Need for a comprehensive medical approach to the neuro-immuno-gastroenterology of irritable bowel syndrome

Efficacy of different courses of acupuncture for diarrhea irritable bowel syndrome: A protocol for systematic review and meta-analysis

Irritable Bowel Syndrome (IBS) is the most common functional gastrointestinal disorder. As one of the most common subtypes of IBS, IBS-D can impair the patients' quality of life (QOL) and decreased work productivity. Acupuncture may be a potential treatment for patients with IBS-D. However, the treatment course of acupuncture was diverse. It is unclear what is the optimal acupuncture treatment courses for acupuncture. The efficacy and safety of different courses of acupuncture for IBS-D have not been systematically evaluated yet. The purpose of this study is to evaluate effectiveness of Acupuncture of different courses in the treatment of IBS-D and provide sufficient evidence for clinical recommendations for IBS-D. We will follow the Preferred reporting items for systematic reviews and meta-analysis protocols (PRISMA-P) guidelines to design the protocol of a systematic review and meta-analysis. This systematic review is registered in PROSPERO (CRD42023418846). We will include randomized controlled trials (RCTs) in which the efficacy of Acupuncture is compared with a placebo, sham acupuncture or Pinaverium bromide in the treatment of IBS-D with no language restrictions. The outcomes of interest will be efficiency rate and the Symptoms Severity Score. RCTs will be searched in the electronic database and Clinical Trials Registry Platform from inception to April 2023. Two independent reviewers will independently select studies, extract data from the included studies, and assess the risk of bias using the Cochrane tool. We will choose a random or fixed-effects model based on the heterogeneity index. We will use the relative risk and mean difference to estimate data with 95% CI. A stratified meta-analysis was conducted to evaluate the effect of different treatment courses of Acupuncture: 2weeks, 4weeks(or 1 months), 6 weeks, and 8 weeks. If there is significant clinical and methodological heterogeneity, we will look for the reason for heterogeneity and perform a subgroup analysis. According to the Grading of Recommendations Assessment, Development and Evaluation (GRADE), we will evaluate the evidence quality and provide the recommendation's strength.

Psychogenic Dysphagia in an Elderly: A Case of Eating Disorder Due to Trauma and Grief

Psychogenic dysphagia is a swallowing condition caused by psychological factors rather than structural or physiological disorders such as neurological impairments or physical abnormalities. This condition has a significant impact on a patient's quality of life. Patients should undergo a thorough swallowing evaluation with the involvement of a multidisciplinary team as early intervention leads to satisfactory outcomes. This report presents a case of a 62-year-old female who had severe malnutrition due to psychogenic dysphagia. We evaluated organic and other functional causes of dysphagia, but no abnormalities were detected.

Diarrhea-predominant Irritable Bowel Syndrome-like Symptoms in Patients With Quiescent Crohn's Disease: Comprehensive Analysis of Clinical Features and Intestinal Environment Including the Gut Microbiome, Organic Acids, and Intestinal Permeability

Background/Aims

Diarrhea-predominant irritable bowel syndrome (IBS-D)-like symptoms frequently occur in patients with quiescent Crohn's disease (CD). To investigate the factors underlying IBS-D-like symptoms in patients with quiescent CD, we performed a comprehensive analysis of the clinical features and intestinal environment in those patients.

Methods

We performed a prospective observational study of 27 patients with quiescent CD (CD activity index [CDAI] ≤ 150; C-reactive protein ≤ 0.3 mg/dL). The presence and severity of IBS-D-like symptoms, health-related quality of life, disease-specific quality of life, and status of depression and anxiety were evaluated. The level of intestinal permeability, fecal calprotectin and organic acids and the profiles of gut microbiome were analyzed.

Results

Twelve of the 27 patients with quiescent CD (44.4%) had IBS-like symptoms, and these patients showed a significantly higher CDAI, IBS severity index and anxiety score than those without. The inflammatory bowel disease questionnaire score was significantly lower in the patients with IBS-D-like symptoms. There were no significant differences in small intestinal/colonic permeability or the levels of organic acids between the patients with and without IBS-D-like symptoms. Fusicatenibacter was significantly less abundant in the patients with IBS-D-like symptoms whereas their fecal calprotectin level was significantly higher (384.8 ± 310.6 mg/kg) than in patients without (161.0 ± 251.0 mg/kg). The receiver operating characteristic curve constructed to predict IBS-D-like symptoms in patients with quiescent CD using the fecal calprotectin level (cutoff, 125 mg/kg) showed a sensitivity and specificity of 73.3% and 91.7%, respectively.

Conclusion

Minimal inflammation is closely associated with the development of IBS-D-like symptoms in patients with quiescent CD.

