Prevalence of depression and anxiety in irritable bowel syndrome: A clinic based study from India

Perceived healthiness of foods, food avoidance and diet-related anxiety in individuals with self-reported irritable bowel syndrome: a cross-sectional study

BACKGROUND

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder in which the intake of food is known to exacerbate symptoms. Experiencing food related symptoms can lead to avoidance of food, and cause anxiety related to food intake. We aimed to explore perceptions of the healthiness of food, food avoidance, and food-related worry and anxiety among individuals with and without IBS.

METHODS

This study was based on a survey conducted in January-February 2017. In total, 2000 participants aged 20-65 were invited by postal letter randomly obtained through the Swedish state personal address register. The questionnaire included aspects of socioeconomic position, different disorders including IBS and food intolerances, food avoidance, and food-related worry or anxiety.

RESULTS

In total, 538 participants were included in this study, of whom 8.4% (n = 45) reported having IBS. There were few differences regarding the perceived healthiness of foods between individuals with and without IBS. Participants with IBS avoided gluten (OR 3.45, p = 0.002), lactose (OR 5.0, p < 0.001) and alcohol (OR 2.0, p = 0.042) more frequently than individuals without IBS, and avoidance was driven by abdominal pain. Participants with IBS also reported feeling more worried and having anxiety about diet than those without IBS (p = 0.032 and p = 0.002, respectively).

CONCLUSION

This study indicates that individuals with IBS perceive most foods as equally healthy as individuals without IBS. Having IBS increases the odds of avoiding gluten, lactose, and alcohol. Worry and anxiety related to diet were more common among individuals with IBS, and these aspects need to be considered both in clinical practice and in future research.

Exploring the burden of irritable bowel syndrome among university students in Saudi Arabia: A study on prevalence, psychological associations, and well-being

Patients with irritable bowel syndrome (IBS) experience not only a detrimental impact on their physical health but also a significant influence on their psychological well-being. This study aimed to assess the prevalence of IBS among university students, investigating the sociodemographic and lifestyle factors influencing its onset. Furthermore, it explored the potential impact of psychological factors such as depression, anxiety, and overall well-being on the prevalence of IBS. A cross-sectional analytical study was conducted at Saudi Arabian universities in November and December 2023. To collect data, an anonymous, validated, predesigned questionnaire was used. The diagnosis of IBS was carried out using the validated Arabic version of the Rome IV questionnaire. We used the Arabic version of the World Health Organization Well-being Index to assess the participants' well-being. We used the Arabic version of the Hospital Anxiety and Depression Scale (HADS) to identify people who show clinically significant symptoms of anxiety and depression. Our study included a total of 379 university students, 46.7% were female 86.0% of participants resided in urban areas, and 7.2% had been previously diagnosed with IBS. The prevalence of IBS among participants was found to be 31.9%. We observed a significant association between marital status and IBS (χ2 = 3.95, P = .047). Furthermore, the highest prevalence of IBS was observed among students majoring in literary and scientific disciplines (χ2 = 0.952, P = .049). Individuals with IBS demonstrate a significantly higher prevalence of anxiety (71.90% vs 41.09%, P < .001) and depression (64.46% vs 42.64%, P < .001) compared to those without IBS. Furthermore, people with IBS had a slightly higher prevalence of poor well-being (38.84%) compared to those without IBS (33.72%), but this association was not statistically significant. In multivariate analysis, having a family history of IBS [OR = 1.75 (95% CI, 1.06-2.87), P = .029] having borderline anxiety [OR = 7.58, 95% CI (2.12-27.06), P = .012] and anxiety [OR = 16.07, 95% CI (4.57-56.52), P < .001], and depression [OR = 2.97, 95% CI (1.13-7.83), P = .010] were the main significant predictors of IBS among university students. The high prevalence of IBS among university students was associated with a family history of IBS as well as depression and anxiety. Increasing awareness, multidisciplinary support, and access to mental health services is required to ensure university students' well-being.

Impact of Depression on Irritable Bowel Syndrome (IBS)-Associated Gastrointestinal Symptoms: A Cross-Sectional Study in Makkah City, Saudi Arabia

Background Irritable bowel syndrome (IBS) is a functional gastrointestinal chronic disorder associated with symptoms such as abdominal pain, diarrhea, and constipation. One of the factors that could affect the pathogenesis of IBS is depression, a common psychological disorder that causes social and physical disability and affects productivity. A number of Saudi teachers were found to have depression, which was linked with multiple risk factors including chronic illnesses. However, there is limited data that exhibits the association between IBS and depression, specifically. Therefore, our study aims to determine the impact of depression on IBS-associated gastrointestinal symptoms in Makkah City schools, Saudi Arabia. Methods In this cross-sectional study, we used two validated scales and translated them into Arabic and then we distributed them to our targeted population. Our sample size was determined to be 383 but we succeeded in recruiting 477 participants in our study. Data were statistically analyzed using the statistical software Statistical Package for Social Sciences (SPSS), version 23.0 (IBM Corp., Armonk, NY). Results Generally, participants who demonstrated mild levels of Patient Health Questionnaire-9 (PHQ-9) depression scale corresponded significantly with minimal/mild and moderate levels of Gastrointestinal Symptom Rating Scale-IBS (GSRS-IBS) scores (n = 85 and 76, respectively; p ˂ 0.001), while participants who scored moderately on the PHQ-9 depression scale corresponded significantly with a severe level of GSRS-IBS scores (n = 29; p ˂ 0.001). Conclusion Our study found a significant association between different levels of depression and IBS among participants with a positive history of IBS. Further studies about the prevalence of IBS, depression, and the nature of their relationship are strongly recommended, in addition to the necessity of a suicide risk assessment for those with severe depression.

A follow-up study of anxiety and depressive symptoms in irritable bowel syndrome

Background

Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder and is closely linked to stress. Psychiatric morbidities such as anxiety and depression are common in IBS. Long-term follow-up studies on anxiety and depressive symptoms in IBS and the impact of treatment are lacking in the Indian scenario.

Aims

This study aimed to assess the various subtypes of IBS according to the Rome IV criteria, assess anxiety and depressive symptoms in patients with IBS at baseline and also at various phases of follow-up over one year, and see the impact of the treatment of both IBS and associated anxiety and depressive symptoms if present, in the severity of IBS and other psychiatric symptoms.

