Female Irritable Bowel Syndrome Patients Research Articles

Different segmental transit times in patients with irritable bowel syndrome and “normal” colonic transit time: is there a correlation with symptoms?

The Rome criteria serve as gold standard for establishing a diagnosis of irritable bowel syndrome (IBS), but only represent a cluster of symptoms. On the other hand, measurement of colonic transit time (CTT) with radiopaque markers is a solid and more objective method to quantify functional abnormalities. The goal of this study was to investigate whether the IBS symptoms, as defined in the Rome II criteria, correspond to objective physiological parameters, i.e. CCTs. The study enrolled 148 healthy control subjects and 1385 consecutive IBS patients. Transit times were measured for the whole rectocolon (overall CTT) and for 3 segments (right colon, left colon, rectosigmoid area); segmental distribution of markers and diffusion coefficients were also assessed. In order to analyze homogeneous groups, we restricted analysis to subjects with "normal" CTT (< or =70 hours). Six hundred forty four IBS patients (46%) and 14 control subjects (9%) had CTT >70 h and were eliminated. In subjects with CTT < or =70 h, CTT did not follow a normal (Gaussian) distribution. We identified 3 different CTT clusters in healthy controls and 4 clusters in IBS patients. Even if CTT was not significantly different between clusters, each cluster was characterized by a specific pattern of segmental colonic transit. There was a marked gender difference: women had longer overall CTT values than men, both in control and IBS patient groups (p<0.001). However, female IBS patients had significantly shorter colorectal transit times than female controls (p<0.001), as well as faster transit than in men through the left colon and rectosigmoid area. There were no significant differences in transit time between male IBS patients and male controls with the exception of a faster rectal transit in IBS patients (p<0.01). There was no association between segmental colonic transit values and sign or symptoms comprising the Rome II criteria. In subjects with CTT < or =70 h, CTT does not follow a normal distribution but is clustered in subgroups that can be distinguished only by measuring segmental colonic transit. Within these subgroups, there is a marked difference in transit times between IBS patients and normal subjects, suggesting that IBS patients with "normal" CTT are not "normal". The Rome II criteria do not reflect differences in segmental transit times in IBS patients with "normal" CTT. We therefore propose to evaluate segmental transit times in IBS patients with "normal" CTT, before and after treatment, in order to correctly interpretate variations in signs and symptoms. These findings have important implications in evaluating the effect of drugs on bowel function and should help define better inclusion criteria for studies evaluating new drugs for the treatment of IBS.

Biopsychosocial Coping and Adjustment of Adult Female Irritable Bowel Syndrome Patients

This study describes the biopsychosocial coping and adjustment of adult female Irritable Bowel Syndrome (IBS) patients in managed health care. The non-probability convenience sample consisted of 36 adult women aged between 18 and 60 years, recruited at a managed health care facility in the Nelson Mandela Metropole, and who volunteered to become part of this study. A biographical questionnaire and two paper-and-pencil measures were used to collect the data. The Coping Resources Inventory (CRI) was used to identify the coping resources used by the participants and the Personal, Home, Social and Formal Relations Questionnaire (PHSF), was used as a measure of biopsychosocial adjustment. The biographical questionnaire screened important demographic information essential for the contextual interpretation of results. Descriptive statistics and correlation coefficients were used in the data analysis. The sample perceived themselves as having slightly lower than average levels of coping resources as well as slightly below-average levels of adjustment. Social resources were more readily relied on as a means of coping, and superior adjustment was also indicated in terms of interpersonal and social functioning. A positive correlation was found between patients' coping resources and their adjustment.

Irritable bowel syndrome in UK adult women: diagnosis and treatment

Irritable bowel syndrome (IBS) is a transcultural condition affecting 10−22% of the UK population with twice as many females presenting as males (British Society of Gastroenterology (BSG), 2006). Symptoms may be gastrointestinal, non-colonic and extraintestinal but present most commonly as abdominal pain and altered bowel habit. There is no specific diagnostic test and the multiplicity of symptoms makes effective treatment difficult. This can have a significant impact on the quality of life of sufferers. IBS constitutes 20−50% (BSG, 2006) of the outpatient gastroenterology workload and results in an enormous financial cost to primary and secondary care. This article explores the role of the gastroenterology nurse specialist working with female IBS patients in a multi-cultural society. Diagnosis and treatment of patients is discussed as well as quality-of-life issues, diet, cultural beliefs and values, and the financial cost to the UK economy.

