non-IBS Subjects Research Articles

The Role Of Cytokines In Irritable Bowel Syndrome: Review Article

(IBS) or Irritable bowel syndrome is a complicated health condition with different causative factors, including inflammation and infection, that have recently acquired as significant triggers of IBS. Inflammatory response might serve as a critical pathway in the progression of IBS, beside inequality in cytokines within the plasma and/or intestinal mucosal lining. Many biomarkers have been associated to possible mechanisms underlying IBS and are used to make differentiation between IBS and non-IBS subjects. Incorporation of these biomarkers into routine clinical work is important for fast and accurate diagnosis and effective treatment. Because IBS patients often experience ambiguous and overlapping symptoms, the creation of precise biomarkers for IBS could significantly enhance both diagnosis and patient care. This review examines the cytokines used in the diagnosis and treatment of IBS, Classifying these cytokines as either pro-inflammatory or anti-inflammatory and understanding their involvement in the development of irritable bowel syndrome.

Effect of a 12-Week Walking Program Monitored by Global Physical Capacity Score (GPCS) on Circulating Cell-Free mtDNA and DNase Activity in Patients with Irritable Bowel Syndrome.

Irritable bowel syndrome (IBS) involves low-grade mucosal inflammation. Among the various approaches capable of managing the symptoms, physical activity is still under investigation. Despite its benefits, it promotes oxidative stress and inflammation. Mitochondria impacts gut disorders by releasing damage-associated molecular patterns, such as cell-free mtDNA (cf-mtDNA), which support inflammation. This study evaluated the effects of a 12-week walking program on the cf-mtDNA and DNase in 26 IBS and 17 non-IBS subjects. Pro- and anti-inflammatory cytokines were evaluated by ELISA. Digital droplet PCR was used to quantify cf-mtDNA; DNase activity was assessed using a single radial enzyme diffusion assay. PCR-RFLP was used to genotype DNASE1 rs1053874 SNP. Significantly lower IL-10 levels were found in IBS than in non-IBS individuals. Exercise reduced cf-mtDNA in non-IBS subjects but not in IBS patients. DNase activity did not correlate with the cf-mtDNA levels in IBS patients post-exercise, indicating imbalanced cf-mtDNA clearance. Different rs1053874 SNP frequencies were not found between groups. The study confirms the positive effects of regular moderate-intensity physical activity in healthy subjects and its role in cf-mtDNA release and clearance. Walking alone might not sufficiently reduce subclinical inflammation in IBS, based on imbalanced pro- and anti-inflammatory molecules. Prolonged programs are necessary to investigate their effects on inflammatory markers in IBS.

Association between irritable bowel syndrome and micronutrients: A systematic review.

Irritable bowel syndrome (IBS) is a highly prevalent disorder of gut brain interaction with a multifactorial etiology. Food trigger avoidance is common among individuals with IBS and exclusion diets are gaining popularity. However, recent guidelines on IBS management cautioned regarding the use of unsupervised dietary therapy with concerns of development of poor eating habits and even nutritional deficiencies. We aimed to review the available literature on the effect of habitual and exclusion diets on micronutrient status as well as the role of micronutrient supplementation in alleviating IBS symptoms. Four electronic databases (PubMed, Embase, Cochrane, Web of Science) were searched for articles that reported micronutrient data in patients with IBS. Serum micronutrient levels and dietary intake of micronutrients in patients with IBS were collected. The extracted data were tabulated and organized by micronutrient type to observe for trends. Twenty-six articles were included in this systematic review (12 interventional and 14 observational studies). Studies showed that generally IBS subjects had lower levels of vitamin B2, vitamin D, calcium, and iron at baseline compared with non-IBS subjects. Studies also found that exclusion diets were associated with lower intake of micronutrients especially vitamin B1, B2, calcium, iron, and zinc. There was a lack of interventional studies on micronutrients. Irritable bowel syndrome patients are at risk of developing multiple micronutrient deficiencies that may have both localized gastrointestinal as well as systemic effects. Dietary management of IBS patients should include a proper dietitian review to ensure nutritional adequacy where possible.

Prevalence and subtype diversity of Blastocystis sp. in an Iraqi population with and without irritable bowel syndrome (IBS).

