Male Irritable Bowel Syndrome Patients Research Articles

Gastroesophageal reflux disease incidence among male patients with irritable bowel syndrome: A single-center cross-sectional study in southern Iran.

Gastrointestinal reflux disease (GERD) and irritable bowel syndrome (IBS) are among the most common gastrointestinal disorders in which the overlap of these diseases and their syndromes has been frequently reported. In this study, we aimed to evaluate GERD incidence among IBS patients and the related risk factors. Male patients aged 18-60 years with an impression of IBS and referred to the gastrointestinal clinic from March 2019 to 2020 in Shiraz, Iran, were included in this study. Among the 163 enrolled patients with an average age of 31.53 ± 9.38 years, 64 (39.3%) were diagnosed with GERD. Based on statistical analysis, there was a significant association between GERD and the IBS patients' age (P=0.006), smoking (P=0.011), and alcohol consumption (P=0.043). Also, GERD among IBS patients was significantly associated with the type of IBS (P < 0.001), with IBS-D having the lowest incidence (19.4%) and IBS-M the highest incidence of GERD (66.7%). Based on multivariate analysis, smoking had a reverse and significant correlation with lower incidence of GERD (OR=-1.364; P=0.002). Our results demonstrate that among male IBS patients, younger age, smoking, and alcohol consumption were among the risk factors for GERD. These findings may provide further insight into the best approach to treating these diseases.

Use of antidepressants and risks of restless legs syndrome in patients with irritable bowel syndrome: A population-based cohort study.

Previous research has suggested an association between antidepressants use and clinical restless legs syndrome (RLS) in patients, but there has never been a single study investigating the risk of RLS in irritable bowel syndrome (IBS) patients treated with antidepressants. Hence, we aimed to explore the association between IBS and RLS and to examine the risk of RLS in IBS patients treated with antidepressants. With the use of the National Health Insurance Research Database of Taiwan, 27,437 adults aged ≥ 20 years with newly diagnosed IBS (ICD-9-CM Code 564.1) and gender- and age-matched 54,874 controls without IBS were enrolled between 2000 and 2012. All patients were followed-up until RLS diagnosis, withdrawal from the National Health Insurance program, or end of 2013. We used the Cox proportional hazards model to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) of RLS. RLS was more prevalent in IBS patients than in the non-IBS group (7.57 versus 3.36 per 10,000 person-years), with an increased risk of RLS (adjusted HR [aHR], 1.91; 95% CI, 1.52–2.40). Multivariate Cox proportional hazards analysis identified older age (age, 51–65 years; aHR, 1.67; 95% CI, 1.09–2.56; and age > 65; aHR, 1.59; 95% CI, 1.02–2.48), hypothyroidism (aHR, 4.24; 95% CI, 1.92–9.37), CAD (aHR, 1.70; 95% CI, 1.17–2.48), and depression (aHR, 3.15; 95% CI, 2.14–4.64) as independent RLS risk factors in IBS patients. In addition, the male SSRIs users were associated with significantly higher risk of RLS (aHR, 3.05 95% CI, 1.34–6.92). Our study showed that the IBS group has higher risk of RLS. Moreover, SSRIs use may increase the risk of RLS in male IBS patients.

Altered brain and gut responses to corticotropin-releasing hormone (CRH) in patients with irritable bowel syndrome

Stress is a known trigger of irritable bowel syndrome (IBS) and exacerbates its gastrointestinal symptoms. However, underlying the physiological mechanism remains unknown. Here, we investigated hypothalamic–pituitary–adrenal (HPA) axis, colonic motility, and autonomic responses to corticotropin-releasing hormone (CRH) administration as well as brain activity alterations in IBS. The study included 28 IBS patients and 34 age and sex-matched healthy control subjects. IBS patients demonstrated greater adrenocorticotropic hormone (ACTH) responses to CRH than control subjects. Male IBS patients had greater increases in colonic motility than male HCs after CRH. Female IBS patients showed altered sympathovagal balance and lower basal parasympathetic tone relative to female control subjects. Brain responses to rectal distention were measured in the same subjects using functional magnetic resonance imaging, and their associations with individual ACTH responses to CRH were tested. A negative association between ACTH response to CRH and activity in the pregenual anterior cingulate cortex (pACC) during rectal distention was identified in controls but not in IBS patients. Impaired top-down inhibitory input from the pregenual ACC to the HPA axis may lead to altered neuroendocrine and gastrointestinal responses to CRH. Centrally acting treatments may dampen the stress induced physical symptoms in IBS.

Irritable bowel syndrome might be associated with dry eye disease.

