Irritable Bowel Syndrome Patients Research Articles

Similarities and Differences in Resting-State Brain Activity Changes of Distinct Chronic Pain Types.

To explore neural similarities and differences between visceral and somatic pain by comparing spontaneous brain activity in patients with chronic temporomandibular disorder (TMD) and irritable bowel syndrome (IBS). Twenty eight IBS patients, 21 TMD patients, and 28 healthy controls (HC) underwent resting-state fMRI and behavioral assessments. The correlations between fMRI metrics such as the amplitude of low-frequency fluctuations (ALFF), regional homogeneity (ReHo), functional connectivity (FC), and clinical manifestations were further analyzed. Compared with HC, both patient groups demonstrated increased ALFF in right parahippocampal gyrus (PHG), insula, medial superior frontal gyrus (SFGmed), precentral gyrus (PreCG), and increased ReHo in right SFGmed and left supplementary motor area (SMA). Compared with IBS patients, TMD patients exhibited reduced ALFF in right SFGmed and insula, increased ALFF in right PHG and PreCG, decreased ReHo in right SFGmed and left lingual gyrus, and increased ReHo in left SMA. Both patient groups exhibited enhanced right PHG-related FC in left precuneus and right cingulate gyrus, and right insula-related FC in left superior temporal gyrus and right paracentral lobule. Specifically, IBS patients showed higher FC between right PHG and orbitofrontal cortex than TMD patients, which was negatively correlated with mood and gastrointestinal symptoms. Mediation analysis revealed that pain in TMD and gastrointestinal symptoms in IBS mediated these relationships. Visceral and somatic pain share abnormal activity in multiple brain networks. Abnormalities in affective region present potential neuroimaging markers for pain disorders, with depression in somatic pain linked to pain intensity and in visceral pain to gastrointestinal symptoms.

The impact of locus of control on somatic and psychological profiles of patients with irritable bowel syndrome engaging in aerobic exercise

Irritable bowel syndrome (IBS) is a chronic and recurrent disorder characterized by gastrointestinal (GI) symptoms and psychological disorders. Individuals with an external locus of control (LoC), a personality trait influencing one’s actions and outcomes, are more vulnerable to IBS. Physical activity can deal with GI symptoms, preserving mental and physical health. In this context, our study aimed to investigate differences in symptom and psychological profiles among IBS patients classified by internal or external LoC when patients engaged in an aerobic exercise program (AEP). Each IBS patient was administered the International Physical Activity Questionnaire—Short Form (IPAQ-SF) before treatment, and the Physical Capacity Assessment Tests were applied before and after treatment. Participants filled out a GI symptom questionnaire before and after the intervention and some validated psychological tests to evaluate the changes induced by AEP. The AEP consisted of 180 min of moderate-intensity aerobic walking activity a week. Fifty-four IBS patients completed the 12-week study; 37 belonged to the internal LoC group and 17 to the external one. The internal LoC subgroup had a higher percentage of physically active subjects and a better physical capacity at baseline than those with external LoC. Only patients with an internal LoC achieved a statistically significant increase in physical capacity as the effect of the AEP. However, there was no statistically significant difference when Delta was considered. The somatic and psychological health status of IBS patients in the external LoC group was poorer than that of the internal LoC group at the baseline, particularly abdominal pain, psychosocial functioning, and emotional distress. After AEP, patients showed significant improvement in scores on the IBS-related and psychological scales, regardless of whether they belonged to the external or internal LoC. The present study confirmed the importance of considering both the GI symptoms and the psychological profile when dealing with IBS. AEP organized in walking groups has shown significant improvements for all IBS patients. Since external LoC was associated with poorer health status, individually tailored interventions should be planned to increase patients’ self-motivation to treatment.Trial registration: registration number NCT05453084. First Posted Date 12/07/2022.

Systematic Review: Integrated Models of Care for Managing Irritable Bowel Syndrome.

