Romania; (L.A.R.); (P.M.)
| | - Andrada Florina Moldovan
- Faculty of Medicine and Pharmacy, Medicine Department, University of Oradea, 410068 Oradea, Romania; (B.A.A.); (A.F.M.)
| | - Petru Mihancea
- Faculty of Medicine and Pharmacy, Doctoral School, University of Oradea, 1 December Square, 410068 Oradea, Romania; (L.A.R.); (P.M.)
| | - Lavinia Mariș
- Faculty of Medicine and Pharmacy, Medicine Department, University of Oradea, 410068 Oradea, Romania; (B.A.A.); (A.F.M.)
- Correspondence: ; Tel.: +40-769627181
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16
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Kim SH. Effect of Diet on Irritable Bowel Syndrome. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2022. [DOI: 10.4166/kjg.2022.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Seung Han Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Liu L, Zhang W, Zhao W, Guo S, Wang Y, Lv X, Li B, Wang H, Xu E, Li Q, Zhu Q, Gou XB, Zhao W, Guo J. Linaclotide for treating patients with irritable bowel syndrome with predominant constipation: a multicentre study of real-world data in China. Therap Adv Gastroenterol 2022; 15:17562848221092596. [PMID: 35509427 PMCID: PMC9058335 DOI: 10.1177/17562848221092596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/17/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Linaclotide, a guanylate cyclase C agonist that improves the symptoms of irritable bowel syndrome with predominant constipation (IBS-C), has been recently approved for IBS-C treatment. This study aimed to report real-world data on linaclotide treatment in China. METHODS This was a prospective multicentre study of the effectiveness of linaclotide treatment in patients with IBS-C from 10 primary medical institutions. Changes in defecation, abdominal symptoms, the IBS symptom severity scale (IBS-SSS), IBS quality of life questionnaire (IBS-QOL), Zung Self-Rating Anxiety Scale and Self-Rating Depression Scale in patients were evaluated to determine the drug's clinical efficacy and safety. RESULTS We enrolled 97 patients (mean age: 52.39 ± 13.99 years), 55 of whom were women (56.7%). In terms of efficacy, the number of the patients' defecation per week and Bristol stool form scale scores significantly increased at week 4 and week 12 compared with the values at the baseline. The baseline average IBS-SSS score was 211.01 ± 81.23. Of the patients, 24 had severe IBS-C, and their IBS-SSS scores at week 4 (51.81 ± 54.42) and week 12 (9.3 ± 30.39) significantly decreased and showed a pronounced improvement. The IBS-QOL total scores at week 4 and week 12 gradually decreased compared with that at the baseline and the QOL significantly improved. Treatment satisfaction rate was 79.3% in week 4 and 100% in week 12, showing a gradually increased satisfaction and significant differences. However, 11 cases (11.3%) had diarrhoea. CONCLUSION Linaclotide has proved to be a safe and effective drug to improve IBS-C symptoms and severity.
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Affiliation(s)
- Lan Liu
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, China
| | - Weihao Zhang
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, China
| | - Wei Zhao
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, China
| | - Shuang Guo
- Department of Gastroenterology, The Second Hospital of Shandong University, Jinan, China
| | - Yaojun Wang
- Department of Gastroenterology, Sunshine Union Hospital, Weifang, China
| | - Xiaojun Lv
- Department of Gastroenterology, Fangzi District People’s Hospital, Weifang, China
| | - Bing Li
- Department of Gastroenterology, Wendeng District People’s Hospital, Weihai, China
| | - Haiping Wang
- Department of Gastroenterology, Rongcheng Hospital of Traditional Chinese Medicine, Weihai, China
| | - Enbin Xu
- Department of Gastroenterology, Rongcheng People’s Hospital, Weihai, China
| | - Quan Li
- Department of Gastroenterology, Shouguang Hospital of Traditional Chinese Medicine, Weifang, China
| | - Qin Zhu
- Department of Gastroenterology, Linqu People’s Hospital, Weifang, China
| | - Xiao bo Gou
- Department of Gastroenterology, Longkou Hospital of Traditional Chinese Medicine, Yantai, China
| | - Weidong Zhao
- Department of Gastroenterology, Zibo Municipal Hospital, Zibo, China
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Ghaffari P, Shoaie S, Nielsen LK. Irritable bowel syndrome and microbiome; Switching from conventional diagnosis and therapies to personalized interventions. J Transl Med 2022; 20:173. [PMID: 35410233 PMCID: PMC9004034 DOI: 10.1186/s12967-022-03365-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/26/2022] [Indexed: 02/08/2023] Open
Abstract
AbstractThe human microbiome has been linked to several diseases. Gastrointestinal diseases are still one of the most prominent area of study in host-microbiome interactions however the underlying microbial mechanisms in these disorders are not fully established. Irritable bowel syndrome (IBS) remains as one of the prominent disorders with significant changes in the gut microbiome composition and without definitive treatment. IBS has a severe impact on socio-economic and patient’s lifestyle. The association studies between the IBS and microbiome have shed a light on relevance of microbial composition, and hence microbiome-based trials were designed. However, there are no clear evidence of potential treatment for IBS. This review summarizes the epidemiology and socioeconomic impact of IBS and then focus on microbiome observational and clinical trials. At the end, we propose a new perspective on using data-driven approach and applying computational modelling and machine learning to design microbiome-aware personalized treatment for IBS.
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Kindt S, Louis H, De Schepper H, Arts J, Caenepeel P, De Looze D, Gerkens A, Holvoet T, Latour P, Mahler T, Mokaddem F, Nullens S, Piessevaux H, Poortmans P, Rasschaert G, Surmont M, Vafa H, Van Malderen K, Vanuytsel T, Wuestenberghs F, Tack J. Belgian consensus on irritable bowel syndrome. Acta Gastroenterol Belg 2022; 85:360-382. [PMID: 35709780 DOI: 10.51821/85.2.10100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is characterised by recurrent abdominal pain related to defaecation or associated with altered stool frequency or consistency. Despite its prevalence, major uncertainties in the diagnostic and therapeutic management persist in clinical practice. METHODS A Delphi consensus was conducted by 20 experts from Belgium, and consisted of literature review and voting process on 78 statements. Grading of recommendations, assessment, development and evaluation criteria were applied to evaluate the quality of evidence. Consensus was defined as > 80 % agreement. RESULTS Consensus was reached for 50 statements. The Belgian consensus agreed as to the multifactorial aetiology of IBS. According to the consensus abdominal discomfort also represents a cardinal symptom, while bloating and abdominal distension often coexist. IBS needs subtyping based on stool pattern. The importance of a positive diagnosis, relying on history and clinical examination is underlined, while additional testing should remain limited, except when alarm features are present. Explanation of IBS represents a crucial part of patient management. Lifestyle modification, spasmolytics and water-solube fibres are considered first-line agents. The low FODMAP diet, selected probiotics, cognitive behavioural therapy and specific treatments targeting diarrhoea and constipation are considered appropriate. There is a consensus to restrict faecal microbiota transplantation and gluten-free diet, while other treatments are strongly discouraged. CONCLUSIONS A panel of Belgian gastroenterologists summarised the current evidence on the aetiology, symptoms, diagnosis and treatment of IBS with attention for the specificities of the Belgian healthcare system.
