Bowel Syndrome Symptom Severity Scale Research Articles

Psychiatric Co-Morbidities and Profile of Patients with Irritable Bowel Syndrome in Northern India.

To study sociodemographic and clinical variables, including psychiatric co-morbidities, in patients with irritable bowel syndrome. A total of 158 patients attending a medical gastroenterology clinic in a tertiary care center in Northern India were screened, from whom 100 were selected for the study. Rome IV criteria were used to diagnose IBS, and the severity of symptoms was assessed by the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS). Psychiatric co-morbidities were screened via clinical evaluation, and if present, a diagnosis was made as per DSM-5. The Depression, Anxiety, and Stress Scale-21 (DASS-21) and Somatic Symptom Scale-8 (SSS-8) were used to assess depression, anxiety, stress, and somatic symptoms. The mean age of cases was 35.6 years' old, and the majority of cases (i.e., 38.0%) were between 18 and 29 years' old. Males comprised 62.0% of the sample and females 38.0%. Moderate IBS was present in 61.0% of the cases. Evaluation via DASS-21 revealed that 53.0% were in the moderate category of depression, 43.0% had moderate anxiety, and 36.0% had moderate stress. The somatic symptom scale revealed that 48.0% patients were in the high category. Psychiatric co-morbidities were present in 29.0% of cases. Depressive disorders were the most common psychiatric co-morbidity. Patients with IBS presenting to a tertiary care center in Northern India were primarily young males living in semi-urban areas who belonged to the Hindu religion, were married, and had a nuclear family. Patients with IBS commonly have associated psychiatric disorders; anxiety disorders and depression are most common.

Gastric dysmotility and gastrointestinal symptoms in myalgic encephalomyelitis/chronic fatigue syndrome

Background Gastrointestinal symptoms are common in ME/CFS, but there is a knowledge gap in the literature concerning gastrointestinal motility features and detailed symptom description. Objective In this study, we aimed to characterize gastric motility and gastric symptoms in response to a liquid meal. Methods We included 20 patients with ME/CFS with abdominal complaints who were recruited to a double-blind randomized placebo-controlled trial of Rituximab. The patients of this sub study were examined with an ultrasound drink test, and gastrointestinal symptoms were evaluated using the Rome III questionnaire and Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS) questionnaire. Results We found that patients commonly reported fullness/bloating (75%), abdominal pain (45%) and nausea (35%). Ultrasound measurements revealed lower proximal measurements of the stomach after a meal (p < 0.01) and larger fasting antral area (p = 0.019) compared to healthy controls. The patients had a stronger symptomatic response to the liquid meal compared to healthy controls regarding epigastric pain, discomfort and nausea (p < 0.05). Ninety percent of the patients reported bowel movement frequencies within the normal range but scored high on bowel habit dissatisfaction and life disruption. Conclusion The patients presented with fullness/bloating, nausea and epigastric pain, showed signs of impaired gastric accommodation and visceral hypersensitivity, showing that the gastrointestinal symptoms of ME/CFS patients are similar to functional dyspepsia. Key summary Gastrointestinal symptoms are common in ME/CFS, but there is a knowledge gap in the literature concerning gastrointestinal motility features and detailed symptom description. • In this study, patients with ME/CFS had signs of impaired gastric accommodation after a liquid meal. • Out of 20 patients, 15 patients reported fullness/bloating, 9 reported abdominal pain, and 7 reported nausea. The patients showed signs of visceral hypersensitivity on a drink test. • Our findings suggest that patients with ME/CFS share many similarities with patients with Functional Dyspepsia. The findings were not typical for Irritable Bowel Syndrome.

