Criteria For Irritable Bowel Syndrome Research Articles

Site and duration of abdominal pain discriminate symptomatic uncomplicated diverticular disease from previous diverticulitis patients.

Abdominal pain in patients with diverticular disease (DD) can be challenging in clinical practice. Patients with symptomatic uncomplicated diverticular disease (SUDD) and patients with a previous acute diverticulitis (PD) may share a similar clinical pattern, difficult to differentiate from irritable bowel syndrome (IBS). We used standardized questionnaires for DD (short and long lasting abdominal pain) and IBS (following Rome III Criteria) to assess clinical features of abdominal pain, in terms of presence, severity and length, in SUDD and PD patients. One hundred and forty-eight SUDD and 118 PD patients completed all questionnaires. Short-lasting pain was more frequent in SUDD than PD patients (p = 0.007). Number of long-lasting pain episodes was higher in SUDD (6.6 ± 11.9) compared to PD patients (3.4 ± 6.9) (p < 0.001). PD patients reported long-lasting pain more frequently in the lower left abdomen (p < 0.001), while in SUDD it was more frequently diffuse (p = 0.002) or localized in the lower right quadrant (p = 0.009). Features associated with long-lasting pain (fever, confinement to bed, consultations, antibiotic therapy, hospitalization) were more often reported in PD patients. IBS criteria were reported in 28.2% of patients and were more frequent in SUDD than PD patients (37.2% vs 17.1%, p < 0.001). SUDD and PD patients presented different pattern of abdominal pain (length, number of long lasting episodes, site and associated features), with a third reporting overlap with IBS. Further observational studies are needed to better characterize abdominal symptoms in DD patients, especially in those not fulfilling IBS criteria.Trial registration: The REMAD Registry is registered as an observational study in ClinicalTrial.gov (ID: NCT03325829).

P651 A randomised controlled trial of IBD-BOOST, a digital cognitive behavioural self-management programme for fatigue, and/or pain, and/or faecal incontinence in inflammatory bowel disease

Abstract Background Many people with IBD experience fatigue, pain and faecal incontinence (FI), impacting quality of life (QoL). We developed an interactive digital online self-management intervention (IBD-BOOST) based on a theoretically informed logic model and cognitive behavioural techniques, to treat these symptoms. We aimed to assess if IBD-BOOST, alongside health care professional (HCP) support and care as usual (CAU), provides greater relief from symptoms and improvement of QoL compared with CAU alone. Methods We conducted a pragmatic multi-centre two-arm parallel group randomised controlled trial (RCT) recruiting patients from clinics and national registries who rated the impact of fatigue and/or pain and/or FI as ≥5/10. Those in the IBD-BOOST arm received 6 months access to the 12-session IBD-BOOST programme, a 30-minute telephone support call with a trained HCP after session 1 and weekly in-site email messages from the HCP for 3 months. The UK Inflammatory Bowel Disease Questionnaire (UK-IBDQ) and global rating of symptom relief (GRSR) at 6 months were dual primary outcomes (alpha=0.025 was considered statistically significant as there were two primary outcomes). Other secondary outcomes, including individual symptoms, were measured at 6 and 12 months. Complier-averaged causal effects (CACE), sensitivity and pre-specified subgroup analyses were conducted. Results 780 participants were randomised (Figure 1), 432 with Crohn’s disease, 348 with ulcerative colitis or other IBD; 520 (66.7%) were female, mean age 49 years. At 6 months, both UK-IBDQ and GRSR were similar between the BOOST and CAU arms, p=0.19 for IBDQ and p=0.39 for GRSR (Table 1). Adverse events were similar between groups. FI score and EQ5D utility score (secondary outcomes) were significantly in favour of IBD-BOOST at 6 months, but pain and fatigue were no different. 57% of the intervention group completed a pre-defined minimum “dose” of 4 sessions (i.e. compliers). The CACE analysis suggested that compliers were more likely to report better QoL (p=0.03). Subgroup analysis of those meeting criteria for irritable bowel syndrome (IBS), showed that IBD-BOOST was more effective in improving IBDQ and GRSR at 6 months when compared with CAU for the IBD-IBS group (pinteraction=0.015 and 0.046, respectively). Conclusion This large RCT found that IBD-BOOST did not improve IBDQ and GRSR in patients with IBD and fatigue and/or pain and/or FI relative to CAU. Participants reported less FI at 6 and 12 months. Those who complied with the intervention showed a more pronounced IBDQ treatment effect. Those with IBD-IBS at baseline improved more than those without, suggesting a possible for further effectiveness research on IBD-BOOST. Trial registration: ISRCTN71618461

