IBS Symptom Severity Scale Research Articles

Effect of electroacupuncture at homotopic and heterotopic acupoints on abdominal pain in patients with irritable bowel syndrome: study protocol for a randomized controlled trial

BackgroundAcupuncture has been widely applied in the clinic to treat irritable bowel syndrome (IBS), but the underlying mechanism remains unknown. Diffuse noxious inhibitory control (DNIC) is deficient in patients with IBS, which attenuates the systemic analgesic effect elicited by noxious stimulation that is remote from pain areas. Therefore, the aim of this study is to investigate the analgesic effect of electroacupuncture (EA) at homotopic or heterotopic acupoints on abdominal pain in patients with IBS.Methods/designThis study is a randomized, single-blinded, controlled, four-arm parallel trial. A total of 144 patients will be randomly assigned to four groups: a homotopic noxious stimulation group (group A), a homotopic innocuous stimulation group (group B), a heterotopic noxious stimulation group (group C), and a heterotopic innocuous stimulation group (group D). Each patient will receive 14 sessions of treatment, twice per week for 7 weeks. The primary outcome will be pain intensity measured with the visual analog scale. The secondary outcomes will include the IBS Symptom Severity Scale, IBS Quality of Life questionnaire, pain threshold (PT), and the Symptom Checklist-90 for psychological distress. The PT will be measured before and after every treatment. All other outcomes will be evaluated before the 1st treatment, after 7th and 14th treatment, and 3 months later during follow-up.DiscussionThe aim of this study is to assess the analgesic effect of EA at homotopic (abdomen) acupoints and heterotopic (lower limb) acupoints on abdominal pain in patients with IBS, as well as the difference in analgesic effects between noxious and innocuous stimulation.Trial registrationChinese Clinical Trial Registry, ChiCTR-IPR-15006879. Registered on 5 August 2015.

UK clinical experience up to 52 weeks with linaclotide for irritable bowel syndrome with constipation.

Background:Linaclotide, a guanylate cyclase C agonist, has been shown in clinical trials to improve symptoms of irritable bowel syndrome with constipation (IBS-C). Here we report data from a real-world study of linaclotide in the UK.Methods:This 1-year, multicentre, prospective, observational study in the UK enrolled patients aged 18 years and over initiating linaclotide for IBS-C. The primary assessment was change from baseline in IBS Symptom Severity Scale (IBS-SSS) score at 12 weeks, assessed in patients with paired baseline and 12-week data. Change from baseline in IBS-SSS score at 52 weeks was a secondary assessment. Adverse events were recorded.Results:In total, 202 patients were enrolled: 185 (91.6%) were female, median age was 44.9 years (range 18.1–77.2) and 84 (41.6%) reported baseline laxative use. Mean (standard deviation) baseline IBS-SSS score was 339 (92), with most patients (n = 129; 66.8%) classified as having severe disease (score ⩾300). In patients with paired data, there was a significant mean (95% confidence interval) decrease in IBS-SSS score from baseline to 12 weeks [−77.0 (−96.3, −57.7); p < 0.001; n = 124] and baseline to 52 weeks [−70.7 (−95.0, −46.5); p < 0.001; n = 76]. Overall, 174 adverse events were reported in 77 (38.1%) patients, most commonly diarrhoea (n = 54; 26.7%), abdominal pain (n = 21; 10.4%) and abdominal distension (n = 13; 6.4%).Conclusion:Linaclotide significantly improved IBS-SSS score at 12 and 52 weeks. These results provide insights into outcomes with linaclotide treatment over 1 year in patients with IBS-C in real-world clinical practice.

Efficacy of individualised diets in patients with irritable bowel syndrome: a randomised controlled trial

BackgroundPatients with irritable bowel syndrome (IBS) are often placed on diets guided by food intolerance assays, although these have not been validated. We assessed the effects of individualised diets in...

Emotional awareness and expression training improves irritable bowel syndrome: A randomized controlled trial.

