Features Of Irritable Bowel Syndrome Research Articles

Chitin-glucan improves important pathophysiological features of irritable bowel syndrome.

Irritable bowel syndrome (IBS) is one of the most frequent and debilitating conditions leading to gastroenterological referrals. However, recommended treatments remain limited, yielding only limited therapeutic gains. Chitin-glucan (CG) is a novel dietary prebiotic classically used in humans at a dosage of 1.5-3.0 g/d and is considered a safe food ingredient by the European Food Safety Authority. To provide an alternative approach to managing patients with IBS, we performed preclinical molecular, cellular, and animal studies to evaluate the role of chitin-glucan in the main pathophysiological mechanisms involved in IBS. To evaluate the roles of CG in visceral analgesia, intestinal inflammation, barrier function, and to develop computational molecular models. Visceral pain was recorded through colorectal distension (CRD) in a model of long-lasting colon hypersensitivity induced by an intra-rectal administration of TNBS [15 milligrams (mg)/kilogram (kg)] in 33 Sprague-Dawley rats. Intracolonic pressure was regularly assessed during the 9 wk-experiment (weeks 0, 3, 5, and 7) in animals receiving CG (n = 14) at a human equivalent dose (HED) of 1.5 g/d or 3.0 g/d and compared to negative control (tap water, n = 11) and positive control (phloroglucinol at 1.5 g/d HED, n = 8) groups. The anti-inflammatory effect of CG was evaluated using clinical and histological scores in 30 C57bl6 male mice with colitis induced by dextran sodium sulfate (DSS) administered in their drinking water during 14 d. HT-29 cells under basal conditions and after stimulation with lipopolysaccharide (LPS) were treated with CG to evaluate changes in pathways related to analgesia (µ-opioid receptor (MOR), cannabinoid receptor 2 (CB2), peroxisome proliferator-activated receptor alpha, inflammation [interleukin (IL)-10, IL-1b, and IL-8] and barrier function [mucin 2-5AC, claudin-2, zonula occludens (ZO)-1, ZO-2] using the real-time PCR method. Molecular modelling of CG, LPS, lipoteichoic acid (LTA), and phospholipomannan (PLM) was developed, and the ability of CG to chelate microbial pathogenic lipids was evaluated by docking and molecular dynamics simulations. Data were expressed as the mean ± SEM. Daily CG orally-administered to rats or mice was well tolerated without including diarrhea, visceral hypersensitivity, or inflammation, as evaluated at histological and molecular levels. In a model of CRD, CG at a dosage of 3 g/d HED significantly decreased visceral pain perception by 14% after 2 wk of administration (P < 0.01) and reduced inflammation intensity by 50%, resulting in complete regeneration of the colonic mucosa in mice with DSS-induced colitis. To better reproduce the characteristics of visceral pain in patients with IBS, we then measured the therapeutic impact of CG in rats with TNBS-induced inflammation to long-lasting visceral hypersensitivity. CG at a dosage of 1.5 g/d HED decreased visceral pain perception by 20% five weeks after colitis induction (P < 0.01). When the CG dosage was increased to 3.0 g/d HED, this analgesic effect surpassed that of the spasmolytic agent phloroglucinol, manifesting more rapidly within 3 wk and leading to a 50% inhibition of pain perception (P < 0.0001). The underlying molecular mechanisms contributing to these analgesic and anti-inflammatory effects of CG involved, at least in part, a significant induction of MOR, CB2 receptor, and IL-10, as well as a significant decrease in pro-inflammatory cytokines IL-1b and IL-8. CG also significantly upregulated barrier-related genes including muc5AC, claudin-2, and ZO-2. Molecular modelling of CG revealed a new property of the molecule as a chelator of microbial pathogenic lipids, sequestering gram-negative LPS and gram-positive LTA bacterial toxins, as well as PLM in fungi at the lowesr energy conformations. CG decreased visceral perception and intestinal inflammation through master gene regulation and direct binding of microbial products, suggesting that CG may constitute a new therapeutic strategy for patients with IBS or IBS-like symptoms.