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Affiliation(s)
- S Kindt
- Department of gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - H Louis
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - H De Schepper
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - J Arts
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Gastroenterology, AZ Sint-Lucas, Brugge, Belgium
| | - P Caenepeel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Gastroenterology, Ziekenhuis Oost-Limburg, Campus Sint-Jan, Genk, Belgium
- UHasselt, Hasselt, Belgium
| | - D De Looze
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Gent, Belgium
| | - A Gerkens
- Boitsfort Medical Center, Brussels, Belgium
| | - T Holvoet
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Gent, Belgium
- Department of Gastroenterology, AZ Nikolaas, Sint Niklaas, Belgium
| | - P Latour
- Department of Gastroenterology, Hepatology and Digestive Oncology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - T Mahler
- Department of Pediatrics, Universitair Ziekenuis Brussel, Brussel, Belgium
| | - F Mokaddem
- Department of Gastroenterology and Hepatology, Vivalia-Centre Sud Luxembourg, Arlon, Belgium
| | - S Nullens
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - H Piessevaux
- Department of Hepato-gastroenterology, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - P Poortmans
- Department of gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - G Rasschaert
- Department of gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - M Surmont
- Department of gastroenterology and Hepatology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - H Vafa
- Department of Gastroenterology and Hepatology, Chirec-Site Delta, Brussels, Belgium
| | - K Van Malderen
- Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium
| | - T Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - F Wuestenberghs
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - J Tack
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
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Joukar F, Yeganeh S, Shafaghi A, Mahjoob A, Hassanipour S, Santacroce L, Mavaddati S, Mansour-Ghanaei F. The seroprevalence of celiac disease in patients with symptoms of irritable bowel syndrome: A cross-sectional study in north of Iran. Hum Antibodies 2022; 30:97-103. [PMID: 35342083 DOI: 10.3233/hab-211516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Celiac disease (CD) is a common cause of malabsorption that is definitively diagnosed by abnormal bowel biopsy, symptoms and histologic changes to gluten free diet. The symptoms of irritable bowel syndrome (IBS) are common in our community as the majority of people in Guilan, north of Iran, consume rice daily. Also, a number of celiac patients are unknown, and IBS are mistakenly diagnosed. OBJECTIVE This study aimed to evaluate the prevalence of CD among IBS patients. METHODS A total of 475 consecutive patients with IBS, confirmed by Rome IV, underwent celiac serological tests antitissue transglutaminase antibodies (IgA-tTG, IgG-tTG) after obtaining a written consent form. In case of positive serological tests, biopsy was performed from small intestine after endoscopyRESULTS: Thirty-one (6.53%, 95% CI: 4.55-9.22) patients were positive for celiac serology. Based on Marsh-Oberhuber criteria, out of 9 patients with positive pathology 77.78% (95% CI: 40.19-96.05) had marsh IIIc. In IBS patients cramp (0.009) and stomach fullness (0.021) were two statistically significant IBS symptoms. CONCLUSIONS We suggest physicians to consider celiac examinations for all patients with IBS symptoms, even for patients with no obvious celiac symptoms.
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Affiliation(s)
- Farahnaz Joukar
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.,Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Sara Yeganeh
- Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.,Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Afshin Shafaghi
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Mahjoob
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Hassanipour
- GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Luigi Santacroce
- Department of Interdisciplinary Medicine, Microbiology and Virology Unit, University Hospital of Bari, Bari
| | | | - Fariborz Mansour-Ghanaei
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.,GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran
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21
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Daniluk J, Malecka-Wojciesko E, Skrzydlo-Radomanska B, Rydzewska G. The Efficacy of Mebeverine in the Treatment of Irritable Bowel Syndrome-A Systematic Review. J Clin Med 2022; 11:jcm11041044. [PMID: 35207315 PMCID: PMC8879004 DOI: 10.3390/jcm11041044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common gastrointestinal tract disorder, affecting 10-20% of adults worldwide. Mebeverine is an antispasmodic agent indicated for the symptomatic treatment of abdominal pain caused by intestinal smooth muscle spasms and intestinal functional disorders in the course of IBS. The aim of this article was to perform a systematic literature review and update previous overviews of the efficacy and safety of mebeverine treatment in IBS. METHODS Major electronic medical databases, PubMed, EMBASE and Cochrane, were systematically searched from January 1965 to January 2021. RESULTS Twenty-two studies met our inclusion criteria, including 19 randomised trials, two observational retrospective studies, and one non-randomised, single-blinded study. Six studies reported a significant decrease in abdominal pain after mebeverine treatment (p-values ranging from <0.05 to <0.001). Only three studies showed no improvement after mebeverine treatment in terms of the severity of abdominal pain or discomfort. Some of the included studies also showed significant improvements in abnormal bowel habits, abdominal distension, as well as stool frequency and consistency. Adverse events were rare and associated mainly with IBS symptoms. CONCLUSIONS Mebeverine is an effective treatment option in IBS, with a good safety profile and low frequency of adverse effects.
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Affiliation(s)
- Jaroslaw Daniluk
- Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, 15-276 Bialystok, Poland
- Correspondence:
| | - Ewa Malecka-Wojciesko
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-153 Lodz, Poland;
| | - Barbara Skrzydlo-Radomanska
- Department of Gastroenterology with Endoscopy Laboratory, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Grazyna Rydzewska
- Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, CSK MSWiA, 02-507 Warsaw, Poland;
- Collegium Medicum, Jan Kochanowski University, 25-516 Kielce, Poland
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22
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Donnet AS, Hasan SS, Whorwell PJ. Hypnotherapy for irritable bowel syndrome: patient expectations and perceptions. Therap Adv Gastroenterol 2022; 15:17562848221074208. [PMID: 35198040 PMCID: PMC8859690 DOI: 10.1177/17562848221074208] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/27/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Numerous studies have shown that hypnotherapy (HT) is effective in irritable bowel syndrome (IBS) using traditional symptom severity end points. However, there is now interest in capturing the patient's perception of their illness and treatment because what patients expect from their treatment may differ from that of their healthcare provider. OBJECTIVE To record patient perceptions and expectations of hypnotherapy as well as their symptom response. METHODS 150 consecutive IBS patients (116 females, 34 males, aged 16-81 years) receiving hypnotherapy completed questionnaires recording IBS symptom severity, quality of life, noncolonic symptoms, anxiety and depression levels before and after treatment. Their expectations and perceptions of HT were also recorded, including a free text reflection. RESULTS 121 patients (81%) responded to treatment consistent with our previous experience. Symptom severity scores, noncolonic symptoms, quality of life, anxiety and depression significantly all improved after HT (p < 0.001). Expectancy of an improvement with hypnotherapy was greater in those who did not respond to treatment (63%) than those who did (57%, p < 0.001). Scepticism and apprehension were common before treatment and replaced with enthusiasm afterwards. Free text responses after treatment were overwhelmingly positive. Patients also reported a variety of other benefits and even 20 of 29 symptom nonresponders (70%) still considered treatment worthwhile. CONCLUSION Although initially perceived negatively, hypnotherapy improved symptoms and resulted in a wide range of additional benefits. Expectation did not necessarily influence outcome. Recording IBS symptoms alone does not fully capture the patient's experience of treatment and needs to be considered in future research.
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23
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Castro J, Garcia-Caraballo S, Maddern J, Schober G, Lumsden A, Harrington A, Schmiel S, Lindstrom B, Adams J, Brierley SM. Olorinab (APD371), a peripherally acting, highly selective, full agonist of the cannabinoid receptor 2, reduces colitis-induced acute and chronic visceral hypersensitivity in rodents. Pain 2022; 163:e72-e86. [PMID: 33863856 PMCID: PMC8675055 DOI: 10.1097/j.pain.0000000000002314] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/12/2021] [Accepted: 04/02/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Abdominal pain is a key symptom of inflammatory bowel disease and irritable bowel syndrome, for which there are inadequate therapeutic options. We tested whether olorinab-a highly selective, full agonist of the cannabinoid receptor 2 (CB2)-reduced visceral hypersensitivity in models of colitis and chronic visceral hypersensitivity (CVH). In rodents, colitis was induced by intrarectal administration of nitrobenzene sulfonic acid derivatives. Control or colitis animals were administered vehicle or olorinab (3 or 30 mg/kg) twice daily by oral gavage for 5 days, starting 1 day before colitis induction. Chronic visceral hypersensitivity mice were administered olorinab (1, 3, 10, or 30 mg/kg) twice daily by oral gavage for 5 days, starting 24 days after colitis induction. Visceral mechanosensitivity was assessed in vivo by quantifying visceromotor responses (VMRs) to colorectal distension. Ex vivo afferent recordings determined colonic nociceptor firing evoked by mechanical stimuli. Colitis and CVH animals displayed significantly elevated VMRs to colorectal distension and colonic nociceptor hypersensitivity. Olorinab treatment significantly reduced VMRs to control levels in colitis and CVH animals. In addition, olorinab reduced nociceptor hypersensitivity in colitis and CVH states in a concentration- and CB2-dependent manner. By contrast, olorinab did not alter VMRs nor nociceptor responsiveness in control animals. Cannabinoid receptor 2 mRNA was detected in colonic tissue, particularly within epithelial cells, and dorsal root ganglia, with no significant differences between healthy, colitis, and CVH states. These results demonstrate that olorinab reduces visceral hypersensitivity through CB2 agonism in animal models, suggesting that olorinab may provide a novel therapy for inflammatory bowel disease- and irritable bowel syndrome-associated abdominal pain.