Multidisciplinary integrated models of care show promise for improving symptoms and quality of life (QoL) in adults with irritable bowel syndrome (IBS). To describe and evaluate the characteristics of integrated models of care for IBS and identify how digital health is being used in these models of care. Four databases were searched to March 2024 for studies that included adults with IBS who participated in multidisciplinary integrated models of care that delivered non-pharmacological therapies. The template for intervention description and replication (TIDieR) checklist was used to appraise study quality and extract model of care characteristics, which were mapped against the Project INTEGRATE framework to establish topics. Sixteen studies (6 randomized controlled trials, 2 quasi-experimental, 8 cohort studies) reported 14 integrated models of care including 2165 patients of which 918 were IBS patients. Integrated models of care led to improved IBS symptoms (n = 11/13 models of care) and QoL (n = 6/9 models of care). Studies showed moderate compliance with the TIDieR checklist. Five topics were established: clinicians involved, therapies provided, location and mode of delivery, coordinating clinical partnerships, and sharing visions and values of integrated care. Most commonly, a gastroenterologist coordinated care with a psychologist, dietitian, and/or nurse in tertiary care. Psychological, dietary, and physical therapies were provided by n = 11, n = 8, and n = 3 integrated models of care, respectively. Six models of care provided joint consultations or group sessions. Four models of care used digital health such as telephone coaching or online modules. Integrated models of care for IBS exhibited diverse characteristics including the clinicians involved, the therapies provided and the mode of delivery of each therapy. There is a need to evaluate the use of digital health and the delivery of integrated models of care in primary care settings.

Patients with Irritable Bowel Syndrome Exhibit Aberrant Expression of Endogenous Retroviruses and SETDB1

Irritable bowel syndrome (IBS) is a common disease, whose etiopathogenesis is poorly understood. Human endogenous retroviruses (HERVs) originate from ancient infections of germinal cells and represent 8% of our DNA. Most HERVs have become defective due to the accumulated mutations; some can, however, still be activated, and their altered expressions have been associated with a number of chronic inflammatory and immune-mediated disorders, including gastrointestinal diseases. Retroviral transcription is modulated by TRIM28 and SETDB1, which also participate in the regulation of epigenetic mechanisms and in shaping the immune system. Expressions of HERVs and TRIM28/SETDB1 have not been investigated in patients affected by IBS. Using a PCR real-time Taqman amplification assay, we explored the RNA levels of HERV-H-pol, HERV-K-pol, and HERV-W-pol; syncytin 1 (SYN1), SYN2, and HERV-W-env; and TRIM28 and SETDB1 in the peripheral blood of 37 IBS patients and healthy controls (HCs) of similar age. The transcript levels were higher in IBS patients than in HCs for all HERVs except for HERV-W-pol, with significant p-values for HERV-H-pol, HERV-K-pol, and SYN1 and borderline p-values for SYN2 and HERV-W-env. The RNA levels of SETDB1 were significantly enhanced in IBS patients, while those of TRIM28 were in the normal range. Patients with severe disease had significant upregulation of SETDB1 compared to those with mild or moderate symptoms. These findings suggest that overexpression of HERVs and SETDB1 may contribute to the development of IBS and open the way to innovative therapeutic strategies.

Effect of Acupuncture on Anxiety, Depression, and Quality of Life in Patients with Irritable Bowel Syndrome: A Meta-Analysis.

Irritable bowel syndrome (IBS) has been effectively treated with acupuncture, but the significance of quality of life, depression, and anxiety in the assessment of IBS patients has received little consideration. This study examined the impact of acupuncture on depression, anxiety, and quality of life in IBS patients. PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), EMBASE, China Science and Technology Journal Database (VIP), Chinese Biological Medical (CBM, SinoMed) Database, and the Wan Fang Database were among the electronic databases from which relevant randomized controlled trials (RCTs) were systematically retrieved between their inception and July 2023. The outcomes included adverse events, total response rate, anxiety, and symptoms of depression, as well as quality of life. In this study, the heterogeneity, publication bias, standardized mean difference (SMD), and risk ratios (RR) with 95% confidence intervals (CI) were estimated. In this study, 29 RCTs including 3114 participants for analysis (treatment group, 1730; control group, 1384) were included. Compared to other therapies, acupuncture significantly improved the quality of life (SMD = 0.61, 95% CI = [0.26, 0.96], P < 0.001) and alleviated anxiety (SMD = - 0.72, 95% CI = [- 1.76, 0.32], P = 0.18) and depression (SMD = - 0.74, 95% CI = [- 1.18, - 0.3], P < 0.001) in IBS patients. A statistically significant improvement was recorded in their quality of life, and they also displayed fewer symptoms of depression. The total response rate (RR = 1.18, 95% CI = [1.12,1.25], P < 0.001) indicated that acupuncture significantly affected IBS treatment in comparison to other methods. Subgroup analysis of primary outcome indicators revealed that acupuncture demonstrated better results regardless of the duration of intervention and was more effective than Western medicine or sham acupuncture. In addition to the total response rate (I2 = 0%), the other three outcome indicators showed significant heterogeneity (I2 > 50%). No publication bias was noted in RR (P < 0.05); however, a significant publication bias was observed in quality of life (P > 0.05). Acupuncture can enhance the quality of life and relieve anxiety and depression in patients with IBS with apparent safety; however, a large number of high-quality RCTs are still needed.

