Functional Bowel Disorders Patients Research Articles

Passive Smoking Is Associated with the Risk of Functional Bowel Disorders Among College Freshmen.

Background: Functional bowel disorders (FBDs) have detrimental effects on young adults, but the risk factors were not fully explored. This study aimed to investigate the prevalence and potential risk factors of FBDs in college freshmen, including, in particular, the association between passive smoking and the risk and symptoms of FBDs. Methods: A cross-sectional study was conducted in September 2019 in freshmen of Huazhong University of Science and Technology with a random cluster sampling method. Validated questionnaires were voluntarily completed by participants. Rome IV criteria were applied for the diagnosis of FBDs. Univariate analysis and multivariate logistic regression analysis (Model 1: unadjusted; Model 2: adjusted for age and sex; Model 3: adjusted for age, sex, intake frequency of coffee and juice, regular exercise, total sedentary time, sleep quality, interpersonal relationship, and SLSI scores) were performed to determine the potential risk factors of FBDs. Results: A total of 3074 participants were included in this study, among whom 236 college freshmen were diagnosed with FBDs. There was a positive relationship between passive smoking and the risk of FBDs (crude odds ratio [OR] = 2.084, 95% confidence interval [CI]: 1.480, 2.936, Model 1; adjusted OR = 1.825, 95%CI: 1.245, 2.675, Model 3). Moreover, the symptoms of hard stool, exertion, and sensation of obstruction in defecation were more frequent in passive smokers than non-passive smokers among FBD patients. Meanwhile, diarrhea was comparable between passive smokers and non-passive smokers among FBD patients. Conclusions: In the present study, around 7.68% of college freshmen were found to have FBDs. Passive smoking was positively associated with the risk of FBDs. Furthermore, passive smoking was significantly associated with constipation-related symptoms rather than diarrhea among FBD patients.

Treatment of functional bowel disorders in an integrative medicine clinic resulting in improved digestive tract symptoms.

Functional bowel disorders (FBDs), including irritable bowel syndrome (IBS) and others, are conditions without a physically identifiable etiology that, as a result, are difficult to treat. Alternatives to traditional medical interventions are needed because IBS patients require more of physician time and higher healthcare spending. The goal of this study was to determine the efficacy of alternative lifestyle interventions for patients with FBDs seen in an integrative medicine (IM) clinic at an academic medical center. We performed a retrospective chart review to determine whether patients with FBDs had improvement in symptoms following predominantly nutrition-based IM interventions that included recommendations for dietary supplements and elimination diets. We measured symptoms before and after intervention (average time between measurements 8.75 months) using a medical symptoms questionnaire (MSQ) commonly used to quantify symptom change in IM clinics. Digestive tract symptoms, as measured by the MSQ, improved significantly in patients (n = 57) with FBDs following IM intervention. The MSQ Digestive Tract subtotal for FBD patients decreased from 10.2 (SD, 5.4) to 7.2 (SD, 5.2) (P < 0.001) after IM intervention. Patients in an IM clinic had improved digestive tract symptoms scores following IM intervention. Because nutrition-based interventions were the primary intervention recommended by IM providers, primary care physicians and gastroenterologists may wish to consider referring FBD patients to registered dietitian-nutritionists (RDNs) skilled in implementing elimination diets.

The role of repetitive transcranial magnetic stimulation therapy in functional bowel disease.

This study investigates the effectiveness of repetitive transcranial magnetic stimulation (rTMS) as a biophysical therapy for alleviating symptoms of functional bowel disorder (FBD) and associated psychological symptoms by targeting the brain-gut axis. We conducted a comparative analysis involving 226 subjects, comprising the FBD group (n = 113) and a healthy control group (n = 113). Within the FBD group, participants were further divided into those who received rTMS therapy (FBD treatment group, n = 63) and those who did not (FBD control group, n = 50). The FBD treatment group was subcategorized based on the number of rTMS treatments received. We evaluated various factors, including gender, age, monthly household income, daily activity level, and sleep quality, as potential risk factors for FBD. Severity assessments of FBD and associated symptoms (constipation, anxiety, depression, and somatization disorders) were conducted using validated scales before and after treatment. Our findings revealed a higher incidence of FBD in women, with most cases emerging at age 50 or older. We identified lower monthly household income, reduced daily activity levels, and poorer sleep quality as factors associated with a higher likelihood of FBD. FBD patients exhibited higher scores for constipation, anxiety, depression, and somatization disorders compared to healthy controls. rTMS therapy was effective in reducing gastrointestinal symptoms, anxiety, depression, and somatization disorders among FBD patients. Notably, the extent of improvement was positively correlated with the number of rTMS sessions. No adverse effects were observed during the study. Our study underscores the efficacy of biophysical therapy, specifically repetitive transcranial magnetic stimulation, in mitigating FBD symptoms and associated psychological distress. The treatment's effectiveness is positively linked to the frequency of rTMS sessions.