Tranilast alleviates visceral hypersensitivity and colonic hyperpermeability by suppressing NLRP3 inflammasome activation in irritable bowel syndrome rat models

Visceral hypersensitivity resulting from compromised gut barrier with activated immune system is a key feature of irritable bowel syndrome (IBS). Corticotropin-releasing factor (CRF) and Toll-like receptor 4 (TLR4) activate proinflammatory cytokine signaling to induce these changes, which is one of the mechanisms of IBS. As activation of the NLRP3 inflammasome by lipopolysaccharide (LPS) or TLR4 leads to release interleukin (IL)-1β, the NLRP3 inflammasome may be involved in the pathophysiology of IBS. Tranilast, an anti-allergic drug has been demonstrated to inhibit the NLRP3 inflammasome, and we evaluated the impact of tranilast on visceral hypersensitivity and colonic hyperpermeability induced by LPS or CRF (IBS rat model). Visceral pain threshold caused by colonic balloon distention was measured by monitoring abdominal muscle contractions electrophysiologically. Colonic permeability was determined by quantifying the absorbed Evans blue within the colonic tissue. Colonic protein levels of NLRP3 and IL-1β were assessed by immunoblot or ELISA. Intragastric administration of tranilast (20–200 mg/kg) for 3 days inhibited LPS (1 mg/kg)-induced visceral hypersensitivity and colonic hyperpermeability in a dose-dependent manner. Simultaneously, tranilast also abolished these alterations induced by CRF (50 µg/kg). LPS increased colonic protein levels of NLRP3 and IL-1β, and tranilast inhibited these changes. β-hydroxy butyrate, an NLRP3 inhibitor, also abolished visceral hypersensitivity and colonic hyperpermeability caused by LPS. In contrast, IL-1β induced similar GI alterations to LPS, which were not modified by tranilast. In conclusion, tranilast improved visceral pain and colonic barrier by suppression of the NLRP3 inflammasome in IBS rat models. Tranilast may be useful for IBS treating.

Irritable bowel syndrome (IBS): could we decide what is behind?

Functional visceral problems are frequently present nowadays in the medical practice probably due to the significant mental and emotional load on people. Although physicians and psychophysiologists are active on the field, still we are far from a complete knowledge, despite the fact that scientists like the Hungarian Professor György Ádám already had initiated a new approach called visceral psychophysiology already a long time ago. In this article, we commemorate Professor Ádám by analyzing one of the most frequent functional disorders, irritable bowel syndrome (IBS), calling psychophysiology for help. First, we try to give a definition, then show the general descriptions and characteristics of IBS. Factors like stress, gender, and gastrointestinal pain are followed by the potential role of the immune system and the neuronal factors as well as the supposed brain mechanisms. We hope that this overview of the IBS-history would show how significant scientists can be decisive in certain fields of the science and practice.

Irritable bowel syndrome among adolescents and adults in Riyadh, Saudi Arabia

Objective: This study aimed to evaluate the features of irritable bowel syndrome (IBS) among adolescents and adults in Riyadh, Saudi Arabia. Methods: This cross-sectional study included 510 randomly selected participants from Riyadh in November and December 2022. Data were collected through a self-administered questionnaire distributed on social media and printed in papers containing demographic information, the incidence of IBS, associated factors, and quality of life (QoL). Result: The majority of participants were females (76%) between the ages of 10-20 years (42%), did not have IBS (71%), did not have gastrointestinal tract diseases (75%), were nonsmokers (83%), were not diagnosed with depression (85%), had an income of less than 5,000 Saudi Riyals (39%), had no difficulty in sexual intercourse (56%) and no issues with their closest relationships (60%), and had poor QoL (83%). But individuals from the age group 10-20 years had good QoL (46%). Conclusion: One-third of the study participants were diagnosed with IBS, and the majority had a low QoL. Further public education and prospective research are both welcomed and required.

A comparative clinical study on the effect of Takra Basti and Erandamooladi Niruha Basti in the management of Grahani (IBS)