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Affiliation(s)
- Joel Castro
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, South Australia, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia, Australia
- Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Sonia Garcia-Caraballo
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, South Australia, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia, Australia
- Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Jessica Maddern
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, South Australia, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia, Australia
- Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Gudrun Schober
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, South Australia, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia, Australia
- Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Amanda Lumsden
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, South Australia, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia, Australia
| | - Andrea Harrington
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, South Australia, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia, Australia
- Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia, Australia
| | - Shirdi Schmiel
- Arena Pharmaceuticals, Inc, San Diego, CA, United States
| | | | - John Adams
- Arena Pharmaceuticals, Inc, San Diego, CA, United States
| | - Stuart M. Brierley
- Visceral Pain Research Group, College of Medicine and Public Health, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Bedford Park, South Australia, Australia
- Hopwood Centre for Neurobiology, Lifelong Health Theme, South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia, Australia
- Discipline of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia, Australia
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Increased prevalence of irritable bowel syndrome in migraine patients: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2022; 34:56-63. [PMID: 33470704 DOI: 10.1097/meg.0000000000002065] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Even though evidence showing increased prevalence of irritable bowel syndrome (IBS) among migraine patients exists, it has not been well-established and the magnitude of association varies substantially across the studies. This study aimed to comprehensively compare the prevalence of IBS among migraineurs versus nonmigraineurs using the systematic review and the meta-analysis technique. METHODS Two authors independently conducted a literature search in MEDLINE, EMBASE and Google Scholar database up to April 2020. The eligible study must consist of two groups of participants, migraineurs and nonmigraineurs, and report the prevalence of IBS in both groups. Alternatively, an eligible study may report the odds ratio (OR) with a 95% confidence interval (CI) of the association between migraine and IBS. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. RESULTS Of the 2531 articles identified from the three databases, 11 studies with a total of 28 336 migraineurs and 1 535 758 nonmigraineurs met the selection criteria and were included into the meta-analysis. The pooled analysis found that migraineurs had a significantly higher prevalence of IBS than nonmigraineurs with the pooled OR of 2.49 (95% CI, 2.22-2.78; I2, 42%). The funnel plot was asymmetric and suggested the presence of publication bias. CONCLUSION A significantly increased prevalence of IBS among patients with migraine was demonstrated in this study.
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25
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Abstract
Living a healthy lifestyle is the most important need in the world today. However, oxidative stress (OS) is caused by several stress-inducing factors such as smoking, alcohol consumption, chronic diseases, and inflammatory responses, oxygen-free radicals are produced in excess and can damage major organs in the body. This phenomenon has been implicated in the pathogenesis of several gastrointestinal (GI) diseases, including gastritis, constipation, and inflammatory bowel diseases, which include Crohn’s disease, ulcerative colitis, functional dyspepsia, acid reflux, diverticular disease, and irritable bowel syndrome. In this review article, we provide a brief overview of the role of OS in the pathogenesis of GI disorders. Additionally, we discuss the therapeutic role of alkaline-reduced water (ARW) on GI diseases and existing studies on ARW related to GI diseases. Furthermore, we believe that findings from this review article will enhance the knowledge of the readers on the role of ARW on OS and inflammation-based GI diseases.
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26
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Nakov R, Heinrich H. New mint on the block - Fresh hope for IBS treatment? United European Gastroenterol J 2021; 9:991-992. [PMID: 34730280 DOI: 10.1002/ueg2.12166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Radislav Nakov
- Clinic of Gastroenterology, Tsaritsa Yoanna University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Henriette Heinrich
- St. Anna Spital, Luzern, Switzerland.,University of Zuerich, Zuerich, Switzerland
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27
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Melchior C, Nuzzo A, Keszthelyi D. How to raise the interest for neurogastroenterology among young gastroenterologists? United European Gastroenterol J 2021; 9:1193-1196. [PMID: 34724358 PMCID: PMC8672086 DOI: 10.1002/ueg2.12174] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- 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, Rouen, France
| | - Alexandre Nuzzo
- APHP.Nord, Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France.,Université de Paris, Paris, France
| | - Daniel Keszthelyi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
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28
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Kahrilas PJ, Savarino E, Anastasiou F, Bredenoord AJ, Corsetti M, Lagergren J, Mendive J, Nelson S, Roman S, Zerbib F, Hungin P. The tapestry of reflux syndromes: translating new insight into clinical practice. Br J Gen Pract 2021; 71:470-473. [PMID: 34593403 PMCID: PMC8463155 DOI: 10.3399/bjgp21x717329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Peter J Kahrilas
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, IL, US
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Foteini Anastasiou
- 4th Local Primary Health Care Unit, Academic Unit of Heraklion, Clinic of Social and Family Medicine, University of Crete, Greece
| | - Albert J Bredenoord
- Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Maura Corsetti
- National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, UK; School of Medicine, University of Nottingham and Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - Jesper Lagergren
- School of Cancer and Pharmaceutical Sciences, King's College London, UK; Professor and Consultant of Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Juan Mendive
- La Mina Primary Care Academic Health Centre, University of Barcelona, Catalan Institute of Health, Barcelona, Spain
| | - Sophie Nelson
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Sabine Roman
- Université Claude Bernard Lyon 1 and Hospices Civils de Lyon, Digestive Physiology, Hopital E Herriot, Lyon, France
| | - Frank Zerbib
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Pali Hungin
- Primary Care and General Practice, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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29
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Wang XJ, Ebbert JO, Gilman EA, Rosedahl JK, Ramar P, Philpot LM. Central Sensitization Symptom Severity and Patient-Provider Relationships in a Community Setting. J Prim Care Community Health 2021; 12:21501327211031767. [PMID: 34235997 PMCID: PMC8273518 DOI: 10.1177/21501327211031767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Central sensitization syndromes (CSS) comprise an overlapping group of clinical conditions with the core feature of “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.” Patients with CSS are known to have challenging interactions with healthcare providers contributing to psychological distress and increased healthcare utilization. CSS symptom severity has been associated with psychologic comorbidities, but little is known about how symptom severity relates to provider interactions. Methods We performed a cross-sectional survey among patients with CSS in our primary care practices to examine the relationship between CSS symptom severity and experiences with doctors. Results A total of 775 respondents completed the survey (775/5000; 15.5%) with 72% reporting high CSS symptom severity. About 44% of respondents had a prior diagnosis of fibromyalgia, 72% had migraines, and 28% had IBS. Patients with high CSS symptom severity were more likely to report that doctor(s) had often/always told them that they don’t need treatment when they feel like they do (OR = 3.6, 95% CI 1.9-7.5), that doctor(s) often/always don’t understand them (OR = 3.1, 95% CI 1.9-5.4), and that doctor(s) often/always seem annoyed with them when compared with respondents with low-moderate CSS symptom severity (OR = 4.8, 95% CI 2.2-12.5). Patients with high CSS symptom severity were at greater than 5 times odds of reporting being told that their symptoms were “all in their head” when compared to patients with low-moderate symptom severity (OR = 5.4, 95% CI 3.3-9.0). Conclusion Patients with CSS spectrum disorders experience frequent pain and decreased quality of life. A high degree of CSS symptom severity is associated with negative experiences with healthcare providers, which deters the establishment of a positive provider-patient relationship. Further research is needed to help understand symptom severity in CSS and harness the power of the therapeutic alliance as a treatment modality.
