Irritable Bowel Syndrome Cohort Research Articles

Identifying a biological signature of prenatal maternal stress.

Psychological stress affects maternal gastrointestinal (GI) permeability, leading to low-grade inflammation, which can negatively affect fetal development. We investigated a panel of circulating markers as a biological signature of this stress exposure in pregnant women with and without the stress-related GI disorder irritable bowel syndrome (IBS). Markers of GI permeability and inflammation were measured in plasma from healthy and IBS cohorts of women at 15 and 20 weeks’ gestation. Biomarkers were evaluated with respect to their degree of association to levels of stress, anxiety, and depression as indicated by responses from the Perceived Stress Scale, State-Trait Anxiety Inventory, and Edinburgh Postnatal Depression Scale. High levels of stress were associated with elevations of soluble CD14, lipopolysaccharide binding protein (LBP), and tumor necrosis factor–α, while anxiety was associated with elevated concentrations of C-reactive protein (CRP) in otherwise healthy pregnancies. Prenatal depression was associated with higher levels of soluble CD14, LBP, and CRP in the healthy cohort. High levels of prenatal anxiety and depression were also associated with lower concentrations of tryptophan and kynurenine, respectively, in the IBS cohort. These markers may represent a core maternal biological signature of active prenatal stress, which can be used to inform intervention strategies via stress reduction techniques or other lifestyle approaches. Such interventions may need to be tailored to reflect underlying GI conditions, such as IBS.

Racial disparity in healthcare utilization among patients with Irritable Bowel Syndrome: results from a multicenter cohort.

Racial disparity in healthcare is defined as differences in healthcare services received by racial groups not due to difference in needs or preferences. As irritable bowel syndrome (IBS) is highly correlated with social factors, healthcare disparities are important factors in the sociocultural model of IBS. We used healthcare utilization as a lens to examine potential racial disparities in IBS. We retrospectively matched 3823 IBS minority patients who self-identified as "Hispanic," "Black," or "Asian" to white IBS controls and examined the number of patients with gastroenterology consults, gastroenterology procedures, and IBS-related Primary Care visits within each cohort from 2003 to 2017. Minority IBS patients were less likely to receive a gastroenterology consult than white IBS controls. Both Black and Asian IBS patients were more likely to have an IBS-related Primary Care visit than white IBS controls. All 3 minority IBS cohorts received significantly more gastroenterology procedures compared to white IBS controls. Minority IBS patients are more likely to receive gastroenterology procedures than white IBS patients. Further studies are needed to determine whether increased procedure likelihood in minority IBS patients represents a communication gap between minority patients and their providers or patient preference.

Sequential laxative-probiotic usage for treatment of irritable bowel syndrome: a novel method inspired by mathematical modelling of the microbiome

The gut microbiome plays an important role in human health. However, its response to external intervention is complex. A previous study showed that the response to Clostridium butyricum (CB) treatment of irritable bowel syndrome (IBS) is heterogeneous. We proposed that mathematical model simulation of the microbiota may help to optimize the management of IBS-associated microbiota. In this study, a novel mathematical non-extinction and defecation normalized (NEDN) model was generated for stable simulation of the dynamic nature of gut microbiota. In silico simulation revealed that a laxative may create a favourable opportunity for Clostridium cluster XIVa to shift the microbiota. An explorative clinical trial was conducted to compare three CB regimens in an IBS cohort: laxative, interval of 2 weeks and CB administration for 2 weeks (L2P); laxative immediately followed by CB administration (LP) for 2 weeks; and CB administration for 2 weeks (P). The LP regimen optimally relieved the IBS symptoms and shifted the microbiota closer to those of the healthy subjects during 2 weeks of CB intake. These results indicate that integration of biological/mathematical approaches and clinical scenarios is a promising method for management of microbiota. Additionally, the optimal effect of sequential laxative-CB usage for IBS treatment warrants further validation.Clinical trial registration numbers: NCT02254629.Date of registration: October 2, 2014.

Increased incidence and recurrence rates of acute diverticulitis in patients with irritable bowel syndrome.