Colonoscopic Findings in Patients Fulfilling ROME IV Criteria of Irritable Bowel Syndrome with or without Recently Discovered Alarming Features

Colonoscopic Findings in Patients Fulfilling ROME IV Criteria of Irritable Bowel Syndrome with or without Recently Discovered Alarming Features

OR34-03 Defining Clinical Characteristics Of Patients With Severe Hypoglycemia After Roux-en-Y Gastric Bypass: How Do They Differ From Asymptomatic Patients?

Abstract Disclosure: A. Grover: None. A.L. Sheehan: None. C. Cummings: None. M. Farahmandsadr: None. H. Saeed: None. A.M. Puleio: None. D.C. Simonson: Stock Owner; Self; Phase V Technologies, GI Windows. M. Patti: Consulting Fee; Self; AstraZeneca, MBX-Biosciences, Hanmi Pharmaceutical. Other; Self; DSMB: Fractyl Health, Inc. Introduction: Post-bariatric hypoglycemia (PBH) is a severe, disabling complication of Roux-en-Y gastric bypass (RYGB). We aimed to identify clinical characteristics distinguishing patients with severe PBH vs. post-RYGB patients without symptomatic hypoglycemia (RYGB non-hypo) to help elucidate PBH pathophysiology and potential risk factors. Methods: Adults aged 18-70, without diabetes mellitus (DM), were recruited into 3 groups: (1) PBH with neuroglycopenia (n=33); (2) RYGB non-hypo (n=16); (3) non-surgical weight-matched controls (n=17). Detailed history of hypoglycemia, medical/surgical/family history, medications, Dumping Symptom Rating Scale (DSRS), and Rome IV diagnostic criteria for Irritable Bowel Syndrome (IBS) was completed. Differences between PBH and RYGB non-hypo were evaluated by unpaired t-tests and chi-square analysis as indicated. Results: PBH participants were 90% female, mean age 53±2 y, BMI 32±1 kg/m2, 39±2% body fat, with similar data for RYGB non-hypo (100% female, age 54±2 y, BMI 33±2 kg/m2, 40±2% fat), and controls (65% female, age 45±4 y, BMI 31±2 kg/m2, 35±3% fat). 90% of PBH reported level 3 hypoglycemia, with ER visits in 29% and motor vehicle accidents in 7%. Reduced awareness of hypoglycemia was reported by 80% of PBH, with hypoglycemia awareness at mean glucose of 57±2 mg/dL. 29% of PBH reported hypoglycemic symptoms occurring preoperatively, and 20% reported family history of hypoglycemia. The majority of PBH reported depression, change in driving habits, and adverse impact on employment. When compared with RYGB non-hypo, PBH participants had no difference in postoperative weight loss trajectories but had higher prevalence of revisional surgeries (p&amp;lt;0.05). PBH participants also had a higher score on DSRS (p&amp;lt;0.05) and higher prevalence of IBS (48 vs. 7% meeting Rome IV criteria, p&amp;lt;0.05). Higher rates of orthostatic hypotension, intestinal dysmotility, and vitamin B12 deficiency requiring treatment were reported by PBH (p&amp;lt;0.05 for all). Additionally, PBH participants reported greater gabapentin, PPI, and hormonal contraceptive use (p&amp;lt;0.05 for all); there were no differences in SSRI/SNRI use. Conclusion: PBH participants reported high rates of hypoglycemia unawareness, a likely contributor to hypoglycemia severity, recurrence, and adverse effects on safety and personal life. High rates of IBS, dumping symptoms, and orthostatic hypotension suggest possible disordered autonomic regulation in the pathophysiology of PBH. Self-reported preoperative symptoms and family history of hypoglycemia suggest possible differences in glucose metabolism prior to surgery in at-risk individuals. Preoperative assessment of these and other factors, together with longitudinal follow-up studies to determine incidence of PBH, will be required to identify risk factors for development of post-bariatric hypoglycemia. Presentation: Sunday, June 18, 2023

