Management Of Irritable Bowel Syndrome Patients Research Articles

Method Development of Nested Allele-Specific Multiplex Polymerase Chain Reaction (NASM-PCR) for the Irritable Bowel Syndrome (IBS)-related Gene Polymorphisms

Polymorphisms in the genes of G-protein subunit beta 3 (GNB3); rs5443, tryptophan hydroxylase 1 (TPH1); rs211105 and rs4537731, tryptophan hydroxylase 2 (TPH2); rs4570625 and sodium voltage-gated channel alpha subunit 5 (SCN5A); rs1805124, have known to cause the abnormalities in the gastrointestinal tract that are implicated to irritable bowel syndrome (IBS) predisposition. Upfront genetic polymorphism genotyping in IBS-related gene polymorphisms will help to intervene and guide the decision-making in the management of IBS patients. This study aimed to develop a genotyping method to detect the respective polymorphisms using nested allele-specific multiplex polymerase chain reaction (NASM-PCR). A combination of nested and allele-specific multiplex PCR method was developed to determine the five single nucleotide polymorphisms (SNPs) mentioned. Annealing temperature, annealing and extension times, and the concentrations of MgCl2, primers, and DNA samples were optimized in the PCR. Sanger sequencing was performed to validate the genotyping results. NASM-PCR for IBS-related gene polymorphisms were successfully developed. DNA bands which correspond to the genes and SNPs have shown 100% homologous with the gene database. The developed method of NASM-PCR was reproducible and specific to be used for determining the respective polymorphisms of IBS. Notably, the described method can easily be integrated into other laboratories for population study or clinical use.

Irritable bowel syndrome with food-related symptoms: Future directions in the clinical management.

The majority of patients with irritable bowel syndrome (IBS) experiences food‐related symptoms, which are associated with high symptom burden, reduced quality of life, increased healthcare consumption and reduced intake of certain nutrients. In this review we aimed to describe a clinically useful approach for physicians, by presenting the latest progress in knowledge and its translation to management in IBS patients with food‐related symptoms, as well as the underlying mechanisms involved. The research tools currently available that can be used in the future for a better characterization of this subgroup of patients are also discussed. Working towards this approach could lead to a more individualised work‐up and management of IBS patients with food‐related symptoms.

The new guideline on irritable bowel syndrome: what is new?

WHAT IS NEW?: The following refers only to irritable bowel syndrome (IBS) in adults. The new guideline includes a separate section on IBS for paediatric patients. Irritable bowel syndrome (IBS) presents as a heterogeneous picture with chronic abdominal complaints related to the bowel. These are usually accompanied by changes in bowel movements and lead to impaired quality of life. The genesis is multifactorial and there are complex underlying pathophysiological mechanisms associated with IBS. Thus, disturbances in various components of the gut-brain axis and the increasing importance of the microbiome can be identified. Various psychological comorbidities also play a role. The diagnosis is made by a thorough anamnesis and symptom-oriented exclusion of important differential diagnoses. A subdivision into different subtypes depending on the main symptoms is beneficial for the further management of IBS patients. The diagnosis of IBS should be made as early as possible after reliable exclusion of the important differential diagnoses. If diarrhoea dominates as a symptom, a detailed differential diagnosis and functional diagnosis should be carried out. There is no proven causal and no established standard therapy. Due to the variable genesis and symptom manifestation of IBS, a broad spectrum of therapy options results, whereby there is no individual prediction regarding effectiveness and therefore every therapy is initially probationary. Symptom-independent general therapies that can be used for all subtypes include dietary methods (e. g. the low-FODMAP diet), probiotics, psychotherapy methods and complementary medicine. The choice of symptom-dependent drug treatments is made according to the subtype/main symptom. In the case of diarrhoea, bile acid binders, the non-absorbable antibiotic rifaximin or, in individual cases, 5-HT3-antagonists can be used in addition to loperamide. In constipation, prucalopride and linaclotide have value in addition to the use of soluble fibre and macrogol/other laxatives. For abdominal pain/cramps, studies show good results for spasmolytics, especially peppermint oil, and for tricyclic-type antidepressants. For the main symptom of flatulence, probiotics, rifaximin and especially the low-FODMAP diet can show positive results in studies.

