Probiophage: A Novel Candidate for the Treatment of Irritable Bowel Disease (IBD): A Systematic Review

Introduction Inflammatory bowel disease (IBD) is a chronic gastrointestinal disease caused by an aberrant immune response in the gut. Irritable bowel syndrome (IBS) is a common disease that may be confused with IBD. Faecal calprotectin concentration is the current recommended biomarker to rule out IBD, but there are no tests to positively diagnose IBS. Consequently, expensive and invasive methods involving colonoscopy and biopsy are still used by many clinicians to rule out other pathologies. Here, we propose a platform for accurately diagnose IBD and IBS based on faecal samples. Method The platform is composed of a gas chromatography coupled to a metal oxide gas sensor (OdoReader) and a computer algorithm. The OdoReader separates the volatile organic compounds (VOCs) present in biological samples, while the computer algorithm identifies resistance patterns associated with specific medical conditions and builds mathematical models to classify unknown samples. This platform was applied to faecal samples collected from 98 patients attending the gastroenterology clinic: 45 patients with active IBD; 24 patients with diarrhoea-predominant IBS; and 29 healthy donors (Control). The following comparisons were performed: IBD vs. IBS; IBD vs. Control; IBS vs. Control; IBD vs. non-IBD (IBS + Control); IBS vs. non-IBS (IBD + Control); Control vs. non-Control (IBD + IBS). The mathematical models developed were validated through rigorous validation schemes namely 10-Fold Cross Validation, Double Cross Validation and their Monte Carlo variations. Results Conclusion This is the first description of an investigation for the positive diagnosis of IBS. The platform presented here classified samples with accuracies from 85% to 94% using rigorous validation schemes. These schemes provide an estimate of out-of-sample predictive accuracy for similar populations. Therefore, the results reported here indicate a successful differentiation of biological samples from patients with IBD, IBS and healthy donors. These results also indicate a better performance than calprotectin alone for diagnosing IBD, which has been reported as 85% before the application of validation schemes. This platform could be used at point of care for non-invasive diagnosis of IBS and IBD. Disclosure of interest None Declared.

IntroductionInflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) are lifelong digestive diseases that severely impact patients’ quality of life. The existence of a causal association between IBS and IBD remains unclear. This study aimed to determine the direction of causality between IBD and IBS by quantifying their genome-wide genetic associations and performing bidirectional two-sample Mendelian randomization (MR) analyses.MethodsGenome-wide association studies (GWAS) among a predominantly European patient cohort identified independent genetic variants associated with IBS and IBD. Two separate databases (a large GWAS meta-analysis and the FinnGen cohort) for both IBS and IBD were consulted to retrieve statistics on instrument-outcome associations. MR analyses included inverse-variance-weighted, weighted-median, MR-Egger regression, MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) methods, and sensitivity analyses were performed. The MR analyses were carried out for each outcome data, followed by a fixed-effect meta-analysis.ResultsGenetically predicted IBD was associated with an increased risk of IBS. Odds ratios (95% confidence intervals) for samples of 211,551 (17,302 individuals with IBD), 192,789 (7,476 Crohn’s disease cases), and 201,143 (10,293 ulcerative colitis cases) individuals were 1.20 (1.00, 1.04), 1.02 (1.01, 1.03), and 1.01 (0.99, 1.03), respectively. After outlier correction using MR-PRESSO, the odds ratio for ulcerative colitis was 1.03 (1.02, 1.05) (p = 0.001). However, an association between genetically influenced IBS and IBD was not identified.DiscussionThis study confirms that IBD is causally related to IBS, which may interfere with the diagnosis and treatment of both diseases.

Inflammatory Bowel Disease and Pregnancy

Manipulation of the Microbiota for Treatment of IBS and IBD—Challenges and Controversies

Dyspepsia and Irritable Bowel Syndrome After a Salmonella Gastroenteritis Outbreak: One-Year Follow-up Cohort Study

Bugs, Stool, and the Irritable Bowel Syndrome: Too Much Is as Bad as Too Little?

