Diagnosis Of IBS Research Articles

Limosilactobacillus reuteri DSM 17938 and ATCC PTA 6475 for the treatment of moderate to severe irritable bowel syndrome in adults: a randomized controlled trial

BackgroundIrritable bowel syndrome (IBS) is a common functional gastrointestinal disorder in adults. Systematic reviews with meta-analyses have demonstrated the efficacy and safety of probiotics in improving symptoms of IBS.AimThe aim of the study was to demonstrate the efficacy and safety of Limosilactobacillus reuteri (L. reuteri) DSM 17938 combined with L. reuteri ATCC PTA 6475 regarding improving the symptoms associated with IBS in adults.MethodsA randomized, double-blind, placebo-controlled clinical trial was conducted in 140 adults aged 18 years to 65 years with a diagnosis of IBS (based on the Rome IV criteria). After 2 weeks of washout, subjects were randomized to receive either 2 × 108 colony-forming units (CFUs) of L. reuteri DSM 17938 combined with L. reuteri ATCC PTA 6475 plus standard of care or placebo plus standard of care for 14 weeks, followed by a post-intervention period of 2 additional weeks. Changes in gastrointestinal symptoms (as measured with the GSRS-IBS), stool pattern (as measured with the Bristol scale), quality of life, depression and anxiety, frequency of adverse events, and fecal calprotectin concentrations were evaluated.ResultsIn total, 70 subjects were allocated to receive L. reuteri and 70 were allocated to receive placebo. During the pre-randomization phase, no differences were observed between the groups in terms of IBS-associated symptoms and stool consistency. Starting at week 6 of the intervention, subjects in group L. reuteri showed a significant improvement in IBS-associated symptoms (p < 0.01). A significant improvement was also observed in fecal calprotectin concentration in the L. reuteri group at the end of interventions (30.2 ± 11.8 mg/g of stool in the L. reuteri group and 41.6 mg/g ± 10.7 mg/g in the placebo group; p = 0.019). The frequency of adverse events was similar between groups.ConclusionsA twice-a-day intervention for 14 weeks is safe and effective, reduces the symptoms associated with IBS in adults aged 18 years to 65 years, improves stool consistency, and reduces symptoms associated with anxiety after 6 weeks.

That head lag is impressive! Infantile botulism in the NICU: a case report

BackgroundInfantile botulism (IB) is a devastating and potentially life-threatening neuromuscular disorder resulting from intestinal colonization by Clostridium botulinum and the resultant toxin production. It can present with constipation, descending paralysis, and, potentially, respiratory failure. Botulism is a diagnosis that is more commonly seen in the pediatric intensive care unit (PICU) or on the general pediatric wards and would not typically be managed in the neonatal intensive care unit (NICU), and therefore requires high clinical suspicion to ensure prompt diagnosis and treatment.Case presentationWe discuss a case where an infant from central Pennsylvania presented to a Level IV NICU rather than to the PICU for an evaluation for sepsis and was uniquely diagnosed with IB. The infant presented with poor oral feeding and reduced oral intake, hypothermia, and lethargy. His symptoms progressed into hypoxia and acute respiratory failure. Interestingly, this infant had no known exposure to honey or any other identifiable sources of botulism contact. The infant’s twin brother and the other infants who attended the mother’s in-home daycare remained asymptomatic. This infant was initially evaluated and managed for a potential infectious etiology. However, a diagnosis of IB was suspected, and was later confirmed through the detection of botulinum toxin in the infant’s stools. A high level of suspicion allowed for timely treatment with Botulism Immune Globulin neutralizing antibodies (BabyBIG), even prior to confirmatory testing. We describe the process of obtaining BabyBIG, as well as the natural course of illness after treatment in our patient who ultimately made a complete recovery.ConclusionsThis case highlights the importance of considering infantile botulism as a diagnostic possibility even in the absence of risk factors, and the need for vigilance in diagnosing and treating this rare but potentially life-threatening condition. With timely recognition, subsequent treatment with BabyBIG, and supportive care, infants with infantile botulism can be expected to recover completely. This information is particularly important for neonatologists providing care for infants outside the neonatal period, especially during times of high patient census and resulting overflow of pediatric admissions in the NICU.

