Rome-III Criteria Research Articles

Measurement properties of the childhood bladder and bowel dysfunction questionnaire.

The childhood bladder and bowel dysfunction questionnaire (CBBDQ) was previously found feasible, structurally valid, with good internal consistency. The purpose of this study was to evaluate the remaining measurement properties according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). A prospective cohort study among parents of children aged 5-12 years was conducted. Calculated were the area under the curve (AUC) (criterion validity, responsiveness, interpretability) and intra-class correlation coefficients (ICCagreement ) (construct validity and test-retest reliability). One hundred and seventy-two parents were included from March 2019 to April 2021. Correlating the bladder subscales of the CBBDQ with the Vancouver symptom score for dysfunctional elimination (VSSDES) and proxy-reported pediatric incontinence quality of life (p-PinQ) showed convergent validity (ICCsagreement : 0.76 and 0.74). Divergent validity was found when correlating the bowel subscales of the CBBDQ with the VSSDES (ICCagreement : 0.52). Excellent criterion validity (AUC: 0.98); excellent test-retest reliability (ICCagreement : 0.94) and, at 6 months, fair responsiveness (AUC: 0.74) were found. The minimal important change was 4.5, with cut-off value of 11. The CBBDQ has been developed according to COSMIN standards. The items were defined using the consensus-based ICCS standards and Rome-III criteria. The measurement properties were identified using enough participants. Although interpretability is not considered a measurement property, interpretability aspects are reported here as they refer to what instrument scores mean. The 18-item-CBBDQ met the measurement properties of validity, reliability, and responsiveness, as defined by COSMIN. The CBBDQ is suitable for self-administration by parents, and completion takes little time.

Risk Factors of Developing Postinfectious Irritable Bowel Syndrome in Shigellosis Patients, 5 Years After Hospitalization During the Outbreak.

Irritable bowel syndrome (IBS) can be triggered by bacterial dysentery. This study aimed to investigate postinfectious IBS and its risk factors after the shigellosis outbreak in hospitalized patients. This retrospective study was conducted in 2020-2021 in referral hospitals for Shigella gastroenteritis during the 2014 shigellosis outbreak in Isfahan. The Shigella-infected group included hospitalized shigellosis patients with clinical symptoms and positive stool culture. The control group included patients matched pairwise on age and sex to the Shigella-infected group, admitted to the same hospitals in the same period with diagnoses other than shigellosis. Both groups had no history of diagnosed IBS before the outbreak. The incidence of IBS (according to Rome-III criteria) and its related factors was compared between the 2 groups 5 years after infection. Of 619 participants, 220 (35.5%) were in the Shigella-infected group. The 5-year incidence of IBS was 31.8% and 5.7% in the Shigella-infected and control groups, respectively. Multivariate analysis showed that shigellosis was significantly associated with increased risk of IBS (odds ratio [OR], 17.18 [95% confidence interval {CI}, 9.37-31.48]). Multivariate analysis indicated education level (OR, 4.15 [95% CI, 1.47-11.73]), diarrhea lasting >4 days (OR, 1.69 [95% CI, 1.17-2.44]), and abdominal cramps during the infection (OR, 0.27 [95% CI, .77-.95]) associated with postinfectious IBS (P < .05). Hospitalized patients with Shigella gastroenteritis are at increased risk of IBS within 5 years after infection. Factors such as higher education level and the absence of abdominal cramps and diarrhea persisting for >5 days during hospitalization can further increase this risk.

