Irritable Bowel Syndrome Constipation Research Articles

Fecal Loading Evaluation by Two Radiological Scores: Comparisons between Functional Constipation and Irritable Bowel Syndrome-Constipation in Children and Adolescents

Aim: Compare fecal loading (FL) using Leech and Starreveld methods in children and adolescents with functional constipation (FC) or irritable bowel syndrome (IBS-C). Methods: Single-center, observational, retrospective, cross-sectional study of consecutive cases referred with unresponsive constipation. Inclusion criteria: FC and IBS-C, according to the Rome IV Criteria, age between 4 and 15 years old. Exclusion criteria: underlying chronic disorders, no medication during the two weeks preceding the radiography. Data collection is executed from electronic medical records. Before the analysis, two pediatric gastroenterologists discussed the methods to ensure an accurate evaluation. The scores were applied to the entire colon. Results: 114 children/adolescents were divided into the FC group (59 patients) and the IBS-C group (55 patients). Baseline characteristics highlight the more prevalent duration of symptoms and painful defecation in FC and female sex, defecation frequency, and abdominal pain in IBS-C. There is a high level of agreement between the two pediatric gastroenterologists in their assessment of FL for both FC and IBS-C, indicating the reliability of the methods. The FL scores in FC were higher than IBS-C, Leech (p<0.001), and Starreveld (p<0.002). The Leech proportion of positive score was FC (93%) and IBS-C (78%), and Starreveld, FC (95%) and IBS-C (89%). Results underscore the effectiveness of the methods in identifying FL. However, in the comparison of the proportion of positive results, FC was higher than IBS-C using only Leech (p<0.02) with Sensitivity (0.93) and Specificity (0.21), and the Starreveld method does not differentiate FC and IBS-C (p=0.30). Conclusions: FC and IBS-C effectively identify groups with differences in FL. Notably, IBS-C had a significantly lower FL score than FC. Thus, the simplicity, low cost, and applicability of the Leech and the Starreveld for observing the FL and gas distribution in the colonic segments may permit better therapeutic planning.

Association of serotonin transporter promoter polymorphism (5-HTTLPR) with orocecal transit time in irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a multifactorial disorder with altered intestinal motility, secretion, and sensation. Serotonin (5-HT) stimulates gut motility and alters serotonin signaling that may lead to both intestinal and extraintestinal symptoms in IBS. The aim of this study was to examine the association of serotonin transporter gene promoter polymorphism (5-HTTLPR) in IBS with orocecal transit time (OCTT) measured by lactulose hydrogen breath test. This prospective case-control study included 151 IBS patients (mean±SD 37.4±11.6 years, median 36, range 19-68). Ninety-two patients were diarrhea-predominant IBS (D-IBS), 44 constipation-predominant IBS (C-IBS), 15 alternating diarrhea and constipation IBS (M-IBS), and 100 healthy controls (mean±SD 37.2±11.4 years, median 36, range 20-64 years). 5-HTTLPR gene polymorphism was studied by polymerase chain reaction-based method. 5-HT levels were measured by enzyme-linked immunosorbent assay (ELISA). Orocecal transit time (OCTT) was measured by a non-invasive lactulose hydrogen breath test. OCTT was also compared with respect to 5-HTTLPR genotypes in differentIBS phenotypes. Serum serotonin levels were significantly higher in overall IBS patients (152±77 ng/mL, p<0.001), D-IBS (184±76 ng/mL, p<0.001), compared to healthy controls (129±56 ng/mL). There was no difference in 5-HT levels between C-IBS (124±53 ng/mL) and controls. In the case of M-IBS, 5-HT levels were (88±49 ng/mL p<0.05) significantly lower than that of controls. OCTT was significantly shorter in D-IBS patients (95±36 min) as compared to controls (112±41 min). In contrast, C-IBS showed significantly prolonged OCTT (136±54 min). There was a significant difference in OCTT between D-IBS and C-IBS patients (p<0.001). There was no significant association found between OCTT and 5-HTTLPR. Serum serotonin concentrations were increased in D-IBS compared to controls and C-IBS. OCTT was shorter in D-IBS and delayed in C-IBS patients. There was no association of 5-HTLPR polymorphism with OCTT.

Association between Serum Vitamin D and Irritable Bowel Syndrome Symptoms in a Sample of Adults.

