Gastrointestinal Symptoms and the Assessment of Diet in Shift Workers: A Systematic Scoping Review.

The COVID-19 Pandemic and Post-Infection Irritable Bowel Syndrome: What Lies Ahead for Gastroenterologists

Potential Long Coronavirus Disease 2019 Gastrointestinal Symptoms 6 Months After Coronavirus Infection Are Associated With Mental Health Symptoms

Understanding the Multidimensional Nature of Illness Severity as Measured by Patient-Reported Outcome Measures in Irritable Bowel Syndrome

Lower gastrointestinal (GI) symptoms are common among endurance athletes and can impair performance. Symptom characteristics are similar to irritable bowel syndrome (IBS). No previous research has examined IBS diagnosis (medically or by diagnostic criteria) within this population. The objectives of this study were to determine the prevalence of IBS among endurance athletes and examine their GI symptom management strategies. A previously validated, online questionnaire assessed IBS diagnosis, the meeting of IBS diagnostic criteria (Rome III or Manning), general GI symptoms, and symptom mitigation strategies of endurance athletes. The questionnaire was distributed to United States athletes completing a marathon, ultra-marathon, half-distance triathlon, or full-distance triathlon. Medically diagnosed IBS was reported by 2.8% of endurance athletes. The total prevalence of IBS (n = 430) was 9.8% (medical diagnosis and Rome III). Athletes with IBS experienced more frequent symptoms during exercise as well as at rest; however, only 47.6% had consulted a medical professional. Over 56% of athletes experienced at least 1 symptom sometimes, often, or always during training and competition and 18.6% had symptoms that sometimes or often interrupted/prevented training. Almost half (45.8%) of athletes and 80.0% of athletes with IBS reported trying nutritional modifications to help ease symptoms while 20.6% and 52.4% used over-the-counter medications, respectively. Novelty Most endurance athletes who suffer from IBS are undiagnosed, while even more experience GI symptoms but do not fit diagnostic criteria. Despite using various symptom management methods, endurance athletes are still experiencing symptoms and could potentially benefit from current IBS-mitigating strategies.

Objective The prevalence of functional gastrointestinal (FGI) symptoms and irritable bowel syndrome (IBS) is high in the society, but the etiology is mainly unknown. This population-based, cross-sectional study aimed to examine the associations between self-reported IBS or gastrointestinal (GI) symptoms within the past 2 weeks and concomitant diseases, drug consumption and family history of diseases. Material and methods Participants from the Malmö Offspring Study (MOS) answered a questionnaire about lifestyle habits, medical history and GI symptoms. Associations between self-reported IBS or GI symptoms and other diseases, drugs, and family history of diseases were calculated by logistic regression, adjusted for false discovery rate (FDR; q < 0.05). Results Of 2648 included patients, 316 had IBS and 459 had GI symptoms. There was an association between IBS and asthma (OR: 1.66; 95% confidence interval [CI]: 1.19–2.32; q = 0.018), and between IBS and using of prescription (OR: 1.44; 95% CI: 1.10–1.89; q = 0.028) and nonprescription drugs (OR: 1.92; 95% CI: 1.43–2.59; q < 0.001), specifically adrenergic beta-antagonists, antihistamines and hypnotics. Regarding family history, GI disease in the family (OR: 2.44; 95% CI: 1.78–3.35; q < 0.001) and the subgroups celiac disease, gastric ulcer, functional dyspepsia, IBS and reflux, as well as prostate cancer were associated with IBS, while GI diseases (OR: 2.56; 95% CI: 1.89–3.46; q < 0.001), joint diseases (OR: 1.61; 95% CI: 1.19–2.16; q = 0.009), and myocardial infarction (OR: 1.48; 95% CI: 1.09–2.99; q = 0.043) were associated with GI symptoms. Abdominal pain was the specific symptom with strongest associations. Conclusions IBS and GI symptoms were mainly associated with GI diseases in the family and drug consumption. To take a family and drug history is pertinent to all clinical history taking, irrespective of the symptomatology.