Introduction Inflammatory bowel disease (IBD) patients in apparent clinical remission who present with irritable bowel syndrome (IBS)-like symptoms pose a diagnostic and therapeutic dilemma that is called post-IBD IBS. When associated with a diarrheal IBS presentation, this clinical syndrome is known as post-IBD IBS-D. Areas covered We review and describe the literature regarding the clinical overlap of IBD and IBS. We discuss prevalent theories regarding the pathophysiology of post-IBD IBS-D and whether this presentation represents coincident inherent IBS-D, IBS-D triggered by IBD, or an even more subtle level of IBD activity that is unrecognized by available laboratory modalities. We also discuss observations that post-IBD IBS-D patients harbor significantly increased colon mucosal eosinophils and appear to respond to a GI-hypoallergenic diet and budesonide therapy. Expert opinion The symptoms overlap between IBD and IBS complicates diagnosis and subsequent management of patients with post-IBD IBS-D. In addition to current theories regarding the pathophysiology of this condition such as alterations in mucosal inflammation, the microbiota, mucosal permeability, and gut–brain interactions. This new avenue of eosinophilic colopathy and therapy directed toward food-derived immune response in patients with post-IBD IBS-D deserves additional investigation.

A Gastroenterologist's Guide to Probiotics

Unnecessary abdominal and back surgery in irritable bowel syndrome: time to stem the flood now?

Introduction Inflammatory Bowel Disease (IBD) typically affects patients during their child-bearing years. With the progress and development of newer IBD treatments patients are increasingly likely to consider having children. The aim of this study was to determine the outcomes of pregnancy in female IBD patients. Method Female IBD patients were recruited from 5 different centres in Europe. These patients were interviewed through a prospective questionnaire. Results 233 patients were recruited (mean age 40; SD±11.9). The mean age at diagnosis was 31.4 years (SD±11.2). 85.5% patients had ulcerative colitis (UC). 224 pregnancies were recorded. 26.6% had one pregnancy. 17.2% were pregnant twice, 6.44% were pregnant three times and 1.72% reported 4 pregnancies. 63.8% patients became pregnant before the diagnosis of IBD. A younger age at IBD diagnosis was associated with a higher number of pregnancies (p 1.7% of patients stopped medications on their own accord during pregnancy. Medications were stopped by the doctor in 13.9% (biologic agents in the 3 rd trimester (2.7%), 5-ASA (9.4%), methotrexate (0.9%), prednisolone (0.9%)). Additional medications were used in 3.9% of pregnancies. There were 0.96 live-births/woman recorded. 54.0% of pregnancies were unplanned, with a higher rate in those who were pregnant after being diagnosed with IBD (p An IBD exacerbation was reported by 9% of patients during pregnancy. Delivery was by caesarian section in 30.8% and by vaginal delivery in 69.2%. Mode of delivery was influenced by the underlying IBD in 12.0%. Delivery was uncomplicated in the majority of patients (92.0%) with most deliveries between 38 and 40 weeks gestation (81.6%). Mean birth weight was 3.34kg (1.90–4.70kg; SD±0.395). Most newborns (94.6%) were healthy. Other outcomes reported: (1) 0.44% had congenital anomalies (0.44%); (2) 1.34% suffered from developmental delay; (3) 1.75% had low birth weight; (4) 0.89% were born prematurely. One patient (0.44%) suffered a stillbirth. There were no correlations between the use of disease modifying drugs and neonatal adverse outcomes. 29 miscarriages were reported. Only 54.4% of IBD patients breastfed their infants which is less than expected compared to healthy non-IBD pregnancies. Conclusion Pregnancy outcomes appear to be favourable in IBD compared to European data on non IBD patients. Although there are improvements in the treatment of IBD there still remains a lower birth rate and breast-feeding rate amongst IBD patients when compared to non IBD European data. Disclosure of interest None Declared.

5-hydroxytryptamine, ulcerative colitis, and irritable bowel syndrome: molecular connections

Trend in incidence of inflammatory bowel diseases in Korea using National Health Insurance database, 2004–2015

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

Immune Activation in Patients With Irritable Bowel Syndrome

Methods of Determining Irritable Bowel Syndrome and Efficiency of Probiotics in Treatment: A Review