Outcome Of Irritable Bowel Syndrome Research Articles

Therapeutic Outcome of Irritable Bowel Syndrome in Children: Role of Pro/Post-Biotics Mixture

Background Irritable bowel syndrome (IBS) is a common pediatric functional gastrointestinal disorder (FGID) with upper and lower gastrointestinal symptoms and extra-intestinal symptoms. It has a significant impact on daily activities, education and health related quality of life of affected children. The healthcare consultation rate is high in affected children and it leads to a significant annual healthcare cost. Aim of the Work Define the magnitude of response to treatment of IBS, identify the effect of pro/post biotics in treatment of IBS and define the time needed to reach a controlled IBS. Patients and Methods This study was a randomized add-on study with open label interventional study. This study was carried from July 2020 till collecting an adequate sample size. It was conducted on 70 patients who were diagnosed as IBS. each patient was subjected to three phases of the study: Phase I: Primary assessment: history taking, examination, and assessment score of pain, diarrhoea, constipation and quality of life. Phase II: Patients were divided into two equal groups: A and B. All patients in both groups received the standard treatment (diet modification, antispasmodic). Pro/post-biotics was added only to the treatment plan in group A.Phase III: reassessment of the patients using same assessment scores after 3 weeks, and after 3 months of receiving the treatment. Through comparing these scores before and after the treatment, we were able to evaluate the effect of each method of treatment on the patient’s symptoms Results Analysis of pain during this study showed that pain was 80% colicky in character and 78.6% at periumbilical area, with duration in range of 3 months up to 36 months. Analysis of symptoms of irritable bowel syndrome in children ranged from 4 - 16 years old showed that vomiting occurred only in 8.6%, diarrhea occurred in 42.9%, constipation occurred in 41.4%, and distention occurred in 70 %. Concerning the intervention comparison, abdominal pain improved in patients who received postbiotics and standard treatment improved by 83.21 % by the end of study compared to 69.57% in patients who received standard treatment only. Regarding diarrhea, patients who received postbiotics and standard treatment improved by 84.76 %, while patients who received standard treatment only improved by 68.16 % by the end of the study. Regarding quality of life, patients who received postbiotics and standard treatment improved by 84.11 % after 3 months, while patients who received standard treatment only improved by 74.46% by the end of the study. Comparison of intervention effects according to IBS subtypes regarding pain showed significant amelioration of abdominal pain (61.86%) in IBS-D group in comparison to (45.5%) in IBS-C group and (43.28%) in IBS-U group after 3 weeks. Regarding quality of life there was improvement in QOL in IBS-D group (52%), IBS-C group (42.5%) and in IBS-U group (50.64%) after 3 weeks. After 3 months of diet modification there was more improvement rate in IBS-D (73.6%), IBS-C (69.2%) and IBS-U (76.1%) which means that all the groups (IBS-C, IBS-D and IBS-U) had significant QOL improvement in similar rates. Conclusion Our data suggest that the standard therapy of IBS (especially FODMAP diet) is very effective alone for amelioration of IBS symptoms. Addition of postbiotics is very helpful to achieve early improvement of symptoms and quality of life of the IBS patients. This early effect is expected to be very important to avoid the non-compliance effect of delayed response.

Is Personalized Dietary Therapy Effective for Individuals With Irritable Bowel Syndrome?

Introduction: Adverse reactions to foods and food additives have a critical role in clinical manifestations of irritable bowel syndrome (IBS). Personalized dietary modifications conducted under the supervision of a qualified health practitioner could considerably impact the clinical care and course of the condition. Objective: To investigate the clinical effectiveness of the Lifestyle Eating and Performance (LEAP) program based on the Leukocyte Activation Assay-MRT (LAA-MRT®) results in improving IBS symptoms and quality of life. Methods: The retrospective study included de-identified client records (n = 146) from private group practices seen by registered dietitians. The eligibility criteria were adults aged > 18years old with an established diagnosis of IBS. Results: Participants were 46.7 ± 12.6years old and had a BMI of 26.7 ± 6.1 kg/m2; the majority were female (87.0%) and followed-up by a registered dietitian for 10.1 ± 6.4weeks. There was a significant reduction post-dietary intervention in overall Global Gastrointestinal Symptom Survey Scores (P < 0.001) and improvement in quality of life (P < 0.001). Conclusion: This study generates real-world evidence of an alternative treatment option for IBS using a personalized dietary approach. A more precise understanding of the effect of food intake reactions is vital for clinical improvements and enhancing health outcomes in IBS.