The parasites that belong to the genus Blastocystis are the most common intestinal parasite detected in a wide range of hosts including humans. Although the pathogenicity of these parasites remains controversial, many studies confirmed their pathogenicity and some researchers strongly believe that the pathogenicity may be linked with specific subtypes of these parasites. The current study investigated the Blastocystis sp. subtypes recovered from individuals suffering from the irritable bowel syndrome (IBS) in comparison with those recovered from non-IBS subjects. Fresh stool samples were collected from each participant and processed during the same day of collection. Iodine wet mounts and trichrome stained smears prepared from fresh stool and sediment concentrates were microscopically examined for Blastocystis parasites. In addition, Jones's medium has been used in order to confirm the identification and also to get the genomic DNA from positive samples for PCR and sequencing. The culture was significantly more sensitive (P=0.0035) than the other identification methods, especially in IBS patients. Blastocystis was detected in 60.0% of patients with IBS and in 22.0% of non-IBS individuals and the difference between two groups was statistically significant (P=0.0001). Regarding the impact of age and gender on the prevalence of infection with Blastocystis, no significant differences were observed between IBS patients and non-IBS subjects except for the age group (10-30 years) where the non-IBS subjects were significantly more prone (P=0.0223) to the infection with this parasite than IBS patients. The abdominal pain and bloating were the leading symptoms. DNA sequencing and phylogenetic analysis of Iraqi Blastocystis isolates identified three subtypes (ST1, ST2 and ST3). Among these three subtypes, ST3 was significantly more prevalent (OR=8.5; P=0.0058) among IBS patients (60%) than non-IBS subjects (25%). In contrast, the dominance of ST1 was significantly higher (OR=7.0; P=0.0062) in the non-IBS subjects (70%) than their IBS patients counterparts (15%). As far as we know, this study is the first to deal with the genetic characterization of Blastocystis subtypes in an Iraqi population with and without IBS.

A questionnaire-based survey on the etiopathogenesis of chronic constipation during a medical check-up in Japan.

The study group of the Japanese Society of Gastroenterology released evidence-based clinical practice guidelines for chronic constipation (CC) in 2017, and irritable bowel syndrome (IBS) was treated as one of the causes of CC. We examined the differences in characteristics between IBS and non-IBS subjects with CC who underwent a medical check-up in Japan. A total of 10,658 subjects participated in this study, and we focused on 467 subjects who fulfilled the diagnostic criteria of CC using a questionnaire survey. The number of IBS subjects was 21, and they had sleep disorders, were more symptomatic (e.g., abdominal pain, abdominal bloating/distension, feeling stressed, annoyance, lack of motivation, fatigue upon waking, and feeling depressed), and had more episodes of sensation of incomplete evacuation and anorectal obstruction/blockage during defecation than non-IBS subjects. Furthermore, stool frequency of IBS subjects was significantly different from non-IBS subjects. Multivariate ordinal logistic regression analysis revealed that the factors associated with a higher stool frequency were IBS [odds ratio (OR), 2.46; 95% confidence interval (CI), 1.00–6.05; p = 0.049], male sex (OR, 1.97; 95% CI, 1.20–3.23; p = 0.007), and regular exercise (OR, 1.80; 95% CI, 1.05–3.07; p = 0.033). These findings suggest that IBS has unique characteristics in subjects with CC.

Novel association between blastocystosis and some hemogram parameters in Iraqi people with and without irritable bowel syndrome.

Many studies have suggested that Blastocystis parasites are pathogenic protozoan parasites and one study proposed that these parasites have contributed to anaemia in children. The primary objective of the present study was to made a comparison between healthy control subjects (group 1), Blastocystis-positive subjects (group 2), subjects with irritable bowel syndrome (IBS) who were Blastocystis-negative (group 3), and IBS patients who were Blastocystispositive (group 4) regarding the haematological indices. From each participant, blood has been collected and the complete blood count (CBC) has been measured. The current study also was designed to evaluate the correlation between blastocystosis and six selected hemogram parameters [monocyte-to-lymphocyte ratio (MLR), neutrophil-tolymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red cell distribution width (RDW), platelet distribution width (PDW), and mean platelet volume (MPV)]. The results revealed that the total numbers of lymphocytes and platelets decreased significantly (P<0.0001), while the numbers of monocytes (P<0.0001) and neutrophils (P<0.0001) increased significantly in the bloods of IBS patients and non-IBS subjects who were infected with Blastocystis parasites in comparison with the healthy subjects in the control group. In addition, our results revealed for the first time that the levels of NLR, MLR, PLR, RDW, PDW and MPV were significantly higher (P=0.05-0.0001) in the bloods of IBS patients and non-IBS subjects who were infected with Blastocystis parasites than in their Blastocystis-negative counterparts. In conclusion, we believe that the levels of these hemogram parameters can be used as novel markers of blastocystosis. In addition, this study revealed that the infection with Blastocystis parasites had a significant impact on the haematological indices in both IBS patients and non-IBS individuals.