A blend of Withania somnifera (L.) Dunal root and Abelmoschus esculentus (L.) Moench fruit extracts relieves constipation and improves bowel function: A proof-of-concept clinical investigation

Ethnopharmacological relevanceWithania somnifera (L.) Dunal (WS) and Abelmoschus esculentus (L.) Moench (AE) are known as Ashwagandha and Okra, respectively, important herbs in traditional medicine for their diverse therapeutic values. WS root is an adaptogen that relieves stress and anxiety and promotes sleep. AE fruit or Okra is widely consumed as a vegetable and is traditionally used to treat diabetes, gastric irritations, ulcers, and obesity. Aim of the studyThe present randomized, double-blind, placebo-controlled study aimed to establish a proof-of-concept evaluating the efficacy and tolerability of a proprietary blend of standardized extracts of WS root and AE fruit, CL18100F4 in relieving constipation and improving quality of life in adults. Materials and methodsForty-eight male and female participants (age: 25–60 years) with functional constipation (following Rome-III criteria) were randomized into placebo, 300 or 500 mg of CL18100F4 groups, and supplemented for fourteen consecutive days. ResultsCL18100F4 supplementation significantly (p < 0.0001) reduced the Patient Assessment of Constipation-Symptoms (PAC-SYM), Patient Assessment of Constipation-Quality of Life (PAC-QOL), and Gastrointestinal Symptom Rating Scale (GSRS) scores. CL18100F4 supplementation improved sleep quality and reduced stress (p < 0.0001). At the end of the study, CL18100F4-500 subjects showed significant increases in serum serotonin, gastrin, and interleukin-10 and decrease in interleukin-6 and cortisol levels. Participants’ hematology, total blood chemistry, vital signs, and urinalysis parameters were within the normal ranges. No adverse events were reported. ConclusionsThis short-duration, single-site clinical investigation demonstrates that CL18100F4 supplementation is tolerable, helps relieve constipation, reduces stress, and improves gastrointestinal function, sleep quality, and general wellness in adults. Trial registrationClinical Trials Registry- India (CTRI/2020/11/029320); Registered on 24/11/2020. Available at: http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=49391&EncHid=&userName=CL18100F4.

Clinical Implications of Low-grade Duodenal Eosinophilia in Functional Dyspepsia: A Prospective Real-life Study.

Functional dyspepsia (FD) is a multifactorial disorder with no targeted therapy. Duodenal eosinophilia and low-grade inflammation are potential pathogenic mechanisms. However, the impact of duodenal eosinophils (D-EO) histologic evaluation in real-life clinical practice was not explored. To evaluate the clinical utility of D-EO and low-grade inflammation in FD in real-life practice. A multicenter prospective study was conducted. A total of 636 patients who meet Rome-III criteria were selected before upper endoscopy and 516 patients were included after normal endoscopy were assessed. Clinical parameters, Helicobacter pylori (H. pylori), and duodenal histology were evaluated. FD subtypes were 231 (45%) patients who had epigastric pain syndrome (EPS), 168 (33%) postprandial distress syndrome (PDS), and 117 (22%) EPS/PDS overlap. Two hundred fifty-nine (50.3%) patients were H. pylori+. Histologic duodenal grading of chronic inflammation and intraepithelial lymphocytes showed no difference between FD subtypes. Increased in D-EO densities (>10 per high power field) was significant in PDS compared with EPS and EPS/PDS overlap subtypes. The odds ratio of PDS in subjects with duodenal eosinophilia densities was 2.28 (95% CI, 1.66-3.14; P<0.0001), adjusting for age, gender, H. pylori and nonsteroidal anti-inflammatory drug the odds ratio was 3.6 (95% CI, 2.45-5.28; P<0.0001). receiver operating characteristic curve analysis further demonstrated that low-grade duodenal eosinophilia, in particular H. pylori-, was highly accurate for PDS with the area under the curve 0.731 compared with H. pylori+ area under the curve 0.598. Furthermore, low-grade duodenal eosinophilia was significantly correlated with treatment response under 4 to 6 weeks of proton pump inhibitor therapy. Our findings suggest that low-grade duodenal eosinophilia is associated with PDS subtype non-H. pylori FD patients and could be a useful marker of treatment response.

Low-grade duodenal eosinophilia is associated with cagA in Helicobacter pylori-related dyspepsia.

