A Comprehensive Review of Transaminitis and Irritable Bowel Syndrome.

Eyad Gadour,Rajaey Gadour,Zeinab Hassan

doi:10.7759/cureus.16583

Abstract

We observed in the literature that irritable bowel syndrome (IBS) may be linked to irregular parameters of the metabolic system (MS) and liver function. For that reason, we conducted this systematic review to comprehensively analyze the association of transaminitis (elevated alanine transaminase (ALT)) with IBS. This review was designed by following methods described in the Cochrane Handbook for Systematic Reviews of Interventions. Published peer-reviewed journal articles were included. Data were extracted based on study design, age, gender, author, date of publication or availability online, publication type, participants, gender (M/F), and types of IBS.Our electronic multiple databases yielded a total of 519 preliminary studies; we then removed duplicate studies and left with 326 studies. After reviewing the full text of these articles, a total of 83 studies were eliminated and lastly, three studies were selected for this systematic review for quantitative and qualitative analysis. All the enrolled subjects in included studies were diagnosed with IBS by the Rome II and III criteria and among these subjects, 50.4% had IBS-D, 13.8% had IBS-C, 30.3% had IBS-M, and 3.5% had IBS-U. The prevalence of elevated ALT with other liver enzymes (γ-GT levels and aspartate aminotransferase (AST)) in patients with irritable bowel syndrome whether their body mass index (BMI) was high or not (16.9% vs. 7.7%; p=0.015) and γ-GT (24.1% vs. 11.5%; p=0.037), Lee et al., 2016. The IBS-D subtype was seen more commonly in patients whose alcohol intake was significantly high however their study data showed no significant change in elevation of ALT. The upper limits normal values for serum liver enzymes were defined as 41 international per liter in males and 31 international units per liter in females for ALT. No significant relationships were observed between IBS status and elevated γ-GT (OR, 1.647; 95% CI, 0.784-3.461).The review study proposes a potential relation between elevated ALT levels, MS, and IBS, and this review might be the first review in IBS patients to observe the association of elevated ALT in the IBS population. Although further additional trials with a large sample size will be required to confirm these results. Furthermore, for assessing the efficacy of the manipulation of gut microbiota randomized controlled trials in a large population of IBS patients are needed to establish a causal-resultant relationship between IBS, MS, and liver damage.

Highlights

BackgroundIrritable bowel syndrome (IBS) is a chronic gastrointestinal tract disorder that is described as abdominal discomfort, alteration of bowel routine, and abdominal pain [1]
With the features of disordered defecation, irritable bowel syndrome (IBS) is associated with abdominal discomfort and pain, which has been recently defined by the Rome III criteria as a functional disorder of the GI tract [6]
While going through this phase of our systematic review, we carefully followed the guidelines of the PRISMA statement [16]

Summary

Introduction

Irritable bowel syndrome (IBS) is a chronic gastrointestinal tract disorder that is described as abdominal discomfort, alteration of bowel routine, and abdominal pain [1]. Several hypotheses proposed that gut permeability could be the reason for altered gut microbiota in the small intestine [7]. In their experimental study in animal models, Brenner and Schnabel demonstrated that the onset and development of nonalcoholic fatty liver disease could be caused by the contribution of intestinal microbiota’s translocation of microbial products and progression via a breakdown of the barrier in intestinal lining [8]. The pathogenesis of nonalcoholic fatty liver disease (NAFLD) is hypothesized as a probable reason for increased gut permeability [9]

Methods

Results

Conclusion