Vitamin D may be associated with irritable bowel syndrome (IBS) pathways. This cross-sectional study evaluated the associations between serum Vitamin D and IBS symptoms in a sample of Lebanese adults. Participants (n = 230; mean (SD) age: 43.36 (16.05) years, 62.9% females) were adults, free of diseases affecting Vitamin D metabolism, and recruited from a large university and the surrounding community. Serum Vitamin D (25-hydroxyvitamin D) was assessed using an automated chemiluminescence micro-particle immunoassay kit. The Birmingham IBS Symptom Questionnaire total scale, and pain, constipation, and diarrhea subscales were used to study IBS symptoms. Four linear regression analyses were performed, taking respectively the total scale and each of the subscales as the dependent variable. Vitamin D was forced into each model. Covariates included sociodemographic and medical variables, fluid intake, physical activity, sleep quality, stress, and adherence to the Mediterranean diet. Mean (SD) serum Vitamin D was 17.53 (12.40) ng/mL and mean (SD) Birmingham IBS Symptom Questionnaire was 16.98 (15.16) (pain: 20.75 (23.63), constipation: 25.06 (29.99), diarrhea: 9.88 (13.37)). Serum Vitamin D was not associated with the total score, nor with any of the subscales (p > 0.05 for the four regression analyses). Serum Vitamin D was not associated with IBS symptoms in a sample of Lebanese adults, adding to the controversy in this field. Further understanding of the pathophysiological mechanisms involved in Vitamin D and IBS is warranted.

Role of Prucalopride in Treating Functional Constipation and Gastroparesis: A Systemic Review.

Prucalopride is a selective serotonin receptor agonist that can be used to treat chronic constipation. This article reviews the clinical efficacy side effects of prucalopride, assessing its role in constipation and gastroparesis. Relevant published medical literature was identified by using the search terms "constipation," "gastroparesis," and "prucalopride" from 2010 and onwards. The databases included PubMed/MEDLINE and EMBASE. Bibliographies from published literature and websites were also reviewed. Results were filtered for English language and randomized controlled trials. Out of the 18 results, abstracts were manually reviewed for studies with similar statistical methodology; eight studies were selected for constipation and two studies for gastroparesis.In two four-week trials, prucalopride showed improvement in gastric emptying and the gastroparesis cardinal symptom index over placebo, with a 1-4 mg/day dosage. In seven 12-week trials in patients with chronic constipation, oral prucalopride 2-4 mg/day was more significant than placebo to improve the number of bowel movements and symptoms. One study showed no significant bowel function differences when prucalopride was compared to placebo over 12 or 24 weeks.Prucalopride was generally well-tolerated, and the most common adverse events reported were headache, nausea, diarrhea, and abdominal pain. Further long-term and comparative data would be beneficial to show that prucalopride can be an advantageous treatment option for patients with chronic idiopathic constipation (CIC) or gastroparesis. Additionally, it would be interesting to see its effect on irritable bowel syndrome-constipation predominant, as it has some overlap with idiopathic constipation.

A Qualitative Study of the Experiences of Complementary and Alternative Medicine of Patients With IBS-C.

The aim of this study was to examine the complementary and alternative medicine (CAM) experiences of patients with constipation irritable bowel syndrome (IBS-C). This qualitative study consisted of a total of 30 patients, who were admitted to a university hospital in Turkey. Data were collected using a descriptive questionnaire and a semistructured interview. Data analysis identified 5 main themes: (1) constipation-related difficulties experienced due to IBS, (2) the feeling that the CAM use is natural and useful, (3) the effect of the environmental stimuli in preferring the use of CAM, (4) the feeling that CAM is not negative and relieves, and (5) suggesting the CAM use. In conclusion, it was determined that all the patients with constipation IBS used various CAM methods. It may be recommended to raise the awareness of the patients by health care professionals about the CAM methods that may be useful.

The Effects on Immune Function and Digestive Health of Consuming the Skin and Flesh of Zespri® SunGold Kiwifruit (Actinidia Chinensis var. Chinensis 'Zesy002') in Healthy and IBS-Constipated Individuals.

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that results in constipation (IBS-C) or diarrhoea with abdominal pain, flatulence, nausea and bloating. Kiwifruit (Actinidia spp.) are nutrient-dense fruit with a number of reported health benefits that include lowering glycaemic response, improving cardiovascular and inflammatory biomarkers, and enhancing gut comfort and laxation. This study investigated the effect of consuming three whole Zespri® SunGold kiwifruit (Actinidia chinensis var. chinensis ‘Zesy002’) with or without skin on cytokine production and immune and gut health in healthy people and those with IBS-C symptoms. This study enrolled thirty-eight participants in a 16 week randomized cross-over study (19 healthy and 19 participants with IBS-C). Participants were randomized to consume either three kiwifruit without eating the skin or three kiwifruit including the skin for 4 weeks each, with a 4 week washout in between each intervention. There was a significant decrease in the pro-inflammatory cytokine, TNF-α, for both the healthy and the IBS-C participants when they consumed whole kiwifruit and skin, and also for the healthy participants when they ate whole kiwifruit without the skin (p < 0.001). The kiwifruit interventions increased bowel frequency and significantly reduced the gastrointestinal symptom rating scale constipation and Birmingham IBS pain scores for both participant groups. We have demonstrated that consuming the skin of SunGold kiwifruit might have beneficial effects on gastrointestinal health that are not produced by consuming the flesh alone.

