Diagnosis Of Irritable Bowel Syndrome Research Articles

Exploring the burden of irritable bowel syndrome among university students in Saudi Arabia: A study on prevalence, psychological associations, and well-being.

Patients with irritable bowel syndrome (IBS) experience not only a detrimental impact on their physical health but also a significant influence on their psychological well-being. This study aimed to assess the prevalence of IBS among university students, investigating the sociodemographic and lifestyle factors influencing its onset. Furthermore, it explored the potential impact of psychological factors such as depression, anxiety, and overall well-being on the prevalence of IBS. A cross-sectional analytical study was conducted at Saudi Arabian universities in November and December 2023. To collect data, an anonymous, validated, predesigned questionnaire was used. The diagnosis of IBS was carried out using the validated Arabic version of the Rome IV questionnaire. We used the Arabic version of the World Health Organization Well-being Index to assess the participants' well-being. We used the Arabic version of the Hospital Anxiety and Depression Scale (HADS) to identify people who show clinically significant symptoms of anxiety and depression. Our study included a total of 379 university students, 46.7% were female 86.0% of participants resided in urban areas, and 7.2% had been previously diagnosed with IBS. The prevalence of IBS among participants was found to be 31.9%. We observed a significant association between marital status and IBS (χ2 = 3.95, P = .047). Furthermore, the highest prevalence of IBS was observed among students majoring in literary and scientific disciplines (χ2 = 0.952, P = .049). Individuals with IBS demonstrate a significantly higher prevalence of anxiety (71.90% vs 41.09%, P < .001) and depression (64.46% vs 42.64%, P < .001) compared to those without IBS. Furthermore, people with IBS had a slightly higher prevalence of poor well-being (38.84%) compared to those without IBS (33.72%), but this association was not statistically significant. In multivariate analysis, having a family history of IBS [OR = 1.75 (95% CI, 1.06-2.87), P = .029] having borderline anxiety [OR = 7.58, 95% CI (2.12-27.06), P = .012] and anxiety [OR = 16.07, 95% CI (4.57-56.52), P < .001], and depression [OR = 2.97, 95% CI (1.13-7.83), P = .010] were the main significant predictors of IBS among university students. The high prevalence of IBS among university students was associated with a family history of IBS as well as depression and anxiety. Increasing awareness, multidisciplinary support, and access to mental health services is required to ensure university students' well-being.

Children And Adolescents With Irritable Bowel Syndrome: Treatment And Management.

Irritable bowel syndrome (IBS) is a disorder that causes stomach pain in children and adolescents. It may also impact one's quality of life. IBS is linked to gastrointestinal issues such as diarrhoea and constipation. Despite the identification of several potential pathophysiological pathways, the aetiology of IBS remained unknown. The aim of this paper is to discuss the diagnosis, pathogenesis, case studies and treatment of Irritable bowel syndrome in children and adolescents. This systematic review covered relevant papers from the previous ten years that were accessible in Science Direct, Elsevier, NCBI, and Web of Science related to the pathophysiology and function of pharmacological drugs such as antidepressants, antispasmodics, prokinetics, and antibiotics in children with irritable bowel syndrome. Only a few prospective therapy techniques have been investigated in children, and even fewer of those have been demonstrated to be effective. This article presents case studies including 50-59 children, which demonstrate a favourable acceptable impact that is more effective than a placebo in terms of reducing symptoms and improving the overall quality of life in children who have irritable bowel syndrome. Furthermore, the majority of the pathophysiological explanations and treatment options discussed are based on adult studies. These major issues arose when treating paediatric IBS, and they must be addressed in order to properly treat children with IBS. Trials that focus on many combinations of pharmacological and non-pharmacological therapies seem to be more helpful. In recent years, a number of systematic reviews have been conducted to evaluate the efficacy of medication treatments in children for IBS; however, the dependability of these systematic reviews needs to be further investigated owing to the various experimental designs and levels of evidence used. This article highlights paediatric therapy options, including pharmaceutical medications such as antidepressants, antispasmodics, prokinetics, and antibiotics. The goal is to alleviate IBS symptoms while also enhancing the quality of life for children with this illness.

