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Haraguchi T, Emoto T. Stimulus-Response Plots as a Novel Bowel-Sound-Based Method for Evaluating Motor Response to Drinking in Healthy People. SENSORS (BASEL, SWITZERLAND) 2024; 24:3054. [PMID: 38793909 PMCID: PMC11125318 DOI: 10.3390/s24103054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
Constipation is a common gastrointestinal disorder that impairs quality of life. Evaluating bowel motility via traditional methods, such as MRI and radiography, is expensive and inconvenient. Bowel sound (BS) analysis has been proposed as an alternative, with BS-time-domain acoustic features (BSTDAFs) being effective for evaluating bowel motility via several food and drink consumption tests. However, the effect of BSTDAFs before drink consumption on those after drink consumption is yet to be investigated. This study used BS-based stimulus-response plots (BSSRPs) to investigate this effect on 20 participants who underwent drinking tests. A strong negative correlation was observed between the number of BSs per minute before carbonated water consumption and the ratio of that before and after carbonated water consumption. However, a similar trend was not observed when the participants drank cold water. These findings suggest that when carbonated water is drunk, bowel motility before ingestion affects motor response to ingestion. This study provides a non-invasive BS-based approach for evaluating motor response to food and drink, offering a new research window for investigators in this field.
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Affiliation(s)
- Takeyuki Haraguchi
- Science and Technology, Graduate School of Sciences and Technology for Innovation, Tokushima University, Tokushima 770-8506, Japan;
| | - Takahiro Emoto
- Division of Science and Technology, Graduate School of Technology, Industrial and Social Sciences, Tokushima University, Tokushima 770-8506, Japan
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Alihosseini S, Khodaei F, Jaberinezhad M, Azari M, Ezzati Khatab M, Akhlaghi H, Ghanini N, Tarzamni MK, Eghbali E. Evaluation of gallbladder contractility and Doppler findings in patients with irritable bowel syndrome; a case-control study. Scand J Gastroenterol 2024; 59:344-351. [PMID: 38031926 DOI: 10.1080/00365521.2023.2287989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder causing abdominal pain, altered bowel habits and bloating without structural issues. Gallbladder dysfunction may be linked to IBS due to disrupted cholecystokinin release. This study aims to assess gallbladder function and related hemodynamic parameters using Doppler ultrasound in IBS before and after meals. METHOD In this case-control study, we investigated gallbladder function differences between constipation-predominant IBS (C-IBS) patients and healthy volunteers. Participants underwent ultrasonography to measure gallbladder parameters before and after consuming a predefined meal. Gallbladder volume, wall thickness and resistance index (RI) of cystic and superior mesenteric arteries (SMA) were assessed. Student t-test and paired t-test were used to compare case and control groups and pre- and post-meal data, respectively. RESULTS A total of 34 people (18 C-IBS and 16 healthy control) were included. The mean (Standard deviation) of gallbladder fasting volume was measured 24.74 (8.85) and 29.73 (9.65) cubic millimeter for case and controls, respectively. Postprandial volume was 11.34 (5.66) and 16.9 (6.16) cubic millimeter for case and controls respectively. We observed a statistically significant difference in emptying fractions (EF) between groups (p value = 0.009). IBS patients had a smaller fasting SMA RI (p value = 0.016) but the fraction of change after meal was not significant (p value = 0.10). The cystic artery RI did not reach statistical significance between the fasting and post-meal values (p value = 0.067). CONCLUSION IBS patients have a higher emptying fraction and lower change in SMA RI compared to healthy controls. Further studies with larger sample size, inclusion of patients with different coexisting conditions and subtypes of IBS and combining colon transit study with gallbladder ejection fraction evaluation can be used to further provide more meaning to this study.
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Affiliation(s)
- Samin Alihosseini
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, The Islamic Republic of Iran
| | - Farzaneh Khodaei
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, The Islamic Republic of Iran
| | - Mehran Jaberinezhad
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, The Islamic Republic of Iran
| | - Mojtaba Azari
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, The Islamic Republic of Iran
| | - Maghsoud Ezzati Khatab
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, The Islamic Republic of Iran
| | - Hedieh Akhlaghi
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, The Islamic Republic of Iran
| | - Nima Ghanini
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, The Islamic Republic of Iran
| | - Mohammad Kazem Tarzamni
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, The Islamic Republic of Iran
| | - Elham Eghbali
- Medical Radiation Sciences Research Group, Tabriz University of Medical Sciences, Tabriz, The Islamic Republic of Iran
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Hung TH, Wang CY, Lee HF. Update in diagnosis and management of irritable bowel syndrome. Tzu Chi Med J 2023; 35:306-311. [PMID: 38035060 PMCID: PMC10683518 DOI: 10.4103/tcmj.tcmj_104_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/13/2023] [Accepted: 08/09/2023] [Indexed: 12/02/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by a lack of structural or biochemical abnormalities. The current diagnosis of IBS is based on the Rome IV criteria, and it is recommended to approach IBS patients using a multidimensional clinical profile (MDCP). The pathophysiology of IBS is multifactorial and involves motility disorders, genetic factors, immune responses, visceral hypersensitivity, brain-gut dysregulation, and altered intestinal microbiota. The management of IBS includes both nonpharmacologic and pharmacologic therapies. Nonpharmacologic therapy options include physical activity, low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet, as well as cognitive behavioral therapy. Pharmacologic therapy options include probiotics, antidepressants, antispasmodics, and new agents. In clinical practice, a multidisciplinary strategy, including nonpharmacologic or/and pharmacologic treatment for IBS, is emphasized. Therefore, clinicians should carefully consider the underlying pathophysiology before selecting an appropriate therapeutic option for the treatment of IBS. In other words, individualized treatment plans are necessary for managing IBS.
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Affiliation(s)
- Tsung-Hsing Hung
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chih-Ying Wang
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Hsing-Feng Lee
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Wal A, Wal P, Verma N, Pandey SS, Krishnan K, Bhowmick M. Children And Adolescents With Irritable Bowel Syndrome: Treatment And Management. Curr Pediatr Rev 2022; 20:CPR-EPUB-127866. [PMID: 36443973 DOI: 10.2174/1573396319666221128094843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 08/13/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a disorder that causes stomach pain in children and adolescents. It may also impact one's quality of life. IBS is linked to gastrointestinal issues such as diarrhoea and constipation. Despite the identification of several potential pathophysiological pathways, the aetiology of IBS remained unknown. OBJECTIVE The aim of this paper is to discuss the diagnosis, pathogenesis, case studies and treatment of Irritable bowel syndrome in children and adolescents. METHOD This systematic review covered relevant papers from the previous ten years that were accessible in Science Direct, Elsevier, NCBI, and Web of Science related to the pathophysiology and function of pharmacological drugs such as antidepressants, antispasmodics, prokinetics, and antibiotics in children with irritable bowel syndrome. RESULT Only a few prospective therapy techniques have been investigated in children, and even fewer of those have been demonstrated to be effective. This article presents case studies including 50-59 children, which demonstrate a favourable acceptable impact that is more effective than a placebo in terms of reducing symptoms and improving the overall quality of life in children who have irritable bowel syndrome. Furthermore, the majority of the pathophysiological explanations and treatment options discussed are based on adult studies. These major issues arose when treating paediatric IBS, and they must be addressed in order to properly treat children with IBS. Trials that focus on many combinations of pharmacological and non-pharmacological therapies seem to be more helpful. DISCUSSION In recent years, a number of systematic reviews have been conducted to evaluate the efficacy of medication treatments in children for IBS; however, the dependability of these systematic reviews needs to be further investigated owing to the various experimental designs and levels of evidence used. This article highlights paediatric therapy options, including pharmaceutical medications such as antidepressants, antispasmodics, prokinetics, and antibiotics. The goal is to alleviate IBS symptoms while also enhancing the quality of life for children with this illness.
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Affiliation(s)
- Ankita Wal
- Pranveer Singh Institute Of Technology Nh2 kanpur Agra Highway Bhaunti Kanpur UP,India
| | - Pranay Wal
- Pranveer Singh Institute Of Technology Nh2 kanpur Agra Highway Bhaunti Kanpur UP,India
| | - Neha Verma
- Pranveer Singh Institute Of Technology Nh2 kanpur Agra Highway Bhaunti Kanpur UP,India
| | | | - Karthickeyan Krishnan
- Vels Institute of Science technology & Advanced studies Pallavaram , Chennai,600117,Tamil Nadu 600117
| | - Mithun Bhowmick
- D101 Shikshak Niketan,campus of Bengal college of Pharmaceutical Sciences and research , Bidhananagar Durgapur,West bengal 713212
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Fawzy IM, ElGindy EM, Abdel-Samie O, Aly H. Probiotic therapy in patients with irritable bowel syndrome: does it have a real role? THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2021. [DOI: 10.1186/s43162-021-00051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Irritable bowel syndrome (IBS) is one of the most prevalent functional gastrointestinal disorders (FGIDs). There is good evidence that microbiota plays a predominant role in the IBS pathophysiology. The aim of the study is to evaluate the role of probiotics in improvement of IBS symptoms via IBS-symptom severity scale (IBS-SSS Arabic version) and improvement of quality of life via irritable bowel syndrome-quality of life survey (IBS-QOL).
