Symptoms Of Diarrhea-predominant Irritable Bowel Syndrome Research Articles

Mechanism of QingHuaZhiXie Prescription Regulating TLR4-IECs Pathway in the Intervention of Diarrhea Predominant Irritable Bowel Syndrome.

To investigate the effect and mechanism of QingHuaZhiXie prescription on diarrhea predominant irritable bowel syndrome (D-IBS), animal models of rats were used in this study. 48 rats were randomly divided into 6 groups, containing one control group, one animal model group (D-IBS group), and four drug intervention groups (low, medium, and high dosage of QingHuaZhiXie prescription and trimebutine maleate intervention group). Abdominal withdrawal reflex (AWR) and Bristol stool form scale were recorded; the expression levels of inflammatory factors (TNF-α and IFN-γ), pathway proteins TLR4, MyD88, NF-κB, and key proteins of tight junction between intestinal epithelial cells (IECs) were detected; the microstructure of intestinal mucosal was observed by hematoxylin and eosin (H&E) staining; MPO activity was detected with immunohistochemical analysis to reflect the inflammation of tissues. Results show that QingHuaZhiXie prescription reduced diarrhea index and intestinal hypersensitivity and intestinal tissue integrity after intervention. MPO activity in QingHuaZhiXie prescription-treated rats was significantly lower relative to their model group. The expression levels of inflammatory factors and TLR4/MyD88/NF-κB pathway proteins were repressed, and the protein levels of occludin and claudin-1 increased. Meanwhile, this study also found that the remission effect of QingHuaZhiXie prescription on D-IBS increased with its dosage increase. Hence, as a therapeutic prescription for D-IBS, QingHuaZhiXie prescription could relieve D-IBS symptoms through balancing the inflammatory factors expression by inhibiting the TLR4/MyD88/NF-κB pathway and maintaining the function and structure of IECs by improving the protein levels of JAM, occludin, claudin-1, and ZO-1.

Improvements over Time in Individual Diarrhea-Predominant Irritable Bowel Syndrome Symptoms (IBS-D) with Rifaximin Repeat Treatment

Improvements over Time in Individual Diarrhea-Predominant Irritable Bowel Syndrome Symptoms (IBS-D) with Rifaximin Repeat Treatment

Mixed MOP/DOP agonist biphalin elicits anti-transit effect in mouse models mimicking diarrhea-predominant irritable bowel syndrome symptoms.

Opioid receptors play a crucial role in the maintenance of homeostasis in the gastrointestinal (GI) tract. The aim of this study was to characterize the effect of biphalin, a mixed MOP/DOP agonist, on mouse intestinal contractility in vitro and GI motility in vivo and in animal models mimicking symptoms of diarrhea-predominant irritable bowel syndrome (IBS-D). The effect of biphalin on muscle contractility in vitro was characterized in the ileum and colon. The anti-transit activity of biphalin in vivo was assessed in the following tests: whole gastrointestinal transit, colonic bead expulsion, fecal pellet output and castor oil-induced diarrhea, alone and in the presence of naloxone, and MOP and DOP antagonists. In vitro, biphalin (10(-10)-10(-6)M) inhibited colonic and ileal smooth muscle contractions in a concentration-dependent, opioid antagonist-reversible manner. In vivo, biphalin at the dose of 5mg/kg ip prolonged the whole GI transit and inhibited colonic bead expulsion. Biphalin reversed hypermotility and exerted anti-diarrheal effect in mouse models mimicking IBS-D symptoms. Biphalin is an interesting template for novel opioid-based agents to be used in therapy of functional GI diseases.

Two gastrointestinal conditions with similar symptoms and endoscopic appearance: irritable bowel syndrome and microscopic colitis.

Irritable bowel syndrome (IBS) is a gastrointestinal condition characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any organic cause. This trial investigated the presence of microscopic colitis (MC) and associated factors related to MC in patients diagnosed with IBS. The study group (group I) consisted of 91 consecutive patients diagnosed with IBS based on the Rome III Criteria for whom colonoscopic examination was requested. The control group (group II) had 41 patients diagnosed with IBS considered as eligible for colonoscopic investigation due to specific conditions, and for whom colonoscopic examination was recommended for screening purposes due to a familial history of colon cancer. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. In the diarrhea-predominant IBS group, nine patients (9.89%) were diagnosed with microscopic colitis, seven with lymphocytic colitis (7.69%), and two with collagenous colitis (CC) (2.19%). None of the patients in group II were found to have MC (P = 0.007). There were no diagnoses of MC in the constipation-predominant and mixed type IBS groups. Clinicians should keep MC in mind for patients presenting with diarrhea-predominant IBS symptoms.

