Clinical Symptoms Of Irritable Bowel Syndrome Research Articles

Новые подходы к ведению пациентов с синдромом раздраженного кишечника

Aim: to evaluate the efficacy and safety of Kolofort® in the treatment of patients with moderate to mild irritable bowel syndrome (IBS). Patients and Methods: an open cohort prospective placebo-controlled study was conducted with the inclusion of 30 patients (average age 30.7±7.8 years) with an established diagnosis of IBS. The control group consisted of 10 healthy subjects. Kolofort® was prescribed for a course of 12 weeks, 2 tablets 2 times a day. All patients were evaluated before and after the therapy course for the main clinical symptoms of IBS, as well as the severity of anxiety and depression, the level of specific anxiety regarding GIT symptoms and life quality. Cortisol levels in the morning and evening portions of saliva were determined in healthy subjects and patients with IBS. Results: initially, patients with IBS had a high level of anxiety and depression, a high index of visceral hyperssensitivity, and a low life quality. In patients with IBS, the cortisol level in the morning and evening portions of saliva before treatment was statistically significantly higher than in healthy subjects (in both cases, p<0,05). After 12 weeks of therapy, there was a statistically significant decrease in the severity of clinical manifestations of the disease (p<0,05), in the severity of depression, anxiety, visceral hypersensitivity and an increase in the life quality. After the therapy course, patients with IBS noted a significant decrease in the cortisol level in the morning and evening portions of saliva. During therapy, 3 adverse events were registered: headache (n=2), nausea (n=1), which did not require drug discontinuation. Conclusion: the efficacy of Kolofort® in the treatment of patients with IBS with a moderate and mild disease course, both in relation to the main GIT symptoms and concomitant psychoemotional disorders, has been shown. Good efficacy and tolerability of the drug ensured high patient adherence to the treatment. KEYWORDS: irritable bowel syndrome, cortisol, stress, Kolofort, visceral hyperssensitivity, anxiety. FOR CITATION: Livzan M.A., Gaus O.V. New methods to the patient management with irritable bowel syndrome. Russian Medical Inquiry. 2021;5(6):391–397 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-391-397.

Randomized clinical trial: the effect of probiotic Bacillus coagulans Unique IS2 vs. placebo on the symptoms management of irritable bowel syndrome in adults

The therapeutic effects of B. coagulans Unique IS2 have been well established in children with irritable bowel syndrome (IBS), but its efficacy in adults remain under reported. Thus, in this study the efficacy of B. coagulans Unique IS2 in the management of IBS symptoms in adults was investigated. Patients (n = 153) fulfilling Rome III criteria were provided placebo capsules for a 2 weeks run-in period. Only patients satisfying compliance criteria (n = 136) were randomized (double blind) to receive either B. coagulans Unique IS2 (2 billion CFU) or placebo capsules daily for 8 weeks. Reduction of abdominal discomfort/pain intensity and increase in complete spontaneous bowel movements were analyzed as primary end points. Other clinical symptoms of IBS and serum cytokines were also evaluated. B. coagulans Unique IS2 showed significant improvement in primary and secondary endpoints, as compared to placebo. Haematology of both the arms remained normal. No significant changes in pro- (IL-6, IL-12, TNF-α, INF- γ) and anti-inflammatory cytokine (IL-10) levels were detected at the end of B. coagulans treatment (8 weeks) as compared to placebo. B. coagulans was well tolerated with no severe adverse events to report. Overall, the results demonstrate that B. coagulans Unique IS2 is efficacious in the management of IBS symptoms in adults (18–60 years).

Predictors of irritable bowel syndrome formation among students

Objective — to establish the role of the nervous system disorders in the formation of irritable bowel syndrome (IBS) among students. Materials and methods. Examination involved 32 students with IBS, aged 19 to 26 years. The Gastrointestinal Quality of Life Index (GIQLI) questionnaire was used, in which 36 questions were presented. Results. The changes in the psycho-emotional sphere in students with IBS occurred in all patients. Upper and lower dyspeptic syndromes with different frequency were inherent in all patients and depended on the nature of the stool. A short-term deterioration of the condition showed after passing tests or exam, which was manifested by increased and upset stools, increased abdominal pain. The skin redness or pallor of the face, excessive sweating, palpitations and fluctuations in blood pressure also were marked. The involvement of the autonomic nervous system with the predominance of the tone of its parasympathetic division has been established. Along with this, the IBS clinical symptoms significantly decreased until the complete disappearance at the peak of the examination period. This phenomenon reflected the formation of a stable psycho-emotional dominant «successful completion of the session». Conclusions. The development of irritable bowel syndrome in a student environment occurs against the background of changes in the autonomic nervous system, which had a significant effect on specific clinical symptoms. Clinical manifestations of IBS in students are reduced in the «peak period» of emotional stress, but are greatly enhanced after «training stresses». In this case, the development of vegetative disorders with acceleration of the heart rate and the lability of blood pressure are traced. The imbalance of the autonomic nervous system not only exacerbates the clinical symptoms of IBS, but also affects the patient quality of life.