Functional dyspepsia (FD) is a multifactorial disorder. Helicobacter pylori (H. pylori)-related dyspepsia (HpD) may be considered a separate entity. Duodenal eosinophilia is a potential pathogenic mechanism in FD. However, the impact of duodenal eosinophilia and H. pylori virulence genes in HpD was not explored. We aim to evaluate the association of H. pylori virulence genes and low-grade duodenal eosinophilia in HpD. A multi-center cross-sectional study was conducted. A total of 301 patients who meet Rome-III criteria were selected before upper endoscopy, and 95 patients were included after normal endoscopy and positive H. pylori in gastric biopsies were assessed. Clinical parameters, H. pylori virulence genes (cagA, oipA, and vacA) and duodenal histology were evaluated. Sixty-nine (72%) patients had epigastric pain syndrome (EPS), 17 (18%) post-prandial distress syndrome (PDS) and 9 (10%) EPS/PDS overlap. FD syndromes were not associated with cagA or oipA strains. A significantly trend of vacA s1/m1 (78%) and s1/m2 (80%) positive strains in EPS was observed. Histological duodenal grading of chronic inflammation, low-grade duodenal eosinophilia and intra-epithelial lymphocytes showed no difference in oipA and vacA strains. Low-grade duodenal eosinophilia was significant in cagA positive strain, and the OR for low-grade duodenal eosinophilia with H. pylori cagA positive strain was 4.2 (95% CI, 1.78-9.93). Adjusting for age, gender, smoking, diabetes, alcohol, PPI, and NSAID, the OR was 5.44 (1.989-14.902). Our findings suggest that low-grade duodenal eosinophilia is significantly associated with cagA strain in HpD.

Prevalence of irritable bowel syndrome: A comparison between rural and urban settings in Bangladesh

Background: Irritable bowel syndrome (IBS) is a common gastrointestinal disorder. The prevalence of irritable bowel syndrome (IBS) varies from 4% to 20% in different Asian nations. Objective: This community-based study was aimed to find out the prevalence of IBS in rural and urban setting in Bangladesh using Rome-III criteria. Methods: This cross-sectional study was conducted with 3500 respondents aged 18 years and above in both rural and urban communities of Bangladesh. The respondents were interviewed using a validated questionnaire in a door-to-door survey. A Rome III criterion was used for diagnosis of IBS. IBS was further classified as constipation predominant, diarrhoea predominant, mixed and un subtype. Statistical analysis was performed with Statistical Package for Social Sciences (SPSS), version 17.0.The level of significance was set at pd” 0.05. Results: The study population consisted almost equal percent respondents from urban (50.1%) and rural (49.9%) community. Among the respondents, 55.06% was male and 44.94% female. Overall prevalence of IBS 7.2% (95% CI, 6.39-8.10) and majority of the participants were associated with IBS belongs to age group 31-40 years with mean age 39.9%. The prevalence of IBS-C, IBS-D, IBS-M, IBS-U were 0.48%, 1.3%, 4.6%, and 0.8% respectively. In rural setting, the prevalence of IBS was 6.5%, (95% CI, 5.46-7.78) and in urban was IBS 7.8% (95% CI, 6.71-9.23). In this study, the prevalence of IBS was higher in males i.e. 57.2% in rural and 52.9% in urban compared with 42.8% in rural and 47.1% in urban females. Conclusion: In conclusion, the prevalence of IBS in urban 7.8% and rural 6.5% among Bangladeshi population. The result of the study suggests that IBS is a major health issue among these respective populations. Bangladesh Med Res Counc Bull 2021; 47(1): 70-77

Comparison of the ROME-III Criteria and a New Multivariable Prediction Model for the Selection of Patients with Symptomatic Cholecystolithiasis for Cholecystectomy

