Predominant Irritable Bowel Syndrome Research Articles

The Effect and Mechanism of Sancao Lichang Decoction on Diarrhea- Predominant Irritable Bowel Syndrome by Regulating Tlr4/Myd88/Nf-Κb Pathway.

To evaluate the effect of Sancao Lichang decoction as traditional Chinese medicine on diarrhea-predominant irritable bowel syndrome (IBS-D) and TLR4/MyD88/NF-κB pathway. Traditional Chinese medicine has made significant progress in preventing and treating irritable bowel syndrome, and its efficacy has been validated by clinical practice. Sancao Lichang decoction is an empirical prescription developed by professor Tang Decai that has been used for many years to treat chronic diarrhoea with good curative effec. Still, its mechanism of action on IBS-D is unknown. The study sample of Fifty SD rats was randomly divided into a blank group, model group, low-dose group, medium-dose group, and high-dose group (n = 10). The IBS-D rat models were established by restraining stress method and acetic acid enema. After different treatments, defecation frequency, fecal water content (FWC), serum IL-6 and TNF-α contents, and protein level of TLR4/MyD88/NF-κB in colon tissues were detected separately. The indexes of rats in each group were significantly different. The increase in body weight in the medium-dose and high-dose groups was significantly higher than that in the model group (p < 0.05). Compared with the model group, the medium and high dose groups had lower diarrhea frequency, FWC, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) (p < 0.05). The expression levels of TLR4, MyD88, and NF-κB protein in the colon of the three groups treated with Sancao-Lichan decoction were significantly lower than those in the model group (p < 0.01). After different treatments, the colonic mucosa of rats in each group was stained with HE, which proved that the structural damage of colonic mucosa was improved after treatment with Sancao Lichang decoction, and the improvement effect was dose-dependent. Sancao Lichang decoction may reduce IBS-D by inhibiting TLR4/MyD88/NF-κB pathway, inhibiting the inflammatory response, and improving intestinal mucosal barrier function.

MiR-10b-5p rescues leaky gut linked with gastrointestinal dysmotility and diabetes.

Diabetes has substantive co-occurrence with disorders of gut-brain interactions (DGBIs). The pathophysiological and molecular mechanisms linking diabetes and DGBIs are unclear. MicroRNAs (miRNAs) are key regulators of diabetes and gut dysmotility. We investigated whether impaired gut barrier function is regulated by a key miRNA, miR-10b-5p,linking diabetesand gut dysmotility. We created a new mouse line using the Mb3Cas12a/Mb3Cpf1 endonuclease todeletemir-10b globally. Loss of function studies in the mir-10b knockout (KO) mice were conducted to characterize diabetes, gut dysmotility, and gut barrier dysfunction phenotypes in these mice. Gain of function studieswere conducted by injecting these mir-10b KO mice with a miR-10b-5p mimic. Further, we performed miRNA-sequencing analysis from colonic mucosa from mir-10bKO, wild type,and miR-10b-5p mimic injected mice to confirm (1) deficiency of miR-10b-5p in KO mice, and (2) restoration of miR-10b-5p after the mimic injection. Congenital loss of mir-10b in mice led to the development of hyperglycemia, gut dysmotility, and gut barrier dysfunction. Gut permeability was increased, but expression of the tight junction protein Zonula occludens-1 was reducedin the colon of mir-10b KO mice. Patients with diabetes or constipation- predominant irritable bowel syndrome, a known DGBI that is linked to leaky gut, had significantly reduced miR-10b-5p expression. Injection of a miR-10b-5p mimic in mir-10b KO mice rescued these molecular alterations and phenotypes. Our study uncovered a potential pathophysiologic mechanism of gut barrier dysfunction that links both the diabetes and gut dysmotility phenotypes in mice lacking miR-10b-5p. Treatment with a miR-10b-5p mimic reversed the leaky gut, diabetic, and gut dysmotility phenotypes, highlighting the translational potential of the miR-10b-5p mimic.