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Kim GL, Yi YH, Hwang HR, Kim J, Park Y, Kim YJ, Lee JG, Tak YJ, Lee SH, Lee SY, Cho YH, Park EJ, Lee Y. The Risk of Osteoporosis and Osteoporotic Fracture Following the Use of Irritable Bowel Syndrome Medical Treatment: An Analysis Using the OMOP CDM Database. J Clin Med 2021; 10:jcm10092044. [PMID: 34068814 PMCID: PMC8126251 DOI: 10.3390/jcm10092044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022] Open
Abstract
Patients with irritable bowel syndrome (IBS) are at increased risk of osteoporosis and osteoporotic fracture. This study investigated whether IBS medication attenuated the rate of osteoporosis and osteoporotic fracture risk. We conducted a retrospective large-scale multicenter study across eight hospital databases encoded in the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM). The primary outcome was the incidence of osteoporosis, whereas secondary outcomes were osteoporotic fractures. After 1:4 matching, 24,723 IBS patients, 78,318 non-IBS patients, 427,640 non-IBS patients with IBS medication, and 827,954 non-IBS patients without IBS medication were selected. The risk of osteoporosis was significantly increased in the IBS group compared to the non-IBS group (hazard ratio (HR) 1.33; confidence interval (CI) 1.17~1.51). Even in patients who were not diagnosed with IBS, the risk of osteoporosis was significantly increased in those with IBS medication compared to those without (HR 1.77, CI 1.62~1.93). The risk of osteoporotic fracture was significantly increased in the IBS medication group (HR 1.69, CI 1.55~1.84). Patients exposed to IBS treatment even without IBS diagnosis were at increased risk of osteoporosis and osteoporotic fracture. Early diagnosis and treatment of osteoporosis should be considered in patients who have received medication for IBS symptoms.
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Affiliation(s)
- Gyu Lee Kim
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
| | - Yu Hyeon Yi
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
- Correspondence: ; Tel.: +82-51-240-7834; Fax: +82-51-240-7843
| | - Hye Rim Hwang
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
| | - Jinmi Kim
- Clinical Trial Center, Department of Biostatistics, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea;
| | - Youngmin Park
- Department of Family Medicine, National Health Insurance Service Ilsan Hospital, Goyang 10444, Korea;
| | - Yun Jin Kim
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
| | - Jeong Gyu Lee
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
| | - Young Jin Tak
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
| | - Seung Hun Lee
- Department of Family Medicine, Medical Research Institute and Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, Korea; (G.L.K.); (H.R.H.); (Y.J.K.); (J.G.L.); (Y.J.T.); (S.H.L.)
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
| | - Sang Yeoup Lee
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center Pusan National University Yangsan Hospital, Yangsan 50612, Korea
| | - Youn Hye Cho
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center Pusan National University Yangsan Hospital, Yangsan 50612, Korea
| | - Eun Ju Park
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center Pusan National University Yangsan Hospital, Yangsan 50612, Korea
| | - Youngin Lee
- Pusan National University School of Medicine, Yangsan 50612, Korea; (S.Y.L.); (Y.H.C.); (E.J.P.); (Y.L.)
- Family Medicine Clinic, Obesity, Metabolism and Nutrition Center Pusan National University Yangsan Hospital, Yangsan 50612, Korea
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Lukic S, Mijac D, Filipovic B, Sokic-Milutinovic A, Tomasevic R, Krstic M, Milosavljevic T. Chronic Abdominal Pain: Gastroenterologist Approach. Dig Dis 2021; 40:181-186. [PMID: 33946069 DOI: 10.1159/000516977] [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: 02/08/2021] [Accepted: 04/29/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Abdominal pain is a common symptom of gastroenterology examination. Chronic abdominal pain is present for >3 months. SUMMARY Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases encountered by both gastroenterologists and general practitioners. GERD is usually a chronic disease presented with a set of symptoms including heartburn and/or regurgitation, and less commonly epigastric pain. Epigastric pain syndrome is characterized by the following symptoms: epigastric pain and/or burning. It does not necessarily occur after meal ingestion, may occur during fasting, and can be even improved by meal ingestion. Duodenal ulcers tend to cause abdominal pain that is localized in the epigastric region and commence several hours after eating, often at night. Hunger provokes pain in most of the cases and decreases after meal. Gastric ulcer pain occurs immediately after eating, and consuming food increases pain. Pain is localized in the epigastrium and can radiate to the back. Abdominal pain in irritable bowel syndrome is related to defecation. A typical symptom of chronic pancreatitis is pain that radiates to the back. In Crohn's disease, inflammation causes pain. Key Messages: Pain can occur at different locations with diverse intensity and propagation and is often associated with other symptoms. For any gastroenterologist, abdominal pain is a big challenge.
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Affiliation(s)
- Snezana Lukic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Mijac
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branka Filipovic
- Clinical and Hospital center "Dr Dragisa Misovic-Dedinje", School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Sokic-Milutinovic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ratko Tomasevic
- Department of Gastroenterology, Clinical and Hospital center "Zemun", School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Miodrag Krstic
- Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
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Reicher-Atir R, Avnat-Becker L, Levy S, Sperber AD, Dickman R. Psychological defense mechanisms and use of corporeal discourse: a comparison between patients with irritable bowel syndrome, medical personnel and healthy volunteers. Eur J Gastroenterol Hepatol 2021; 33:514-521. [PMID: 32956177 DOI: 10.1097/meg.0000000000001940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of this study was to compare the use of psychological defense mechanisms and corporeal discourse among patients with irritable bowel syndrome (IBS), medical personnel and healthy volunteers. METHODS All participants completed an identical battery of questionnaires: a demographic questionnaire, the Corporeal Discourse Questionnaire, the Defense Style Questionnaire and a Visual Analogue Scale for situational anxiety and depression. Patients and medical personnel were recruited from the Rabin Medical Center, a tertiary university-affiliated hospital. Findings were analyzed according to the study variables and compared among the groups. RESULTS Questionnaires were completed by 40 patients with IBS, 39 medical personnel and 40 healthy volunteers. Correlations between the study variables within the entire study group (all study participants, N = 119) revealed that corporeal discourse was found to be significantly correlated with the immature and neurotic class of defense mechanisms (r = 0.41, P < 0.01 and r = 0.20, P < 0.05, respectively), depression (r = 0.46, P < 0.05) and anxiety (r = 0.46, P < 0.05). Differences between IBS and the other two groups were significant for corporeal discourse, depression, anxiety and use of immature defense mechanisms. Posthoc analyses showed that medical personnel differed from IBS patients in all of these measures. Healthy volunteers had an inconsistent pattern of differences from the other two groups. CONCLUSION Maturity level of defense mechanisms and the tendency to use corporeal discourse are expressed among IBS patients in a diverse and unique manner. These findings may indicate additional psychological mechanisms that could explain the use of somatic complaints in IBS and support the implementation of tailored psychological interventions.