Attenuation of the colorectal tonic reflex in female patients with irritable bowel syndrome

Alterations in normal intestinointestinal reflexes may be important contributors to the pathophysiology of irritable bowel syndrome (IBS). Our aims were to compare the rectal tonic responses to colonic distension in female IBS patients with predominant constipation (IBS-C) and with predominant diarrhea (IBS-D) to those in healthy females, both fasting and postprandially. Using a dual barostat assembly, 2-min colonic phasic distensions were performed during fasting and postprandially. Rectal tone was recorded before, during, and after the phasic distension. Colonic compliance and colonic sensitivity in response to the distension were also evaluated fasting and postprandially. Eight IBS-C patients, 8 IBS-D patients, and 8 age- and sex-matched healthy subjects (group N) participated. The fasting increments in rectal tone in response to colonic distension in both IBS-C (rectal balloon volume change -4.6 +/- 6.1 ml) and IBS-D (-7.9 +/- 4.9 ml) were significantly reduced compared with group N (-34 +/- 9.7 ml, P = 0.01). Similar findings were observed postprandially (P = 0.02). When adjusted for the colonic compliance of individual subjects, the degree of attenuation in the rectal tonic response in IBS compared with group N was maintained (fasting P = 0.007; postprandial P = 0.03). When adjusted for colonic sensitivity there was a trend for the attenuation in the rectal tonic response in IBS patients compared with group N to be maintained (fasting P = 0.07, postprandial P = 0.08). IBS patients display a definite attenuation of the normal increase in rectal tone in response to colonic distension (colorectal reflex), fasting and postprandially. Alterations in colonic compliance and sensitivity in IBS are not likely to contribute to such attenuation.

Absence of increasing cortical fMRI activity volume in response to increasing visceral stimulation in IBS patients.

Cerebral cortical activity associated with perceived visceral sensation represents registration of afferent transduction and cognitive processes related to perception. Abnormalities of gut sensory function can involve either or both of these processes. Cortical registration of subliminal viscerosensory signals represents cerebral cortical activity induced by stimulation of intestinal sensory neurocircuitry without the influence of perception-related cortical activity, whereas those associated with perception represent both neural circuitry and cognitive processes. Our aims were to determine and compare quantitatively cerebral cortical functional magnetic resonance imaging (fMRI) activity in response to subliminal, liminal, and nonpainful supraliminal rectal distension between a group of irritable bowel syndrome (IBS) patients and age/gender-matched controls. Eight female IBS patients and eight age-matched healthy female control subjects were studied using brain fMRI techniques. Three barostat-controlled distension levels were tested: 1) 10 mmHg below perception (subliminal), 2) at perception (liminal), and 3) 10 mmHg above perception (supraliminal). In control subjects, there was a direct relationship between stimulus intensity and cortical activity volumes, ie., the volume of fMRI cortical activity in response to subliminal (3,226 +/- 335 microl), liminal (5,751 +/- 396 microl), and supraliminal nonpainful stimulation (8,246 +/- 624 microl) were significantly different (P < 0.05). In contrast, in IBS patients this relationship was absent and fMRI activity volumes for subliminal (2,985 +/- 332 microl), liminal (2,457 +/- 342 microl), and supraliminal nonpainful stimulation (2,493 +/- 351 microl) were similar. Additional recruitment of cortical fMRI activity volume in response to increasing stimulation from subliminal to liminal and supraliminal domains is absent in IBS patients, suggesting a difference in the processing of perceived stimulation compared with controls.