Efficacy of fecal microbiota transplantation in patients with post-infection irritable bowel syndrome with diarrhea

Objective — to evaluate efficacy of potentiation of remission and safety of fecal microbiota transplantation (TFM) in patients with post‑infection irritable bowel syndrome with predominance of diarrhea (PI — IBS‑D), in whom standard therapy was ineffective.
 Materials and methods. The study involved 16 patients with patients with moderate to severe PI — IBS with diarrhea who did not respond to standard therapy and did not have any significant comorbidities. The diagnosis of IBS was made according to the Rome IV criteria. IBS severity was assessed with the use of Irritable bowel syndrome — Severity Scoring System, and the frequency of defecation and stool consistency according to the Bristol scale. Donor selection, preparation for TFM and the procedure itself were carried out in accordance with the recommendations of the European Consensus on TFM (2017). TFM was performed once with a colonoscope in the right part of the large intestine — 180 ml of a solution prepared from 50 g of donor feces. The total follow‑up period was 6 months after TFM. Efficacy was assessed by the level of score reduction of the IBS‑SSS questionnaire — a decrease of 50 points or more was considered a significant improvement. During the observation period, the patient did not take any additional drugs and procedures.
 Results. The obtained results showed a positive TFM effects on the clinical manifestations of post‑infection IBS, resistant to standard therapy. After 1 month post transplantation, the severity of symptoms decreased by more than 75 IBS‑SSS points in 75 % of patients and 3 of them had remission. The TFM procedure resulted in a significant decrease compared to baseline in the severity of abdominal pain (37 points) and its duration (31 points), bloating (41 points), dissatisfaction with defecation (40 points) against the background of almost twofold reduction in the frequency of defecation from 3.68 to 1.81 bowel movements/day) and improved stool consistency according to the Bristol scale (from 6.81 to 5.21 points). These rates remained unchanged until the end of the third month after TFM, they did not differ significantly compared to the end of the first month: 75 % of patients experienced adequate relief of abdominal pain, satisfaction with defecation, reduced bloating and reduced impact on quality of life. However, by the end of 6th month, the symptoms of PI — IBS began to increase: the average score of IBS‑SSS increased to 169 points, including indicators of the intensity of abdominal pain and its duration, severity of bloating, dissatisfaction with defecation and defecation frequency, thus PI — IBS increasingly affected the quality of life of patients. Despite the increased PI — IBS severity by the end of 6th month after TFM, its symptoms remained significantly lower than before treatment and still 62.5 % of patients reported adequate relief of abdominal pain and satisfaction with defecation, reduction of diarrhea and bloating. None of patients reported about serious adverse events. During the first hours after procedure, only 31.25 % trial participants noticed insignificant adverse events (abdominal discomfort, flatulence and stomach growling) that disappeared on their own during the day.
 Conclusions. Colonoscopy‑delivered fecal microbiota transplantation proved to be effective and safe procedure in patients with PI — IBS who have not responded to standard therapy.

A244 PROVIDING THE FODMAP DIET THROUGH AN ONLINE PLATFORM: IMPACT ON THE QUALITY OF LIFE AND THE PHYSICAL AND PSYCHOLOGICAL SYMPTOMS IN IRRITABLE BOWEL SYNDROME

BackgroundIrritable bowel syndrome (IBS) is a functional gastrointestinal disorder that affects approximately 15 % of the worldwide population. It is characterized by recurring abdominal pain and changes in bowel habits. This population is more at risk of suffering from chronic fatigue and psychological distress. Moreover, IBS significantly reduces the quality of life of patients and increases the economic burden on the health system. Many therapies have been developed to try to alleviate the symptoms and improve the lives of people with IBS. Among these is the FODMAP ( Fermentable Oligosaccharides Disaccharides Monosaccharides and Polyols) diet which aims to establish a personal tolerance to these nutrients (carbohydrates) that accentuate the symptoms related to IBS. This diet, lasting on average twelve weeks, is separated into three steps: elimination, reintroduction, and personalization. An innovative approach has been developed by the online platform SOSCuisine.com® to allow people with IBS to safely follow the FODMAP diet in a ‘self-service’ way. It consists of using an online service of personalized weekly menus low in FODMAP with tips and instructions for each step of the diet in combination with access to a peer support group, moderated by a specialized registered dietician.AimsThe aim of this project is to evaluate the impact of this new online service on the quality of life and the control of the physiological and psychological symptoms of people living with IBS. We hypothesized that this online service improve the quality of life and the control of the symptoms.MethodsThe participant has to be at least 18 years old, understand French, have access to Internet and a Facebook account (sufficient familiarity to use them) and have an IBS diagnosis (Rome IV criteria) validated or re-validated by a gastroenterologist within three months. People with eating disorders, mental health problems, other chronic gastrointestinal illnesses (except gastroesophageal reflux disease), diabetes and with a pregnancy are excluded. Validated questionnaires are used to assess the quality of life ( IBS-Quality Of Life), physical symptoms ( IBS-Severity Scoring System), state and trait ( State-Trait Anxiety Inventory, Form Y) whereas food intake is assessed with a online 24-hour dietary recall.ResultsSo far, 35 participants have been included in the study (83% female, 45,3±12,8 years old). After the intervention, the severity of symptoms significantly decreased (p<0.001), and quality of life (p=0.041) and state anxiety (p=0.034) significantly improved.ConclusionsThis study should allow the identification of facilitating elements to adhere to the FODMAP diet and possibly improve the quality of life of this population.Funding AgenciesNone