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Affiliation(s)
- Rebecca Reicher-Atir
- Statistics Education Unit, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo
| | - Lee Avnat-Becker
- Statistics Education Unit, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo
| | - Sigal Levy
- Statistics Education Unit, The Academic College of Tel Aviv-Yaffo, Tel Aviv-Yaffo
| | - Ami D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva
| | - Ram Dickman
- Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Jones J, Lembo A, Heidelbaugh J, Kuritzky L, Lacy B. Management of irritable bowel syndrome with diarrhea: focus on eluxadoline. Curr Med Res Opin 2021; 37:567-578. [PMID: 33566707 DOI: 10.1080/03007995.2021.1888705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We sought to summarize current recommendations for the diagnosis of diarrhea-predominant irritable bowel syndrome (IBS-D) and describe available management options, highlighting a newer US Food and Drug Administration (FDA)-approved agent, eluxadoline. METHODS Literature on IBS-D was assessed up to January 2020 using PubMed, with key search terms including "IBS-D diagnosis", "IBS-D management", and "eluxadoline". RESULTS IBS is a common gastrointestinal disorder affecting up to 14% of US adults and is particularly prevalent in women and those aged under 50. Symptoms include abdominal pain associated with altered bowel habits (i.e. diarrhea and/or constipation subtyped based on the predominant stool pattern). As IBS-D is challenging to manage with varying symptom severity, effective treatment requires a personalized management approach. Evidence-based therapeutic options endorsed by the American Gastroenterological Association and the American College of Gastroenterology can be used to effectively guide treatment. Dietary and lifestyle modifications, including adequate hydration, reducing caffeine and alcohol intake, and increasing soluble fiber intake may lead to symptom improvement. Over-the-counter medications such as loperamide are frequently recommended and may improve stool frequency and rectal urgency; however, for the outcome of abdominal pain, mixed results have been observed. Several off-label prescription medications are useful in IBS-D management, including tricyclic antidepressants, bile acid sequestrants, and antispasmodics. Three prescription medications have been approved by the FDA for IBS-D: alosetron, eluxadoline, and rifaximin. CONCLUSIONS IBS-D can be effectively managed in the primary care setting in the absence of alarm features. Benefits and risks of pharmacologic interventions should be weighed during treatment selection.
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Affiliation(s)
- Jennifer Jones
- UCF College of Medicine, HCA Consortium Family Medicine Residency, Gainesville, FL, USA
| | - Anthony Lembo
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joel Heidelbaugh
- Departments of Family Medicine and Urology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Louis Kuritzky
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Brian Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
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Seamark L, Barclay Y, Marchant C, Williams M, Hickson M. Long-term symptom severity in people with irritable bowel syndrome following dietetic treatment in primary care: A service evaluation. J Hum Nutr Diet 2021; 34:890-900. [PMID: 33761153 DOI: 10.1111/jhn.12860] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Evidence suggests that dietary interventions can improve symptoms in people with irritable bowel syndrome (IBS), although most data explore the short-term (immediate) impact. Data on long-term (>6 months) impact are limited, especially from primary care settings. The present study aimed to investigate the long-term effect of dietetic-led interventions for IBS delivered in primary care. METHODS A service evaluation of a dietetic-led IBS clinic was completed, analysing data on symptom severity, stool frequency and consistency, and healthcare input. Data were collected before and immediately after dietary intervention as part of patients' routine clinical appointments. Long-term data were collected via a postal questionnaire at least 11 months later. RESULTS In total, 211 patients responded to the long-term follow-up questionnaire at a median of 13 months (interquartile range 12-16 months) post follow-up appointment. Of these, 84% had been advised to follow a low FODMAP (i.e., fermentable oligosaccharides, disaccharides, monosaccharides and polyols carbohydrates) diet. All symptoms were reported significantly less frequently short term, and all except heartburn and acid regurgitation remained so over the long term. The four most commonly reported bowel symptoms reduced in frequency were abdominal pain (62%), bloating (50%), increased wind (48%) and urgency to open bowels (49%) (p < 0.001). The percentage of patients reporting satisfactory relief of gut symptoms was 10% at baseline and 55% at long-term follow-up (p < 0.001). Visits to a general practitioner were reduced (from 96% to 34%; p < 0.001), as were those to the gastroenterologist (from 37% to 12%; p = 0.002), during the year prior to long-term follow-up compared to the year prior to dietary intervention. CONCLUSIONS Patients with IBS who received dietetic-led interventions in primary care reported long-term symptoms improvements that may result in reduced healthcare usage.
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Affiliation(s)
- Leah Seamark
- Community Dietetics, Somerset NHS Foundation Trust, Bridgwater, Somerset, UK
| | - Yvonne Barclay
- Community Dietetics, Somerset NHS Foundation Trust, Bridgwater, Somerset, UK
| | - Ceri Marchant
- Community Dietetics, Somerset NHS Foundation Trust, Bridgwater, Somerset, UK
| | - Marianne Williams
- Community Dietetics, Somerset NHS Foundation Trust, Bridgwater, Somerset, UK
| | - Mary Hickson
- Plymouth Institute of Health Research, University of Plymouth, Plymouth, UK
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Diagnosing Constipation Spectrum Disorders in a Primary Care Setting. J Clin Med 2021; 10:jcm10051092. [PMID: 33807888 PMCID: PMC7961346 DOI: 10.3390/jcm10051092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Understanding pathophysiological causes of constipation is worthwhile in directing therapy and improving symptoms. This review aims to identify and fill gaps in the understanding of the pathophysiology of constipation, understand its prevalence, review diagnostic tools available to primary care physicians (PCPs), and highlight patients’ expectations for the management of this common spectrum of disorders. Literature searches conducted via PubMed included terms related to constipation, diagnosis, and patient perceptions. Case studies were developed to highlight the differences between patients who may be appropriately managed in the primary care setting and those requiring specialty consultation. Myriad pathophysiological factors may contribute to constipation, including stool consistency, altered intestinal motility, gut microbiome, anorectal abnormalities, as well as behavioral and psychological factors. Common diagnoses of “primary constipation” include slow-transit constipation, defecation disorders, irritable bowel syndrome with constipation, and chronic idiopathic constipation. A detailed medical history should be conducted to exclude alarm features and PCPs should be familiar with pathophysiological factors that cause constipation, available diagnostic tools, alarm signs, and the various classification criteria for constipation subtypes in order to diagnose and treat patients accordingly. PCPs should understand when a referral to a gastroenterologist, anorectal specialist, pelvic floor physical therapist, and/or mental health specialist is appropriate.
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Yang H, Liu X, Peng W, Chen R, Chen Y. Lipi Guben decoction in treating diarrheal irritable bowel syndrome: A study protocol for a randomized controlled trial. Medicine (Baltimore) 2021; 100:e23887. [PMID: 33545956 PMCID: PMC7837987 DOI: 10.1097/md.0000000000023887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a common functional bowel disorder. The global incidence of IBS is as high as 9% to 23%, accounting for about 50% of outpatients in gastroenterology, and the new case detection rate is 0.2% every year. IBS has become a global gastrointestinal functional disease. Although IBS is not a life-threatening disease, it seriously affects the quality of life of patients, causing huge economic and mental burden to individuals, society and families. Lipi Guben decoction (LPGBD) is an important auxiliary treatment for IBS, but lack of robust Evidence-based medicine evidence proving its efficacy. Therefore, we designed a randomized controlled trial to evaluate the efficacy and safety of LPGBD in the treatment of IBS. METHODS In this randomized controlled trial, a total of 100 eligible patients will be allocated to the blank control group or LPGBD group in a ratio of 1:1. The treatment period was 12 weeks. The primary outcome measure will be the total clinical effective rate. The Secondary outcomes will include IBS clinical symptom scores, IBS-Severity Scoring System, IBS-Quality of life, Hamilton Rating Scale for Anxiety, Hamilton Rating Scale for Depression, and Bristol Stool Form Scale. The safety outcome will include Echocardiogram, blood examination (including blood routine test, liver function test, and renal function test), urine routine test and stool routine test. The evaluation indicators and all safety results will be performed at baseline, week 4, week 8 and week 12. RESULTS This study will be helpful to evaluate the efficacy and safety of LPGBD in the treatment of IBS. CONCLUSION LPGBD may improve the clinical efficacy of patients with IBS, which has important value in practical application. TRIAL REGISTRATION Chictr20000039617, registration time: November 3, 2020.