Current clinical guidelines identify several psychological treatments for irritable bowel syndrome (IBS). IBS patients, however, have elevated trauma, life stress, relationship conflicts, and emotional avoidance, which few therapies directly target. We tested the effects of emotional awareness and expression training (EAET) compared to an evidence-based comparison condition-relaxation training-and a waitlist control condition. Adults with IBS (N=106; 80% female, Mean age=36years) were randomized to EAET, relaxation training, or waitlist control. Both EAET and relaxation training were administered in three, weekly, 50-minute, individual sessions. All patients completed the IBS Symptom Severity Scale (primary outcome), IBS Quality of Life, and Brief Symptom Inventory (anxiety, depressive, and hostility symptoms) at pretreatment and at 2weeks posttreatment and 10weeks follow-up (primary endpoint). Compared to waitlist controls, EAET, but not relaxation training, significantly reduced IBS symptom severity at 10-week follow-up. Both EAET and relaxation training improved quality of life at follow-up. Finally, EAET did not reduce psychological symptoms, whereas relaxation training reduced depressive symptoms at follow-up (and anxiety symptoms at posttreatment). Brief emotional awareness and expression training that targeted trauma and emotional conflicts reduced somatic symptoms and improved quality of life in patients with IBS. This emotion-focused approach may be considered an additional treatment option for IBS, although research should compare EAET to a full cognitive-behavioral protocol and determine which patients are best suited for each approach. Registered at clinicaltrials.gov (NCT01886027).

Visceral sensitivity, gut barrier function and autonomic nerve function in patients with diarrhea-predominant irritable bowel syndrome

To evaluate visceral sensitivity, gut barrier function and autonomic nerve function (ANF) in patients with diarrhea-predominant irritable bowel syndrome (IBS-D), and to explore their roles in IBS-D pathophysiology. Methods: A total of 46 IBS-D patients (IBS-D group) were selected from the Department of Gastroenterology of China-Japan Friendship Hospital from October 2015 to March 2016, and 20 healthy volunteer were served as a control group (HC group). Clinical and psychological symptoms were evaluated by questionnaire, and visceral sensitivity to rectal balloon distention, gut barrier function and autonomic nerve function (ANF) were examined. The difference in the above-mentioned indexes were compared between the 2 groups, and the correlations in the parameters were analyzed in the IBS-D group. Results: The scores of IBS symptom severity scale (IBS-SSS), Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD) and visceral sensitivity index (VSI) were significantly higher in the IBS-D group than those in the HC group (P<0.01). In the visceral sensitivity test, maximum tolerable threshold in the IBS-D group was significantly decreased compared to that in the HC group (P<0.01); there was no significant difference in first sensation threshold and defecating sensation threshold between the two groups (P>0.05). As gut barrier function markers, the serum diamine oxidase (DAO) and d-lactate were significantly increased in the IBS-D group (P<0.05). In ANF test, the total score and parasympathetic score as well as the proportion of abnormal scores in the IBS-D group were significantly higher than those in the HC group (P<0.05). In IBS-D group, the HAMA, VSI and serum DAO were positively correlated with IBS-SSS (r=0.528, 0.575, 0.507; P<0.01), while the 3 visceral sensitivity thresholds were negatively correlated with IBS-SSS (r= -0.636, -0.476, -0.697; P<0.01); in addition to the IBS-SSS, the HAMA, HAMD, VSI and serum DAO were also significant negatively correlated with the visceral sensitivity thresholds (all P<0.05); no significant correlations were found between the ANF and the other parameters. Conclusion: IBS-D patients show psychological symptoms, visceral hypersensitivity, impaired gut barrier function and abnormal ANF characterized by parasympathetic dysfunction; the former 3 factors are all associated with disease severity, and thus may play vital roles in IBS-D pathophysiology.

Do Symptoms of Irritable Bowel Syndrome Improve when Patients Receive Cognitive Behavioural Therapy for Co-morbid Anxiety Disorders in a Primary Care Psychological Therapy (IAPT) Service?

Irritable bowel syndrome (IBS) is a common co-morbid condition with anxiety disorders, and patients often report a fear of incontinence in public places. This type of bowel control anxiety (BCA) can be conceptualized as a phobic syndrome. Yet little evidence exists on the prevalence or outcomes of these co-morbidities in routine primary care psychological therapy (Improving Access to Psychological Therapies, IAPT) services. To examine the prevalence and outcomes of IBS and BCA patients treated with cognitive behavioural therapy (CBT) for anxiety disorders within a routine IAPT service. An observational cohort study screened 2322 referrals to an IAPT service over 12 months for the presence of IBS. Patients with co-morbid anxiety disorders and IBS were grouped into those with, and without BCA. Patients completed the IBS symptom severity scale and the IAPT minimum data set. Diagnoses and outcomes were examined for all groups up to 6 months follow-up. A greater proportion of BCA patients had a primary diagnosis of phobic disorder. After receiving CBT, patients made clinically significant improvement in both anxiety and IBS symptoms at 6 months follow-up. Patients with BCA made greater improvement in phobia scales and IBS symptoms than non-BCA patients. Anxiety disorders with co-morbid IBS improved significantly in a routine IAPT service. A significant proportion of co-morbid IBS sufferers had a fear of incontinence in public places (BCA). Directly addressing and modifying these fears with CBT appeared to enhance improvement in both phobic anxiety and IBS symptoms.