Materials and Methods

Patients with IBS, aged between 18 and 65 years, were enrolled for the study. Subtypes and severity of IBS were assessed. Anxiety and depressive symptoms were assessed by the Hamilton Rating Scale for Anxiety (HAM-A) and the Hamilton Rating Scale for Depression (HAM-D), respectively. The patients were treated with conventional treatment of IBS with concomitant treatment of anxiety and depressive symptoms and were followed up for 1 year.

Results

Thirty-seven patients completed a 1-year follow-up. The mean age was 38.4 ± 11.6 years. The majority were males (81%), and IBS-D (84%) was the most common subtype. Stressful life events (67.6%) and chronic stressors (64.9%) were present in the majority of the patients. The patients had moderate-to-severe anxiety at baseline (HAM-A score 27.8 ± 6.4) and moderate-to-severe depression at baseline (HAM-D score 19.7 ± 6.6). The improvement over 1 year was statistically significant (P = 0.000, two-tailed). A positive correlation between the severity score of IBS and HAM-D (r = 0.604) and HAM-A (r = 0.536) scores was present.

Conclusion

There is a high prevalence of anxiety and depression in patients with IBS. With adequate treatment of both IBS and concomitant anxiety-depressive symptoms, there is a significant decrease in the severity of IBS, anxiety, and depression.

Anxiety and depression in Indian patients with irritable bowel syndrome: A meta-analysis

BACKGROUND

Functional gastrointestinal disorders (FGIDs), including irritable bowel syndrome (IBS), are associated with psychological abnormalities, such as anxiety and depression. Though the data on this are plenty in global literature, Indian data are sparse. We performed a systematic review and meta-analysis of Indian data on anxiety and depression among patients with IBS to estimate their pooled prevalence and to identify the shortcomings so that future areas of research can be identified.

METHOD

A comprehensive literature search was performed for studies applying tests for psychological issues in patients with IBS. After applying prospectively decided exclusion criteria, the eligible papers were examined using a meta-analysis approach for the prevalence of anxiety and depression in IBS patients using different tests. The odds ratios (OR) of anxiety and depression among subjects with IBS were calculated compared to controls.

RESULTS

Of seven studies (590 IBS patients and 1520 controls) included in the meta-analysis, the pooled OR of anxiety was 8.060 (95% confidence interval [CI] 4.007-16.213) as compared to controls (random-effect model). The pooled OR of depression was 7.049 (95% CI 3.281-15.147) compared to controls (random-effect model). There was significant heterogeneity in the included studies.

CONCLUSION

The current meta-analysis shows that the patients with IBS from India have eightfold greater risks of anxiety and sevenfold greater risks of depression than the controls. However, most of these data were from tertiary urban centers, and hence, there might be recruitment bias over-estimating the frequency.

Evaluating the role of anxiety on the association between irritable bowel syndrome and brain volumes: a mediation analysis in the UK Biobank cohort

There is a strong link between irritable bowel syndrome and brain volumes, yet, to date, research examining the mediators of this association has been little. Based on the phenotypic data of 15 248 participants from the UK Biobank, a two-stage mediation analysis was performed to assess the association among brain volumes, anxiety, and irritable bowel syndrome. In the first stage, we identified the candidate mediating role of anxiety for irritable bowel syndrome associated with brain volumes using regression models. Then, we quantified the magnitude of the mediation effects by evaluating the average causal-mediated effect and proportion of mediation through performing mediation analyses in the R package in the second stage. In the first stage, we identified the partly mediating role of anxiety in the association between irritable bowel syndrome and the volume of thalamus (P _left = 1.16 × 10^-4, P _right = 2.41 × 10^-4), and grey matter (P _left = 3.22 × 10^-2, P _right = 1.18 × 10^-2) in the VIIIa cerebellum. In the second stage, we observed that the proportion of the total effect of irritable bowel syndrome on volume of thalamus mediated by anxiety was 14.3% for the left region (β _{Average causal-mediated effect} = -0.008, P _{Average causal-mediated effect} = 0.004) and 14.6% for the right region (β _{Average causal-mediated effect} = -0.007, P _{Average causal-mediated effect} = 0.006). Anxiety mediated 30.8% for the left region (β _{Average causal-mediated effect} = -0.013, P _{Average causal-mediated effect} = 0.002) and 21.6% for the right region (β _{Average causal-mediated effect} = -0.010, P _{Average causal-mediated effect} x= 0.018) of the total effect of irritable bowel syndrome on the volume of grey matter in the VIIIa cerebellum. Our study revealed the indirect mediating role of anxiety in the association between irritable bowel syndrome and brain volumes, promoting our understanding of the functional mechanisms of irritable bowel syndrome and its related psychosocial factors.

Economic living standard and abdominal pain mediate the association between functional gastrointestinal disorders and depression or anxiety

BACKGROUND

Functional gastrointestinal disorders (FGIDs) are common and cause significant morbidity. Psychiatric comorbidities associated with FGIDs include anxiety and depression. However, little is understood about the factors that modulate this association. The aim of this study was to examine the association between FGIDs and depression and anxiety, and to determine the covariates influencing this association in a New Zealand cohort.

METHODS

The Christchurch IBS cOhort to investigate Mechanisms FOr gut Relief and improved Transit (COMFORT) study is an observational case-control study that recruited FGID cases and healthy controls between 2016 and 2018. In addition to the collection of a wide range of biological samples, participants completed questionnaires concerning socioeconomic status, physical activity, smoking, alcohol intake, anxiety, and depression (the latter two measured using the Hospital Anxiety and Depression Score [HADS]). A multivariate analysis was performed using the significant covariates from the univariate analyses to test whether their effect was independently significant on anxiety and depression.

KEY RESULTS

A total of 315 participants (57 with diarrhea-predominant IBS (IBS-D), 30 with constipation-predominant IBS (IBS-C), 41 with mixed-IBS (IBS-M), 16 with functional diarrhea (FD), 42 with functional constipation (FC), and 129 controls); mean age 53 years (range 18-70 years), 221 (70%) female) completed the questionnaires. Anxiety (odds ratio [OR] 2.85 [95% confidence interval [CI] 1.64-4.94, p < 0.01) and depression (OR 3.40 [95% CI 1.35-8.55, p = 0.01]) were strongly associated with FGID cases versus controls. Lower economic living status (p < 0.01) was an independent covariate associated with depression, while lower economic living status (p < 0.005) and abdominal pain (p = 0.005) were both independently associated with anxiety.

CONCLUSIONS & INFERENCES

In addition to the established associations between FGIDs and anxiety and depression, we have shown that the economic standard of living, pain, and IBS phenotype are significant independent covariates. This study demonstrates the range of lifestyle and demographic factors that modulate morbidity associated with FGIDs and may provide targets for intervention.