Bacillus coagulans MTCC 5856 supplementation in the management of diarrhea predominant Irritable Bowel Syndrome: a double blind randomized placebo controlled pilot clinical study.

Background Bacillus coagulans MTCC 5856 has been marketed as a dietary ingredient, but its efficacy in diarrhea predominant irritable bowel syndrome (IBS) condition has not been clinically elucidated till date. Thus, a double blind placebo controlled multi-centered trial was planned to evaluate the safety and efficacy of B. coagulans MTCC 5856 in diarrhea predominant IBS patients.MethodsThirty six newly diagnosed diarrhea predominant IBS patients were enrolled in three clinical centres. Along with standard care of treatment, 18 patients in group one received placebo while in group two 18 patients received B. coagulans MTCC 5856 tablet containing 2 × 109 cfu/day as active for 90 days. Clinical symptoms of IBS were considered as primary end point measures and were evaluated through questionnaires. The visual analog scale (VAS) was used for abdominal pain. Physician’s global assessment and IBS quality of life were considered as secondary efficacy measures and were monitored through questionnaires.ResultsLaboratory parameters, anthropometric and vital signs were within the normal clinical range during the 90 days of supplementation in placebo and B. coagulans MTCC 5856 group. There was a significant decrease in the clinical symptoms like bloating, vomiting, diarrhea, abdominal pain and stool frequency in a patient group receiving B. coagulans MTCC 5856 when compared to placebo group (p < 0.01). Similarly, disease severity also decreased and the quality of life increased in the patient group receiving B. coagulans MTCC 5856 when compared to placebo group.ConclusionsThe study concluded that the B. coagulans MTCC 5856 at a dose of 2 × 109 cfu/day along with standard care of treatment was found to be safe and effective in diarrhea predominant IBS patients for 90 days of supplementation. Hence, B. coagulans MTCC 5856 could be a potential agent in the management of diarrhea predominant IBS patients.

Review article: potential mechanisms of action of rifaximin in the management of irritable bowel syndrome with diarrhoea.

The role of gut microbiota in the pathophysiology of irritable bowel syndrome (IBS) is supported by various lines of evidence, including differences in mucosal and faecal microbiota between patients with IBS and healthy individuals, development of post-infectious IBS, and the efficacy of some probiotics and nonsystemic antibiotics (e.g. rifaximin). To review the literature regarding the role of rifaximin in IBS and its potential mechanism(s) of action. A literature search was conducted using the terms 'rifaximin', 'irritable bowel syndrome' and 'mechanism of action'. Rifaximin was approved in 2015 for the treatment of IBS with diarrhoea. In contrast to other currently available IBS therapies that require daily administration to maintain efficacy, 2-week rifaximin treatment achieved symptom improvement that persisted ≥12 weeks post-treatment. The mechanisms of action of rifaximin, therefore, may extend beyond direct bactericidal effects. Data suggest that rifaximin may decrease host proinflammatory responses to bacterial products in patients with IBS. In some cases, small intestinal bacterial overgrowth (SIBO) may play a role in the clinical symptoms of IBS. Because of the high level of solubility of rifaximin in the small intestine, rifaximin may reset microbial diversity in this environment. Consistent with this hypothesis, rifaximin has antibiotic efficacy against isolates derived from patients with SIBO. Resetting microbial diversity via rifaximin use may lead to a decrease in bacterial fermentation and a reduction in the clinical symptoms of IBS.

Tight junctions and IBS ‐ the link between epithelial permeability, low‐grade inflammation, and symptom generation?

In this issue of Neurogastroenterology and Motility, Dr Ewa Wilcz-Villega and colleagues report low expression of E-cadherin, a tight junction protein involved in the regulation of paracellular permeability, in the colonic mucosa of patients with the irritable bowel syndrome (IBS) with predominance of diarrhea (IBS-D) or alternating symptoms (IBS-A). These findings constitute an improvement in our knowledge of epithelial barrier disruption associated with IBS. There is mounting evidence to indicate that a compromised epithelial barrier is associated with low-grade immune activation and intestinal dysfunction in at least a proportion of IBS patients. During the last 10 years of research, much interest has focused on the increase in the number of different types of immune cells in the gut mucosa of IBS patients including: mast cells, T lymphocytes, and other local cells such as enteroendocrine cells. The inflammatory mediators released by these cells or other luminal factors could be at the origin of altered epithelial barrier functions and enteric nervous system signaling, which lead to gut hypersensitivity. A current conceptual framework states that clinical symptoms of IBS could be associated with structural and functional abnormalities of the mucosal barrier, highlighting the crucial importance of elucidating the contributory role of epithelial barrier defects in the pathogenesis of IBS. More importantly, disruption of the epithelial barrier could also participate in the generation of persistent abdominal pain and discomfort mimicking IBS in patients with inflammatory bowel diseases considered in remission. This mini review gives a brief summary of clinical and experimental evidence concerning the mechanisms underlying epithelial barrier defects in IBS.