Irritable bowel syndrome in childhood: treatment in accordance with international guidelines

Irritable bowel syndrome (IBS) is diagnosed accor­ding to the Rome IV criteria for functional gastrointestinal di­sorders. It is estimated that 10–15 % of older children and adolescents suffer from IBS. IBS causes abdominal discomfort and pain and can worsen quality of life in children. The article provides an analysis of changes in ideas about pathogenetic mechanisms, approaches to the diagnosis and treatment of IBS in children. Once the diagnosis of IBS is made, it is important to explain to the pa­rents and children that there is no serious underlying disease. This reassurance may be effective treatment in many cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics, laxatives, and antidiarrheals, they play a positive role in severe cases.

Diet and Physical Activity in Fabry Disease: A Narrative Review.

Fabry disease (FD) is caused by mutations in the galactosidase alpha (GLA) gene which lead to the accumulation of globotriaosylceramide (Gb-3). Enzyme replacement therapy (ERT) and oral chaperone therapy are the current pharmacological treatments for this condition. However, in the literature, there is a growing emphasis on exploring non-pharmacological therapeutic strategies to improve the quality of life of patients with FD. In particular, the nutritional approach to FD has been marginally addressed in the scientific literature, although specific dietary interventions may be useful for the management of nephropathy and gastrointestinal complications, which are often present in patients with FD. Especially in cases of confirmed diagnosis of irritable bowel syndrome (IBS), a low-FODMAP diet can represent an effective approach to improving intestinal manifestations. Furthermore, it is known that some food components, such as polyphenols, may be able to modulate some pathogenetic mechanisms underlying the disease, such as inflammation and oxidative stress. Therefore, the use of healthy dietary patterns should be encouraged in this patient group. Sports practice can be useful for patients with multi-organ involvement, particularly in cardiovascular, renal, and neurological aspects. Therefore, the aim of this review is to summarize current knowledge on the role of nutrition and physical activity in FD patients.

Prevalence and Associated Risk Factors of Irritable Bowel Syndrome Among General Population: A Cross-Sectional Study in Qassim Region, Saudi Arabia.

Background Irritable bowel syndrome (IBS) affects 10-20% of the global population, primarily manifesting as functional issues leading to abdominal discomfort. Key contributors like genetics, psychological factors, weakened immunity, and environmental pollutants play significant roles. Regional variations exist, with prevalence rates ranging from 7-10% in certain areas like South Asia and the Middle East to as high as 20% in many Western countries. Objective The objective of this study is to assess the prevalence of irritable bowel syndrome (IBS) and its related risk factors among the general populace of the Qassim region, Saudi Arabia, aiming to offer valuable insights for healthcare planning and intervention strategies. Methods A cross-sectional descriptive study was conducted, utilizing a validated self-administered questionnaire among residents of the Qassim region aged over 18 years. The questionnaire included demographic information about the participants and the validated Rome IV questionnaire for IBS in adults. Ethical approval for the study was obtained from the Qassim Research Ethics Committee, and data analysis was conducted using R script language version 4.3.3. A significance level of p < 0.05 was employed to interpret the results. Results Overall, significant associations were observed between IBS diagnosis and food allergy (AOR = 2.34, 99% CI: 1.27-4.29), family history of IBS (Adjusted Odd Ratio (AOR) = 7.03, 99% CI: 3.51-15.74), and abdominal pain lasting more than six months (AOR = 2.54, 99% CI: 1.49-4.33). Conclusion This study highlights a high IBS prevalence (21.4%) in Saudi Arabia's Qassim region. While no overall soda-IBS link was found, males showed a protective effect. Significant associations were noted between food allergy, family history, and abdominal pain with IBS diagnosis, especially among females. Further research on gender disparities and familial and abdominal pain roles in IBS management is warranted.

Delayed mammalian meat allergy (Alpha-Gal Syndrome) and hereditary angioedema in the differential diagnosis of irritable bowel syndrome

Delayed mammalian meat allergy (Alpha-Gal Syndrome) and hereditary angioedema in the differential diagnosis of irritable bowel syndrome

Co-Morbidities of Irritable Bowel Syndrome in a Racially and Ethnically Diverse Population.