Results
This double-armed comparative trial was conducted on IBS patients, who fulfill ROME IV criteria and the IBS diagnostic questionnaire between August and December 2019. Ninety patients were followed up for 4 weeks from the first visit. The first group was prescribed probiotics (10 billion colony of Lactobacillus delbruekii and Lactobacillus fermentum) and itopride hcl 50 mg three times daily, while the second group received only itopride hcl 50 mg by the same dose for 4 weeks. There was a highly significant improvement in the IBS-SSS score in group 1 after 4 weeks of treatment than in group 2 (137.56±67.53 vs 258.44±34.18) (p=0.001). Also, there was a highly significant improvement in the overall QOL terms in group 1 in comparison with baseline QOL score [with overall mean score (60.64±7.77) at baseline vs (81.54±7.87) at 4 weeks (p value <0.001)].
Conclusion
Probiotics are useful for the improvement of IBS symptoms and quality of life of the studied patients. Larger multicenter studies are needed in the future.
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Takahashi S, Matsumura T, Kaneko T, Tokunaga M, Oura H, Ishikawa T, Nagashima A, Shiratori W, Akizue N, Ohta Y, Kikuchi A, Fujie M, Saito K, Okimoto K, Maruoka D, Nakagawa T, Arai M, Kato J, Kato N. Clinical Characteristics of Esophageal Motility Disorders in Patients With Heartburn. J Neurogastroenterol Motil 2021; 27:545-554. [PMID: 34642275 PMCID: PMC8521463 DOI: 10.5056/jnm20131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/30/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022] Open
Abstract
Background/Aims Esophageal motility disorders (EMDs) contribute to the pathophysiology of gastroesophageal reflux disease. However, the causes of EMDs and their impact on gastroesophageal reflux disease-associated symptoms remain unknown. This study aims to elucidate clinical features associated with various types of EMDs in patients with heartburn symptoms. Methods Of the 511 patients who underwent high-resolution manometry, 394 who were evaluated for heartburn symptoms were examined. Patients subjected to high-resolution manometry were classified into 4 groups outflow obstruction group, hypermotility group, hypomotility group, and normal motility group. Symptoms were evaluated using 3 questionnaires. Patient characteristics and symptoms for each EMD type were compared with those of the normal motility group. Results Of the 394 patients, 193 (48.9%) were diagnosed with EMDs, including 71 with outflow obstruction, 15 with hypermotility, and 107 with hypomotility. The mean dysphagia score was significantly higher in each of the 3 EMD groups compared with those with normal motility. The mean acid reflux and dyspepsia scores were significantly lower in the outflow obstruction group (P < 0.05). The mean body mass index and median Brinkman index were significantly higher in the hypermotility group (P = 0.001 and P = 0.018, respectively), whereas the mean diarrhea and constipation scores were significantly lower in the hypomotility group (P < 0.05). Conclusions The results of our study indicate that different EMDs have distinct characteristics. Cigarette smoking and high body mass index were associated with esophageal hypermotility. Assessment of the dysphagia symptom scores may help identify patients with EMDs.
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Affiliation(s)
- Satsuki Takahashi
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tatsuya Kaneko
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mamoru Tokunaga
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hirotaka Oura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tsubasa Ishikawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ariki Nagashima
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Wataru Shiratori
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoki Akizue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Ohta
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsuko Kikuchi
- Department of Clinical Engineering Center, Chiba University Hospital, Chiba, Japan
| | - Mai Fujie
- Department of Clinical Engineering Center, Chiba University Hospital, Chiba, Japan
| | - Keiko Saito
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kenichiro Okimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daisuke Maruoka
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoo Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makoto Arai
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Prakash K, Thakur A, Malhotra AS. Association of heart rate variability, blood pressure variability, and baroreflex sensitivity with gastric motility at rest and during cold pressor test. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2021; 14:132-140. [PMID: 33968340 PMCID: PMC8101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To understand the mutual interaction of gastric motility and autonomic functions, the present study evaluated the association of heart rate variability (HRV), blood pressure variability (BPV), and baroreflex sensitivity (BRS) with gastric motility assessed by electrogastrography (EGG) at rest and during CPT and explored the effect of sympathetic activation by cold pressor test (CPT) on gastric motility. BACKGROUND The autonomic nervous system has a significant influence on gastrointestinal motility. HRV is commonly employed to assess the functions of the autonomic nervous system. BPV and BRS are relatively newer techniques and give a more holistic picture of autonomic functions along with the short-term regulation of blood pressure (BP). METHODS In fourteen young, healthy subjects, gastric motility was assessed by EGG. Beat-to-beat BP and lead II ECG were recorded to assess HRV, BPV, and BRS. BPV and BRS parameters were calculated for systolic, mean, and diastolic BP. Parameters of HRV and BPV were calculated for time and frequency domains. BRS was calculated by sequence and spectral methods. RESULTS Significant increases in diastolic BP (p = <0.0001) and EGG frequency (p = 0.0229) were observed during CPT. Significant correlations were observed between EGG frequencies and many of the HRV, BPV, and BRS parameters. The correlation coefficient was found to be highest between total power of HRV and EGG frequencies during baseline (p = 0.0107, r = -0.6571) and during CPT (p = 0.0059, r = -0.6935). CONCLUSION EGG frequency can be decreased by an acute increase in sympathetic activity induced by CPT. The novel findings are the significant correlations between many of the HRV, BPV, and BRS parameters and EGG frequency.
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Daily Short Message Service Reminders Increase Treatment Compliance and Efficacy in Outpatients with Functional Dyspepsia: a Prospective Randomized Controlled Trial. J Gen Intern Med 2020; 35:2925-2931. [PMID: 32779141 PMCID: PMC7572925 DOI: 10.1007/s11606-020-06088-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many outpatients with functional dyspepsia (FD) do not follow the medication schedule recommendations, which can lead to illness relapse. OBJECTIVE To investigate whether short message service (SMS) reminders improve medication regimen adherence and therapeutic efficacy in outpatients with FD. DESIGN Participants with FD were randomly allocated to the control group or intervention group. Patients in the control group received a 4-week medication treatment with no reminders, those in the intervention group received medication treatment plus a daily SMS reminder of dose and medication time. PARTICIPANTS Newly diagnosed FD patients from April 2019 to June 2019 were recruited from the GI outpatient clinics at Renji Hospital. MEASUREMENTS The scores for FD symptoms (LDQ) and psychological conditions (PHQ-9 for depression and GAD-7 for anxiety) were assessed before and after the treatment. The medication possession ratio (MPR) was calculated. KEY RESULTS A total of 352 eligible patients was enrolled in the study. The overall compliance rates of patients in the intervention and control groups were 87.5% and 80.7% in the intention-to-treat (ITT) analysis (P = 0.08) and 94.48% and 86.59% in per-protocol (PP) analysis (P = 0.015), respectively. In the intervention group, the compliance rate of younger patients (age ≤ 40 years) was significantly higher than that of age-matched patients in the control group (ITT: 86.1% vs. 70.5%, P = 0.018). Compared with the control group, the reduction in scores of LDQ (9.33 vs. 8.02, P = 0.017), PHQ-9 (6.97 vs. 5.69, P = 0.004), and GAD-7 (8.70 vs.7.53, P = 0.028) was significantly greater in patients receiving SMS reminders. The MPR of patients positively correlated with the reduction in scores of LDQ, PHQ-9, and GAD-7 in both groups. CONCLUSIONS SMS reminders can improve treatment compliance and efficacy in patients with FD. TRIAL REGISTRATION NCT04052750.