과민대장증후군 여대생을 위한 동기강화 자가관리 프로그램의 효과

Purpose: The purpose of this study was to develop a motivation-enhanced self-management (MESM) intervention for irritable bowel syndrome (IBS) and to evaluate its effects on female college students with IBS. Methods: The program was constructed to reflect the conceptual framework of the self-determination theory including autonomous motivation enhancement strategy through the satisfaction of psychological needs. The experimental group (n=24) participated in the all eight weekly MESM sessions, and the control group (n=25) received one hour education of IBS. Primary outcome measures were the IBS symptom severity scale (IBS-SSS) and the IBS specific quality of life (IBS-QOL), and assessed at the baseline and at eight and 16 weeks after the allocation. Others were autonomous motivation, self-determined behavior, and psychological distress assessed at the baseline and at eight weeks. Results: The experimental group showed improvement in the IBS-SSS (p<.001) at 16 weeks compared to the control group. They showed markedly more improvement in the IBS QOL (p=.008), but the magnitude of this difference decreased at 16 weeks. The experimental group showed improvements in autonomous motivation (p=.035), self-determined behavior (p=.023), and psychological distress (p=.044) compared to the control group. Conclusion: Study results suggest that the MESM intervention for female college students may effectively improve the IBS-SSS and the QOL. Key Words: Irritable bowel syndrome; Motivation; Self-management; Quality of life Key Words: 과민성장증후군; ìžê¸°ê²°ì •ì„± ì´ë¡ ; 동기강화 자가관리 프로그램; 삶의 질

Long-term response to gluten-free diet as evidence for non-celiac wheat sensitivity in one third of patients with diarrhea-dominant and mixed-type irritable bowel syndrome

PurposeIrritable bowel syndrome (IBS) is common but therapies are unsatisfactory. Food is often suspected as cause by patients, but diagnostic procedures, apart from allergy testing, are limited. Based on the hypothesis of non-celiac wheat sensitivity (WS) in a subgroup of IBS patients, we tested the long-term response to a gluten-free diet (GFD) and investigated HLA-DQ2 or -DQ8 expression as a diagnostic marker for WS in diarrhea-dominant (IBS-D) and mixed-type IBS (IBS-M).MethodsThe response to a GFD served as reference test for WS and HLA-DQ2/8 expression was determined as index test. Patients were classified as responders if they reported complete or considerable relief of IBS symptoms on at least 75 % of weeks over a 4-month period of gluten-free diet. Established questionnaires (IBS-Quality of Life (IBS-QoL), IBS Symptom Severity Scale (IBS-SSS), European Quality of Life-5 Dimensions (EQ-5D)) were used for secondary outcome measures.ResultsThirty-five patients finished the study. Of these, 12 (34 %) were responders and classified as having WS (95 % CI 21–51 %). HLA-DQ2/8 expression had a specificity of 52 % (95 % CI 33–71 %) and sensitivity of 25 % (95 % CI 8–54 %) for WS. Responders showed improvement in quality of life and symptom scores. At 1-year follow-up, all responders and 55 % of non-responders were still on GFD and reported symptom relief.ConclusionUsing strict criteria as recommended for IBS studies, about one third of patients with IBS-D or IBS-M are wheat sensitive, with a similar proportion in both IBS types. Expression of HLA-DQ2/8 is not useful as diagnostic marker for WS. Long-term adherence to a GFD is high and can sustain symptomatic improvement.

PTU-127 Efficacy of Linaclotide in Constipation-Predominant Irritable Bowel Syndrome in Routine Clinical Practice: A Multicentre Experience