Association between impaired healing after orthognathic surgery and irritable bowel syndrome: A case report and literature review

Introduction

In the disease irritable bowel syndrome (IBS), gastrointestinal function is worsened even though no organic abnormalities are observed in the gastrointestinal mucosa. We report the case of an orthognathic surgery patient with suspected irritable bowel syndrome.

Case

In September 2017, a 15-year-old Japanese female was referred to us with dental crowding, malocclusion, and mandibular protrusion. In June 2019, a disagreement with classmates led to abdominal pain, diarrhea, and hemorrhage; in August 2019, a preoperative blood test showed sudden anemia, and her surgery was thus postponed. Subsequent upper and lower gastrointestinal endoscopy revealed no organic abnormality, and no definitive diagnosis was made. In March 2020, after an improvement in anemia was observed, a segmental Le Fort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) were performed under general anesthesia. On the third post-operative day, due to the mucosal dehiscence adjacent to the suture part, the titanium plate was exposed, and irrigation of the wound with normal saline solution and oral hygiene instruction was continued daily for 2 weeks. Two years and eight months have passed since the surgery, and the healing of the oral mucosa and bone has been uneventful.

Discussion

The relationship between IBS and post-operative impaired healing associated with the fragility of the oral mucosa is unknown. However, psychological stress has been reported as a cause of IBS and to be related to oral microorganisms.

Conclusion

Reducing risk factors for IBS and maintaining proper perioperative oral hygiene is essential in managing similar cases.

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Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with recurrent abdominal pain.

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It is difficult to diagnose IBS since the clinical symptoms are confusing.

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IBS and psychological stress affect post-surgical healing.

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Reducing risk factors for IBS and maintaining proper perioperative oral hygiene is essential in the management.

Acupuncture and Moxibustion in the Treatment of Adult Diarrhea Irritable Bowel Syndrome: A Network Meta-analysis

Objective

This study was aimed at comparing the clinical efficacy of acupuncture and moxibustion on irritable bowel syndrome complicated with diarrhea (IBS-D) in adults and providing guidance for clinical treatment.

Methods

PubMed, The Cochrane Library, Embase, CBM, CNKI, and VIP and Wanfang databases were searched to obtain clinical randomized controlled trials (RCTs) on acupuncture and moxibustion in the treatment of IBS-D published from establishment of the database to August 5, 2021. Relevant data were extracted to assess the risk of bias in the included studies, and statistical software Stata 16.0 was used for meta-analysis.

Results

Twenty-one studies were eventually included in the network meta-analysis (NMA), including 1626 patients with IBS-D and 8 therapeutic measures. NMA showed that acupuncture [OR = 0.35, 95%CI (0.25, 0.49), P < 0.05], warming needle moxibustion [OR = 6.34, 95%CI (2.83, 14.21), P < 0.05], acupuncture+sandwiched moxibustion [OR = 12.83, 95%CI (4.49, 36.64), P < 0.05], acupuncture+heat-sensitive moxibustion [OR = 9.86, 95%CI (1.77, 55.00), P < 0.05] were more effective than pinaverium bromide in the treatment of IBS-D. Cumulative ranking probability (SUCRA) showed that the comprehensive efficacy of acupuncture and moxibustion (86.8%) and quality of life (QOL) (70.4%) was the best, while the comprehensive efficacy of pinaverium bromide (2.1%) and QOL (16.3%) was the worst. GV20, GV29, ST 25, ST37, ST36, SP6, LR3, and CV12 were used frequently.

Conclusion

Acupuncture+sandwiched moxibustion has the best effect on improving the efficacy and QOL of IBS-D patients. Limited by the number and quality of studies, we still need a large sample, multicenter, and high-quality clinical trials to confirm our findings.

Treatment of Chronic Atopy and Irritable Bowel Syndrome in a 7-year-old: A Case Report

Irritable bowel syndrome and atopic conditions can co-occur in children and appear to be associated with alterations in the gut microbiota and immune function. A 7-y-old girl was frequently sent home from school due to symptoms related to her long-standing urticaria and gastrointestinal complaints. She was evaluated by pediatric gastroenterologists and allergists; however, she did not respond to treatment. The successful approach to this patient's treatment included dietary modifications and probiotics guided by clinical insight gleaned from often-overlooked diagnostic biomarkers.