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Fu R, Chen M, Chen Y, Mao G, Liu S. Expression and clinical significance of 5-HT and 5-HT 3R in the intestinal mucosa of patient with diarrhea-type irritable bowel syndrome. Exp Ther Med 2019; 17:3077-3082. [PMID: 30936979 PMCID: PMC6434247 DOI: 10.3892/etm.2019.7297] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/18/2019] [Indexed: 12/13/2022] Open
Abstract
Expression levels and clinical significance of 5-HT and 5-HT3R in the intestinal mucosa tissue of patients with diarrhea-type irritable bowel syndrome (D-IBS) were investigated. A retrospective analysis was performed on 46 tissue specimens (observation group) of the intestinal mucosa of patients with D-IBS, who were diagnosed in the Tongde Hospital of Zhejiang Province and received colonoscopy from March 2016 to December 2017, and 18 tissue specimens (control group) of the intestinal mucosa of healthy subjects who received physical examinations. The expression levels of 5-HT and 5-HT3R in the intestinal mucosa tissue of patients in the observation and control group were detected by ELISA, and the relationship between 5-HT, 5-HT3R and the clinicopathological parameters of patients with D-IBS was analyzed. Pearson's correlation analysis was used to analyze the correlation of 5-HT and 5-HT3R in the intestinal mucosa tissue of patients with D-IBS. The expression levels of 5-HT and 5-HT3R in the intestinal mucosa tissue of patients in the observation group were significantly higher than those of the patients in the control group (344.86±67.52 ng/ml and 13.04±8.34 pg/ml) (P<0.001). There was a positive correlation between the expression level of 5-HT and the expression level of 5-HT3R in the intestinal mucosa tissue of patients with D-IBS (r=0.725, P<0.001). The expression levels of 5-HT and 5-HT3R in the intestinal mucosa tissue of patients with D-IBS were both significantly higher than those of the healthy subjects. The expression levels of 5-HT and 5-HT3R in patients with D-IBS were correlated with age, sex and the history of gastrointestinal infection. 5-HT and 5-HT3R may be involved in the pathogenesis of D-IBS, and potentially used for clinical treatment.
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Affiliation(s)
- Rui Fu
- Department of Gastroenterology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Mingxian Chen
- Department of Gastroenterology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Yu Chen
- Laboratory Animal Center, Zhejiang Province Academy of Traditional Chinese Medicine, Hangzhou, Zhejiang 310012, P.R. China
| | - Guoqun Mao
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Saiyue Liu
- Department of Adverse Drug Reaction Monitoring, Zhejiang Province Center of Adverse Drug Reaction Monitoring, Hangzhou, Zhejiang 310012, P.R. China
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Wang X, Qi Q, Wang Y, Wu H, Jin X, Yao H, Jin D, Liu Y, Wang C. Gut microbiota was modulated by moxibustion stimulation in rats with irritable bowel syndrome. Chin Med 2018; 13:63. [PMID: 30574173 PMCID: PMC6299671 DOI: 10.1186/s13020-018-0220-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022] Open
Abstract
Background The pathogenesis of irritable bowel syndrome (IBS) is closely related to intestinal dysbacteriosis and can be controlled by moxibustion treatment. However, the mechanism underlying the therapeutic value of moxibustion in IBS treatment remains unknown. Methods An IBS rat model was established by colorectal distention (CRD) stimulus and mustard oil clyster. Sixty-five male rats were randomly divided into six groups: normal, IBS model, moxibustion, electroacupuncture (EA), Bifid-triple Viable Capsule (BTVC) and Pinaverium Bromide (PB) groups. The moxibustion group was treated with mild moxibustion at the bilateral Tianshu (ST25) and Shangjuxu (ST37) for 10 min/day for 7 days, the EA group was given EA at ST25 and ST37 once daily for 7 days, while the BTVC group and PB groups received Bifid-triple Viable Capsule and Pinaverium Bromide solution (at the proportion of 1:0.018) respectively by gavage once daily for 7 days. After the treatment, abdominal withdrawal reflex (AWR) scores were determined based on CRD stimulus, gut microbiota profiling was conducted by 16S rRNA high-throughput sequencing. Results Irritable bowel syndrome model rats had significantly increased AWR scores at all intensities (20, 40, 60 and 80 mmHg) compared with the normal group. Moxibustion treatment significantly reduced AWR scores compared with the IBS model group at all intensities. Across all groups the most abundant phyla were Bacteroidetes and Firmicutes followed by Proteobacteria and Candidatus Saccharibacteria. At genus level IBS model rats had a higher abundance of Prevotella, Bacteroides and Clostridium XI and a lower abundance of Lactobacillus and Clostridium XIVa compared with normal rats. These changes in microbiota profiles could however be reversed by moxibustion treatment. Alpha diversity was decreased in IBS model rats compared with normal rats, yet significantly increased in moxibustion- and PB-treated rats compared with IBS rats. Conclusion Our findings suggest that moxibustion treats IBS by modulating the gut microbiota.
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Affiliation(s)
- Xiaomei Wang
- 1Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, 650 South Wanping Road, Xuhui District, Shanghai, 200030 China.,2Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030 China
| | - Qin Qi
- 3Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437 China
| | - Yuanyuan Wang
- 3Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437 China
| | - Huangan Wu
- 1Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, 650 South Wanping Road, Xuhui District, Shanghai, 200030 China.,2Key Laboratory of Acupuncture and Immunological Effects, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030 China
| | - Xiaoming Jin
- 4Stark Neurosciences Research Institute & Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Huan Yao
- 5Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Duiyin Jin
- 3Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437 China
| | - Yanan Liu
- 3Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437 China
| | - Cun Wang
- 3Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437 China
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Kim YS, Kim N. Sex-Gender Differences in Irritable Bowel Syndrome. J Neurogastroenterol Motil 2018; 24:544-558. [PMID: 30347934 PMCID: PMC6175559 DOI: 10.5056/jnm18082] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/08/2018] [Accepted: 08/24/2018] [Indexed: 12/11/2022] Open
Abstract
Because of the sex-gender differences that are shown in a diversity of physiological and psychological factors, it can be speculated that the clinical presentation of symptoms as well as treatment strategies in women and men with irritable bowel syndrome (IBS) may differ. Studies have revealed that IBS is more common in women than men. As for the IBS subtype, IBS with constipation is significantly more prevalent among women than men. Sex hormones and gender differences may play important roles in the pathophysiology of IBS. However, its pathophysiologic mechanisms still remain largely unknown, and therapeutic implications are limited. Moreover, women IBS patients have been reported to feel more fatigue, depression, anxiety, and lower quality of life than men IBS patients. Furthermore, there has been evidence of differences in the appropriate treatment efficacy to IBS in men and women, although relatively few men are enrolled in most relevant clinical trials. A more sex-gender-oriented approach in the medical care setting could improve understanding of heterogeneous patients suffering from IBS. An individualized and multicomponent approach including sex and gender issues might help improve the treatment of IBS.
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Affiliation(s)
- Young Sun Kim
- Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Nayoung Kim
- Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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12
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Jia M, Lu X, Wang Z, Zhao L, Zhang S. Effects of Fengliao-Changweikang in Diarrhea-predominant Irritable Bowel Syndrome Rats and Its Mechanism Involving Colonic Motility. J Neurogastroenterol Motil 2018; 24:479-489. [PMID: 29715711 PMCID: PMC6034674 DOI: 10.5056/jnm17093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/21/2017] [Accepted: 11/20/2017] [Indexed: 12/13/2022] Open
Abstract
Background/Aims This study was designed to investigate the effect of Fengliao-Changweikang (FLCWK) in diarrhea-predominant irritable bowel syndrome (IBS-D) rats and explore its underlying mechanisms. Methods IBS-D model rats were induced by neonatal maternal separation (NMS) combined with restraint stress (RS). In in vivo experiments, the model rats were randomly divided into 5 groups: NMS + RS, FLCWK (low dose, middle dose, and high dose), and pinaverium bromide. The normal control (no handling) rats were classified as the NH group. The therapeutic effect of FLCWK was evaluated by fecal characteristics, electromyographic response and abdominal withdrawal reflex scores. In in vitro experiments, the model rats were randomly divided into 2 groups: NMS + RS, FLCWK (middle dose), and no handling rats were used as the NH group. The differences in basic tension and ACh-induced tension of isolated colonic longitudinal smooth muscle strips (CLSMs) among the 3 groups were observed. In addition, different inhibitors (nifedipine, TMB-8, L-NAME, methylene blue, and 4-AP) were pretreated to explore the underlying mechanisms. Results In in vivo experiments, fecal characteristics, electromyographic response, and abdominal withdrawal reflex scores significantly improved in the FLCWK group, compared with the NMS + RS group. In in vitro experiments, the basic tension and ACh-induced tension of CLSMs in IBS-D rats were significantly inhibited by FLCWK. After pre-treatment with different inhibitors, the ACh-induced tension of CLSMs in each group showed no significant difference. Conclusions FLCWK manifested curative effect in IBS-D rats by inhibiting colonic contraction. The underlying mechanisms may be related to regulatory pathway of nitric oxide/cGMP/Ca2+ and specific potassium channels.