<h3>Introduction</h3> Constipation-predominant irritable bowel syndrome (IBS-C) is a common and difficult disorder to manage. Linaclotide is licensed in the UK for symptomatic treatment of moderate to severe IBS-C. Data from randomised, controlled trials demonstrate that the drug improves symptoms in patients with IBS-C, but real-world data are lacking. <h3>Methods</h3> We treated adult patients with IBS-C (Rome III Criteria), attending outpatient clinics in three UK hospitals, with linaclotide 290 mcg once daily. IBS symptoms were assessed at baseline, 4 weeks, and 12 weeks after commencing therapy using the validated IBS symptom severity scale (IBS-SSS). Responders were defined as those patients with a decrease in total IBS-SSS score of &gt;75. <h3>Results</h3> A total of 108 patients (mean age 43.2; range 17–84 years; 94 (87.0%) female) received linaclotide. In total, 4 week IBS-SSS scores were available for 72 (66.7%) patients, and 12 weeks scores in 26 (24.1%) patients. Effect of linaclotide on individual components of the IBS-SSS, as well as total IBS-SSS score, at 4 and 12 weeks are detailed in Table 1. There were 49 (45.4%) patients who responded to linaclotide, with a reduction in IBS-SSS of &gt;75 at 4 weeks. The drug also led to a significant reduction in straining (3.9 at baseline vs. 2.0 at 4 weeks, P &lt; 0.001), and increase in mean number of stools per week (3.8 at baseline vs. 8.9 at 4 weeks, P &lt; 0.001). At 4 weeks, 61 (56.5%) patients continued the drug and 47 (43.5%) discontinued, 24 (22.2%) due to lack of efficacy or losses to follow-up, and 23 (21.3%) due to adverse events (AEs). Among the 61 patients continuing linaclotide, 22 (36.1%) were responders at 12 weeks. AEs occurred in 43 (39.8%) patients overall, which lead to discontinuation of the drug in 23 (21.3%) patients either before or at their 4 week assessment. These included diarrhoea in 28 (25.9%) (15 discontinued), abdominal pain in 6 (5.6%) (5 discontinued), nausea in 3 (2.8%) (1 discontinued), flatulence in 2 (1 discontinued), headaches in 2 (0 discontinued), faecal incontinence in 1 (1 discontinued), and urgency in 1 (0 discontinued). <h3>Conclusion</h3> Linaclotide was effective in IBS-C patients in a real-world setting, with significant reductions in IBS-SSS scores and straining, and a significant increase in mean number of stools per week. Responder rates at 4 and 12 weeks were 45% and 36% respectively. 40% of patients reported AEs, with diarrhoea the commonest, occurring in 26% of patients. Previous literature has reported a lower frequency of AEs, which infrequently led to withdrawal of linaclotide. However, in our study the occurrence of AEs led to discontinuation in 21% of patients. <h3>Disclosure of Interest</h3> None Declared

Mo1635 Efficacy of Linaclotide in Constipation-Predominant Irritable Bowel Syndrome in Routine Clinical Practice: A Multicentre Experience

Introduction Constipation-predominant irritable bowel syndrome (IBS-C) is a common and difficult disorder to manage. Linaclotide is licensed in the UK for symptomatic treatment of moderate to severe IBS-C. Data from randomised, controlled trials demonstrate that the drug improves symptoms in patients with IBS-C, but real-world data are lacking. Methods We treated adult patients with IBS-C (Rome III Criteria), attending outpatient clinics in three UK hospitals, with linaclotide 290 mcg once daily. IBS symptoms were assessed at baseline, 4 weeks, and 12 weeks after commencing therapy using the validated IBS symptom severity scale (IBS-SSS). Responders were defined as those patients with a decrease in total IBS-SSS score of >75. Results A total of 108 patients (mean age 43.2; range 17–84 years; 94 (87.0%) female) received linaclotide. In total, 4 week IBS-SSS scores were available for 72 (66.7%) patients, and 12 weeks scores in 26 (24.1%) patients. Effect of linaclotide on individual components of the IBS-SSS, as well as total IBS-SSS score, at 4 and 12 weeks are detailed in Table 1. There were 49 (45.4%) patients who responded to linaclotide, with a reduction in IBS-SSS of >75 at 4 weeks. The drug also led to a significant reduction in straining (3.9 at baseline vs. 2.0 at 4 weeks, P Conclusion Linaclotide was effective in IBS-C patients in a real-world setting, with significant reductions in IBS-SSS scores and straining, and a significant increase in mean number of stools per week. Responder rates at 4 and 12 weeks were 45% and 36% respectively. 40% of patients reported AEs, with diarrhoea the commonest, occurring in 26% of patients. Previous literature has reported a lower frequency of AEs, which infrequently led to withdrawal of linaclotide. However, in our study the occurrence of AEs led to discontinuation in 21% of patients. Disclosure of Interest None Declared

Feasibility and Usability Pilot Study of a Novel Irritable Bowel Syndrome Food and Gastrointestinal Symptom Journal Smartphone App.