Ondansetron for irritable bowel syndrome with diarrhoea: randomised controlled trial

Background Irritable bowel syndrome with diarrhoea is characterised by frequent, loose or watery stools with associated urgency, resulting in marked reduction of quality of life. Ondansetron, a 5-hydroxytryptamine-3 receptor antagonist, has been shown to benefit patients with irritable bowel syndrome with diarrhoea. Objective To evaluate the effect of ondansetron in irritable bowel syndrome with diarrhoea. Design Phase III, parallel-group, randomised, double-blind, multicentre, placebo-controlled trial in 400 patients, with embedded mechanistic studies. Setting Hospital, primary care and community. Participants Eighty participants meeting Rome IV criteria for irritable bowel syndrome with diarrhoea. Intervention Ondansetron 4 mg (dose titrated up to two tablets three times a day) or matched placebo for 12 weeks. Main outcome measures Clinical – Primary patient-reported end point was % ‘Food and Drug Administration-defined responders’ over 12 weeks. Secondary end points were worst abdominal pain intensity, worst urgency, stool consistency, stool frequency, anxiety, depression and dyspepsia at 12 and 16 weeks. Main outcome measures Mechanistic – Whole gut transit time, faecal water, protease (FP), bile acids and assessment of rectal sensitivity using a barostat. Results Clinical – The study closed early due to slow recruitment. Between 1 January 2018 and 11 May 2020, 80 patients were recruited and randomised (20% of target), 37 to ondansetron, 43 to placebo. Discontinuations (4 ondansetron; 2 placebo) meant 75 completed the 12-week trial treatment. There were four protocol violations. In the intention-to-treat analysis, 15 (40.5%) on ondansetron were primary end-point responders (95% CI 24.7% to 56.4%), and 12 (27.9%) on placebo (95% CI 14.5% to 41.3%), p = 0.19, adjusted OR 1.93 (0.73, 5.11). Pain intensity reduction occurred in 17 (46.0%) on ondansetron (95% CI 29.9% to 62.0%) and 16 (37.2%) on placebo (95% CI 22.8% to 51.7%), p = 0.32. Improvement in stool consistency occurred in 25 (67.6%) on ondansetron (95% CI 52.5% to 82.7%) and 22 (51.2%) on placebo (95% CI 36.2% to 66.1%), p = 0.07. Use of rescue medication, loperamide, was lower on ondansetron [7 (18.9%) vs. 17 (39.5%)]. Average stool consistency in the final month of treatment reduced significantly more on ondansetron, adjusted mean difference –0.5 [standard error (SE) 0.25, 95% CI (–1.0 to –0.02), p = 0.042]. Ondansetron improved dyspepsia score (SFLDQ), adjusted mean difference –3.2 points [SE 1.43, 95% CI (–6.1 to –0.4), p = 0.028]. There were no serious adverse events. Mechanistic – mean (SD). Ondansetron increased whole gut transit time between baseline and week 12 by 3.8 (9.1) hours on ondansetron, significantly more than on placebo –2.2 (10.3), p = 0.01. Mean volume to reach urgency threshold using the barostat increased on ondansetron by 84 (61) ml and 38 (48) ml on placebo, n = 8, p = 0.26. Ondansetron did not significantly alter protease, faecal water or bile acids. Changes in referral pathways substantially reduced referrals, impairing recruitment, which meant the study was underpowered. Conclusion Our results are consistent with previous studies and confirmed ondansetron improves stool consistency and urgency but showed minor effect on pain. We plan to undertake a simplified version of this trial overcoming the changed referral pathways by recruiting in primary care, using software linked to primary care records to identify and randomise patients with irritable bowel syndrome with diarrhoea to ondansetron or placebo and remotely follow their progress; thus minimising barriers to recruitment. Trial registration This trial is registered as ISRCTN17508514. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation programme and will be published in full in Efficacy and Mechanism Evaluation; Vol. 10, No. 9. See the NIHR Journals Library website for further project information.

Gut-Brain Interaction Disorders and Anorexia Nervosa: Psychopathological Asset, Disgust, and Gastrointestinal Symptoms.