Background-Grahani roga described in classical text books of Ayurveda represents a group of disorders of digestive system caused by impairment of Agni. Grahani is such a disorder, where in its significance is emphasized by its inclusion among Ashta maha gadas. Aim &amp; Objective- To evaluate the efficacy of Takra Basti and Erandamooladi Niruha Basti individually in each group in the management of Grahani. To compare the efficacy of Takra Basti and Erandamooladi Niruha Basti in the management of Grahani. Methodology- Patients were selected from college attached Hospital of NKJ AMC Bidar. Sample size -A total of 30 patients were selected GROUP A: 15 patients were treated with Takra Basti and Changeryadighrita Anuvasana Basti. GROUP B: 15 patients were treated with Erandamooladi Niruha Basti and Changeryadighrita Anuvasana Basti, Discussion &amp;Conclusion-Among the types of Grahani, clinical features of vataja Grahani have at most similarities with the clinical features of irritable bowel syndrome. Diagnostic criteria of IBS i.e. Rome III criteria is same as the Pratyatmaka lakshanas of Grahani. Takra Basti is having more pratyagamana kala than Eradamooladi Niruha Basti. Both Takra Basti and Eradamooladi Niruha Basti Showed significant results in all the parameters. The efficacy of the treatment group A results was statistically significant of all parameters statistically even after follow up period compared to group B. Hence it can be concluded that IBS can be treated in Ayurveda under the treatment principles of Vataja Grahani.

Factors influencing rectal hypersensitivity in irritable bowel syndrome: A systematic review and meta-analysis.

A frequent, although not universal, feature of irritable bowel syndrome (IBS) is heightened sensitivity to mechanical stimulation of the rectum, termed rectal hypersensitivity (RH). Differences in RH-based on sex, IBS subtype, IBS diagnostic criteria and age of population studied are incompletely understood. We aimed to determine whether IBS population had lower pain thresholds than healthy controls. We searched MEDLINE and EMBASE databases (1970-2021). Prospective studies that compared pain/discomfort thresholds to mechanical rectal stimuli in IBS and healthy controls were included. Data were pooled for meta-analyses and effect sizes were calculated with 95% confidence interval (CIs). Our search strategy identified 809 studies of which 32 studies met the inclusion criteria. Reduced rectal pain thresholds was more common in IBS patients compared to healthy controls with an effect size of 1.00 95% CIs (0.77-1.24) (p< 0.0001) (I2 = 78.6%). The pediatric IBS population had lower pain thresholds than adult IBS populations (p= 0.05) but no difference based on IBS diagnostic criteria, subtype or sex. The results suggest that reduced rectal pain threshold to experimental stimulation is far more common in IBS patients than healthy controls. Further research is required to understand the pathophysiological and therapeutic implications of rectal sensitivity such as its role in measuring response to treatment and prognosis in IBS.

An Epidemiological Study of Irritable Bowel Syndrome among Students of Medical and Nursing Colleges in Kirkuk University

Background: Irritable Bowel syndrome is a functional bowel disease characterized by abdominal pain associated with change in the frequency and consistency of stool, this study was carried out to study the prevalence and the clinical characteristics of irritable bowel syndrome among students of medical school of Kirkuk university. Subjects and Methods: This is a cross sectional study done among students in medical and nursing college of Kirkuk university from September 2012 to March 2013 according to a standardized questionnaire based on Rome II criteria for the diagnosis of IBS. Results: This study showed that symptoms of IBS is present in (35%) of students in nursing college and (31%) of students in medical college with overall frequency of (33%), also this study showed a frequency of IBS among (24.3%) of female and (11.2%) of male in nursing college while (18.6%) among female, (12.9%) of male in college of medicine. Regarding the type of IBS according to the bowel motion, diarrheal type was present in (41.6%), constipation type in (30.5%) and the mixed type in (27.7%). Conclusion: The present study showed that symptoms of IBS are frequent among students in medical and nursing college and it is commoner in females more than males.

Food Avoidance and Restriction in Irritable Bowel Syndrome: Relevance for Symptoms, Quality of Life and Nutrient Intake