OBJECTIVES:Seventy percent of patients with irritable bowel syndrome (IBS) identify certain foods as triggers for their symptom flare-ups. To help identify potential trigger foods, practitioners often rely on patient food and gastrointestinal (GI) symptom journaling. The aim of the study was to evaluate the feasibility and usability of a novel food and symptom journal app, specifically designed for patients with IBS. Secondary aims were to explore the effect of using the app on GI symptoms and to describe associations between diet and GI symptoms suggested by individual patient data.METHODS:The feasibility and usability of the novel app was studied in 11 IBS patients (8 women), aged 21–65 years. Participants were asked to log GI symptoms (abdominal pain, bloating, diarrhea, constipation) using a 100-point color-graded sliding scale (green=none, red=severe) four times a day and to log every meal/snack they ate (at least three times a day) over a 2-week period. The app's feasibility as a data collection tool was evaluated by daily completion, compliance, data hoarding, and fatigability rates. Usability was evaluated with the System Usability Scale (SUS). To explore potential impact of using the app on bowel distress, we compared before and after intervention IBS-Symptom Severity Scale (IBS-SSS) scores. Meal entries were analyzed for nutrients using the Nutrition Data System for Research. Regression analyses were conducted for each participant journal to explore relationships between meal nutrients and subsequent GI symptoms.RESULTS:Daily average completion rates of the minimum requested entries for meal and GI symptoms were 112±47% and 78±44%, respectively. Average 24-h compliance rates were 90±19% and 94±12%, respectively. The SUS score was above average (mean 83, range 65–97.5; n=10). Most participants did not have a clinically significant decrease in IBS-SSS. At least one strong association (P≤0.05) between GI symptoms and a meal nutrient was found in 73% of participants. The mean number of associations was 2 (range 0–7; n=11). Patterns of associations differed between individual participants.CONCLUSIONS:Our app appeared to be a feasible and usable tool for IBS patients. Our findings are in line with anecdotes that most IBS patients have food triggers and that these vary by individual. Future studies can explore whether individualized dietary changes guided by an app can result in IBS symptom improvement.

Correlation between food intolerance and colon mucosal mast cells and substance P in 27 patients with diarrhea predominant irritable bowel syndrome

Objective To investigate the significance and possible mechanism of food intolerance in diarrhea-predominant irritable bowel syndrome (IBS-D). Methods Twenty-seven IBS-D patients matched the Rome Ⅲ criteria were selected as IBS-D group. Twenty-seven healthy individuals without gastrointestinal symptoms were assigned to control group. Food intolerance situation of two groups were analyzed with food intolerance status evaluation questionnaire, and detection of 14 food specific IgG antibody. The severity of IBS symptoms of IBS-D group were scored by IBS-symptom severity scale (SSS). Two pieces of mucosal tissues of both ileocecal junction and sigmoid colon were obtained under colonoscopy. The content of mucosal substance P (SP) was determined by immunohistochemistry.The quantity of mast cells were detected by Giemsa staining. Chi square test and Fisher exact probability method were performed for rate comparison between two groups.Measurement data were compared with t test and Mann-Whitney rank sum test.The correlation between IBS-SSS score and mast cells and the expression of SP positive cells were analyzed by Spearman rank correlation analysis. Results There was no statistically significant difference in positive rates of food specific IgG between two groups (χ2=3.085, P=0.389), however according to food intolerance status evaluation questionnaire, the incidence of food intolerance of IBS-D group was 44.4%(12/27) which was higher than that of control group (14.8%, 4/27), the difference was statistically (χ2=5.684, P=0.017). Food intolerance severity index of IBS-D group (median: 0(0, 60)) was higher than that of control group (median: 0(0, 0)), and the difference was statistically significant (U=239.50, P=0.007). In foods that may cause intolerance, the percentage of foods rich in fermentable oligosaccharides and monosaccharides, disaccharides and polyol (FODMAP) such as milk, noodles, soybeans was up to 71.4% (30/42). The expression tates of SP positive cells in the mucosa of ileocecal junction and sigmoid colon of patients with IBS-D were higher than those of the control group (χ2=20.735 and 22.071, both P<0.01). The numbers of mast cell in the mucosa of ileocecal junction and sigmoid colonic of patients with IBS-D (2.40±1.04/high power field(HPF) and 2.35±1.11/HPF) were more than those of the control group (0.97±0.70/HPF and 0.89±0.72/HPF), and the difference was statistically significant (t=-5.850 and -5.629, both P<0.01). The severity of bowel symptom of patients with IBS-D was moderately correlated with the number of mast cells in the mucosa of sigmoid colon (r=0.576, P=0.002), and was moderately correlated with the expression of SP positive cells (r=0.691, P<0.01). Conclusions There may be relation ship among low-grade inflammation of intestinal mucosa, food intolerance and severity of intestinal symptoms in patients with IBS-D. Key words: Food intolerance; Diarrhea-predominant irritable bowel syndrome; Mast cells; Substance P