Gastrointestinal (GI) symptoms are very common in subjects with eating disorders (EDs). This study aimed to (a) investigate the prevalence of gut-brain interaction disorders (DGBIs) in anorexia nervosa (AN) patients, according to ROME IV criteria; and (b) explore AN psychopathological assets and disgust that might impact GI symptoms. Thirty-eight female patients consecutively diagnosed with untreated AN (age 19.32 ± 5.59) in an outpatient clinic devoted to EDs underwent Eating Disorder Inventory-3 (EDI-3), Hospital Anxiety and Depression Scale (HADS), Social Phobia Anxiety Scale (SPAS), Body Uneasiness Test (BUT), and Disgust Scale (DS) questionnaires. The presence of DGBIs was evaluated and GI symptoms were assessed using a standardized intensity-frequency questionnaire. A total of 94.7% of our sample met the diagnostic criteria for functional dyspepsia (FD), of which 88.8% presented the postprandial distress syndrome (PDS) subtype and 41.6% presented the epigastric pain syndrome (EPS) subtype. In addition, 52.6% of the sample met the diagnostic criteria for irritable bowel syndrome (IBS), while for functional constipation (FC), prevalence reached 7.9%. All participants presented a pathological score on the disgust scale. Significant correlations were found between several GI symptoms and psychopathological asset and disgust. AN is a multifactorial disorder. It is necessary to implement studies with an integrated approach, taking into account DGBIs, as well as to monitor the emotional-cognitive structure that acts as a factor in maintaining the disorder.

Evaluation of the Symptom-Based Diagnostic Criteria for Irritable Bowel Syndrome in Conjunction With Clinical Examinations and Laboratory Investigations.

Background Irritable bowel syndrome (IBS) is a chronic condition characterized by persistent abdominal pain or discomfort and impaired bowel function. Symptoms often vary in onset and severity, are worse during flare-ups, and affect the patient's quality of life. A positive diagnosis of IBS based on clinical symptoms may lead to a better outcome. There are different diagnostic criteria like Kruis score, Manning criteria, Rome I, II, III, and IV criteria, and each new one addresses the deficiencies of the previous ones. We analyze the effectiveness of the most commonly used diagnostic criteria associated with clinical examinations and laboratory tests in treating IBS in these studies. Methodology This is a retrospective study in which data from IBS subjects were collected by simple random samplingand compared using Manning criteria, Kruis score, and Rome IV criteria. Laboratory tests included complete blood count (CBC), erythrocyte sedimentation rate (ESR), andC-reactive protein (CRP). Results Of the 130 patients, IBS is more prevalent in adults aged 30-50 years, with a male predominance. The Kruis score outperformed the Manning criterion in distinguishing between organic bowel disease and IBS.This, together with the Rome IV criteria, increases the likelihood of identifying IBS. Conclusions Differentiating IBS from functional and organic gastrointestinal problems is critical. Irritable bowel syndrome can be diagnosed using symptom-based diagnostic criteria. Clinical observation and physical examination should be supplemented with laboratory indicators.

Children with functional gastrointestinal disorders with and without co-existing nausea: A comparison of clinical and psychological characteristics.

Nausea co-existing with functional gastrointestinal disorders (FGIDs) has been suggested to negatively impact physical and psychological factors in children. This study aims to compare clinical and psychological characteristics of a large cohort of pediatric patients with an FGID with and without nausea. Patients of two previous randomized controlled trials were included, the first assessing the effect of hypnotherapy (HT) in 260 children fulfilling Rome criteria of irritable bowel syndrome (IBS) or functional abdominal pain (FAP), the second examining the effect of HT in 100 children with nausea in children with either functional nausea (FN) or functional dyspepsia (FD). At inclusion, demographics, clinical features, including the presence of nausea, depression and anxiety, somatization, and health-related quality of life (QoL) were assessed in patients. In total, 355 patients with IBS (n = 131), FAP (n = 127), FN (n = 62), and FD (n = 35) were included, of which 255 (72%) patients experienced nausea versus 100 (28%) without nausea. Age at onset of symptoms was higher in children experiencing nausea (12.0y vs. 9.0y, p = 0.000). Significantly higher somatization, anxiety and depression scores, and lower health-related QoL were reported for children with nausea. There were no significant differences between children with only nausea and children with nausea and abdominal pain. Children with nausea, either with or without abdominal pain, report higher somatization scores, increased anxiety and depression, and lower overall QoL, compared to children with pain-related FGIDs without accompanying nausea. Addressing the presence of nausea in children with FGIDs seems essential to customize their treatment and improve overall quality of life.