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Affiliation(s)
- Hongmei Yang
- The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine
| | - Xin Liu
- The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine
| | - Wei Peng
- The Chinese People's Liberation Army 921 Hospital of the Joint Logistics Support Force
| | | | - Yang Chen
- The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine
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Ma C, Congly SE, Novak KL, Belletrutti PJ, Raman M, Woo M, Andrews CN, Nasser Y. Epidemiologic Burden and Treatment of Chronic Symptomatic Functional Bowel Disorders in the United States: A Nationwide Analysis. Gastroenterology 2021; 160:88-98.e4. [PMID: 33010247 PMCID: PMC7527275 DOI: 10.1053/j.gastro.2020.09.041] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/10/2020] [Accepted: 09/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Functional bowel disorders (FBDs) are the most common gastrointestinal problems managed by physicians. We aimed to assess the burden of chronic symptomatic FBDs on ambulatory care delivery in the United States and evaluate patterns of treatment. METHODS Data from the National Ambulatory Medical Care Survey were used to estimate annual rates and associated costs of ambulatory visits for symptomatic irritable bowel syndrome, chronic functional abdominal pain, constipation, or diarrhea. The weighted proportion of visits associated with pharmacologic and nonpharmacologic (stress/mental health, exercise, diet counseling) interventions were calculated, and predictors of treatment strategy were evaluated in multivariable multinomial logistic regression. RESULTS From 2007-2015, approximately 36.9 million (95% CI, 31.4-42.4) weighted visits in patients of non-federally employed physicians for chronic symptomatic FBDs were sampled. There was an annual weighted average of 2.7 million (95% CI, 2.3-3.2) visits for symptomatic irritable bowel syndrome/chronic abdominal pain, 1.0 million (95% CI, 0.8-1.2) visits for chronic constipation, and 0.7 million (95% CI, 0.5-0.8) visits for chronic diarrhea. Pharmacologic therapies were prescribed in 49.7% (95% CI, 44.7-54.8) of visits compared to nonpharmacologic interventions in 19.8% (95% CI, 16.0-24.2) of visits (P < .001). Combination treatment strategies were more likely to be implemented by primary care physicians and in patients with depression or obesity. The direct annual cost of ambulatory clinic visits alone for chronic symptomatic FBDs is approximately US$358 million (95% CI, 233-482 million). CONCLUSIONS The management of chronic symptomatic FBDs is associated with considerable health care resource use and cost. There may be an opportunity to improve comprehensive FBD management because fewer than 1 in 5 ambulatory visits include nonpharmacologic treatment strategies.
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Affiliation(s)
- Christopher Ma
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Stephen E Congly
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Kerri L Novak
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul J Belletrutti
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maitreyi Raman
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Matthew Woo
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher N Andrews
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yasmin Nasser
- Division of Gastroenterology and Hepatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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AlAmeel T, Roth LS, Al Sulais E. The Prevalence of Irritable Bowel Syndrome Among Board-Certified Medical Doctors In Saudi Arabia: A Cross-sectional Study. J Can Assoc Gastroenterol 2020; 3:e32-e36. [PMID: 33241184 PMCID: PMC7678731 DOI: 10.1093/jcag/gwz020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders. A pooled analysis showed a global prevalence of 11.2%. Few studies looked at the prevalence of IBS in health care providers. The aim of this study was to determine the prevalence of IBS among board-certified physicians and surgeons. METHODS Board-certified physicians and surgeons in Saudi Arabia were invited to complete a web-based survey. It included questions regarding participant demographics, specialty, practice type and hours worked per week. The Rome IV-validated questionnaire was used to identify subjects with IBS. The primary outcome of the study was the prevalence of IBS among physicians. Secondary outcomes included exploring the effect on IBS prevalence of age, gender, marital status, work hours, specialty, gastroenterology subspecialty and working in a public versus private hospital. RESULTS The final analysis included 594 subjects, with 419 males and a median age of 41. The vast majority (86%) were married. Nearly 90% worked in a public hospital exclusively, and the median number of hours worked per week was 48. The overall prevalence of IBS was 16.3%. In a binary logistic regression model, age (odds ratio [OR] = 0.931, P < 0.0001), gender (OR = 0.504, P = 0.003) and work hours (OR = 2.397, P < 0.0001) significantly predicted the presence of IBS. Marital status and specialty did not predict IBS prevalence. DISCUSSION This cross-sectional study shows that the prevalence of IBS among physicians in Saudi Arabia to be 16.3%. IBS was more common in females, those who worked longer hours and younger physicians. There was no association between practicing certain specialties and IBS. However, the lack of difference in our cohort may be attributed to the relatively small sample size from each specialty.
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Affiliation(s)
- Turki AlAmeel
- Department of Medicine, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Lee S Roth
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eman Al Sulais
- Department of Medicine, King Fahad Specialist Hospital-Dammam, Saudi Arabia
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Farmer AD, Wood E, Ruffle JK. An approach to the care of patients with irritable bowel syndrome. CMAJ 2020; 192:E275-E282. [PMID: 32179536 DOI: 10.1503/cmaj.190716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Adam D Farmer
- Department of Gastroenterology (Farmer, Wood), University Hospitals of North Midlands, Stoke-on-Trent, UK; Institute of Applied Clinical Science (Farmer), University of Keele, Keele, Staffordshire, UK; Centre for Neuroscience, Surgery and Trauma (Farmer, Ruffle), Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Emma Wood
- Department of Gastroenterology (Farmer, Wood), University Hospitals of North Midlands, Stoke-on-Trent, UK; Institute of Applied Clinical Science (Farmer), University of Keele, Keele, Staffordshire, UK; Centre for Neuroscience, Surgery and Trauma (Farmer, Ruffle), Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - James K Ruffle
- Department of Gastroenterology (Farmer, Wood), University Hospitals of North Midlands, Stoke-on-Trent, UK; Institute of Applied Clinical Science (Farmer), University of Keele, Keele, Staffordshire, UK; Centre for Neuroscience, Surgery and Trauma (Farmer, Ruffle), Blizard Institute, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Abstract
Functional bowel disorders refer to disorders of gut-brain interaction that affect the intestinal tract. Irritable bowel syndrome (IBS) is the most common functional bowel disorder and affects individuals regardless of age and gender. It can result in impaired quality of life and significant health care utilization and is therefore important to recognize and manage. The diagnosis of IBS is based on clinical symptoms. IBS is categorized based on predominant bowel habit (constipation, diarrhea, mixed, or unclassified), and the treatment of IBS is individually tailored based on subtype and symptom severity.
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Low Fermentable Oligo- Di- and Mono-Saccharides and Polyols (FODMAPs) or Gluten Free Diet: What Is Best for Irritable Bowel Syndrome? Nutrients 2020; 12:nu12113368. [PMID: 33139629 PMCID: PMC7692077 DOI: 10.3390/nu12113368] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 02/07/2023] Open
Abstract
Irritable Bowel Syndrome (IBS) is a very common functional gastrointestinal disease. Its pathogenesis is multifactorial and not yet clearly defined, and hence, its therapy mainly relies on symptomatic treatments. Changes in lifestyle and dietary behavior are usually the first step, but unfortunately, there is little high-quality scientific evidence regarding a dietary approach. This is due to the difficulty in setting up randomized double-blind controlled trials which objectively evaluate efficacy without the risk of a placebo effect. However, a Low Fermentable Oligo-, Di- and Mono-saccharides And Polyols (FODMAP) Diet (LFD) and Gluten Free Diet (GFD) are among the most frequently suggested diets. This paper aims to evaluate their possible role in IBS management. A GFD is less restrictive and easier to implement in everyday life and can be suggested for patients who clearly recognize gluten as a trigger of their symptoms. An LFD, being more restrictive and less easy to learn and to follow, needs the close supervision of a skilled nutritionist and should be reserved for patients who recognize that the trigger of their symptoms is not, or not only, gluten. Even if the evidence is of very low-quality for both diets, the LFD is the most effective among the dietary interventions suggested for treating IBS, and it is included in the most updated guidelines.