Abdominal Pain Severity Is Mainly Associated with Bloating Severity in Patients with Functional Bowel Disorders and Functional Abdominal Pain

Abdominal pain is a cardinal sign of functional bowel disorders (FBD), in favor of irritable bowel syndrome (IBS). However, the determinants of abdominal pain severity (APS) are unknown. The present study aimed to search the relationships between APS and demographic, psychological, and clinical parameters in tertiary care FBD outpatients. In this retrospective study, we included 2043 new outpatients with FBD or functional abdominal pain. They fulfilled the Rome III questionnaire, psychological evaluation, and four 10-points Likert scale for the perceived severity of constipation, diarrhea, bloating, and abdominal pain. Linear regression was performed for each phenotype to model the severity of abdominal pain with demographic, psychological parameters, and symptoms severity. APS was positively associated with bloating severity in all phenotypes, but APS was also associated with other variables according to gender and phenotype. APS was negatively associated with age and positively with depression, constipation severity, and diarrhea severity in female patients. In male patients, APS was associated with state anxiety, constipation severity, and diarrhea severity. APS severity was associated with bloating severity and transit severity in IBS patients, while in non-IBS patients, APS was only associated with bloating severity. Perceived abdominal pain severity is always associated with perceived bloating severity in FBD and FAP patients.

Long-Term Effect of a Gluten-Free Diet on Diarrhoea- or Bloating-Predominant Functional Bowel Disease: Role of the 'Low-Grade Coeliac Score' and the 'Coeliac Lymphogram' in the Response Rate to the Diet.

1. Background: The long-term effect of a gluten-free diet (GFD) on functional bowel disorders (FBDs) has been scarcely studied. The aim was to assess the effect of a GFD on FBD patients, and to assess the role of both the low-grade coeliac score and coeliac lymphogram in the probability of response to a GFD. 2. Methods: 116 adult patients with either predominant diarrhoea or abdominal bloating, fulfilling Rome IV criteria of FBD, were treated with a GFD. Duodenum biopsies were performed for both pathology studies and intraepithelial lymphocyte subpopulation patterns. Coeliac lymphogram was defined as an increase in TCRγδ+ cells plus a decrease in CD3− cells. A low-grade coeliac score >10 was considered positive. 3. Results: Sustained response to GFD was observed in 72 patients (62%) after a median of 21 months of follow-up, who presented more often with coeliac lymphogram (37.5 vs. 11.4%; p = 0.02) and a score >10 (32 vs. 11.4%; p = 0.027) compared to non-responders. The frequency of low-grade coeliac enteropathy was 19.8%. 4. Conclusion: A GFD is effective in the long-term treatment of patients with previously unexplained chronic watery diarrhoea- or bloating-predominant symptoms fulfilling the criteria of FBD. The response rate was much higher in the subgroup of patients defined by the presence of both a positive low-grade coeliac score and coeliac lymphogram.

Data Mining Approach for the Characterization of Functional Bowel Disorders According to Symptom Intensity Provides a Small Number of Homogenous Groups

Background/Aims: The aim of the present study is to evaluate if the intensity of the cardinal symptoms of functional bowel disorders could be used to identify homogenous groups of patients defined by the Rome criteria. Method: In this observational study, 1,729 consecutive outpatients (73% females) filled out the Rome III questionnaire and 10-point Likert scales for constipation, diarrhea, bloating (BL)/distension, abdominal pain (AP) during the week before the medical consultation. A Gaussian mixture model was used for clustering the patients according to the intensity of symptoms without a priori information, and a classification tree was constructed from this clustering. Data were analyzed using analysis of variance and logistic regression analysis. Results: According to the intensity of symptoms, the patients are divided into 8 groups named according to their main symptomatology: “painful constipation” (PFC), “mild pain constipation” (MPC), “painful diarrhea” (PFD), “mild pain diarrhea” (MPD), “mixed transit” (MT), “BL,” “AP,” and “nonspecific” (NS). The study of the relationship between the Rome III classification and this new grouping shows that irritable bowel syndrome (IBS)-constipation is associated with PFC, IBS-diarrhea with PFD and MPD, SII-mixed with MT, SII-unspecified with BL, functional constipation with PFC and MPC, functional diarrhea with MPD and NS, BL with “BL” and NS, nonspecific functional bowel disorders (FBD) with NS, and functional AP with “BL” and AP (p < 0.01 for all associations). Conclusion: A symptom intensity-based classification of FBD patients could simplify clinical phenotype, give homogeneous groups of patients, and could eventually be used by nongastroenterologists and in clinical research.