과민대장증후군 환자의 증상의 중증도와 식습관 및 증상유발식품과의 관련성

Purpose: The purpose of this study was to investigate eating habits and the frequency of trigger-food consumption in patients with irritable bowel syndrome (IBS) and to examine the associations of these variables with IBS symptom severity. Methods: We included 145 ROME III-positive IBS patients (mean age 31.2 years, 73.8% of female). Subjects completed an eating-habits and food-consumption questionnaire, IBS-Symptom Severity Scale (IBS-SSS) and Brief Symptom Inventory-18 (BSI-18) for psychological distress. Results: Subjects with unhealthy eating-habits such as irregular meal times, frequently eating out and overeating tended to show higher IBS symptom severity. The severity of IBS symptoms related to the frequency of the consumption of trigger foods. Subjects who ate trigger-foods (i.e., tofu, beans, almonds, and peanuts) less frequently showed higher IBS symptom severity (p=.045, .042, .016, and .019, respectively). However, subjects who ate spicy foods, instant foods, and noodles more frequently experienced more severe IBS symptoms (p=.018, .011, and .023 respectively). Conclusion: This study showed that IBS symptom severity was related to meal intake patterns and frequency of trigger food consumption. These findings could provide a basis for developing an intervention program for IBS patients.

Systematic review: instruments to assess abdominal pain in irritable bowel syndrome.

Consensus on standard methods to assess chronic abdominal pain in patients with irritable bowel syndrome (IBS) is currently lacking. To systematically review the literature with respect to instruments of measurement of chronic abdominal pain in IBS patients. Systematic literature search was performed in PubMed/Medline databases for studies using pain measurement instruments in patients with IBS. One hundred and ten publications were reviewed. A multitude of different instruments is currently used to assess chronic abdominal pain in IBS patients. The single-item methods, e.g. the validated 10-point numeric rating scale (NRS), and questionnaires assessing gastrointestinal symptoms severity, focus mostly on the assessment of only the intensity of abdominal pain. Of these questionnaires, the validated IBS-Symptom Severity Scale includes the broadest measurement of pain-related aspects. General pain questionnaires and electronic momentary symptom assessment tools have been used to study abdominal pain in IBS patients, but have not yet been validated for this purpose. The evidence for the use of provocation tests, e.g. the rectal barostat with balloon distention, for measurement of abdominal pain in IBS is weak, due to the poor correlation between visceral pain thresholds assessed by provocation tests and abdominal pain as assessed by retrospective questionnaires. The multitude of different instruments to measure chronic abdominal pain in IBS makes it difficult to compare endpoints of published studies. There is need for validated instruments to assess chronic abdominal pain in IBS patients, that overcome the limitations of the currently available methods.

Gender differences in irritable bowel syndrome: the interpersonal connection.

While irritable bowel syndrome (IBS) affects women more than men, the reasons are unclear. Research on the female preponderance of IBS has focused on gender differences in sex-linked biological processes; much less attention has been paid to the role of psychosocial factors. Interpersonal difficulties may be one source of stress that may significantly impact on women with IBS. Because of the importance that women attach to relationships, we suspected they would be more reactive to interpersonal stress. A total of 283 (M age=41years, F=80%), Rome III-diagnosed IBS patients completed a test battery that included the IBS Symptom Severity Scale, McGill Pain Questionnaire, Inventory of Interpersonal Problems (IIP), interpersonal support evaluation list (social support), Negative Interactions Scale, Brief Symptom Inventory (distress), Beck Depression Inventory, Anxiety Sensitivity Inventory, and IBS-Quality of Life as part of baseline assessment of an NIH trial. Males scored higher on two IIP scales reflecting a hostile-dominant interpersonal pattern, and reported less social support. The quality of relationship problems (more interpersonal difficulties, lower support) correlated with IBS symptom severity as measured mainly by gastroenterologists. Male, not female, IBS patients reported more interpersonal difficulties. Male patients-a population for whom little is known-are characterized by hostile-dominant interpersonal problems. This finding has clinical importance, given that relationship problems may influence MDs' estimation of IBS symptom severity and undermine the physician-patient relationship.

Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome as Well as Traditional Dietary Advice: A Randomized Controlled Trial