Fermentable carbohydrate intake and food avoidance behaviour in elderly patients with irritable bowel syndrome: A case report

Background: Fermentable carbohydrates or FODMAPs (Fermentable Oligo-, Di-, Monosaccharides, and Polyols) are short-chained, poorly absorbed carbohydrates which trigger gastrointestinal symptoms causing pain, bloating, distension, diarrhea, and constipation in Irritable Bowel Syndrome (IBS) patients. This debilitating condition has an impact on the quality of life of patients. In addition, due to lack of dietary intervention, it can result in food restriction to alleviate symptoms as patients avoid a wide variety of food and beverages. Objective: To compare FODMAP and nutrient intake, food avoidance behavior and quality of life in 2 long standing patients with IBS. Methods: Patients were selected on the basis of being diagnosed with IBS by a gastroenterologist. A 24-hour dietary recall with multiple pass method was used to assess intake. FODMAP intake was determined using published data. Symptom severity and quality of life was measured using a validated questionnaire. Meanwhile, food avoidance was assessed using a dietary trigger piloted questionnaire. Results: Two female Chinese patients with severe gastrointestinal symptoms were selected for this case series. Patient 1 was a 75-year-old female presenting with constipation-predominant IBS and patient 2 was a 61-year-old presenting with diarrhea-predominant IBS. Patient 1 had a higher energy intake: 2198 kcal, and FODMAP intake 10.6g/d, compared to patient 2 with an energy and FODMAP intake of 1800 kcal and 3.6g/d respectively. Both patients avoided a wide of range of food groups including cereals and grains, animal products, dairy and spicy foods. They also reported reduced scores for quality of life. Conclusion: Both patients had low intake of calcium as a result of food avoidance. This highlights the importance of appropriate and timely dietary intervention to this group of patients, to promote improved symptom management without compromising nutrient intake.

A Qualitative Study of the Experiences of Complementary and Alternative Medicine Use in Patients With IBS-C.

The aim of this study was to explore the experiences of complementary and alternative medicine (CAM) among patients with constipation irritable bowel syndrome (IBS-C). This qualitative study consisted of a total of 30 patients who were admitted to a university hospital in Turkey. Data were collected using a descriptive questionnaire and a semistructured interview. Data analysis identified 5 main themes: (1) the constipation-associated difficulties experienced because of IBS; (2) the feeling that CAM is natural and useful; (3) the effect of environmental stimuli in preferring the use of CAM; (4) the feeling that CAM is not negative and relieves symptoms; and (5) suggesting the use of CAM. In conclusion, it was determined that all the patients with IBS-C used various CAM methods. It may be recommended that health care professionals should raise awareness among patients about CAM methods that may be useful.

A123 GASTROINTESTINAL SYMPTOMS AND DISORDERS OF GUT BRAIN INTERACTION ARE COMMON IN PATIENTS WITH EHLERS-DANLOS SYNDROME (EDS) IN TERTIARY REFERRAL CENTER

Abstract Background Ehlers Danlos Syndrome (EDS) is a group of rare connective tissue disorders. Gastrointestinal (GI) symptoms such as abdominal pain, nausea, vomiting, bloating and altered bowel habits are common in patients with EDS. Specifically, disorders of gut brain interaction (DGBI) appear to be more common in this patient population. The University Health Network (UHN) has the first and only multi-disciplinary clinic, including specialized gastroenterology services, in Canada for the management of EDS. Aims The aim of this study is to describe the GI symptoms and DGBI that are present in our cohort of EDS patients. Methods A retrospective chart review of all EDS who were seen in the gastroenterologist clinic of the GoodHope EDS clinic at UHN were reviewed from November 1, 2017 to September 26, 2019. Demographic information including age, sex and EDS subtype were collected. GI symptoms that were collected include constipation, diarrhea, fecal incontinence, nausea, vomiting, bloating, abdominal pain, early satiety, heart burn, dysphagia and regurgitation. A physician made diagnosis of irritable bowel syndrome (IBS) was recorded. Descriptive statistics were performed. Results The charts of 79 EDS patients were reviewed; 4 were excluded due to missing data. 75 patients were included in the final analysis. 93.3% of patients were female with a mean age of 36.4 +/- 12.5 years. Of these 75 patients, 43 (57.3%) had EDS-hypermobile subtype, 13 (17.3%) EDS-classic, 3 (4%) EDS-vascular, 3 (4%) unknown EDS subtype and 13 (17.3%) were categorized as having a hypermobile spectrum disorder. The most common GI symptoms observed in this patient group included abdominal pain in 85.5%, bloating in 64.4%, heartburn in 61.8%, constipation in 57.9%, nausea in 50%, diarrhea 43.4%, dysphagia in 43.4%, regurgitation in 34.2%, early satiety in 32.89%, vomiting in 30.2%,and fecal incontinence in 13.1%. It was also observed that 50.7% (n=38) had a physician made diagnosis of IBS. Of these patients with IBS, 16 (42.1%) had IBS constipation, 12 (31.5%) had IBS mixed, and 10 (26.3%) had IBS diarrhea. Conclusions Our study demonstrated that GI symptoms are common in patients with EDS. In our cohort, abdominal pain is the most commonly reported GI symptom, though other various GI symptoms are also reported in high numbers. DGBI are also common, with IBS being much more common than what has been reported in the general population. Further studies are needed to better understand the pathophysiology and impact of these GI symptoms and DGBI in patients with EDS. Funding Agencies UNH Foundation Goodhope Fund

