Factors associated with irritable bowel syndrome symptoms in hemodialysis patients

The Effect of Inflammatory Bowel Disease and Irritable Bowel Syndrome on Pravastatin Oral Bioavailability: In vivo and in silico evaluation using bottom-up wbPBPK modeling

The common disorders irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) can modify the drugs' pharmacokinetics via their induced pathophysiological changes. This work aimed to investigate the impact of these two diseases on pravastatin oral bioavailability. Rat models for IBS and IBD were used to experimentally test the effects of IBS and IBD on pravastatin pharmacokinetics. Then, the observations made in rats were extrapolated to humans using a mechanistic whole-body physiologically-based pharmacokinetic (wbPBPK) model. The rat in vivo studies done herein showed that IBS and IBD decreased serum albumin (> 11% for both), decreased PRV binding in plasma, and increased pravastatin absolute oral bioavailability (0.17 and 0.53 compared to 0.01) which increased plasma, muscle, and liver exposure. However, the wbPBPK model predicted muscle concentration was much lower than the pravastatin toxicity thresholds for myotoxicity and rhabdomyolysis. Overall, IBS and IBD can significantly increase pravastatin oral bioavailability which can be due to a combination of increased pravastatin intestinal permeability and decreased pravastatin gastric degradation resulting in higher exposure. This is the first study in the literature investigating the effects of IBS and IBD on pravastatin pharmacokinetics. The high interpatient variability in pravastatin concentrations as induced by IBD and IBS can be reduced by oral administration of pravastatin using enteric-coated tablets. Such disease (IBS and IBD)-drug interaction can have more drastic consequences for narrow therapeutic index drugs prone to gastric degradation, especially for drugs with low intestinal permeability.

Enhancing Atorvastatin In Vivo Oral Bioavailability in the Presence of Inflammatory Bowel Disease and Irritable Bowel Syndrome Using Supercritical Fluid Technology Guided by wbPBPK Modeling in Rat and Human

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are common disorders that can change the body's physiology and drugs pharmacokinetics. Solid dispersion (SD) preparation using supercritical fluid technology (SFT) has many advantages. Our study aimed to explore the effect of IBS and IBD on atorvastatin (ATV) pharmacokinetics, enhance ATV oral bioavailability (BCS II drug) using SFT, and analyze drug-disease-formulation interaction using a whole-body physiologically based pharmacokinetic (wbPBPK) model in rat and human. A novel ATV formulation was prepared using SFT and characterized in vitro and in vivo in healthy, IBS, and IBD rats. The resulting ATV plasma levels were analyzed using a combination of conventional and wbPBPK approaches. The novel formulation increased ATV solubility by 20-fold and resulted in a zero-order release of up to 95%. Both IBS and IBD increased ATV exposure after oral and intravenous administration by more than 30%. The novel SFT formulation increased ATV bioavailability by 28, 14, and 18% in control, IBD, and IBD rat groups and resulted in more consistent exposure as compared to raw ATV solution. Higher improvements in ATV bioavailability of more than 2-fold upon receiving the novel SFT formulation were predicted by the human wbPBPK model as compared to receiving the conventional tablets. Finally, the established wbPBPK model could describe ATV ADME in the presence of IBS and IBD after oral administration of raw ATV and using the novel SFT formula and can help scale the optimized ATV dosing regimens in the presence of IBS and IBD from rats to humans.

Irritable Bowel Syndrome in Dialysis Patients and Symptom Check List Revised (SCL 90-R) Screening

OBJECTIVE

Irritable bowel syndrome (IBS) is a frequently seen functional bowel disease. Although not lifethreatening, it impairs quality of life and leads to economic losses. IBS symptoms are widespread in dialysis patients. Psychopathological disorders are known to increase in both IBS and dialysis patients. The purpose of this study was to investigate the prevalence of IBS, IBS-related factors, and psychopathological disorders in patients.

MATERIALS AND METHODS

One hundred fifty patients followed-up in hemodialysis (HD) or peritoneal dialysis (PD) programs were included in this prospective study. Patients were divided into groups with and without diagnoses of IBS based on the Rome-III diagnostic criteria. The Symptom Check List Revised (SCL90-R) test was then applied to the patients. Patients with and without IBS were compared according to the scores obtained from the questionnaire.

RESULTS

IBS was determined in 59 (39.3%) of the dialysis patients. The prevalence of IBS was significantly higher in women (P = .030). The presence of coronary artery disease (CAD) and use of erythropoietin (EPO) were significantly higher in patients with IBS (P = .029, P = .031). Somatization, obsessive-compulsive disorder, interpersonal sensitivity, depression, anxiety, phobic anxiety, psychoticism, and additional items were also higher in patients with IBS. Subscale scores for somatization, depression, and additional parameters in dialysis patients with IBS were above the threshold values for screening.

CONCLUSION

IBS is common in dialysis patients. The presence of CAD or use of EPO were frequently observed in dialysis patients with IBS, and psychopathologies in depression, somatization, and additional subparameters were also higher in these patients.