Serological levels of cytokines in irritable bowel syndrome (IBS) patients and non-IBS subjects with and without Blastocystis spp. infection.

The objectives of the present study were to investigate the prevalence of Blastocystis spp. and to determine the levels of some pro-and anti-inflammatory cytokines in patients with irritable bowel syndrome (IBS) and without Blastocystis infection in comparison with non-IBS control individuals. Stool samples were collected from 250 IBS patients and 100 samples from controls, examined for the presence of Blastocystis and the percentage of infection was recorded. After that each group subdivided into two groups: non-IBS subjects not infected with Blastocystis (group 1), non-IBS subjects infected with Blastocystis (group 2), IBS patients not infected with Blastocystis (group 3), and IBS patients infected with Blastocystis (group 4). After that, blood samples were collected from 10 participant from each group and sera were separated and used for measuring the levels of the selected pro- and anti-inflammatory cytokines using ELISA method. The results revealed that about 60% of IBS patients were found infected with Blastocystis while 22% of the subjects in the control group were found infected with this parasite and the difference between the two groups was highly significant (P=0.0001). In addition, the results revealed that IBS patients with Blastocystis showed significantly higher In addition, the results revealed that IBS patients with Blastocystis showed significantly higher serum IL-6 (P=0.0004), IL-10 (P=<0.0001), IL-18 (P=0.0001), IFN-γ (P=<0.0001), and TNF-α (P=<0.0001) when compared with the subjects in the control group. Similarly, the non-IBS subjects infected with Blastocystis showed significantly higher serum IL-6 (P=0.0032), IL-10 (P=0.0001), IL-18 (P=0.0002), IFN-γ (P=0.0001), and TNF-α (P=0.0001) in comparison with the subjects in the control group. In conclusion, the infection with Blastocystis has a significant impact on the levels of all the selected cytokines.

High-Fat Foods and FODMAPs Containing Gluten Foods Primarily Contribute to Symptoms of Irritable Bowel Syndrome in Korean Adults.

Dietary control plays an important role in the treatment of irritable bowel syndrome (IBS). However, few studies have examined the relationship between dietary intake and symptoms of IBS in Koreans. The current cross-sectional study aimed to examine the diet in food consumption and nutrient intake in Korean adults aged 20 to 40 with IBS. The data collected were completed by 857 subjects using a community-based web survey. The questionnaire covered functional bowel disorders based on Rome III, the semi-quantitative Food Frequency Questionnaire (SQ-FFQ), and the food items causing symptoms. In total, 186 of 857 subjects (21.7%) were diagnosed with IBS. The non-IBS group had a fat intake of 76.9 ± 47.9 g/day, while the IBS group had a fat intake of 86.6 ± 55.1 g/day (p = 0.014). The non-IBS group had a total fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) intake of 12.6 ± 9.7 g/day, whereas the IBS group had a total FODMAP intake of 13.9 ± 9.9 g/day (p = 0.030). Foods that contributed to the onset of symptoms in the IBS group were instant noodles (70.8%), Chinese noodles with vegetables and seafood (68.7%), pizza (67.2%), and black bean sauce noodles (66.3%) which are mostly classified as high fat and high gluten foods. The dietary intake of IBS patients differs from that of non-IBS subjects. Increased intake of gluten-containing or high-fat foods due to the westernized diet caused more IBS symptoms than high FODMAPs and dairy products in Korean adults in their 20 s to 40 s.