BackgroundA possible association between dry eye disease (DED) and irritable bowel syndrome (IBS) has been hypothesized based on the fact that they both share an inflammatory pathogenesis.MethodsNinety-five patients with IBS and 276 healthy controls were enrolled in the study. All patients answered a questionnaire regarding DED symptoms and had a complete ophthalmic examination. DED signs were evaluated using Schirmer’s 1 and tear break-up time (tBUT) tests in both groups.ResultsFemale IBS participants presented significantly lower Schirmer’s test and tBUT (P=0.002 and P<0.001 respectively) than controls. Both diagnostic tests in male IBS patients were also significantly lower than in controls (P<0.001). 72% of IBS patients gave at least 3 positive answers to the questionnaire compared with 42% of the control group (P<0.01).ConclusionOur results suggest a correlation between IBS and DED. DED symptoms can cause further complications in patients with IBS, and should be considered in their management. However, further research is needed to establish a possible pathophysiologic association.

Symptomatic fructose malabsorption in irritable bowel syndrome: A prospective study.

Fructose can trigger or worsen symptoms in irritable bowel syndrome (IBS) patients. The aim of this study was to determine the prevalence of symptomatic fructose malabsorption in IBS patients and to test whether the patient's characteristics can help to detect a fructose malabsorption. Ninety Rome III IBS patients (predominant diarrhoea (IBS-D): 31%, predominant constipation (IBS-C): 18%, mixed type (IBS-M): 51%) were included prospectively. After exclusion of a small intestinal bacterial overgrowth by a glucose breath test, fructose malabsorption was assessed by a five-hour breath test, with symptom monitoring, after a 25 g load of fructose. An increase of more than 20 ppm of hydrogen (H2) or methane (CH4) levels in the exhaled air led to the diagnosis of malabsorption. Fructose test was abnormal in 20/90 patients among whom only 35% were intolerant, with a simultaneous rise of H2/CH4 levels and the onset of abdominal discomfort or diarrhoea. IBS characteristics were not predictive even if young (p = 0.031) and male IBS patients (p = 0.029) were at higher risk of malabsorption. At variance, 18 additional patients experienced intestinal symptoms during the test despite normal fructose absorption. After a 25 g fructose load, symptomatic fructose malabsorption and intolerance without malabsorption were detected in 22% and 28% of IBS patients respectively.

PP075-MON DIFFERENCES IN SYMPTOM SEVERITY, QUALITY OF LIFE AND BOWEL HABITS BETWEEN MALE AND FEMALE IBS PATIENTS

Rationale: Irritable bowel syndrome (IBS) is thought to be more prevalent in women than in men. We investigated the relationship between gender and symptomatology and quality of life (QoL) in patients with IBS. Methods: 174 patients who fulfilled the Rome III criteria for IBS were included. Symptom severity was scored using the IBS Symptom Severity Score (IBS-SSS). The IBS-QoL was used to assess quality of life. Stool frequency and stool consistency were determined using the Bristol stool scale. Results: Patient’s age ranged from 19 to 66 years (mean 37.4) and the male to female ratio was 1:2.6. According to the Rome-III-criteria, 31% were diagnosed as diarrheapredominant IBS (IBS-D), 12.6% as constipation-predominant (IBS-C) and 1.1% as unsubtyped (IBS-U). The most common subtype was the mixed-type (IBS-M) with 55.2%. The gender composition between the four subtypes differed significantly (p < 0.05). 16.7% of the women were classified as constipationpredominant IBS, whereas only one man had IBS-C. The severity of IBS (scored with the IBS-SSS questionnaire) did not differ between men and women. The number of days with pain was significantly higher in women than in men (p < 0.05). The overall score of the IBS-QoL as well as 7 of the 8 subscales were significantly lower in women than in men (p < 0.05), only the subscale ‘interference with activity’ showed no gender differences. Stool frequency differed significantly between men and women (p < 0.001). Men reported a stool frequency of 11.8 times a week (SD: 9.5), women 7.8 (SD: 4.9). Conclusion: There are significant gender differences in patients with IBS regarding the symptoms (e.g. IBS-C occurred almost exclusively in females) as well as in QoL. Our data showed that although women did not report higher severity of IBS, their QoL was significantly worse than the QoL of male IBS patients.