Fecal Microbiota Transplantation and Health Outcomes: An Umbrella Review of Meta-Analyses of Randomized Controlled Trials.

BackgroundMeta-analysis of randomized clinical trials (RCT) demonstrated several health benefits of fecal microbiota transplantation (FMT). However, there has been little comprehensive assessment of the strength and quality of evidence. We conducted an umbrella review to summarize the evidence of the association between FMT and health outcomes.MethodsPubMed, Embase, and Cochrane library databases were searched from inception to August 6, 2021. The random-effects model was applied to recalculate the effect estimates. We used AMSTAR 2 and GRADE to assess the methodological quality and to grade the evidence.ResultsA total of 7 meta-analyses comprising 26 RCTs (median [IQR] primary study, 6 [2-7]; median [IQR] sample size, 267 [147-431] participants) were included in the current umbrella review describing 45 unique associations. There were 22 statistically significant associations (49%) demonstrating beneficial outcomes of FMT for antibiotic resistance burden, functional constipation, inflammatory bowel disease, and C. difficile infection. FMT does not appear to be associated with positive outcomes in irritable bowel syndrome and metabolic syndrome. Eight significant associations (36%) were supported by moderate-quality evidence, nine associations (41%) were supported by low-quality evidence, and the remaining associations found to be significant were supported by very low-quality evidence.ConclusionAlthough we found that FMT was positively associated with several outcomes, caution should be exercised in choosing this approach, given the insufficient number of primary studies, low methodological quality, and low quality of evidence. Further high-quality randomized controlled trials with long-term follow-up are needed to improve the strength and credibility of the evidence base.

Risk for Post-Colonoscopy Irritable Bowel Syndrome in Patients With and Without Antibiotic Exposure: A Retrospective Cohort Study

Laboratory studies have demonstrated that antibiotic use in conjunction with bowel purgatives causes alterations to the gut microbiota. Because gut microbiota changes may be a trigger for the development of irritable bowel syndrome (IBS), we sought to assess whether individuals who undergo bowel cleansing for colonoscopy and have concurrent antibiotic exposure develop IBS at higher rates than individuals who undergo colonoscopy without antibiotic exposure. We used data from Optum's de-identified Clinformatics Data Mart Database in the United States to study a cohort of 50- to 55-year-olds who underwent screening colonoscopy. Individuals exposed to antibiotics within 14 days of colonoscopy were propensity-score matched to individuals who were not exposed to antibiotics around colonoscopy. The primary outcome was a new IBS diagnosis, and the composite outcome was a new claim for IBS, IBS medications, or IBS symptoms. The association of antibiotic exposure and the outcomes was calculated using Cox proportional hazards regression. There were 408,714 individuals who met criteria for the screening colonoscopy cohort. Of these, 24,617 (6.0%) were exposed to antibiotics around the time of colonoscopy, and they were propensity-score matched to 24,617 individuals not exposed to antibiotics. There was no statistically significant association between antibiotic use and IBS (hazard ratio, 1.11; 95% confidence interval, 0.89-1.39), but there was a weak association between antibiotic use and the composite outcome (hazard ratio, 1.12; 95% confidence interval, 1.02-1.24; number needed to harm, 94). Individuals concurrently exposed to antibiotics and bowel purgative had slightly higher rates of surrogate IBS outcomes compared with matched controls who did not receive antibiotics concurrently with bowel purgative.