495 A Prospective Study of Gender and Quality of Life in Patients With Irritable Bowel Syndrome

INTRODUCTION: Irritable bowel syndrome (IBS) is a highly prevalent functional bowel disorder characterized by abdominal pain and change in bowel habits. IBS represents a significant public health problem because of its substantial reduction of quality of life (QoL) and increased healthcare cost. There is a significant paucity of data regarding gender-based QoL measures. Therefore, we report here results of a prospective study on gender based QoL measures in outpatients with IBS conducted at a single tertiary care center. METHODS: We prospectively enrolled adult outpatients with IBS (N = 72) and non-IBS patients (N = 181) based on a validated Rome III criteria questionnaire. Electronic medical records were reviewed, and demographic data were collected. Validated IBS-specific QoL (IBSQoL 34-item instrument) and general QoL (Veterans RAND-12, VR-12) questionnaires were completed by the study sample. Statistical analyses of data were performed using Chi-square, Fisher's exact, and two-samples t-test. RESULTS: The proportion of female IBS patients (N=44; 61%) was not different (P = 0.35; Table 1) from female non-IBS patients (N = 99; 55%). Other demographics, including BMI, marital status, smoking and insurance status were also comparable between these 2 groups, but IBS patients were younger (45 vs 51 yrs; P = 0.01, Table 1). Female and male subgroup analysis within both the IBS and non-IBS samples showed all similar demographic characteristics (age, BMI, smoking, marital and insurance status; data not shown). QoL in IBS subjects was highly significantly reduced as compared with non-IBS subjects both using the VR-12 and the IBSQoL instruments (Tables 2 and 3 and data not shown). In IBS patients, QoL (by VR-12) was significantly lower in males (P = 0.02) as compared to females in MCS (P = 0.02), but not in PCS (P = 0.07; Table 2). Male IBS patients scored significantly lower in the IBSQoL instrument than females in 2 of 8 domains (dysphoria and interference) and in the overall score whereas no gender differences were noted within the non-IBS sample (Table 3). The greatest IBSQoL reduction occurred in the food avoidance domain without gender disparity. CONCLUSION: IBS patients suffer from substantial impairment of QoL. This gender-based study is the first to demonstrate lower QoL scores in male IBS patients as compared to females in specific domains of validated general QoL and IBS-specific QoL instruments. Gender disparities demonstrated in this study were not associated with differences in age, BMI, and other demographics.

Self-reported Food Intolerance in Korean Patients With Irritable Bowel Syndrome.

Background/AimsVarious foods trigger and/or worsen the symptoms of irritable bowel syndrome (IBS). However, Korean food-related gastrointestinal (GI) symptoms in IBS patients have not yet been investigated. This study aims to evaluate the prevalence of self-reported food intolerance in Korean IBS patients and determine the Korean food items and food groups perceived by patients to worsen their GI symptoms.MethodsWe recruited 393 study subjects, comprising 101 IBS patients, 167 symptomatic non-IBS subjects, and 125 control subjects. All participants completed a questionnaire to identify the most problematic foods and assess the occurrence of GI symptoms caused by 119 Korean food items. They also completed the validated Rome III questionnaire for IBS.ResultsThe prevalence of self-reported food intolerance in Korean IBS patients was 79.2%, which was significantly higher than that in control subjects (44.8%, P < 0.001). The most problematic foods reported by IBS patients who experienced food intolerance were high-fat foods (25.0%), gluten foods (23.8%), spicy foods (15.0%), and dairy products (15.0%). A total of 63.4% of IBS patients reported GI symptoms related to the consumption of foods high in fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP), while 48.5% of IBS patients reported symptoms associated with high-fat foods. Gas problems and loose stools were the most frequently reported symptoms.ConclusionsA large proportion of Korean IBS patients complained of intolerance to certain food items, with high-fat and high-FODMAP foods being the main triggers. This study provides a basis for planning food intervention studies for Korean IBS patients.