Introduction: Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction (DGBI), and associated co-morbidities worsen quality of life. Research concerning IBS co-morbidities in different racial/ethnic groups is very sparse. This study aimed to determine the prevalence rates of co-morbidities and possible differences in a multiracial/ethnic IBS cohort. Methods: Based on ICD-9-coded IBS diagnosis, 740 outpatients (≥18 years) were included in this retrospective study at Boston Medical Center. Demographics and ICD-9-coded co-morbidities were extracted from electronic records. Descriptive statistics and multiple logistic regression were used for data analyses. Results: The most prevalent co-morbidities in this IBS cohort included gastroesophageal reflux disorder (GERD) (30%), depression (27%), anxiety (23%), (chronic obstructive pulmonary disease) COPD/asthma (16%), and obesity (10%). GERD was more prevalent in Hispanics and Blacks (p = 0.0005), and non-ulcer dyspepsia (NUD) was more prevalent in Blacks and Asians (p = 0.003). Higher rates of diabetes mellitus type 2 (DMT2) (p = 0.0003) and depression (p = 0.03), but not anxiety (p = 0.9), were present in Blacks and Hispanics. GERD was significantly associated with Hispanics (p = 0.003), dependent on age, overweight, and obesity. NUD was significantly associated with Blacks (p = 0.01) and Asians (p = 0.006), independent of sex, age, and BMI. Cancer of the thyroid, ovaries, and testis occurred at a five-fold higher rate than expected. Conclusions: Significant racial/ethnic differences exist for IBS co-morbidities in this study cohort, including depression, DMT2, GERD, and NUD. Certain cancers were found to be more frequent in this IBS sample as compared with the general population.

The Time-Dependent Association Between Irritable Bowel Syndrome and All-Cause and Cause-Specific Mortality: A Prospective Cohort Study Within the UK Biobank.

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders, but few studies have evaluated mortality risks among individuals with IBS. We explored the association between IBS and all-cause and cause-specific mortality in the UK Biobank. We included 502,369 participants from the UK Biobank with mortality data through 2022. IBS was defined using baseline self-report and linkage to primary care or hospital admission data. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality using multivariable Cox proportional hazards regression models within partitioned follow-up time categories (0-5, >5-10, and >10 years). A total of 25,697 participants (5.1%) had a history of IBS at baseline. After a median follow-up of 13.7 years, a total of 44,499 deaths occurred. Having an IBS diagnosis was strongly associated with lower risks of all-cause (HR = 0.70, 95% CI = 0.62-0.78) and all-cancer (HR = 0.69, 95% CI = 0.60-0.79) mortality in the first 5 years of follow-up. These associations were attenuated over follow-up, but even after 10 years of follow-up, associations remained inverse (all-cause: HR = 0.89, 95% CI = 0.84-0.96; all-cancer: HR = 0.87, 95% CI = 0.78-0.97) after full adjustment. Individuals with IBS had decreased risk of mortality from breast, prostate, and colorectal cancers in some of the follow-up time categories. We found that earlier during follow-up, having diagnosed IBS was associated with lower mortality risk, and the association attenuated over time. Additional studies to understand whether specific factors, such as lifestyle and healthcare access, explain the inverse association between IBS and mortality are needed.

Risk Associated with Antibiotic in Irritable Bowel Syndrome (IBS), Role of Microbiota and Future Aspects

Irritable bowel syndrome (IBS) is functional gastrointestinal (GI) disorder that characterized by abdominal pain in relation to disturbed bowel habits. It is a substantial burden on both patient health –related quality of life and healthcare cost. Although various path physiologic mechanisms have been formulated including visceral hypersensitivity, altered bowel motility, gut- brain dysregulations but it is believed that gut microbiome plays an important role in the genesis of symptoms. The composition and diversity of the gut micro biota can be modified by use of antibiotics, as they have the capacity to diminish the levels of advantageous bacteria while allowing the proliferation of detrimental bacteria. It is well known that micro biome takes a crucial role in development of IBS, but antibiotics itself is a potential risk factors for IBS has not been clarified yet. However, lack of highly predictive diagnostics biomarkers and the complexity and the heterogeneity of IBS patients make management difficult and unsatisfactory in most of the cases, thereby reducing patient health- related quality of life and increasing the sanitary burden. So, this review would help us to understand the risk factors associated with antibiotics in developing IBS, the role of gut micro biome and the other potential future approaches which are useful for the diagnosis, prevention and treatment of irritable bowel syndrome.