Diagnostic Value of Plasma M2-Pyruvate Kinase in Egyptian Patients with Colorectal Cancer

Background: M2-pyruvate kinase (M2-PK) is a tumor growth key regulator and plays a crucial role in tumor metabolism and can dynamically regulate aerobic glycolsis. Notwithstanding, the colonoscopy is the gold standard for early detection of colorectal cancer (CRC), the acceptance of this invasive technique is low. Aim of the work: to assess the diagnostic value of plasma M2-PK in Egyptian patients with CRC. Methods: we measured the plasma M2-PK using Enzyme-linked immunosorbent assay in CRC patients and comparing these levels with those obtained from patients with functional bowel disorders (FBD), inflammatory bowel disease (IBD),colorectal polyp and apparently healthy individuals and to detect its sensitivity and specificity. Results: the value of plasma M2-PK level was higher in CRC patients, 15.22 U/ml than other groups. Average plasma M2-PK was 6.78, 5.28, 2.25 and 2.1 U/ml among colorectal polyp, IBD, FBD patients and normal individuals respectively. The plasma M2-PK can be used in differentiating between CRC and normal individual with 83.33% sensitivity, 100% specificity at area under the curve (AUC) 0.949 with cut-off >6U/ml. Also, it can be used to discriminate between colorectal polyp and CRC patients at cut-off level of >10.6 U/mL with 75.5% sensitivity and 87.5% specificity and to differentiate between FBD and organic colonic lesions at cut-off level >3 U/ml with 81.94% sensitivity and 83.3% specificity. Conclusion: plasma M2-PK was considerably elevated in CRC patients and may be used as non-invasive biomarker for CRC. Recommendation: future researches including a large and long-term follow-up studies are recommended.

NaV1.1 inhibition can reduce visceral hypersensitivity.

Functional bowel disorder patients can suffer from chronic abdominal pain, likely due to visceral hypersensitivity to mechanical stimuli. As there is only a limited understanding of the basis of chronic visceral hypersensitivity (CVH), drug-based management strategies are ill defined, vary considerably, and include NSAIDs, opioids, and even anticonvulsants. We previously reported that the 1.1 subtype of the voltage-gated sodium (NaV; NaV1.1) channel family regulates the excitability of sensory nerve fibers that transmit a mechanical pain message to the spinal cord. Herein, we investigated whether this channel subtype also underlies the abdominal pain that occurs with CVH. We demonstrate that NaV1.1 is functionally upregulated under CVH conditions and that inhibiting channel function reduces mechanical pain in 3 mechanistically distinct mouse models of chronic pain. In particular, we use a small molecule to show that selective NaV1.1 inhibition (a) decreases sodium currents in colon-innervating dorsal root ganglion neurons, (b) reduces colonic nociceptor mechanical responses, and (c) normalizes the enhanced visceromotor response to distension observed in 2 mouse models of irritable bowel syndrome. These results provide support for a relationship between NaV1.1 and chronic abdominal pain associated with functional bowel disorders.

Su1591 - The Impact of a Gi-Specific Behavioral Intervention on Sleep Quality in Functional Bowel Disorder Patients

Su1591 - The Impact of a Gi-Specific Behavioral Intervention on Sleep Quality in Functional Bowel Disorder Patients

Quality of Life, Anxiety, Depression and Sexual Dysfunction in Patients With Chronic Intestinal Diseases