Somatization in patients with predominant diarrhoea irritable bowel syndrome: the role of the intestinal barrier function and integrity

BackgroundIrritable bowel syndrome (IBS) is characterised by gastrointestinal (GI) and psychological symptoms (e.g., depression, anxiety, and somatization). Depression and anxiety, but not somatization, have already been associated with altered intestinal barrier function, increased LPS, and dysbiosis. The study aimed to investigate the possible link between somatization and intestinal barrier in IBS with diarrhoea (IBS-D) patients.MethodsForty-seven IBS-D patients were classified as having low somatization (LS = 19) or high somatization (HS = 28) according to the Symptom Checklist-90-Revised (SCL-90-R), (cut-off score = 63). The IBS Severity Scoring System (IBS-SSS) and the Gastrointestinal Symptom Rating Scale (GSRS) questionnaires were administered to evaluate GI symptoms. The intestinal barrier function was studied by the lactulose/mannitol absorption test, faecal and serum zonulin, serum intestinal fatty-acid binding protein, and diamine oxidase. Inflammation was assessed by assaying serum Interleukins (IL-6, IL-8, IL-10), and tumour necrosis factor-α. Dysbiosis was assessed by the urinary concentrations of indole and skatole and serum lipopolysaccharide (LPS). All data were analysed using a non-parametric test.ResultsThe GI symptoms profiles were significantly more severe, both as a single symptom and as clusters of IBS-SSS and GSRS, in HS than LS patients. This finding was associated with impaired small intestinal permeability and increased faecal zonulin levels. Besides, HS patients showed significantly higher IL-8 and lowered IL-10 concentrations than LS patients. Lastly, circulating LPS levels and the urinary concentrations of indole were higher in HS than LS ones, suggesting a more pronounced imbalance of the small intestine in the former patients.ConclusionsIBS is a multifactorial disorder needing complete clinical, psychological, and biochemical evaluations.Trial registration: https://clinicaltrials.gov/ct2/show/NCT03423069.

No distinction in the gut microbiota between diarrhea predominant-irritable bowel syndrome and healthy subjects: matched case\u2013control study in Thailand

BackgroundAlteration in the gut microbiota has been proposed in irritable bowel syndrome (IBS) pathogenesis, especially in the diarrheal type (IBS-D). We conducted this study to evaluate the fecal microbiota in Thai IBS-D patients when compared with healthy subjects as well as to evaluate the effects of probiotics on changes in the gut microbiota correlated with symptoms.MethodsA matched case–control study was conducted on diagnosed IBS-D patients, based on the Rome IV criteria and healthy controls. Stool samples were collected in preservation tubes. Bacterial deoxyribonucleic acid extraction was performed and amplified. Next, 16S ribosomal ribonucleic acid genes sequencing was performed to identify the microbiome in both the groups. IBS-D patients were provided with a probiotic mixture that was rich in Lactobacillus acidophillus and Bifidobacterium bifidum over 8 weeks. Changes in the symptoms, stool characteristics, and fecal microbiota were evaluated and compared with the corresponding baseline values.ResultsTwenty IBS-D patients with 20 age and gender-matched controls were included in this study. The baseline characteristics were not significantly different between the groups, including the mode of birth and the history of breastfeeding in infancy. No significant difference was noted in the fecal microbiota between the IBS-D patients and controls. The IBS symptom severity scales (IBS-SSS) were not statistically different after probiotic prescription; although, the bowel movements, the sense of urgency to go to the toilet and passing of mucous stool had obviously decreased. No change was noted in the fecal microbiota after receiving the experimental probiotic, except for an increase in the proportion of B. bifidum.ConclusionAlteration in the gut microbiota composition was probably not the main pathogenic mechanism in the Thai IBS-D patients assessed in this study. However, modifying microbiomes with potentially protective bacteria seems to be a beneficial therapy.Thai Clinical trial registry: TCTR20191211006, Date of registration: 10 Dec 2019. Retrospectively registered, Clinical trial URL: www.clinicaltrials.in.th

Impact of irritable bowel syndrome and body mass index on mental health - A prospective cross sectional study