Association of healthy lifestyle behaviours with incident irritable bowel syndrome: a large population-based prospective cohort study

ObjectivesTo evaluate the association between healthy lifestyle behaviours and the incidence of irritable bowel syndrome (IBS).DesignPopulation-based prospective cohort study.SettingThe UK Biobank.Participants64 268 adults aged 37 to 73 years who had...

Assessing Diagnostic Performance of Modifications to the Rome IV Criteria for Irritable Bowel Syndrome

The gold standard symptom-based criteria for diagnosis of irritable bowel syndrome (IBS) are the Rome IV criteria.1 These are more restrictive than their predecessor, Rome III, because the cardinal feature required to meet criteria for IBS was changed to presence of abdominal pain alone, rather than abdominal pain or discomfort.2 This change was made because discomfort was believed to be an ambiguous term, with no equivalent in some languages. In addition, symptom frequency required for the presence of abdominal pain was increased to 1 day per week from 2 to 3 days per month. This has led to reduced sensitivity for detecting IBS and a 50% decrease in the prevalence of the disorder in the community.3,4 In a cross-sectional survey applying both Rome IV and III criteria to people living with IBS, 89% of those with Rome III-defined IBS not meeting Rome IV criteria did not meet Rome IV criteria because of this change in pain frequency.5 Previous iterations of the Rome criteria have performed only modestly in predicting a diagnosis of IBS.6-8 However, in a validation study, the Rome IV criteria outperformed Rome III,9 largely because their more restrictive nature made them more specific than Rome III. We assessed whether modifications to the Rome IV criteria led to a better trade-off between sensitivity and specificity.

Association Between Celiac Disease and Irritable Bowel Syndrome: A Nationwide Cohort Study

Background & aimsTo determine the risk of irritable bowel syndrome (IBS) diagnosis in patients with celiac disease (CD) compared to general population comparators. MethodsUsing Swedish histopathology and register-based data, we identified 27,262 patients with CD diagnosed in 2002-2017 and 132,922 age- and sex-matched general population comparators. Diagnoses of IBS were obtained from nationwide inpatient and non-primary outpatient records. Cox regression estimated hazard ratios (aHRs) for IBS adjusted for education level and Charlson Comorbidity Index. To reduce potential surveillance bias our analyses considered incident IBS diagnosis ≥1 year after CD diagnosis. Using conditional logistic regression, secondary analyses were calculated to estimate odds ratios (ORs) for IBS diagnosis ≥1 year before CD diagnosis. ResultsDuring an average of 11.1 years of follow-up, 732 (2.7%) celiac patients were diagnosed with IBS vs. 1,131 (0.9%) matched general population comparators. Overall (≥1 year of follow-up), the aHR for IBS was 3.11 (95% confidence interval, CI=2.83-3.42), with an aHR of 2.00 (95%CI=1.63-2.45) after ≥10 years of follow-up. Compared to siblings (n=32,010), celiac patients (n=19,211) had a ≥2-fold risk of later IBS (aHR=2.42; 95%CI=2.08-2.82). Compared to celiac patients with mucosal healing, those with persistent villus atrophy on follow-up biopsy were less likely to be diagnosed with IBS (aHR=0.66; 95%CI=0.46-0.95). CD was also associated with having an earlier IBS diagnosis (OR=3.62; 95%CI=3.03-4.34). ConclusionsIn patients with CD, the risk of IBS is increased long before and after diagnosis. Clinicians should be aware of these long-term associations and their implications on patient management.

A Systematic Review: Fecal Bacterial Profile in Patients with Irritable Bowel Syndrome Analyzed with the GA-Map Dysbiosis Test Based on the 16S rRNA Gene of Bacterial Species or Groups.