Relationships of Microbiome Markers With Extraintestinal, Psychological Distress and Gastrointestinal Symptoms, and Quality of Life in Women With Irritable Bowel Syndrome.

Altered microbial diversity has been associated with gastrointestinal (GI) symptoms in persons with irritable bowel syndrome (IBS). Less is known about the relationship of microbiome with extraintestinal pain and psychological distress symptoms and quality of life (QOL) in persons with IBS. We aimed to evaluate the relationship of fecal microbiota to GI symptoms, stool consistency, psychological distress, extraintestinal pain, and QOL in participants meeting Rome III criteria for IBS. Seventy-six women completed a 28-day diary that included GI, stool consistency, psychological distress, and extraintestinal pain ratings. Participants completed the IBS-Specific Quality of Life questionnaire. Stool samples were collected and analyzed by 16S rRNA gene sequencing. Principal component analysis was performed and the first 2 components (PC1, PC2) were used to test relationships among bacterial families and clinical measures. Participants were categorized as IBS constipation (n=22), IBS diarrhea (n=39), IBS mixed (n=13), and IBS unsubtyped (n=2). There was a significant group effect for the Firmicutes to Bacteroidetes ratio and PC1. Lower microbial diversity and richness were associated with increased urgency and extraintestinal pain, worse QOL, and looser stools. Lower extraintestinal pain was associated with increased Rikenellaceae, Christensenellaceae, Dehalobabacteriaceae, Oscillospiraceae, Mogibacteriaceae, Ruminococcaceae, Sutterellaceae, Desulfovibrionaceae, and Erysipelotrichaceae abundances. QOL was positively associated with many of these same bacterial families. Higher Firmicutes to Bacteroidetes ratio was positively associated with loose stools. There were no statistically significant relationships between daily psychological distress or abdominal pain and bacterial families. Stool microbial diversity and composition are linked to daily extraintestinal symptoms, stool consistency, and QOL in women with IBS.

499 Plecanatide for Patients With Chronic Idiopathic Constipation and Irritable Bowel Syndrome-Constipation: Analysis of Abdominal Bloating From Four Randomized Phase 3 Clinical Trials

INTRODUCTION: Patients with chronic idiopathic constipation (CIC) or with irritable bowel syndrome with constipation (IBS-C) often report bloating. Plecanatide is an analogue of human uroguanylin, an intestinal peptide that induces fluid and ion secretion. Data from 4 large randomized, placebo-controlled trials in CIC (2 studies) or in IBS-C (2 studies) were analyzed to determine whether plecanatide improved bloating in patients with CIC or IBS-C. METHODS: Patients (N = 2683) who met modified Rome III criteria for CIC or patients (N = 2189) who met Rome III criteria for IBS-C were included in separate combined phase III intention-to-treat populations in CIC and IBS-C, respectively. Patients were randomized to placebo, plecanatide 3 mg QD, or plecanatide 6mg QD for 12 weeks. Baseline characteristics were comparable between groups within the CIC studies and within the IBS-C studies. The primary endpoint for the CIC trials was the percentage of durable overall complete spontaneous bowel movement (CSBM) responders (≥3 CSBMs plus increase of ≥1 CSBM over baseline in the same week) for ≥9 of the 12 treatment weeks, including ≥3 of the last 4 weeks. The IBS-C primary endpoint was the percentage of Overall Responders, defined as a patient who was a weekly responder (CSBM + ≥30% improvement in abdominal pain) for ≥6 of the 12 treatment weeks. Electronic diaries recorded daily symptoms of bloating (0 = none to 4 = very severe) and bowel movements. RESULTS: In patients with CIC, pooled efficacy demonstrated a significantly greater percentage of CSBM responders in each of the plecanatide groups when compared to the placebo group. Both plecanatide 3mg and 6mg resulted in a significantly greater percentage of Overall Responders than did placebo in the IBS-C studies (Table 1). In CIC or IBS-C, over the 12-week treatment period, both plecanatide treatment groups experienced a significantly greater reduction in weekly mean abdominal bloating scores compared with the placebo group (Table 2). The most common adverse event (AE) was diarrhea across all studies; discontinuation rates due to AEs including diarrhea were similar across studies (Table 3). CONCLUSION: Patients with CIC or IBS-C who received plecanatide 3 mg and 6 mg demonstrated a significantly greater percentage of responders compared to patients who received placebo. Bloating was significantly improved both in patients with CIC and IBS-C. Plecanatide treatment was associated with a low incidence of diarrhea and other AEs.