Sex-based differences in gastrointestinal pain

Recent interest has focused on sex-related differences in irritable bowel syndrome (IBS) physiology and treatment responsiveness to novel pharmacologic therapies. Similar to a variety of other chronic pain conditions and certain affective disorders, IBS is more prevalent amongst women, both in population-based studies as well as in clinic-based surveys. Non-painful gastrointestinal symptoms, constipation and somatic discomfort are more commonly reported by female IBS patients. While perceptual differences to rectosigmoid stimulation are only observed following repeated noxious stimulation of the gut, sex-related differences in certain sympathetic nervous system (SNS) responses to rectosigmoid stimulation are consistently seen. Consistent with experimental findings in animals, current evidence is consistent with a pathophysiological model which emphasizes sex-related differences in autonomic and antinociceptive responses to certain visceral stimuli.

Sex differences of brain serotonin synthesis in patients with irritable bowel syndrome using alpha-[11C]methyl-L-tryptophan, positron emission tomography and statistical parametric mapping.

Irritable bowel syndrome (IBS) is the most common functional bowel disorder and has a strong predominance in women. Recent data suggest that the brain may play an important role in the pathophysiology of IBS in the brain-gut axis. It is strongly suspected that serotonin (5-HT), a neurotransmitter found in the brain and gut, may be related to the pathophysiology of IBS. It is reported that a 5-HT3 antagonist is effective only in female patients with diarrhea-predominant IBS. In the present study, 5-HT synthesis was measured using positron emission tomography, with alpha-[11C]methyl-L-tryptophan as the tracer, in patients with IBS. The aim of the present study was to compare 5-HT synthesis in the IBS patients with that in the controls, and to compare 5-HT synthesis between male and female IBS patients. Six male and six female nonconstipated IBS patients were scanned. Age-matched healthy volunteers were scanned as controls. Eighty minute dynamic scans were performed. Functional 5-HT synthesis images were analyzed using statistical parametric mapping. 5-HT synthesis was greater only in the female IBS patients in the right medial temporal gyrus (multimodal sensory association cortex) compared with the female controls (P<0.001). The greater brain 5-HT synthesis in the female IBS patients than in the controls may be related to the pathological visceral pain processing of the IBS patients, a larger female predominance of the disorder, and the sex difference of the efficacy of the 5-HT3 antagonist in treatment.

Is sleep disorder treatment appropriate for premenstrual syndrome?

Acta Obstet Gynecol Scand 2003; 82: 99. © Acta Obstet Gynecol Scand 2003 Sir , Medical literature suggests that the symptoms of irritable bowel syndrome (IBS) are analogous with the gastrointestinal and sleep disorder-related mood symptoms of premenstrual syndrome (PMS). The literature reports that IBS is secondary to sleep disorders (1). Consequently this suggests that sleep disorder treatment would alleviate both the gastrointestinal and mood symptoms of PMS and improve the quality of life of PMS patients. Violent diaphragm action during respiratory events (VDA), a characteristic common to upper airway resistance syndrome (UARS) and obstructive sleep apnea (OSA), underlies irritable bowel syndrome (IBS) (1). The clinician evaluates the symptoms of IBS unaware that the symptoms of two disorders have melded. The gastrointestinal symptoms of PMS are similar to the symptoms of an IBS patient who is in remission during the menstrual cycle follicular phase. Some mood symptoms of sleep apnea are depression, irritability, mood swings and concentration difficulties (2). Nocturia, headache and fatigue are some of the physical symptoms (2, 3). The synchronism of PMS with altered bowel habits in female IBS patients (4) is impossible for male IBS patients. Altered bowel habits in IBS patients are associated with the previous night's sleep disturbances (5). However, women are diagnosed with IBS more than twice as often as men (6) despite sleep apnea being about twice as prevalent in men as in women (7). For this prevalence reversal to occur, a unique factor that increases sleep disturbance must exist in females. Lower sleep efficiency during the luteal phase than the follicular phase of the menstrual cycle (8) is consistent with increased sleep disturbance experienced by IBS patients during PMS. In PMS, bowel habits change on a monthly cycle. If sleep disorders are a factor in such changes, sleep quality would vary between the follicular and luteal phases of the menstrual cycle. Again, lower sleep efficiency during the luteal phase than the follicular phase of the menstrual cycle (8) is consistent with increased sleep disturbance experienced during PMS. The luteal phase of the menstrual cycle should be included with respiratory allergies, alcohol consumption (2) and supine sleeping (9) as exacerbators of OSA. The exacerbators of a sleep disorder precipitate altered sleep disturbances and consequently could lead to changed bowel habits. Irritable bowel syndrome, premenstrual syndrome, chronic pelvic pain, chronic fatigue syndrome and Fibromyalgia are the diagnoses for the same set of symptoms depending on the specialty of the physician consulted (10). Whether IBS is different from PMS, patients of either disorder experience sleep disturbances, which change their bowel habits. Therefore, treatment for sleep disorders would alleviate the sleep disorder and gastrointestinal symptoms of PMS. There is precedence for utilizing sleep disorder treatments to manage menstrual cycle associated symptoms. Continuous positive airway pressure (CPAP) successfully treated dysmenorrhea and amenorrhea (11). CPAP is a treatment for both OSA and upper airway resistance syndrome (UARS). With CPAP the prescription fixed pressure is determined during a sleep study. However, considering the nightly variations in sleep disturbance the patient would be more likely to comply with a device that adjusted the treatment pressure based on the patient's need. As the various manufacturers' models of automatic adjusting positive airway pressure machines use different methods of detecting the patient's instantaneous pressure requirement, patient compliance will be best with a machine whose detection algorithm matches that patient's unique characteristics.