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Manuelyan Z, Siomara Muñiz K, Stein E. Common Urinary and Bowel Disorders in the Geriatric Population. Med Clin North Am 2020; 104:827-842. [PMID: 32773048 DOI: 10.1016/j.mcna.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The prevalence of urinary incontinence and other lower urinary tract symptoms increases with older age. These symptoms are more noticeable in men after the seventh decade of life and in women after menopause. Constipation and fecal incontinence are major causes of symptoms in elderly patients and can significantly impair quality of life. This article summarizes the current literature regarding the occurrence and implications of lower urinary tract and bowel symptoms in the geriatric population.
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Affiliation(s)
- Zara Manuelyan
- Department of Gastroenterology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, 3rd Floor, A Building Johns Hopkins Bayview, Baltimore, MD 21224, USA
| | - Keila Siomara Muñiz
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, 301 Building, Suite 3100, Baltimore, MD 21224, USA
| | - Ellen Stein
- Department of Gastroenterology, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, 3rd Floor, A Building Johns Hopkins Bayview, Baltimore, MD 21224, USA.
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Vasant DH, Ford AC. Functional gastrointestinal disorders in inflammatory bowel disease: Time for a paradigm shift? World J Gastroenterol 2020; 26:3712-3719. [PMID: 32774052 PMCID: PMC7383849 DOI: 10.3748/wjg.v26.i26.3712] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/23/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023] Open
Abstract
Recent advances in biological therapies have revolutionalised and redefined treatment targets in inflammatory bowel disease (IBD). There is now a stronger emphasis on achieving the more stringent therapeutic goals of mucosal and histological healing, rather than clinical remission alone. Consequently, the treatment of refractory “functional” gastrointestinal symptoms, often attributed as the aftermath of previous inflammation, has recently become more prominent in quiescent disease. With further expected advances in anti-inflammatory treatments on the horizon, the burden of such symptoms in quiescent disease, which have been relatively neglected, is set to become an even bigger problem. In this article, we highlight the current state of research and understanding in this field, including recent developments and clinical practice guidelines on the diagnosis and management of functional gastrointestinal symptoms, such as irritable bowel syndrome and functional anorectal and pelvic floor disorders, in patients with quiescent IBD. These disorders are not only highly prevalent in these patients, they are often misdiagnosed, and are difficult to treat, with very few evidence-based therapies. Moreover, they are associated with substantial impairment in quality-of-life, considerable morbidity, and psychological distress. There is therefore an urgent need for a change in emphasis towards earlier recognition, positive diagnosis, and targeted treatment for patients with ongoing functional gastrointestinal symptoms in the absence of active IBD. This article also highlights the need for further research to develop much needed evidence-based therapies.
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Affiliation(s)
- Dipesh H Vasant
- Gastroenterology, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester M23 9LT, United Kingdom
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester M23 9LT, United Kingdom
| | - Alexander C Ford
- Leeds Institute of Medical Research at St. James’s, University of Leeds, Leeds LS9 7TF, United Kingdom
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, United Kingdom
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Moayyedi P, Simrén M, Bercik P. Evidence-based and mechanistic insights into exclusion diets for IBS. Nat Rev Gastroenterol Hepatol 2020; 17:406-413. [PMID: 32123377 DOI: 10.1038/s41575-020-0270-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 12/14/2022]
Abstract
Exclusion diets are becoming increasingly popular in the management of irritable bowel syndrome (IBS). Several mechanisms exist by which food items might cause gastrointestinal symptoms, such as direct osmotic effects of food in the gut lumen, changes to the gut microbiota and immune activation. These effects have been demonstrated in animal models and in human studies, particularly in the case of gluten-free diets and diets low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). Indeed, randomized controlled trials (RCTs) suggest that gluten-free diets and low-FODMAP diets improve IBS symptoms, and guidelines recommend the latter approach for treating symptoms in some patients with IBS. Designing such RCTs is challenging as participants need to eat so an 'inert' placebo is not an option. Blinding is also an issue with these studies; in the future, new exclusion diets should not advertise what the diet consists of until it is proved to reduce symptoms. In this Review, we outline the advantages and disadvantages of each choice of control group and emphasize the importance of collecting mechanistic data (regarding direct effects of food on the gut lumen, changes in gut microbiota and intestinal inflammation) as well as symptom data in RCTs of exclusion diets in IBS.
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Affiliation(s)
- Paul Moayyedi
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada.
| | - Magnus Simrén
- Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Premysl Bercik
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
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Wongtrakul W, Charoenngam N, Ungprasert P. The association between irritable bowel syndrome and osteoporosis: a systematic review and meta-analysis. Osteoporos Int 2020; 31:1049-1057. [PMID: 32008157 DOI: 10.1007/s00198-020-05318-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recent studies have suggested that irritable bowel syndrome (IBS) could be a risk factor for osteoporosis although the evidence is still limited. The current study aimed to comprehensively examine the risk of osteoporosis among patients with IBS using systematic review and meta-analysis technique. METHODOLOGY Literature search was independently conducted by two investigators using MEDLINE, EMBASE, and Google Scholar database up to October 2019. Eligible study must evaluate whether patients with IBS have a higher risk of osteoporosis and/or osteoporotic fracture. It could be either cross-sectional study, case-control study, or cohort study. Point estimates and standard errors from each eligible study were combined together using the generic inverse variance method of DerSimonian and Laird. RESULTS Of the 320 articles identified from the three databases, four cohort and one cross-sectional study with 526,633 participants met the eligibility criteria and were included into the meta-analysis. All five studies investigated the risk of osteoporosis among patients with IBS, and the pooled analysis found that patients with IBS had a significantly higher risk of osteoporosis than individuals without IBS with the pooled risk ratio of 1.95 (95% CI, 1.04-3.64; I2 100%). Sensitivity analysis including only cohort studies found a lower RR (pooled RR 1.55; 95% CI, 1.39-1.72) with a lower I2 (59%). Three studies investigated the risk of osteoporotic fracture, and the pooled analysis found that patients with IBS also had a higher risk of osteoporotic fracture than individuals without IBS with the pooled risk ratio of 1.58 although statistical significance was not reached (95% CI, 0.95-2.62; I2 99%). Sensitivity analysis including only cohort studies found a lower RR (pooled RR 1.27; 95% CI, 1.20-1.39) with a dramatically lower I2 (0%). Limitations included high heterogeneity and reliance on diagnostic codes. CONCLUSION A significantly increased risk of osteoporosis among IBS patients was observed in this study. Early intervention to prevent the development of osteoporosis, such as weight-bearing exercise, adequate intake of vitamin D and calcium, and early screening for osteoporosis, may be beneficial to these patients although further studies are still required to confirm the efficacy and cost-effectiveness of this approach.
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Affiliation(s)
- W Wongtrakul
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - N Charoenngam
- Department of Internal Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - P Ungprasert
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA.
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Agnello M, Carroll LN, Imam N, Pino R, Palmer C, Varas I, Greene C, Hitschfeld M, Gupta S, Almonacid DE, Hoaglin MC. Gut microbiome composition and risk factors in a large cross-sectional IBS cohort. BMJ Open Gastroenterol 2020; 7:e000345. [PMID: 32518661 PMCID: PMC7254124 DOI: 10.1136/bmjgast-2019-000345] [Citation(s) in RCA: 9] [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: 10/05/2019] [Revised: 12/30/2019] [Accepted: 01/09/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that is difficult to diagnose and treat due to its inherent heterogeneity and unclear aetiology. Although there is evidence suggesting the importance of the microbiome in IBS, this association remains poorly defined. In the current study, we aimed to characterise a large cross-sectional cohort of patients with self-reported IBS in terms of microbiome composition, demographics, and risk factors. Design Individuals who had previously submitted a stool sample for 16S microbiome sequencing were sent a comprehensive survey regarding IBS diagnosis, demographics, health history, comorbidities, family history, and symptoms. Log ratio-transformed abundances of microbial taxa were compared between individuals reporting a diagnosis of IBS without any comorbidities and individuals reporting no health conditions. Univariable testing was followed by a multivariable logistic regression model controlling for relevant confounders. Results Out of 6386 respondents, 1692 reported a diagnosis of IBS without comorbidities and 1124 reported no health conditions. We identified 3 phyla, 15 genera, and 19 species as significantly associated with IBS after adjustment for confounding factors. Demographic risk factors include a family history of gut disorders and reported use of antibiotics in the last year. Conclusion The results of this study confirm important IBS risk factors in a large cohort and support a connection for microbiome compositional changes in IBS pathogenesis. The results also suggest clinical relevance in monitoring and investigating the microbiome in patients with IBS. Further, the exploratory models described here provide a foundation for future studies.