P076 Abdominal pain severity for IBD in remission correlates with genetic clustering and enzymatic activity of faeces-derived Candida albicans strains

Abstract Background Abdominal pain is a common occurrence for approximately 39% of patients with inflammatory bowel diseases in remission (quiescent IBD; qIBD). There is increasing evidence for a contributing role of the gastrointestinal fungal community (i.e., mycobiome) in relation to intestinal inflammation and irritable bowel syndrome (IBS). As such, abundance of Candida spp. and sub-species variation of Candida albicans were previously associated with IBD severity. In the current study, we aim to investigate mycobiome of patients with qIBD and qIBD with abdominal pain (qIBD–AP). Methods Patients with qIBD (defined as faecal calprotectin (FCP) ≤250 μg/g) with (n=91) or without (n=58) abdominal pain provided faecal samples. Abdominal pain was scored based on either the Irritable Bowel Syndrome Symptom Severity Scale (IBS–SSS) or Gastrointestinal Symptom Rating Score (GSRS) questionnaire. Faecal fungal communities were determined based on Internal Transcribed Spacer 1 (ITS1) sequencing. Cultivable yeasts from faecal samples were identified using Matrix Assisted Laser Deionization Time–of–Flight Mass Spectrometry. C. albicans strains (n=137 from 29 patients) were genotyped by ITS Sanger sequencing analysis and typing of seven microsatellite loci. Release of virulence-related enzymes (proteinase, phospholipase, lipase, esterase) by C. albicans was assessed through determination of precipitation zones on solid agar mediums containing enzyme-specific substrates. Results Descriptive mycobiota analysis revealed limited differences between compositions of qIBD and qIBD–AP patients, but a discriminative signature for abdominal pain was extracted using machine-based learning models. While ITS Sanger sequencing of faeces-derived C. albicans was insufficient to elucidate genetic variability, analysis of microsatellite loci revealed extensive variability and clustering into six clone clusters and a likely distinction between qIBD and qIBD-AP patients (Fig. 1). Phospholipase enzymatic activity of C. albicans strains correlated with GSRS–Abdominal Pain sub-score, as did proteinase activity with severity of abdominal pain according to the IBS–SSS (Fig. 2). Additionally, lipase activity inversely correlated with faecal calprotectin (Fig. 2). Conclusion The faecal gut mycobiome is associated with self–reported abdominal pain in patients with IBD in remission. This notion is based on both compositional and culture-dependent methods and specified clones of C. albicans may selectively contribute to abdominal pain for qIBD patients. This study opens further possibilities to investigate the role of faecal gut fungi in light of abdominal pain for qIBD-AP patients.

Psychometric properties of Persian version of irritable bowel syndrome- behavioral responses questionnaire (IBS-BRQ).

This study aimed to determine the psychometric properties of Persian version of Irritable Bowel Syndrome-Behavioral Responses Questionnaire (IBS-BRQ). In addition to somatic symptoms and complaints, patients with irritable bowel syndrome have specific dysfunctional behaviors that lead to disease persistence and functional disturbance. Participants included 170 patients with irritable bowel syndrome, who were diagnosed based on ROM-IV criteria and selected from patients referring to the Gastrointestinal Disorders Clinic, as well as 100 persons from the general population in Isfahan in 2020. Both groups completed the 26-item Irritable Bowel Syndrome-Behavioral Responses Questionnaire (IBS-BRQ). Also, questionnaires including the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS), Irritable Bowel Syndrome-Quality of Life IBS-QOL, Illness Perception Questionnaire (IPQ-R), Irritable Bowel Syndrome-Patient Satisfaction (IBS-SAT), Hope Scale, Interpersonal Forgiveness Inventory (IFI), and Dysfunctional Attitude Scale- 26-item (DAS-26) were completed to determine the validity of IBS-BRQ. Tests of internal consistency, principal components analyses (PCAs), differentiation analysis, and correlation were used to determine its reliability, along with criterion and construct validity. IBS-BRQ was valid and reliable in both groups with a high degree of internal consistency. Cronbach's alpha was obtained in the sample of patients with IBS and the total sample of participants 0.87 and 0.95 respectively. This scale differentiated significantly between IBS patients and non-patients (p<.001). The criterion validity was high as evidenced by a high correlation with DAS-26 (r=0.53, p<0.001), IBS-QOL (r=0.76, p<0.001), IBS-SSS (r=0.44, p<0.001), IPQ-R (r=0.56, p<0.001), and reverse correlation with IFI (r=-0.031, p<0.001), IBS-SAT (r=-0.23, p<0.001), and HOPE (r=-0.49, p<0.001). The Persian version of the IBS-BRQ proved to be a well-defined behavioral response measure in IBS patients with high validity and reliability, making it a suitable measure to be used in future IBS clinical research in Iran.