Hypnotherapy and IBS: Implicit, long-term stress memory in the ENS?

The association between irritable bowel syndrome (IBS) and psychiatric and mood disorders may be more fundamental than was previously believed. Prenatal, perinatal, postnatal, and early-age conditions can have a key role in the development of IBS. Subthreshold mental disorders (SMDs) could also be a significant source of countless diverse diseases and may be a cause of IBS development. We hypothesize that stress-induced implicit memories may persist throughout life by epigenetic processes in the enteric nervous system (ENS). These stress-induced implicit memories may play an essential role in the emergence and maintenance of IBS. In recent decades, numerous studies have proven that hypnosis can improve the primary symptoms of IBS and also reduce noncolonic symptoms such as anxiety and depression and improve quality of life and cognitive function. These significant beneficial effects of hypnosis on IBS may be because hypnosis allows access to unconscious brain processes.

Acupuncture and related therapies for the anxiety and depression in irritable bowel syndrome with diarrhea (IBS-D): A network meta-analysis of randomized controlled trials

Objective

A growing number of clinical studies have suggested the value of acupuncture-related therapies for patients with irritable bowel syndrome with diarrhea (IBS-D), and the patient's mental state plays an important role, but there are many types of acupuncture-related therapies involved. This study aimed to evaluate the mental status, efficacy and safety of the different acupuncture-related therapies for IBS-D patients.

Methods

We searched seven databases to collect randomized controlled trials of acupuncture-related therapies for IBS-D. After independent literature screening and data extraction, the quality of the final included literature was evaluated. Hamilton anxiety rating scale (HAMA), hamilton depression rating scale (HAMD), self-rating anxiety scale (SAS), and self-rating depression scale (SDS) was used as the primary outcome indicator. And the network meta-analysis (NMA) was performed by using Revman 5.4, Stata 15.0 and WinBUGS 1.4.3 software, and the surface under the cumulative ranking curve was conducted to rank the included interventions.

Results

We analyzed 24 eligible studies with 1,885 patients, involving eight types of acupuncture and related therapies along with comprehensive therapies. The NMA result shows that: for SAS scores, combined therapies were more efficacious than anti-diarrheal or antispasmodic (western medicine, WM) (SMD: -8.92; 95% CI: -15.30, -2.47); for SDS scores, combined therapies were more efficacious than WM (SMD: -8.45; 95% CI: -15.50, -1.41). For HAMA scores, moxibustion (MOX) was more efficacious than placebo (SMD: -8.66; 95% CI: -16.64, -0.38). For HAMD scores, MOX was more efficacious than all other included interventions. For response rate, MOX was more efficacious than the following interventions: acupuncture (ACU) (SMD:0.29; 95% CI:0.08,0.93), Chinese herb medicine (CH) (SMD:0.09; 95% CI:0.02,0.36), combined therapies (SMD:0.23; 95% CI:0.06, 0.85), electroacupuncture (EA) (SMD:0.06; 95% CI:0.01,0.33), warm acupuncture (WA) (SMD:22.16; 95% CI:3.53,148.10), WM (SMD:15.59; 95% CI:4.68,61.21), and placebo (SMD:9.80; 95% CI:2.90,45.51). Combined therapies were more efficacious than the following interventions: CH (SMD:0.39; 95% CI:0.19,0.80), WA (SMD:4.96; 95% CI:1.30,21.62), and WM (SMD:3.62; 95% CI:2.35,5.66). The comprehensive ranking results show that MOX, ACU, combined therapies, and EA had high SUCRA rankings involving different outcome indicators.

Conclusion

MOX, ACU, combined therapies, and EA better alleviate anxiety and depression among IBS-D patients, and with a higher safety level, may be the optimal therapies. In addition, combining acupuncture-related treatments and other therapies also delivers a higher global benefit level.

Systematic review registration

[https://www.crd.york.ac.uk/], identifier [CRD42022364560].

An Open-Label Trial Study of Quality-of-Life Assessment in Irritable Bowel Syndrome and Their Treatment

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.

Effects of red ginseng on gut, microbiota, and brain in a mouse model of post-infectious irritable bowel syndrome

Background

Irritable bowel syndrome (IBS), the most common functional gastrointestinal disorder, is characterized by chronic abdominal pain and bowel habit changes. Although diverse complicated etiologies are involved in its pathogenesis, a dysregulated gut–brain axis may be an important factor. Red ginseng (RG), a traditional herbal medicine, is proven to have anti-inflammatory effects and improve brain function; however, these effects have not been investigated in IBS.

Methods

Three-day intracolonic zymosan injections were used to induce post-infectious human IBS-like symptoms in mice. The animals were randomized to receive either phosphate-buffered saline (CG) or RG (30/100/300 mg/kg) for 10 days. Amitriptyline and sulfasalazine were used as positive controls. Macroscopic scoring was performed on day 4. Visceral pain and anxiety-like behaviors were assessed by colorectal distension and elevated plus maze and open field tests, respectively, on day 10. Next-generation sequencing of gut microbiota was performed, and biomarkers involved in gut–brain axis responses were analyzed.

Results

Compared to CG, RG significantly decreased the macroscopic score, frequency of visceral pain, and anxiety-like behavior in the IBS mice. These effects were comparable to those after sulfasalazine and amitriptyline treatments. Moreover, RG significantly increased the proliferation of beneficial microbes, including Lactobacillus johnsonii, Lactobacillus reuteri, and Parabacteroides goldsteinii. RG significantly suppressed expression of IL-1β and c-fos in the gut and prefrontal cortex, respectively. Further, it restored the plasma levels of corticosterone to within the normal range, accompanied by an increase in adrenocorticotropic hormone.

Conclusion

RG may be a potential therapeutic option for the management of human IBS.

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.

Psychological and Gastrointestinal Symptoms of Patients with Irritable Bowel Syndrome Undergoing a Low-FODMAP Diet: The Role of the Intestinal Barrier

A diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (LFD) improves both gastrointestinal (GI) symptoms and the psychological profile of patients with irritable bowel syndrome with diarrhea (IBS-D). The effects of 12 weeks of LFD on GI symptom and psychological profiles in relation to inflammation and the involvement of the intestinal barrier were studied in twenty IBS-D patients. The IBS Severity Scoring System, the Symptom Checklist-90-Revised, the Italian version of the 36-Item Short-Form Health Survey, the IBS-Quality of Life (QoL) questionnaire, and the Psychophysiological questionnaire were administered. The GI barrier function was assessed by sugar absorption test, the serum and fecal zonulin levels, and the serum levels of intestinal fatty-acid binding protein and diamine oxidase. Interleukins (ILs) and lipopolysaccharide (LPS) serum levels were evaluated along with dysbiosis. At the end of LFD, GI symptoms, psychological state (mainly anxiety, somatization, psychoticism, and interpersonal sensitivity), and QoL significantly improved in these patients. Simultaneously, an improvement in small intestinal permeability and intestinal mucosal integrity occurred, while IL-6, Il-10, LPS, and fermentative dysbiosis significantly decreased. The LFD can modify the immune-inflammatory features and enhance intestinal permeability and mucosal integrity, thus determining a concurrent improvement in the clinical and psychological conditions.