Written expressive disclosure in adults with irritable bowel syndrome: A randomized controlled trial

BackgroundThe benefits of written expressive disclosure (WED) to health are documented in a variety of healthy and clinical populations. This study investigates the effect of WED on health-related outcomes in irritable bowel syndrome (IBS). MethodsAdults (N = 189) meeting Rome III criteria for IBS were randomly assigned to write about their: (1) deepest thoughts and feelings about the most stressful life event of the past five years (n = 67), (2) deepest thoughts and feelings about their IBS (n = 61) or (3) daily activities in an objective manner (control condition; n = 61). Participants completed four 20-min writing sessions over 2–6 weeks. Gastrointestinal (GI) symptoms, healthcare utilization, health-related quality of life (HR-QOL), pain catastrophizing, and pain self-efficacy were assessed at baseline, one month post-writing completion, and three months post-writing completion. ResultsA significant group (combined WED vs. control) X time interaction was detected for healthcare utilization, F(1,147) = 6.16, p = 0.014, η2 = 0.04. Specifically, number of GI-related medical appointments significantly increased from baseline to 3-month follow-up in the control group, while no significant change was observed in the combined WED group. Among the WED group, individuals assigned to write about their IBS experienced greater improvements in pain self-efficacy than those assigned to write about a life stressor, F(1,92) = 3.89, p = 0.024, η2 = 0.08. GI symptom severity, HR-QOL, and pain catastrophizing improved significantly across groups over time, with no significant between-group differences. ConclusionWriting about one's deepest thoughts and feelings about IBS may increase pain self-efficacy and reduce healthcare utilization compared to control writing in adults with IBS.

Longitudinal follow-up of a novel classification system for irritable bowel syndrome: natural history and prognostic value.

Conventionally, irritable bowel syndrome (IBS) is subgrouped using predominant stool form, yet it is a complex disorder, with multiple biopsychosocial contributors. We previously derived and validated a latent class model subgrouping people with IBS into seven clusters based on gastrointestinal and extraintestinal symptoms and psychological profile. To conduct longitudinal follow-up examining the natural history and prognostic value of these clusters. Participants completed a 12-month follow-up questionnaire. We applied our model to these data, comparing cluster membership between the two time points in those still meeting Rome IV criteria at follow-up, including stratifying the analysis by predominant stool pattern, and level of psychological burden, at baseline. We examined whether baseline cluster predicted the course of IBS, and whether starting new treatment was associated with changing cluster. Eight hundred and eleven participants met Rome IV criteria for IBS at baseline, of whom 452 (55.7%) responded, and 319 (70.6%) still met Rome IV criteria for IBS at follow-up. Of these, 172 (53.9%) remained in the same IBS cluster as at baseline and 147 changed cluster. Cluster membership stratified according to psychological comorbidity was more stable; 84% of those in a cluster with high psychological burden at baseline remained in such a cluster at follow-up. People in clusters with high psychological burden at baseline had more severe symptoms (P<0.001), received a higher mean number of subsequent treatments (P<0.001), and were more likely to consult a doctor than people in clusters with low psychological burden (P<0.001). There was no significant association between starting a new treatment and changing cluster at follow-up. Longitudinal follow-up demonstrated little transition between clusters with respect to psychological burden, and these appeared to predict disease course. Directing treatment according to cluster, including earlier use of psychological therapies, and exploring how this approach influences outcomes in IBS, should be examined.

Association of irritable bowel syndrome in patients with atrial fibrillation: a nationwide population-based investigation.

We seek to characterize the association between atrial fibrillation and irritable bowel syndrome. We identify 11,642 cases (atrial fibrillation) and 46,487 sex-, age-, and index year-matched controls (non-atrial fibrillation) from Longitudinal Health Insurance Database. Kaplan-Meier, Cox proportional hazards regression methods and competing risk analysis methods were used to assess the association of atrial fibrillation with outcome of irritable bowel syndrome. After adjustment for gender, age, comorbidities and medications, patients with atrial fibrillation had a significant higher risk (adjusted hazard ratio = 1.12, p < 0.01) to develop irritable bowel syndrome than patients without atrial fibrillation. Compared to participants without atrial fibrillation, those with atrial fibrillation had 1.13-fold (p < 0.05) and 1.11-fold (p < 0.05) risk of irritable bowel syndrome in female and male subgroup, respectively. Among subjects aged ≥65 years, those with AF had 1.11-fold risk of irritable bowel syndrome than non-AF cohort (P < 0.01). Among participants with any one of the comorbidities, those with atrial fibrillation had 1.10-fold risk of irritable bowel syndrome than non-atrial fibrillation cohort (p < 0.05). We report that the presence of atrial fibrillation is associated with greater incidence of irritable bowel syndrome and the association is stronger among female gender, age 65 years or above, and with comorbidities.