Blastocystis ST1: Protein Profile and Specific Serum Immunoglobulin in Irritable Bowel Syndrome (IBS) Patients.

Blastocystis sp. is a common enteric human parasite, which recently has been linked to gastrointestinal disorders i.e. Irritable Bowel Syndrome (IBS) and symptomatic patients (non IBS). Analyzing antibodies level in these patients could help in differential diagnosis. The current study aimed to identify the protein profile of the Blastocystis ST1 (Syrian strain: OR537347) lysates and to investigate the differences in IgG serum immunoglobulin between patients with IBS and non IBS. Twenty two IBS (Rome III) and nineteen patients suffering from different gastrointestinal disorders (non IBS), positive for Blastocystis were enrolled in this study. SDS-PAGE was used to identify the protein profile of the Blastocystis ST1 lysates and immunoblotting using sera from patients was used for reactivity compared to known Blastocystis protein targets. The crude protein profile of Blastocystis ST1 showed 24 protein bands ranged between 10 and 130kDa. Western blot demonstrated that the proteins (27-29);32;(39-42);(50-51) kDa had similar immunogenicity characteristic in IBS and non IBS patients while the proteins (60-95kDa) only interacted with IBS patients' sera. Our results highlighted the importance of Blastocystis proteins 60-95kDa (probably a metalloproteases) in IBS patients compared to non IBS, suggesting that these metalloproteases may be important Blastocystis antigens and can be used as a serologic test tool or as a biomarker for differential diagnosis.

Specialty laboratory testing for chronic abdominal pain in irritable bowel syndrome

Background Irritable bowel syndrome (IBS) is a common gastrointestinal disorder seen by both primary care providers (PCPs) and gastroenterologists, and further diagnostic testing is generally discouraged unless red-flag symptoms are present. Aims Examine if advanced serologic testing for chronic abdominal pain in IBS patients followed society-specific guidelines and evaluate the diagnostic accuracy of these tests. Methods The study involved a retrospective cross-sectional analysis of adults aged 18 and older who were seen at our institution between 2013 and 2018. Tests included: C1 esterase inhibitor, MEFV gene, urine porphobilinogen, anti-dsDNA, and heavy metal screening. Patients with preexisting rheumatological conditions or diagnoses such as hereditary angioedema, porphyria, familial Mediterranean fever, or lead poisoning were excluded. An appropriateness scale based on disease-specific guidelines was used to evaluate test suitability. Results Among 26,732 IBS patients, 143 underwent advanced laboratory testing, with 85.3% ordered by gastroenterologists. Only 12.5% of tests adhered to society-specific guidelines, and the positive test rate was 2.1%. The total cost of testing was $46,542, with $39,007 spent on tests deemed inappropriate. Conclusions The findings emphasize the effectiveness and importance of adhering to Rome IV criteria, as advanced testing often fails to improve diagnostic accuracy and increases unnecessary healthcare costs.

Impact of vitamin D supplementation on symptom severity and quality of life in patients with irritable bowel syndrome: A meta-analysis.