Factor Analysis of the Rome IV Criteria for Major Disorders of Gut-Brain Interaction (DGBI) Globally and Across Geographical, Sex, and Age Groups

The Rome criteria are widely accepted for diagnosing disorders of gut-brain interaction, buttheir global applicability has been debated. This studyaimed to evaluate the validity of the Rome IV criteria by factor analysis globally, across geographical regions, by sex, and by age groups. Data were collected in 26 countries using the Rome IV questionnaire. Forty-nine ordinal variables were used in exploratory factor analysis (EFA) to identify clusters of inter-correlated variables (factors) within the data set. Confirmatory factor analysis with predefined factors of the disorders of gut-brain interaction was compared with the factors in the EFA. Analyses were performed globally, for each geographical region (North and Latin America, Western and Eastern Europe, Middle East, Asia), sex, and age groups (18-34, 35-49, 50-64, ≥65). A total of 54,127 people were included. The EFA identified 10 factors accounting for 57% of the variance: irritable bowel syndrome, constipation, diarrhea, upper gastrointestinal symptoms, globus, regurgitation/retching, chest pain, nausea/vomiting, and 2 right upper quadrant painfactors. Most factors had close correspondence to a Rome IV criteria diagnosis, but notably, functional dysphagia and heartburn symptoms were often included in the same factor and/or in upper gastrointestinal symptoms. Most factors were consistent across geographical regions, sex, andage groups, and compatible to the global results. All prespecified factors in the confirmatory analysis had a loading ≥0.4, indicating validity of the Rome IV criteria. The results indicate that the Rome IV criteria for irritable bowel syndrome, functional dyspepsia, functional constipation, globus, and biliary pain are globally valid and represent universal diagnostic entities that are similar across sex and age groups.

Assessing the relationship between burnout syndrome and irritable bowel syndrome among medical health providers and medical students in Saudi Arabia.

Burnout syndrome, characterized by chronic unmanageable workplace stress, has been linked to lower gastrointestinal disorders, including irritable bowel syndrome. However, the relationship between burnout syndrome and irritable bowel syndrome among medical health providers and medical students in Saudi Arabia has not been fully explored. This cross-sectional correlational study was conducted in Southern Saudi Arabia from 2021 to 2022 and involved 931 medical health providers and medical students who completed an electronic questionnaire. The study assessed the presence and severity of burnout and irritable bowel syndrome and examined their relationship. Burnout syndrome was evaluated using the Maslach Burnout Inventory-Student Survey (MBI-SS), while irritable bowel syndrome criteria and severity were assessed using validated tools. The study found that 85% of medical health providers and medical students experienced high levels of burnout and irritable bowel syndrome severity, with physicians and nurses mainly affected. Occupational exhaustion was high in 44.4% of participants, while depersonalization was high in 53% of participants. Personal accomplishment was low in 73.5% of participants. Mild, moderate, and severe irritable bowel syndrome was reported in 25.6%, 23.8%, and 12% of participants, respectively. The study highlights a significant association between burnout syndrome and irritable bowel syndrome severity among medical health providers and medical students in Saudi Arabia. These findings underscore the importance of developing effective interventions to prevent and manage burnout syndrome and related health issues among healthcare professionals and medical students in the region.

Low-FODMAP Diet for the Management of Irritable Bowel Syndrome in Remission of IBD.

Approximately 30% of patients with quiescent inflammatory bowel disease (IBD) meet the diagnostic criteria for irritable bowel syndrome (IBS). The aim of this study was to evaluate the effectiveness of a low-FODMAP diet in patients who meet the diagnostic criteria for IBS whilst in IBD remission. A total of 200 patients in remission of IBD were included in the study. Sixty-five of these patients (32.5%) were diagnosed with IBS according to the R4DQ. On the patients who met the IBS diagnostic criteria, anthropometric measurements, laboratory tests and lactulose hydrogen breath tests were performed. A low-FODMAP diet was introduced for 6 weeks. Of the 59 patients with IBS diagnosed at baseline for whom data were collected at the end of follow-up, after the low-FODMAP intervention IBS-like symptoms were not present in 66.1% (n = 39) (95% CI (53.4%; 76.9%)). The difference between the two groups (with SIBO at baseline (33 of 48 patients) and without SIBO at baseline (6 of 11 patients)) in the low-FODMAP diet's effectiveness was not statistically significant (p = 0.586). The low-FODMAP diet improved the gut symptoms of flatulence and diarrhea. It had no effect on the occurrence of constipation. In IBD patients in remission who meet the IBS criteria, the dietary intervention of a low-FODMAP diet is effective for a reduction in IBS-like symptoms, regardless of the coexistence of bacterial overgrowth.