IBS Patients' Treatment Expectancy and Motivation Impacts Quality of the Therapeutic Alliance With Provider: Results of the IBS Outcome Study.

In the absence of a satisfactory medical or dietary treatment, the quality of the therapeutic alliance between irritable bowel syndrome (IBS) patients and their provider is deemed critical to managing refractory IBS. Surprisingly, little research has been conducted on the nature of the therapeutic alliance, factors that influence it, or practical strategies to improve it. This study sought to identify actionable variables that impact therapeutic alliance in patients with refractory IBS. Subjects included a total of 436 Rome III-diagnosed IBS patients (80% female, mean age=41.39 y) who completed a battery of clinical measures at the beginning of the acute treatment phase of an National Institutes of Health (NIH) behavioral trial. Pretreatment candidate predictor variables were organized into 4 categories: sociodemographic, extraintestinal, interpersonal, clinical (eg, symptom severity, pain intensity), cognitive (eg, treatment motivation, expectancy for improvement). Alliance was assessed by patient and clinician-rated measures of the Working Alliance Inventory after first treatment session. Patient reports of alliance were most strongly and consistently predicted by patient access to interpersonal support [β=0.16; 95% confidence interval (CI)=0.07-0.25], motivation for IBS symptom improvement (β=0.12; 95% CI=0.02-0.21), and expectancy of IBS symptom improvement (β=0.35; 95% CI=0.25-0.44). Therapist ratings of alliance also were predicted by patient expectancy of IBS symptom improvement (β=0.16; 95% CI=0.05-0.26). When managing IBS, a focus on dynamic factors of treatment motivation, social support, and treatment expectancy may be useful in improving the quality of the therapeutic alliance between patient and clinical gastroenterologist.

Derived Postbiotics of a Multi‐strain Probiotic Formula Clinically Validated for the Treatment of Irritable Bowel Syndrome

IntroductionThe pathophysiology of Irritable Bowel Syndrome (IBS) involves increased intestinal permeability, micro‐inflammation and gut dysbiosis with associated visceral hypersensitivity. The probiotic mix of Lactobacillus plantarum strains CECT7484 (KABP022) and CECT7485 (KABP023) and Pediococcus acidilactici CECT7483 (KABP021) has shown positive clinical outcomes in IBS. However, their exact mechanisms of action have not been elucidated. Postbiotics are probiotic‐derived metabolites or cell components that can improve host health. In this work we sought to characterize said strains about the production of specific postbiotics known to influence gut permeability and inflammation, as well as their inhibitory activity against bacteria known to be increased in IBS.MethodsWe measured the capacity to biosynthesize acetate from 3 carbon sources (glucose, xylose and arabinose) by colorimetric assay, acetylcholine (ACh) by HPLC‐ESI‐MS/MS and polyphosphate (polyP) granules by fluorescence, using Lactobacillus rhamnosus ATCC53103 as control. Inhibitory activity was tested on 6 IBS‐associated bacteria (2 enterobacteria, 2 Actinomyces spp. and 2 Streptococcus spp. strains). Supernatants from co‐cultures of probiotic and target bacteria were obtained and adjusted to pH 6 to only detect organic‐acid independent inhibition. Target bacteria were cultured on the supernatants for 16 h. Genomes were sequenced by Hiseq 2500–3000 and key genes involved in the biosynthesis of these postbiotics were searched. Additionally, susceptibility of the 3 strains to 8 antibiotics were determined according to ISO10932.ResultsResults are summarized in Table 1. Production of acetate was dependent on carbon source. The production from glucose was low (&lt; 1 mM). The fermentation of xylose increased the acetate production by all the strains (3 mM approx.) while arabinose yielded the greatest concentrations (up to 13.5 mM for L. plantarum CECT7484). L. plantarum strains synthesized the largest amounts of ACh (12.5 mg/L for CECT7484 and 13.8 mg/L for CECT7485) whereas P. acidilactici CECT7483 produced 1.9 mg/L and control strain produced none. After 6 h of growth, accumulation of PolyP granules was observed for the L. plantarum and control strains but not for Pediococcus. The 3 strains produced antimicrobials against all 6 target bacteria. Consistent with phenotypic analysis, in silico study confirmed the presence of phosphofructokinase (pfk) gene (responsible for acetate synthesis) in the 3 genomes and polyphosphate kinase (ppk) gene (polyP synthesis) in the 2 L. plantarum genomes. Bacteriocin (antimicrobial compound) genes were found in the genomes of L. plantarum CECT7484 and CECT7485. Moreover, the 3 strains were susceptible to all the antibiotics tested.ConclusionThe probiotic strains were proven to produce postbiotic molecules including acetate, polyP, ACh and antimicrobial compounds (potentially bacteriocins) against IBS‐associated microorganisms. This unique combination of postbiotics could explain the clinically beneficial effects of the probiotic mix in IBS subjects.Support or Funding InformationAB‐Biotics ‐KANEKA Postbiotics produced by the 3 probiotic strains and the control strain. Acetate production was tested from three carbon sources. Production of antimicrobials was determined by testing the inhibition of growth of 6 IBS‐related bacteria. ACh, acetylcholine; PolyP, polyphosphate (−/+, traces; +, production). Strains Acetate ACh PolyP No. bacteria inhibited Glucose Xylose Arabinose L. plantarum CECT7484 (KABP022) −/+ ++ ++++ ++++ +++ 6 out of 6 L. plantarum CECT7485 (KABP023) −/+ ++ +++ ++++ ++ 6 out of 6 P. acidilactici CECT7483 (KABP021) −/+ ++ +++ + − 6 out of 6 L. rhamnosus ATCC53103 (Control) −/+ ++ + − + NA