Autonomic functioning during REM sleep differentiates IBS symptom subgroups.

The aim of this study was to investigate autonomic activity by means of heart rate variability analysis in a sample of irritable bowel syndrome (IBS) patients, allowing stratification into IBS symptom subgroups. Thirty-three female IBS patients (mean age 37 yr) and 21 healthy female controls (mean age 38 yr) participated. Patients were stratified into 16 subjects with only lower bowel symptoms (IBS only) and 17 subjects with both lower bowel and dyspeptic symptoms (IBS+D). The protocol included standard polysomnography to assess stages of sleep with concomitant electrocardiographic measurement of beat-to-beat intervals of the cardiac cycle. Fifteen-min segments were selected from presleep waking, stage 2 of non-rapid eye movement (REM), and REM sleep and analyzed by spectral analysis of heart rate variability to calculate the high-frequency band, a measure of vagal tone, and the low-frequency/high-frequency ratio, an indicator of sympathovagal balance. The high-frequency band power during REM sleep was significantly lower, indicating substantial vagal withdrawal in IBS-only patients compared with IBS+D patients and controls. The low-frequency/high-frequency band ratio was significantly higher during REM sleep for IBS-only patients. IBS-only patients had greater sympathetic dominance, indicated by elevated low-frequency/high-frequency band ratio, during REM sleep because of vagal withdrawal. Autonomic functioning, unique to REM sleep, differentiates IBS symptom subgroups, suggesting that autonomic functioning during REM sleep may be a useful biological marker to identify IBS patient subgroups.

Alterations in cerebral potentials evoked by rectal distension in irritable bowel syndrome.

Central nervous system correlates of the visceral hyperalgesia documented in patients with irritable bowel syndrome are limited. Reproducible cerebral evoked potentials can be recorded in response to rhythmic balloon distension of the rectum in healthy adults. Irritable bowel syndrome patients and healthy subjects were studied to compare the characteristics of mechanically-evoked rectal cerebral potentials obtained during fasting and after the ingestion of a standard meal. Twenty-two pairs of age-matched healthy female subjects and female irritable bowel syndrome patients were studied. Cerebral evoked potentials were recorded in response to rhythmic rectal distension (two distension series each of 100 repetitions at 0.8 hertz); cerebral evoked potential recordings were repeated after a 1000 kcal (46% fat) liquid meal. Trait and state anxiety questionnaires were also completed. Compared to healthy subjects, irritable bowel syndrome patients demonstrated higher prevalence of cerebral evoked potential early peaks (latency < 100 ms) postprandially, and uniformly shorter cerebral evoked potential latencies both before and after feeding. These findings provide further objective evidence for defective visceral afferent transmission in irritable bowel syndrome patients.