Introduction: Irritable bowel syndrome (IBS) is one of the most common causes of chronic diarrhea. Chronic diarrhea has substantial effect on the physical and mental health (MH) of the patient. Aims: The aim of this study was to evaluate the association between IBS with chronic diarrhea and body mass index (BMI) and effect of severity of symptoms, body weight on MH of patients with IBS. Study Design: A prospective cross-sectional study was performed on patients having diarrhea predominant IBS during September 2017–August 2019. Methods: Ninety-seven patients suffering from IBS-D as diagnosed on the basis of Rome criteria IV had were studied. The severity of symptoms in IBS-D where evaluated according to the IBS-score of symptom-severity. MH was assessed by Patient Health Questionnaire-9 questionnaire. Statistical Analysis: SPSS statistical software was used to analyze the data. ANOVA was used to analyze demographic data. Pearson correlation coefficients were used to analyze linear correlation between demographics, BMI, and MH. Multiple regression test was used in MH analysis with respect to predictive role of BMI. Impact of confounding factors was tested with respect to the gender, age, family status, educational status, severity of the symptoms, and BMI. Results considered statistically significant if P

G protein beta 3(GNβ3) C825T polymorphism and irritable bowel syndrome susceptibility: an updated meta-analysis based on eleven case-control studies.

Several studies have reported an association between GNβ3 C825T polymorphism and irritable bowel syndrome (IBS). However, the results remain inconclusive and controversial, particularly for the data derived from different ethnicities and IBS subtypes. Therefore, we performed an updated meta-analysis to evaluate this association. All eligible case-control studies that met the search criteria were retrieved from multiple databases, and eleven case-control studies were included for detailed evaluation. The pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated to assess the strengths of the association between GNβ3 C825T polymorphism and susceptibility to IBS and its subtypes. Our meta-analysis found no significantly associations of GNβ3 C825T polymorphism with IBS risk in all populations. Whereas the C allele was demonstrated to be a decreased risk factor for constipation predominant IBS (IBS-C) in allele model. Additionally, the CC genotype was found to be associated with increased diarrhea predominant IBS (IBS-D) risk in recessive model. Subgroup analysis by ethnicity revealed that these associations held true for the Asian subpopulation. In conclusion, this meta-analysis suggests the C allele of GNβ3 C825T might be associated with a decreased risk of IBS-C, and the CC genotype of GNβ3 might be associated with increased IBS-D risk.

Editorial: Clinical Implications of Diagnosing Irritable Bowel Syndrome: Do All Roads Need to Lead to Rome?

Irritable bowel syndrome (IBS) is one of the most common diagnoses made by healthcare providers. Yet the majority of patients with IBS are undiagnosed. The study by Sayuk et al. allows insight into the characteristics of different patient groups, e.g., with and without a formal diagnosis of diarrhea predominant IBS (IBS-D). We discuss the questions raised by this study regarding the importance of making a confident diagnosis, conveying it to patients and their implications for clinical practice.

Does frequency of restless legs syndrome and poor sleep quality increase with age in irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a common gastrointestinal disease which leads to a reduction in the quality of life. Restless legs syndrome (RLS) and the incidence of poor sleep quality (PSQ) are known to increase in IBS. In this study, we aimed to investigate the prevalence and association of RLS and PSQ in a young population. A total of 112 IBS patients (46 constipation predominant IBS, 17 diarrhea predominant IBS, 23 mixed IBS and 26 unsubtyped IBS) and 106 healthy controls were included in the study. The Pittsburgh Sleep Quality Index (PSQI) and the 2012 revised diagnostic criteria of the International Restless Legs Syndrome Study Group were used in the groups. In the patients with IBS and the control group, the respective results obtained were as follows: presence of PSQ 16 (13.4%) and 5 (4.7%) and presence of RLS 10 (8.9%) and 4 (3.7%), respectively. There were significant differences between the two groups in terms of these values. According to the PSQI, the mean global PSQI scores of patients with IBS and control group were 7.61±3.9 and 4.5±3.7, respectively (P=0.01). While PSQ was detected in 21 out of 218 participants, RLS was detected in 14. PSQ and RLS coexisted in nine of the participants and all of them were IBS patients. Previous studies and our study reveal that the frequency of RLS and PSQ increases in IBS. However, this result is a lower rate compared to previous studies. The controlled and prospective studies with larger numbers of cases which demonstrate the real frequency.