EVALUATION OF CARBOHYDRATE AND FIBER CONSUMPTION IN PATIENTS WITH IRRITABLE BOWEL SYNDROME IN OUTPATIENT TREATMENT.

Irritable bowel syndrome (IBS) is a chronic functional condition, which main symptoms of pain, discomfort and abdominal distension, constipation, diarrhea, altered fecal consistency and sensation of incomplete evacuation can be influenced by the presence of dietary fiber and fermentable carbohydrates (FODMAPs). This study aimed to assess the relationship between the quantity of fermentable carbohydrates (FODMAP) and fiber consumed by individuals diagnosed with IBS, and their classification according to the Rome III criteria. A transversal study was carried out in the Intestinal Outpatient Clinic of the Gastroenterology Discipline of UNIFESP. The nutrients of interest for the study were: fiber, general carbohydrates and FODMAPs, with intake quantity measured in grams, analyzed through portions consumed. A nutrition log was used, along with a semi-quantitative questionnaire of consumption frequency. The sample included 63 adult patients; 21 with constipated IBS, 21 with diarrhea IBS, and 21 with mixed IBS. Carbohydrate intake was suboptimal in 55.6% of patients in all groups; excessive consumption was identified in 38.1% of the diarrhea group, 14.3% of the mixed group and 38.1% of the constipated group. Low consumption of carbohydrates was found in 28.6% of diarrhea patients and 47.6% of the mixed group. A mean intake of 23 g of fiber per day was identified, lower than recommended. The study identified a number of inadequacies in the consumption of different nutrients, excessive carbohydrate intake, especially FODMAPs, identified by the respondents as responsible for a worsening of their conditions. By contrast, other food groups such as meat, eggs and dairy were consumed by the sample population in insufficient quantities.

Bile and fat excretion are biomarkers of clinically significant diarrhoea and constipation in irritable bowel syndrome.

Biomarkers in irritable bowel syndrome (IBS) may guide targeted therapy in this multifactorial disease. It has been suggested that 75% accuracy and cost <$500 categorise biomarkers as cost-effective. To identify differences in faecal bile acids, faecal fat and fasting serum C4 (7a-hydroxy-4-cholesten-3-one) and fibroblast growth factor 19 (FGF19) among patients with IBS-D, IBS-C and healthy controls and to determine accurate, cost-effective biomarkers for clinically relevant diarrhoea and constipation. We assessed daily stool frequency and consistency (Bristol Stool Form Scale) from validated bowel diaries, 48hours total and individual faecal bile acids, 48hours faecal fat and weight, fasting serum C4 and FGF19, and colonic transit by scintigraphy from healthy volunteers (HV) and patients with IBS-D and IBS-C (Rome III criteria). We utilised multivariate logistic regression to determine biomarkers of clinically significant diarrhoea or constipation based on stool frequency, consistency and weight. Among the 126 HV (44M/82F, 37.5±10.9years [SD]), 64 IBS-D (5M/59F, 41.9±12.2years), and 30 IBS-C (0M/30F, 44.6±10years) patients, there were significant differences between all groups in stool weight, frequency, and consistency; in addition, there were differences in colonic transit at 48hours, faecal fat, and total and individual faecal bile acids between IBS-D and IBS-C. Reduced total and primary faecal bile acids and increased faecal lithocholic acid were significant predictors of decreased faecal weight, frequency and consistency with AUC>0.82 (sensitivity >76%, specificity >72%). Total and primary faecal bile acids and faecal fat were significant predictors of increased stool weight, frequency and consistency with AUC>0.71 (sensitivity >55%, specificity >74%).The faecal parameters had a 11.5 positive likelihood ratio in predicting elevated faecal weight. Faecal bile acids and faecal fat are cost-effective and accurate biomarkers associated with significant bowel dysfunction among IBS-D and IBS-C patients.