Performance Assessment of Certain Machine Learning Models for Predicting the Major Depressive Disorder among IT Professionals during Pandemic times

Major depressive disorder (MDD) is the most common mental disorder in the present day as all individuals' lives, irrespective of being employed or unemployed, is going through the depression phase at least once in their lifetime. In simple terms, it is a mood disturbance that can persist for an individual for more than a few weeks to months. In MDD, in most cases, the individuals do not consult a professional, and even if being consulted, the results are not significant as the individuals find it challenging to identify whether they are depressed or not. Depression, most of the time, cooccurs with anxiety and leads to suicide in few cases, among the employees, who are about to handle the pressure at work and home and mostly unnoticing such problems. This is why this work aims to analyze the IT employees who are mostly working with targets. The artificial neural network, which is modeled loosely like the brain, has proved in recent days that it can perform better than most of the classification algorithms. This study has implemented the multilayered neural perceptron and experimented with the backpropagation technique over the data samples collected from IT professionals. This study aims to develop a model that can classify depressed individuals from those who are not depressed effectively with the data collected from them manually and through sensors. The results show that deep-MLP with backpropagation outperforms other machine learning-based models for effective classification.

The level and prevalence of depression and anxiety among patients with different subtypes of irritable bowel syndrome: a network meta-analysis

BACKGROUND

Irritable bowel syndrome (IBS) is a very common functional bowel disorder. However, the difference of depression and anxiety comorbidities among different IBS subtypes is still not well evaluated. This study aims to investigate the difference in the level and prevalence of depression and anxiety among healthy controls and patients with different subtypes of IBS.

METHODS

PubMed, EMBASE and the Cochrane library were searched systematically until August 17, 2020. Studies that investigated depression and/or anxiety levels or prevalence among different IBS-subtype patients measured at baseline or the same point were included. Network meta-analysis was conducted to analyze standardized mean difference (SMD) of anxiety and depression levels, and single arm meta-analysis was performed for prevalence of anxiety and depression among different IBS subtypes.

RESULTS

Eighteen studies involving 7095 participants were included. Network meta-analyses results showed healthy controls had a lower level of depression than IBS with mixed symptoms of constipation and diarrhea (IBS-M) [SMD =  - 1.57; 95% confidence interval (CI) - 2.21,  - 0.92], IBS with constipation (IBS-C) (SMD =  - 1.53; 95% CI - 2.13,  - 0.93) and IBS with diarrhea (IBS-D)(SMD =  - 1.41; 95% CI - 1.97,  - 0.85), while no significant difference was found between IBS unclassified (IBS-U) and healthy controls (SMD =  - 0.58; 95% CI  - 2.15, 1.00). There was also no significant difference in the level of depression among different IBS subtypes patients. The results of anxiety were similar to depression. Ranking probability showed that IBS-M was associated with the highest level of depression and anxiety symptoms, followed by IBS-C/IBS-D and IBS-U. Single-arm meta-analysis showed IBS-C had the highest prevalence of depression (38%) and anxiety (40%), followed by IBS-D, IBS-M and IBS-U.

CONCLUSION

The results indicated that IBS-M was more likely to be associated with a higher level of depression and anxiety, and the prevalence of depression and anxiety in IBS-C was highest. The psychological screening and appropriate psychotherapy are needed for patients with IBS-C, IBS-D and IBS-M instead of IBS-U.

Depressive symptoms in patients with irritable bowel syndrome: a meta-analysis of comparative studies

Depression is common in patients with irritable bowel syndrome (IBS), but the reported prevalence across different studies is inconsistent. This meta-analysis systematically examined the presence and severity of depressive symptoms in patients with IBS. Two investigators independently performed a literature search. The pooled depressive symptom severity was calculated using a random effects model. Subgroup, sensitivity and meta-regression analyses were conducted to examine the moderating factors of the development of depressive symptoms. Twenty four studies (n=2,837) comparing depressive symptoms between IBS patients (n=1,775) and healthy controls (n=1,062) were identified; 14 (58.3%) studies were rated as high quality. Compared to healthy controls, IBS patients had more frequent (OR=9.21, 95%CI: 4.56-18.57, P<0.001; I2=76%) and more severe depressive symptoms (n=1,480, SMD=2.02, 95%CI: 1.56-2.48, P<0.001; I2=94%). Subgroup analyses revealed that patients with all IBS subtypes had more severe depressive symptoms than controls. In addition, versions of the Hamilton Depression Rating Scale (HAM-D) and IBS diagnostic criteria were significantly associated with depressive symptom severity. Meta-regression analyses revealed that female gender, younger age and small sample size were significantly associated with more severe depressive symptoms. In conclusion, meta-analytic data showed that IBS patients had more frequent and severe depressive symptoms than healthy controls. Adequate screening and treatment for depression should be developed and implemented in this patient population.

Medically unexplained syndromes: irritable bowel syndrome, fibromyalgia and chronic fatigue

This is a review of three of the more common medically unexplained syndromes that present for treatment to liaison psychiatry services in general medical hospitals: chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome. The three are interrelated, extremely disabling and comorbid mood disorders are frequent. In general, treatment, whether psychological or medical, has very modest impact. The disputed classification of medically unexplained syndromes is also reviewed. There is a clear gulf between the views and experiences of patients with these syndromes and the medical establishment. In this article I summarise give the evidence for pharmacological, psychosocial and ‘alternative’ or ‘complementary’ interventions for a range of disorders, about which there is some dispute. I leave it to the reader to decide which interventions hold the most promise.

LEARNING OBJECTIVES

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DECLARATION OF INTEREST

None.

Quality of life and depression in patients with irritable bowel syndrome

INTRODUCTION

While irritable bowel syndrome (IBS) is not life-threatening for most, it has enormous influence on quality of life (QOL) and mental health.