Introduction: Currently, selection for cholecystectomy in patients with uncomplicated cholecystolithiasis is based on the Rome-III criteria; severe pain attacks, in the right upper quadrant, and lasting 15-30 minutes or longer. This study evaluates these Rome-criteria and a new prediction model based on pre-operative variables for outcome after cholecystectomy. Methods: In two multicenter, prospective trials, the SECURE and SUCCESS, patients from 25 Dutch hospitals with symptomatic, uncomplicated cholecystolithiasis were included between April’14-June’19. We evaluated the Rome-criteria to predict a pain-free state or clinically relevant pain reduction after surgery. Furthermore, we developed and validated a multivariable model to predict both outcomes after surgery. Model performance was evaluated using calibration and discrimination. Results: We included 1,561 patients, of which 494 patients in the SUCCESS cohort. In the SUCCESS cohort, 80% underwent cholecystectomy. After, 57% was pain-free and 80% reported a clinically relevant pain reduction. A prediction model based on the Rome-criteria poorly predicted a pain-free state or clinically relevant pain reduction (c-statistic 0.56 (95%CI 0.50-0.61) and 0.59 (95%CI 0.50-0.67), respectively). A multivariable model showed that increased age, no history of abdominal surgery, increased baseline VAS pain-score, pain-radiation to the back, pain-reduction with simple analgesics, nausea, and no heartburn are independent predictors of clinically relevant post-operative pain reduction. After validation, good discrimination between patients with and without clinically relevant pain reduction was found (c-statistic 0.80 (95%CI 0.74-0.84). Conclusion: A comprehensive model with the SUCCESS-criteria better predicts outcome in patients after a cholecystectomy compared with a prediction model based on current Rome-III criteria.

The differences between fecal microbiota and intestinal fluid microbiota in colon polyps: An observational study.

Generally, intestinal microbiota can be classified into intestinal cavity microbiota and mucosal microbiota, among which, the former is the default type. This study aimed to identify the differences between fecal microbiota and intestinal fluid microbiota in colon polys.This study enrolled patients with colon polys who met the Rome-III criteria to carry out 16s rDNA gene sequencing. Then, both fresh feces as well as intestinal fluid was sampled. Thereafter, α/β diversities, together with the heterogeneities with regard to microbial function and structure were assessed among those intestinal fluid and fresh feces samples collected.According to bioinformatics analysis, difference in α-diversity was not statistically significant between intestinal fluid microbiota and fecal microbiota among patients with colorectal polyps (CPs). Non-metric multidimensional scaling analysis of β-diversity revealed that differences were of statistical significance between both groups. In addition, linear discriminant analysis effect size analysis displayed great heterogeneities in intestinal microbiota of both groups, including Firmicutes, Clostridia, and Phascolarctobacterium. At the phylum level, difference (P = .016) in Spirochaetes was statistically significant between the intestinal fluid group and fecal group. At the family level, differences in Bacteroidaceae, Micrococcaceae, F16, Spirocheatacae, Enterobacteriaceae, Cardiobacteriaceae, Turkish Spirobacteriaceae, Bifidobacteriaceae, and Dethiosulfovibrionaceae were statistically significant between the 2 groups. At the genus level, there were statistical differences between the 2 groups in terms of Bacteroidetes, Rothia, Actinobacillus, F16, Treponema, Oscillospira, Turicibacter, Sharpea, Heamophilus, Veillonella, and Cardiobacterium.There are statistical differences in the composition between intestinal microbiota and fecal microbiota in CP patients, both of which are equally important and indispensable for analyzing the intestinal microbiota in CP patients.

Mindfulness-based cognitive therapy in functional dyspepsia: A pilot randomized trial.