Diagnostic value of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and mean thrombocyte volume in irritable bowel syndrome-constipation according to rome IV criteria

Aim: Structural and biochemical reagents that could help diagnose irritable bowel syndrome (IBS) are still lacking. Moreover, use of certain diagnosis criteria in the diagnosis of the disease decreases the need for making over-diagnostic tests in order to rule out other diseases. Rome IV criteria include new parameters for the diagnosis of IBS. Our objective in this study is to research the diagnostic value of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) count in IBS-Constipation (IBS-C).Material and Methods: Data of the cases among patients who applied to general surgery polyclinics of Ordu University Medical Faculty who were diagnosed with IBS and have Rome IV IBS-C diagnosis criteria. Healthy volunteers were selected from adult healthy patients who applied to general surgery policlinics of our hospital for general health check purposes. The age, sex, WBC (white blood cell), NLR, PLR, MPV values of the cases were analyzed. Results:Average age of IBS-C group was 39.47±9.97 (min 19-max 57). Average age of the control group was 40.16±11.50 (min 18-max 59). Out of 78 IBS-C group patients, 48 (61.5%) were women and 30 (38.5%) were men. Of 82 patients 54 (65.9%) were women, 28 (%34.1) were men. Average age of the patients was 39.83±10.75 (min 18-max 59). A significant result was obtained for NLR when control group was compared with IBS-C group (p=0.01). No significant difference was determined between two groups for MPV, PLR (p>0.05). Cut-off value of NLR was calculated as 1.895, and the sensitivity in IBS diagnosis was calculated as 51.3%, and the specificity was calculated as 59.8%. Conclusion: We have determined significant results with NLR, which is an inflammatory reagent, in IBS-C according to Rome IV Criteria. However, NLR has low sensitivity and specificity for IBS-C diagnosis from the other causes of constipation. We are of the opinion that inflammatory reagents such as NLR, PLR, MPV are not useful in the diagnosis of this disease. We consider that our study will shed a light on future studies with larger research populations.

Treatment failure in children diagnosed with constipation in a paediatric emergency department in relation to Rome III criteria.

To determine if treatment failure varies based on ROME III classification and adherence to guideline congruent therapy among children diagnosed in an emergency department with functional constipation. Children aged 1 month to 18 years who were diagnosed with constipation in a paediatric emergency department underwent chart review and 7-day phone follow-up to complete the ROME III questionnaire, confirm treatments administered, and assess treatment failure. Participants were classified according to the ROME III criteria as having functional constipation (FC) or irritable bowel syndrome - constipation (IBS-C) subtype. The primary outcome was treatment failure defined as ≥ 2 of the following: 1) presenting symptom persistence; 2) < 1 bowel movement every other day; 3) pain/difficulty passing stools; and 4) abdominal pain between bowel movements. Five hundred and thirteen children completed follow-up; 40% (204/513) had FC, 23% (118/513) IBS-C, and 37% (191/513) did not meet either criteria. Treatment failure rates in children who received guideline congruent treatment were 28% (38/135) among those classified as FC and 43% (37/86) among those with IBS-C; P=0.02, a difference of 15% (95% confidence interval [CI]: 0.02, 0.27). On regression analysis, ROME III classification was not an independent predictor of treatment failure (odds ratio [OR]: 1.56 [95% CI: 0.97, 2.51]). At 7-day follow up, pain in between bowel movements was present in 22% (44/204) in FC patients versus 45% (53/118) of IBS-C patients; P=0.001. Treatment failure rates in children who receive guideline congruent therapy are higher among those with IBS-C, however, after adjustment for known confounders the relationship was not statistically significant.

Association between SERT insertion/deletion polymorphism and the risk of irritable bowel syndrome: A meta-analysis based on 7039 subjects

PurposeWe performed this study to better assess the relationship between serotonin transporter (SERT) insertion/deletion polymorphism and the risk of irritable bowel syndrome (IBS). MethodsEligible studies were searched in PubMed, Medline, Embase and CNKI. A total of 27 studies with 7039 participants were analyzed. ResultsSignificant association with the risk of IBS was detected for the SERT insertion/deletion polymorphism in additive comparison (p < 0.0001). Further subgroup analyses according to ethnicity of participants revealed that the SERT insertion/deletion polymorphism was significantly associated with the risk of IBS in Asians (dominant model: p = 0.001; recessive model: p = 0.0003; allele model: p = 0.001) and Caucasians (dominant model: p = 0.04; additive model: p < 0.0001). When we stratified available data according to type of disease, we found that the SERT insertion/deletion polymorphism was significantly correlated with the risk of constipation predominant IBS (IBS-C) in recessive comparison (p = 0.04). However, no positive results were detected in the diarrhea predominant IBS (IBS-D) and mixture of diarrhea and constipation IBS (IBS-M) subgroups. ConclusionsOur findings indicated that the SERT insertion/deletion polymorphism may serve as a genetic biomarker of IBS in Asians and Caucasians.