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Affiliation(s)
- Mengdi Jia
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Xiaofang Lu
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Zhengfang Wang
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Luqing Zhao
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
| | - Shengsheng Zhang
- Digestive Disease Center, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing, China
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13
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Fukui H, Xu X, Miwa H. Role of Gut Microbiota-Gut Hormone Axis in the Pathophysiology of Functional Gastrointestinal Disorders. J Neurogastroenterol Motil 2018; 24:367-386. [PMID: 29969855 PMCID: PMC6034676 DOI: 10.5056/jnm18071] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/21/2018] [Indexed: 12/13/2022] Open
Abstract
Gut microbiota exert a pivotal influence on various functions including gastrointestinal (GI) motility, metabolism, nutrition, immunity, and the neuroendocrine system in the host. These effects are mediated by not only short-chain fatty acids produced by microbiota but also gut hormones and inflammatory signaling by enteroendocrine and immune cells under the influence of the microbiota. GI motility is orchestrated by the enteric nervous system and hormonal networks, and disturbance of GI motility plays an important role in the pathophysiology of functional gastrointestinal disorders (FGIDs). In this context, microbiota-associated mediators are considered to act on specific receptors, thus affecting the enteric nervous system and, subsequently, GI motility. Thus, the pathophysiology of FGIDs is based on alterations of the gut microbiota/gut hormone axis, which have crucial effects on GI motility.
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Affiliation(s)
- Hirokazu Fukui
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa, Nishinomiya,
Japan
| | - Xin Xu
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa, Nishinomiya,
Japan
- Department of Digestive Diseases, Tianjin Medical University General Hospital, Tianjin,
China
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa, Nishinomiya,
Japan
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Shin SP, Choi YM, Kim WH, Hong SP, Park JM, Kim J, Kwon O, Lee EH, Hahm KB. A double blind, placebo-controlled, randomized clinical trial that breast milk derived- Lactobacillus gasseri BNR17 mitigated diarrhea-dominant irritable bowel syndrome. J Clin Biochem Nutr 2018; 62:179-186. [PMID: 29610559 PMCID: PMC5874236 DOI: 10.3164/jcbn.17-73] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/27/2017] [Indexed: 12/12/2022] Open
Abstract
The exact pathogenesis of diarrhea-dominant irritable bowel syndrome (IBS) is not known, but the abnormal microbiota of the gastrointestinal tract is considered to be one of the important contributing factors as in other gastrointestinal diseases such as inflammatory bowel disease, antibiotic-associated diarrhea, and colorectal cancer as well as systemic diseases. Though diverse trials of probiotics had been continued in the treatment of diarrhea-IBS, only a few proved by randomized clinical trial. To prove the efficacy of Lactobacillus gasseri BNR17 isolated from breast milk in patients with diarrhea-IBS, prospective, randomized, placebo controlled clinical trial was done including health related-quality of life analysis, colon transit time, and the changes of fecal microbiota. BNR17 significantly improved the symptoms of diarrhea compared to control group. Health related-QOL analysis showed significant improvement of abdominal pain, distension, disturbed daily life, and mean defecation frequency with BNR17. On comparative CTT before and after BNR17, 6 out of 24 subjects showed significant correction of rapid colon transit pattern, while only 2 out of 24 in placebo (p<0.01). Upon fecal microbiota analysis, BNR17 significantly increased B. fecalis, E. rectale, C. aerofaciens, F. prausnitzil and B. steroris. Conclusively, Lactobacillus gasseri BNR17 can be a potential probiotics to ameliorate diarrhea-IBS.
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Affiliation(s)
- Suk Pyo Shin
- Department of Gastroenterology, Hallym University Sacred Hospital, Chooncheon, Korea
| | - Yoon Mi Choi
- Digestive Disease Center, CHA University Bundang Medical Center, 59 Yatap-roBundang-gu, Seongnam 13496, Korea
| | - Won Hee Kim
- Digestive Disease Center, CHA University Bundang Medical Center, 59 Yatap-roBundang-gu, Seongnam 13496, Korea
| | - Sung Pyo Hong
- Digestive Disease Center, CHA University Bundang Medical Center, 59 Yatap-roBundang-gu, Seongnam 13496, Korea
| | - Jong-Min Park
- CHA Bio Complex CHA Cancer Prevention Research Center, Pangyo, 13488, Korea
| | - Joohee Kim
- Department of Nutritional Science and Food management, Ewha Woman University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
| | - Oran Kwon
- Department of Nutritional Science and Food management, Ewha Woman University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
| | - Eun Hyun Lee
- Graduate School of Public Health, Ajou University, Suwon, 16499, Korea
| | - Ki Baik Hahm
- Digestive Disease Center, CHA University Bundang Medical Center, 59 Yatap-roBundang-gu, Seongnam 13496, Korea.,CHA Bio Complex CHA Cancer Prevention Research Center, Pangyo, 13488, Korea
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15
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Kim SY, Woo HS, Kim KO, Choi SH, Kwon KA, Chung JW, Kim YJ, Kim JH, Kim SJ, Park DK. DA-9701 improves colonic transit time and symptoms in patients with functional constipation: A prospective study. J Gastroenterol Hepatol 2017; 32:1943-1948. [PMID: 28431454 DOI: 10.1111/jgh.13807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/24/2017] [Accepted: 04/13/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM DA-9701, a newly developed prokinetic agent formulated with Pharbitis Semen and Corydalis Tuber, has been shown to effectively treat functional dyspepsia. Recently, it has also been suspected to improve gastrointestinal motor function. The aims of this study were to assess the effect of DA-9701 on colonic transit time (CTT) and symptoms of functional constipation. METHODS Thirty-three patients with functional constipation based on the Rome III criteria were prospectively enrolled. The patients received 30-mg DA-9701 three times a day for 24 days. CTT was estimated initially and at the end of treatment. Symptoms such as spontaneous bowel movements, straining, stool form, feeling of incomplete emptying and anorectal blockage, abdominal discomfort and pain, overall defecation satisfaction, and incidence of adverse events were also analyzed. RESULTS Twenty-seven patients completed the study. DA-9701 was associated with a significantly reduced CTT from 34.9 ± 17.6 to 23.7 ± 19.1 h (P = 0.001). Segmental CTT also significantly decreased after treatment (right CTT: from 16.8 [0.0-28.8] to 6.0 [0.0-25.2] hours, P < 0.001; rectosigmoid transit time: from 13.2 [0.0-38.4] to 6.0 [0.0-33.6] hours, P = 0.021). In addition, all constipation-related subjective symptoms, including spontaneous bowel movement frequency, significantly improved compared with those before treatment. Serious adverse events did not occur. CONCLUSIONS DA-9701 accelerates colonic transit and safely improves symptoms in patients with functional constipation. Therefore, we suggest that this novel agent could help to treat patients with this condition.
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Affiliation(s)
- Su Young Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Hyun Sun Woo
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Kyoung Oh Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Sung Han Choi
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Kwang An Kwon
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Jun-Won Chung
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Yoon Jae Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Jung Ho Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Su Ji Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Dong Kyun Park
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
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Temiz TK, Demir O, Simsek F, Kaplan YC, Bahceci S, Karadas B, Celik A, Koyluoglu G. Effect of nitrergic system on colonic motility in a rat model of irritable bowel syndrome. Indian J Pharmacol 2017; 48:424-429. [PMID: 27756955 PMCID: PMC4980932 DOI: 10.4103/0253-7613.186189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIM The aim of this study is to investigate whether nitric oxide (NO)-mediated colonic motility was altered in rat irritable bowel syndrome (IBS) model, using different isoforms of NO-synthase (NOS) inhibitors. MATERIALS AND METHODS The animal model of IBS-like visceral hypersensitivity was induced by intra-colonic infusion of 0.5% acetic acid (AA) in saline once daily from postnatal days 8 to 21. Control animals received saline instead of AA. Experiments were performed at the end of 8 weeks. Distal colon tissues were resected and direct effects of different NOS inhibitors; N-omega-nitro-L-arginine methyl ester hydrochloride, (L-NAME), ARL-17477 dihydrochloride hydrate (ARL 17477), N-[3-(Aminomethyl) phenyl] methyl]-ethanimidamidedihydrochloride (1400 W), and N5-(1-Iminoethyl)-L-ornithine dihydrochloride (L-NIO) were evaluated concentration-dependently in vitro tissue bath. Besides, morphology of both groups was assessed with hematoxylin and eosin (H and E) staining and the impact of NO antibodies was determined using the immunohistochemical method. RESULTS The mean pressure values of spontaneous contractions and KCL (80 mmol/L) responses of distal colonic segments were similar in normal and IBS rats. L-NAME and ARL-17477 significantly increased the mean pressure of spontaneous colonic contractions in normal rats versus own base values (P < 0.05), but this increase did not significantly different when compared to IBS rats. In H and E staining, there was no difference with regard to morphology between two groups. Neuronal NOS (nNOS) immunoreactivity was found to be significantly decreased in IBS when compared to control groups (P < 0.05). CONCLUSION L-NAME and ARL-17477 mediated mean pressure values were found to be slightly decreased in IBS rats. These findings may be related to a decrease in nNOS level in IBS.