A195 GEOEPIDEMIOLOGICAL CHANGES DUE TO ALTERATIONS IN DIAGNOSTIC ROME CRITERIA FOR IRRITABLE BOWEL SYNDROME

Abstract Background Irritable bowel syndrome (IBS) is a positive diagnosis based on consensus opinions. The Rome (R) criteria, have gone through 4 rounds. R4 restricted diagnosis of IBS over R3, reducing global prevalence. Previously, there were no correlations of world distributions of IBS and Inflammatory Bowel Disease [IBD](Lovell). There are also epidemiological studies showing relationships between IBD and national wealth. Aims We reevaluate relationships among different R criteria and latitude(Lat), lactose digestion status (LNP), human development index(HDI), gross domestic product/capita(GDP/c), Crohn’s disease (CD and ulcerative colitis (UC) incidence(i) and prevalence(p). Methods Literature on world prevalence of national IBS (Oka,Sperber), IBD rates (Ng), and GDP (Lopez Ruiz) (4) were sought on PubMed and Google Scholar.National HDI(08 or 2016) were available on the internet (http://hdr.undp.org/en/data). National lactase distributions and latitudes were quoted (Szilagyi). Target dates were for the year 2008±8yrs. After log transformation of IBD incidence, Pearson’s correlations were carried out.(strong at; r ≥0.7, moderate ≥0.5, weak ≤ 0.49, negligible ≤ 0.3). (significance was p&amp;lt;0.05). Results Correlations of HDI08 and HDI16 was 0.98. Comparisons of R2 and a composite based on Manning, R 1 and 2 (Lovell) was r = 0.96 (N21 countries), Correlation of R 3 and 4 were r = 0.85 (N17). Correlations of R2 and R3 or R4 were negligible (r = -0.2 (n15) and -0.12 (N22). Correlations of R2 and both economic metrics were weak but significant (r = 0.42 – r = 0.49, p &amp;lt; 0.03 - &amp;lt; 0.001). However, correlations of metrics with R3 were non significant and negligible with R4. Comparisons of R2 with LNP or Lat were negligible, but those of R3 or R4 with Lat were significant. Comparisons of R3 with CDp showed a strong correlation while R4 showed a weak but significant correlation with UCi. R2 had negligible correlations with IBD. Conclusions Although, these results are based on limited data variations in R criteria have changed relations with IBS prevalence.Earlier R criteria showed increased IBS in poorer nations. The recent R3 and R4 criteria are independent of national economy, but show more relations with increasing latitudes. Consequences of the change include R3 and 4 reflecting western society symptoms perhaps linking it more with IBD.It is unclear if this new relationship incorporates an irritable inflammatory bowel syndrome (Gajula).The generalizability therefore of the new R4 criteria may still be limited. Table: Rome criteria compared to variables. Statistical significance * &amp;lt; 0.03, ** ≤ 0.05 Funding Agencies None

Overlap between irritable bowel syndrome and common gastrointestinal diagnoses: a retrospective cohort study of 29,553 outpatients in Germany

BackgroundIrritable bowel syndrome (IBS) represents the most common functional disorder of the gastrointestinal tract. Many patients with IBS display complex gastrointestinal (GI) symptoms leading to overlapping diagnosis of IBS and other GI diseases in many patients.MethodsUsing the Disease Analyzer database (IQVIA) featuring patients treated within 2010 and 2019 within 1240 general practices in Germany, we analyzed the prevalence of common GI diseases within 12 months prior to and after the first diagnosis of IBS.Results65,569 patients with an initial diagnosis of IBS were included into the analysis. Out of these, 29,553 patients had an observation time of at least 12 months prior to the first IBS diagnosis and at least 12 months after the first IBS diagnosis. Mean age was 48.8 (SD: 18.4) years, 65.0% were female. Notably, 16,164 (55%) of these patients had at least one preexisting diagnosis of another GI diseases within 12 months prior to the first IBS diagnosis. Most common overlapping diagnoses were intestinal infectious diseases (26%), gastritis/ duodenitis (21%), diseases of the esophagus (15%), non-infectious enteritis or colitis (7.4%), functional dyspepsia (6%) and ulcers (1.0%). Additionally, 12,048 (41%) received one of these diagnosis within 12 months after the first IBS diagnosis.ConclusionOur data provide evidence for a high overlap between IBS and other GI diagnoses. Moreover, we show that IBS is frequently diagnosed in patients with preexisting GI diseases, potentially putting into question the validity of IBS diagnosis at least in some cases.