BACKGROUND: "Quality of life" (QoL) has been emphasized to assess the impact of a disease and its treatment in the patient's life. The QoL of chronic patients is significantly impaired, and it can lead to psychological and social changes, engendering anxiety, depression and other injuries, including sexual dysfunction. The aim of this study is to compare the QoL, the presence of anxious and depressive symptoms, the frequency of female sexual dysfunction and erectile dysfunction, and patient's self-esteem in the following groups: Inflammatory Bowel Diseases (IBD), Functional Bowel Disorders (FBD), Colon Cancer (CC) and Control Group (CG). METHODS: Cross-sectional study with specific questionnaires application, approved in the Research Ethics Committee (n.1.356.518). Ninety-nine patients with IBD (43 with Ulcerative Colitis and 56 with Crohn's Disease), 35 with FBD (20 with Chronic Constipation and 13 with Irritable Bowel Syndrome), 33 with CC and 150 healthy controls were interviewed. The SF-36 questionnaire was used to evaluate the Quality of Life, the Hospital Anxiety and Depression Scale (HADS) to assess the presence of anxiety and depression, the Rosenberg Self-esteem Scale to study the patients' self-esteem, the International Index of Erectile Function to evaluate the erectile dysfunction and the Female Sexual Function Index to assess the female sexual dysfunction. Statistical: descriptive and association tests, p <0.05. RESULTS: The mean age was 38.89 (± 10.15) years in the IBD group; 46.77 (± 15.87) in FBD patients; 62.88 (± 11.46) years in the CC group and 36.26 (± 12.39) in the CG. There was a predominance of women in IBD (56.6%), in FBD (97.1%) and in control (67.33%) groups, p <0.0001. Men had a small predominance in the CC group (51.5%), p <0.0001. The quality of life was impaired in the FBD group, with a significant difference compared to IBD (p <0.001) and control groups (p <0.0001). The prevalence of anxiety was higher in FBD patients (77.1%) compared to IBD (47.5%), CC (34.4%) and CG (38.7%), P=0.0003 Depression prevalence was higher in FBD group (60%) compared to the others: CC (40.63%), IBD (24.2%) and CG (21.33%), P<0.0001. Patients had high self-esteem in the majority of cases: CG (96%), IBD (90.9%), CC (93.75%), except in FBD group (61.76%), P<0.0001. There was a high prevalence of Erectile Dysfunction in the sample: FBD (100%), CC (50%), IBD (27.9%) and CG (35.42%) with no difference among groups (P=0.19). The Female Sexual Dysfunction was more prevalent in CC group (100%) compared to the others FBD (66.67%), IBD (46.4%) and CG (33.33%), P<0.0001. CONCLUSION(S): Patients with FBD had a greater impairment in their quality of life compared to IBD and control groups, as well as a higher prevalence of mood disorders compared to patients with organic diseases and the CG. They also had lower rates of high self-esteem. The female sexual dysfunction was higher in CC compared to the others and no difference in erectile dysfunction rates between the groups was found.

Long-term symptom development of functional bowel disease and the effects of lactose-restricted diet on the symptoms

Objective To explore the long-term symptom development in functional bowel disorders (FBD) and the effects of lactose-restricted diet on the symptoms. Methods From January 2008 to December 2010, 805 patients with FBD were included. Among them 245 patients who completed lactose hydrogen breath test and the lactose intake exceeded median value (48.75 g/month) were followed up with telephone interview. The changes of gastrointestinal symptoms, lactose intake and anxiety/depression status of the patients were observed. Chi-square test, t test and inspection rank test were performed for statistically analysis. Binary Logistic regression analysis was used for influence factors analysis. Results Among 805 patients with FBD, there were 432 (53.7%) mild patients and 373 (46.3%) severe patients. The proportions of female patients, patients with gastrointestinal disease history (gastroenteritis, ulcers, chronic diarrhea etc.), anxiety, depression and irritable bowel syndrome (IBS) of severe patients were all higher than those of mild patients (50.4%, 188/373 vs 40.3%, 174/432; 53.6%, 200/373 vs 43.5%, 188/432; 29.5%, 110/373 vs 16.9%, 73/432; 32.2%, 120/373 vs 21.5%, 93/432; 77.2%, 288/373 vs 45.1%, 195/432), and the differences were statistically significant (χ2=8.60, 0.90, 18.10, 22.10 and 8.20, all P<0.05). Among 245 FBD patients included in telephone follow-up, 144 cases (58.8%) were successfully followed up (follow-up group) and the follow-up duration was five to seven years. Since the first visit, some diseases have been detected including five cases of colonic polyps, three cases of ulcerative colitis (UC), three cases of gallbladder common bile duct stones, two cases of H. pylori-related peptic ulcer, one case of digestive tract hemorrhage and one case of chronic pancreatitis. The frequency scores of abdominal pain, abdominal distension, hard stools and loose stools were all lower than initial status (0 (0 to 1) vs 5 (3 to 6), 0 (0 to 1) vs 3 (0 to 5), 0 (0 to 0) vs 0 (0 to 1), 0 (0 to 2) vs 2 (1 to 3)); the general sensation improved compared with that of initial status (2(1 to 2) vs 3(3 to 4)), and the differences were statistically significant (Z=11.23, 7.82, 2.19, 8.42 and 11.49, all P<0.05). During follow-up, anxiety/depression symptoms of patients in follow-up group were improved (4 (3 to 4) vs 3 (3 to 4), 1 (1 to 1) vs 2 (1 to 2)); and the differences were statistically significant ( Z=-5.81 and 5.06, both P<0.01). The median value of lactose intake was decreased compared with before in follow-up group (27.0 g/month (3.0 g/month to 99.8 g/month) vs 135.1 g/month (91.6 g/month to 238.6 g/month)); and the difference was statistically significant (Z=-0.14, P<0.01). Lactose-restricted diet could improve the gastrointestinal symptoms including abdominal pain, bloating, loose stool and overall feelings of patients, and the differences were statistically significant (χ2=6.09, 5.46, 10.04 and 6.40, all P<0.05). Conclusions Over time, there is still possibility that FBD developed into organic diseases. So the patients still needed close follow-up. Lactose-restricted diet could improve the symptoms of FBD. Key words: Functional bowel disorders; Telephone follow up; Symptom development; Lactose-restricted diet; Lactose intolerance