Eating disorders in patients with irritable bowel syndrome

IntroductionEating disorders (ED) constitute an important group of conditions that commonly occur in adolescents. Gastrointestinal complaints are frequently reported in ED patients. Few studies assessed the association of irritable bowel syndrome (IBS) with ED. The aim of the current study is to determine the prevalence of ED in a group of IBS patients and compare it with a healthy control group and assess the relationship of IBS sub-types, it's duration and severity with ED. Patients and methods100 IBS patients diagnosed according to the Rome-IV criteria and a control group consisting of 100 healthy adults, between 18 and 65 years old, were enrolled in this study. Sub-type, duration and severity of IBS were determined. All participants were requested to fill questionnaires to screen for ED. Results200 subjects participated in the study. 118(59%) were female and 92(41%) were male. The Eating Attitudes Test (EAT) score was significantly higher in the IBS group (Odds ratio: 5.3 CI 95%:4.3–9.3; p<0.001). The number of subjects with EAT score >30 was significantly higher in the IBS group (p<0.001). EAT scores were significantly higher in female IBS patients and in younger patients (p=0.013 and p=0.043; respectively). No significant association between the IBS sub-type and EAT score was found (p>0.05). However, IBS severity and duration positively correlated with EAT scores. DiscussionED should be considered in the management of IBS patients. Since many psychological factors can exacerbate IBS symptoms a multidisciplinary approach consisting of medical and behavioral therapeutic modalities should be employed for a better management of these patients.

487 Use of Central Neuromodulators by Gastroenterologists in the Treatment of IBS: A Pilot Survey

INTRODUCTION: Central neuromodulators (CN) include antidepressants and other CNS-targeted medications. They are effective in providing symptom relief in Irritable Bowel Syndrome (IBS) and other chronic abdominal pain disorders. However, little is known about gastroenterologists' practices, attitudes and knowledge regarding the use of these medications. METHODS: A 44-question survey designed by two national experts in functional gastrointestinal disorders (FGID) and a GI fellow was distributed via email to 7 experts in FGID and the GI faculty and alumni at UC-Los Angeles. Responses were reported using simple proportions and descriptive statistics. RESULTS: Characteristics of the 46 GIs that participated in the survey (response rate = 19.2%) are described in Table 1. 64.4% considered the use of CN extremely or very important in their management of IBS patients (Table 2) and 46.7% believed that CN were effective in at least half of their patients (Table 3). However, 37.9% prescribed CN to ≤20% of their IBS patients. 42.2% rated their competency in prescribing CN as ≥4 on a 5-point scale (5 = most competent). 97.8% of respondents used TCA, 63.6% used SSRI and 53.3% used SNRI. Respondents were more comfortable prescribing TCA than SSRI (100% vs. 59.5%; P &lt; 0.01) and SNRI (100% vs. 60.0%; P &lt; 0.01), however, their knowledge about the side effects of TCA (68.9%), SSRI (68.9%) and SNRI (64.4%) was similar (P = 0.87). The most common reasons GIs provided for not prescribing CN was concern about side effects (65.9%). 57.7% of respondents estimated that &gt;20% of their patients refused treatment with a CN, most commonly due to psychiatric stigma (80.0%) and potential side effects (57.8%). FGID experts had higher mean scores for self-assessed confidence (4.3 vs. 2.3; P &lt; 0.01) and competence (4.6 vs. 3.2; P &lt; 0.01) in prescribing CN when compared to non-experts. While experts were more likely than non-experts to feel comfortable prescribing CN for IBS patients' psychiatric symptoms (P &lt; 0.01), there was no difference in their comfort prescribing CN for patients' IBS symptoms (P = 0.32). CONCLUSION: Many surveyed gastroenterologists infrequently prescribe CN to their patients with IBS even though most consider them important in managing these patients. Perceived lack of competence and concern about CN side effects may be significant barriers to prescribing these medications. In particular, non-TCA CN such as SSRI and SNRI may be underutilized. These results warrant further study in a larger population of gastroenterologists.