Abnormalities in ileal stem, neurogenin 3, and enteroendocrine cells in patients with irritable bowel syndrome

BackgroundThis study examined whether the densities of stem- and enteroendocrine cell progenitors are abnormal in the ileum of patients with irritable bowel syndrome (IBS), and whether any abnormalities in ileal enteroendocrine cells are correlated with abnormalities in stem cells and enteroendocrine cell progenitors.MethodsOne hundred and one IBS patients covering all IBS subtypes were recruited, and 39 non-IBS subjects were included as a control group. The patients and controls underwent standard colonoscopies, during which biopsy specimens were obtained from the ileum. The biopsy specimens were stained with hematoxylin-eosin and immunostained for Musashi-1 (Msi-1), neurogenin 3 (NEUROG3), chromogranin A (CgA), serotonin, peptide YY (PYY), oxyntomodulin (enteroglucagon), pancreatic polypeptide, and somatostatin. The immunoreactive cells were quantified by computerized image analysis.ResultsThe densities of Msi-1, NEUROG3, CgA, and serotonin cells were reduced in all IBS patients and in patients with diarrhea-predominant IBS (IBS-D), mixed-diarrhea-and-constipation IBS (IBS-M), and constipation-predominant (IBS-C) relative to the control subjects. While the PYY cell density was increased in IBS-C relative to controls, it did not differ between control subjects and IBS-D and IBS-M patients. The densities of Msi-1 and NEUROG3 cells were strongly correlated with that of CgA cells.ConclusionsThe abnormalities in the ileal enteroendocrine cells appear to be caused by two mechanisms: (1) decreases in the clonogenic activity of the stem cells and in the endocrine-cell progenitors differentiating into enteroendocrine cells, and (2) switching on the expression of PYY and switching off the expression of certain other hormones in other types of the enteroendocrine cells.

Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation (IBS-C): a large population-based Internet survey in Japan.

BackgroundAbdominal bloating is a common symptom in patients with irritable bowel syndrome with constipation (IBS-C). However, it is not included among the required items in the Rome III diagnostic criteria for IBS. Little is known about an impact of abdominal bloating seen in patients with IBS-C. Using a large population-based sample, the aim of the present study was to investigate what is the most bothersome symptom in subjects with IBS-C.MethodsAn Internet survey of 30,000 adults drawn from the general public throughout Japan was conducted to identify subtypes of IBS using the Rome III diagnostic questionnaire. Consecutively, the screened subjects with IBS-C and the same number of age- and sex-matched non-IBS subjects who were randomly selected as controls were asked to answer a questionnaire on the degree of anxiety they experienced in their daily lives, thoughts about bowel habit, and their dominant gastrointestinal symptoms together with exacerbation factors (for IBS-C only).ResultsThe screening survey showed that the prevalence of overall IBS was 16.5 % (female 17.4 %, male 15.5 %) and that 2.8 % met the criteria for IBS-C, 4.5 % for IBS with diarrhea (IBS-D) and 8.2 % for mixed IBS (IBS-M). Seven hundred and fifty-nine of 835 (90.9 %) subjects with IBS-C and 746 of 830 (89.9 %) control subjects completed the consecutive questionnaire. IBS-C subjects felt a higher degree of anxiety in their daily lives (p < 0.01) and considered bowel habit to be an indicator of health (p < 0.01) to a greater extent than control subjects. In IBS-C, the degree of anxiety was significantly associated with abdominal discomfort (p < 0.01), pain (p < 0.01) and bloating (p = 0.02), but not with the frequency of bowel habit (p > 0.1). Abdominal bloating was the most bothersome symptom (27.5 %), which was more likely to occur after a meal (52.2 %), at work/school (29.2 %) and during times of stress (26.8 %). Only 4.5 % of IBS-C subjects reported abdominal pain as the ‘most bothersome’ symptom.ConclusionsA large population-based Internet survey suggests that abdominal bloating has a great impact on the daily lives of subjects diagnosed with IBS-C. Not only bowel movement/abdominal pain but also abdominal bloating should be evaluated in patients with IBS-C.Electronic supplementary materialThe online version of this article (doi:10.1186/s13030-016-0070-8) contains supplementary material, which is available to authorized users.

Development and validation of a biomarker for diarrhea-predominant irritable bowel syndrome in human subjects.