Vitamin D supplementation could offer irritable bowel syndrome (IBS) patients significant improvements in terms of symptom severity and overall quality of life (QoL). Yet, the potential benefits and risks associated with vitamin D supplementation still require additional investigation. We aimed to evaluate the impact of vitamin D supplementation on IBS using a systematic review and meta-analysis. A comprehensive search was carried out utilizing 4 electronic databases (PubMed, Embase, Scopus, and Cochrane Library) to identify articles published in English-language peer-reviewed journals. The odds ratios (ORs), risk ratios (RRs) and mean differences (MDs), along with their respective 95% confidence intervals (95% CIs), were computed. Heterogeneity was evaluated using the appropriate p-value and Cochrane Q and I2 statistics. For the analysis, RevMan 5.3 was utilized. Nine randomized controlled trials involving a total of 780 participants were included in this study. Vitamin D supplementation, in adolescents and young adults with IBS, improves the IBS symptoms severity score, QoL and serum 25(OH)D levels compared to controls. We obtained an OR of 2.34 (95% CI: 1.56-3.50) for change in the IBS severity scoring system (IBS-SSS), OR = 2.51 (95% CI: 1.71-3.70) for change in QoL, low risk of any adverse events (RR 0.49 (95% CI: 0.35-0.69)), and substantial changes in serum 25(OH)D level (MD = 11.29 (95% CI: 7.13-15.45)). Results were statistically significant (p < 0.05). Vitamin D supplementation could lead to better IBS management with a low risk of adverse events.

Lactiplantibacillus plantarum (CECT7484 and CECT7485) and Pedioccoccus acidilactici (CECT7483) enhance actin cytoskeleton and CYP1A1 expression restoring epithelial permeability alterations induced by irritable bowel syndrome mediators

ABSTRACT Irritable bowel syndrome (IBS) is a multifactorial condition with heterogeneous pathophysiology, including intestinal permeability alterations. The aim of the present study was to assess the ability of a probiotic blend (PB) consisting of two Lactiplantibacillus plantarum strains (CECT7484 and CECT7485) and one strain of Pediococcus acidilactici (CECT7483) to recover the permeability increase induced by mediators from IBS mucosal biopsies and to highlight the underlying molecular mechanisms. Twenty-one IBS patients diagnosed according to ROME IV criteria (11 IBS-D and 10 IBS-M) and 7 healthy controls were enrolled. Mucosal mediators spontaneously released by IBS and HC biopsies were collected and incubated with/without the PB (104 and 106 CFU/ml). Paracellular permeability was assessed by evaluating the amount of sulfonic-acid-conjugated to fluorescein passing through the Caco-2 monolayer. RNA was extracted from Caco-2 cells and used to perform qPCR analyses, to evaluate the expression of ZO-1 and β-actin, and RNAseq to evaluate the transcriptomic profile. Untargeted metabolomics was used to characterize metabolites produced by the PB. The PB significantly reduced paracellular permeability after 3 h of incubation. Both doses of the PB significantly recovered the increase in paracellular permeability induced by IBS mediators. qPCR analyses showed that both doses of the PB co-incubated with IBS mediators induced a significant increase in beta-actin expression compared to IBS mediators alone. Concerning IBS subtypes, the high dose of the PB recovered the increase of permeability induced by IBS-D mediators. Transcriptomic analyses, confirmed by qPCR, showed that the high dose of the PB significantly increased CYP1A1 compared to IBS mediators alone. The PB produced a high amount of indole-3-lactic acid. The PB recovers the permeability increase induced by IBS mediators inducing the up-regulation of β-actin. In addition, the PB up-regulates the expression of CYP1A1, known to be involved in the metabolism of xenobiotics, possibly through the production of the indole-3-lactic acid.

Burden of Common Mental Disorders in Ulcerative Colitis and Irritable Bowel Syndrome Patients: An Analysis of Risk Factors.

Background: Common mental disorders are an underdiagnosed comorbidity, which can significantly worsen the prognosis of the main disease and decrease the quality of life. We aimed to investigate the prevalence of depression and anxiety in a cohort of irritable bowel syndrome with diarrhea (IBS-D) and ulcerative colitis (UC) patients and to evaluate the risk factors for their occurrence. Materials and Methods: A total of 112 patients were evaluated. Multivariable analysis was used to determine associations between patient factors and common mental disorders, evaluated with PHQ-9 and GAD-7 questionnaires. Results: We found a significantly higher prevalence of moderate and severe anxiety among patients with IBS-D, when compared with the UC group (p < 0.01). Linear regression analysis revealed an inverse association between anti-TNF-alpha monoclonal antibodies treatment and a higher PHQ-9 score (p = 0.02). Multivariate analysis revealed that, in patients with UC, the presence of children has been associated with a higher GAD-7 score (p = 0.01), both individually and in combination with a higher duration of the disease. (p < 0.01). For IBS-D, a combination of active employment status and religious belief, active employment status and higher educational level, as well as religious belief and the presence of children correlated with higher GAD-7 scores (p = 0.03, p = 0.03 and p = 0.02, respectively). Conclusions: Infliximab used in the treatment for UC improved the parameters of depression. Patients with UC who have university education and a longer duration of the disease are at increased risk of developing depression and anxiety, especially if they have children in care. Regarding IBS-D patients who have an active work status, religious beliefs and caregivers are at increased risk of developing anxiety.