Irritable bowel syndrome and diet.

Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract and is one of the most commonly diagnosed gastrointestinal diseases. The impact of IBS on the general population is large due to its high prevalence, suboptimal medical treatments and significant economic burden. The pathophysiology of IBS is complex and treatments are often symptom-specific. The most common therapeutic approaches for IBS include education and reassurance, lifestyles (especially nutrition-based interventions), peripherally acting medications (which typically target motility), centrally acting medications (which target visceral hypersensitivity and pain) and psychological interventions (which aim to reduce the effects of stress or symptom-specific anxiety). A beneficial dietary approach might include the following measures: a diet low in fermentable oligo-,di- and monosaccharides and polyols (FODMAPs), limitation or exclusion of gas-producing foods and/or lactose and gluten and fiber supplementation in selected cases. New therapeutic agents, namely nutraceutics, are also an interesting option in the management of IBS patients. This paper will focus on available dietary interventions for IBS and will review the evidence for nutrition-based therapies.

The Majority of Quality of Life Domains Are Impacted in IBS Patients: A Need for Intervention

Introduction: Irritable bowel syndrome (IBS) is a widespread gastrointestinal disorder affecting up to 20% of the U.S. population. While it is known that quality of life (QOL) is greatly affected in IBS patients, there is not much evidence regarding what areas of quality of life are involved. This study determined what domains of QOL are most impacted in a cohort of IBS patients at a tertiary care center and if age or BMI have an influence on their QOL. Methods: Patients diagnosed with IBS by Rome III criteria visiting a general gastroenterology clinic at a tertiary medical center were surveyed using the IBS-QOL. IBS-QOL is a psychometrically validated questionnaire which assesses overall quality of life and along eight subscales: dysphoria, interference with activity, body image, health worry, food avoidance, social reaction, sexual, and relationships. IBS-QOL and its subscales are both scored from 0-100. Lower scores suggest worse quality of life. Demographic data including age, gender, race; clinical data including BMI and IBS subtype (IBS-U, IBS-C, IBS-D); responses to IBS-QOL questionnaires were collected and analyzed. We compared overall IBS-QOL and its subscales by subtype as well as by age and BMI. Analysis of variance (ANOVA) or non-parametric Kruskal-Wallis tests assessed differences in continuous variables. Pearson's chi-square tests were used for categorical factors. Post-hoc comparisons were done at a significance of 0.017 (0.05/3 comparisons). Spearman's correlation coefficients assessed if IBS QOL correlated to age or BMI. Results: A total of 80 patients were analyzed [mean age 49yrs, 85% female]. Overall IBS-QOL and all subscales except body image and health worry were found to be significantly associated with diagnosis (Table 1). IBS-D patients had significantly lower QOL than IBS-C; there was no significant difference between either of these two groups and the IBS-U group (Figures 1&2). There was no correlation between age or BMI and any IBS-QOL subscale (Table 2).Figure 1Figure 2Conclusion: Majority of QOL domains are impacted in IBS patients. Providers should acknowledge dysphoria, interference with activity, food avoidance, social reactions and relationship issues in these patients. Further study is needed to determine possible treatment modalities to improve QOL and these domains in IBS patients. A multidisciplinary clinic with nutrition, psychology and psychiatry resources may be beneficial in management of IBS patients. IBS-D patients may require more intensive therapies.Figure 3

Meditation over Medication for Irritable Bowel Syndrome? On Exercise and Alternative Treatments for Irritable Bowel Syndrome

Complimentary alternative treatment regimens are widely used in irritable bowel syndrome (IBS), but the evidence supporting their use varies. For psychological treatment options, such as cognitive behavioral therapy, mindfulness, gut-directed hypnotherapy, and psychodynamic therapy, the evidence supporting their use in IBS patients is strong, but the availability limits their use in clinical practice. Dietary interventions are commonly included in the management of IBS patients, but these are primarily based on studies assessing physiological function in relation to dietary components, and to a lesser degree upon research examining the role of dietary components in the therapeutic management of IBS. Several probiotic products improve a range of symptoms in IBS patients. Physical activity is of benefit for health in general and recent data implicates its usefulness also for IBS patients. Acupuncture does not seem to have an effect beyond placebo in IBS. A beneficial effect of some herbal treatments has been reported.