A diet with reduced content of fermentable short-chain carbohydrates (fermentable oligo-, di-, monosaccharides, and polyols [FODMAPs]) has been reported to be effective in the treatment of patients with irritable bowel syndrome (IBS). However, there is no evidence of its superiority to traditional dietary advice for these patients. We compared the effects of a diet low in FODMAPs with traditional dietary advice in a randomized controlled trial of patients with IBS. We performed a multi-center, parallel, single-blind study of 75 patients who met Rome III criteria for IBS and were enrolled at gastroenterology outpatient clinics in Sweden. Subjects were randomly assigned to groups that ate specific diets for 4 weeks-a diet low in FODMAPs (n= 38) ora diet frequently recommended for patients with IBS (ie, a regular meal pattern; avoidance of large meals; and reduced intake of fat, insoluble fibers, caffeine, and gas-producing foods, such as beans, cabbage, and onions), with greater emphasis on how and when to eat rather than on what foods to ingest (n= 37). Symptom severity was assessed using the IBS Symptom Severity Scale, and patients completed a 4-day food diary before and at the end of the intervention. A total of 67 patients completed the dietary intervention (33 completed the diet low in FODMAPs, 34 completed the traditional IBS diet). The severity of IBS symptoms was reduced in both groups during the intervention (P < .0001 in both groups before vs at the end of the 4-week diet), without a significant difference between the groups (P= .62). At the end of the 4-week diet period, 19 patients (50%) in the low-FODMAP group had reductions in IBS severity scores ≥50 compared with baseline vs 17 patients (46%) in the traditional IBS diet group (P=.72). Food diaries demonstrated good adherence to the dietary advice. A diet low in FODMAPs reduces IBS symptoms as well as traditional IBS dietary advice. Combining elements from these 2 strategies might further reduce symptoms of IBS. ClinicalTrials.gov ID NCT02107625.

Su1371 Non-Traumatic Stressful Events At the Time of Abdominal Pain Onset Is a Marker of Current Psychological but Not GI Health in More Severe IBS Patients

BACKGROUND. IBS is a chronic, potentially disabling GI disorder that affects up to 50 million Americans. Despite its prevalence, IBS symptoms of a significant proportion of individuals go unrecognized or untreated. Efforts to improve case detection by encouraging MDs to adopt Rome diagnostic criteria have been suboptimal. An alternative approach is to improve symptom reporting through the use of self-administered checklists or screeners that increase individuals' awareness and knowledge of the diagnostic symptoms of IBS. When shared with the treating gastroenterologist (GE), information derived from symptom checklists have potential to improve diagnostic accuracy, conserve time and resources, strengthen patient engagement, and help patients obtain improved quality of life and relief for the disorder for which they seek care. These goals have been hampered by the lack of a brief, easy to administer, simple to score/interpret, and validated measure.AIM. To examine the diagnostic accuracy of a brief (4 True-False questions) screening tool of IBS symptoms based on Rome III criteria. METHOD. 384 IBS patients (80% F; M age = 41 yrs.) completed the IBS screener (4-IBS) that was embedded in a test battery administered at pretreatment assessment of an NIH trial for IBS. Assessment included the IBS Symptom Severity Scale, IBS QOL, Brief Symptom Inventory (distress), SF-12, Visceral Sensitivity Inventory (VSI, fear of visceral sensation). Administration time was < 1 minute. GI symptoms were assessed by a board certified GE who confirmed Rome diagnosis (‘gold standard') in all cases. GEs were blind to patient responses to the 4-IBS when Rome diagnosis was made. RESULTS. Agreement between GE diagnosis and 4-IBS screener diagnosis was good to excellent. The 4-IBS symptom screener correctly diagnosed IBS in 71% of IBS-C patients and 75% of IBSD patients. Agreement was strongest (90%) for IBS-M patients. Patients for whom there was greatest agreement between self-report and GE diagnosis were characterized by stronger fears of GI symptoms (VSI, p<.05).CONCLUSION. Data corroborated the diagnostic validity of a brief, self-report IBS screener for identifying patients likely to meet Rome criteria for IBS. While a clinical evaluation is necessary to confirm IBS and rule out other potential conditions whose GI symptoms mimic those of IBS, the 4-IBS screener may prove useful for identifying IBS patients in busy clinical settings. A self-screener may be particularly useful for early identification of patients who drive health care use. For patients with stronger fears of GI symptoms (high VSI), their hypervigilance to core IBS symptoms and features (e.g., pain onset associated with change in stool consistency) may promote accurate diagnosis of IBS relative to less fearful patients with lower attentional focus to visceral sensations. Acknowledgements: NIH grant DK77738

Su1370 Diagnostic Accuracy of a Brief IBS Screener (4-IBS) for Use in Busy GI Practices