Electro-acupuncture for irritable bowel syndrome patients: study protocol for a single-blinded randomized sham-controlled clinical trial

BackgroundIrritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders in clinical practice. IBS diagnosis is based on symptoms defined by abdominal pain or discomfort associated with defecation or changes in bowel habits. Gut-brain interaction caused by stress or depressive emotion is one of the essential pathologies. Acupuncture has been used for the treatment of internal medicine, including digestive disorders and depressive disorders in Chinese medicine. This study aims to determine whether electro-acupuncture could have significant benefits than sham acupuncture for IBS.Methods/designThis is a single-blinded randomized sham-controlled clinical trial with two arms. A total of 120 IBS patients will be recruited. After a 2-week run-in period, eligible subjects will be randomly assigned to one of two arms, acupuncture (AC) arm and sham acupuncture (SAC) arm. Each eligible subject will go through a 2-week run-in-period, 6-week treatment period, and 6-week follow-up period. Five visits in total were scheduled for each subject in week 0, week 2, week 5, week 8, and week 14. The outcomes would be measured with (1) IBS-SSS, (2) Hamilton Depression Rating Scale (HAMD-17), (3) Clinical Global Impression-Severity (CGI-S), (4) Self-Rating Depression Scale (SDS), and (5) IBS Quality of Life (IBS-QoL).DiscussionThe study will compare electro-acupuncture with sham acupuncture to explore the feasibility of electro-acupuncture in improving IBS symptoms.Trial registrationClinicalTrials.govNCT04387383. Registered on 13 May 2020

Pain and psyche in a patient with irritable bowel syndrome: chicken or egg? A time series case report

BackgroundIrritable bowel syndrome (IBS) appears to have a bidirectional interaction with both depressive and anxiety-related complaints. However, it remains unclear how exactly the psychological complaints, at the individual level, are related to somatic symptoms on a daily basis. This single case study investigates how somatic and psychological variables are temporally related in a patient with irritable bowel syndrome.Case reportThe patient was a woman in her mid-twenties with an IBS diagnosis. She reported frequent soft bowel movements (5–6 times per day), as well as flatulence and abdominal pain. She resembled a typical IBS patient; however, a marked feature of the patient was her high motivation for psychosomatic treatment as well as her willingness to try new strategies regarding the management of her symptoms. As an innovative approach this single case study used a longitudinal, observational, time series design. The patient answered questions regarding somatic and psychological variables daily over a period of twelve weeks with an online diary. The diary data was analysed using an autoregressive (VAR) modeling approach. Time series analyses showed that in most variables, strong same-day correlations between somatic (abdominal pain, daily impairment) and psychological time series (including coping strategies) were present. The day-lagged relationships indicated that higher values in abdominal pain on one day were predictive of higher values in the psychological variables on the following day (e.g. nervousness, tension, catastrophizing, hopelessness). The use of positive thinking as a coping strategy was helpful in reducing the pain on the following days.ConclusionIn the presented case we found a high correlation between variables, with somatic symptoms temporally preceding psychological variables. In addition, for this patient, the use of positive thoughts as a coping strategy was helpful in reducing pain.

Irritable Bowel Syndrome and Coping Strategies: A Cross-sectional Study for Identifying Psychological Alarms and Factors Related to Coping in Riyadh, Saudi Arabia.

Psychological alarms including severity of pain, functional impairment, depression, and impaired coping strategies have been correlated with (IBS); however, these attributes, particularly coping strategies, have not been well studied. The aim of this study was to assess psychological alarms, life stressors, and coping strategies of adults diagnosed with IBS. A total of 806 participants completed a self-administered survey consisting of socio-demographic data and life stressors, the Rome IV criteria to diagnose IBS, the Psychological Alarm Questionnaire, and the Coping Strategies Questionnaire (CSQ 24). IBS diagnosis was established among 372 (46.15%) participants. Anxiety (OR = 1.81; 95% CI: 1.35-2.45), severe pain (OR = 1.92; 95% CI: 1.42-2.63), financial life stressors (OR = 1.98; 95% CI: 1.33-2.40), and coping strategies such as reinterpretation (OR = 1.92; 95% CI: 1.39-2.68) and diversion (OR = 2.01; 95% CI: 1.05-3.89) were all significantly and independently associated with IBS diagnosis. Giving the chronic nature of IBS, future research should focus on coping as a potential treatment goal for IBS patients.

Is Celiac Disease Testing Necessary in Functional Abdominal Disorders? A Study in Predominantly Latino Children.