Acute diverticulitis (AD) is commonly diagnosed in outpatient and emergency departments and is associated with severe complications such as perforation and fistula. Symptoms of irritable bowel syndrome (IBS), such as abdominal pain, constipation and diarrhoea, are also common with AD. This study aimed to evaluate the strength of a possible association between IBS and AD. This retrospective study analysed records from Taiwan's National Health Insurance Research Database and involved a total of 25810 patients, including 12905 IBS patients diagnosed between 2000 and 2012. The IBS and non-IBS cohorts were matched by propensity score for age, gender, comorbidities and medication, then compared for confounding variables by the chi-square test or Student's t-test. The association between AD and IBS was determined using Cox proportional hazards models. Kaplan-Meier curves assessed the cumulative incidence of AD in IBS patients. The overall incidence of AD was 3.95-fold higher in the IBS cohort than in the non-IBS cohort (63.34 vs 16.02 per 100000 person-years, respectively) and IBS was an independent risk factor for subsequent diagnosis of AD in multivariate Cox proportional hazards regression model adjusted hazards ratio (aHR=3.84, 95% CI=2.29-6.44, P<0.001) and Kaplan-Meier (log-rank test, P<0.001) analysis. IBS was also associated with a high recurrence rate of AD (aHR=8.30, 95% CI=1.07-64.30, P=0.04). The epidemiological evidence in this study demonstrates that patients with IBS are associated with a higher incidence of AD and also its recurrence.

Irritable bowel syndrome increases the risk of chronic obstructive pulmonary disease: A retrospective cohort study

Both inflammation and infection are associated with the development of irritable bowel syndrome (IBS) and chronic obstructive pulmonary disease (COPD). The purpose of this study is to further elucidate the association between IBS and COPD through a retrospective cohort study. We enrolled IBS patients diagnosed between 2000 and 2011 with follow-up for at least one year. The non-IBS patients as comparison group were selected with 1:3 matching by propensity score. Statistical analysis was utilized to assess the differences in characteristic distribution, and to compare the cumulative incidence of COPD between the IBS and non-IBS cohorts. We selected 14,021 IBS patients and 42,068 non-IBS patients for comparison. The IBS patients exhibited a significant risk to develop COPD compared with non-IBS patients. Additionally, the cumulative incidence rate of COPD in the IBS cohort increased significantly during the follow-up period of more than ten years, compared to the non-IBS cohort, based on the Kaplan-Meier analysis. The risk of COPD was also significantly decreased in those patients with more than eighteen IBS-related clinical visits. This retrospective cohort study demonstrates the significantly increased risk of COPD in patients with IBS. Therefore, early inspection and prevention of COPD is essential for patients with IBS.

Association of Habitual Dietary Fiber Intake and Fecal Microbiome Gene Abundance with Gastrointestinal Symptoms in an Irritable Bowel Syndrome Cohort

Abstract Objectives Dietary fibre supplementation is recognised as important for functional gastrointestinal disorders (FGID). The exact role of the microbiome in this relationship remains unclear. We explored differences in dietary fibre intake, GI symptoms and the fecal microbiome in those with FGID. Methods The COMFORT cohort is an observational case control study examining FGID, particularly irritable bowel syndrome (IBS) aetiology (Ethics 16/NTA/21). Participants prospectively completed a food and GI symptoms diary over 3 days. Severity of GI symptoms and mood disorders were assessed using clinical questionnaires; SAGIS and PROMIS for GI symptoms and HADS for anxiety and depression. Fecal samples were analysed by shotgun sequencing; 95 healthy controls (HC), 22 constipation IBS (IBS-C) and 50 diarrhea IBS (IBS-D). Taxonomic classifications were assigned by aligning sequences against the NCBI non-redundant database using DIAMOND. Results Diet diaries were completed by 292 participants (176 cases, 71.2% female). Average daily fibre intake was higher in HC compared to FGID (23.99g, 95% CI = –2.06-0.55; 20.28g, 95% CI = -1.96-0.45; P &amp;lt; 0.05). Low fibre daily intake (&amp;lt; 15g) was associated with higher depression scores (P &amp;lt; 0.05) and increased anxiety in those with functional diarrhea (r2 = -0.554, P = 0.03). A negative association between fibre consumption and increased bloating in IBS (r2 = -0.19, P = 0.04) was also found. The GI microbiome in IBS was characterised by differences in Firmicutes belonging to the Lachnospiraceae family (e.g., Blautia and Ruminococcus, P &amp;lt; 0.05). Other differentiating taxa included Bilophila (higher in IBS-D) and Methanobrevibacter (lower in IBS-D) (P &amp;lt; 0.05). At the phylum level, bloating and constipation were correlated with Firmicutes relative abundance, and negatively correlated with Bacteroides (canonical r &amp;gt; |0.5|). At the genus level, Blautia were correlated with diarrhea and faecal incontinence (canonical r &amp;gt; 0.5). Conclusions Higher fibre consumption was associated with decreased bloating, anxiety and depression in different FGID subgroups. IBS was also associated with altered fecal microbiome composition including some taxa linked to carbohydrate and hydrogen metabolism. Funding Sources Funded by the Ministry of Business, Innovation and Employment through the High-Value Nutrition National Science Challenge.