Alterations in cerebral potentials evoked by rectal distension in irritable bowel syndrome

OBJECTIVE: Central nervous system correlates of the visceral hyperalgesia documented in patients with irritable bowel syndrome are limited. Reproducible cerebral evoked potentials can be recorded in response to rhythmic balloon distension of the rectum in healthy adults. Irritable bowel syndrome patients and healthy subjects were studied to compare the characteristics of mechanically-evoked rectal cerebral potentials obtained during fasting and after the ingestion of a standard meal. METHODS: Twenty-two pairs of age-matched healthy female subjects and female irritable bowel syndrome patients were studied. Cerebral evoked potentials were recorded in response to rhythmic rectal distension (two distension series each of 100 repetitions at 0.8 hertz); cerebral evoked potential recordings were repeated after a 1000 kcal (46% fat) liquid meal. Trait and state anxiety questionnaires were also completed. RESULTS: Compared to healthy subjects, irritable bowel syndrome patients demonstrated higher prevalence of cerebral evoked potential early peaks (latency < 100 ms) postprandially, and uniformly shorter cerebral evoked potential latencies both before and after feeding. CONCLUSION: These findings provide further objective evidence for defective visceral afferent transmission in irritable bowel syndrome patients.

Autonomic functioning during REM sleep differentiates IBS symptom subgroups

Abstract OBJECTIVE: The aim of this study was to investigate autonomic activity by means of heart rate variability analysis in a sample of irritable bowel syndrome (IBS) patients, allowing stratification into IBS symptom subgroups. METHODS: Thirty-three female IBS patients (mean age 37 yr) and 21 healthy female controls (mean age 38 yr) participated. Patients were stratified into 16 subjects with only lower bowel symptoms (IBS only) and 17 subjects with both lower bowel and dyspeptic symptoms (IBS+D). The protocol included standard polysomnography to assess stages of sleep with concomitant electrocardiographic measurement of beat-to-beat intervals of the cardiac cycle. Fifteen-min segments were selected from presleep waking, stage 2 of non-rapid eye movement (REM), and REM sleep and analyzed by spectral analysis of heart rate variability to calculate the high-frequency band, a measure of vagal tone, and the low-frequency/high-frequency ratio, an indicator of sympathovagal balance. RESULTS: The high-frequency band power during REM sleep was significantly lower, indicating substantial vagal withdrawal in IBS-only patients compared with IBS+D patients and controls. The low-frequency/high-frequency band ratio was significantly higher during REM sleep for IBS-only patients. CONCLUSIONS: IBS-only patients had greater sympathetic dominance, indicated by elevated low-frequency/high-frequency band ratio, during REM sleep because of vagal withdrawal. Autonomic functioning, unique to REM sleep, differentiates IBS symptom subgroups, suggesting that autonomic functioning during REM sleep may be a useful biological marker to identify IBS patient subgroups.

Review article: gender-related differences in functional gastrointestinal disorders.

Many functional gastrointestinal disorders and other chronic visceral pain disorders such as interstitial cystitis and chronic pelvic pain are more common in women than in men. In irritable bowel syndrome (IBS) there is a 2:1 female to male ratio in prevalence of symptoms in community samples. Female irritable bowel syndrome patients are more likely to be constipated, complain of abdominal distension and of certain extracolonic symptoms. While animal studies have clearly demonstrated gender-related differences in pain perception and antinociceptive mechanisms, unequivocal evidence for gender-related differences in human pain perception or modulation has only been provided recently. Gender-related differences may be related to constant differences in the physiology of pain perception, such as structural or functional differences in the visceral afferent pathways involved in pain transmission or modulation, and/or they may be related to fluctuations in female sex hormones. Preliminary evidence suggests that female irritable bowel syndrome patients show specific perceptual alterations in regards to rectosigmoid balloon distension and that they show differences in regional brain activation measured by positron emission tomography. This preliminary evidence suggests that gender-related differences in symptoms and in the perceptual responses to visceral stimuli exist in IBS patients and can be detected using specific stimulation paradigms and neuroimaging techniques.