Functional abdominal pain disorders (FAPDs) are among the most common causes of consultation in general pediatrics and pediatric gastroenterology. The Rome IV criteria recommend testing for celiac disease (CD) in children with irritable bowel syndrome-diarrhea (IBS-D) and leaves testing in cases of other FAPDs to the practitioner's discretion. These recommendations were based on a single study that showed a 4-fold increase of CD among patients with IBS in Italy. It is unclear if these findings can be extrapolated to other populations. Understanding whether those results are reproducible in areas with different racial/ethnic backgrounds can optimize patient care. The aim of the study was to assess the prevalence of CD in a sample of children consulting for FAPDs to a tertiary care center in Miami. The charts of all pediatric patients consulting for FAPDs from January 2016 to November 2019 at the University of Miami were reviewed. Demographics, diagnosis, and CD testing for each child were analyzed. One hundred eighty-one children with FAPDs and celiac testing were seen. Mean age of 12.89 years, girls 61.34%. 84 (46.40%) had a diagnosis of IBS and 97 (53.59%) had a diagnosis of other FAPD. One of 181 children with FAPDs (0/84 with IBS and 1/97 with other FAPDs) had positive CD serological testing and EGD confirmation. Our study suggests that the prevalence of CD among children with FAPDs is similar to the community prevalence. This data questions the benefit of testing all children FAPDS (including IBS) for CD. Studies with larger sample size and various racial/ethnic makeup should be done to confirm our findings.

Gut microbiome composition and risk factors in a large cross-sectional IBS cohort

ObjectiveIrritable bowel syndrome (IBS) is a common gastrointestinal disorder that is difficult to diagnose and treat due to its inherent heterogeneity and unclear aetiology. Although there is evidence suggesting the...

The use of electronic healthcare records for colorectal cancer screening referral decisions and risk prediction model development

BackgroundThe database used for the NHS Bowel Cancer Screening Programme (BCSP) derives participant information from primary care records. Combining predictors with FOBTs has shown to improve referral decisions and accuracy. The richer data available from GP databases could be used to complement screening referral decisions by identifying those at greatest risk of colorectal cancer. We determined the availability of data for key predictors and whether this information could be used to inform more accurate screening referral decisions.MethodsAn English BCSP cohort was derived using the electronic notifications received from the BCSP database to GP records. The cohort covered a period between 13th May 2009 to 17th January 2017. Completeness of variables and univariable associations were assessed. Risk prediction models were developed using Cox regression and multivariable fractional polynomials with backwards elimination. Optimism adjusted performance metrics were reported. The sensitivity and specificity of a combined approach using the negative FOBT model plus FOBT positive patients was determined using a probability equivalent to a 3% PPV NICE guidelines level.Results292,059 participants aged 60–74 were derived for the BCSP screening cohort. A model including the screening test result had a C-statistic of 0.860, c-slope of 0.997, and R2 of 0.597. A model developed for negative screening results only had a C-statistic of 0.597, c-slope of 0.940, and R2 of 0.062. Risk predictors included in the models included; age, sex, alcohol consumption, IBS diagnosis, family history of gastrointestinal cancer, smoking status, previous negatives and whether a GP had ordered a blood test. For the combined screening approach, sensitivity increased slightly from 53.90% (FOBT only) to 58.82% but at the expense of an increased referral rate.ConclusionsThis research has identified several potential predictors for CRC in a BCSP population. A risk prediction model developed for BCSP FOBT negative patients was not clinically useful due to a low sensitivity and increased referral rate. The predictors identified in this study should be investigated in a refined algorithm combining the quantitative FIT result. Combining data from multiple sources enables fuller patient profiles using the primary care and screening database interface.

Postinfectious Irritable Bowel Syndrome After Campylobacter Infection.

Postinfectious irritable bowel syndrome (PI-IBS) is an important sequela of Campylobacter infection. Our goal is to estimate the incidence of Campylobacter-associated PI-IBS in the United States. Data from January 1, 2010 to December 31, 2014, were obtained from the MarketScan Research Commercial Claims and Encounters Database. We identified patients with an encounter that included an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for "intestinal infection due to Campylobacter" (008.43) and individually matched them (on age group, sex, and length of enrollment) to a group of persons without a diagnosed Campylobacter infection (non-cases). The primary outcome of interest was a new diagnosis of IBS (International Classification of Diseases, Ninth Revision, Clinical Modification 564.1). Our final matched cohort included 4,143 cases and 20,491 non-cases. At 1 year, the incidence rate of IBS was 33.1 and 5.9 per 1,000 among cases and non-cases, respectively, with an unadjusted risk ratio of 5.6 (95% confidence interval [CI]: 4.3-7.3). After adjusting for healthcare utilization, the Cox proportional hazard ratio was 4.6 (95% CI: 3.5-6.1). Excluding those who received an IBS diagnosis within 90 days, the 1-year incidence rate of IBS was 16.7 and 3.9 per 1,000 among cases and non-cases, respectively, with an unadjusted risk ratio of 4.3 (95% CI: 3.0-6.2). Persons with a Campylobacter infection have a much higher risk of developing IBS compared with those not diagnosed with Campylobacter infection. The burden of Campylobacter-associated PI-IBS should be considered when assessing the overall impact of Campylobacter infections.