The diagnosis of irritable bowel syndrome (IBS) is based on symptom-based criteria due to lack of reliable disease-specific biomarkers. Gut microbiota is perturbed in IBS and when comparing different methods used to analyze gut microbiota, the results might be obscured. Therefore, in this systematic review we aimed to investigate the profile of fecal bacterial markers and dysbiosis index (DI) in patients with IBS and IBS subgroups compared to healthy controls (HCs) conducted by the same method (GA-map Dysbiosis Test based on16S rRNA sequencing). We searched PubMed, EMBASE (Ovid) and Cochrane Library for case-control studies comparing fecal gut microbiota analyzed with the GA-map® Dysbiosis Test (Oslo, Norway) in patients with IBS and HCs. Our outcomes were the difference in fecal bacterial markers and DI in patients with IBS and IBS subgroups compared to HCs. The search identified 28 citations; five articles were included. Most studies evaluated fecal bacterial markers and DI in patients with diarrhea-predominant IBS (IBS-D). Results of fecal bacteria profile in IBS and IBS subgroups compared to HCs are inconsistent, however, two studies showed increased levels of Ruminococcus gnavus in IBS-D compared to HCs and results of DI indicated IBS and IBS subgroups (especially IBS-D) having higher DI compared to HCs. This systematic review revealed inconsistent findings in respect to differences in bacterial markers between IBS and IBS subgroups with HCs in studies using the GA-map Dysbiosis Test based on 16S rRNA sequencing. However, the test is quite novel, and few studies have used the method so far. More research comparing fecal microbiota profile differences in IBS and IBS subgroups compared to HCs utilizing the same method of analysis is needed to give us further insight into the gut bacteria profile in IBS and the clinical consequences of intestinal dysbiosis.

WARNING TO DELAY IN DIAGNOSING MICROSCOPIC COLITIS IN OLDER ADULTS. A SERIES OF CASES.

Microscopic colitis (MC) is a chronic inflammatory bowel disease causing non-bloody diarrhea, and several cases are undiagnosed as a hidden cause of chronic diarrhea. We aimed to report the symptoms, delay diagnosis and the treatment of MC in a case series. All patients were treated at a Gastroenterology reference office from May 2022 to June 2023. Personal history including preexisting disorders, use of medications and smoking habits were collected. The delay between the onset of symptoms and the correct diagnosis was informed. All patients consented to use budesonide MMX (Corament®) off label. During the study period, six Caucasoid patients were diagnosed with MC, five females and one male, between the ages of 65 and 74. All patients had comorbities and were taking multiple prescription drugs. Laboratory findings showed negative serology for celiac disease for all patients, normal levels of albumin and vitamin B12. The delay between the symptoms and the MC diagnosis varied from 2 months to 6 years. All patients had a previous diagnosis of irritable bowel syndrome. All patients were in complete clinical remission during the treatment and referred no side effects of the drug. Older females using high-risk medications are suggestive of MC. Preventing delay in the diagnosis of MC is crucial to improvement in patients´ quality of life. Budesonide MMX appears to be effective, safe and well-tolerated. • Microscopic Colitis is a chronic inflammatory bowel disease causing non-bloody diarrhea. • Several cases are undiagnosed and can be a hidden cause of chronic diarrhea. • Treatment with budesonide MMX (Corament®, off label) was effective and safe.

Assessment of pain intensity and methods of its relief in patients with irritable bowel syndrome