Cumulative Effects of Psychologic Distress, Visceral Hypersensitivity, and Abnormal Transit on Patient-reported Outcomes in Irritable Bowel Syndrome.

Little is known about the link between pathophysiologic factors and symptoms of irritable bowel syndrome (IBS), or whether these factors have cumulative effects on patient-reported outcomes (PROs). We investigated whether pathophysiologic alterations associated with IBS have cumulative or independent effects on PROs. We performed a retrospective analysis of data from 3 cohorts of patients with IBS (n= 407; 74% female; mean age, 36 ± 12 years), based on Rome II or Rome III criteria, seen at a specialized unit for functional gastrointestinal disorders in Sweden from 2002 through 2014. All patients underwent assessments of colonic transit time (radiopaque markers); compliance, allodynia, and hyperalgesia (rectal barostat); anxiety and depression (Hospital Anxiety and Depression scale), as pathophysiologic factors. Dysfunction was defined by available normal values. PROs included IBS symptom severity, somatic symptom severity, and disease-specific quality of life. Allodynia was observed in 36% of patients, hyperalgesia in 22%, accelerated colonic transit in 18%, delayed transit in 7%, anxiety in 52%, and depression in 24%: each of these factors was associated with severity of at least 1 symptom of IBS. Rectal compliance was not associated with more severe symptoms of IBS. At least 3 pathophysiologic factors were present in 20% of patients, 2 in 30%, 1 in 31%, and none in 18%. With increasing number of pathophysiologic abnormalities, there was a gradual increase in IBS symptom severity (P < .0001) and somatic symptom severity (P< .0001), and a gradual reduction in quality of life (P < .0001). Visceral hypersensitivity, including allodynia and hyperalgesia, abnormal colonic transit, and psychologic factors are all associated with IBS symptoms. These factors have a cumulative effect on gastrointestinal and nongastrointestinal symptoms, as well as on quality of life, in patients with IBS and are therefore relevant treatment targets.

Cumulative Effects of Psychologic Distress, Visceral Hypersensitivity, and Abnormal Transit on Patient-reported Outcomes in Irritable Bowel Syndrome

Cumulative Effects of Psychologic Distress, Visceral Hypersensitivity, and Abnormal Transit on Patient-reported Outcomes in Irritable Bowel Syndrome

Probiotics in irritable bowel syndrome: Where are we?