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Affiliation(s)
| | | | | | | | | | | | - Claire Greene
- Medical Affairs, uBiome, San Francisco, California, USA
| | | | - Sarah Gupta
- Medical Affairs, uBiome, San Francisco, California, USA
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Efficacy of the Combination of Pinaverium Bromide 100 mg Plus Simethicone 300 mg in Abdominal Pain and Bloating in Irritable Bowel Syndrome: A Randomized, Placebo-controlled Trial. J Clin Gastroenterol 2020; 54:e30-e39. [PMID: 31385885 PMCID: PMC7069394 DOI: 10.1097/mcg.0000000000001242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
GOALS We aimed to evaluate the efficacy and safety of PB+S (pinaverium bromide 100 mg plus simethicone 300 mg) in patients with irritable bowel syndrome (IBS). BACKGROUND IBS is a multifactorial disorder; thus, combination therapy with different mechanisms of action is expected to be useful. PB+S has shown effectiveness in an open-label clinical study in IBS. However, there are no placebo-controlled trials. MATERIALS AND METHODS IBS-Rome III patients with abdominal pain/discomfort for at least 2 days within the week prior to baseline assessment were included in this 12-week, randomized, double-blind, placebo-controlled study of PB+S versus placebo, bid. The primary endpoint was overall symptom improvement, evaluated weekly by the patient (Likert Scale). Secondary endpoints included the weekly improvement in the severity of abdominal pain and bloating assessed both by patients (10-cm Visual Analogue Scale) and investigators (Likert Scale); frequency of Bristol Scale stool types (consistency) evaluated by patients and the IBS Quality of Life scores. RESULTS A total of 285 patients (female: 83%; 36.5±8.9 y old) received at least 1 dose of PB+S (n=140) or placebo (n=145). No difference was observed in overall symptom improvement between the groups (P=0.13). However, PB+S was superior in abdominal pain (effect size: 31%, P=0.038) and bloating (33%, P=0.019). Patients with IBS-C and IBS-M showed the best improvement in the frequency of stool types with PB+S. No differences were observed in IBS Quality of Life scores and adverse events. CONCLUSIONS PB+S was superior to placebo in improving abdominal pain and bloating in patients with active IBS. The effect on the frequency of stool consistency was particularly significant in IBS-C and IBS-M.
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Gayathri R, Aruna T, Malar S, Shilpa B, Dhanasekar KR. Efficacy of Saccharomyces cerevisiae CNCM I-3856 as an add-on therapy for irritable bowel syndrome. Int J Colorectal Dis 2020; 35:139-145. [PMID: 31807856 DOI: 10.1007/s00384-019-03462-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The symptoms of irritable bowel syndrome (IBS) lead to considerable impairment of health-related quality of life and high health care costs. Available therapies are not efficient in treating the symptoms of IBS. Studies have shown the beneficial effects of Saccharomyces cerevisiae CNCM I-3856. Therefore, this study was done to evaluate the efficacy and safety of S. cerevisiae CNCM I-3856 in the treatment of IBS. METHODS This was a prospective, randomized, placebo-controlled study. One hundred newly diagnosed subjects with IBS were subgrouped into IBS-D, IBS-C, and IBS-M and then randomized to the S. cerevisiae CNCM I-3856 and placebo groups. Saccharomyces cerevisiae/placebo was administered in addition to standard treatment for a period of 8 weeks. Subjects were assessed for improvement of abdominal pain and change in stool consistency using a 7-point Likert scale and Bristol stool scale respectively. RESULTS The mean reduction of abdominal pain score in the S. cerevisiae CNCM I-3856 group was statistically significant when compared with the placebo group (p < 0.001). Similar improvement was also seen in the subgroups. Improvement in stool consistency in IBS-D subgroup at the end of treatment period was found to be statistically significant in S. cerevisiae group when compared to that of placebo (p < 0.001). A similar improvement was seen in the IBS-C and IBS-M subgroups. No serious adverse events were recorded in both groups. CONCLUSION The use of Saccharomyces cerevisiae CNCM I-3856 in IBS at a dose of 2 billion CFU twice daily for 8 weeks has shown to have an improvement in abdominal pain and stool consistency due to its analgesic and anti-inflammatory activity in subjects with IBS.
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Affiliation(s)
| | - Thangavelu Aruna
- Department of Pharmacology, Kilpauk Medical College, Chennai, Tamil Nadu, India
| | - Sivaraman Malar
- Department of Pharmacology, Kilpauk Medical College, Chennai, Tamil Nadu, India
| | - Bennur Shilpa
- Department of Medical & Scientific Affairs, Tablets India Limited, Jhaver Centre, 72 Marshalls Road, Egmore, Chennai, 600008, India
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Paredes S, Cantillo S, Candido KD, Knezevic NN. An Association of Serotonin with Pain Disorders and Its Modulation by Estrogens. Int J Mol Sci 2019; 20:E5729. [PMID: 31731606 PMCID: PMC6888666 DOI: 10.3390/ijms20225729] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
Ovarian hormones play an important role in pain perception, and are responsible, at least in part, for the pain threshold differences between the sexes. Modulation of pain and its perception are mediated by neurochemical changes in several pathways, affecting both the central and peripheral nervous systems. One of the most studied neurotransmitters related to pain disorders is serotonin. Estrogen can modify serotonin synthesis and metabolism, promoting a general increase in its tonic effects. Studies evaluating the relationship between serotonin and disorders such as irritable bowel syndrome, fibromyalgia, migraine, and other types of headache suggest a clear impact of this neurotransmitter, thereby increasing the interest in serotonin as a possible future therapeutic target. This literature review describes the importance of substances such as serotonin and ovarian hormones in pain perception and illustrates the relationship between those two, and their direct influence on the presentation of the aforementioned pain-related conditions. Additionally, we review the pathways and receptors implicated in each disorder. Finally, the objective was to stimulate future pharmacological research to experimentally evaluate the potential of serotonin modulators and ovarian hormones as therapeutic agents to regulate pain in specific subpopulations.
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Affiliation(s)
- Stephania Paredes
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (S.P.); (S.C.); (K.D.C.)
| | - Santiago Cantillo
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (S.P.); (S.C.); (K.D.C.)
| | - Kenneth D. Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (S.P.); (S.C.); (K.D.C.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, 836 W. Wellington Ave. Suite 4815, Chicago, IL 60657, USA; (S.P.); (S.C.); (K.D.C.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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A Practical Guide to the Clinical Evaluation of Endometriosis-Associated Pelvic Pain. J Minim Invasive Gynecol 2019; 27:270-279. [PMID: 31669551 DOI: 10.1016/j.jmig.2019.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
Endometriosis-associated pain (EAP) has a significant impact on the quality of life of those affected and their families. Recognizing that endometriosis is a chronic condition associated with an impairment in function and negative social impact, there is a shift toward reducing diagnostic delays and initiating timely management. This article provides a comprehensive and practical approach to the clinical diagnosis of EAP, which can subsequently facilitate prompt and directed treatment. The key components of the history, physical examination, and high-quality imaging to evaluate suspected EAP and related pain conditions are presented. Currently, biomarkers have limited utility in the diagnosis of endometriosis, but research in this area continues; development of a reliable noninvasive test for endometriosis may further improve early identification of this condition.
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