Is Otilonium Bromide Really Effective for Treating Asian Patients With Irritable Bowel Syndrome?

Irritable bowel syndrome (IBS) is a complex and very common disease. It is a condition characterized by abdominal pain/discomfort associated with disordered defecation in the absence of any organic abnormalities. Although the exact pathophysiology of IBS is not fully understood, the treatment of IBS is targeted at the management of abdominal pain/discomfort including pharmacotherapy with antispasmodics.1 Mebeverine is a musculotropic agent that has antispasmodic activity and regulatory effects on the bowel functions, and has been effectively used in the treatment of IBS for many years.2 Otilonium bromide (OB) is a quaternary ammonium compound whose spasmolytic action is mainly due to its direct myolytic properties.3 In the meta-anlaysis of smooth muscle relaxants in the treatment of IBS, both mebeverine and OB were superior to placebo in relieving symptoms such as abdominal pain and distension without adverse effects.4 In addition, a double-blind, placebo-controlled study among Italian IBS patients showed that the reduced episode of abdominal pain was higher in OB treated patients (53.3%) than in placebo patients (39.9%).5 With great interest, I read the report by Chang et al6 regarding evaluation of otilonium bromide treatment in Asian patients with IBS. In this study, overall 117 IBS patients meeting Rome II criteria were enrolled in an 8-week trial, and randomized participants received either OB 40 mg or mebeverine 100 mg 3 doses daily. The primary endpoints were to evaluate the changes of abdominal pain/discomfort frequency scores (APDFS) and safety profile. The authors showed that the reduced APDFS in OB and mebeverine were 0.55 ± 1.20 (P = 0.011) and 0.37 ± 1.11 (P = 0.042), respectively, after 8-week treatment compared to baseline. The most reported side effects were dry mouth, nausea and dizziness. OB was not inferior to mebeverine in treating IBS patients with alleviations in abdominal pain intensity, flatulence and abdominal bloating. These results suggest that OB is as effective as mebeverine for alleviating IBS symptoms in Oriental populations. Although the authors showed an important result of OB treatment for Asian IBS patients, there are a few limitations regarding this study. First, the dose of mebeverine used was 400 mg per day in the previous study, but mebeverine of 300 mg was used in this study.2 I wonder whether the lower dose of mebeverine may have influence on the results or not, but there was no explanation about this in the discussion. Second, I also wonder if there was any difference in the reduction of APDFS according to the subgroup of IBS patients. It has been known that mebeverine is more effective than placebo in the management of diarrhea-predominant IBS patients by diminishing stool frequency, but there is few data about the effect of OB on stool frequency.7 Third, the number of patients receiving rescue treatment were very high (100% in OB and 98% in mebeverine). As mentioned in the discussion, patients were very concerned about the abnormal bowel movement activity during the treatment, therefore the rescue treatment might have been helpful for relieving their psychological stress. However, is there any possibility that this high portion of rescue therapy may affect the result by decreasing the differences of APDFS between the 2 groups? Despite these limitations of the present study, it provides us with the important information in the management of IBS patients in Asian, because it is the first trial of OB in Asia. Further large-scaled studies are needed to validate the results of the present study.

OC-087 Can faecal calprotectin reduce the demand for colonoscopy in patients with irritable bowel syndrome?: Abstract OC-087