Diarrhea-predominant irritable bowel syndrome (IBS) is diagnosed through clinical criteria after excluding “organic” conditions, and can be precipitated by acute gastroenteritis. Cytolethal distending toxin B (CdtB) is produced by bacteria that cause acute gastroenteritis, and a post-infectious animal model demonstrates that host antibodies to CdtB cross-react with vinculin in the host gut, producing an IBS-like phenotype. Therefore, we assessed circulating anti-CdtB and anti-vinculin antibodies as biomarkers for D-IBS in human subjects. Subjects with D-IBS based on Rome criteria (n=2375) were recruited from a large-scale multicenter clinical trial for D-IBS (TARGET 3). Subjects with inflammatory bowel disease (IBD) (n=142), subjects with celiac disease (n=121), and healthy controls (n=43) were obtained for comparison. Subjects with IBD and celiac disease were recruited based on the presence of intestinal complaints and histologic confirmation of chronic inflammatory changes in the colon or small intestine. Subjects with celiac disease were also required to have an elevated tTG and biopsy. All subjects were aged between 18 and 65 years. Plasma levels of anti-CdtB and anti-vinculin antibodies were determined by ELISA, and compared between groups. Anti-CdtB titers were significantly higher in D-IBS subjects compared to IBD, healthy controls and celiac disease (P<0.001). Anti-vinculin titers were also significantly higher in IBS (P<0.001) compared to the other groups. The area-under-the-receiver operating curves (AUCs) were 0.81 and 0.62 for diagnosis of D-IBS against IBD for anti-CdtB and anti-vinculin, respectively. Both tests were less specific in differentiating IBS from celiac disease. Optimization demonstrated that for anti-CdtB (optical density≥2.80) the specificity, sensitivity and likelihood ratio were 91.6%, 43.7 and 5.2, respectively, and for anti-vinculin (OD≥1.68) were 83.8%, 32.6 and 2.0, respectively. These results confirm that anti-CdtB and anti-vinculin antibodies are elevated in D-IBS compared to non-IBS subjects. These biomarkers may be especially helpful in distinguishing D-IBS from IBD in the workup of chronic diarrhea.

Molecular assessment of differences in the duodenal microbiome in subjects with irritable bowel syndrome

Objective. Breath testing and duodenal culture studies suggest that a significant proportion of irritable bowel syndrome (IBS) patients have small intestinal bacterial overgrowth. In this study, we extended these data through 16S rDNA amplicon sequencing and quantitative PCR (qPCR) analyses of duodenal aspirates from a large cohort of IBS, non-IBS and control subjects. Materials and methods. Consecutive subjects presenting for esophagogastroduodenoscopy only and healthy controls were recruited. Exclusion criteria included recent antibiotic or probiotic use. Following extensive medical work-up, patients were evaluated for symptoms of IBS. DNAs were isolated from duodenal aspirates obtained during endoscopy. Microbial populations in a subset of IBS subjects and controls were compared by 16S profiling. Duodenal microbes were then quantitated in the entire cohort by qPCR and the results compared with quantitative live culture data. Results. A total of 258 subjects were recruited (21 healthy, 163 non-healthy non-IBS, and 74 IBS). 16S profiling in five IBS and five control subjects revealed significantly lower microbial diversity in the duodenum in IBS, with significant alterations in 12 genera (false discovery rate < 0.15), including overrepresentation of Escherichia/Shigella (p = 0.005) and Aeromonas (p = 0.051) and underrepresentation of Acinetobacter (p = 0.024), Citrobacter (p = 0.031) and Microvirgula (p = 0.036). qPCR in all 258 subjects confirmed greater levels of Escherichia coli in IBS and also revealed increases in Klebsiella spp, which correlated strongly with quantitative culture data. Conclusions. 16S rDNA sequencing confirms microbial overgrowth in the small bowel in IBS, with a concomitant reduction in diversity. qPCR supports alterations in specific microbial populations in IBS.

The Intestinal Gas Questionnaire: development of a new instrument for measuring gas‐related symptoms and their impact on daily life