Neither food intake nor the clinical characteristics of irritable bowel syndrome (IBS) patients with severe food avoidance and restriction have been investigated. The aim of our study was to identify those patients and to characterize their symptoms, quality of life, and nutrient intake.IBS patients who completed the IBS Quality of Life Instrument (IBS-QOL) at our secondar and tertiary center were included. The 3 questions constituting the food domain were used to identify patients with reported severe food avoidance and restriction. The patients also completed validated questionnaires to assess stool form (Bristol Stool Form), gastrointestinal (GI) symptom severity (z score of IBS Severity Scoring System and Gastrointestinal Symptom Rating Scale-IBS), psychological distress (Hospital Anxiety and Depression Scale), GI-specific anxiety (Visceral Sensitivity Index), and somatic symptom severity (z score of Symptom Checklist-90-Revised and Patient Health Questionnaire-15). A 4-day food diary was used to analyze food intake in 246 patients.We included 955 IBS patients (75 % women; mean age 38.3 ± 13.3 years). In total, 13.2 % of the patients reported severe food avoidance and restriction, and in these patients all aspects of quality of life were lower (P < .01) and psychological, GI, and somatic symptoms were more severe (P < .05). Reported severe food avoidance and restriction was associated with lower total energy intake (P = .002) and lower intake of protein (P = .001) and carbohydrates (P = .005). In a logistic regression analysis, loose stools were found to be independently associated with reported severe food avoidance and restriction (R2 = 0.062).IBS patients with severe food avoidance and restriction constitute a subgroup with more severe symptoms overall, reduced quality of life, and reduced intake of nutrients. This needs to be acknowledged in the clinical management of these patients.

Mucosal Biofilms Are an Endoscopic Feature of Irritable Bowel Syndrome and Ulcerative Colitis

Background & AimsIrritable bowel syndrome (IBS) and inflammatory bowel diseases result in a substantial reduction in quality of life and a considerable socioeconomic impact. In IBS, diagnosis and treatment options are limited, but evidence for involvement of the gut microbiome in disease pathophysiology is emerging. Here we analyzed the prevalence of endoscopically visible mucosal biofilms in gastrointestinal disease and associated changes in microbiome composition and metabolism.MethodsThe presence of mucosal biofilms was assessed in 1426 patients at 2 European university-based endoscopy centers. One-hundred and seventeen patients were selected for in-depth molecular and microscopic analysis using 16S ribosomal RNA gene amplicon-sequencing of colonic biopsies and fecal samples, confocal microscopy with deep learning–based image analysis, scanning electron microscopy, metabolomics, and in vitro biofilm formation assays.ResultsBiofilms were present in 57% of patients with IBS and 34% of patients with ulcerative colitis compared with 6% of controls (P < .001). These yellow-green adherent layers of the ileum and right-sided colon were microscopically confirmed to be dense bacterial biofilms. 16S-sequencing links the presence of biofilms to a dysbiotic gut microbiome, including overgrowth of Escherichia coli and Ruminococcus gnavus. R. gnavus isolates cultivated from patient biofilms also formed biofilms in vitro. Metabolomic analysis found an accumulation of bile acids within biofilms that correlated with fecal bile acid excretion, linking this phenotype with a mechanism of diarrhea.ConclusionsThe presence of mucosal biofilms is an endoscopic feature in a subgroup of IBS and ulcerative colitis with disrupted bile acid metabolism and bacterial dysbiosis. They provide novel insight into the pathophysiology of IBS and ulcerative colitis, illustrating that biofilm can be seen as a tipping point in the development of dysbiosis and disease.

Protective effect of HCN2-induced SON sensitization on chronic visceral hypersensitivity in neonatal-CRD rat model

Abnormal brain-gut interactions contribute to the development of chronic visceral hypersensitivity (CVH), which is the pivotal feature of irritable bowel syndrome (IBS). Despite the consensus with respect to the vital role of hyperpolarization-activated cyclic nucleotide-gated 2 (HCN2) channels in promoting painful symptoms in the peripheral nervous system, we identified that the upregulation of HCN2 in supraoptic nucleus (SON) was involved in the modulation of CVH in rat model of neonatal colorectal distention (n-CRD). Specifically, colorectal distention (CRD) upregulated the expression of c-Fos in SON in adult CVH rats, indicating the involvement of SON sensitazation in visceral sensation. Moreover, the administration of ZD7288 (the pan-HCN channel inhibitor) rather than 8-Br-cAMP (the non-specific HCN channel agonist) aggravated the CVH symptoms and reduced the phosphorylation level of CaMKII-CREB cascade. Together, the findings indicated that the upregulation of supraoptic HCN2 contributed to the sensitization of SON, which had protective effects on the modulation of CVH with the involvement of CaMKII-CREB cascade in n-CRD rat model.

Of bowels, brain and behavior: A role for the gut microbiota in psychiatric comorbidities in irritable bowel syndrome.