Gender Differences in Motility of the Large and Small Intestine in Patients With IBS

Background: Visceral hypersensitivity, and altered gastrointestinal motility and secretion, are considered to be key pathophysiological factors in irritable bowel syndrome (IBS), and of great importance for symptom generation. The symptom pattern differs between female and male IBS patients , with more severe abdominal pain, bloating and constipation in females (Khatai et al. DDW 2010). Whether this can be explained by gender differences in pathophysiological alterations is incompletely understood. Aim: To evaluate potential gender differences in small intestinal motility and secretion, colonic motility and rectal sensorimotor function in patients with IBS. Methods: We included 36 male and 36 female IBS patients, matched for age (mean age 39 (20-64) years), who fulfilled the ROME II criteria. All patients underwent investigations to assess colonic motility (colonic transit time using radiopaque markers), small intestinal motility and secretion (antroduodenojejunal manometry with jejunal transmural potential difference (PD) measurement in the fasting state (3h) and after meal intake (1h)) and rectal sensorimotor function (rectal balloon distensions before and after meal intake; 800kcal; 60% fat). Results: Colonic transit time differed between female and male IBS patients, with slower transit in females (2.1±1.3 (mean±SD) vs. 1.2±0.8 days; p<0.0001). Differences were also found in the small intestinal motility with slower propagation velocity of phase III in females (8.7±4.5 vs. 15±9.4 cm/min; p<0.01), and a tendency towards shorter duration of phase III in females (p<0.1). The motility indices in the jejunum also tended to be lower in female versus male IBS patients, but this only reached statistical significance in the fasting state (last 30 min of phase II) (3310±1040 vs. 4510±2730 mmHg x sec; p<0.05). No gender differences were seen in PD measurements in the small intestine, reflecting chloride secretion, or in rectal compliance, tone or sensitivity. Conclusion: We have demonstrated gender differences in small and large intestinal motility in IBS patients, but not in small intestinal secretion or rectal sensorimotor function. These findings are of potential importance for observed differences in the symptom pattern between male and female IBS patients.

Sex-related differences in prepulse inhibition of startle in irritable bowel syndrome (IBS).

Alterations in central networks involved in the regulation of arousal, attention, and cognition may be critical for irritable bowel syndrome (IBS) symptom maintenance and exacerbation. Differential sensitivities in these networks may underlie sex differences noted in IBS. The current study examined prepulse inhibition (PPI), a measure of sensorimotor gating, in male and female IBS patients. Relationships between PPI and symptom severity were examined, as well as potential menstrual status effects. Compared to healthy controls, male IBS patients had significantly reduced PPI; whereas female IBS patients (particularly naturally cycling women) had significantly enhanced PPI suggesting hypervigilance. Considering previously demonstrated sex-related differences in perceptual and brain imaging findings in IBS patients, the current findings suggest that different neurobiological mechanisms underlie symptom presentation in male and female IBS patients. Compromised filtering of information in male IBS patients may be due to compromised top down (prefrontal, midcingulate) control mechanisms while increased attention to threat due to increased limbic and paralimbic circuits may be characteristic of female IBS patients.

Different segmental transit times in patients with irritable bowel syndrome and “normal” colonic transit time: is there a correlation with symptoms?

The Rome criteria serve as gold standard for establishing a diagnosis of irritable bowel syndrome (IBS), but only represent a cluster of symptoms. On the other hand, measurement of colonic transit time (CTT) with radiopaque markers is a solid and more objective method to quantify functional abnormalities. The goal of this study was to investigate whether the IBS symptoms, as defined in the Rome II criteria, correspond to objective physiological parameters, i.e. CCTs. The study enrolled 148 healthy control subjects and 1385 consecutive IBS patients. Transit times were measured for the whole rectocolon (overall CTT) and for 3 segments (right colon, left colon, rectosigmoid area); segmental distribution of markers and diffusion coefficients were also assessed. In order to analyze homogeneous groups, we restricted analysis to subjects with "normal" CTT (< or =70 hours). Six hundred forty four IBS patients (46%) and 14 control subjects (9%) had CTT >70 h and were eliminated. In subjects with CTT < or =70 h, CTT did not follow a normal (Gaussian) distribution. We identified 3 different CTT clusters in healthy controls and 4 clusters in IBS patients. Even if CTT was not significantly different between clusters, each cluster was characterized by a specific pattern of segmental colonic transit. There was a marked gender difference: women had longer overall CTT values than men, both in control and IBS patient groups (p<0.001). However, female IBS patients had significantly shorter colorectal transit times than female controls (p<0.001), as well as faster transit than in men through the left colon and rectosigmoid area. There were no significant differences in transit time between male IBS patients and male controls with the exception of a faster rectal transit in IBS patients (p<0.01). There was no association between segmental colonic transit values and sign or symptoms comprising the Rome II criteria. In subjects with CTT < or =70 h, CTT does not follow a normal distribution but is clustered in subgroups that can be distinguished only by measuring segmental colonic transit. Within these subgroups, there is a marked difference in transit times between IBS patients and normal subjects, suggesting that IBS patients with "normal" CTT are not "normal". The Rome II criteria do not reflect differences in segmental transit times in IBS patients with "normal" CTT. We therefore propose to evaluate segmental transit times in IBS patients with "normal" CTT, before and after treatment, in order to correctly interpretate variations in signs and symptoms. These findings have important implications in evaluating the effect of drugs on bowel function and should help define better inclusion criteria for studies evaluating new drugs for the treatment of IBS.