Although gas-related symptoms (GRS) are common and intrusive, there are no questionnaires to quantitate this problem. This study aimed to develop an instrument to rectify this gap in our knowledge. Concepts were initially identified from the literature and interviews with gastroenterologists. Exploratory one-to-one interviews and focus groups with irritable bowel syndrome (IBS) patients (n = 28) and non-IBS subjects (n = 27) with GRS were conducted in UK, France, and Spain leading to a conceptual framework for the questionnaire. Last, iterative rounds of cognitive debriefing were performed with IBS (n = 16) and non-IBS subjects (n = 14). From the first three steps, nine GRS (bloating, distension, flatulence, odorous flatulence, difficult gas evacuation, stomach rumbling, belching, bad breath, and abdominal movement) were identified although abdominal movement was subsequently excluded. Twelve quality of life domains affected by these symptoms were identified as: Clothing, emotional, physical appearance, diet, daily living, work, social life, physical activity, relationships, sex life, sleep, and cognitive function. A 24-h recall for symptoms and a 7-day recall for impact assessment were supported by the qualitative findings. Cognitive debriefing confirmed the understanding of the instrument. Across the three languages, the instrument was conceptually and linguistically consistent. The International Gas Questionnaire is a 2-part instrument, developed rigorously and simultaneously in three languages assessing seven symptoms (17 items) and their impact on 12 domains (26 items) in IBS and general population. It is now undergoing psychometric validation and should provide a unique tool for epidemiological surveys and clinical trials for developing new treatments for these symptoms.

Health related quality of life in irritable bowel syndrome patients, Kashan, Iran: A case control study.

Background:Irritable bowel syndrome has significant impacts on the quality of life (QOL) but IBS subtypes may be different in QOL. This study aimed to assess QOL in IBS subtypes and also two prevalent questionnaires applied to evaluate the QOL in IBS.Materials and Methods:In this case-control study conducted in Kashan in 2010-2013. One hundred and eighty- eight patients with IBS with 215 of non-IBS patients were included in the baseline. Subjects divided into three subtypes based on symptoms of diarrhea-predominant (IBS-D), constipation-predominant (IBS-C) and IBS with mixed bowel habits (IBS-M) and in each subtype were 42, 62 and 84 patients, respectively. All IBS subjects completed questionnaires containing the disease-specific QOL for IBS (IBSQOL), World Health Organization QOL Assessment-BREF (WHOQOL-BREF) and IBS severity scores (IBSSS). The non-IBS subjects completed the WHOQOL-BREF only.Results:Mean scores of IBSQOL in person with subtypes of IBS-D, IBS-C and IBS-M were 74.34 ± 19.01, 76.77 ± 22.91 and 73.15 ± 26.51, respectively which was not significantly different (P value = 0.507). As well as mean scores of WHOQOL-BREF in person with subtypes of IBS-D, IBS-C and IBS-M were 81.01 ± 16.23, 88.32 ± 15.66, and 82.65 ± 16.67, respectively, which were not significantly different (P value = 0.412) but mean scores of WHOQOL-BREF in non-IBS subjects was 89.53 ± 11.71 which was significantly different from IBS subjects (P value = 0.022). Strong positive relationship between two instruments was shown (r = 0.826 when P < 0.05).Conclusions:The WHOQOL-BREF instrument showed poorer QOL in IBS patients. The QOL was not different significantly among IBS-M, IBS-C, and IBS-D subtypes. We found that WHOQOL-BREF instrument strongly correlate with QOLIBS instrument.

Rifaximin for small intestinal bacterial overgrowth in patients without irritable bowel syndrome.

BackgroundRifaximin is a minimally absorbed antibiotic with high luminal activity, used to treat various gastrointestinal diseases. Although rifaximin has been proposed as first line treatment for small intestinal bacterial overgrowth (SIBO), few data are available regarding its efficacy in non-IBS subjects. We aimed to assess the ability of rifaximin to normalize lactulose-H2 breath tests in non-IBS subjects with symptoms suggestive of SIBO.Materials and methodsConsecutive non-IBS patients presenting with bloating and flatulence were prospectively recruited and submitted to lactulose-H2 breath testing (LBT). Patients who had a positive result were offered rifaximin 1200 mg daily for 10 days. Breath testing was repeated two weeks after treatment completion in all patients in order to assess for response.ResultsA total of 19 patients with a positive result received rifaximin and repeated the breath test (7 (36.8%) males, age 56.5 ± 17.6 years). The mean peak hydrogen excretion was 13.7 ± 2.8 and 10.3 ± 7.3 ppm at baseline and following rifaximin treatment, respectively (t = 1.98, p = 0.06). LBT normalized in 8/19 (42.1%) subjects. No patients reported symptom resolution. No adverse events were reported.DiscussionStrengths include the study's prospective design. Limitations include the small sample size and open label design.ConclusionRifaximin was not effective in normalizing LBT in our cohort of non-IBS subjects with symptoms suggestive of SIBO.