Poor reproducibility of breath hydrogen testing: Implications for its application in functional bowel disorders.

Limited data are available regarding the reproducibility of lactulose and fructose breath testing for clinical application in functional bowel disorders. The purpose of this study was to investigate the reproducibility of lactulose and fructose breath hydrogen testing and assess symptom response to fructose testing. Results were analysed from 21 patients with functional bowel disorder with lactulose breath tests and 30 with fructose breath tests who completed another test >2 weeks later. Oro-caecal transit time, hydrogen responses, both qualitatively (positive/negative) and quantitatively (area under the curve (AUC) for hydrogen), were compared between tests. In another 36 patients, data scores for overall abdominal symptoms, abdominal pain, bloating, wind, nausea and fatigue were collected during the fructose test and compared to hydrogen responses. No correlations were found for lactulose AUC (linear regression, p = 0.58) or transit time (Spearman's p = 0.54) between tests. A significant proportion (30%) lost the presence of fructose malabsorption (p < 0.01). Hydrogen AUC for fructose did not correlate between tests, (r = 0.28, p = 0.17) independent of time between testing (p = 0.82). Whilst patients with fructose malabsorption were more likely to report symptoms than those without (56% vs 17%; p = 0.04), changes in symptom severity were not different (p > 0.05). Routine use of lactulose and fructose breath tests in functional bowel disorder patients is not supported due to its poor reproducibility and low predictive value for symptom responses.

Adding glucose to food and solutions to enhance fructose absorption is not effective in preventing fructose-induced functional gastrointestinal symptoms: randomised controlled trials in patients with fructose malabsorption.

In healthy individuals, the absorption of fructose in excess of glucose in solution is enhanced by the addition of glucose. The present study aimed to assess the effects of glucose addition to fructose or fructans on absorption patterns and genesis of gastrointestinal symptoms in patients with functional bowel disorders. Randomised, blinded, cross-over studies were performed in healthy subjects and functional bowel disorder patients with fructose malabsorption. The area-under-the-curve (AUC) was determined for breath hydrogen and symptom responses to: (i) six sugar solutions (fructose in solution) (glucose; sucrose; fructose; fructose + glucose; fructan; fructan + glucose) and (ii) whole foods (fructose in foods) containing fructose in excess of glucose given with and without additional glucose. Intake of fermentable short chain carbohydrates (FODMAPs; fermentable, oligo-, di-, monosaccharides and polyols) was controlled. For the fructose in solution study, in 26 patients with functional bowel disorders, breath hydrogen was reduced after glucose was added to fructose compared to fructose alone [mean (SD) AUC 92 (107) versus 859 (980) ppm 4 h-1 , respectively; P = 0.034). Glucose had no effect on breath hydrogen response to fructans (P = 1.000). The six healthy controls showed breath hydrogen patterns similar to those with functional bowel disorders. No differences in symptoms were experienced with the addition of glucose, except more nausea when glucose was added to fructose (P = 0.049). In the fructose in foods study, glucose addition to whole foods containing fructose in excess of glucose in nine patients with functional bowel disorders and nine healthy controls had no significant effect on breath hydrogen production or symptom response. The absence of a favourable response on symptoms does not support the concomitant intake of glucose with foods high in either fructose or fructans in patients with functional bowel disorders.