Evaluating Walnut-Fig Syrup as an Innovative Herbal Medicine for Functional Constipation in the Elderly: A Randomized Controlled Clinical Trial

Objectives: Functional constipation (FC), or chronic idiopathic constipation, is one of the most common chronic disorders with no specific cause. Although FC is not associated with the progress of severe disease or additional mortality, it significantly decreases the patients’ quality of life. While several medications are available to treat constipation, there is no adequate treatment response in most cases. Herbal remedies are one of the most widely used options for FC. Materials and Methods: In this double-blind controlled trial, all patients, researchers, and analysts were unaware of the ingredients contained in the drugs, as well as the assigned groups. We recruited a total of 90 elderly patients diagnosed with FC according to the Rome IV diagnostic criteria for irritable bowel syndrome (IBS). Patients were divided into two equal groups (n=45 in each) receiving fig-walnut syrup and lactulose syrup. Then, CBC-FBS-TSH-CR-NA-K-CA tests were taken from all patients, and the developed syrups (walnut-fig or lactulose) were prescribed to patients (15 cc half an hour before bedtime). Results: While 43 (95.6%) patients responded to treatment in the intervention group, 41 (91.1%) patients responded to treatment in the conventional treatment group. There was no statistically significant difference between the two groups in terms of response to treatment (P = 0.677). Conclusions: The results showed that the oral syrups developed in this study improved FC in the elderly and had no side effects.

Central sensitisation in pelvic pain: A cohort study.

Central sensitisation (CS) leads to pain amplification and impacts on the management of pelvic pain (PP). Identification of CS in patients with PP may provide additional treatment pathways and improve patient outcomes. The aims are to quantify the prevalence of questionnaire-predicted CS (QPCS) in patients presenting with PP and investigate associations between QPCS and clinical variables. This was an observational, cross-sectional study. Subjects with PP completed a questionnaire comprising four validated tools: the Central Sensitisation Inventory (CSI) for QPCS, Pain Catastrophising Scale for Catastrophising Trait, Bladder Pain/Interstitial Cystitis Symptom Score for bladder pain syndrome (BPS) and the Rome IV criteria for irritable bowel syndrome (IBS). One hundred and eleven women were enrolled in the study; 74.8% (n=83) had a CSI score of >40, indicating the presence of QPCS. Subjects with QPCS were more likely to screen positive for catastrophising trait (odds ratio (OR) 3.57, 95% CI 1.19-10.76, P=0.02), BPS (OR 11.77, 95% CI 2.13-64.89, P=0.005) and IBS (OR 2.6, 95% CI 1.05-6.43, P=0.04). They were more likely to experience pain for more than two years (OR 4.98, 95% CI 1.94-12.82, P=0.001) and other pain symptoms involving bladder (OR 9.87, 95% CI 2.52-38.67, P=0.001), bowel (OR 3.13, 95% CI 1.31-7.48, P=0.01), back (OR 4.17, 95% CI 1.66-10.51, P=0.002) and vulva (OR 3.61, 95% CI 1.21-10.82, P=0.02). They also had higher previous diagnoses of mental health disorder (OR 3.5, 95% CI 1.5-8.4, P=0.005) or IBS (OR 8.9, 95% CI 1.6-49.1, P=0.01). QPCS occurs frequently in patients with PP, and subjects with QPCS experience more prolonged and complex pain.

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

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

Prevalence of primary eosinophilic colitis in patients with chronic diarrhea and diarrhea-predominant irritable bowel syndrome.