Dexloxiglumide for the treatment of constipation predominant irritable bowel syndrome

ABSTRACTIntroduction: Irritable bowel syndrome (IBS) is a multifactorial functional gut disorder, where sensory/motor disturbances seem to play a major role, with no satisfactory treatment for a majority of patients. Cholecystokinin (CCK) is a hormone with several effects on gastrointestinal function, and IBS patients have been shown to produce altered sensory/motor responses to CCK.Areas covered: Dexloxiglumide is a selective antagonist of the type 1 receptor of CCK, which has demonstrated to revert the CCK mediated effects on gastrointestinal motility and sensitivity. In humans, Dexloxiglumide has been shown to accelerate gastric emptying, slow down transit in the proximal colon, and increase the tolerance to intestinal gas. In phase 2 clinical trials Dexloxiglumide 200 mg tid has demonstrated to be superior to placebo in symptom relief in constipation predominant IBS (IBS-C). In a phase 3 withdrawal study Dexloxiglumide obtained a more sustained effect than placebo. However, these promising effects in IBS-C have not been confirmed in large phase 3 studies so far.Expert opinion: Dexloxiglumide has demonstrated positive effects on important aspects of gastrointestinal function, like gastric emptying and gas tolerance, that deserves consideration in future studies. However, the available data is insufficient to recommend dexloxiglumide for treatment of IBS-C today.

Gender differences in irritable bowel syndrome among medical students at Inner Mongolia Medical University, China: a cross-sectional study

There is little epidemiological research on Irritable bowel syndrome (IBS) in Inner Mongolia, China. Here we investigated the prevalence of IBS and factors associated with IBS in both males and females in Inner Mongolia Medical University by a cross-sectional study. We recruited Inner Mongolia Medical University students residing in campus and asked them to complete a self-administered questionnaire. The prevalence of IBS in each factor we chose in all, male, and female students was determined. We assessed IBS subtypes in male and female students. Multivariate logistic regression models were used to assess the factors associated with IBS in male and female students. The overall prevalence of IBS was 29.5%. The prevalence of IBS in female students was significantly higher than that in male students (31.3% vs. 24.8%, p < .001). Logistic regression results showed that attempting to lose weight and anxiety were both associated with increasing odds of IBS, while exercise was not associated with IBS in either male or female students. In female students, snack consumption and depression were also both associated with increasing odds of IBS. The predominant IBS subtype was the diarrhea-predominant type in both male and female students. Considering the high prevalence of IBS in students and the fact that the factors associated with IBS can be improved by individuals, students should be given adequate education and counseling to improve their mental health and lifestyle, especially female students in higher grades.

Specific carbohydrate diet: irritable bowel syndrome patient case study

Purpose – The purpose of this paper was to investigate the impact of specific carbohydrate restriction (polysaccharides and disaccharides) in the form of the specific carbohydrate diet (SCD) in treating irritable bowel syndrome (IBS). Design/methodology/approach – A female patient diagnosed with diarrhea predominant IBS was assigned to the SCD for six months. The diet occurred in phases and was advanced based on the individual’s tolerance level under the guidance of a registered dietitian. Quality of life was measured by a pre- and post-IBS severity score questionnaire. Gastrointestinal symptoms were measured by self-assessment of IBS symptoms using a seven-point Likert-like scale, with −3 = substantially worse to +3 = substantially better. Probiotics were consumed throughout the duration of the study. Findings – The quality of life severity score significantly improved from a severity of 315 (with 500 being the most severe) to 15. The initial symptoms from the first day on the diet compared to the total period for bloating, abdominal pain/discomfort, flatulence/wind, diarrhea, bowel urgency, stool consistency, stool frequency, energy levels, incomplete evacuation and abdominal rumbling were improved significantly (p &lt; 0.0005). The SCD diet significantly improved the quality of life and IBS symptoms in a female patient with IBS-diarrhea. Originality/value – This study is the first of its kind to evaluate the efficacy of the SCD to treat IBS. The SCD should be considered a therapeutic option to treating IBS after fermentable carbohydrate restriction.

Clinical observation of diarrhea type irritable bowel syndrome with Shugan Jianpi prescription