AIM

To evaluate the association between QOL and depressive symptoms in IBS patients.

MATERIAL AND METHODS

A total of 87 patients and 56 healthy subjects were enrolled consecutively. All participants were asked to complete self-administered questionnaires: an IBS-specific quality of life (IBS-QOL) questionnaire and the Beck Depression Inventory questionnaire (BDI).

RESULTS

Mean BDI score was higher in IBS group than in controls. IBS-QOL score was significantly lower in IBS patients compared to the control group, in all IBS-QOL domains: dysphoria (DY), interference with activity (IN), body image (BI), health worry (HW), food avoidance (FA), social relation (SR), and sexual (SX) and relationship (RL) issues. QOL DY, IN, and BI scores and overall score were significantly lower in women with IBS compared to men. We found that BDI score was significantly negatively correlated with IBS-QOL score in the domain of DY, IN, HW, FA, SR, and RL scores and overall QOL score. We also found a negative correlation between older age and health worry. RL and IN QOL scores represented the highest correlation with BDI score.

CONCLUSIONS

Irritable bowel syndrome is connected with impaired patient quality of life and high prevalence of depression with high correlation rate of both parameter scores. Assessment of depression and QOL should be provided during patient visits in outpatients clinics.

Anxiety and Depression in Irritable Bowel Syndrome

BACKGROUND

Psychological factors have been prominently implicated in the causation as well as maintenance of irritable bowel syndrome (IBS). Studies comparing psychiatric morbidity in IBS with healthy controls have reported contrasting findings. The current study was undertaken to assess the prevalence of anxiety and depression in patients with IBS in comparison to healthy controls and to explore the relationship, if any, of anxiety and depression with various subtypes of IBS.

MATERIALS AND METHODS

Fifty consecutive patients of IBS (diagnosed as per Rome III criteria) between 18 and 65 years of age and fifty age- and sex-matched healthy controls were assessed for the presence of anxiety and depression using Hamilton Rating Scale for Anxiety (HAMA) and Hamilton Rating Scale for Depression (HAMD), respectively.

RESULTS

The patient group scored higher than controls (P < 0.001) in both HAMA and HAMD scores. The HAMA scores were significantly higher (P < 0.001) in the severe IBS group compared to those with moderate IBS. HAMA scores predicted 25.6% (R² = 0.256) of variance in IBS severity scores. However, there was no significant difference between the two groups in terms of HAMD scores.

CONCLUSION

The high prevalence of psychiatric comorbidities such as anxiety and depression in IBS samples in our study provides evidence in favor of proper screening for these disorders in gastrointestinal clinics. Recognition and treatment for these comorbidities can improve the quality of life as well as overall outcomes.

Diagnosis and treatment of irritable bowel syndrome with predominant constipation in the primary-care setting: focus on linaclotide

Irritable bowel syndrome (IBS) is a complex functional gastrointestinal disorder that is exceedingly common in clinical practice. IBS with predominant constipation (IBS-C) is a subtype of IBS that accounts for more than a third of the IBS diagnosed. Diagnosis of IBS requires a careful personalized approach, a comprehensive clinical history, limited but relevant investigations, and continued follow-up. Major IBS societies and guidelines recommend offering a positive diagnosis of IBS based on presenting symptomatology. Abdominal pain that may or may not be relieved by defecation is the cardinal symptom of IBS; distension and bloating are other common symptoms. Careful attention should be paid to alarm symptoms before a diagnosis of IBS is made. Pharmacotherapy with linaclotide is recommended for moderate-severe IBS-C, based on high-quality evidence from randomized controlled trials. Diarrhea is the major side effect of linaclotide, and limited cost-effectiveness data currently exist.

Psychiatric Co-morbidity in Patients With Irritable Bowel Syndrome at a Tertiary Care Center in Northern India

Background/Aims

Irritable bowel syndrome (IBS) is a chronic psycho-physiological disorder. It is considered to be the most common functional gastrointestinal disorder, and about 50–90% of IBS patients have associated psychiatric co-morbidity. We aimed to study psychiatric co-morbidities in patients with IBS visiting a tertiary care center.

Methods

This was a cross-sectional case-control study conducted over a duration of one and a half years from January 2014 to July 2015. Patients were selected from the out-patient department of gastroenterology. About 160 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. The healthy attendants of cases were selected as controls. A total of 200 controls were selected. Rome-III criteria were used to diagnose IBS. For diagnosing psychiatric disorders, we used the Mini International Neuropsychiatric Interview Schedule Plus.

Results

Mean age of our cases and controls was 39.7 ± 11.4 and 37.7 ± 9.6 years, respectively. Females outnumbered males in our cases as well as their controls by a ratio of 2:1 approximately. Psychiatric disorders were seen in 84.4% of IBS patients as compared to 41.5% in controls. Major psychiatric disorders seen in our patients were generalized anxiety disorders (30.0%) and depression (28.0%).

Conclusions

The majority of patients with IBS who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.

The role of high expectations of self and social desirability in emotional processing in individuals with irritable bowel syndrome: A qualitative study

OBJECTIVES

Although high levels of distress are associated with the onset and severity of Irritable bowel syndrome (IBS), it is unclear how this relates to emotional processing, particularly in relation to maintenance of symptoms and treatment outcome. This qualitative study embedded within a randomized controlled trial aimed to explore how individuals with refractory IBS experience, express, and manage their emotions after either therapist-delivered cognitive behavioural therapy (TCBT) or Web-based CBT (WBCBT) compared to treatment as usual (TAU).

DESIGN

Cross-sectional qualitative study.

METHODS

Fifty-two semi-structured interviews were conducted at post-treatment with 17 TCBT, 17 WBCBT, and 18 TAU participants. The transcripts were analysed using inductive thematic analysis with grounded theory elements. NVivo 11 was used to compare themes across groups.

RESULTS

Across all groups, high expectations of self was a recurring reason for how participants experienced and expressed their emotions. Three themes with subthemes captured how high expectations related to specific aspects of emotional processing: perceived causes of emotions, strategies for coping with emotions (bottling up, avoiding emotions, and active coping strategies), and the perceived interplay between emotions and IBS symptoms.