Stress has been implicated as contributing to the initiation and exacerbation of bowel and discomfort symptoms in patients with irritable bowel syndrome (IBS). To examine the relationships of daily self-reported stress to gastrointestinal (GI) and psychological distress symptoms both across women and within woman in a comparison group of women without IBS and among subgroups of women with IBS. Women with IBS (n = 181; age = 18-49 years) who were divided into subgroups based on bowel pattern (constipation, n = 52; diarrhea, n = 67; alternating, n = 62) were compared to a group of women without IBS (n = 48). Self-report stress measures; abdominal (abdominal pain, bloating, and intestinal gas), bowel pattern (constipation, diarrhea), and intestinal gas; and psychological (anxiety and depression) distress symptoms were obtained daily over 1 month. Across-women and within-woman analyses were used. There were significant across-women correlations among mean daily stress, psychological distress, and GI symptoms in the total IBS group and the IBS bowel pattern subgroups. The across-women relationships between daily stress and GI symptoms were diminished when anxiety and depression were controlled in the analyses. Within-woman analyses showed little evidence of relationship between day-to-day variations in stress and day-to-day variations in GI symptoms; however, stress was strongly related to anxiety and depression. Gastrointestinal symptom distress is associated with self-reported stress in women with IBS. Psychological distress moderates the effects of stress on GI symptoms. The IBS treatment protocols that incorporate strategies that decrease stress and psychological distress are likely to reduce GI symptoms.

Prevalence and Socioeconomic Impact of Upper Gastrointestinal Disorders in the United States: Results of the US Upper Gastrointestinal Study

Does Consuming the Recommend Daily Level of Fiber Prevent Crohn's Disease?

Heavy alcohol intake may exacerbate gastrointestinal (GI) symptoms in adults with irritable bowel syndrome (IBS); however, the role of alcohol in IBS is unclear. We investigated prospective associations between daily patterns of alcohol intake and next day's GI symptoms using daily diaries. In an observational study of women aged 18-48 years with IBS and healthy controls, participants recorded daily GI symptoms, alcohol intake, caffeine intake, and cigarette smoking for ≈ 1 month. GI symptoms included abdominal pain, abdominal bloating, intestinal gas, diarrhea, constipation, nausea, stomach pain, heartburn, and indigestion. Binge drinking was defined as 4+ alcohol-containing drinks/day. Patterns of alcohol intake did not differ between IBS patients and controls. Although patterns of drinking were associated with GI symptoms among women with IBS, this was not the case with the healthy controls. The strongest associations for IBS patients were between binge drinking and the next day's GI symptoms (e.g., diarrhea, P=0.006; nausea, P=0.01; stomach pain, P=0.009; and indigestion, P=0.004), whereas moderate and light drinking either were not associated or weakly associated with GI symptoms. Associations between alcohol intake and GI symptoms were stronger for women with IBS-diarrhea than for IBS-constipation or IBS-mixed. Effects of binge drinking on GI symptoms were strongest when comparing between individuals (rather than within individuals). Our findings indicate that IBS symptoms differ according to the pattern of alcohol intake among IBS patients, suggesting that the pattern of drinking may in part explain the inconsistent findings between alcohol and IBS symptoms.

Gastrointestinal (GI) issues are known to be common among endurance athletes and can impair performance in training and competition. Symptom characteristics, particularly those of the lower GI, are similar to irritable bowel syndrome (IBS). No previous research has examined IBS diagnosis or fit to IBS diagnostic criteria within this population. PURPOSE: To determine the prevalence of IBS among endurance athletes as well as their GI symptom management strategies. METHODS: A 92-item online questionnaire was previously validated for the purpose of assessing IBS diagnosis, fit to IBS diagnostic criteria (Rome III or Manning), general GI symptoms, and symptom mitigation strategies of endurance athletes. The questionnaire was distributed between December 2015 and October 2016 to the athletes in the U.S. completing a marathon, ultra-marathon, half-distance triathlon, or full-distance triathlon within that calendar year. RESULTS: The total prevalence of irritable bowel syndrome among 321 endurance athletes who completed the questionnaire was between 9.0% to 22.1% (medically diagnosed: 1.6%; undiagnosed but meeting the diagnostic criteria: 7.5% fitting Rome III criteria or 20.6% fitting 3 2 Manning criteria). Significantly more IBS sufferers were undiagnosed (p=.007 or <.001 for Rome III and Manning, respectively). Only 10.9% of athletes reported seeing a medical professional due to GI issues, while 17.1% had issues which sometimes or often interrupted or prevented their training. Additionally, 65.7% experienced at least one lower GI symptom at a frequency of sometimes or more during training. Almost half (46.7%) of the athletes tried nutritional modifications to help ease their symptoms and 19.0% used over-the-counter medications. CONCLUSION: Most endurance athletes that may suffer from IBS are undiagnosed, while even more have GI issues but do not fit IBS diagnostic criteria. The overall prevalence may be greater than that seen in the general population and the percent diagnosed may be lower among endurance athletes. Despite using various methods to manage their symptoms, endurance athletes are still experiencing issues and could potentially benefit from current IBS-mitigating strategies. Supported by University of Illinois Nutritional Science Margin of Excellence Research and Vision 20/20 Awards.

Redux: Do Little Bellyachers Grow up to Become Big Bellyachers?

Inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are chronic gastrointestinal (GI) syndromes in which both GI and psychological symptoms have been shown to negatively impact health-related quality of life (HRQOL). The objective of this study was to use structural equation modeling (SEM) to characterize the interrelationships among HRQOL, GI, and psychological symptoms to improve our understanding of the illness processes in both conditions. Study participants included 564 Rome positive IBS patients and 126 IBD patients diagnosed via endoscopic and/or tissue confirmation. All patients completed questionnaires to assess bowel symptoms, psychological symptoms (SCL-90R), and HRQOL (SF-36). SEM with its two components of confirmatory analyses and structural modeling were applied to determine the relationships between GI and psychological symptoms and HRQOL within the IBS and IBD groups. For both IBD and IBS, psychological distress was found to have a stronger direct effect on HRQOL (-0.51 and -0.48 for IBS and IBD, respectively) than GI symptoms (-0.25 and -0.28). The impact of GI symptoms on psychological distress was stronger in IBD compared with IBS (0.43 vs. 0.22; P<0.05). The indirect effect of GI symptoms on HRQOL operating through psychological distress was significantly higher in IBD than IBS (-0.21 vs. -0.11; P<0.05). Psychological distress is less dependent on GI symptom severity in IBS compared with IBD even though the degree that psychological distress impacts HRQOL is similar. The findings emphasize the importance of addressing psychological symptoms in both syndromes.

Objective Functional gastrointestinal (GI) symptoms can develop into persistent states often categorised as the irritable bowel syndrome (IBS). In the severe end of the GI symptom continuum, other coexisting symptoms are common. We aimed to investigate the GI symptom continuum in relation to mortality and development of GI diseases, and to examine if coexisting symptoms had an influence on the outcomes. Material and methods A longitudinal population-based study comprising two 5-year follow-up studies: Dan-Monica1 (1982–1987) and Inter99 (1999–2004). IBS was defined according to a population-based IBS definition. The pooled cohort (n = 7278) was followed until December 2013 in Central Registries. Results Fifty-one percent had no GI symptoms, 39% had GI symptoms but never fulfilled the IBS definition, 8% had fluctuating IBS and 2% had persisting IBS. There was no significant association between symptom groups and mortality (p = 0.47). IBS and GI symptoms with abdominal pain were significantly associated with development of GI diseases. Only GI symptoms with abdominal pain were associated with development of severe GI diseases (HR: 1.38; 95% CI: [1.06–1.79]). There were no statistically significant interactions between symptom groups and coexisting symptoms in relation to the two outcomes. Conclusions GI diseases were seen more frequently, but IBS was not associated with severe GI diseases or increased mortality. Clinicians should be more aware when patients do not fulfil the IBS definition, but continue to report frequent abdominal pain. Coexisting symptoms did not influence mortality and development of GI diseases.

Association of Habitual Dietary Fiber Intake and Fecal Microbiome Gene Abundance with Gastrointestinal Symptoms in an Irritable Bowel Syndrome Cohort

Irritable bowel syndrome (IBS) reduces health-related quality of life (HRQOL). It is unclear how having IBS modifies the impact of gastrointestinal (GI), psychosocial, and somatic symptom variables on HRQOL compared with healthy controls (HCs). (1) Determine psychosocial, somatic, and physical status variables most predictive of HRQOL in IBS and HCs and (2) determine if IBS status modifies relationships between predictive factors and HRQOL. IBS patients and HCs completed validated questionnaires measuring GI symptoms, psychosocial/somatic variables, and physical [physical component score (PCS)] and mental [mental component score (MCS)] HRQOL via the Short-Form-36. Associations between these variables and HRQOL were evaluated with multiple linear regressions. Variables were standardized to determine the strongest predictors of HRQOL. Statistical significance level was 0.01. Mean HRQOL was higher in 417 HCs versus 290 IBS subjects (PCS: 55.6 vs. 48.6, P<0.001; MCS: 53.7 vs. 44.8, P<0.001). The GI symptom measures were negatively associated with PCS in IBS, but only usual severity was associated with MCS (P<0.01). In all subjects, psychosocial and somatic measures were associated with MCS and not PCS excluding GI symptom anxiety, which correlated with both (P<0.01). The strongest predictor of MCS was perceived stress in IBS and depression symptoms in HCs. GI symptom anxiety was the strongest predictor of PCS in both. Greater perceived stress and somatic symptom severity and less mindfulness was linked to larger reductions in HRQOL for IBS compared with HCs (P<0.01). GI symptom severity and anxiety correlate with PCS, whereas psychosocial/somatic measures parallel MCS. However, HRQOL is comparable in IBS and HCs when perceived stress, somatic symptom severity, and mindfulness are at optimal levels. These findings may have important implications in the management of IBS.