Objective To discuss the clinical observation of diarrhea type irritable bowel syndrome with Shugan Jianpi prescription. Methods 82 cases of diarrhea- predominant irritable bowel syndrome were selected using a random number table,the observation group(n= 45) was treated with relieving liver and reinforcing spleen methods; the control group(n= 37)was treated with the universal application of clinical Pinaverium bromide, were observed after treatment of irritable bowel syndrome score, treatment effects as well as the clinical symptoms, the results were processed using SPSS 17.0 analysis. Results The scores of the two groups at 1 month after treatment, the control group was(157.38±72.72), the observation group was(101.52±60.16)(t=- 7.994,P= 0.000). The score of the two groups at 3 months after treatment, the control group was(172.71±62.91), the observation group was(109.92±42.38)(t=- 8.428,P= 0.000), the results had statistical significance; The total efficiency of the two groups at 1 month after treatment, the control group was 75.7%, the observation group was 95.6%(χ2= 6.909,P= 0.019), the total efficiency of the two groups at 3 months after treatment,the control group was 86.5%,the observation group was 100%,the comparison was(χ2= 6.476,P= 0.016),the results had statistical significance.On the aspect of the relieve of clinical symptoms, On the abdominal pain, the control group controlled 21cases,the observation group controlled 38 cases, compared (χ2= 7.713,P= 0.007), On the diarrhea,the control group relieved 15 cases,the observation group relieved 30 cases,compared(χ2= 7.713,P= 0.007),both had statistical significance. Conclusion The methods with relieving liver and reinforcing spleen, to the patients with irritable bowel syndrome medicine syndrome differentiation, play each medicine spleen and stomach, benefit lung and kidney tonic win effect, can effectively reduce symptoms and reduce IBSintegration,reduce symptoms treatment results. Key words: Irritable bowel syndrome; Shuganjianpi France; Pinaverium bromide

Observation of the clinical curative effect when adopt smoothing liver and invigorating spleen treatment to cure diarrhea-predominant irritable bowel syndrome

Objective To evaluate the clinical effects and safety when adopt smoothing liver and invigorating spleen treatment to cure diarrhea- predominant irritable bowel syndrome(D- IBS)characterized by liver stagnation with spleen deficiency. Methods 71 patients met the inclusion criteria of D- IBS were randomly divided into the treatment group(36 cases)and control group(35 cases), the treatment group used Shugan Jianpi therapy, traditional Chinese medicine Tongxieyao Fang and additive Shenlingbaishu Decoction; the control group taking Lactobacillus Complex Capsules treatment. Two groups of the time of taking medicine for 4 weeks.Observation and analysis of comprehensive effects and D- IBS symptom score before and after treatment. Results There was no statistical significance in the two groups before treatment, symptom total score difference, after the treatment group and the control group of symptom score were(4.83±3.30),(7.00±3.96), with a significant difference between the two groups(t= 2.51,P< 0.05); the total effective rate of treatment group was 91.67%, which was higher than 68.57% in the control group(χ2= 5.98,P< 0.05). Conclusion The adoption of the smoothing liver and invigorating spleen treatment characterized by the use of Tong Xie Yao Fang and additive Shen LingBaiZhu decoction to cure D- IBS patients with liver stagnation and spleen deficiency has a relatively satisfactory clinical curative effect. Key words: Smoothing liver and invigorating spleen treatment; Irritable bowel syndrome

Tu1969 Probiotic (Probio'Stick®) Attenuates Hypothalamic-Pituitary-Adrenal (HPA) Axis Response to Chronic Psychological Stress Through an Improvement of Cellular Proliferation and Changes Gene Expression in the Brain Mice