Low FODMAP diet significantly improves IBS symptoms: an Irish retrospective cohort study.

There is growing evidence that a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) improves symptoms in irritable bowel syndrome (IBS) patients. We aimed to retrospectively investigate the effects of this diet in Irish IBS cohort over a 12-month follow-up period, including after re-introduction of the high FODMAP foods. All the tertiary referrals seen by an FODMAP-trained dietician were reviewed (2013-2016). Patients were evaluated for IBS symptoms by a questionnaire (four-point Likert scale). Subsequently, advice regarding the low FODMAP diet was given. Symptoms' response was assessed at 3-, 6-, and 12-month follow-up, by use of the same questionnaire. Re-introduction of high FODMAP foods was aimed to commence at the subsequent follow-up. A total of 164 patients were identified. Thirty-seven patients were excluded due to failure to attend for follow-up. Hundred and twenty-seven patients (77% patients, of which85% were female) completed the initial 3-month follow-up. Forty-five percent (74/164) and twenty-five percent (41/164) of the patients had continued follow-up at 6 and 12months, respectively. Of the 127 patients who returned for follow-up, their commonest baseline symptoms were lethargy (92%), bloating (91%), flatulence (91%), and abdominal pain (89%). All symptoms were significantly improved at the initial follow-up (p < 0.0001 for all). Most patients (66%) were satisfied with their overall symptoms control. In patients who had a longer follow-up duration, all symptoms remained significantly improved compared to the baseline (p < 0.0001 for combined symptoms at 6 and 12months). After re-introduction of the high FODMAP foods, all patients maintained their symptomatic response (n = 14/14 and n = 7/7 at 6- and 12-month follow-up, respectively). The best symptoms' improvement was seen in those who were fully adherent to the FODMAP diet. In this Irish retrospective cohort study, the low FODMAP diet significantly improved all IBS symptoms at 3-, 6-, and 12-month follow-up. Following the re-introduction of the high FODMAP foods in a subgroup of patients, they were able to maintain their long-term symptomatic response up to 9months. The low FODMAP diet might be continued for longer than 3months; however, further studies are needed to assess the long-term safety of this diet.

Conditioned Pain Modulation (CPM) is Reduced in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of CPM and the Role of Psychological Factors.

This systematic review summarises evidence assessing endogenous pain inhibition in people with irritable bowel syndrome (IBS) compared with healthy controls using conditioned pain modulation (CPM) and offset analgesia (OA). Evidence regarding the role of psychological variables is also examined. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Four electronic databases were searched to retrieve studies assessing CPM or OA in adults diagnosed with IBS according to the ROME II/III criteria. Standardized mean differences were calculated for each study and a random effects model was used for meta-analysis. Eleven studies were included, 5 of which reported results on the relationship between CPM and psychological variables. None of the studies assessed OA. The risk of bias assessment found a lack of assessor blinding in all studies. The pooled effect estimate was 0.90 (95% CI, 0.40-1.40) indicating a significantly lower CPM effect in people with IBS compared with controls. This effect was reduced to 0.51 when 1 outlier was excluded from the analysis. In addition, reduced CPM responses were significantly correlated with higher anxiety (r=0.17 to 0.64), stress (r=0.63), and pain catastrophizing (r=0.38) in people with IBS; however, the evidence available was limited and the strength of these associations variable. Depression was not found to be associated with CPM in these IBS cohorts. The results of this review suggest that people with IBS, as a group, demonstrate reduced pain inhibition measured by CPM. The preliminary evidence about the association between psychological factors and CPM warrants further investigations.