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Affiliation(s)
- Tijen Kaya Temiz
- Department of Pharmacology, Atatürk Education and Research Hospital, Faculty of Medicine, Izmir Katip Celebi University, 35640, Izmir, Turkey
| | - Omer Demir
- Department of Pharmacology, Faculty of Medicine, Izmir University, 35350, Izmir, Turkey
| | - Fatma Simsek
- Department of Histology and Embriyology, Ataturk Training and Research Hospital, Faculty of Medicine, Izmir Katip Celebi University, 35640, Izmir, Turkey
| | - Yusuf Cem Kaplan
- Department of Pharmacology, Atatürk Education and Research Hospital, Faculty of Medicine, Izmir Katip Celebi University, 35640, Izmir, Turkey
| | - Selen Bahceci
- Department of Histology and Embriyology, Ataturk Training and Research Hospital, Faculty of Medicine, Izmir Katip Celebi University, 35640, Izmir, Turkey
| | - Barıs Karadas
- Department of Pharmacology, Atatürk Education and Research Hospital, Faculty of Medicine, Izmir Katip Celebi University, 35640, Izmir, Turkey
| | - Aslı Celik
- Department of Laboratory Animal Science, Faculty of Medicine, Dokuz Eylul University, 35340, Izmir, Turkey
| | - Gokhan Koyluoglu
- Department of Pediatric Surgery, Tepecik Training and Research Hospital, Faculty of Medicine, Izmir Katip Celebi University, 35640, Izmir, Turkey
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Krasaelap A, Madani S. Cyproheptadine: A Potentially Effective Treatment for Functional Gastrointestinal Disorders in Children. Pediatr Ann 2017; 46:e120-e125. [PMID: 28287686 DOI: 10.3928/19382359-20170213-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Functional gastrointestinal disorders (FGIDs) negatively affect children's quality of life and health care costs. It has been proposed that alteration of gut serotonin leads to gastrointestinal dysmotility, visceral hypersensitivity, altered gastrointestinal secretions, and brain-gut dysfunction. Cyproheptadine, a serotonin antagonist, has been shown to be a potentially effective and safe treatment option in children who meet the clinical criteria for FGIDs. Well-designed multicenter trials with long-term follow-up are needed to further investigate its efficacy. [Pediatr Ann. 2017;46(3):e120-e125.].
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18
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Effects of Buscopan on human gastrointestinal smooth muscle activity in an ex vivo model: Are there any differences for various sections? Eur J Pharmacol 2016; 780:180-7. [PMID: 27020547 DOI: 10.1016/j.ejphar.2016.03.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 03/19/2016] [Accepted: 03/24/2016] [Indexed: 01/04/2023]
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Abstract
The symptom-based diagnosis of irritable bowel syndrome (IBS) has not been established in everyday clinical practice, and the diagnosis of this disorder remains one of exclusion. It has been demonstrated that the densities of duodenal chromogranin A, rectal peptide YY and somatostatin cells are good biomarkers for the diagnosis of sporadic IBS, and low-grade mucosal inflammation is a promising biomarker for the diagnosis of postinfectious IBS. Genetic markers are not useful as biomarkers for IBS since the potential risk genes have yet to be validated, and the intestinal microbiota cannot be used because of the lack of an association between a specific bacterial species and IBS. Furthermore, gastrointestinal dysmotility and visceral hypersensitivity tests produce results that are too nonconsistent and noncharacteristic to be used in the diagnosis of IBS. A combination of symptom-based assessment, exclusion of overlapping gastrointestinal diseases and positive biomarkers appears to be the best way to diagnose IBS.
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Affiliation(s)
- Magdy El-Salhy
- a Department of Medicine, Section for Gastroenterology, Stord Hospital, Stord, Norway
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Every-Palmer S, Nowitz M, Stanley J, Grant E, Huthwaite M, Dunn H, Ellis PM. Clozapine-treated Patients Have Marked Gastrointestinal Hypomotility, the Probable Basis of Life-threatening Gastrointestinal Complications: A Cross Sectional Study. EBioMedicine 2016; 5:125-34. [PMID: 27077119 PMCID: PMC4816835 DOI: 10.1016/j.ebiom.2016.02.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/22/2016] [Accepted: 02/09/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Gastrointestinal side effects are particularly common with clozapine and occur with other antipsychotics, ranging from mild constipation to fatal bowel obstruction and/or ischemia. While this adverse-effect spectrum has been attributed to 'gastrointestinal hypomotility', gastrointestinal transit times in antipsychotic-treated patients have not previously been measured, making this mechanism speculative. METHODS Using standardized radiopaque marker ('Metcalf') methods we established colonic transit times of antipsychotic-treated psychiatric inpatients and compared them with population normative values. We analyzed results by antipsychotic type, antipsychotic dose equivalent, anticholinergic load, duration of treatment, gender, ethnicity, and age. OUTCOMES For patients not prescribed clozapine, median colonic transit time was 23 h. For patients prescribed clozapine, median transit time was 104.5 h, over four times longer than those on other antipsychotics or normative values (p < 0.0001). Eighty percent of clozapine-treated patients had colonic hypomotility, compared with none of those prescribed other antipsychotics (olanzapine, risperidone, paliperidone aripiprazole, zuclopenthixol or haloperidol). In the clozapine group, right colon, left colon and rectosigmoid transit times were all markedly abnormal suggesting pan-colonic pathology. Hypomotility occurred irrespective of gender, age, ethnicity, or length of clozapine treatment. Transit times were positively correlated with clozapine plasma level (rho = 0.451, p = 0.045), but not with duration of treatment, total antipsychotic load or demographic factors. INTERPRETATION Clozapine, unlike the other antipsychotics examined, causes marked gastrointestinal hypomotility, as previously hypothesized. Pre-emptive laxative treatment is recommended when starting clozapine.
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Affiliation(s)
- Susanna Every-Palmer
- Te Korowai Whāriki Central Regional Forensic Service, Capital and Coast District Health Board, New Zealand
- Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Mike Nowitz
- Department of Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - James Stanley
- Biostatistics Group, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Eve Grant
- Te Korowai Whāriki Central Regional Forensic Service, Capital and Coast District Health Board, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Helen Dunn
- Pharmacy Department, Capital and Coast District Health Board, Private Bag 7902, Wellington South, New Zealand
| | - Pete M. Ellis
- Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Wellington 6242, New Zealand
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Yoo HY, Kim MR, Park HW, Son JS, Bae SH. Colon Transit Time Test in Korean Children with Chronic Functional Constipation. Pediatr Gastroenterol Hepatol Nutr 2016; 19:38-43. [PMID: 27064388 PMCID: PMC4821981 DOI: 10.5223/pghn.2016.19.1.38] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/14/2015] [Accepted: 11/02/2015] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Each ethnic group has a unique life style, including diets. Life style affects bowel movement. The aim of this study is to describe the results of colon transit time (CTT) tests in Korean children who had chronic functional constipation based on highly refined data. METHODS One hundred ninety (86 males) out of 415 children who performed a CTT test under the diagnosis of chronic constipation according to Rome III criteria at Konkuk University Medical Center from January 2006 through March 2015 were enrolled in this study. Two hundreds twenty-five children were excluded on the basis of CTT test result, defecation diary, and clinical setting. Shapiro-Wilk and Mann-Whitney U, and chi-square tests were used for statistical analysis. RESULTS The median value and interquartile range (IQR) of CTT was 54 (37.5) hours in Encopresis group, and those in non-encopresis group was 40.2 (27.9) hours (p<0.001). The frequency of subtype between non-encopresis group and encopresis was statistically significant (p=0.002). The non-encopresis group (n=154, 81.1%) was divided into normal transit subgroup (n=84, 54.5%; median value and IQR of CTT=26.4 [9.6] hours), outlet obstruction subgroup (n=18, 11.7%; 62.4 [15.6] hours), and slow transit subgroup (n=52, 33.8%; 54.6 [21.0] hours]. The encopresis group (n=36, 18.9%) was divided into normal transit subgroup (n=8, 22.2%; median value and IQR of CTT=32.4 [9.9] hours), outlet obstruction subgroup (n=8, 22.2%; 67.8 [34.8] hours), and slow transit subgroup (n=20, 55.6%; 59.4 [62.7]hours). CONCLUSION This study provided the basic pattern and value of the CTT test in Korean children with chronic constipation.