Development and Validation of the Gastrointestinal Unhelpful Thinking Scale (GUTs): A Brief Self-Report Measure for Clinical and Research Settings.

This article describes the development and validation of the Gastrointestinal Unhelpful Thinking scale. The purpose of the research was to develop the Gastrointestinal Unhelpful Thinking scale to assess in tandem the primary cognitive-affective drivers of brain-gut dysregulation, gastrointestinal-specific visceral anxiety, and pain catastrophizing. The research involved 3 phases which included undergraduate and community samples. In the first phase, an exploratory factor analysis revealed a 15-item 2-factor (visceral sensitivity and pain catastrophizing) scale (N= 323), which then was confirmed in the second phase: N = 399, χ2(26) = 2.08, p = .001, Tucker-Lewis Index = 0.94, comparative fit index = 0.96, standardized root mean square residual = 0.05, and root mean square error of approximation = 0.07. Demonstrating convergent validity, Gastrointestinal Unhelpful Thinking scale total and subscales were strongly correlated with the modified Manitoba Index, Irritable Bowel Syndrome Symptom Severity Scale scores, Visceral Sensitivity Index, and the Pain Catastrophizing Scale. A third phase (N = 16) established test-retest reliability for the Gastrointestinal Unhelpful Thinking scale (total and subscales). The test-retest reliability correlation coefficient for the Gastrointestinal Unhelpful Thinking scale total score was .93 (p < .001) and for the subscales was .86 (p < .001) and .94 (p < .001), respectively. The Gastrointestinal Unhelpful Thinking scale is a brief psychometrically valid measure of visceral anxiety and pain catastrophizing that can be useful for both clinicians and researchers who wish to measure these thinking patterns and relate them to changes in gastrointestinal and psychological symptoms.

Serum zonulin is elevated in IBS and correlates with stool frequency in IBS-D.

Studies have shown increased intestinal permeability in irritable bowel syndrome. Validating serum biomarkers for altered intestinal permeability in irritable bowel syndrome will facilitate research and pathophysiology-based therapy. To measure serum zonulin and intestinal fatty acid binding protein levels in diarrhea-predominant irritable bowel syndrome and constipation-predominant irritable bowel syndrome and compare with healthy controls and celiac disease. Serum zonulin and intestinal fatty acid binding protein levels were measured using enzyme-linked immunosorbent assays in constipation-predominant irritable bowel syndrome (n = 50), diarrhea-predominant irritable bowel syndrome (n = 50), celiac disease (n = 53) and healthy controls (n = 42). Irritable bowel syndrome symptom severity was measured using the irritable bowel syndrome-symptom severity scale. Patients with constipation-predominant irritable bowel syndrome and diarrhea-predominant irritable bowel syndrome had higher zonulin levels compared with healthy controls (p = 0.006 and 0.009 respectively), which was comparable to those with active celiac disease. Although zonulin levels did not correlate with the overall irritable bowel syndrome symptom severity scale, it positively correlated with stool frequency per week (p = 0.03) and dissatisfaction with bowel habits (p = 0.007) in diarrhea-predominant irritable bowel syndrome. Patients with diarrhea-predominant irritable bowel syndrome and constipation-predominant irritable bowel syndrome had lower intestinal fatty acid binding protein levels compared with celiac patients (p = 0.005 and p = 0.047 respectively). Serum zonulin is upregulated in irritable bowel syndrome and the levels are comparable to those in celiac disease. Zonulin levels correlated with severity of bowel habits in diarrhea-predominant irritable bowel syndrome. Intestinal fatty acid binding protein levels in irritable bowel syndrome patients were not increased suggesting no significant increase in enterocyte death.