Study of dynamic brain function in irritable bowel syndrome via Hidden Markov Modeling.

Irritable bowel syndrome (IBS) is a common bowel-brain interaction disorder whose pathogenesis is unclear. Many studies have investigated abnormal changes in brain function in IBS patients. In this study, we analyzed the dynamic changes in brain function in IBS patients using a Hidden Markov Model (HMM). Resting-state functional magnetic resonance imaging (rs-fMRI) data and the clinical characteristics of 35 patients with IBS and 31 healthy controls (HCs) were collected. The rs-fMRI data of all participants were analyzed using HMM to identify recurrent brain activity states that evolve over time during the resting state. Additionally, the temporal properties of these HMM states and their correlations with clinical scale scores were examined. This study utilized the Hidden Markov Model (HMM) method to identify six distinct HMM states. Significant differences in fractional occupancy (FO) and lifetime (LT) were observed in states 5 and 6 between the IBS and HCs. The state transition probabilities differed between IBS and HCs, with an increased probability of transitioning from state 2 to state 6 in IBS patients. The reconfiguration of HMM states over time scales in IBS patients was associated with abnormal activity in the default mode network (DMN), sensorimotor network (SMN), and cingulo-opercular network (CON). This study offers novel insights into the dynamic reorganization of brain activity patterns in IBS and elucidates potential links between these patterns and IBS-related emotional regulation and symptom experience, thereby contributing to a deeper understanding of the neural mechanisms underlying IBS.

Magnitude of depression and anxiety in patients with irritable bowel syndrome: A comparative cross-sectional study.

Objective: To find out the magnitude of depression and anxiety in patients with irritable bowel syndrome (IBS) presenting at a tertiary care Gastroenterology clinic of Karachi, Pakistan. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital &amp; Medical College, Karachi, Pakistan. Period: February 2022 to July 2022. Methods: Patients of both genders, aged 18 – 50 years and newly diagnosed IBS patients (as per ROME-IV criteria) were assessed. Patient’s attendants, hospital staff, and students without any symptoms of IBS were taken as healthy controls. Non-probability, consecutive sampling technique was adopted. Depression and anxiety were determined using hospital anxiety and depression scale (HADS). The collected data was entered and analyzed using IBM-SPSS Statistics, version 26.0. Chi-square test was applied to compare data taking p&lt;0.05 as significant. Results: This study was conducted on 110 IBS and 110 healthy controls. The mean age of the IBS group was 32.81± 1.12 years while that of the healthy group was 37.60 ± 1.08 years. There were 47 (42.7%) males and 63 (57.3%) females in IBS group while 72 (65.5%) males and 38 (34.5%) females in healthy groups. The prevalence of anxiety was 52.7% and that of depression was 49% according to HAD Scale in IBS group (p&lt;0.001). Conclusion: A strong association of IBS with anxiety and depression was noted, highlighting the necessity of screening for these disorders in gastrointestinal clinics.

Probiotics Combined With Trimebutine for the Treatment of Irritable Bowel Syndrome Patients: A Systematic Review and Meta-Analysis.