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Affiliation(s)
- Ha Yeong Yoo
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Mock Ryeon Kim
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Hye Won Park
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Sung Son
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Sun Hwan Bae
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
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Sinagra E, Pompei G, Tomasello G, Cappello F, Morreale GC, Amvrosiadis G, Rossi F, Lo Monte AI, Rizzo AG, Raimondo D. Inflammation in irritable bowel syndrome: Myth or new treatment target? World J Gastroenterol 2016; 22:2242-2255. [PMID: 26900287 PMCID: PMC4734999 DOI: 10.3748/wjg.v22.i7.2242] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 09/28/2015] [Accepted: 12/21/2015] [Indexed: 02/06/2023] Open
Abstract
Low-grade intestinal inflammation plays a key role in the pathophysiology of irritable bowel syndrome (IBS), and this role is likely to be multifactorial. The aim of this review was to summarize the evidence on the spectrum of mucosal inflammation in IBS, highlighting the relationship of this inflammation to the pathophysiology of IBS and its connection to clinical practice. We carried out a bibliographic search in Medline and the Cochrane Library for the period of January 1966 to December 2014, focusing on publications describing an interaction between inflammation and IBS. Several evidences demonstrate microscopic and molecular abnormalities in IBS patients. Understanding the mechanisms underlying low-grade inflammation in IBS may help to design clinical trials to test the efficacy and safety of drugs that target this pathophysiologic mechanism.
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Corticotropin-releasing factor receptor type 1 and type 2 interaction in irritable bowel syndrome. J Gastroenterol 2015; 50:819-30. [PMID: 25962711 DOI: 10.1007/s00535-015-1086-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/25/2015] [Indexed: 02/06/2023]
Abstract
Irritable bowel syndrome (IBS) displays chronic abdominal pain or discomfort with altered defecation, and stress-induced altered gut motility and visceral sensation play an important role in the pathophysiology. Corticotropin-releasing factor (CRF) is a main mediator of stress responses and mediates these gastrointestinal functional changes. CRF in brain and periphery acts through two subtype receptors such as CRF receptor type 1 (CRF1) and type 2 (CRF2), and activating CRF1 exclusively stimulates colonic motor function and induces visceral hypersensitivity. Meanwhile, several recent studies have demonstrated that CRF2 has a counter regulatory action against CRF1, which may imply that CRF2 inhibits stress response induced by CRF1 in order to prevent it from going into an overdrive state. Colonic contractility and sensation may be explained by the state of the intensity of CRF1 signaling. CRF2 signaling may play a role in CRF1-triggered enhanced colonic functions through modulation of CRF1 activity. Blocking CRF2 further enhances CRF-induced stimulation of colonic contractility and activating CRF2 inhibits stress-induced visceral sensitization. Therefore, we proposed the hypothesis, i.e., balance theory of CRF1 and CRF2 signaling as follows. Both CRF receptors may be activated simultaneously and the signaling balance of CRF1 and CRF2 may determine the functional changes of gastrointestinal tract induced by stress. CRF signaling balance might be abnormally shifted toward CRF1, leading to enhanced colonic motility and visceral sensitization in IBS. This theory may lead to understanding the pathophysiology and provide the novel therapeutic options targeting altered signaling balance of CRF1 and CRF2 in IBS.
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El-Salhy M. Recent developments in the pathophysiology of irritable bowel syndrome. World J Gastroenterol 2015; 21:7621-7636. [PMID: 26167065 PMCID: PMC4491952 DOI: 10.3748/wjg.v21.i25.7621] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 03/31/2015] [Accepted: 05/21/2015] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder, the pathophysiology of which is not completely known, although it has been shown that genetic/social learning factors, diet, intestinal microbiota, intestinal low-grade inflammation, and abnormal gastrointestinal endocrine cells play a major role. Studies of familial aggregation and on twins have confirmed the heritability of IBS. However, the proposed IBS risk genes are thus far nonvalidated hits rather than true predisposing factors. There is no convincing evidence that IBS patients suffer from food allergy/intolerance, with the effect exerted by diet seemingly caused by intake of poorly absorbed carbohydrates and fiber. Obesity is a possible comorbidity of IBS. Differences in the microbiota between IBS patients and healthy controls have been reported, but the association between IBS symptoms and specific bacterial species is uncertain. Low-grade inflammation appears to play a role in the pathophysiology of a major subset of IBS, namely postinfectious IBS. The density of intestinal endocrine cells is reduced in patients with IBS, possibly as a result of genetic factors, diet, intestinal microbiota, and low-grade inflammation interfering with the regulatory signals controlling the intestinal stem-cell clonogenic and differentiation activities. Furthermore, there is speculation that this decreased number of endocrine cells is responsible for the visceral hypersensitivity, disturbed gastrointestinal motility, and abnormal gut secretion seen in IBS patients.
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Yamada E, Inamori M, Uchida E, Tanida E, Izumi M, Takeshita K, Fujii T, Komatsu K, Hamanaka J, Maeda S, Kanesaki A, Matsuhashi N, Nakajima A. Association between the location of diverticular disease and the irritable bowel syndrome: a multicenter study in Japan. Am J Gastroenterol 2014; 109:1900-5. [PMID: 25331347 PMCID: PMC4261138 DOI: 10.1038/ajg.2014.323] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 08/03/2014] [Accepted: 08/05/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES No previous reports have shown an association between location of diverticular disease (DD) and the irritable bowel syndrome (IBS). METHODS We included 1,009 consecutive patients undergoing total colonoscopy in seven centers in Japan from June 2013 to September 2013. IBS was diagnosed using Rome III criteria, and diverticulosis was diagnosed by colonoscopy with transparent soft-short-hood. Left-sided colon was defined as sigmoid colon, descending colon, and rectum. Right-sided colon was defined as cecum, ascending colon, and transverse colon. We divided the patients into IBS and non-IBS groups and compared characteristics. RESULTS Patient characteristics included mean age, 64.2±12.9 years and male:female ratio, 1.62:1. Right-sided DD was identified in 21.6% of subjects. Left-sided and bilateral DD was identified in 6.6 and 12.0% of subjects, respectively. IBS was observed in 7.5% of subjects. Multiple logistic regression analysis showed left-sided DD (odds ratio, 3.1; 95% confidence interval (CI): 1.4-7.1; P=0.0060) and bilateral DD (odds ratio, 2.6; 95% CI, 1.3-5.2; P=0.0070) were independent risk factors for IBS. Right-sided DD was not a risk factor for IBS. CONCLUSIONS Our data showed that the presence of left-sided and bilateral DD, but not right-sided disease, was associated with a higher risk of IBS, indicating that differences in pathological factors caused by the location of the DD are important in the development of IBS. Clarifying the specific changes associated with left-sided DD could provide a better understanding of the pathogenic mechanisms of IBS (Trial registration # R000012739).