Patients with functional dyspepsia (FD) often have concomitant anxiety and depression. Mindfulness-based cognitive therapy (MBCT) combines the principles of cognitive behavioral therapy and mindfulness. It is a group-based therapy and has been shown to be efficacious in functional gastrointestinal disorders. There are no randomized controlled trials (RCTs) evaluating MBCT in FD. We aimed to evaluate feasibility and efficacy of MBCT in FD management. We performed a mixed-method single-center pilot randomized trial of 28 patients fulfilling ROME-III criteria for FD. Fifteen patients were randomized to an 8-week MBCT program while 13 underwent treatment-as-usual (TAU). Patients completed questionnaires at baseline and at week 8. Two focus-groups were conducted. Feasibility of recruitment, acceptability of randomization, procedures and intervention, handout compliance and feasibility of quantitative measures were assessed. The primary outcome was subjective-clinical-assessment of FD symptoms (SCA-FD). Secondary outcome measures included Short-form Nepean Dyspepsia Index (SF-NDI), subjective-clinical-assessment of general health (SCA-GH), EuroQoL-Visual Analog Scale (EuroQoL-VAS), and Depression, Anxiety and Stress Scale-21 Items (DASS-21). Twelve of 15 patients in the MBCT group completed the program. There was a trend towards symptom improvement, with 90% in the MBCT group reporting improvement in SCA-FD compared with 45% in TAU(P=0.063). Patients who underwent MBCT reported greater improvement in SF-NDI (mean change: -8.8 (SD: 7.5) vs -0.7 (7.2), P=0.018) and DASS-21 (-19.8 (29.5) vs -5.5 (6.6) P=0.13) compared with TAU. There was no difference in SCA-GH and EuroQoL-VAS. Based on SCA-FD improvement, the eventual RCT will require 50 patients (25 in each group). Mindfulness-based cognitive therapy is likely efficacious for FD, and it would be feasible to conduct a RCT.

The Prevalence of Functional Gastrointestinal Disorders in Patients with Uncomplicated Cholecystolithiasis (PERFECT): a Prospective, Multicenter Observational Study

Background: Symptomatic gallstones, functional dyspepsia(FD), and irritable bowel syndrome(IBS) have similar symptom pattern. This study determined the prevalence of FD/IBS in patients with gallstones and assessed the outcome of a cholecystectomy in terms of resolution of biliary colics and abdominal pain. Methods: A multicentre, prospective observational study was conducted. Adult patients with abdominal pain and ultrasonically confirmed gallstones were included. The presence of FD/IBS was assessed with the validated ROME-IV questionnaire. A biliary colic was defined by the ROME-III criteria. Pain-free was defined as an Izbicki Pain Score ≤10. Patients with and without FD/IBS at baseline were compared. Results: Between January 2018-April 2019, 401 patients (51.7 years, 76.3% females) were included. In total, 34.9% (140/401) of the patients with gallstones fulfilled the ROME-IV criteria for FD/IBS, and 64.1% (257/401) fulfilled the ROME-III criteria for biliary colic. Cholecystectomy rate was similar between the groups (73.8% in FD/IBS-group vs. 75.5% in patients without FD/IBS, p=0.720). After follow-up of 24 weeks the biliary colic was resolved in 93.9% of patients with surgery (91.4% in FD/IBS-group vs. 95.1% in patients without FD/IBS, p=0.220). Pain-free after surgery was achieved in 56.8% of patients (40.7% in FD/IBS-group vs. 64.4% in patients without FD/IBS, p< 0.001). Conclusion: One-third of the patients with gallstones fulfil criteria for FD and/or IBS. Cholecystectomy resolves biliary colics in 94% of patients, with similar outcome between patients with and without FD/IBS. However, pain-free after surgery is significantly less in patients with FD/IBS. This study partially explains the poor pain reduction after cholecystectomy.

Efficacy of Weikang Pian in Patients with Functional Dyspepsia: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial.