This study aimed to assess the efficacy and safety of probiotics combined with trimebutine in the treatment of irritable bowel syndrome (IBS), addressing an important gap in current treatment strategies. Randomized controlled trials (RCTs) of trimebutine combined with probiotics for the treatment of IBS were collected from various databases. All retrieved articles were screened and assessed for quality. The methodological quality of the included studies was assessed following the guidelines recommended by the Cochrane Collaboration. The meta-analysis of the included studies was conducted using RevMan 5.3 software. A total of 37 RCTs involving 4360 participants were included in this study. Among them, the treatment group consisted of 2177 participants, and the control group consisted of 2183 participants. The results showed that the overall efficacy of trimebutine combined with probiotics in the treatment of IBS was significantly higher than that of trimebutine alone (odds ratio [OR] = 5.09, 95 % confidence interval [CI] [4.19, 6.20], p < 0.00001). The effective rate in the combination therapy group was 93.5 % compared with 73.8 % in the trimebutine alone group. The safety profile was favorable, with adverse event rates of 1.75 % and 1.69 % in the combination and monotherapy groups, respectively. The most common adverse events were mild and included dry mouth, nausea and dizziness. No serious adverse events were reported in either group. Subgroup analysis based on the type of probiotic intervention showed that combination use was better than trimebutine alone, and the differences between each subgroup were statistically significant. Combination use of compound Lactobacillus capsules had the best effect (OR = 16.03, 95 % CI [4.57, 56.21], p < 0.0001]. These results highlight the potential role of strain-specific benefits in IBS treatment and suggest that probiotic strain selection may significantly influence treatment outcomes. The combination of trimebutine and probiotics is more effective in the treatment of IBS compared with trimebutine alone. https://www.crd.york.ac.uk/prospero/, identifier: CRD42024516044.

Efficacy of fermented foods in irritable bowel syndrome: a systematic review and meta-analysis of randomized controlled trials.

Fermented foods (FFs) may theoretically benefit irritable bowel syndrome (IBS) symptoms, but the role of FFs for IBS patients in the real world is inconsistent and has not been systematically assessed. We performed a systematic review and meta-analysis to examine this issue. PubMed, MEDLINE, Embase and Cochrane Library databases were searched up to August 2024. Randomized controlled trials (RCTs) investigating the efficacy of FFs in IBS were eligible for the analysis. Two authors independently screened studies and extracted data. Data were pooled using relative risk (RR) of dichotomous data and standardized mean difference (SMD) for continuous data. A total of 16 RCTs with 1,264 IBS patients were included. There were 12 RCTs involving 975 patients providing primary outcomes which was defined as symptom relief. The proportion of symptom relief was associated with the administration of FFs (RR 1.22, 95% CI 1.04-1.42, p = 0.01, I 2 = 0%). For secondary outcomes, FFs also exerted a beneficial effect on global symptoms scores (SMD = -0.15; 95% CI -0.29 to -0.02, p = 0.02, I 2 = 46%), but no significant improvement on abdominal pain scores and bloating scores. Subgroup analysis showed that fermented milk had a beneficial effect on symptom relief (RR 1.19, 95% CI 1.01 to 1.39, p = 0.04, I 2 = 0%). Fermented foods, especially fermented milk with probiotics properties, appear to be efficacious in irritable bowel syndrome. However, given the limitations of current evidence, this conclusion should be interpreted with caution. This study was registered on the International Prospective Register of Systematic Reviews (PROSPERO) as CRD42024576608.

Aberrant functional connectivity patterns in the pregenual anterior cingulate cortex and anterior midcingulate cortex of patients with irritable bowel syndrome accompanied by depressive symptoms.

Irritable bowel syndrome (IBS) is a common brain-gut disorder often accompanied by depressive symptoms, with atrophy and hyperactivity of the anterior cingulate gyrus (ACC) being key drivers of both IBS and its psychiatric comorbidities. This study aimed to investigate the functional connectivity (FC) patterns of pregenual ACC (pgACC) and anterior midcingulate cortex (aMCC) in IBS patients with depressive symptoms (DEP-IBS). A whole-brain FC analysis was conducted using pgACC and aMCC as regions of interest in three groups: 28 DEP-IBS patients, 21 IBS patients without depressive symptoms (nDEP-IBS), and 36 matched healthy controls (HCs). Partial correlation and mediation analyses were performed between abnormal FC and clinical symptoms. The ability of aberrant FC to identify IBS and its psychiatric comorbidity was evaluated using receiver operating characteristic (ROC) curve. DEP-IBS patients exhibited increased pgACC-related FC in the left medial prefrontal cortex (mPFC) and aMCC-related FC in the right middle frontal gyrus, angular gyrus and cerebellum, while showing decreased aMCC-related FC in the right precentral gyrus, superior parietal gyrus and precuneus. Both patient groups demonstrated increased FC between aMCC and left dorsolateral prefrontal cortex (dlPFC), effectively distinguishing them from HCs (AUC = 0.755). The FC between pgACC and left mPFC partially mediated the relationship between gastrointestinal and depressive symptoms, effectively distinguishing DEP-IBS from nDEP-IBS patients (AUC = 0.808). Aberrant FC within the emotional arousal network may serve as a neurobiological marker for IBS with comorbid depression. Furthermore, abnormal FC between the aMCC and the dlPFC may underlie the neural mechanism of IBS.