Introduction The diagnosis of irritable bowel syndrome (IBS) in primary care relies on typical clinical features, absence of alarm symptoms and normal tests. Apart from usual blood tests, patients are often referred to secondary care and often undergo GI imaging (Barium studies or endoscopy), despite NICE guidelines recommendation to the contrary. Faecal calprotectin (FC) appears to be a very sensitive test for activated neutrophils from the small and large bowel and so may allow the diagnosis of IBS to be established in primary care. Methods 1. Outcomes based analysis of patients having a FC test between Jan 05-Jan 09 using HES, PACS and SNOMED CT pathology data sets. 2. Statistical analysis using Bayesian MCMC modelling of patient population data to determine cut-offs for computer modelling. 3. Linear modelling of two diagnostic strategies for costs and outcomes using a decision tree approach for a cohort of 1000 suspected IBS patients until diagnosis confirmed. Costs were limited to direct healthcare costs (ie, tests, endoscopies, drugs and outpatient visits). Outcomes were analysed for the number of correctly diagnosed IBS and IBD patients. Data inputs were drawn from published studies, established national databases, and expert clinical opinion. Results From a data set of >16 000, 2419 patients aged 50. For the 1750 patients with negative results, computer modelling indicated that cut-offs Conclusion These studies show that faecal calprotectin is more effective, in terms of diagnostic accuracy, and is a less costly diagnostic strategy for distinguishing IBS from IBD than the use of ESR plus CRP. Faecal calprotectin has the potential to improve the management of IBS patients in primary care by increasing the confidence with which diagnoses are made by healthcare professionals, and reducing the need for referral to secondary care.

An examination of subgroup classification in irritable bowel syndrome patients over time: A prospective study

Background Irritable bowel syndrome (IBS) is a complex functional gastrointestinal disorder which to date remains poorly understood. Therapies for irritable bowel syndrome (IBS) patients are usually aimed at relieving the predominant symptom; however, little evidence exists as to whether or not the predominant symptom changes with time. Nurses are becoming increasingly involved in the assessment and management of IBS patients. Objectives To categorise IBS patients into one of three sub-types, namely diarrhoea-predominant, constipation-predominant and a third group who alternate between the two, and to investigate changes in patient sub-type classification over time. Design Observational cohort study. Setting The general population of the United Kingdom (UK). Methods A cohort of 494 IBS patients, with a confirmed Rome II classification diagnosis, was recruited in the UK. Patients’ IBS symptoms were recorded throughout a 26-week period. Proportions of individuals in each IBS subgroup were calculated and probabilities of moving from one subgroup to another between consecutive weeks were estimated. Results The percentage of patients given an overall subgroup classification of diarrhoea-predominant IBD (D-IBS) is 40.9%; 58.1% and 1% were classified as belonging to the alternator (A-IBS) and constipation-predominant (C-IBS) subgroups, respectively. Patients classified as an alternator or as diarrhoea-predominant have a high probability (0.67 and 0.71, respectively) of remaining in the same subgroup; however this probability is lower for constipation-predominant patients (0.35). Conclusion Although many patients remain in the same IBS subgroup classification over time, there are individuals whose subgroup classification varies. As such, patients’ IBS subgroup classification should be reviewed regularly and treatment adjusted accordingly in order to optimise patient care.

Is There a Relation Between Irritable Bowel Syndrome and Urinary Stone Disease?

Our aim was to investigate the role of renal colic, a clinical condition characterized by excruciating pain, in the etiopathogenesis of irritable bowel syndrome (IBS). Two groups of patients were enrolled in the study. Group I consisted of 59 patients (33 male and 26 female) with a median age of 41.9 (18 to 58) years. The patients in group I were admitted to our clinic with urinary stone disease and with a medical history of acute renal colic. Group II consisted of 55 patients (25 male and 30 female) with a median age of 40.1 (18 to 56) years, complaining of urologic abnormalities other than stone disease. IBS was diagnosed using Rome criteria. Metabolic analysis for stone disease was performed on patients in group I. The incidence of five metabolic abnormalities--low urine volume, hypercalciuria, hyperoxaluria, hyperuricosuria and hypocitraturia--in patients with and without irritable bowel disease was investigated. IBS was found in 16 of the 59 patients (27.1%) in group I and in 6 of the 55 patients (10.9%) in group II. The difference was statistically significant (P < 0.05). Relative risk of developing IBS was 2.48 times higher in patients with urinary stone disease than in those without stone disease. There was no statistically significant difference in the metabolic analysis of patients with and without IBS in group I. IBS causes great suffering. Urinary stone disease should be considered as an etiological factor during management of IBS patients. In the presence of gastrointestinal symptoms, a patient with a medical history of acute renal colic might be referred to a gastroenterologist.