CONCLUSIONS

Patients recognized that their IBS symptoms both triggered and were triggered by negative emotions. However, there was a tendency to bottle up or avoid negative emotions for reasons of social desirability regardless of whether patients had CBT for IBS or not. Future psychological interventions in IBS may benefit from addressing negative beliefs about expressing emotions, promoting assertive emotional expression, and encouraging the experience of positive emotions. Statement of contribution What is already known on this subject? High levels of distress are consistently associated with both the onset and maintenance of IBS symptoms. Little is known about how this relates to the concept of emotional processing. Preliminary findings suggest a positive correlation between poor emotional processing and IBS. However, further studies need to confirm its role in relation to aetiology, maintenance of symptoms, and response to treatment. What does this study add? High expectations of self and social desirability seem to be important aspects shaping the way individuals with IBS experience, express, and manage their emotions. Emotional avoidance and bottling up were reported as key strategies to cope with negative emotions. The study revealed that bottling up is not perceived as an all-or-nothing strategy but can be applied selectively depending on the context. Psychological interventions in IBS may benefit from addressing not only illness-related causes of negative emotions but also personal and social triggers of distress.

The Increased Level of Depression and Anxiety in Irritable Bowel Syndrome Patients Compared with Healthy Controls: Systematic Review and Meta-analysis

BACKGROUND/AIMS

Irritable bowel syndrome (IBS) patients commonly experience psychiatric disorders, such as depression and anxiety. This meta-analysis sought to compare depression and anxiety levels between IBS patients and healthy controls.

METHODS

We searched major electronic databases (PubMed, EMBASE, MEDLINE, and Cochrane library) to find comparative studies on IBS patients and healthy controls. The primary outcome was a standardized mean difference (SMD) of anxiety and depression levels; sub-group analyses were conducted according to IBS-subtypes.

RESULTS

In total, 2293 IBS patients and 4951 healthy controls from 27 studies were included. In random effect analysis, depression and anxiety levels were significantly higher in IBS patients (pooled SMD = 0.76; 95% CI, 0.62-0.90; P < 0.001; I2 = 77.2% and pooled SMD = 0.84; 95% CI, 0.67-1.01; P < 0.001; I2 = 85.6%, respectively). Both analyses' funnel plots showed symmetry. In meta-regression analysis, heterogeneity was due to the studied region and questionnaire type for both depression and anxiety. In sub-group analyses of IBS-subtype, the pooled SMDs of depression and anxiety levels (IBS with predominant constipation: 0.83 and 0.81, IBS with predominant diarrhea: 0.73 and 0.65, and IBS with mixed bowel habits: 0.62 and 0.75; P < 0.001, respectively) were significantly higher in all IBS-subtypes.

CONCLUSIONS

The present meta-analysis showed depression and anxiety levels to be higher in IBS patients than in healthy controls, regardless of IBS-subtype. However, the gender effect on psychological factors among IBS patients could not be determined and should be evaluated in prospective studies.

Therapeutic effects of flupentixol and melitracen combined with Saccharomyces boulardii in patients with diarrhea-predominant irritable bowel syndrome

AIM

To assess the therapeutic effects of flupentixol and melitracen tablets combined with Saccharomyces boulardii on patients with diarrhea-predominant irritable bowel syndrome (IBS).

METHODS

From January 2014 to January 2015, 75 diarrhea-predominant IBS patients treated at our hospital were randomly divided into a control group (n = 37) and an observation group (n = 38). Flupentixol and melitracen was administrated in both groups, and Saccharomyces boulardii was added in the observation group. The treatment course was 4 wk. Gastrointestinal symptoms and mood disorders were evaluated before treatment and 4 wk after treatment. Adverse reactions were also recorded.

RESULTS

The patients randomized into the observation group experienced a greater reduction in symptom scores and Bristol stoll scale score compared with those in the control group (P < 0.05), and the rate of improvement of gastrointestinal symptoms was significantly higher in the observation group than in the control group (P < 0.05). At 4 wk after treatment, the improvement of the Hamilton Depression Scale score and the Hamilton Anxiety Scale score was significantly better in the observation group than in the control group (P < 0.05). There was no statistically significant difference in the rate of adverse events between the two groups (P > 0.05).

CONCLUSION

Flupentixol and melitracen combined with Saccharomyces boulardii could improve the anxiety and depression symptoms and gastrointestinal symptoms in patients with diarrhea-predominant IBS. The efficacy of combined treatment is better than flupentixol and melitracen alone.

Dietary patterns and prevalence of irritable bowel syndrome in Iranian adults

BACKGROUND

Although several dietary factors have been reported to alleviate or aggravate the symptoms of irritable bowel syndrome (IBS), no information is available linking habitual dietary patterns to irritable bowel syndrome.

OBJECTIVE

This study was undertaken to assess the association between dietary patterns and the risk of IBS among Iranian adults.

METHODS

In this cross-sectional study, data on 3846 Iranian adults working in 50 different health centers were examined. Dietary intake of study participants was assessed using a 106-item self-administered Dish-based Semi-quantitative Food Frequency Questionnaire (DS-FFQ) which was designed and validated specifically for Iranian adults. To identify major dietary patterns based on the 39 food groups, we used principal component analysis. A modified Persian version of the Rome III questionnaire was used for assessment of IBS.

RESULTS

We identified four major dietary patterns: (i) 'fast food', (ii) 'traditional', (iii) 'lacto-vegetarian', and (iv) 'western' dietary pattern. After adjustment for potential confounders, we found that those in the highest quartile of 'fast food' dietary pattern were tended to have higher risk of IBS than those in the lowest quartile (OR = 1.32; 95% CI: 0.99, 1.75, p_trend = 0.05). An inverse association was also found between 'lacto-vegetarian' dietary pattern and risk of IBS; such that even after adjustment for potential confounders, those in top quartile of this dietary pattern were 24% less likely to have IBS (0.76; 0.59, 0.98; p_trend = 0.02). No overall significant associations were observed between 'traditional' and 'western' dietary patterns and risk of IBS, either before or after adjustment for covariates.

CONCLUSION

We found that 'lacto-vegetarian' dietary pattern was associated with reduced risk, while 'fast food' dietary pattern was associated with a greater risk of IBS in Iranian adults.

Therapeutic effects of flupentixol and melitracen combined with trimebutine in patients with irritable bowel syndrome accompanied with anxiety and depression

AIM: To assess the therapeutic effects of flupentixol and melitracen tablets combined with trimebutine in patients with abdominal pain-predominant irritable bowel syndrome (IBS) accompanied with anxiety and depression.

METHODS: This multi-center, randomized, prospective study enrolled 48 patients with abdominal pain-predominant IBS who were divided into either a combination treatment group (24 patients) or a control group (24 patients). Trimebutine was administrated in both groups, while flupentixol and melitracen was added in the combination treatment group. The treatment lasted 4 wk. Gastrointestinal symptoms and mood disorders were evaluated before treatment, 1 wk and 4 wk after treatment.