Clinical efficacy of modified cistanche decoction combined with lactulose oral liquid in the treatment of constipated irritable bowel syndrome and its impact on quality of life

Objective To investigate the clinical efficacy of modified cistanche decoction combined with lactulose oral liquid in the treatment of patients with constipation-type irritable bowel syndrome, and to observe its effect on improving the quality of life of patients. Methods From June 2013 to June 2016, the clinical diagnosis and treatment of 76 patients with constipation-predominant irritable bowel syndrome in the People's Hospital of Qingyuan County were retrospectively analyzed.Among them, lactulose oral liquid was used in the control group.On the basis of the control group, cistanche soup was given in the treatment group, the control group and the treatment group had 38 cases.The clinical effects, adverse reactions were analyzed, and before and after treatment, TCM syndrome score and quality of life score were recorded. Results After treatment, the TCM syndrome scores of the treatment group were significantly lower than those of the control group (t=2.87, 3.17, 2.68, 3.75, 4.27, 3.83, 5.02, 4.40, 2.48, P=0.00, 0.00, 0.00, 0.00, 0.00, 0.00, 0.00, 0.00, 0.01), the quality of life dimensions scores of the treatment group were significantly higher than those of the control group (t=3.10, 3.44, 3.36, 3.58, 4.51, 3.32, 2.95, 2.89, P=0.00, 0.00, 0.00, 0.00, 0.00, 0.00, 0.00, 0.00). However, after treatment, the scores of TCM syndromes in both two groups were significantly lower than those before treatment (control group: t=4.28, 5.11, 4.07, 6.38, 5.06, 2.11, 7.32, 4.38, 20.22, P=0.00, 0.00, 0.00, 0.00, 0.00, 0.00, 0.04, 0.00, 0.00; treatment group: t=7.81, 9.86, 7.68, 13.76, 9.31, 6.57, 14.639.62, 7.36, P=0.00, 0.00, 0.00, 0.00). The scores of all dimensions of life quality were significantly higher than those before treatment (control group: t=2.85, 3.59, 2.58, 2.60, 4.01, 4.88, 3.05, 2.36, P=0.00, 0.00, 0.01, 0.01, 0.00, 0.00, 0.00, 0.02; treatment group: t=5.57, 6.72, 6.60, 6.40, 7.74, 7.63, 5.84, 6.30, P=0.00, 0.00, 0.00, 0.00, 0.00, 0.00, 0.00, 0.00). The total effective rate of the treatment group was 86.84%, which was significantly higher than 65.79% of the control group(χ2=7.13, P=0.02). There were no significant adverse reactions during treatment. Conclusion Cistanche decoction combined with lactulose oral solution for constipation-irritable bowel syndrome patients has significant effect, and can help to improve the quality of life of patients. Key words: Irritable bowel syndrome; Quality of life; Cistanche; Lactulose

Evaluation of Carbohydrate and Fiber Consumption in Patients with Irritable Bowel Syndrome in Outpatient Treatment

ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) is a chronic functional condition, which main symptoms of pain, discomfort and abdominal distension, constipation, diarrhea, altered fecal consistency and sensation of incomplete evacuation can be influenced by the presence of dietary fiber and fermentable carbohydrates (FODMAPs). This study aimed to assess the relationship between the quantity of fermentable carbohydrates (FODMAP) and fiber consumed by individuals diagnosed with IBS, and their classification according to the Rome III criteria. METHODS: A transversal study was carried out in the Intestinal Outpatient Clinic of the Gastroenterology Discipline of UNIFESP. The nutrients of interest for the study were: fiber, general carbohydrates and FODMAPs, with intake quantity measured in grams, analyzed through portions consumed. A nutrition log was used, along with a semi-quantitative questionnaire of consumption frequency. RESULTS: The sample included 63 adult patients; 21 with constipated IBS, 21 with diarrhea IBS, and 21 with mixed IBS. Carbohydrate intake was suboptimal in 55.6% of patients in all groups; excessive consumption was identified in 38.1% of the diarrhea group, 14.3% of the mixed group and 38.1% of the constipated group. Low consumption of carbohydrates was found in 28.6% of diarrhea patients and 47.6% of the mixed group. A mean intake of 23 g of fiber per day was identified, lower than recommended. CONCLUSION: The study identified a number of inadequacies in the consumption of different nutrients, excessive carbohydrate intake, especially FODMAPs, identified by the respondents as responsible for a worsening of their conditions. By contrast, other food groups such as meat, eggs and dairy were consumed by the sample population in insufficient quantities.