Objective — to develop a questionnaire for assessing the condition of patients with irritable bowel syndrome (IBS); to evaluate clinical effectiveness of personalized diet, synthetic agonist of peripheral opioid receptors m‑, k‑, and d‑ trimebutine maleate, and complex pro‑prebiotic drug (Lactobacillus acidophilus 500 million, Lactobacillus rhamnosus 1 billion, Sacchromyces boulardii 30 million, Bifidobacterium lactis 275 million, Bifidobacterium longum 1 billion, Clostridium butyricum 2 million, Bacillus clausii spores 2 billion, Fructo oligosaccharides 100 mg) in patients with IBS.&#x0D; Materials and methods. To evaluate the clinical effectiveness of the treatment, 28 patients with IBS have been examined. The investigated group included 15 (53.6%) patients with IBS and diarrhea, 11 (39.3%) subjects with mixed IBS, and two (7.1%) patients with IBS and constipation. The age of the patients was 32.5±3.1 years; from them 17 (51.7%) were women and 11 (39.3%) men. Nine women (52.9%) and five (45.5%) men were married, and 11 (64.7%) women and 7 (63.3%) men had higher education. The average duration of the disease in women was 3.4±1.8 years, and 3.1±1.5 years in men. The diagnosis of IBS was established according to the Rome criteria IV revision. Defecation was evaluated according to the Bristol stool scale. All patients filled out the «Questionnaire for a patient with irritable bowel syndrome» before the treatment start and during the treatment. The examined patients were prescribed a personalized diet with account their nutritional status, and drug therapy that included trimebutine maleate (film‑coated tablets) in a dose of 200 to 600 mg depending on pain intensity, and synbiotic (Lactobacillus acidophilus, Lactobacillus rhamnosus, Sacchromyces boulardii, Bifidobacterium lactis, Bifidobacterium longum, Clostridium butyricum, Bacillus clausii spores, Fructo oligosaccharides) in a dose of one capsule twice a day, regardless of the severity of the pain syndrome.&#x0D; Results. Complex treatment with the use of personalized dietary recommendations, synthetic agonist of peripheral opioid receptors trimebutine maleate and synbiotic that included Lactobacillus acidophilus, Lactobacillus rhamnosus, Sacchromyces boulardii, Bifidobacterium lactis, Bifidobacterium longum, Clostridium butyricum, Bacillus clausii spores, Fructo oligosaccharides, promoted to the decrease of pain syndrome severity, improvement of the psychoemotional state and quality of life of patients.&#x0D; Conclusions. The developed questionnaire for a patient with IBS was comprehensible and easy to fill out by patients; it allowed a practitioner to quickly analyze the dynamics of the pain syndrome. Personalized dietary treatment, a differentiated approach in administration of the peripheral opioid receptor agonist trimebutine maleate and synbiotics (Lactobacillus acidophilus, Lactobacillus rhamnosus, Sacchromyces boulardii, Bifidobacterium lactis, Bifidobacterium longum, Clostridium butyricum, Bacillus clausii spores, IBS oligosaccharides) was clinically effective for patients with IBS, it promoted the significant pain relief and improvement of the quality of life of patients.

Knowledge, attitude and practice of community pharmacists toward irritable bowel syndrome, Sudan

Irritable Bowel Syndrome (IBS) is a common disorder affecting around 20% of the populations worldwide. Treatment of IBS typically focuses on managing predominant symptoms and the pathophysiology, such as the visceral hypersensitivity. This study was conducted to assess community pharmacist knowledge, attitude and practice of Irritable Bowel Syndrome in Khartoum locality.A descriptive cross-sectional study was done. The study was performed among all community pharmacist working at the pharmacies in the study area. Ethical approval from the Ministry of health was first granted (NUSU2021/3-5), then approvals was obtained from each of pharmacy administration. Pharmacists that were registered by Sudan medical counsel, while pharmacy technician and other staff were excluded. Association among variables was assessed through chi-square test, all tests were considered significant when p <0.05.Most of the pharmacist were females (68%, n= 70). Fifty-eight percent (n=60) had good knowledge about IBS. Ninety-three percent (n=96) knew the common symptoms. Eighty-six percent (n=89) of the participants reported that the diagnosis of IBS was based on symptoms. Although the knowledge score was good, but their knowledge about medications and lifestyle modifications was poor. Good attitude was noticed in 55% (n= 57) of the pharmacists. Sixty-one percent (n=63) of pharmacists agree with that they need courses regarding IBS. Fifty-one percent (n= 53) of them agreed with IBS has become one of the most health problems they were involved. Also fifty-one percent (n=53) of them agree with that the symptoms of IBS never disappear. Regarding practice, 63% (n= 65) of pharmacists had good practice.Majority of the participants had good knowledge and attitude and practice about IBS. The need for continuous education was recommended by the participants.

Prevalence of and factors associated with symptoms consistent with a diagnosis of irritable bowel syndrome among resident physicians in standardised training in China: a cross-sectional study

ObjectivesThis study aims to investigate the incidence of and factors associated with irritable bowel syndrome (IBS) among resident physicians in standardised training at eight traditional Chinese medicine (TCM) hospitals in...

Knowledge, Attitude, and Practices Regarding the Rome IV Criteria for the Diagnosis of Irritable Bowel Syndrome Among Primary Healthcare Physicians in Saudi Arabia.