Irritable bowel syndrome correlates with increased risk of Parkinson's disease in Taiwan

This study investigated whether an association exists between irritable bowel syndrome (IBS) and the risk of Parkinson's disease. This is a retrospective cohort study using the dataset of the Taiwan National Health Insurance Program from 2000 to 2010. We identified 23,875 patients (aged 20 years or older) with newly diagnosed IBS as the IBS group and 95,500 subjects without IBS as the non-IBS group for comparison. The main outcome was incident Parkinson's disease compared between both groups by the end of 2010. We measured the hazard ratio (HR) to evaluate the association between IBS and Parkinson's disease. The overall incidence of Parkinson's disease in the IBS group was 1.76-fold higher than that in the non-IBS group (16.4 vs. 9.33 per 10,000 person-years). The multivariable Cox proportional hazards regression analysis revealed that the adjusted HR of Parkinson's disease associated with IBS was 1.48 (95% CI 1.27, 1.72), compared with the non-IBS group. Age, women, hypertension, dementia, cerebrovascular disease and depression were also significantly associated with Parkinson's disease. Patients with irritable bowel syndrome are at an increased risk of developing Parkinson's disease. Further studies are required to explore the pathophysiological connection between these disorders.

Complementary and alternative medicines in irritable bowel syndrome: An integrative view

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder with a high incidence in the general population. The diagnosis of IBS is mainly based on exclusion of other intestinal conditions through the absence of inflammatory markers and specific antigens. The current pharmacological treatment approaches available focus on reducing symptom severity while often limiting quality of life because of significant side effects. This has led to an effectiveness gap for IBS patients that seek further relief to increase their quality of life. Complementary and alternative medicines (CAM) have been associated with a higher degree of symptom management and quality of life in IBS patients. Over the past decade, a number of important clinical trials have shown that specific herbal therapies (peppermint oil and Iberogast^®), hypnotherapy, cognitive behavior therapy, acupuncture, and yoga present with improved treatment outcomes in IBS patients. We propose an integrative approach to treating the diverse symptoms of IBS by combining the benefits of and need for pharmacotherapy with known CAM therapies to provide IBS patients with the best treatment outcome achievable. Initial steps in this direction are already being considered with an increasing number of practitioners recommending CAM therapies to their patients if pharmacotherapy alone does not alleviate symptoms sufficiently.

Irritable bowel syndrome and organic diseases: A comparative analysis of esophageal motility

AIM: To assess the esophageal motility in patients with irritable bowel syndrome (IBS) and to compare those with patients with autoimmune disorders.

METHODS: 15 patients with IBS, 22 with systemic lupus erythematosus (SLE) and 19 with systemic sclerosis (SSc) were prospectively selected from a total of 115 patients at a single university centre and esophageal motility was analysed using standard manometry (Mui Scientific PIP-4-8SS). All patients underwent esophago-gastro-duodenoscopy before entering the study so that only patients with normal endoscopic findings were included in the current study. All patients underwent a complete physical, blood biochemistry and urinary examination. The grade of dysphagia was determined for each patient in accordance to the intensity and frequency of the presented esophageal symptoms. Furthermore, disease activity scores (SLEDAI and modified Rodnan score) were obtained for patients with autoimmune diseases. Outcome parameter: A correlation coefficient was calculated between amplitudes, velocity and duration of the peristaltic waves throughout esophagus and patients’ dysphagia for all three groups.

RESULTS: There was no statistical difference in the standard blood biochemistry and urinary analysis in all three groups. Patients with IBS showed similar pathologic dysphagia scores compared to patients with SLE and SSc. The mean value of dysphagia score was in IBS group 7.3, in SLE group 6.73 and in SSc group 7.56 with a P-value > 0.05. However, the manometric patterns were different. IBS patients showed during esophageal manometry peristaltic amplitudes at the proximal part of esophagus greater than 60 mmHg in 46% of the patients, which was significant higher in comparison to the SLE (11.8%) and SSc-Group (0%, P = 0.003). Furthermore, IBS patients showed lower mean resting pressure of the distal esophagus sphincter (Lower esophageal sphincter, 22 mmHg) when compared with SLE (28 mmHg, P = 0.037) and SSc (26 mmHg, P = 0.052). 23.5% of patients with SLE showed amplitudes greater as 160 mmHg in the distal esophagus (IBS and SSc: 0%) whereas 29.4% amplitudes greater as 100 mmHg in the middle one (IBS: 16.7%, SSc: 5.9% respectively, P = 0.006). Patients with SSc demonstrated, as expected, in almost half of the cases reduced peristalsis or even aperistalsis in the lower two thirds of the esophagus. SSc patients demonstrated a negative correlation coefficient between dysphagia score, amplitude and velocity of peristaltic activity at middle and lower esophagus [r = -0.6, P < 0.05].

CONCLUSION: IBS patients have comparable dysphagia-scores as patients with autoimmune disorders. The different manometric patterns might allow differentiating esophageal symptoms based on IBS from other organic diseases.