Understanding How Metabolites Link Diet, Host, and Microbiota in a Dysfunctional Gut Model Is Important to Establishing a System-wide Understanding of Gut Function (P20-035-19)

ObjectivesNutrition modulates the interactions between the host and the gut microbiota. Changes in metabolites resulting from this interaction in a healthy compared to a perturbed gut is a critical approach to identify putative biomarkers that can be used to assess how diet effects gut function. Bile acids (BAs) are metabolites produced from cholesterol and the microbial-conversion of BAs play an important role in digestion and metabolism. Modification of BA metabolism has been reported in participants with Irritable Bowel Syndrome (IBS), which is characterised by abdominal bloating, pain, dysfunction, and a perturbed gut microbiota. One aim of the clinical nutrition study was to characterise BA profiles of healthy control and IBS participants. This work is part of a wider study investigating gut health and how food can be used to alleviate symptoms. MethodsHealthy control and IBS participants were recruited and IBS subtypes determined (n = 337) (Rome Criteria IV). Biological samples and dietary questionnaire information were collected. 97 plasma samples (n = 42 healthy control, n = 25 IBS-diarrhoea, n = 17 IBS-constipation, n = 13 IBS-mixed) were quantitatively analysed for 13 BAs using a SCIEX 6500 + QTrap liquid chromatography-mass spectrometer in multiple reaction monitoring mode. Partial least squares discriminant analysis (SIMCA 14.1) and analysis of variance (Metaboanalyst 4.0) were used to perform multivariate and univariate analyses respectively. Ethical approval was obtained from the University of Otago Human Ethics Committee (Health) (Reference H16/094). ResultsUnivariate analysis of the 13 BAs showed no significant difference within or between IBS subtypes or healthy controls (P > 0.05). However, multivariate analysis of 13 BAs showed separation of the data between IBS subtypes and healthy controls indicating that while individual BA concentrations did not vary significantly, differences in profiles existed in IBS participants. ConclusionsData from a subset of an IBS cohort shows BA metabolism is likely perturbed in IBS. Further analysis of faecal samples will provide additional information that could confirm the relationships to IBS subtypes, and provide putative biomarkers for food interventions targeting improvement of gut comfort and function. Funding SourcesHigh-Value Nutrition National Science Challenge, New Zealand.

PGI17 COMORBID MENTAL HEALTH DISORDERS AND PATIENT-REPORTED PAIN SCORES IN IRRITABLE BOWEL SYNDROME PATIENTS: A RETROSPECTIVE ANALYSIS OF A LARGE US ELECTRONIC HEALTH RECORD DATABASE

Irritable bowel syndrome (IBS) is a gastro-intestinal disorder characterized by pain, one of the most common symptoms of IBS. Pain is noted to be among the most bothersome symptoms, leading patients to seek medical care. Apart from pain, IBS is also known to be associated with mental health disorders. The objective of the present study was to examine IBS sub-types, comorbid mental health disorders, and patient-reported pain scores within an IBS patient cohort. Adult patients (≥18 years) with an ICD-9/10 diagnosis for IBS, from 2012-2016, were retrospectively analyzed from a U.S. electronic health record dataset (Cerner Health Facts®). Medication prescriptions were used to classify patients into the three main IBS subtypes related to bowel habit abnormalities, constipation (IBS-C), diarrhea (IBS-D), and mixed bowel habits (IBS-M). ICD-9 codes were used to identify mental health comorbidities. First patient visit with a patient-reported pain score was assessed to define pain severity (mild, moderate, or severe based on a Numeric Pain Scale 0-10). The study included 57,600 IBS patients (81.9% female), with 52.6% presenting with IBS-D, 42.6% with IBS-M, and 4.8% with IBS-C. About half of the patients were in the ‘36-65 years’ age group (50.6%). The vast majority of IBS patients were of Caucasian race (88.6%). In patients with a mental health comorbidity (67.3%), anxiety and depression were the most common (54.0%). Pain scores were available in 34.72% (N=20,000) of patients. More than half of the patients in the IBS cohort reported either moderate or severe pain (57.1%), with 26.1% suffering from severe pain overall. This retrospective analysis highlights types of IBS and provides evidence of prevalence of mental health conditions, that can pose as a risk factor and/or complication. Additional analyses can be performed to better understand the complexity of IBS using real-world data, especially patient-reported pain scores.