Dietary Inflammatory and Glycemic Indices in Newly Diagnosed Irritable Bowel Syndrome Patients Compared to Healthy People: A Case-Control Study

Dietary Inflammatory and Glycemic Indices in Newly Diagnosed Irritable Bowel Syndrome Patients Compared to Healthy People: A Case-Control Study

Assessment of Knowledge, Attitude, Practice, and Related Factors among a Sample of Patients with Irritable Bowel Syndrome Attending Al-Imamain Al-Kadhimain Medical City in 2023

Abstract Background: Irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder seen in both primary and secondary care. It is a major socioeconomic burden because affected patients use more health-care resources with reduced work productivity when compared to the healthy population. Objectives: The objectives of this study were to assess the knowledge, attitude, and practice of IBS patients and to assess some sociodemographic factors that may related to these variables. Patients and Methods: A cross-sectional study was conducted in the Gastroenterology Clinic and Internal Medicine clinic at Al-Imamain Al-Kadhimain Medical City in Baghdad/Iraq during the period from April 1, 2023, to August 31, 2023. All patients 18 years and older diagnosed with IBS were included in the study. A total of 280 patients participated in the study. Data were collected through a face-to-face interview with the patients using a standardized questionnaire with some modifications. Results: The average participant age was 39.61 ± 14.77 years, with most (72.1%) falling between 18 and 45 years, and 65.7% reported having a family history of IBS. The results show that 171 patients (61%) had an acceptable level of knowledge score. Two hundred and sixty-six patients (95%) acknowledged the role of stress and anxiety in IBS, and most participants (92.5%) knew the importance of immediate medical attention for serious symptoms. Education plays a pivotal role (P = 0.0001). Higher education correlates with excellent knowledge, Illiterates mostly have poor knowledge. One hundred and seventy-eight patients (64%) had positive attitude. One hundred and sixty-nine patients (60%) had bad practice. One hundred and ninety-five patients (69.6%) avoid certain foods that are known to trigger IBS symptoms, and 157 patients (56.1%) reported adequate sleep. Conclusions: The majority of IBS patients had an acceptable level of knowledge, positive attitude, and bad practice. Most of them know that managing anxiety and changing diet can improve IBS symptoms.

Efficacy and Safety of a Mixture of Microencapsulated Sodium Butyrate, Probiotics, and Short Chain Fructooligosaccharides in Patients with Irritable Bowel Syndrome—A Randomized, Double-Blind, Placebo-Controlled Study

Objective: Biotics are increasingly being used in the treatment of irritable bowel syndrome (IBS). This study aimed to assess the efficacy and safety of a mixture of microencapsulated sodium butyrate, probiotics (Lactocaseibacillus rhamnosus DSM 26357, Lactobacillus acidophilus DSM 32418, Bifidobacterium longum DSM 32946, Bifidobacterium bifidum DSM 32403, and Bifidobacterium lactis DSM 32269), and short-chain fructooligosaccharides (scFOSs) in IBS patients. Methods: This was a randomized, double-blind, placebo-controlled trial involving 120 adult participants with IBS. The primary outcome of the 12-week intervention was the improvement in IBS symptoms and quality of life (QOL), assessed with the use of IBS-Adequate Relief (IBS-AR), IBS-Global Improvement Scale (IBS-GIS), IBS-Symptom Severity Score (IBS-SSS), and IBS-QOL. Secondary outcomes were the number and type of stools (assessed via the Bristol Stool Form scale), patient-recorded symptoms, anthropometric parameters, and levels of selected inflammatory cytokines. Results: As early as at 4 weeks, there was a higher percentage of patients in the biotic group reporting adequate relief of symptoms (based on IBS-AR) than in the placebo group (64.7% vs. 42.0%, respectively, p = 0.023). At 12 weeks, fewer patients in the biotic group reported a ‘worsening of symptoms’ (based on IBS-GIS) than in the placebo group (5.9% vs. 16.0% respectively, p = 0.015). There were no significant differences between groups in IBS-QOL or IBS-SSS or any of the secondary outcome measures except the patient-recorded ‘urgency to defecate’ (p = 0.015) at week 12, which was significantly lower in the biotic group. The intervention was safe and well tolerated. Conclusions: A biotic mixture consisting of microencapsulated butyrate, probiotics, and small amounts of scFOSs is safe and effective in improving gastrointestinal symptoms in patients with IBS.