Review article: the safety and efficacy of alosetron, a 5-HT3 receptor antagonist, in female irritable bowel syndrome patients.

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal-related conditions. In this review, the safety and efficacy of alosetron, a potent and selective 5-HT3 receptor antagonist, in the treatment of IBS are discussed. Alosetron has been shown to produce statistically significant improvements in abdominal pain, stool consistency, stool frequency and urgency in female IBS patients. By contrast, no consistent improvement has been seen in male IBS patients treated with alosetron. The only adverse event of note with alosetron was constipation, and this represents a class effect of 5-HT3 receptor antagonists. In conclusion, alosetron is a safe and effective treatment for female IBS patients.

Physiological modulation of jejunal sensitivity in health and in irritable bowel syndrome.

In irritable bowel syndrome (IBS), enhanced sensitivity to distention of the small bowel has been demonstrated. We sought to compare, in healthy subjects and in IBS patients, the effects on jejunal sensitivity and compliance of feeding, nonperceived rectal mechanoreceptor stimulation, and the above two stimuli in combination. Eleven female IBS patients (49 +/- 13 yr)--six with predominant constipation (IBS-C), and five with predominant diarrhea (IBS-D)--and seven healthy female controls (39 +/- 13 yr) participated. Jejunal distention was applied during fasting, 30 min after a 400-kcal meal, and also during simultaneous nonperceived rectal stimulation. Jejunal sensitivity was increased after feeding in IBS patients (p = 0.004), specifically in IBS-C patients (p = 0.0001) and in controls (p = 0.02), and was reduced during rectal stimulation in IBS patients (p = 0.0001)--both in IBS-D (p = 0.0001) and in IBS-C (p = 0.03) patients--but not significantly so in controls (p = 0.06). Jejunal sensitivity remained unaltered in both IBS patients and controls during concurrent feeding and rectal stimulation. Physiological stimuli in different parts of the gut modify the intensity of jejunal perception, and the interaction of such stimuli further modifies enteric sensitivity. Nonperceived rectal stimulation appears to modify the intensity of jejunal perception to a greater extent in IBS than in health.

Abnormal colonic fermentation in irritable bowel syndrome

The cause of irritable bowel syndrome (IBS) is unknown. It may follow gastroenteritis and be associated with an abnormal gut flora and with food intolerance. Our study was designed to assess whether these factors were associated with colonic malfermentation. We carried out a crossover controlled trial of a standard diet and an exclusion diet matched for macronutrients in six female IBS patients and six female controls. During the final 72 h on each diet, faecal excretion of fat, nitrogen, starch, and non-starch polysaccharide NSP was measured, and total excretion of hydrogen and methane collected over 24 h in a purpose-built 1.4 m3 whole-body calorimeter. Breath hydrogen and methane excretion were then measured for 3 h after 20 g oral lactulose. The maximum rate of gas excretion was significantly greater in patients than in controls (2.4 mL/min IQR 1.7-2.6 vs 0.6, 0.4-1.1). Although total gas production in patients was not greater than in controls (median 527 mL/24 h IQR 387-660 vs 412, 234-507), hydrogen production was higher (332, 318-478 vs 162, 126-217, p=0.009). In patients, the exclusion diet reduced symptoms and produced a fall in maximum gas excretion (0.5 mL/min IQR 0.3-0.7). After lactulose, breath hydrogen was greater on the standard than on the exclusion diet. Colonic-gas production, particularly of hydrogen, is greater in patients with IBS than in controls, and both symptoms and gas production are reduced by an exclusion diet. This reduction may be associated with alterations in the activity of hydrogen-consuming bacteria. Fermentation may be an important factor in the pathogenesis of IBS.

Alosetron, a 5HT3-receptor antagonist, is effective in the treatment of female irritable bowel syndrome patients

Alosetron, a 5HT3-receptor antagonist, is effective in the treatment of female irritable bowel syndrome patients