Systematic review with meta-analysis: diagnostic overlap of microscopic colitis and functional bowel disorders.

Microscopic colitis shares certain common clinical manifestations with functional bowel disorders, especially diarrhoea-dominant irritable bowel syndrome (IBS) and functional diarrhoea. However, the exact relationship between microscopic colitis and functional bowel disorders has not been systematically assessed. To conduct a systematic review and meta-analysis on the diagnostic overlap between functional bowel disorders and microscopic colitis. We searched MEDLINE, EMBASE and SCOPUS databases, as well as the abstract books of the major gastroenterology meetings, to investigate the prevalence of microscopic colitis among patients with functional bowel disorders (considering all subtypes of both disorders) and vice versa. Data were pooled with a random-effects model. Of 227 references identified, data were collected from 26 studies and a total of 5,099 adult patients. The pooled prevalence any type of functional bowel disorders in patients who present diagnostic criteria of microscopic colitis was 39.1% (95% CI: 22.8-56.6%; I2 : 97%) and was higher for lymphocytic colitis than for collagenous colitis (40.7% vs. 28.4%, respectively; P = 0.58). The prevalence of microscopic colitis in functional bowel disorders patients was 7% (95% CI: 3.6-11.4%), reaching 9.8% (95% CI: 4.4-17.1%; I2 : 95%) in patients exhibiting diarrhoea-dominant IBS, nonsignificantly higher than microscopic colitis rates among patients with constipation-dominant IBS (1.3%) or mixed-dominant IBS (1.9%). There is a significant overlap of symptoms between microscopic colitis and functional bowel disorders, especially in diarrhoeal subtypes. The high proportion of microscopic colitis among diarrhoea-dominant functional syndromes should serve as a call for more active diagnosis in selected patients.

Use of the Biphasic (13)C-Sucrose/Glucose Breath Test to Assess Sucrose Maldigestion in Adults with Functional Bowel Disorders.

Sucrase insufficiency has been observed in children with of functional bowel disorders (FBD) and symptoms of dietary carbohydrate intolerance may be indistinguishable from those of FBD. A two-phase 13C-sucrose/13C-glucose breath test (13C-S/GBT) was used to assess sucrase activity because disaccharidase assays are seldom performed in adults. When 13C-sucrose is hydrolyzed to liberate monosaccharides, oxidation to 13CO2 is a proportional indicator of sucrase activity. Subsequently, 13C-glucose oxidation rate was determined after a secondary substrate ingestion (superdose) to adjust for individual habitus effects (Phase II). 13CO2 enrichment recovery ratio from 13C-sucrose and secondary 13C-glucose loads reflect the individualized sucrase activity [Coefficient of Glucose Oxidation for Sucrose (CGO-S)]. To determine if sucrase insufficiency could be a factor in FBD, 13C-S/GBT was validated using subjects with known sucrase gene mutation status by comparing 13CO2-breath enrichment with plasma 13C-glucose enrichment. 13C-S/GBT was used to assess sucrose digestion in FBD patients and asymptomatic controls. 13CO2-breath enrichment correlated with the appearance of 13C-sucrose-derived glucose in plasma (r 2 = 0.80). Mean, control group CGO-S-enrichment outcomes were 1.01 at 60′, 0.92 at 75′, and 0.96 at mean 60′–75′ with normal CGO-S defined as >0.85 (95% C.I.). In contrast, FBD patients demonstrated lower CGO-S values of 0.77 at 60′, 0.77 at 75′, and 0.76 at mean 60′–75′ (Chi Square: 6.55; p < 0.01), which points to sucrose maldigestion as a cause of FBD.

Are floating stools associated with specific functional bowel disorders?

Functional bowel disorders are recognized as being common, but remain very difficult to diagnose accurately and to differentiate from one another, despite their significant impact on the quality of life of patients.The aim of this study was to evaluate whether the clinical sign of 'floating stools' is associated with psychological disorders, colonic transit time, or other specific bowel disorders as defined by the Rome III diagnostic criteria. A total of 1252 consecutive patients, referred for and found to have functional gastrointestinal disorders, filled in a standard clinical questionnaire on the basis of the Rome III diagnostic criteria and were asked to provide information on the presence of floating stools. Overall, 344 of these scored positive for functional bowel disorders and underwent psychometric testing and colonic transit time studies. Floating stools were reported by 26% of functional bowel disorder patients and 3% of the other functional gastrointestinal disorder patients (P<0.001). The basic demographic characteristics, psychometric evaluation scores, Bristol stool form scales, and total and segmental colonic transit times were not statistically different according to the presence or not of floating stools in these patients. Logistic regression showed that mixed irritable bowel syndrome was the only functional gastrointestinal disorder associated independently with floating stools (P=0.003). Floating stools are a characteristic of patients with mixed irritable bowel syndrome.