Irritable bowel syndrome frequency and related factors in hemodialysis patients

INTRODUCTION

Irritable bowel syndrome (IBS) is a functional bowel disease that is common in society, does not threaten life, impairs quality of life, and causes serious economic losses. Gastrointestinal system complaints and especially IBS are common in patients with chronic kidney disease. It has also been shown that psychiatric diseases are more common in patients with IBS. In this study, we aimed to determine the frequency of IBS in hemodialysis patients and to investigate the factors associated with IBS.

METHODS

In this cross-sectional study, the questionnaire prepared to evaluate depression, anxiety, and abdominal pain was administered face-to-face to 686 patients by the same researcher in seven dialysis centers; 404 patients without exclusion criteria were included in the study. The diagnosis of IBS was made according to Rome IV criteria. A multivariate logistic regression model was used to identify factors that are significantly related to IBS.

FINDINGS

In 69 (17.1%) of the patients included in the study, symptoms were consistent with IBS. Binominal logistic regression analysis was performed to evaluate the effect of age, dialysis duration, diabetes, proton pump inhibitor, non-steroidal anti-inflammatory drugs, calcium acetate use, Hamilton depression and anxiety scores associated with IBS in the presence of IBS of the participants. The logistic regression model was statistically significant, χ² (3) = 69.748, P < 0.001. Independent risk factors for IBS in hemodialysis patients were determined as anxiety, long-term dialysis treatment, and using calcium acetate as a phosphorus binder.

DISCUSSION

In hemodialysis patients, IBS occurs approximately twice as often as in a healthy population. Independent risk factors for IBS in hemodialysis patients are anxiety, long-term dialysis treatment, and using calcium acetate as a phosphorus binder.

Relationship between Nutritional Status and Gastrointestinal Symptoms in Geriatric Patients with End-Stage Renal Disease on Dialysis

Gastrointestinal symptoms (GIS) are common in patients with end-stage renal disease (ESRD) and are associated with nutritional risks resulting from low food intake. Little is known about the relationship between GIS and malnutrition in geriatric patients with ESRD. The main objective of this study was to determine the relationship between nutritional status and severity of GIS in geriatric patients on dialysis therapy. Clinically-stable geriatric patients (older than 60 years old) who were dialysis outpatients were included in this cross-sectional study. The severity of GIS was assessed using the Gastrointestinal Symptoms Questionnaire (GSQ, short version), with patients classified into three groups: mild, moderate, and severe. Nutritional status was evaluated with the Malnutrition Inflammation Score (MIS), anthropometric assessment, biochemical parameters, and bioelectrical impedance. Descriptive statistics were used and differences between groups were analyzed with ANOVA and Kruskal Wallis, with a p < 0.05 considered to indicate significance. Fifty patients completed the study; the median age was 67 years old. Twenty-three patients were on hemodialysis (HD) and 27 were on peritoneal dialysis (PD). No significant differences were found according to dialysis modality, presence of diabetes, or gender. Ninety percent of patients had at least one GIS. Poorer nutritional status (evaluated by MIS) was related to a higher severity of GIS. There were no significant differences with other nutritional parameters. Our study showed a high prevalence of GIS in geriatric patients. There were no differences in observed GIS values that were attributed to dialysis modality, gender, or presence of type 2 diabetes mellitus (DM2). Severe GIS values were associated with poorer nutritional status determined by MIS, however, there was no association with anthropometry, biochemical values, or bioimpedance vector analysis.

Smoking in Irritable Bowel Syndrome: A Systematic Review

OBJECTIVE

The aim of this review was to examine (1) the prevalence of smoking in subjects with irritable bowel syndrome (IBS), (2) whether smoking prevalence significantly differs between subjects with and without IBS, and (3) whether smoking significantly predicts the presence or the development of IBS.

METHODS

Articles were retrieved by systematically searching the Scopus, Web of Science, and PubMed electronic databases from inception to July 2016, using the keywords "smoking" and "tobacco" combined with "irritable bowel syndrome." Reference lists of included articles were also searched. Articles were included if they (1) reported data on smoking prevalence in subjects with IBS and/or on the association (assessed by means of multivariate analyses) between smoking and IBS, (2) identified IBS according to Manning criteria or Rome I-III criteria, (3) were English-language articles, and (4) involved only adult subjects.

RESULTS

The electronic searches yielded a total of 1,637 records, and 42 articles met inclusion criteria. Another 13 articles were retrieved through manual search, leading to a total of 55 included articles. Smoking prevalence in subjects with IBS was assessed by 48 articles and ranged from 0% in university students to 47.1% in patients with microscopic colitis. Thirty-three articles compared smoking prevalence between subjects with and without IBS. In 25 articles no significant difference was found. In seven articles smoking was significantly more frequent in subjects with IBS compared to those without IBS, while one study found a significantly higher smoking prevalence in controls. Eighteen multivariate analyses assessing the association between smoking and IBS were presented in 16 articles. Only one study employed a prospective design. In 11 analyses, smoking was not significantly associated with IBS after adjusting for covariates. In seven studies smoking independently predicted the presence of IBS.