The investigation of chronic diarrhoea: new BSG guidance.

Chronic diarrhoea has an estimated prevalence of about 4–5% in Western populations and is one of the most common reasons for gastroenterology referral.1 There is a myriad of causes for chronic diarrhoea, which can make the investigation and diagnosis of the underlying cause difficult. In 2003, the British Society of Gastroenterology (BSG) released guidelines2 to aid in the investigation of chronic diarrhoea; however, these have since been updated, in April 2018. Below, we provide a brief and focused summary of the new 2018 guidelines1 for primary care, highlight the new changes compared with the 2003 edition, and discuss some limitations of the new guidance. Initial investigations in primary care are aimed at differentiating organic gastrointestinal (GI) disease from functional disease. Routine, screening blood tests are recommended in all patients presenting with chronic diarrhoea, and these include full blood count, ferritin, c-reactive protein, coeliac serology, and thyroid function tests. Faecal calprotectin (FCP) is now recommended as a screening tool to detect inflammatory causes of chronic diarrhoea, and stool cultures remain useful in distinguishing infection from other inflammatory causes of chronic diarrhoea. Faecal immunochemical testing (FIT) is a new method of detecting the presence of blood in faeces and can be used instead of the traditional faecal occult blood test (FOBT) where available. In general, for patients with typical symptoms of functional bowel disease, normal physical examination, and normal screening investigations, a diagnosis of IBS can be made. However, referral should be considered for those with abnormal screening investigations or persistent symptoms that impact the quality of life and do not respond …

Patient Reported Outcomes in Women With IBS Using Opioids for Chronic Non-Cancer Pain: ACG/Radhika Srinivasan Gender-Based Research Award: Presidential Poster Award

Introduction: Opioids can reduce gut motility, causing a number of adverse GI effects including vomiting, nausea, and constipation. These side effects are further exacerbated in individuals with functional bowel disorders such as IBS. Consequently, opioids are not recommended to treat pain in IBS. Yet, opioids continue to be prescribed at alarming rates particularly for chronic noncancer pain, and there is limited research on the extent to which an IBS diagnosis would discourage a clinician from prescribing narcotics to a patient. We sought to better understand opioid use and health outcomes in women with chronic noncancer pain and comorbid IBS. Methods: Cross-sectional data on comorbidities, current medication use, and patient-reported outcomes relating to physical health, mental health, and pain interference was collected as part of a larger study assessing patient preferences for chronic noncancer pain management. We conducted a subgroup analysis on respondents who selected IBS as a comorbidity (N = 209), restricting the sample to females (N = 194) due to insufficient male response (N = 15). Linear regressions were used to examine differences in PROMIS t-scores for mental health, physical health, and pain interference among opioid users and non-users, after adjusting for age and ethnicity. Results: 42.8% of female respondents with chronic pain and comorbid IBS reported currently using opioids compared to 36.3% of women without IBS (p = 0.107). Respondents had mean t-scores of 38, 32, and 64 for mental health, physical health, and pain interference, respectively. Adjusting for age and ethnicity, women using opioids reported lower PROMIS mental health scores (B = -4.37; p = 0.018) and physical health scores (B = -3.15; p < 0.001) than those not using opioids. Pain interference did not differ between women using opioids and those not using opioids, independent of age and ethnicity (p = 0.652).Conclusion: Opioid use in women with chronic pain and comorbid IBS was associated with reduced mental and physical health. Pain interference was higher than the general population for women with comorbid IBS, with no improvement in pain interference observed as a result of opioid use. Despite this, women with IBS using opioids to treat a primary pain condition reported similar rates of opioid use as respondents without IBS, indicating that an IBS diagnosis may not discourage opioid prescribing. Further research should investigate the risks and benefits of opioid use in women with chronic pain and IBS.460_A Figure 1. Mean mental health t-score as measured by PROMIS Global Health for women with comorbid IBS currently using opioids and those not using opioids.460_B Figure 2. Mean physical health t-score as measured by PROMIS Global Health for women with comorbid IBS currently using opioids and those not using opioids.460_C Figure 3. Mean pain interference t-score as measured by PROMIS Pain Interference for women with comorbid IBS currently using opioids and those not using opioids.