The gastrointestinal microbiota has emerged as a key regulator of gut-brain axis signalling with important implications for neurogastroenterology. There is continuous bidirectional communication between the gut and the brain facilitated by neuronal, endocrine, metabolic, and immune pathways. The microbiota influences these signalling pathways via several mechanisms. Studies have shown compositional and functional alterations in the gut microbiota in stress-related psychiatric disorders. Gut microbiota reconfigurations are also a feature of irritable bowel syndrome (IBS), a gut-brain axis disorder sharing high levels of psychiatric comorbidity including both anxiety and depression. It remains unclear how the gut microbiota alterations in IBS align with both core symptoms and these psychiatric comorbidities. In this review, we highlight common and disparate features of these microbial signatures as well as the associated gut-brain axis signalling pathways. Studies suggest that patients with either IBS, depression or anxiety, alone or comorbid, present with alterations in gut microbiota composition and harbor immune, endocrine, and serotonergic system alterations relevant to the common pathophysiology of these comorbid conditions. Research has illustrated the utility of fecal microbiota transplantation in animal models, expanding the evidence base for a potential causal role of disorder-specific gut microbiota compositions in symptom set expression. Moreover, an exciting study by Constante and colleagues in this issue highlights the possibility of counteracting this microbiota-associated aberrant behavioral phenotype with a probiotic yeast, Saccharomyces boulardii CNCM I-745. Such data highlights the potential for therapeutic targeting of the gut microbiota as a valuable strategy for the management of comorbid psychiatric symptoms in IBS.

Prevalence and Symptom Characteristics of Irritable Bowel Syndrome Among Bronchial Asthma Patients in Pakistan

Introduction: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that leads to a variety of symptoms including abdominal discomfort and change in stool frequency and consistency. Asthma is a common disease of the airway. Some studies have suggested that a relationship between IBS and asthma exist, while others have contradicted the claim. This study aims to determine the prevalence of IBS in asthmatic patients and compare their symptoms with symptoms of IBS patients in non-asthmatic patients.Methodology: In this case-control study, 100 known and documented asthmatic patients were included as cases, and 100 non-asthmatic healthy patients were included as controls from July to August 2019. These patients were given a questionnaire based on ROME II criteria for the diagnosis of IBS. Prevalence and symptoms of IBS were compared between cases and controls. A probability level, P < 0.05 was considered significant. Result: IBS was found in 41 out of 100 asthma patients (41%) and 18 out of 100 controls (18%) with a P-value of 0.0005 and was more common in females in both asthmatic (63.41%) and non-asthmatic patients (66.66%). Symptoms such as abdominal pain/distress (63.41% vs. 11.11%, P-value: 0.0013) and bloating (82.92% vs. 33.33%, P-value: 0.0005) were significantly higher in asthmatic patient with IBS compared to non-asthmatic patient with IBS.Conclusion: Prevalence of IBS among asthma patients was significantly higher as compared to non-asthmatics. Routine screening of asthma patients and further studies to understand the pathogenesis underlying association between IBS and asthma should be conducted to detect and manage such patients effectively.

Association between pain sensitivity and gray matter properties in the sensorimotor network in women with irritable bowel syndrome.

BackgroundEnhanced perception of visceral stimuli is an important feature of Irritable Bowel Syndrome (IBS), but it is not known whether visceral sensitivity is associated with regional structural brain properties in IBS.MethodsStructural brain magnetic resonance imaging data from 216 women with IBS and 138 healthy women were parcellated with FreeSurfer to define regional gray matter morphometry (volume, cortical thickness, surface area and mean curvature) in the sensorimotor network. General linear models were used to detect group differences between IBS and health. In a second set of 48 female IBS patients, pain threshold, pain intensity ratings during rectal balloon distension, and reported levels of abdominal pain and bloating were correlated with brain regions that showed differences between IBS and health in the first data set.Key ResultsSeveral statistically significant differences between IBS patients and healthy controls were found, mainly higher gray matter volume and cortical thickness in primary somatosensory cortex, secondary somatosensory cortex, and subcortical regions, and lesser gray matter volume, surface area and cortical thickness in posterior insula and superior frontal gyrus. Pain intensity ratings during rectal distension were associated with left primary somatosensory cortical thickness, and pain threshold was associated with right nucleus accumbens volume.Conclusions and InferencesRegional gray matter differences in sensorimotor network are associated with visceral sensitivity and may represent neuroplastic changes in female IBS patients.