Irritable Bowel Syndrome Is a Risk of Osteoporosis: A Population-Based Nationwide 1 Cohort Study

Background: Previous cohort studies, have reported higher rates of osteoporosis associated with irritable bowel syndrome (IBS). We evaluated the IBS as a risk factor for osteoporosis and osteoporotic fractures in Korea after adequately adjusting for basic confounding factors. Methods: We performed a nationwide population-based retrospective cohort study between January 1, 2002, and December 31, 2010 using National Health Insurance data, including 3,714 newly-diagnosed IBS patients. We matched every IBS case with non-IBS case from the database at a 1:4 frequency ratio (14,856 non-IBS patients). The outcome parameter was newly diagnosed patients with osteoporosis and osteoporotic fractures, defined as per the International Classification of Diseases, 10th Revision (ICD-10) code, and included those assigned the relevant diagnostic codes for osteoporosis, those receiving osteoporosis medications, those with non-traumatic vertebral, hip, pelvic, femur, clavicle, humerus, wrist, and ankle fractures, and those undergoing operative procedures for hip fractures. Findings: We found 3,714 patients (included 2,169 males and 1,545 females) with newly diagnosed IBS, and the number of the final age- and sex-matched study population was 18,570. The median follow-up duration was 85.97 and 87.48 months for males and females, respectively. The incidence of osteoporosis was higher in the IBS cohort. The Cox proportional regression model revealed that the hazard ratio [HR] for osteoporosis in patients with IBS was 1.509 (95% confidence interval [CI], 1.055-2.159) and 1.476 (95% CI, 1.241-1.754) in males and females, respectively. Furthermore, HR for osteoporotic fractures in female patients with IBS was 1.427 (95% CI, 1.086-1.876). Interpretation: Among patients with IBS 1.9% males and 11.4% females developed osteoporosis during the 7-year study period. We found a higher incidence of osteoporosis in patients with IBS than in those without, indicating an association of IBS with osteoporosis. Funding: None. Declaration of Interest: All authors have completed the ICMJE uniform disclosure form and declare: no financial relationships with any organizations that might have an interest in the submitted work i 321 n the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Ethical Approval: This study was approved to be an exemption study by the Research Ethics Board of the Pusan University Hospital (E-2014090, 25th July 2014) because it was dealt with anonymous patient health records presented by HIRA. Therefore, there was no personally identifiable variable in our data and there were no need informed consents of patients in the present study.

Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link?

The low-FODMAP diet has emerged as an option for the treatment of irritable bowel syndrome (IBS). This diet is very restrictive, and compliance is usually low. Preliminary findings suggest an association between eating disorders (EDs) and the risk of developing IBS. The aim of this study was to assess the correlation between compliance with a low-FODMAP diet and the risk of ED behaviours among patients with IBS. A single-centre prospective study was carried out among 233 IBS patients (79.8% females) at University College London Hospital, who commenced a low FODMAPs group programme for IBS (Rome III or IV). Self-reported diet adherence at the end of the 6-week programme was measured. At baseline, and at the 6-week follow-up visit, participants completed the validated IBS-Symptom Severity Score, the SCOFF ED screening questionnaire and the Hospital Anxiety and Depression Scale. Adherence with a low-FODMAP diet was found in 95 (41%) patients. Overall, 54 (23%) patients were classified to be at risk for ED behaviour. Adherence was 57% in the ED group (31/54) versus 35% in the non-ED group (64/179); P<0.05. Adherence with a low-FODMAP diet was highest (51%) in the IBS with diarrhoea subtype and lowest (10%) in IBS with constipation. There was no significant correlation between IBS-Symptom Severity Score and either adherence (P=0.39) or ED behaviour (P=0.28). In this IBS cohort, greater adherence to a low-FODMAP diet is associated with ED behaviour. The implications of our study are important in clinical practice for a clinician to have a high index of suspicion of EDs in IBS patients when a high level of low-FODMAP diet achieved.

Metabolomics analysis revealed metabolic changes in patients with diarrhea-predominant irritable bowel syndrome and metabolic responses to a synbiotic yogurt intervention.