We have only recently begun to understand how alterations of the intestinal microbial ecosystem lead to the disruption of host-microbial interactions and are associated with diseases, including functional gastrointestinal disorders such as irritable bowel syndrome (IBS). Although we are still far from understanding the human microbiome, gut microbiota is already a therapeutic target. Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit to the host and may represent a therapeutic option for diseases characterized by dysbiosis such as IBS. Meta-analyses suggest that probiotics provide a therapeutic gain over placebo on global symptoms with a high safety profile in IBS patients. However, the mechanisms by which they provide benefit in IBS remain virtually unknown. In this issue of Neurogastroenterology and Motility, BIO-25, a multispecies probiotic, did not significantly modify the composition of the fecal microbiota, but interestingly, patients with specific basal features of the intestinal microbial ecosystem improved with treatment. Based on these data, it is tantalizing to speculate that microbiota composition serves as a predictor of the response to probiotic intervention. This mini-review addresses unresolved issues related to mechanisms through which probiotics may exert their beneficial effects, the biological, as well as clinical predictors of favorable outcomes in IBS and finally considers possible new directions for future studies.

Factors Associated With Efficacy of Cognitive Behavior Therapy vs Education for Patients With Irritable Bowel Syndrome

Among patients with irritable bowel syndrome (IBS), it would be helpful to identify those most likely to respond to specific treatments, yet few factors have been identified that reliably predict positive outcome. We sought to identify pretreatment baseline characteristics that associate with gastrointestinal symptom improvement in patients who received empirically validated regimens of cognitive behavior therapy (CBT) or IBS education. We analyzed data from the IBS Outcome Study, in which 436 patients with IBS (average age, 41years; 80%, female) were randomly assigned to groups that received 4 or 10 sessions of cognitive behavior therapy or education over 10 weeks. Baseline data were collected from all participants on sociodemographic and clinical features and comorbidities. Interaction analyses used a modified linear probability model with Huber-White robust estimators to identify baseline factors that moderated as a function of treatment condition GI symptom improvement based on the IBS-version of the Clinical Global Impressions-Improvement Scale. Whether the primary outcome of IBS symptom improvement was rated by patients or physician assessors blind to treatment 2 weeks after it ended, higher percentages of patients had symptom improvement after CBT compared with EDU among those with low levels of trait anxiety (71.3% vs 34.9%; P < .05) or anxiety sensitivity (71.7% vs 38.6%; P < .05) and for those with baseline typical levels of trait anxiety (66.0% vs 47.1%; P < .05) or anxiety sensitivity (66.3% vs 47.1%; P<.05). For patients with high trait anxiety or anxiety sensitivity, the difference in percentage ofresponders to CBT vs EDU was non-significant for trait anxiety (60.6% vs 59.2%) and anxiety sensitivity (60.9% vs 55.9%). If patients scored at or below 22 on the Trait Anxiety Inventory, CBThad a statistically significant advantage over EDU. If patients scored at or below 29 on the AnxietySensitivity Inventory, there was a statistically significant advantage for CBT vs EDU. In analyses of outcomes of patients with treatment-refractory IBS, baseline levels of trait anxiety and anxiety sensitivity (fear of arousal symptoms) were associated with improved gastrointestinal symptoms following CBT compared to IBS education. These findings and approaches might be used to optimize selection of treatment for patients with IBS.

Evaluation of Socio-demographic and Lifestyle Factors Among Subtypes of Irritable Bowel Syndrome