BACKGROUND: Irritable Bowel Syndrome (IBS) is a common disorder characterized by visceral hypersensitivity and increased intestinal permeability. Abnormalities of gut flora as well as gut immune cells subtype variation have also been observed in IBS. Stress events can affect the onset and course of IBS. Clinical trials showed a beneficial effect of fermented milk (FM) containing Bifidobacterium lactis CNCM-I2494 in constipation predominant IBS (IBS-C) subjects. Recently, we reported that this FM product, dose dependently suppresses visceral hypersensitivity by normalizing intestinal epithelial barrier dysfunctions induced by acute stress in rats. Beside it has been shown that the relief of IBS symptoms by Bifidobacterium. infantis 35624 is associated with normalization in the ratio of proinflammatory/antiinflammatory cytokines IL-12/IL10. Therefore, the aim of this study was to investigate the modulatory effect of FM product containing Bifidobacterium lactis CNCM-I2494 on gut immune barrier impairment promoted by an acute stress in rats. MATERIAL ANDMETHODS: Wistar rats (200-250g) were orally given FM product containing Bifidobacterium lactis CNCM-I2494 for 15 days (1 mL/rat-corresponding to 108 colony forming units of Bifidobacterium lactis CNCM I-2494) or saline. At day 15, paracellular permeability to dextran-FITC (4kD), and transmucosal flux of the protein antigen, horseradish peroxidase 40kD (HRP), were measured in Ussing chamber at different gut levels (ileal Peyer's patches, ileal and colonic segments) in both basal and after 2h of partial restraint stress (PRS) session. Moreover, IL10 and IL12 levels were measured by biochemistry assay on Peyer's patches. RESULTS: In saline treated animals, compared to basal condition, acute stress significantly increased dextran-FITC flux in Peyer's patches and in colonic segment and also substantially increased HRP flux in all gut segments tested as well as in Peyer's patches. FM consumption did not affect the in vitro measured intestinal permeability in basal condition but reduced the increase of both dextran-FITC and HRP flux induced by acute stress. Moreover, in comparison with basal condition, acute stress decreased the ratio of IL10/IL12 in ileal Peyer's patches, illustrating a pro-inflammatory effect. All these stress immune changes were significantly counteracted by 15 days of FM consumption. CONCLUSIONS: These data show in rats, that the consumption of a FM containing Bifidobacterium lactis CNCM-I2494 i) not only reduces the increased gut permeability function but also normalize local immune platform permeability (ileal Payer' patches) altered by acute stress; ii) protects the intestinal immunity barrier by modulating cytokines levels towards an anti-inflammatory profile.

Tu1966 Protective Effect of a Fermented Milk Dairy Product Containing Bifidobactrium Lactis CNCM I-2494 on Gut Immune Barrier Impairment Promoted by Acute Stress in Rats

BACKGROUND: Irritable Bowel Syndrome (IBS) is a common disorder characterized by visceral hypersensitivity and increased intestinal permeability. Abnormalities of gut flora as well as gut immune cells subtype variation have also been observed in IBS. Stress events can affect the onset and course of IBS. Clinical trials showed a beneficial effect of fermented milk (FM) containing Bifidobacterium lactis CNCM-I2494 in constipation predominant IBS (IBS-C) subjects. Recently, we reported that this FM product, dose dependently suppresses visceral hypersensitivity by normalizing intestinal epithelial barrier dysfunctions induced by acute stress in rats. Beside it has been shown that the relief of IBS symptoms by Bifidobacterium. infantis 35624 is associated with normalization in the ratio of proinflammatory/antiinflammatory cytokines IL-12/IL10. Therefore, the aim of this study was to investigate the modulatory effect of FM product containing Bifidobacterium lactis CNCM-I2494 on gut immune barrier impairment promoted by an acute stress in rats. MATERIAL ANDMETHODS: Wistar rats (200-250g) were orally given FM product containing Bifidobacterium lactis CNCM-I2494 for 15 days (1 mL/rat-corresponding to 108 colony forming units of Bifidobacterium lactis CNCM I-2494) or saline. At day 15, paracellular permeability to dextran-FITC (4kD), and transmucosal flux of the protein antigen, horseradish peroxidase 40kD (HRP), were measured in Ussing chamber at different gut levels (ileal Peyer's patches, ileal and colonic segments) in both basal and after 2h of partial restraint stress (PRS) session. Moreover, IL10 and IL12 levels were measured by biochemistry assay on Peyer's patches. RESULTS: In saline treated animals, compared to basal condition, acute stress significantly increased dextran-FITC flux in Peyer's patches and in colonic segment and also substantially increased HRP flux in all gut segments tested as well as in Peyer's patches. FM consumption did not affect the in vitro measured intestinal permeability in basal condition but reduced the increase of both dextran-FITC and HRP flux induced by acute stress. Moreover, in comparison with basal condition, acute stress decreased the ratio of IL10/IL12 in ileal Peyer's patches, illustrating a pro-inflammatory effect. All these stress immune changes were significantly counteracted by 15 days of FM consumption. CONCLUSIONS: These data show in rats, that the consumption of a FM containing Bifidobacterium lactis CNCM-I2494 i) not only reduces the increased gut permeability function but also normalize local immune platform permeability (ileal Payer' patches) altered by acute stress; ii) protects the intestinal immunity barrier by modulating cytokines levels towards an anti-inflammatory profile.