Increased subsequent risk of erectile dysfunction in patients with irritable bowel syndrome: a nationwide population-based cohort study

This retrospective population-based study aimed to investigate associations between erectile dysfunction (ED) and the irritable bowel syndrome (IBS) using a Taiwanese cohort. We identified 17608 male patients who were newly diagnosed with IBS from 1997 to 2010. The date that the diagnosis of IBS had been made was the index date. IBS patients with a history of ED before the index date or with incomplete demographic information were excluded. 70432 age-matched subjects without IBS were selected as comparison cohort. Both cohorts were followed until the end of 2010 or censored. Cox proportional hazard regression model was used to estimate the effects of IBS on ED risks. The incidence rate ratio of ED in the IBS cohort was 2.92 times higher than that in the non-IBS cohort (29.5 vs. 10.1 per 10000 person-years), with an adjusted hazard ratio (aHR) of 2.58 (95% confidence interval [CI]: 2.24-2.98). The risk of ED increased with increasing age and number of comorbidities. Patients with depression were at a higher risk of ED (aHR: 1.97; 95% CI: 1.49-2.63) compared with the subjects without depression. IBS patients had a higher risk of developing ED compared with non-IBS subjects. Ageing and comorbidities including diabetes, cardiovascular disease, chronic kidney disease and depression were associated with the risk of ED.

Effects of personality traits on the manifestations of irritable bowel syndrome

ObjectivePrevious studies have reported that patients with irritable bowel syndrome (IBS) show high neuroticism. However, the precise association between the IBS subtypes and the degree of neuroticism in younger populations is largely unknown. We tested our hypothesis that subjects with diarrhea-predominant IBS may have a higher degree of neuroticism than subjects without IBS or those with other subtypes of IBS. We also verified the additional hypothesis that the severity of neuroticism might be correlated with the severity of IBS in younger populations.MethodsWe conducted a cross-sectional survey of 557 university students, ranging in age from 18 to 21 years. Presence/ absence of IBS and determination of the IBS subtype was by the Rome II Modular Questionnaire, while the severity of IBS was determined by the IBS severity index (IBS-SI). The degree of neuroticism was evaluated using the Maudsely Personality Inventory (MPI). The presence/absence of psychological distress was measured with the K6 scale.ResultsNeuroticism scores in the subjects with diarrhea-predominant IBS were significantly higher than those in the non-IBS subjects or subjects with constipation-predominant IBS. The neuroticism scores were significantly correlated with the IBS-SI scores in all subjects with IBS.ConclusionThese results suggest that neuroticism is involved in the pathophysiology of IBS in young subjects, especially in that of the diarrhea-predominant subtype.

Risk of inflammatory bowel disease following a diagnosis of irritable bowel syndrome

BackgroundIrritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) symptoms often overlap. In some IBS cases there are subtle inflammatory changes similar to the immune-mediated pathophysiology of IBD, and the risk of both increases after infectious gastroenteritis (IGE).MethodsTo evaluate the effect of IBS and IGE on IBD risk utilizing US Department of Defense medical encounter data, active duty personnel with IBS were matched to subjects without IBS. Medical encounter history was analyzed to assess for incident IBD. IGE was identified from documented medical encounters and by self-report. Relative risks were calculated using Poisson regression models.ResultsWe identified 9,341 incident IBS cases and 18,678 matched non-IBS subjects and found an 8.6-fold higher incidence (p < 0.0001) of IBD among those with IBS (238.1 per 100,000 person-years) compared to our referent population (27.8 per 100,000 person-years). In a subset (n = 2,205) of well-defined IBS cases, IBD risk was 15 times that of subjects without IBS. The median time between IBS and IBD diagnoses was 2.1 years. IGE also increased IBD risk approximately 2-fold ( p < 0.05) after controlling for IBS.ConclusionsThese data reflect a complex interaction between illness presentation and diagnosis of IBS and IBD and suggest intercurrent IGE may increase IBD risk in IBS patients. Additional studies are needed to determine whether IBS lies on the causal pathway for IBD or whether the two are on a pathophysiological spectrum of the same clinical illness. These data suggest consideration of risk reduction interventions for IGE among IBS patients at high disease risk.