Background: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorder with absence of organic damages to the intestine. The pathophysiology of IBS is still not completely understood, but in some cases psychological disorders may affect the onset and outcome of IBS. Some studies have found disparities between subtypes of irritable bowel syndrome (IBS) regarding socio-demographic characteristics and lifestyle factors.Methods: This cross-sectional study aimed to investigate whether there are differences in sociodemographic and lifestyle factors including smoking and physical activity between the subtypes of IBS. The study was performed on outpatients diagnosed as irritable bowel syndrome (from January 2015 to December 2015) in Dhaka Medical College Hospital and Shaheed Suhrawardy Medical College Hospital in Dhaka. A total of purposively selected 208 diagnosed IBS patients were interviewed by semi-structured questionnaire in which subtype of irritable bowel syndrome were measured by Rome-III criteria regarding stool consistency.Results: Mean age of the respondents was 32.3 (+ 10.32) years and majority of them were male (77%), married (66.8%), educated up to secondary level (35.6%), labour (skilled and unskilled) (30%), non- smoker (67.3%) and HEPA (health enhancing physical activity) active (65.9%). Diarrhea predominant irritable bowel syndrome (50%) was found the most common subtype among the irritable bowel syndrome respondents followed by mixed type irritable bowel syndrome (42%) and constipation predominant irritable bowel syndrome (8%) There were no statistical differences found between constipation predominant irritable bowel syndrome ( IBS-C), Diarrhea predominant irritable bowel syndrome (IBS-D), and mixed type irritable bowel syndrome (IBSM) patients regarding to socio-demographic characteristics and lifestyle factors (P&lt;0.05).Conclusion: Our study concluded that there are no different socio-demographic and lifestyle characteristics between IBS subtypes.J Shaheed Suhrawardy Med Coll, June 2017, Vol.9(1); 6-9

Pilot study of acceptance and commitment therapy for irritable bowel syndrome: A preliminary analysis of treatment outcomes and processes of change

BackgroundThe aim of this study was to investigate the efficacy and proposed processes of change of acceptance and commitment therapy (ACT) in improving the outcomes of irritable bowel syndrome (IBS).MethodsA total of 56 consecutive patients recruited from a specialist clinic were included in the study and completed an ACT treatment protocol (one‐day group workshop plus self‐help manual). Assessments of process (acceptance of IBS) and outcome variables (symptom severity, avoidance behaviours, quality of life, and gastrointestinal anxiety) were carried at four time points (assessment, pre‐treatment, post‐treatment, and follow‐up).ResultsA significant increase in the acceptance of IBS and improvement in all outcome variables was observed from pre‐ to post‐treatment and follow‐up (effect sizes medium to large). Improvements in all outcomes were associated with increases in acceptance of IBS. Changes in acceptance of IBS from pre‐ to post‐treatment were a significant predictor of improvements in outcomes from pre‐treatment to follow‐up.ConclusionsResults support the efficacy of a brief ACT protocol in improving IBS outcomes and maintaining therapy effects at six‐month follow‐up. Preliminary support for the treatment process proposed was also found.

Doctor-patient relationship and quality of life in Irritable Bowel Syndrome: an exploratory study of the potential mediating role of illness perceptions and acceptance

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterised by unpredictable bowel symptoms. These can be difficult to manage, consequently impacting quality of life (QoL). In addition, a strained doctor–patient relationship is independently reported in the qualitative literature. Given the doctor is often the first port of call for people with IBS, a difficult relationship may influence subsequent IBS management. Research suggests illness perceptions are important in determining IBS outcomes in therapy; however, their association with doctor–patient relationship and QoL is yet to be investigated. This exploratory study aimed to investigate the association between these constructs in IBS, as well as potential mediation by illness perceptions. Online questionnaires measuring doctor–patient relationship, illness perceptions, acceptance and QoL, were completed by 167 participants who reported an IBS diagnosis (144 female, mean age = 44.22 years, SD = 15.91 years). Bootstrapped pathway analysis was used to model the relationship and mediation effects. There was a significant positive correlation between patient–doctor relationship and QoL, r = .258, n = 167, p = .001. There was a significant indirect effect between doctor–patient relationship and QoL through illness coherence and acceptance (bootstrapped estimate = .058, 95%CI Lower-Upper = .02, .095, p = .002). No other indirect effects were observed in combination with good fit indices for the other illness perceptions. Findings suggest a doctor–patient relationship which fosters mutual understanding and helps patients make sense of symptoms, increases their ability to manage their IBS in a psychologically flexible manner, subsequently helping them maintain their QoL.