Health-related quality of life, work productivity and health care resource use associated with constipation predominant irritable bowel syndrome

Objectives:Irritable bowel syndrome (IBS) is a common gastrointestinal disorder. Prevalence estimates of IBS vary widely, from 10 to 15%, in the U.S. However, few studies have examined constipation predominant IBS (IBS-C), a subtype of IBS. The aim of this study was to assess the effect of IBS-C on health-related quality of life (HRQOL), work productivity and activity impairment, and health care resource use.Methods:Using data from the 2007 U.S. National Health and Wellness Survey, IBS-C patients (n = 789) were compared to a propensity-score matched comparison group (n = 789). Differences between the groups were examined on HRQOL (SF-12v2), work productivity and activity impairment (WPAI questionnaire), and self-reported resource use in the last 6 months.Results:Patients with IBS-C reported significantly lower levels of HRQOL (physical component summary score: 41.55 [95% CI: 40.72–42.37] versus 44.49 [95% CI: 43.67–45.31]; mental component summary score: 40.58 [95% CI: 39.75–41.40] vs. 45.87 [95% CI: 45.04–46.70]) and significantly higher mean levels of presenteeism (31.72% [95% CI: 28.25%–35.61%] vs. 21.43% [95% CI: 19.03%–24.15%]), overall work impairment (35.54% [95% CI: 31.76%–39.76%] vs. 25.29% [95% CI: 22.59%–28.30%]), and activity impairment (45.78% [95% CI: 43.08%–48.66%] vs. 33.03% [95% CI: 31.08%–35.11%]) than matched comparators (all P values < 0.01). Patients with IBS-C reported significantly more provider visits (8.07 [95% CI: 7.38–8.82] vs. 5.55 [95% CI: 5.07–6.08]) and emergency room visits (0.57 [95% CI: 0.46–0.70] vs. 0.36 [95% CI: 0.29–0.45]) in the past 6 months (all Ps < 0.01). No statistically significant differences between the groups were observed in absenteeism or the number of the days hospitalized.Conclusions:IBS-C was associated with poorer HRQOL, greater work productivity loss and activity impairment, and greater healthcare resource use. Limitations include the study’s cross-sectional design and its self-reported nature. Nevertheless, improved management of IBS-C may reduce the humanistic and economic burden of the condition and benefit patients, employers, and the healthcare system.

The expression ofprotease-activated receptors in colon mucosa tissue of patients with diarrhea - predominantirritable bowel syndrome and its significance

Objective To investigate the expression of protease-activatedreceptors (PARs) in colon mucosal tissue of patients with diarrhea-predominant irritablebowel syndrome (D-IBS). Methods Colon mucosa tissues were obtained from 28 D-IBS patientsand 18 normal controls by colonoscopy.The expression of PARs was detected using Westernblotting and real-time PCR. Data were analysed by SPSS 18. 0 softwave, and comparisonsbetween groups were done using Mann-Whitney U test.Results There was no difference inexpression of PAR1 between D-IBS patients and normal controls (P=0. 300). The expressionsof PAR2 and PAR4 were higher in D-IBS patients than those in normal controls (0.99±0.67vs 0.63±0.38, P=0.038 and 0.37±0. 14 vs 0.25±0. 11, P=0.013,respectively). The resultsof real-time PCR were in accordance with those of Western blotting.Conclusion Theincreased expressions of PAR2 and PAR4 in colon mucosa of D-IBS patients indicate thatthese two PAR receptors may be involved in the process of D-IBS.