Rectal Hypersensitivity in Irritable Bowel Syndrome and Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Objectives: A frequent, although not universal, feature of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD), is heightened sensitivity to mechanical stimulation of the rectum, termed rectal hypersensitivity (RH). Differences in RH based on gender, IBS/IBD subtype, presence of inflammation and adult compared to paediatric populations are incompletely understood. We aimed to determine the magnitude of RH in IBS/IBD compared to healthy controls. Design: We searched MEDLINE and EMBASE databases (1970-2018). Prospective studies that compared pain/ discomfort thresholds to mechanical rectal stimuli in IBS/IBD and healthy controls were included. Data was pooled for meta-analyses and Hedges’ g effect sizes were calculated with 95% confidence interval (CIs). Results: Our search strategy identified 684 studies of which 31 studies met the IBS inclusion criteria. RH was more common in IBS patients effect size 0.97 95% CI (0.77-1.17), p < 0.0001, I2 = 77.2%. Paediatric IBS populations were more likely to be hypersensitive than adult populations (p = 0.04) but there were no differences based on diagnostic criteria, subtype or gender. In 8 studies met the IBD inclusion criteria, RH was not more common in IBD patients effect size 0.46 95% CI (-0.21-1.12), p = 0.18, I2 = 87.6% except during disease flares (p = 0.02). RH is more common in IBS than IBD populations (p = 0.0001). Conclusions: The results suggest that reduced rectal pain threshold to experimental stimulation is a marker of IBS. RH is not normally present in IBD except during active inflammation. Further research is required to understand the pathophysiological and therapeutic implications of rectal sensitivity in IBS compared to IBD. Funding Statement: AA was funded by the People Programme of the European Union’s Seventh Framework Programme under REA grant agreement no.607652 (NeuroGu). ADF was supported by the West Midlands Clinical Research Network Scholarship. Declaration of Interests: None of the authors have any conflict of interests to declare.

Abdominal Massage Reduces Visceral Hypersensitivity via Regulating GDNF and PI3K/AKT Signal Pathway in a Rat Model of Irritable Bowel Syndrome.

Changes in gut motility and visceral hypersensitivity are two major features of irritable bowel syndrome (IBS). Current drug treatments are often poorly efficacious, with many side effects for patients with IBS. Complementary therapies, such as acupuncture or abdominal massage, have received more attention in recent years. In this study, a rat model of IBS with diarrhea (IBS-D) was established by instillation of acetic acid from the colon. The effects of abdominal massage on changes in gut motility, visceral hypersensitivity, and the possible mechanism were investigated. Continuous abdominal massage could decrease the stool consistency score and increase the efflux time of glass beads compared with model groups, while also decreasing mast cell counts in IBS-D rats. The mRNA and protein expressions of neuronal nitric oxide synthase (nNOS), choline acetyl transferase (CHAT), and protein gene product 9.5 (PGP9.5) were significantly upregulated by continuous abdominal massage compared with model groups. Continuous abdominal massage also improved the ultrastructure of enteric glial cells (EGCs) by decreasing the number of mitochondria and increasing the level of the heterochromatin. Meanwhile, continuous abdominal massage could upregulate the expression of glial cell line-derived neurotrophic factor (GDNF) and P-Akt/Akt. Furthermore, it could reduce visceral hypersensitivity and improve the IBS-D symptoms by regulating the phosphoinositide 3-kinase (PI3K)-Akt pathway, which would provide a novel method for the treatment of IBS-D in the clinical setting.

Study of Psychological Factors in Etiopathogenesis of Grahani with special reference to Irritable Bowel Syndrome