Irritable bowel syndrome is a gastrointestinal disorder which can influence human metabolism. It has been demonstrated that probiotics are beneficial in controlling IBS. Thus, the main objective of the present study was to determine metabolic changes in response to diarrhea predominant irritable bowel syndrome (IBS-D) and to investigate the metabolic effects of a synbiotic intervention on serum, urine, and stool samples from IBS-D patients and healthy controls using proton nuclear magnetic resonance (1HNMR). A 1HNMR-based metabolomics study was conducted on urine and serum metabolites from 16 healthy and eight IBS-D participants at baseline and after 4weeks of a synbiotic yogurt intervention. At the baseline, serum acetoacetate, myo-inositol, and sarcosine concentrations were higher and threonine and methionine concentrations were lower in the IBS-D cohort than the control group. Moreover, Indoxyl-sulfate concentration of urine was lower and dimethylamine and taurine were higher in the IBS-D group. After intervention, serum concentration of ketone bodies decreased, choline, phenylalanine, and branched-chain amino acids increased in IBS-D group. Metabolomics analysis indicated a shift in one-carbon metabolism. Thus, the level of serum homocysteine was determined and found to be higher in the IBS-D cohort at baseline, and then decreased after the intervention. IBS causes a shift in one-carbon metabolism and these changes can be reversed by a synbiotic intervention. An increase in the number of fecal Lactobacilli and an improvement in the health status of IBS-D patients were also observed in response to intervention.

Health-related quality of life and long-term outcomes after endoscopic therapy for walled-off pancreatic necrosis.

Walled-off pancreatic necrosis (WON) frequently develops after necrotizing pancreatitis. Endoscopic drainage has become the preferred modality for symptomatic or infected WON. The aim of the present study was to assess health-related quality of life (HR-QOL) and long-term outcomes in patients undergoing endoscopic drainage for WON. Patients undergoing endoscopic drainage of WON from January 2006 to May 2016 were identified. Data recorded included demographic information, and the incidence of long-term sequelae including pancreatic endocrine and exocrine insufficiency. Attempts were made to contact all patients. HR-QOL was assessed using the SF-36 questionnaire. Eighty patients were analyzed, 41 (51.3%) of whom completed the SF-36. One-year all-cause mortality was 6.2%, and disease-related mortality was 3.7%. A notable proportion of patients developed exocrine insufficiency (32.5%), endocrine insufficiency (27.7%), and long-term opiate use (42.5%). Development of exocrine insufficiency was predictive of lower total SF-36 scores (P = 0.016). Patients with WON had better HR-QOL compared with cohorts of irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). In patients developing exocrine insufficiency versus healthy controls, poorer scores in the physical role (P < 0.001), general health (P < 0.001), vitality (P = 0.001), and emotional role (P = 0.029) domains were observed. Exocrine insufficiency patients had better HR-QOL than the IBS and IBD cohorts, although these differences were less pronounced. After undergoing endoscopic drainage for WON, patients have relatively preserved HR-QOL. The subset of patients that develop exocrine insufficiency have significantly poorer HR-QOL compared to healthy controls, although not to the degree of chronic gastrointestinal disorders such as IBS and IBD.

Long, Non-coding RNA Gene Expression Signatures to Distinguish Irritable Bowel Syndrome and Inflammatory Bowel Disease