Mo1304 The Effect of YH12852, Novel 5-HT4 Partial Agonist, on Postoperative Ileus in Guinea Pig

Background: Functional bowel disorders (FBDs) are common, impact on quality of life and are associated with significant healthcare costs. The occurrence of FBD symptoms has been linked to dietary intolerance; however the interaction between dietary, demographic, and psychosocial factors has not been assessed in adequately powered, population-based studies. Aims: To investigate the prevalence of FBDs in an Chinese population with lactase deficiency and the contribution of food intolerance (self-reported lactose intolerance (SLI) and lactose intake), psychological factors and stressful life events on FBDs. Methods: Adult subjects (16-74 years) selected at random from the community completed questionnaires detailing demographic information, gastrointestinal symptoms, consumption of lactose, psychological factors, life event stress and quality of life. FBDs were diagnosed by Rome III criteria. A logistic regression model was used to identify independent risk factors that increased the likelihood of subjects reporting FBD symptoms.Results: Complete responses were available from 1999/2115 (94.5%) subjects. 831 (41.6%) reported FBD symptoms. Among them the unspecified functional bowel disorder was the most prevalent (12.6%). The second was functional constipation (FC) (9.9%), the followed by functional bloating (FB)(6.8%),functional diarrhea(FD)(6.5%) and IBS (5.9%). More women than men had functional constipation (6.2% vs. 3.8%, p<0.001) and bloating (4.0% vs. 2.8%, p=0.038) but this was not found for functional diarrhea (3.0% vs. 3.5%) or irritable bowel syndrome (2.9% vs. 3.0%). FBDs reported food intolerance and specifically SLI more often than non-FBDs (28.8% vs. 16.0%, p<0.001) and consumed less lactose (p=0.019). FBD patients had a greater likelihood of depression or anxiety than non-FBDs (both, p<0.001), experienced more Life Event stress than non-FBDs (p<0.001) and reported lower quality of life (p<0.001). The joint effects of psychiatric morbidity, life event stress and lactose intake on the risk of FBDs are observed. In a logistic regression model, independent risk factors for FBDs included SLI (OR 1.81 (95%CI 1.44-2.27, p<0.001)), psychological illness (OR 1.46 (95% CI 1.19-1.81, p<0.001)) and recent life event stress (OR 1.28 (95%CI 1.06-1.55, p=0.009)). Conclusions: FBDs are common in China. Food intolerance, psychological factors and life event stress increase the likelihood of subjects in the general population reporting FBD symptoms. Table 1. The joint association of psychologic disease, life event stress, lactose intake with FBD among subjects.

Mo1303 Inflammation and Impaired Motility in Postoperative Ileus

Background: Functional bowel disorders (FBDs) are common, impact on quality of life and are associated with significant healthcare costs. The occurrence of FBD symptoms has been linked to dietary intolerance; however the interaction between dietary, demographic, and psychosocial factors has not been assessed in adequately powered, population-based studies. Aims: To investigate the prevalence of FBDs in an Chinese population with lactase deficiency and the contribution of food intolerance (self-reported lactose intolerance (SLI) and lactose intake), psychological factors and stressful life events on FBDs. Methods: Adult subjects (16-74 years) selected at random from the community completed questionnaires detailing demographic information, gastrointestinal symptoms, consumption of lactose, psychological factors, life event stress and quality of life. FBDs were diagnosed by Rome III criteria. A logistic regression model was used to identify independent risk factors that increased the likelihood of subjects reporting FBD symptoms.Results: Complete responses were available from 1999/2115 (94.5%) subjects. 831 (41.6%) reported FBD symptoms. Among them the unspecified functional bowel disorder was the most prevalent (12.6%). The second was functional constipation (FC) (9.9%), the followed by functional bloating (FB)(6.8%),functional diarrhea(FD)(6.5%) and IBS (5.9%). More women than men had functional constipation (6.2% vs. 3.8%, p<0.001) and bloating (4.0% vs. 2.8%, p=0.038) but this was not found for functional diarrhea (3.0% vs. 3.5%) or irritable bowel syndrome (2.9% vs. 3.0%). FBDs reported food intolerance and specifically SLI more often than non-FBDs (28.8% vs. 16.0%, p<0.001) and consumed less lactose (p=0.019). FBD patients had a greater likelihood of depression or anxiety than non-FBDs (both, p<0.001), experienced more Life Event stress than non-FBDs (p<0.001) and reported lower quality of life (p<0.001). The joint effects of psychiatric morbidity, life event stress and lactose intake on the risk of FBDs are observed. In a logistic regression model, independent risk factors for FBDs included SLI (OR 1.81 (95%CI 1.44-2.27, p<0.001)), psychological illness (OR 1.46 (95% CI 1.19-1.81, p<0.001)) and recent life event stress (OR 1.28 (95%CI 1.06-1.55, p=0.009)). Conclusions: FBDs are common in China. Food intolerance, psychological factors and life event stress increase the likelihood of subjects in the general population reporting FBD symptoms. Table 1. The joint association of psychologic disease, life event stress, lactose intake with FBD among subjects.