Novel mixed NOP/MOP agonist BU08070 alleviates pain and inhibits gastrointestinal motility in mouse models mimicking diarrhea-predominant irritable bowel syndrome symptoms

The opioid and nociceptin systems play a crucial role in the maintenance of homeostasis in the gastrointestinal (GI) tract. The aim of this study was to characterize the effect of BU08070, a novel mixed MOP/NOP agonist, on mouse intestinal contractility in vitro and GI motility in vivo in physiological conditions and in animal models mimicking symptoms of irritable bowel syndrome (IBS), including diarrhea and abdominal pain. The effect of BU08070 on muscle contractility in vitro was characterized in the ileum and colon. To assess the effect of BU08070 in vivo, the following parameters were assessed: whole GI transit, gastric emptying, geometric center, colonic bead expulsion, fecal pellet output and time to castor oil-induced diarrhea. The antinociceptive activity of BU08070 was characterized in the mustard oil (MO)-induced abdominal pain model and the writhing test, alone and in the presence of MOP and NOP antagonists. in vitro, BU08070 (10−10–10−6M) inhibited colonic and ileal smooth muscle contractions in a concentration-dependent manner. in vivo, BU08070 prolonged the whole GI transit and inhibited colonic bead expulsion. The antitransit and antidiarrheal effects of BU08070 were observed already at the dose of 0.1mg/kg (i.p.). BU08070 reversed hypermotility and reduced pain in mouse models mimicking IBS-D symptoms. Our results suggest that BU08070 has a potential of becoming an efficient drug in IBS-D therapy. Here we also validate mixed NOP/MOP receptor targeting as possible future treatment of functional GI diseases.

Su2034 Diagnosis of Small Intestinal Bacterial Overgrowth by Lactulose Hydrogen Breath Test With Scintigraphic Oro-Caecal Transit Test: Methodological Validation of Diagnostic Criteria in Healthy Controls and Patients With Diarrhea Predominant Irritable Bowel Syndrome

INTRODUCTION: The prevalence of small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome (IBS) patients remains contentious due to continuing uncertainty regarding diagnostic methodology. The lactulose hydrogen breath test (LHBT) is used to detect SIBO; however, recent papers have suggested that the results are confounded by wide variation of oro-caecal transit time. Combination with an independent, scintigraphic assessment of oro-cecal transit time (SOCTT) may address this problem with SIBO diagnosed when there is a rise in breath hydrogen before scintigraphic marker is seen in the caecum. AIM: To determine the most appropriate diagnostic criteria and clinical relevance of SIBO diagnosed using LHBT alone and combined HBT/SOCTT. SUBJECTS: 60 patients with diarrhea predominant irritable bowel syndrome (D-IBS) and 13 healthy controls. METHODS: A systematic analysis of the ability of six published diagnostic criteria to detect SIBO in D-IBS patients and controls was performed (Criteria 1: A H2 rise of ≥20ppm within 180 min; Criteria 2: A H2 rise of ≥20ppm within 90 min; Criteria 3: dual breath H2 peaks; Initial H2 rise, ≥5ppm (Criteria 4), 10ppm (Criteria 5) and 20ppm (Criteria 6) above baseline before the scintigraphic OCTT). In a subgroup of these patients the clinical relevance of these diagnostic markers was tested in an open label study of antibiotic therapy (rifaximin 1200mg/d, 10days). The short-term effect of this treatment on D-IBS symptoms in patients with and without SIBO was assessed. RESULTS: There was a close association between the time to breath H2 increase to 5ppm and 20ppm on LHBT and scintigraphic OCTT in health (R5ppm =0.896, p,0.001; R20ppm =0.860, p=0.003); however this association was lost in D-IBS patients (R5ppm =0.214, p=0.165). A 5ppmH2 increase prior to appearance of cecal contrast (criteria 4) was detected in more D-IBS patients than healthy subjects (28/60 vs. 1/13; p=0.009). This was not the case for other candidate diagnostic markers. Compared to D-IBS patients with negative findings (n=9/32), patients with a positive diagnosis of SIBO based on criteria 4 (n=27/28) had improved D-IBS symptoms following antibiotic therapy (table 1). CONCLUSIONS: Combined LHBT/scintigraphy is required for non-invasive SIBO diagnosis. The presence of a 5ppm increase in breath H2 prior to the arrival of contrast in the cecum may identify a subset of D-IBS patients with SIBO that have good clinical outcomes following antibiotic therapy.

Pharmacologic and Complementary and Alternative Medicine Therapies for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort in association with altered bowel habits (diarrhea and/or constipation). Other gastrointestinal symptoms, such as bloating and flatulence, are also common. A variety of factors are believed to play a role in the development of IBS symptoms, including altered bowel motility, visceral hypersensitivity, psychosocial stressors, altered brain-gut interactions, immune activation/low grade inflammation, alterations in the gut microbiome, and genetic factors. In the absence of biomarkers that can distinguish between IBS subgroups on the basis of pathophysiology, treatment of this condition is predicated upon a patient's most bothersome symptoms. In clinical trials, effective therapies have only offered a therapeutic gain over placebos of 7-15%. Evidence based therapies for the global symptoms of constipation predominant IBS (IBS-C) include lubiprostone and tegaserod; evidence based therapies for the global symptoms of diarrhea predominant IBS (IBS-D) include the probiotic Bifidobacter infantis, the nonabsorbable antibiotic rifaximin, and alosetron. Additionally, there is persuasive evidence to suggest that selected antispasmodics and antidepressants are of benefit for the treatment of abdominal pain in IBS patients. Finally, several emerging therapies with novel mechanisms of action are in development. Complementary and alternative medicine therapies including probiotics, herbal therapies and acupuncture are gaining popularity among IBS sufferers, although concerns regarding manufacturing standards and the paucity of high quality efficacy and safety data remain.