Probiotics Ameliorate Stool Consistency in Patients with Chronic Constipation: A Randomized, Double-Blind, Placebo-Controlled Study.

The efficacy of probiotics for improving clinical symptoms, altering the fecal microbiota, and regulating serum immune cytokine levels was investigated in patients with irritable bowel syndrome-constipation (IBS-C) or functional constipation (FC). A randomized, double-blind, placebo-controlled trial was conducted at Kyung Hee University Hospital between October 2016 and February 2017. Consecutive 18-75-year-old patients with diagnosis of IBS-C or FC (based on Rome IV criteria) consumed probiotics (3.0 × 108CFU/g Streptococcus thermophilus MG510 and 1.0 × 108CFU/g Lactobacillus plantarum LRCC5193) or a placebo daily for 4weeks (weeks 1-4) and were followed up for a 4-week washout period without intervention (weeks 5-8). The primary outcomes of the study were Bristol Stool Form Scale and Complete Spontaneous Bowel Movements (CSBM). Efficacy was assessed by per protocol. Stool consistency measured by the Bristol Stool Form Scale was significantly better in the probiotic group (n = 88) than in the placebo group (n = 83) at 4 and 8 weeks (3.7 ± 1.1 vs. 3.1 ± 1.1 at 8weeks, P = 0.002). No significant difference was found in CSBM. The quality of life was significantly better in the probiotic group than in the placebo group at 4weeks (P = 0.044) and 8weeks (P = 0.049). The relative abundance of L. plantarum among the fecal microbiomes was significantly greater in the probiotic group than in the placebo group at 4weeks (P = 0.029). However, the levels of other microbiomes and of serum cytokines (IL-10/IL-12 ratio and TNF-α) did not differ significantly between the two groups. Probiotics significantly ameliorated stool consistency in patients with chronic constipation. In addition, the beneficial effect of L. plantarum on stool consistency remained after the probiotic supplementation was discontinued. The mechanism whereby probiotics benefit patients with chronic constipation should be clarified in further studies.

Comparative efficacy of prucalopride and tegaserod in patients with predominantly constipated irritable bowel syndrome

Introduction: Irritable bowel syndrome (IBS) affects 5-20% of all individuals aroun d the world. In Mexico (Veracruz), a prevalence of 16.9% has been documented. Its diagnosis is based on the Rome III criteria, and its treatment has different approaches; within the pharmacological options are the serotonin receptor agonist drugs (5-HT4). The effectiveness of tegaserod has been established in patients with IBS with constipation (IBS-C), considering prucalopride as a drug with therapeutic potential for this condition, since it shows greater affi nity for the 5-HT4 receptor than tegaserod, and accelerates colonic transit. However, more data from randomized controlled trials that prove this are required. Objective: To compare the efficacy of prucalopride versus tegaserod in the treatment of irritable bowel with constipation, by means of the Bristol scale, the global scale of symptoms and associated symptoms. Material and methods: Two groups of patients were established (A and B) in a randomized manner: men and women between 18 and 50 years of age with Rome criteria III for IBS-C; all were given the same diet. In group A, Prucalopride was administered at a dose of 2 mg orally every 24 hours for two weeks. In group B, 6 mg of tegaserod were administered every 12 hours for two weeks. The clinical evolution of each patient was assessed each week during the two weeks of the study period, including the assessments of the adapted and validated Bristol scale, and the global scale of symptoms and associated symptoms. Results: Twenty-two patients were included, 21 (95.5%) female, with a 1:21 ratio; the average age was 37.27 years; 11 (50%) received prucalopride, and the rest, tegaserod. To evaluate the association between the treatment given and the symptoms of «rectal fullness, evacuation effort and evacuation urgency», Fisher’s exact test was used, being not statistically significant (p &gt; 0.05); for «abdominal distension, abdominal movements and Bristol scale», Mann-Whitney U was used, being not statistically signifi cant (p &gt; 0.05); however, for «abdominal pain», with the same test, a statistically signifi cant difference was found (p &lt; 0.05). Of those treated with prucalopride, one (9%) had diarrhea, three (27%) headache, and one (9%) headache and nausea; with tegaserod, two (18%) had diarrhea, two (18%) headache, and one (9%) headache and nausea. Conclusions: Both, prucalopride and tegaserod improve to some degree all the symptoms evaluated for IBS-C, but prucalopride signifi cantly and more promptly improves the symptom of «abdominal pain». It was evidenced that the diarrea event implied change of treatment in both groups.