Characteristics of functional bowel disorder patients: a cross‐sectional survey using the Rome III criteria

There is some evidence that, despite attempts to classify them separately, functional bowel disorders are not distinct entities and that such divisions are artificial. To examine this issue in a large cohort of secondary care patients. Consecutive, unselected adults with gastrointestinal (GI) symptoms attending out-patient clinics at two hospitals in Hamilton, Ontario were recruited. Demographic data, symptoms and presence of anxiety, depression or somatisation were collected prospectively. We used validated questionnaires, including the Rome III questionnaire, with patients categorised as having irritable bowel syndrome (IBS), functional diarrhoea or chronic idiopathic constipation (CIC). We compared data between these disorders, and measured degree of overlap between them by suspending their mutual exclusivity. Of 3656 patients providing complete lower GI symptom data, 1551 (42.4%) met criteria for a functional bowel disorder. Diarrhoea-predominant IBS (IBS-D) patients were younger, and more were female, met criteria for anxiety, and reported somatisation-type behaviour, compared with functional diarrhoea. Only loose, mushy or watery stools were more common in functional diarrhoea. When mutual exclusivity was suspended, overlap occurred in 27.6%. Constipation-predominant IBS (IBS-C) patients were younger, and more were female, had never married, reported anxiety type symptoms and exhibited somatisation-type behaviour. One in five CIC patients reported abdominal pain or discomfort. All constipation symptoms were more common in IBS-C. When the mutual exclusivity was suspended, overlap occurred in 18.1%. There were significant differences in demographics between individuals with functional bowel disorders. Despite this, the Rome III classification system falls short of describing unique entities.

Five-year follow-up of 263 cases of functional bowel disorder

To determine the mortality associated with functional bowel disorders (FBDs) and their possible relationship with organic bowel disease. Patients who satisfied the Rome III criteria for FBD (retrospective diagnosis) were followed up by telephone interview and/or outpatient review at 5 years after their first attendance. The patients were divided into the following groups: irritable bowel syndrome, functional abdominal bloating, functional constipation, functional diarrhea and unspecified FBD. The survival of the FBD patients overall and of those with each FBD were compared with data obtained from the Guangzhou population in 2005. The incidences of colonic cancer overall and for each FBD were compared with data from the Chinese population obtained from 56 cancer registries in 19 provinces of the country in 2008. Two hundred and sixty-three patients were followed-up. Five patients died, which was not significantly different from the expected survival rate. No differences in mortality among the FBDs were found. There were nine cases of organic bowel disease: three colonic cancers and six colonic polyps. The incidence of colonic cancer in FBD patients was higher than that in the general Chinese population (0.23% vs 0.03%, P < 0.05). There were significant differences in the incidence of colonic cancer among the FBDs (0/134, 0/24, 2/29, 1/66, 0/10, respectively, P < 0.05); functional constipation was the most common. The incidence of colonic polyps was similar among the FBDs. The baseline age of patients who died was greater than that of those who survived (66.60 ± 6.84 years vs 45.14 ± 10.34 years, P < 0.05). The baseline age of patients who had colonic cancer or polyps during follow-up was greater than that of those without colonic cancer or polyps (60.33 ± 1.53 years vs 45.38 ± 10.62 years; 54.50 ± 6.47 years vs 45.34 ± 10.68 years, P < 0.05). FBDs do not increase the risk of death. The incidence of colonic cancer in patients with FBDs may be increased, especially in those with functional constipation and in the elderly.