Irritable bowel syndrome (IBS) presents a significant challenge in the medical field due to its complex nature as a functional gastrointestinal illness (FGID) without clear biological markers. Diagnosis often involves ruling out other potential causes, leading to frustration for patients and difficulty in effective treatment. Given its high prevalence among FGIDs, primary healthcare (PHC) physicians play a crucial role in its initial assessment and management. This cross-sectional study surveyed 623 PHC physicians using a structured, closed-ended questionnaire. Employing a multistage sampling approach, physicians were selected from various provinces and cities in Saudi Arabia. Clusters within these cities were also sampled. The research revealed that a majority of physicians (n = 411, 66%) exhibited a strong awareness of the Rome IV criteria, essential for diagnosing IBS. This awareness correlated significantly with variables, such as age, nationality, marital status, specialty, classifications, and years of experience. PHC physicians in the study demonstrated a commendable level of familiarity with the Rome IV criteria for diagnosing IBS. Their knowledge was particularly robust concerning symptoms outlined in these criteria. However, there is room for improvement in their understanding, attitude, and application of the Rome IV guidelines in practice. Addressing these gaps could enhance the overall management of IBS cases by these physicians.

Fecal calprotectin as a marker of inflammatory bowel diseases

Calprotectin is a calcium- and zinc-binding protein belonging to the S100 protein family. This protein is found mainly in the cytoplasm of neutrophils, and, to a lesser extent, in monocytes and macrophages, which can be found in any human organs, but mainly in blood, cerebrospinal fluid, feces, saliva, and synovial fluid. Calprotectin is an effective tool forthe differential diagnosis of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). There is a connection of fecal calprotectin (FC) with the endoscopic activity of IBD, however, the available literature shows significant differences in the sensitivity and specificity of FC for predicting the endoscopic activity of the disease. In addition, FC can be considered as a predictor of histological mucosal healing and as a marker for assessing the response to treatment, including surgical, but there is still no consensus on the threshold value of a biomarker for these purposes. Conflicting data are presented in reports on FC as a predictor of IBD recurrence. FC seems to be effective for detecting relapse, however, there is no specific threshold value, therefore, the marker cannot completely replace endoscopic examination methods. In addition, there is intraindividual variability in the concentration of FC in patients, depending on age, type of feeding in the first year of life, taking medications, which significantly complicates the interpretation of the results.

Exploring the Nutrition Strategies Employed by Ultra-Endurance Athletes to Alleviate Exercise-Induced Gastrointestinal Symptoms-A Systematic Review.

(1) Background: Participation in ultra-endurance sports, particularly ultra-running, has increased over the previous three decades. These are accompanied by high energetic demands, which may be further exacerbated by extreme environmental conditions. Preparation is long-term, comprising of sufficient exercise management, supportive dietary habits, and nutritional intakes for optimal adaptations. Gastrointestinal symptoms are often cited as causing underperformance and incompletion of events. Though the majority do not pose serious long-term health risks, they may still arise. It has been suggested that the nutritional interventions employed by such athletes prior to, during, and after exercise have the potential to alter symptom incidence, severity, and duration. A summary of such interventions does not yet exist, making it difficult for relevant personnel to develop recommendations that simultaneously improve athletic performance by attenuating gastrointestinal symptoms. The aim of this research is to systematically review the literature investigating the effects of a nutrition intervention on ultra-endurance athletes exercise-induced gastrointestinal symptom incidence, severity, or duration. (2) Methods: A systematic review of the literature was conducted (PubMed, CINAHL, Web of Science, and Sports Discus) in January 2023 to investigate the effects of various nutrition interventions on ultra-endurance athletes' (regardless of irritable bowel syndrome diagnosis) exercise-induced gastrointestinal symptoms. Variations of key words such as "ultra-endurance", "gastrointestinal", and "nutrition" were searched. The risk of bias in each paper was assessed using the ADA quality criteria checklist. (3) Results: Of the seven eligible studies, one was a single field-based case study, while the majority employed a crossover intervention design. A total of n = 105 participants (n = 50 male; n = 55 female) were included in this review. Practicing a diet low in short-chain, poorly absorbed carbohydrates, known as fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), as well as employing repetitive gut challenges of carbohydrates, remain the most promising of strategies for exercise-induced gastrointestinal symptom management. (4) Conclusion: Avoiding high-FODMAP foods and practicing repetitive gut challenges are promising methods to manage gastrointestinal symptoms. However, sample sizes are often small and lack supportive power calculations.