Irritable bowel syndrome at young age: Salofalk treatment efficacy

Objective — to analyze the effect of granules of mesalazine on the course of IBS in adolescents and young patients.Materials and methods. We observed 58 children in late adolescence from 15 to 18 years old and 120 young adults aged 19 to 25 years. In both groups, female patients 44 (75.9 %) and 87 (72.5 %) predominated. The study was of an open multicenter nature. The diagnosis of IBS was exhibited on the basis of the IV Rome criteria. Patients in both the pediatric and adult populations were randomized into two groups. In the group of 1P to 30 adolescents (mean age 16.8 ± 1.7 years) and in group 1B, 60 young adults (mean age 23.3 ± 1.1 years) received, in addition to basic therapy, mesalazine (Salofalk) in granules of 1.5 g once a day. In groups 2P, 28 adolescents (mean age 16.1 ± 2.0 years) and 2B 60 adults (mean age 24.7 ± 1.5 years) received only basic therapy. Prior to treatment and after 6 weeks of therapy, all patients were assessed for the frequency of the stool and its shape according to the Bristol scale, the severity of the pain syndrome in the 10-cm visual analogue scale (VAS), and the manifestation of flatulence by the ultrasonic accessibility coefficient (UAC). Also in all patients, we determined the level of fecal calprotectin and the presence of SIBO in the hydrogen respiratory test with lactulose.Results. After 6 weeks of treatment in all groups of patients, the pain syndrome decreased. In group 1P, the intensity of pain decreased by 46 % compared with the baseline and was 3.5 ± 0.8 cm in VAS (p = 0.042); in the 2P group by 21 % and 5.3 ± 1.0 cm (p = 0.419); in group 1B by 42 % and 4.0 ± 0.9 cm (p = 0.044), and in group 2B by 29 % and 4.7 ± 1.1 cm (p = 0.246), respectively. Also, in the Salofalk treatment groups, more patients did not have abdominal pain. In group 1P, 9 people remained in pain (30 %); in 1B in 21 (35 %), and in groups 2P in 15 (54 %) and 2B in 32 people (53 %), everywhere (p &lt; 0.001). Salofalk therapy contributed to a decrease in the degree of flatulence. UAC in the 1P group was 52.8 ± 7.1 % (p = 0.008), in group 1B — 49.7 ± 6.3 % (p = 0.026), and in the 2P groups — 44.2 ± 6.9 % (p = 0.11) and 2B — 41.1 ± 5.3 % (p = 0.074).Conclusions. In the group of adolescents with IBS-D and IBS-M the post infection variant occurred almost twice as often as in young adults — 22.4 and 13.3 %, respectively. In the post infection variant, an increase in fecal calprotectin and SIBO is more common. The use of mesalazine in granules helps to reduce the intensity and frequency of abdominal pain, both in child and in adult population. In patients with a post infection variant of IBS, Salofalk was more effective.

32 Does faecal calprotectin measurement have an impact on patient management

Background Faecal calprotectin (FC) is recommended to support the differential diagnosis of IBD or IBS in adults with recent onset lower gastrointestinal symptoms. FC can assess IBD activity in those with known disease, as a rising level is an early marker of potential relapse. There is presently no formal funding for FC within Northern Ireland. Aim To assess if FC measurement directs an immediate modification in patient management within two out-patient groups: 1) new patients with differential diagnosis of IBS or IBD; 2) review patients with known IBD. Method A random selection of FC results from secondary care patients over 12 months were analysed. Patient outcomes following the FC result stratified patients into one of four groups: Discharged, colonoscopy performed, clinic review or escalation of medical therapy. Results Group 1 (n=28): 8 positive FC, all proceeding to endoscopy. In the 14 negative FC, 12 patients were discharged, 2 had clinic review. For indeterminate result: one patient with 2 indeterminate results underwent colonoscopy; 4 had clinic review; 1 was discharged. Group 2 (n=28): of the 20 positive results, 11/20 (55%) had medical management escalated, 5/20 (25%) underwent colonoscopy and 20% had clinic review. In the negative and indeterminate results: 7/8 had clinic review. Conclusions For patients with suspected IBS, a negative FC avoided unnecessary colonoscopy. In patients with known IBD, a raised FC led to an escalation in therapy in the majority of patients to minimise the risk of relapse and potential hospital admission. This study supports the need for a Northern Ireland FC service.