Primary eosinophilic colitis (PEC) is an inflammatory disease caused by the infiltration of eosinophils into the mucosa of the colon, determined after having ruled out other possible causes. It is characterized by abdominal pain and diarrhea and its prevalence is unknown. To know the prevalence of PEC in patients with chronic diarrhea and in those with clinical criteria for diarrhea-predominant irritable bowel syndrome (IBS-D). All patients with chronic noninflammatory diarrhea that were consecutively seen over a decade were studied through colonoscopy, with systematic biopsy. Patients with a known or decompensated organic disease, alarm features, abnormal minimal laboratory test results, and factors associated with eosinophilia were excluded. Patients with the clinical criteria for IBS-D (Rome III) were selected from the general group. Eosinophilic colitis was defined as the presence of>35eosinophils/100 epithelial cells per field in any of the segments. From the 683 patients seen, a total of 545 patients (361 women) were included in the study. Twenty-two cases of PEC were detected, resulting in a prevalence of 4.0%. A total of 343 patients had IBS-D criteria (223 women), with 16 cases of PEC detected, for a prevalence of 4.7%. Colonoscopy was normal, or almost normal, in all the PEC cases detected. The prevalence of PEC was 4.0% in the patients with chronic diarrhea and 4.7% in the patients with IBS-D. Peripheral eosinophilia appeared to be the main distinctive clinical characteristic, but systematic biopsy was essential for making the diagnosis.

Irritable Bowel Syndrome Onset after New Coronavirus Infection COVID-19

Aim. A psychometric comparison in patients with previous irritable bowel syndrome (IBS) vs. those with IBS presenting six months or later since COVID-19 infection.Materials and methods. The study included patients having had COVID-19 infection over 6 months ago and complying with Rome IV criteria (2016). The study cohort was 100 patients with gastrointestinal symptoms. Fourteen patients (cohort 1) complied with the IBS criteria, 5 males and 9 females. A comparison cohort was 40 patients with IBS verified prior to the COVID-19 pandemic (cohort 2), 12 males and 28 females. Data were obtained from the SIPSITEST 9.0 DBMS resource. The control cohort comprised 50 healthy respondents (cohort 3), 23 males and 27 females. Depression was scored with the Beck Inventory, anxiety — with Spielberger—Khanin (adapted STAI) questionnaire; childhood psychogeny has also been assessed.Results. In statistical analysis of cohort 1, mean depression, personality and reactive anxiety scores were 11 ± 2.27, 43.8 ± 1.93 and 46.7 ± 2.05, respectively. Mean values in cohort 2: personality anxiety 47.3 ± 1.46, reactive anxiety 50.7 ± 1.96 and depression 12.85 ± 1.13. With childhood psychogeny, positive answers to at least one question were reported in 9 of 14 (65%) patients in cohort 1 and 33 (82.5%) — in cohort 2. No study inter-cohort differences have been observed for personality or reactive anxiety and depression, nor for the history of childhood psychogeny.Conclusion. The new coronavirus infection entails postinfectious IBS in 6 months after COVID-19.

Neonatal Antibiotics and Food Allergy Are Associated With FGIDs at 4-6 Years of Age.

Antibiotics may contribute to the development of functional gastrointestinal disorders (FGIDs). This study aimed to determine whether antibiotics during the first week of life, infantile colic in the first year of life, gut-associated immune markers at 1 year of age, and allergies at 4-6 years of age in term-born children were associated with a higher prevalence of FGIDs at 4-6 years of age. A prospective observational cohort of 436 term-born infants was followed up at the age of 4-6 years; 151 received broad-spectrum antibiotics (AB+), and 285 healthy controls (AB-). Validated Questionnaire On Pediatric Gastrointestinal Symptoms-Rome III and International Study of Asthma and Allergy in Childhood questionnaires were sent to parents of 418 available children. The independent t-test, chi-squared test or non-parametric test and logistic multivariate regression analyses were used. In total, 340 of 418 (81%) questionnaires were completed. Only the presence of functional abdominal pain was significantly higher in AB+ than AB- (4% vs 0.4%, respectively, P = 0.045). Children with food allergy fulfilled significantly more often the criteria for irritable bowel syndrome (IBS) and abdominal migraine (26% vs 9%, P = 0.002 and 7% vs 1%, P = 0.043, respectively) compared to non-allergic children. No differences in FGIDs existed at the age of 4-6 years between children with and without a history of infantile colic. There were significant differences in gut-associated immune markers between children with and without FGIDs. Antibiotics during the first week of life resulted in a higher risk for functional abdominal pain at 4-6 years. Furthermore, food allergy was associated with IBS and abdominal migraine at 4-6years.