Incidence and Clinical Course of Post-infectious Irritable Bowel Syndrome in Patients Admitted to University Hospitals: 1-year Prospective Follow-up Study.

Post-infectious irritable bowel syndrome (PI-IBS) is characterized by chronic gastrointestinal symptoms that arise following an episode of infectious enteritis. The incidence rates vary, ranging from 5% to 32% and the risk factors are not well known. We aim to investigate the incidence and risk factors of PI-IBS in enteritis patients admitted to university hospitals in Korea. This multi-center prospective study was conducted in patients hospitalized for infectious enteritis. Each patient underwent 1 outpatient visit and 3 telephone surveys during the first year after discharge to determine if PI-IBS occurred within the follow-up period. In the 3-month survey, 7 out of 354 patients (2%) were diagnosed with PI-IBS, and after 1 year, only 1 patient met the criteria for IBS. No statistically significant difference was found between the PI-IBS group and the non-PI-IBS group in terms of age, sex, underlying diseases, medication history, gastrointestinal symptoms, enteritis location, causative strain, hospitalization and treatment periods, and laboratory findings. Female sex (P = 0.003), enteropathogenic Escherichia coli (EPEC) infection (P = 0.044), and a longer total treatment period (P = 0.018) were independent risk factors for diarrhea lasting ≥ 3 months after enteritis. The incidence of PI-IBS in Korea was relatively low, and most cases improved over time. No risk factors associated with the development of PI-IBS were found. However, persistent diarrhea after enteritis was associated with female sex, EPEC infection, and severe or long-lasting enteritis. IBS symptoms may persist after severe enteritis but usually improve with time.

Abdominal Wall-targeted Myofascial Release Therapy in Pediatric Patients with Irritable Bowel Syndrome: A Feasibility and Acceptability Study.

Myofascial release (MFR) is a form of massage therapy that involves identifying and releasing restrictions in the fascia and muscles. MFR-like techniques have shown improvement in abdominal pain, distention, constipation, and quality of life (QoL) in adults. Therefore, MFR may be helpful in patients with irritable bowel syndrome (IBS), a disorder of gut-brain interaction or functional gastrointestinal disorder, mainly presenting with prolonged abdominal pain, bloating, and altered defecation patterns, leading to impairment in QoL. Treatments for IBS are limited and do not always completely relieve pain. To date, no studies have evaluated the feasibility and acceptability of MFR for children with IBS as a potential therapy. The aim of the study is to assess the feasibility and acceptability of administering abdominal wall-targeted MFR in children with IBS. This study was approved and conducted at Children's Hospital of Philadelphia. Males and females aged 13-18 years meeting Rome IV criteria for IBS were included in the study. Participants underwent six 1-h weekly sessions of abdominal wall-targeted MFR with a licensed massage therapist (LMT) and performed self-MFR at home between sessions. Feasibility and acceptability data were collected via REDCap (Research Electronic Data Capture) by the study team and LMTs. Symptoms and QoL were assessed before and after the intervention period using child and parent versions of validated pediatric questionnaires. Of 10 participants aged 14-18 years, 60% females underwent the MFR intervention and completed the 6-week protocol. The median visit compliance with questionnaire completion was 90%. All participants received self-MFR education and performed self-MFR between sessions. Fascia restrictions were identified and released in all participants, as reported by the LMTs. Most participants voluntarily provided positive feedback on MFR. All participants reported no or minimal soreness during or after MFR, and no adverse events were reported. Abdominal wall-targeted MFR is feasible to administer and well accepted in pediatric IBS patients.