Irritable Bowel Syndrome among Medical Students and Interns in King Faisal University

Background: One of the most highly prevalent costly gastrointestinal disorders is IBS. It is a consequence of emotional conflicts and stress. So people who are in medical education, they have highest percentage of IBS. Objective: To estimate the prevalence of IBS and its effects on the academic achievement among medical students of KFU, Al-Hasa, Saudi Arabia. Methods: A cross-sectional study was carried out among medical students and interns from August 2015 to September 2016 at (KFU) in Al-Hasa, Saudi Arabia. All participants were asked to complete a confidential self-administered questionnaire. Diagnosis of IBS was according to Rome III criteria. Results: 173 medical students completed the survey. The prevalence of IBS was 44.5%, with a high prevalence in females (31.8%). IBS was present significantly higher among students who experience emotional stress in the past 6-month (25.4%) and higher among students with a positive family history of IBS. Moreover, IBS was associated with a decrease in the academic performance among medical students (p < 0.05). Conclusion: The study revealed a high percentage of IBS among medical students and interns in KFU. Female gender, having emotional stress in the past 6 months and family history of IBS were the main predictors of IBS. However, the main predictor of IBS was in family history.

Confounding Presentation of Small Bowel Ischemia in an IBS Patient and Diagnosis and Treatment Utilizing CO2 Angiography: New None-nephrotoxic Diagnostic Modality

Introduction: Mesenteric ischemia is a difficult diagnosis to make but should be considered in older patients with weight loss. Since, CKD is a common comorbidity in patients with vascular disease contrast agents may contraindicated. CO2 angiography is a non-nephrotoxic alternative to vascular intervention. Case: The patient is a 90 year old female with a 40 year history of functional dyspepsia and IBS - diarrhea. 1 year PTA (prior to admission) she began noting vague post-prandial epigastric discomfort relieved with belching and probiotics. 9 months PTA, she noted early satiety and nausea following greasy food ingestion resulting in decrease intake and a 20lbs weight loss. Malignancy work-up (EGD, colonoscopy, CT abdomen/pelvis without contrast because of ↓ GFR, standard lab work) were negative except for marked atherosclerosis of the aorta and a small benign antral ulcer. She was treated with PPI and sucralfate. 7 months PTA, repeat EGD revealed another, small clean based antral ulcer at a different site with negative histology. She had now lost 40 lbs. with a BMI of 20. She attributed her weight loss to severe siderophobia as her postprandial epigastric pain occurred 20 minutes following meals with an intensity of 7-9/10, lasting 2-3 hours. She was also noted to have a retinal artery occlusion possibly 2nd to an atheromatous plaque which alerted us to the possibility of mesenteric ischemia. PE: Significant abdominal bruit. A CTA or MRA could not be performed because of her CKD.Figure 1Figure 2She was referred to vascular surgery who performed a Doppler US noting a >70 % stenosis of the SMA. Because of her CKD, she underwent CO2 angiography which identified a 90-99% stenosis of the SMA. After 6 hours, the SMA was catheterized and a stent was placed across the stenosis resulting in >50% flow. She had immediate and complete symptom relief. After 6 months, she had gained 20 lbs. Discussion: Mesenteric ischemia can present insidiously at first with vague, non-specific symptoms. When this is combined with a history of well-established functional GI disease, further delay in diagnosis can occur. Therefore, a high suspicion for the diagnosis of mesenteric ischemia is necessary and any new symptoms in a functional disease patient should be followed closely. For patients with CKD, CO2 angiography with digital subtraction angiography (DSA) is a preferred alternative to contrast angiography for treatment of mesenteric ischemia. This technique, which is relatively unknown to radiologists, is a therapeutic advance which few gastroenterologists recognize. It is a new armamentarium that can be used in older patients with poor kidney function. Further discussion and Illustrations of CO2 angiography will accompany the abstract.

Is NICE too Optimistic about Savings from Normal Faecal Calprotectin Results?

Background: A recent systematic review confirmed the utility of faecal calprotectin (FC) in distinguishing organic (inflammatory bowel disease) from non-organic gastrointestinal disease (irritable bowel syndrome). FC levels 92% to exclude organic GI disease. Levels >250mcg/g correlate with endoscopic IBD disease activity; sensitivity 90%. This study aimed to determine clinical outcomes in those with a normal FC result. Method: Adults (>16 years old) with FC results between July 2012 - October 2013 were reviewed. Clinical data was collected from hospital databases and General Practitioners (GPs). GPs were provided with a referral pathway prior introduction of FC in 2012. Clinical data at 12 months post index FC test was available in 275 patients; 208 normal, 41 intermediate and 26 raised results. Results: A new IBD diagnosis was made in only 1% of patients with a normal FC result. Conversely, a new IBS diagnosis was made in a further 40% of normal FC results referred to secondary care. Despite a normal FC and referral guidance, 40% of patients were still referred to secondary care. Conclusions: Normal FC testing remains a useful test in excluding organic GI conditions, although 40% were still referred to secondary care despite a normal FC. Despite a normal FC, 6% still remained in secondary care at 12 months without a new diagnosis.