Guidelines for the Treatment of Irritable Bowel Syndrome

Traditional symptom-based therapies of irritable bowel syndrome (IBS) are directed at the relief of individual IBS symptoms, but they are often of limited efficacy in addressing the entire symptom complex. Combinations of drugs to target bothersome symptoms are suggested as the first-line pharmacologic treatment. Increasing knowledge of the pathophysiology and molecular mechanisms of IBS has resulted in the development of several new therapeutic approaches. Thirteen consensus statements for the treatment of IBS were developed using the modified Delphi approach. Exclusion diets have modest efficacy in improving symptoms in some IBS patients. Symptom-based therapies with dietary fiber, bulking agents, laxatives, antispasmodics and laxatives are effective in the improvement of some individual symptoms, e.g. dietary fiber and bulking agents for constipation, laxatives for constipation, antispasmodics for abdominal pain and discomfort, antidiarrheals for diarrhea. 5HT3 receptor antagonists and 5HT((4)) receptor agonists are effective in the relief of global IBS symptoms and individual symptoms such as abdominal pain and abnormal bowel habits. A short term course of nonabsorbable antibiotics may improve global IBS symptoms, particularly in patients with diarrhea- predominant IBS. Some probiotics appear to have the potential benefit in improving global IBS symptoms. Selective C-2 chloride channel activator is more effective than placebo at relieving global IBS symptoms in patients with constipation-predominant IBS. Both tricyclic antidepressants and selective serotonin reuptake inhibitors are equally effective in relieving global IBS symptoms, and have some benefits in treating abdominal pain. Certain types of psychologic therapy may be effective in improving global symptoms in some IBS patients. Further studies are strongly needed to develop better treatment strategies for Korean patients with IBS.

S1274 Bacterial Overgrowth and Mucosal Inflammation in Irritable Bowel Syndrome

Introduction: A high prevalence of small bowel bacterial overgrowth (SBBO) has been reported in Irritable Bowel Syndrome (IBS) patients potentially contributing to symptoms. Low grade mucosal inflammation has also been implicated in at least a subset of patients. However, no relationship has been demonstrated between inflammation and the presence of bacterial overgrowth in IBS patients. The aim of this study was to investigate the prevalence of SBBO in IBS patients using the combined 14C-xylose/lactulose breath test and to correlate the presence of SBBO with mucosal inflammation assessed by faecal calprotectin levels. Methods: Forty-nine IBS patients (53.78±2.19yrs) who fulfilled the ROME II criteria and 26 healthy controls (50.62±3.24yrs) were enrolled. IBS patients were further categorised into diarrhoea predominant (n=25), constipation predominant (n=7) or mixed IBS (n=15). After an overnight fast, all subjects underwent a 14C-xylose/lactulose breath test. Breath samples were collected before ingestion of the test solution and at 30min intervals for 240min and analysed for CO2, H2 and CH4. In addition, stool samples were collected for a faecal calprotectin assay (normal 0.05). It was interesting to note that 50% of the IBS patients positive for mucosal inflammation were also positive for SBBO. Specifically these patients were exclusively positive for the 14C xylose breath test (p<0.05). Conclusion: In this study, SBBO was not more prevalent in IBS patients compared with healthy age matched controls. Inflammation was present in 50% of patients with IBS who had SBBO and in no healthy controls. The positive 14C xylose breath test in this group of IBS patients suggests that specific colonising organisms may be responsible for the inflammatory response and further studies are required.

Can Pain be an Optional Inclusion Criterion for Irritable Bowel Syndrome?

Dear Editor, The diagnosis of irritable bowel syndrome (IBS) is based on Manning or Rome criteria. These criteria have been formulated for the deviations in normal bowel habits for the western population. The normal bowel habits in India differ from those in the West with a median frequency of 2/day [1]. The application of Rome criteria for the Indian subpopulation is not well understood. A retrospective symptom analysis of 320 IBS labeled individuals was done with an aim to derive symptoms which could prospectively predict a diagnosis of IBS. A diagnosis of IBS was made when individuals presented with altered bowel habits with or without abdominal pain for a period exceeding 3 months, absence of alarm symptoms like bleeding per rectum, nocturnal symptoms, weight loss and anorexia. The haemogram, stool microscopy, blood sugar and thyroid hormone profile, small bowel and colon were normal. Data retrieved included age, sex, duration of illness, details of location and duration of abdominal pain, relation of pain to defecation, presence of abdominal bloat, stool frequency, presence or absence of mucus in stool, urgency, and history of incomplete evacuation. The male/female ratio was 2:1. Almost two-thirds of the individuals were between the third and fourth decades (189 patients; 59%). The duration of illness ranged from 3 months to 22 years with a mean of 1.7 ! 1 years. Among the symptoms, diarrhea was the commonest (82%) followed by abdominal pain/abdominal discomfort (33%). Constipation was the least common symptom (15.6%). The abdominal pain was associated with diarrhea and uncommonly with constipation (10%). In conclusion, IBS was more common in males, diarrhea was the predominant presentation and abdominal pain was present only in one third of patients in contrast to the West where IBS prevalence is common in the female gender and constipation predominant IBS is frequent.