The role of alexithymia and gastrointestinal-specific anxiety as predictors of treatment outcome in irritable bowel syndrome

In a previous investigation irritable bowel syndrome (IBS) was associated more to alexithymia than gastrointestinal-specific anxiety (GSA). In this study their independent contribution in predicting treatment outcome was longitudinally investigated. Consecutive 150 IBS patients were evaluated for IBS symptoms, alexithymia, GSA, and psychological distress with validated scales after as-usual treatment for 6–12months. The primary treatment outcome was improvement measured with the IBS-Severity Scoring System that showed 111 patients who improved and 39 who did not improve. Improvement was associated to both alexithymia (d=1.27) and GSA (d=4.63) but only alexithymia showed overtime stability by hierarchical regression, controlled for co-variables. A series of logistic and linear regressions showed that baseline alexithymia, but not GSA, independently predicted both post-treatment improvement status (Cox & Snell R2=0.15; overall classification rate=74%) and symptom change (23% of explained variance). Although alexithymia and GSA were closely related IBS symptoms, only alexithymia was found to be a stable trait and a stronger predictor of treatment outcome than GSA. Since no treatment was established to be definitely effective for IBS, clinicians might improve treatment outcome by identifying patients with high alexithymia, attempting to improve their coping skills, emotional regulation, and affective awareness.

Personality traits and emotional patterns in irritable bowel syndrome.

The review focuses on those personality traits (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness), constructs (alexithymia and distressed - Type D personality) and emotional patterns (negative and positive) that are of particular concern in health psychology, with the aim to highlight their potential role on the pathogenesis, onset, symptom clusters, clinical course, and outcome of irritable bowel syndrome (IBS). Personality traits and emotional patterns play key roles in affecting autonomic, immune, inflammatory, and endocrine functions, thus contributing not only to IBS clinical expression and symptomatic burden, but also to disease physiopathology. In this sense, psychological treatments should address those personality traits and emotional features that are constitutive of, and integral to IBS. The biopsychosocial model of illness applied to IBS acknowledges the interaction between biological, psychological, environmental, and social factors in relation to pain and functional disability. A holistic approach to IBS should take into account the heterogeneous nature of the disorder, and differentiate treatments for different types of IBS, also considering the marked individual differences in prevalent personality traits and emotional patterns. Beyond medications, and lifestyle/dietary interventions, psychological and educational treatments may provide the optimal chance of addressing clinical symptoms, comorbid conditions, and quality of life in IBS patients.

Symbiotics in irritable bowel syndrome--better than probiotics alone?

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder associated with significant physical and psychological comorbidity. The etiology of the condition is uncertain but recent research suggests that the gut bacterial composition may play a role in its development. Therefore, manipulation of the intestinal microbiome by using probiotics and symbiotics has the potential to improve patient outcomes in IBS. Numerous randomized controlled trials suggest a benefit of probiotics in the management of IBS, with a significant reduction in the likelihood of symptoms persisting after therapy, and improvements in abdominal pain, bloating and flatulence when probiotics are compared with placebo. Evidence for the effect of probiotics on quality of life is conflicting. Relatively few randomized controlled trials have examined the effect of symbiotics on outcomes in IBS, but results thus far are promising. Probiotics appear to be beneficial in IBS. Data supporting the use of symbiotics is sparse. Whether symbiotics are superior to probiotics is unclear.

Sex hormones in the modulation of irritable bowel syndrome

Compelling evidence indicates sex and gender differences in epidemiology, symptomatology, pathophysiology, and treatment outcome in irritable bowel syndrome (IBS). Based on the female predominance as well as the correlation between IBS symptoms and hormonal status, several models have been proposed to examine the role of sex hormones in gastrointestinal (GI) function including differences in GI symptoms expression in distinct phases of the menstrual cycle, in pre- and post-menopausal women, during pregnancy, hormonal treatment or after oophorectomy. Sex hormones may influence peripheral and central regulatory mechanisms of the brain-gut axis involved in the pathophysiology of IBS contributing to the alterations in visceral sensitivity, motility, intestinal barrier function, and immune activation of intestinal mucosa. Sex differences in stress response of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, neuroimmune interactions triggered by stress, as well as estrogen interactions with serotonin and corticotropin-releasing factor signaling systems are being increasingly recognized. A concept of "microgenderome" related to the potential role of sex hormone modulation of the gut microbiota is also emerging. Significant differences between IBS female and male patients regarding symptomatology and comorbidity with other chronic pain syndromes and psychiatric disorders, together with differences in efficacy of serotonergic medications in IBS patients confirm the necessity for more sex-tailored therapeutic approach in this disorder.