BACKGROUND: lncRNAs play critical roles in the regulation gene activity. This extends to genes whose protein products are critical for mounting both innate and adaptive immune responses. Our understanding of the functional role of lncRNAs in human diseases, including gastrointestinal disease, is in its infancy. No blood-based RNA biomarkers have been made commercially available to distinguish IBS from IBD or identify individual inflammatory colitides. Here we sought to develop machine learning classifiers using long, non-coding RNA (lncRNA) gene expression data from blood to distinguish irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). METHODS: Peripheral whole blood collected into PAXgene tubes was obtained from healthy control subjects (n=115), and patients diagnosed with irritable bowel syndrome (n=128), Crohn's disease (n=89), and ulcerative colitis (n=84). Patients diagnosed with celiac disease (n=39) were recruited as an additional inflammatory disease control group for classifiers capable of distinguishing IBS from Crohn's disease or ulcerative colitis. RNA sequencing was performed using a small subset of healthy control, celiac, Crohn's disease and ulcerative colitis patient samples to derive 48 highly differentially expressed candidate lncRNA gene targets. To validate sequencing findings, RT-PCR was performed on all patients recruited in the study (n=489). Gene expression datasets generated were used to train and independently validate machine learning classifiers capable of distinguishing IBS and IBD from other subjects in the study cohort. RESULTS: lncRNAs measured by RT-PCR exhibit high degrees of differential expression across healthy control, IBS, and IBD cohorts. Unlike previous studies of mRNAs, lncRNA expression differences were frequently 4-fold or greater in case/control comparisons. lncRNAs exhibit a high degree of discriminatory power and confidence of machine learning predictions with accuracy exceeding 90% for classifiers capable of discriminating irritable bowel syndrome from other inflammatory conditions and healthy controls. CONCLUSION(S): Gene expression data derived from peripheral whole blood analyzed using machine learning methods produces classifiers capable of distinguishing presence of irritable bowel syndrome and inflammatory bowel disease. Use of this information may provide clinically actionable information for healthcare providers.

Children are likely to grow out of irritable bowel syndrome

Objectives: Irritable bowel syndrome (IBS) includes weekly abdominal pain/discomfort associated with: constipation (C-IBS), diarrhea (D-IBS) or alternating C and D (A-IBS). Few data exist on IBS natural history in children. We investigated symptoms evolution over time in a pediatric IBS cohort.

Bidirectional Association between Asthma and Irritable Bowel Syndrome: Two Population-Based Retrospective Cohort Studies.

BackgroundThere is a demonstrated association between asthma and irritable bowel syndrome (IBS). In this study, we examined the bidirectional association between asthma and IBS using a nationwide database.MethodsWe conducted two retrospective cohort studies using data obtained from the National Health Insurance of Taiwan. Study 1 included 29,648 asthma patients newly diagnosed between 2000 and 2010. Study 2 included 29,875 IBS patient newly diagnosed between 2000 and 2010. For each study, four subjects without asthma and IBS were selected, respectively, frequency-matched by sex, age, and the diagnosis date. All four cohorts were followed up until the end of 2011 to estimate incident IBS for Study 1 and incident asthma for study 2. Adjusted hazard ratios (aHRs) were estimated using the Cox proportional hazards model after controlling for sex, age and comorbidities.ResultsThe incidence of IBS was 1.89 times higher in the asthma cohort than in the comparison cohort (8.26 vs. 4.36 per 1,000 person-years), with an aHR of 1.57 [95% confidence interval (CI) = 1.47–1.68]. The aHRs remained significant in all subgroups measured by sex, age and the presence of comorbidities. In contrast, the incidence of asthma was 1.76 times higher in the IBS cohort than the comparison cohort (7.09 vs. 4.03 per 1,000 person-years), with an aHR of 1.54 (95% CI = 1.44−1.64). Similarly, aHRs remained significant in all subgroups measured by sex, age and the presence of comorbidities.ConclusionThe present study suggests a bidirectional association between asthma and IBS. Atopy could be a shared pathophysiology underlying this association, deserving a further investigation.

Relations between symptom severity, illness perceptions, visceral sensitivity, coping strategies and well-being in irritable bowel syndrome guided by the common sense model of illness

Irritable Bowel Syndrome (IBS) is a common condition affecting around 10–20% of the population and associated with poorer psychological well-being and quality of life. The aim of the current study was to explore the efficacy of the Common Sense Model (CSM) using Structural Equation Modelling (SEM) in an IBS cohort. One hundred and thirty-one IBS patients (29 males, 102 females, mean age 38 years) participating in the IBSclinic.org.au pre-intervention assessment were included. Measures included IBS severity (Irritable Bowel Syndrome Severity Scoring System), coping patterns (Carver Brief COPE), visceral sensitivity (Visceral Sensitivity Index), illness perceptions (Brief Illness Perceptions Questionnaire), psychological distress (Depression, Anxiety and Stress Scale), and quality of life (IBS Quality of Life scale; IBS-QoL). Using SEM, a final model with an excellent fit was identified (χ2 (8) = 11.91, p = .16, χ2/N = 1.49, CFI > .98, TLI > .96, SRMR < .05). Consistent with the CSM, Illness perceptions were significantly and directly influenced by IBS severity (β = .90, p < .001). Illness perceptions in turn directly influenced maladaptive coping (β = .40, p < .001) and visceral sensitivity (β = .70, p < .001). Maladaptive coping and visceral sensitivity were significantly associated with psychological distress (β = .55, p < .001; β = .22, p < .01) and IBS-QoL (β = –.28, p < .001; β = –.62, p < .001). Based on these findings, we argue that to augment the adverse impact of IBS severity on IBS-QoL and psychological distress, psychological interventions will be best to target the mediating psychological processes including illness beliefs, visceral sensitivity and maladaptive coping.