BACKGROUND. IBS is a chronic, potentially disabling GI disorder that affects up to 50 million Americans. Despite its prevalence, IBS symptoms of a significant proportion of individuals go unrecognized or untreated. Efforts to improve case detection by encouraging MDs to adopt Rome diagnostic criteria have been suboptimal. An alternative approach is to improve symptom reporting through the use of self-administered checklists or screeners that increase individuals' awareness and knowledge of the diagnostic symptoms of IBS. When shared with the treating gastroenterologist (GE), information derived from symptom checklists have potential to improve diagnostic accuracy, conserve time and resources, strengthen patient engagement, and help patients obtain improved quality of life and relief for the disorder for which they seek care. These goals have been hampered by the lack of a brief, easy to administer, simple to score/interpret, and validated measure.AIM. To examine the diagnostic accuracy of a brief (4 True-False questions) screening tool of IBS symptoms based on Rome III criteria. METHOD. 384 IBS patients (80% F; M age = 41 yrs.) completed the IBS screener (4-IBS) that was embedded in a test battery administered at pretreatment assessment of an NIH trial for IBS. Assessment included the IBS Symptom Severity Scale, IBS QOL, Brief Symptom Inventory (distress), SF-12, Visceral Sensitivity Inventory (VSI, fear of visceral sensation). Administration time was < 1 minute. GI symptoms were assessed by a board certified GE who confirmed Rome diagnosis (‘gold standard') in all cases. GEs were blind to patient responses to the 4-IBS when Rome diagnosis was made. RESULTS. Agreement between GE diagnosis and 4-IBS screener diagnosis was good to excellent. The 4-IBS symptom screener correctly diagnosed IBS in 71% of IBS-C patients and 75% of IBSD patients. Agreement was strongest (90%) for IBS-M patients. Patients for whom there was greatest agreement between self-report and GE diagnosis were characterized by stronger fears of GI symptoms (VSI, p<.05).CONCLUSION. Data corroborated the diagnostic validity of a brief, self-report IBS screener for identifying patients likely to meet Rome criteria for IBS. While a clinical evaluation is necessary to confirm IBS and rule out other potential conditions whose GI symptoms mimic those of IBS, the 4-IBS screener may prove useful for identifying IBS patients in busy clinical settings. A self-screener may be particularly useful for early identification of patients who drive health care use. For patients with stronger fears of GI symptoms (high VSI), their hypervigilance to core IBS symptoms and features (e.g., pain onset associated with change in stool consistency) may promote accurate diagnosis of IBS relative to less fearful patients with lower attentional focus to visceral sensations. Acknowledgements: NIH grant DK77738

Symptom-association probability between meal ingestion and abdominal pain in patients with irritable bowel syndrome. Does somatization play a role?

Patients with irritable bowel syndrome (IBS) complain of postprandial abdominal pain, but it is still unknown how much of this association is due to chance. Somatization enhances the perception of symptoms after a meal. We assessed: (i) the proportion of meal-related pain periods and the symptom-association probability (SAP) between the two variables in IBS patients; and (ii) how this association is affected by somatization. Seventy IBS patients recorded the times of meals and abdominal pain in a 10-day diary card. The proportion of postmeal pain periods was calculated in relation to the total number of 90-min periods with pain. Fisher's exact test was used to calculate the probability (p) of an association within a time window of 90 min, and the SAP was calculated as (1 - p) × 100%. The IBS Symptom Severity Scale, the SCL90-R for psychological symptoms, and the SF-36 for the quality of life were completed. The proportion of postmeal pain periods was 42 ± 27%. SAP was significant (p < 0.05) in 32 patients (45%). Somatization was altered in 30 patients (47%), who were younger and had more severe IBS and a poorer quality of life. Somatization did not influence the association between meal ingestion and abdominal pain. Meal ingestion and abdominal pain are significantly associated in 45% of IBS patients. Somatization influences IBS severity and the patients' quality of life, but not the strength of the association between eating and pain.

An exploratory comparative investigation of Food Allergy/Sensitivity Testing in IBS (The FAST Study): A comparison between various laboratory methods and an elimination diet

ObjectiveTo determine the ability of several non-IgE mediated food allergy (NIMFA) test methods to identify which foods would elicit symptoms in irritable bowel syndrome (IBS) sufferers. MethodsThis was a correlative, hypothesis generating study. Participants (n=4) with IBS (Rome III >200) provided blood samples for various marketed NIMFA tests (cytotoxic assay, IgG food antigen, electrodermal screening), prior to initiating an Elimination/Challenge diet. Eight foods were challenged following a 4-week elimination diet. Challenge foods were selected from reported reactive foods on test results. Participants and team members were blinded to the test results until study completion. Dietary choices and symptoms were tracked daily and reviewed bi-weekly. The IBS symptom severity scale (IBS-SS) was administered at each visit (n=5). ResultsThere was poor agreement, assessed by Fleiss’ kappa, between the various test results and those foods, on challenge, elicited a reaction. The sensitivity of the NIMFA tests ranged from 20 to 75%, while the specificity, from 50 to 89%. ConclusionNone of the NIMFA tests evaluated in this study were found to be diagnostically predictive in the identification of specific foods that exacerbate the gastrointestinal symptoms in our small sample of IBS sufferers.