RESULTS: At the end of one week after treatment, the rates of improvement of gastrointestinal symptoms in the combination treatment group and control group were 16.7% and 20.8%, and there was no statistically significant difference between them (P > 0.05). At the end of 4 wk after treatment, the rates of improvement of gastrointestinal symptoms in the combination treatment group was 87.5%, which was significantly higher than that of the control group (41.7%; χ² = 9.507, P = 0.002). At the end of 1 week after treatment, there were no statistically significant differences in the rates of Hamilton Depression Scale score improvement (14.3% and 9.09%, P > 0.05) or the rates of Hamilton Anxiety Scale score improvement (25.2% vs 22.2%, P > 0.05) between the combination treatment group and control group. At the end of 4 weeks after treatment, the rate of Hamilton Depression Scale score improvement in the combination treatment group was significantly higher than that of the control group (61.9% vs 22.7%, χ² = 6.776, P = 0.009), and the rate of Hamilton Anxiety Scale score improvement was also significantly higher in the combination treatment group (66.7% vs 33.3%, χ² = 4.582, P = 0.032).

CONCLUSION: Flupentixol and melitracen combined with trimebutine could not only improve the anxiety and depression symptoms of patients with abdominal pain-predominant IBS, but also effectively improve gastrointestinal symptoms. The efficacy of the combination treatment is better than that of trimebutine monotherapy.

Effects of Mastalgia in Young Women on Quality of Life, Depression, and Anxiety Levels

The aims of this study are to evaluate whether or not there is a relationship between mastalgia with anxiety and depression in young women with mastalgia who do not have organic breast pathology and to examine the effect of pain on the quality of life. Forty female pre-menopausal patients between the ages of 20-40 years with mastalgia and 40 totally healthy volunteers with the same characteristics were investigated with the Short Form 36 (SF-36), Hamilton Depression Scale, and the Hamilton Anxiety Rating Scale prospectively following breast examination and radiological examination. Statistical assessments were performed using the SPSS 11.5. Anxiety levels were observed to be higher in the patient group (p = 0.04). The depression level was higher in the patient group; however, this was not statistically significant (p = 0.08). The quality of life of the mastalgia group was determined to be lower than that of the control group, and the sub-parameters of physical function (p = 0.04), body pain (p = 0.02), general health (p = 0.03), and energy (p = 0.008) were found to be significantly low. There may be a relationship between mastalgia and depression in young women with mastalgia; however, a closer relationship between anxiety and mastalgia is observed. Mastalgia affects the quality of life of an individual negatively at a significant degree.

Anxiety and IBS revisited: ten years later

Background and aim

Irritable bowel syndrome (IBS) has been associated with high prevalence of psychological and psychiatric disorders. However, the association between IBS and each of its subtypes (diarrhea IBS-D, constipation IBS-C, mixed IBS-M) with anxiety still remains unclear. The purpose of this study was to perform a comparative analysis of the association between anxiety and IBS on a period of ten years.

Methods

PubMed was searched for studies analyzing IBS and anxiety, published at 10 years interval. The study presents a comparative analysis of the articles that were published between 2003–2005 and 2013–2015, investigating the correlation between anxiety and IBS.

Results

The initial search identified 220 articles, from which 156 were published between 2013 and 2015, and 64 were published between 2003 and 2005. Of these articles, 15 articles were included in the review. Out of these 15 articles, 10 articles analyzed the correlation between anxiety-depression status in IBS patients using specific questionnaires, 2 articles analyzed genetic variables in IBS, 1 article analyzed serotonin and monoamine oxidase levels in IBS, 1 article analyzed serum levels of IL-1β and IL-10 in IBS, 1 article analyzed somatostatin and vasoactive intestinal peptide levels in IBS. The result was a review of 15 studies that analyzed the association between IBS and anxiety.

Conclusions

IBS is a heterogeneous disorder caused by numerous psychological, immunological, infectious, endocrine and genetic factors. In recent years, the number of studies concentrating on genetic factors, cytokines and hormones has increased in comparison with the 2003–2005 period, when clinical investigation, using mainly questionnaires was the essential method. Also, the total number of papers investigating anxiety and IBS, considerably increased. The recent studies have confirmed the fact that IBS symptoms are often exacerbated during stressful events and the psychiatric treatment has a positive effect on gastro-intestinal symptomatology.

Effect of Changkang Fang on serotonin transporter expression in brain-gut axis of visceral hypersensitive rats with irritable bowel syndrome

AIM: To investigate the effect of Changkang Fang on the expression of serotonin transporter (SERT) in the brain-gut axis of visceral hypersensitive rats with irritable bowel syndrome (IBS).

METHODS: Seventy-two male immature SD rats were randomly divided into either a blank control group or a model group. AL-Chaer's modeling method was used in this study. After successful modeling, the model rats were randomly divided into a model group, a Western medicine group, high-, medium- and low-dose Chinese medicine groups. After 70 d, brain and intestinal mucosal tissues were taken for detecting the expression of SERT by immunohistochemistry.

RESULTS: The expression levels of SERT in intestinal mucosal and brain tissues of visceral hypersensitive IBS rats were significantly lower compared with normal controls (P < 0.05, P < 0.001). The expression levels of SERT in intestinal mucosal and brain tissues were significantly improved in the high-dose Chinese medicine group (P < 0.001 for both) and the medium-dose Chinese medicine group (P < 0.001, P < 0.05).

CONCLUSION: Changkang Fang can regulate the expression of SERT in the brain-gut axis of visceral hypersensitive IBS rats.

Genetic polymorphism in pathogenesis of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a complex symptom-based disorder without established biomarkers or putative pathophysiology. IBS is a common functional gastrointestinal disorder which is defined as recurrent abdominal pain or discomfort that has at least two of the following symptoms for 3 d per month in the past 3 mo according to ROME III: relief by defecation, onset associated with a change in stool frequency or onset with change in appearance or form of stool. Recent discoveries revealed genetic polymorphisms in specific cytokines and neuropeptides may possibly influence the frequencies and severity of symptoms, as well as the therapeutic responses in treating IBS patients. This review gives new insights on how genetic determinations influence in clinical manifestations, treatment responses and potential biomarkers of IBS.

Efficacy of tandospirone in patients with irritable bowel syndrome-diarrhea and anxiety

AIM: To investigate the efficacy of tandospirone in patients with irritable bowel syndrome-diarrhea (IBS-D) and anxiety in a prospective, randomized, controlled study.