Irritable bowel syndrome is associated not only with organic but also psychogenic erectile dysfunction.

This study investigated the correlation between irritable bowel syndrome (IBS) and organic erectile dysfunction (OED) and psychogenic erectile dysfunction (PED), and analyzed the influence of various comorbidities. Data were obtained from reimbursement claims of the National Health Insurance Program in Taiwan. We selected male patients aged >20 years, who were diagnosed with IBS during the 2000-2011 period as the IBS cohort. The index date for patients with IBS was the date of their first medical visit. We excluded patients with a diagnosis of OED and PED at baseline and those without information on age and sex. The IBS to non-IBS cohorts were estimated using univariable and multivariable Cox proportional hazards regression model. Adjusted hazard ratios were determined after adjusting for age and comorbidities. The Kaplan-Meier method was used to plot the cumulative incidence of OED and PED, and a log-rank test was used to compare the cohorts. A total of 15,533 IBS patients and 62,124 controls without IBS were enrolled in our study. Among the study participants, 48.2% were 49 years of age or younger. Patients with IBS were more likely to develop erectile dysfunction (ED) than those without IBS. Patients with IBS were 2.12 times more likely to develop OED and 2.38 times more likely to develop PED than the controls. There is an increased risk of both PED and OED in patients with IBS. Not only with organic but also PED should be considered when patients with IBS complain of ED.

Irritable Bowel Syndrome Increases the Risk of Epilepsy: A Population-Based Study.

An abnormal interaction in the brain–gut axis is regarded as the cause of irritable bowel syndrome (IBS). We attempted to determine the association between IBS and subsequent development of epilepsy.A total of 32,122 patients diagnosed with IBS between 2000 and 2011 were identified from the Longitudinal Health Insurance Database as the study cohort, and 63,295 controls were randomly selected from the insurants without IBS and frequency-matched according to age, sex, and index year as the comparison cohort. Both cohorts were followed up until the end of 2011 to measure the incidence of epilepsy. We analyzed the risks of epilepsy using Cox proportional hazards regression models.The IBS patients had greater cumulative incidence of epilepsy than the cohort without IBS (log-rank test, P < 0.001 and 2.54 versus 1.86 per 1000 person-years). The IBS cohort had a higher risk of epilepsy after adjusting for age, sex, diabetes, hypertension, stroke, coronary artery disease, head injury, depression, systemic lupus erythematosus, brain tumor, and antidepressants usage (adjusted hazard ratio [aHR]: 1.30, 95% confidence interval [CI]: 1.17–1.45). Stratified by the presence of other risk factors, the relative risk was also greater for patients with (aHR: 1.25, 95% CI: 1.10–1.41) or without other risk factors (aHR: 1.68, 95% CI: 1.35–2.10) in the IBS cohort than for those in the non-IBS cohort. The age-specific relative risk of epilepsy in the IBS cohort was greater than that in the non-IBS cohort for both 35 to 49 age group and 50 to 64 age group (age ≤ 34, aHR:1.31, 95% CI: 0.93–1.85; age 35–49, aHR: 1.43, 95% CI: 1.12–1.83; age 50–64, aHR: 1.56, 95% CI: 1.27–1.91). However, there was no difference between patients > 65 years with IBS and those without IBS (aHR: 1.11, 95% CI: 0.94–1.31).This population-based cohort study revealed that IBS increases the risk of developing epilepsy. However, IBS may be less influential than other risk factors. Further study is necessary to clarify whether IBS is a risk factor or an epiphenomenon for epilepsy development.