CONCLUSIONS

According to the selected articles, a significant association between smoking and IBS cannot be confirmed. However, different shortcomings may hinder generalizability and comparability of many studies. A dimensional assessment of smoking, a prospective design, the differentiation between IBS subgroups, and the recruitment of patients in clinical settings, especially in primary care, are necessary to clarify the role of smoking in IBS.

Tiaoshen acupuncture for diarrhea type IBS in patients with chronic hepatitis B (liver stagnation and spleen deficiency syndrome): Curative effect and influence on plasma SP and VIP

AIM: To assess the curative efficacy of Tiaoshen acupuncture for diarrhea type irritable bowel syndrome (IBS) in chronic hepatitis B (CHB) patients (liver stagnation and spleen deficiency syndrome) and its impact on serum levels of substance P (SP) and vasoactive intestinal peptide (VIP).

METHODS: One hundred and eight patients were randomly assigned to two groups (a treatment group and a control group) to receive both acupuncture and sham acupuncture treatment for 4 wk. The treatment group received acupuncture at gastric area and intestinal area of scalp acupuncture, and sham acupuncture at Tianshu, Zusanli, and Taichong. The control group were acupunctured at Tianshu, Zusanli, and Taichong, and sham-acupunctured at gastric area and intestinal area of scalp acupuncture. Traditional Chinese medicine (TCM) syndrome curative efficacy, TCM syndrome scores and serum levels of SP and VIP were evaluated before and after therapy.

RESULTS: A total of 96 patients (including 49 in the treatment group) completed the four-week study. Clinical curative effect in the treatment group was significantly better than that in the control group [89.80% (44/49) vs 65.96% (31/47), P < 0.05]. Compared with pretreatment values, TCM syndromes of both groups after treatment were decreased significantly [(26.4 ± 3.6) vs (8.5 ± 1.8); (25.3 ± 2.5) vs (15.6 ± 2.7)], while the treatment group showed a more significant decrease compared with the control group [(8.5 ± 1.8) vs (15.6 ± 2.7), P < 0.05]. After treatment, serum levels of SP and VIP in the two groups decreased significantly [SP: (43.68 ± 15.15) vs (22.08 ± 11.47); VIP: (45.24 ± 15.07) vs (34.52 ± 14.76)], and the decrease was more significant in the treatment group [SP: (38.44 ± 13.57) vs (16.31 ± 13.72); VIP: (37.13 ± 10.19) vs (25.47 ± 12.75), P < 0.05]. There were no adverse reactions or seroconversion in the study.

CONCLUSION: Tiaoshen acupuncture has a better clinical efficacy in CHB patients with diarrhea type IBS (liver stagnation and spleen deficiency syndrome) than traditional acupuncture treatment. Tiaoshen acupuncture may alleviate syndromes of CHB patients with diarrhea type IBS by altering serum levels of SP and VIP and thereby modulating intestine-brain responses.

Prevalence of gastrointestinal and psychosomatic symptoms among Asian patients undergoing regular hemodialysis

AIM

Gastrointestinal (GI) symptoms are reported to be common among patients with chronic disorders including end-stage renal disease (ESRD). This questionnaire study assessed the prevalence of GI symptoms among patients undergoing hemodialysis (HD) and to correlate with the presence of diabetes mellitus and psychosomatic symptoms in Asian patients with ESRD.

METHODS

A total of 123 patients (male 47.2%) participated in this study. GI symptoms (upper GI: anorexia, nausea, vomiting, odynophagia, dysphagia, early satiety, heartburn, dyspepsia and lower GI: abdominal bloating, non-epigastrium abdominal pain, bowel habit and bleeding per rectum) and psychosomatic symptoms (anxiety, backache, depression, headache and insomnia) in the previous 12 months were enquired and compared with age and gender matched controls (n = 197).

RESULTS

The mean age of patients was 51.8 ± 12.9 years with mean duration of HD of 28 ± 38.2 months. Overall, 70.7% of ESRD patients had experienced any GI symptoms; upper GI, 65% and lower GI, 34.1%, significantly more than controls (P < 0.05). ESRD patients had more anorexia, nausea, vomiting, dyspepsia, irregular bowel habit and bleeding per rectum (all P < 0.05). Overlap of upper and lower GI symptoms was reported by 34.1%, significantly higher than control (14.2%, P < 0.05). ESRD patients also experienced significantly more anxiety, depressive symptoms and insomnia (all P < 0.05). Among the patients with ESRD, the presence of any psychosomatic symptoms correlated significantly with the presence of any upper or lower GI symptoms and overlapping of GI symptoms. Such correlations were not seen with diabetes mellitus.

CONCLUSION

Gastrointestinal and psychosomatic symptoms are common among our Asian patients with ESRD undergoing regular HD. The presence of underlying psychosomatic symptoms but not diabetes mellitus correlated significantly with the presence of GI symptoms.