METHODS: Two hundred patients with IBS-D and moderate anxiety were randomized to receive pinaverium and tandospirone (arm A) or pinaverium and placebo (arm B). Tandospirone or placebo was given thrice daily at a fixed dose of 10 mg and pinaverium was given thrice daily at a fixed dose of 50 mg. The duration of treatment was 8 wk. Patients were assessed for abdominal pain and diarrhea. Anxiety was evaluated using the Hamilton Rating Scale for Anxiety (HAM-A). The primary study endpoints were response rates for abdominal pain and diarrhea. The secondary study endpoints were response rates for anxiety. Adverse events were also evaluated.

RESULTS: One hundred and seventy of 200 patients (82 patients in arm A and 88 patients in arm B) completed the study. Demographic and baseline characteristics of the 200 participants were comparable in the two arms. At week 8, the overall response rate for abdominal pain and diarrhea was 52.0% for arm A and 37.0% for arm B (P < 0.05). The HAM-A score showed that the response rate was 61.0% for arm A and 21.0% for arm B (P < 0.01). The treatments were well tolerated and no significant adverse events were reported.

CONCLUSION: Tandospirone is effective and can be combined with pinaverium in IBS-D patients with anxiety.

Methylglyoxal induces systemic symptoms of irritable bowel syndrome

Patients with irritable bowel syndrome (IBS) show a wide range of symptoms including diarrhea, abdominal pain, changes in bowel habits, nausea, vomiting, headache, anxiety, depression and cognitive impairment. Methylglyoxal has been proved to be a potential toxic metabolite produced by intestinal bacteria. The present study was aimed at investigating the correlation between methylglyoxal and irritable bowel syndrome. Rats were treated with an enema infusion of methylglyoxal. Fecal water content, visceral sensitivity, behavioral tests and serum 5-hydroxytryptamine (5-HT) were assessed after methylglyoxal exposure. Our data showed that fecal water content was significantly higher than controls after methylglyoxal exposure except that of 30 mM group. Threshold volumes on balloon distension decreased in the treatment groups. All exposed rats showed obvious head scratching and grooming behavior and a decrease in sucrose preference. The serum 5-HT values were increased in 30, 60, 90 mM groups and decreased in 150 mM group. Our findings suggested that methylglyoxal could induce diarrhea, visceral hypersensitivity, headache as well as depression-like behaviors in rats, and might be the key role in triggering systemic symptoms of IBS.

Acute hepatitis after starting pinaverium bromide in a patient taking mirtazapine

A 56-year-old man presented with chronic abdominal pain. He had been evaluated extensively in the recent past undergoing upper gastrointestinal endoscopy, colonoscopy and CT scan of the abdomen with normal results. The provisional diagnosis of irritable bowel syndrome was performed and pinaverium bromide was started. The patient had pre-existing hypertension, a major depressive disorder and gastro-oesophageal reflux disease. He had been taking nebivolol and pantoprazole for several years and mirtazapine for the last 1 year. The patient developed nausea, vomiting and anorexia after 5 days of starting pinaverium bromide. Investigations revealed marked elevation of liver enzymes and bilirubin. He was negative for HIV, HBSAg, anti-hepatitis C virus, IgM for hepatitis A virus, hepatitis E virus, antinuclear antibody and antimitochondrial antibody. An ultrasound showed mild hepatomegaly with hypoechoic echo texture; the rest of scan was normal. Pinaverium and mirtazapine were stopped immediately. The patient was treated symptomatically and his liver profile returned to normal after 4 weeks.

Association between depression and irritable bowel syndrome in elderly patients

AIM: To investigate the association between depression and irritable bowel syndrome (IBS) in elderly patients.

METHODS: Seventy-four elderly patients (60-75 years, and > 75 years) and seventy-four non-elderly patients (< 60 yeas) with IBS treated at Department of Gastroenterology of the Affiliated Puai Hospital of Tongji Medical College of Huazhong University of Science and Technology from May 2010 to February 2013 were recruited. The patients were assessed using the ZUNG self-rating depression scale (SDS) and irritable bowel syndrome-quality of life measure (IBS-QOL) to predict the association between SDS and IBS-QOL in each group.

RESULTS: The SDS score in elderly patients was significantly higher than that in non-elderly patients (< 60 years and 60-75 years: 50.51 ± 6.60 vs 62.29 ± 7.34, P < 0.001; < 60 years and > 75 years: 50.51 ± 6.60 vs 63.72 ± 5.74, P < 0.001), but there was no significant difference in the two subgroups of elderly patients (60-75 years and > 75 years: 62.29 ± 7.34 vs 63.72 ± 5.74, P > 0.5). The majority of IBS types in the > 75 years group belonged to IBS-C, and the percentage of patients with IBS-C in the > 75 years group was significantly different from those in the <60 years and 60-75 years groups (both P < 0.05), but there were no difference between the latter two groups. There were negative correlations between SDS score and IBS-QOL score (P < 0.001) in each group, and the IBS-QOL score in elderly patients was significantly lower than that in non-elderly patients (P < 0.001), although there was no difference between the two subgroups of elderly patients (P > 0.5).

CONCLUSION: Depression in elderly patients is prone to initiate irritable bowel syndrome, compared with non-elderly patients. The dominant IBS type in elderly patients is IBS-C, which severely affects the patient's quality of life.

An Evidence-Based Look at Misconceptions in the Treatment of Patients with IBS-D

Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder and affects up to 12% to 15% of adults in the United States, with a higher prevalence among women and those younger than 50 years. IBS adversely impacts quality of life and medical expenditures, with significant costs arising from healthcare visits and reduced workplace productivity. Recent studies have shown that the adverse effects of IBS are so significant that many patients are willing to accept risks of adverse events from effective treatment to gain symptom relief. Alosetron is a 5-HT3 receptor antagonist approved by the US Food and Drug Administration (FDA) for women with severe diarrhea-predominant IBS that has not responded to traditional therapies. Alosetron yields overall improvements in IBS symptoms in 51% of patients vs 36% treated with placebo, with efficacy continuing undiminished over the course of a 48-week randomized, controlled trial. In real-world clinical practice, patients receiving alosetron had significant improvements in multiple IBS-related clinical parameters, including the new FDA IBS-diarrhea composite endpoint, lower gastrointestinal symptoms, fecal incontinence, and quality of life. Ischemic colitis and complications of constipation have been rare in occurrence. After nearly a decade of alosetron use under the risk management plan, adjudication of ischemic colitis and complications of constipation cases indicate that their incidence rates have remained low and stable.