Influence of Rome IV diagnostic criteria on patients with irritable bowel syndrome

Objective To investigate the improvement of symptoms of the patients after treatment in patients with Rome Ⅳ or non-Rome Ⅳ irritable bowel syndrome (IBS), and to explore the influence of IBS diagnosed by different criteria on the patients. Methods From June 2nd to 8th in 2016, at Outpatients Department of Gastroenterology, Union Hospital Affiliated to Tongji Medical College, Huazhong Uiversity of Science and Technology in Wuhan, 1 500 outpatients aged over 18 years old and with intestinal symptom were selected for questionnaire. After treatment for six months, IBS patients, non-IBS patients, patients with Rome Ⅳ IBS and patients with non-Rome Ⅳ IBS were followed up by phone calls. After treatment, the improvement of symptoms of the patients was evaluated by irritable bowel syndrome symptom severity scale (IBS-SSS). The degree of influence of IBS diagnosed with different criteria on patients was evaluated by the patient′s daily work whether to choose colonoscopy examination, whether to choose medication, and the efficacy of medicine. Student′s t test, Mann-Whitney U test and chi-square test were performed for statistical analysis. Results A total of 352 patients with intestinal symptoms were followed-up, including 175 patients with IBS (84 patients with Rome Ⅳ IBS and 91 patients with non-Rome Ⅳ IBS) and 177 non-IBS patients, and 142 patients responded. There were no statistically significant differences in response rate between non-IBS patients and IBS patients (37.3%, 66/177 vs. 43.4%, 76/175), and between patients with Rome Ⅳ IBS and patients with non-Rome Ⅳ IBS (40.5%, 34/84 vs. 46.2%, 42/91) (χ2=1.379 and 0.573, P=0.240 and 0.449). Compared with the non-IBS patients, the degree of satisfaction of medicine was lower in IBS patients (71.4%, 30/42 vs. 47.5%, 19/40). Compared with non-Rome Ⅳ IBS patients, Rome type Ⅳ IBS patients were more likely to receive colonoscopy (35.7%, 15/42 vs. 58.8%, 20/34), and the differences were statistically significant (χ2=4.878 and 4.039, P=0.027 and 0.044). After six months of treatment, symptoms improved in both Rome Ⅳ IBS patients and non-Rome Ⅳ IBS patients (both P<0.05), however, the symptoms improved more significantly in Rome Ⅳ IBS patients and the total score of IBS-SSS was lower than that of non-Rome Ⅳ IBS patients (-130, -185 to 60 vs. -70, -100 to 28), and the difference was statistically significant (Z=-3.065, P=0.002). The difference was mainly showed the symptom of abdominal pain, and the IBS-SSS abdominal pain score of Rome Ⅳ IBS patients was lower than that of non-Rome Ⅳ IBS patients (-80, -100 to -40 vs. 0, -40 to 0), and the difference was statistically significant (Z=-4.631, P<0.01). Conclusions IBS symptoms influence a lot on the satisfaction degree of treatment in outpatients. Even with similar good therapeutic effects, the Rome Ⅳ IBS symptoms have a more severe impact on patients than non-Rome Ⅳ IBS symptoms. Key words: Irritable bowel syndrome; Diagnosis; Rome type Ⅳ; Treatment response

34 An investigation of gastrointestinal symptoms, psychological well-being and cognitive performance in informal dementia caregivers

Background Caring for a relative with dementia is considered particularly stressful and is associated with numerous adverse health effects at multiple levels of the brain-gut axis. There is also evidence that long-term family caregivers are more likely to develop irritable bowel syndrome. Aim The current study aimed to compare family dementia caregivers to a non-caregiver control group, and to examine the impact of interventions, designed to help dementia caregivers manage stress and the caregiving role, on gastrointestinal symptoms, cognitive performance and psychological well-being. Method Caregiver participants were recruited via clinics at St. Finbarr’s Hospital, Cork and control participants via the university community. Participants completed the irritable bowel syndrome symptom severity scale, as well as validated tests of stress, anxiety, and depression. Participants also completed cognitive tasks from the CANTAB battery. A subset of caregivers completed both a carer training program and mindfulness-based stress reduction program. Each program was delivered in a group setting by an experienced instructor and lasted 6-8 weeks. Results Although caregivers had higher levels of stress and poorer cognitive performance, gastrointestinal symptoms were not altered compared to controls. Following both interventions, caregivers had improved cognitive performance. However, reported stress, anxiety and depression were not significantly altered following the interventions. Stress-reduction interventions also had no significant impact on gastrointestinal function. Conclusions The stress associated with informal dementia caregivers does not manifest across gastrointestinal symptoms and stress-reduction techniques do not improve gastrointestinal well-being. This is in contrast to the impact of caregiving at higher levels of the brain-gut axis.