Gender‐related differences in visceral perception in health and irritable bowel syndrome

Irritable bowel syndrome (IBS) is more common in female subjects, and IBS patients generally exhibit reduced pain thresholds to rectal distension. The aim of the present paper was to determine gender-related differences in rectal perception in both healthy controls and IBS patients. Fifty-nine IBS patients (age 20-65 years; mean, 39.2 years; 31 women, 28 men) with symptoms that fulfilled Rome-II criteria and 21 healthy controls (age 25-58 years; mean, 37.8 years; 11 women, 10 men) were recruited. Participants completed a questionnaire regarding bowel symptoms and psychological distress, and maximal tolerable pressures were evaluated via barostat tests. Although healthy women appear to have lower perception thresholds than men, significant gender differences in pain sensitivity were not detected (P > 0.05). In addition, female patients with IBS also exhibited no enhanced colorectal perception, as compared with male IBS patients (P > 0.05). No gender differences in visceral perception were determined to exist between the healthy controls and the IBS patients. Therefore, the increased prevalence of IBS in women may be related to another set of pathophysiological factors, and not to gender-related differences in visceroperception.

Differences in brain responses to visceral pain between patients with irritable bowel syndrome and ulcerative colitis

Patients with mild chronic inflammation of the rectum or ileum have reduced perceptual responses to rectosigmoid distension compared to patients with irritable bowel syndrome (IBS). The current study sought to identify differences in regional cerebral blood flow (rCBF) during rectal distension, which might correspond to these perceptual differences. In 8 male ulcerative colitis (UC) patients with quiescent disease, 7 male IBS patients and 7 healthy male controls, rCBF was assessed using 15O-water positron emission tomography at baseline and during actual and anticipated but undelivered rectal distensions. No group differences were seen in anterior insula and dorsal anterior cingulate cortex (dACC), two regions consistently activated by painful intestinal stimuli. However, IBS patients showed greater activation of the amygdala, rostroventral ACC, and dorsomedial frontal cortical regions. In contrast, no significant differences were observed between UC and controls. When these two non-IBS groups were combined, functional connectivity analyses showed that right lateral frontal cortex (RLFC) activation positively correlated with activation of the dorsal pons/periaqueductal gray, a key region involved in endogenous pain inhibition. According to the connectivity analysis, this effect was mediated by inhibition of medial frontal cortex by the RLFC. Chronic colonic inflammation is not necessarily associated with increased visceral afferent input to the brain during rectal distension. In the sample studied, the primary difference between functional and quiescent inflammatory disease of the colon was in terms of greater activation of limbic/paralimbic circuits in IBS, and inhibition of these circuits in UC and controls by the RLFC.

Tolerability and safety of alosetron during long-term administration in female and male irritable bowel syndrome patients

OBJECTIVES: Alosetron (Lotronex) is a new therapeutic agent for irritable bowel syndrome (IBS) in women with diarrhea-predominant IBS. This multicenter randomized, double-blind, placebo-controlled study assessed the safety and tolerability of alosetron during long-term (≤12 months) treatment. METHODS: A total of 859 subjects (637 female and 222 male) with IBS were enrolled from 130 sites in the United States and were randomized 3:1 to receive 1 mg alosetron or placebo b.i.d. for 48 wk; of the subjects, 649 (76%) were randomized to the alosetron group and 212 (24%) to the placebo group. Of the original group, 850 subjects received at least one dose of alosetron (n = 640) or placebo (n = 210). RESULTS: In all, 59% of the subjects completed the study. Safety data were similar in treatment groups and within age, sex, racial origin, and hormone use. Adverse events were reported by 83% (530/640) and 76% (159/210) of subjects in the alosetron and placebo groups, respectively, ( p < 0.05) and were similar with the exception of constipation; 32% of subjects receiving alosetron reported constipation, compared to 5% in the placebo group ( p < 0.001). Most reports (72%) of constipation were of mild or moderate severity, and 66% of subjects with constipation had single episode of 8 days median duration. Constipation occurred a median of 13 days after initiating treatment and resolved spontaneously, with laxative, or after a brief interruption of therapy. Of the subjects, 4% (11/210) in the alosetron and 5% (28/640) in the placebo group experienced serious adverse events. Two deaths occurred in subjects with pre-existing cardiovascular risk factors; neither death was attributed to the study drug. CONCLUSIONS: Alosetron 1 mg b.i.d. for 12 months was well tolerated. Constipation is the most frequent adverse event, with a higher incidence of transient constipation in alosetron-treated patients, typically occurring in the first month of treatment.