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Affiliation(s)
- Eiji Yamada
- Gastroenterology Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masahiko Inamori
- Gastroenterology Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Eri Uchida
- Department of Gastroenterology, Machida Municipal Hospital, Machida, Tokyo, Japan
| | - Emiko Tanida
- Department of Gastroenterology, Machida Municipal Hospital, Machida, Tokyo, Japan
| | - Motoyoshi Izumi
- Department of Gastroenterology, Machida Municipal Hospital, Machida, Tokyo, Japan
| | - Kimiya Takeshita
- Department of Gastroenterology, International University of Health and Welfare Atami Hospital, Atami, Shizuoka, Japan
| | - Tetsuro Fujii
- Department of Gastroenterology, Tokyo Metropolitan, Hiroo General Hospital, Shibuya-ku, Tokyo, Japan
| | - Kazuto Komatsu
- Department of Gastroenterology, Yokosuka City Hospital, Yokosuka, Kanagawa, Japan
| | - Jun Hamanaka
- Department of Gastroenterology, Yokohama Minami Kyosai Hospital, Yokosuka, Kanagawa, Japan
| | - Shin Maeda
- Gastroenterology Division, Yokohama City University School of Medicine, Yokohama, Japan
| | - Akira Kanesaki
- Department of Gastroenterology, Machida Municipal Hospital, Machida, Tokyo, Japan
| | - Nobuyuki Matsuhashi
- Department of Gastroenterology, NTT Medical Center Tokyo, Gotanda, Tokyo, Japan
| | - Atsushi Nakajima
- Gastroenterology Division, Yokohama City University School of Medicine, Yokohama, Japan,Gastroenterology Division, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama 236-0004, Japan. E-mail:
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EL-SALHY MAGDY, GILJA ODDHELGE, GUNDERSEN DORIS, HATLEBAKK JANG, HAUSKEN TRYGVE. Interaction between ingested nutrients and gut endocrine cells in patients with irritable bowel syndrome (review). Int J Mol Med 2014; 34:363-71. [PMID: 24939595 PMCID: PMC4094590 DOI: 10.3892/ijmm.2014.1811] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 02/10/2014] [Indexed: 12/15/2022] Open
Abstract
Several endocrine cell abnormalities have been reported in different segments of the gastrointestinal tract of patients with irritable bowel syndrome (IBS). These cells have specialized microvilli that project into the lumen; they function as sensors for the gut contents and respond to luminal stimuli (mostly ingested nutrients) by releasing hormones into the lamina propria, where they exert their effects via a paracrine/endocrine mode of action. Certain food items trigger the symptoms experienced by IBS patients, including those rich in fermentable oligo-, di- and monosaccharides, and polyols (FODMAPs). In this review, we present the argument that the effects of both FODMAPs and the proportional intake of proteins, fats and carbohydrates on IBS symptoms may be caused by an interaction with the gut endocrine cells. Since the gut hormones control and regulate gastrointestinal motility and sensation, this interaction may be responsible for abnormal gastrointestinal motility and the visceral hypersensitivity observed in these patients. There is no consistent evidence that IBS patients suffer from food allergy. The role of gluten intolerance in the development of IBS symptoms in these patients remains a matter of controversy. Individual guidance on food management, which includes restrictions in the intake of FODMAP-rich foods and testing diets with different proportions of proteins, fats and carbohydrates has been found to reduce the symptoms, improve the quality of life, and make the habitual diet of IBS patients more healthy.
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Affiliation(s)
- MAGDY EL-SALHY
- Section of Gastroenterology, Department of Medicine, Stord Helse-Fonna Hospital, University of Bergen, Bergen, Norway
- Section of Gastroenterology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - ODD HELGE GILJA
- Section of Gastroenterology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - JAN G. HATLEBAKK
- Section of Gastroenterology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - TRYGVE HAUSKEN
- Section of Gastroenterology, Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Chang FY. Irritable bowel syndrome: The evolution of multi-dimensional looking and multidisciplinary treatments. World J Gastroenterol 2014; 20:2499-2514. [PMID: 24627587 PMCID: PMC3949260 DOI: 10.3748/wjg.v20.i10.2499] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 10/16/2013] [Accepted: 01/02/2014] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is common in the society. Among the putative pathogeneses, gut dysmotility results in pain and disturbed defecation. The latter is probably caused by the effect of abnormal gut water secretion. The interaction between abnormal gas accumulation, abdominal pain and bloating remains controversial. Visceral hypersensitivity and its modification along with the central transmission are the characteristics of IBS patients. The identification of biologic markers based on genetic polymorphisms is undetermined. Imbalanced gut microbiota may alter epithelial permeability to activate nociceptive sensory pathways which in turn lead to IBS. Certain food constituents may exacerbate bowel symptoms. The impact of adult and childhood abuses on IBS is underestimated. Using the concept of biopsychosocial dysfunction can integrate multidimensional pathogeneses. Antispasmodics plus stool consistency modifiers to treat the major symptoms and defecation are the first-line drug treatment. New drugs targeting receptors governing bowel motility, sensation and secretion can be considered, but clinicians must be aware of their potential serious side effects. Psychiatric drugs and modalities may be the final options for treating intractable subjects. Probiotics of multi-species preparations are safe and worth to be considered for the treatment. Antibiotics are promising but their long-term safety and effectiveness are unknown. Diet therapy including exclusion of certain food constituents is an economic measure. Using relatively safe complementary and alternative medicines (CAMs) may be optional to those patients who failed classical treatment. In conclusion, IBS is a heterogeneous disorder with multidimensional pathogeneses. Personalized medicines with multidisciplinary approaches using different classes of drugs, psychiatric measures, probiotics and antibiotics, dietary therapy, and finally CAMs, can be considered.
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El-Salhy M, Gundersen D, Gilja OH, Hatlebakk JG, Hausken T. Is irritable bowel syndrome an organic disorder? World J Gastroenterol 2014; 20:384-400. [PMID: 24574708 PMCID: PMC3923014 DOI: 10.3748/wjg.v20.i2.384] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/05/2013] [Accepted: 11/13/2013] [Indexed: 02/06/2023] Open
Abstract
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that is generally considered to be functional because there appears to be no associated anatomical defect. Stress and psychological factors are thought to play an important role in IBS. The gut neuroendocrine system (NES), which regulates all functions of the gastrointestinal tract, consists of endocrine cells that are scattered among the epithelial cells of the mucosa, and the enteric nervous system. Although it is capable of operating independently from the central nervous system (CNS), the gut NES is connected to and modulated by the CNS. This review presents evidence for the presence of an anatomical defect in IBS patients, namely in the gastrointestinal endocrine cells. These cells have specialized microvilli that project into the lumen and function as sensors for the luminal content and respond to luminal stimuli by releasing hormones into the lamina propria, which starts a chain reaction that progresses throughout the entire NES. The changes in the gastrointestinal endocrine cells observed in IBS patients are highly consistent with the other abnormalities reported in IBS patients, such as visceral hypersensitivity, dysmotility, and abnormal secretion.
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Seo AY, Kim N, Oh DH. Abdominal bloating: pathophysiology and treatment. J Neurogastroenterol Motil 2013; 19:433-53. [PMID: 24199004 PMCID: PMC3816178 DOI: 10.5056/jnm.2013.19.4.433] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 09/10/2013] [Accepted: 10/16/2013] [Indexed: 12/13/2022] Open
Abstract
Abdominal bloating is a very common and troublesome symptom of all ages, but it has not been fully understood to date. Bloating is usually associated with functional gastrointestinal disorders or organic diseases, but it may also appear alone. The pathophysiology of bloating remains ambiguous, although some evidences support the potential mechanisms, including gut hypersensitivity, impaired gas handling, altered gut microbiota, and abnormal abdominal-phrenic reflexes. Owing to the insufficient understanding of these mechanisms, the available therapeutic options are limited. However, medical treatment with some prokinetics, rifaximin, lubiprostone and linaclotide could be considered in the treatment of bloating. In addition, dietary intervention is important in relieving symptom in patients with bloating.
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Affiliation(s)
- A Young Seo
- Department of Internal Medicine, Seoul National University, Bundang Hospital, Seongnam, Gyeonggi-do, Korea
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Uehara R, Isomoto H, Minami H, Yamaguchi N, Ohnita K, Ichikawa T, Takeshima F, Shikuwa S, Nakao K. Characteristics of gastrointestinal symptoms and function following endoscopic submucosal dissection and treatment of the gastrointestinal symptoms using rikkunshito. Exp Ther Med 2013; 6:1083-1088. [PMID: 24223626 PMCID: PMC3820687 DOI: 10.3892/etm.2013.1299] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 08/07/2013] [Indexed: 12/15/2022] Open
Abstract
The aim of the present study was to investigate the gastrointestinal (GI) symptoms and gastric emptying following endoscopic submucosal dissection (ESD), as well as to evaluate a novel treatment strategy using rikkunshito, a traditional Japanese herbal medicine. GI symptoms and gastric emptying were evaluated 6–8 days after ESD as part of the Step I study. In the Step 1 study, the Gastrointestinal Symptom Rating Scale (GSRS) scores of the two groups after 4 and 8 weeks of treatment with either a proton pump inhibitor (PPI; PPI monotreatment group, n=5) or a PPI plus rikkunshito (PPI + rikkunshito group, n=8) were compared against baseline values. Abdominal pain and constipation occurred in the majority of patients after ESD. The mean T-max 6–8 days after gastric emptying was 75.4±13.6 min, which was significantly longer compared with that reported in healthy subjects (43.9±10.3 min). In the Step 2 study, the total GSRS score was significantly improved only in the PPI + rikkunshito group after 8 weeks of treatment. In conclusion, ESD affects gastric emptying and is associated with an increased incidence of upper GI symptoms such as abdominal pain and indigestion. Rikkunshito may be useful as a novel supporting therapeutic drug for the treatment of GI symptoms in patients who have undergone ESD.