Grahani Roga described in classical text books of Ayurveda represents a group of disorders of digestive system caused by impairment of Agni. Grahani is such a disorder, where in its significance is emphasized by its inclusion among Ashta Maha Gadas. The cardinal features of Grahani explained in the classical text books of Ayurveda, have at most similarities with the clinical features of Irritable Bowel Syndrome (IBS) explained in Modern medicine. Since one is Adhara and the other is Adheya, one can influence the other. Thus it is clear that somatic disorders have a Psychological backup. So to remove a disease from its root, the causative psychological factors should also be understood and ruled out completely. Psychological Factors are the tools to understand the state of Manas. According to Charaka Samhita imananasthana assessment of Manasika Bhavas or Psycological Factors like Chinta, Krodha, Kama, Shoka and Bhaya can be done by Anumana Pramana. Ayurvedic texts clearly state the Manasika hetus of Grahani Roga in general. Since separate Nidana Panchakas are not mentioned individually for Grahani Roga. Samanya Nidana is applicable for Grahani Roga also. Influence of Psychological factors in the Chikitsa is also mentioned. Since Grahani Roga is a Pitta Vata predominant disease, the Psychological Factors which can easily be disturbed by Vata and Pitta Dosha also have significant role in it. The study shows the understanding of Psychological Factors in detail and etiopathogenesis of Psychological Factors in the manifestation and prevention of recurrence of Grahani roga.

Presentation and Characteristics of Abdominal Pain Vary by Irritable Bowel Syndrome Subtype: Results of a Nationwide Population-Based Study.

Abdominal pain is a cardinal feature of irritable bowel syndrome (IBS); however, differences in abdominal pain among IBS subtypes remain unknown. We aimed to characterize abdominal pain symptoms among established IBS subtypes using data from the National Gastrointestinal (GI) Survey. Individuals participating in the National GI Survey completed National Institutes of Health GI Patient-Reported Outcomes Measurement Information System (GI-PROMIS) questionnaires. Adults meeting modified Rome III IBS criteria and reporting abdominal pain in the previous 7 days were eligible. Outcomes included abdominal pain severity, bothersomeness, interference with daily activities, frequency, and location. Results were stratified by subtype (diarrhea [IBS-D], constipation [IBS-C], and mixed [IBS-M]). Regression models adjusted for demographics and comorbidities. One thousand one hundred fifty-eight individuals (245 IBS-D, 232 IBS-C, and 681 IBS-M) with active IBS symptoms (defined as abdominal pain in the past 7 days) were included. Demographics were similar among the subtypes except for age, race/ethnicity, education, and marital status. The GI-PROMIS score was lower for IBS-D (percentile score of 68.6, SD = 25.1; P = 0.001) and IBS-M (69.1, SD = 25.1; P < 0.001) compared with IBS-C (75.5, SD = 20.7). Abdominal pain was more bothersome (P = 0.001), caused more interference with daily activities (P = 0.03), and was more frequent (P = 0.047) for individuals with IBS-C compared with individuals with IBS-D. No differences in these domains were seen between individuals with IBS-D and IBS-M. Individuals with IBS-C and IBS-M had more widespread pain compared with those with IBS-D. In this population-based study, we found that abdominal pain characteristics differ between the IBS subtypes. Namely, individuals with IBS-C experience more bothersome, frequent, and diffuse abdominal pain compared with those with IBS-D.

Contemporary concepts of gender- and age-related features of irritable bowel syndrome

Contemporary concepts of gender- and age-related features of irritable bowel syndrome

443 – Intestinal Biofilms are an Endoscopic Feature of Irritable Bowel Syndrome

443 – Intestinal Biofilms are an Endoscopic Feature of Irritable Bowel Syndrome

Irritable bowel syndrome in children: new in diagnostics and treatment

In the review there are presented the modern scientific concept of the shaping of irritable bowel syndrome (IBS) in children, giver significant etiological aspects of IBS. Genetic and epigenetic, immure and inflammatory, neurological, and psychological factors, chamges im the imtestimal microbiota with emvirommemtal imfluemces were determimed to superimpose manifestations of visceral hypersensitivity and disorders of intestinal motility in the clinical picture of IBS, which in turn depends or a complex interaction between the intestine and the nervous system in the regulation of the digestive system of a growimg orgamism. There has beem formulated the statememt that IBS is a biopsychosocial disorder imvolving disturbances at different levels of the regulation ofpathological mechanisms - from the psycho-social impact to the sensory-motor dysfunction due to a combination of disorders of visceral sensitivity and motor activity of the intestine. New diagnostic methods and means of comprehensive treatment of this common form of the disease in children are described, diagnostic features of IBS in the ambulatory conditions are determined. There are considered various groups of pharmacological agents used in the treatment of IBS, mechanisms of action of artispasmodic drugs of new generations, features of the use ofprebiotics and probiotics, as well as medications for psychosomatic correction.