Irritable bowel syndrome in Egyptian medical students, prevalence and associated factors: a cross-sectional study.

Introductionirritable bowel syndrome is a recurrent chronic gastrointestinal functional disorder. Despite it is not dangerous; it carries a significant feedback on self-confidence and quality of life. Medical students are expected to develop irritable bowel syndrome because they are subjected to stress due to over academic pressure. The objectives were to investigate irritable bowel syndrome prevalence, and to detect the related risk factors in this specific group of Egyptian people.Methodsthis cross-sectional study performed in two faculties of medicine in Nile Delta, Egypt. It had been built on self-administered questionnaires including Rome III criteria for diagnosis of irritable bowel syndrome, as well as several questions for gathering socio-demographic information and manifestations suggesting irritable bowel syndrome.Resultsfifty (27.5%) of 182 evaluated medical students achieved criteria of irritable bowel syndrome, 64% of them were mixed type. Irritable bowel syndrome had a significant relationship with coffee, milk products, fewer vegetables, and fruits intake (P=0.034, P=0.044, P<0.001 respectively). Depression, anxiety, and food intolerance were detected to be significantly related to irritable bowel syndrome (p<0.001, p=0.005, p=0.04) respectively.Conclusionit was demonstrated that many Egyptian medical students were suffering from irritable bowel syndrome. Some dietary habits, anxiety, and depression of the students could be risk factors related to development of irritable bowel syndrome.

Association between Insomnia and Irritable Bowel Syndrome among Adolescents in South Korea: A Quantitative Cross-Sectional Study

Insomnia refers to having difficulty sleeping even when given the opportunity and environment to sleep. Irritable bowel syndrome is a functional bowel disease that is accompanied by abdominal pain and irregular defecation but not organic lesions. Although insomnia and irritable bowel syndrome are pathophysiologically related, studies on their relationship among adolescents are lacking. This study aimed to determine the prevalence of insomnia and irritable bowel syndrome among adolescents and the association between them. In May 2021, a survey was conducted among high school adolescents from Daegu Metropolitan City, South Korea, using the Korean version of the Insomnia Severity Index and the Rome IV diagnostic criteria for irritable bowel syndrome. Data were analyzed using chi-square and Mann–Whitney tests and logistic regression analyses. The incidence of insomnia (Insomnia Severity Index score ≥ 10) was 18.4% (n = 74) while that of irritable bowel syndrome was 10.7% (n = 43). Irritable bowel syndrome was strongly associated with an increased incidence of insomnia (odds ratio = 3.30, 95% confidence interval: 1.66–6.53). Therefore, the association between insomnia and irritable bowel syndrome has relevance in the treatment of insomnia in adolescents.

The role of mood state and emotion regulation in the discrepancy between gastrointestinal symptom burden recorded prospectively and via recall questionnaire.

There is limited empirical evidence of the magnitude of the discrepancy between prospectively recorded gastrointestinal symptom burden and that reported in recall questionnaires. Further, potential sources of the discrepancy are largely unknown. This study sought to quantify the discrepancy and to evaluate the potential role of mood disorder and emotion regulation in the discrepancy. One hundred and forty nine subjects (mean age 20years, 75% female) who met Rome IV criteria for irritable bowel syndrome and/or functional dyspepsia completed a 7-day prospective recording of the symptoms on a smartphone implemented ecological momentary assessment app, and then on day 8 were asked to recall their symptoms for the preceding 7days. Gastrointestinal symptom burden assessed by recall was exaggerated relative to that recorded prospectively. The discrepancy was moderate for overall score (Cohen d=0.52), abdominal pain (d=0.61) and indigestion (d=0.49). The discrepancy was generally larger among subjects who reported a physician diagnosis of a gastrointestinal condition with d=0.87 for overall score and d=0.89 for abdominal pain. A number of correlations between the discrepancy and psychological traits were identified, including neuroticism with diarrhea discrepancy (r=0.23, p=0.004) and visceral-specific anxiety with abdominal pain discrepancy (r=-0.18, p=0.03). There was no evidence of recency or Hawthorne (observer) effects. Reports of gastrointestinal symptoms obtained via recall are likely to be exaggerated relative to the actual patient experience, particularly among healthcare seekers. While psychological traits are likely to play some role, much more needs to be understood about the discrepancy.