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Affiliation(s)
- Ryohei Uehara
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
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Theoharides TC, Asadi S, Chen J, Huizinga JD. Irritable bowel syndrome and the elusive mast cells. Am J Gastroenterol 2012; 107:727-9. [PMID: 22552242 DOI: 10.1038/ajg.2012.61] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Irritable bowel syndrome (IBS) is the most common condition seen by gastroenterologists. It presents with alternating symptoms of bowel dysfunction that often worsens with stress. The cause of these symptoms eludes investigators and many attempts have been made to discover an underlying pathology. This is a daunting task since symptoms come and go, and change characteristics. Furthermore, the pathology of IBS is unlikely to be identical in all patients. In addition, all symptoms and all features studied thus far have a strong overlap with healthy volunteers. Elsewhere in this issue, Braak et al. report a well-designed clinical investigation in patients with IBS and come to the conclusion that IBS is not characterized by mast cell or other immune cell proliferation, but by immune dysregulation in the colon. Is this the final answer?
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Plasma hormones facilitated the hypermotility of the colon in a chronic stress rat model. PLoS One 2012; 7:e31774. [PMID: 22363728 PMCID: PMC3282740 DOI: 10.1371/journal.pone.0031774] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/18/2012] [Indexed: 01/12/2023] Open
Abstract
Objective To study the relationship between brain-gut peptides, gastrointestinal hormones and altered motility in a rat model of repetitive water avoidance stress (WAS), which mimics the irritable bowel syndrome (IBS). Methods Male Wistar rats were submitted daily to 1-h of water avoidance stress (WAS) or sham WAS (SWAS) for 10 consecutive days. Plasma hormones were determined using Enzyme Immunoassay Kits. Proximal colonic smooth muscle (PCSM) contractions were studied in an organ bath system. PCSM cells were isolated by enzymatic digestion and IKv and IBKca were recorded by the patch-clamp technique. Results The number of fecal pellets during 1 h of acute restraint stress and the plasma hormones levels of substance P (SP), thyrotropin-releasing hormone (TRH), motilin (MTL), and cholecystokinin (CCK) in WAS rats were significantly increased compared with SWAS rats, whereas vasoactive intestinal peptide (VIP), calcitonin gene-related peptide (CGRP) and corticotropin releasing hormone (CRH) in WAS rats were not significantly changed and peptide YY (PYY) in WAS rats was significantly decreased. Likewise, the amplitudes of spontaneous contractions of PCSM in WAS rats were significantly increased comparing with SWAS rats. The plasma of WAS rats (100 µl) decreased the amplitude of spontaneous contractions of controls. The IKv and IBKCa of PCSMs were significantly decreased in WAS rats compared with SWAS rats and the plasma of WAS rats (100 µl) increased the amplitude of IKv and IBKCa in normal rats. Conclusion These results suggest that WAS leads to changes of plasma hormones levels and to disordered myogenic colonic motility in the short term, but that the colon rapidly establishes a new equilibrium to maintain the normal baseline functioning.
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Kim ER, Rhee PL. How to interpret a functional or motility test - colon transit study. J Neurogastroenterol Motil 2012; 18:94-9. [PMID: 22323993 PMCID: PMC3271260 DOI: 10.5056/jnm.2012.18.1.94] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 12/30/2011] [Accepted: 12/30/2011] [Indexed: 12/20/2022] Open
Abstract
Measurement of colon transit time is the most basic and primary tool in evaluating disorders of colonic motility. In particular, it is helpful in pathologic diagnosis and for planning management in patients with constipation. Several techniques for measuring colon transit time currently exist. The standard measurement of colon transit time has been performed using radioopaque marker test. The radioopaque marker test is the most widely used method; it is simple to perform as well as being cost effective. But, this technique produces radiation exposure. Radionuclide scintigraphy and wireless motility capsules are other techniques used to measure colon transit time. In radionuclide scintigraphy, the transit of radioisotope is viewed by gamma camera; this approach has an advantage in that it uses minimal radiation and it allows a physiological assessment of gastrointestinal transit. Wireless motility capsules have been validated most recently, but this technique is not useful in Korea. This review presents the techniques used to measure colon transit time and the interpretations provided in different colon transit studies.
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Affiliation(s)
- Eun Ran Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chang FY, Lu CL, Luo JC, Chen TS, Chen MJ, Chang HJ. The evaluation of otilonium bromide treatment in asian patients with irritable bowel syndrome. J Neurogastroenterol Motil 2011; 17:402-10. [PMID: 22148110 PMCID: PMC3228981 DOI: 10.5056/jnm.2011.17.4.402] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 05/23/2011] [Accepted: 06/07/2011] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Antispasmodics including otilonium bromide (OB) are recommended to treat irritable bowel syndrome (IBS). However, reports about OB experience in Asia is sparse. The purpose of present study was to provide the efficacy of OB in treating Asian IBS patients. Methods Overall, 117 IBS patients meeting Rome II criteria were enrolled in an 8-week, double-blind, active-controlled and single center trial. Randomized participants received either OB 40 mg or mebeverine 100 mg 3 doses daily. The primary endpoints were to evaluate the net changes of abdominal pain/discomfort frequency score (APDFS) and safety profile, while the secondary endpoints were to assess the changes in abdominal pain/discomfort intensity, flatulence, abdominal bloating, satisfied stool frequency etc. Results Finally, 49 OB and 52 mebeverine subjects were eligible for efficacy analysis. Compared to baselines in per protocol populations, the reduced APDFSs in OB and mebeverine were 0.55 ± 1.20 (P = 0.011) and 0.37 ± 1.11 (P = 0.042), respectively, to show similarly reduced scores. The most reported side effects included dry mouth, nausea and dizziness. Besides, the improved APDFSs at 4th week visit, final alleviations in abdominal pain intensity, flatulence, abdominal bloating and satisfied stool frequency with global assessments filled by both patients and investigators were significantly achieved by both treatments, and OB was not inferior to mebeverine in treating these parameters. Conclusions In Orientals, OB is as effective as mebeverine for alleviating IBS symptoms in terms of abdominal pain, flatulence, abdominal bloating etc. However, obvious side effects are also observed. A large-scaled trial and post-marketing surveillance are recommended to confirm its efficacy and safety.
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Affiliation(s)
- Full-Young Chang
- Division of Gastroenterology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan.
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Chey WD, Maneerattaporn M, Saad R. Pharmacologic and complementary and alternative medicine therapies for irritable bowel syndrome. Gut Liver 2011; 5:253-66. [PMID: 21927652 PMCID: PMC3166664 DOI: 10.5009/gnl.2011.5.3.253] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 06/25/2011] [Indexed: 12/11/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort in association with altered bowel habits (diarrhea and/or constipation). Other gastrointestinal symptoms, such as bloating and flatulence, are also common. A variety of factors are believed to play a role in the development of IBS symptoms, including altered bowel motility, visceral hypersensitivity, psychosocial stressors, altered brain-gut interactions, immune activation/low grade inflammation, alterations in the gut microbiome, and genetic factors. In the absence of biomarkers that can distinguish between IBS subgroups on the basis of pathophysiology, treatment of this condition is predicated upon a patient's most bothersome symptoms. In clinical trials, effective therapies have only offered a therapeutic gain over placebos of 7-15%. Evidence based therapies for the global symptoms of constipation predominant IBS (IBS-C) include lubiprostone and tegaserod; evidence based therapies for the global symptoms of diarrhea predominant IBS (IBS-D) include the probiotic Bifidobacter infantis, the nonabsorbable antibiotic rifaximin, and alosetron. Additionally, there is persuasive evidence to suggest that selected antispasmodics and antidepressants are of benefit for the treatment of abdominal pain in IBS patients. Finally, several emerging therapies with novel mechanisms of action are in development. Complementary and alternative medicine therapies including probiotics, herbal therapies and acupuncture are gaining popularity among IBS sufferers, although concerns regarding manufacturing standards and the paucity of high quality efficacy and safety data remain.
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Affiliation(s)
- William D Chey
- Division of Gastroenterology, University of Michigan Health System, Ann Arbor, MI, USA
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36
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Saad RJ. Peripherally acting therapies for the treatment of irritable bowel syndrome. Gastroenterol Clin North Am 2011; 40:163-82. [PMID: 21333906 DOI: 10.1016/j.gtc.2010.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Gut-acting therapies are common therapies for irritable bowel syndrome (IBS). Most of these peripheral acting agents are primarily targeted at individual symptoms. The evidence supporting the use of these agents in IBS is largely anecdotal. Serotonergic agents and the chloride channel activator lubiprostone have shown efficacy in treating symptoms of IBS. The clinical evidence supporting the use of these agents is based on data from high-quality clinical trials. The use of serotonergic agents for IBS in the United States is limited to the 5-hydroxytryptamine-3 antagonist alosetron in the treatment of women with severe IBS with diarrhea refractory to traditional therapy.
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Affiliation(s)
- Richard J Saad
- Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, 1500 East Medical Center Drive, SPC 5362, Ann Arbor, MI 48109, USA.
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