Background FD (functional dyspepsia) is a common functional gastrointestinal disorder, which lacks effective and safe treatment. Chinese herbal medicine (CHM) has been applied in FD treatment for thousands of years with satisfactory clinical outcomes. Zhishi is a classical traditional Chinese medicine used to treat FD. Weikang pian (WKP) is made of flavonoids extracted from zhishi which could effectively alleviate the symptoms of FD. This research aimed to assess the efficacy and safety of WKP in FD treatment. Methods This was a randomized, double-blinded and placebo-controlled clinical trial. The patients were diagnosed as FD according to RomeIII criteria. Then, FD patients were selected and assigned randomly to either WKP or placebo group. The subjects randomly received WKP or placebo for 4 weeks with 4 tablets each time, 3 times daily. The single dyspepsia symptom (SDS) scale and the gastric emptying function were measured before and after the treatment. Moreover, the safety of the trial and patient compliance were evaluated. Results A total of 60 FD patients were eventually enrolled in the trial, among them 45 patients in the WKP group and 15 patients in the placebo group. The primary outcome was the SDS scale, including assessments of postprandial distension, early satiety, epigastric burning, and pain. The secondary outcome was the gastric emptying function. Compared with the placebo group, the symptoms of FD in the WKP group were relieved after 4 weeks of treatment (P < 0.05). Some minor changes appeared in the four groups, but there were no significant differences in gastric emptying parameters of GER (2-hour gastric emptying rate) and GET/2 (gastric semiempty time) (P > 0.05). Severe adverse events were absent. The compliance to treatment was 94%–96%, and there was no significant difference between the groups. Conclusion WKP can relieve FD symptoms to some extent. This trial is registered with Chinese Clinical Trial Registry (ChiCTR): CTR 20132482.

Gallbladder motility in children with chronic functional abdominal pain

Background: Chronic abdominal pain is a common gastrointestinal symptom in children that significantly lowers their quality of life. In adults, Gall bladder (GB) hypomotility / dyskinesia is associated with many functional abdominal disorders but there is scarcity of evidence on its role in childhood gastro-intestinal disorders. Aim of the study is to evaluate the GB motility in children with chronic functional abdominal pain (FAP).Methods: Children aged 5-15 years with chronic abdominal pain fulfilling ROME-III criteria and healthy controls were included and all study participants were subjected to ultrasonographic evaluation of the gall bladder volume in fasting state and post - Fatty test meal (FTM) and its ejection fraction was calculated.Results: Sixtysix children including 31 with chronic FAP underwent sonographic evaluation for GB motility. The mean ejection fraction (EF) of cases and controls were 51.72±17.76% and 57.3±23.26% (p value - 0.158). The mean EF of cases with upper abdominal pain and lower/peri-umbilical abdominal pain were 41.7±17.1% and 57.2±15.9% respectively (p value &lt; 0.0001). Increasing BMI had no significant association with GB motility among the participants.Conclusions: There is lack of significant association between children with chronic FAP and GB hypomotility. Children with upper abdominal pain have lesser GB EF, suggesting a possible abnormal GB motility.

Intestinal Microbiome in Irritable Bowel Syndrome before and after Gut-Directed Hypnotherapy.

Irritable bowel syndrome (IBS) is a disorder with brain-gut-microbiome alterations. Gut-directed hypnotherapy (GHT) has been shown to improve quality of life and symptoms in IBS. This therapy targets psychological coping, central nervous processing and brain-gut interaction. Studies have also demonstrated effects of hypnosis on intestinal transit and the mucosal immune system. So far, no study has examined the effect of GHT on the intestinal microbiome. This study aimed at examining microbial composition, IBS symptoms, and psychological distress before and after GHT. Methods: Fecal samples were collected from 38 IBS patients (Rome-III criteria, mean age 44 years, 27 female, 11 male, 22 diarrhea-dominant, 12 alternating-type and 4 constipation-dominant IBS) before and after 10 weekly group sessions of GHT. Assessments in psychological (perceived stress, PSQ; psychological distress, HADS-D; quality of life, visual analogue scales) and IBS symptom-related variables (IBS severity, IBS-SSS; single symptoms, visual analogue scales) were performed with validated questionnaires. Fecal samples underwent microbial 16S rRNA analyses (regions V1–2). Results: Microbial alpha diversity was stable before and after GHT (chao1 2591 ± 548 vs. 2581 ± 539, p = 0.92). No significant differences were found in relative bacterial abundances but trends of reduced abundance of Lachnospiraceae 32.18 (4.14–39.89) Median (Q1–Q3) vs. 28.11 (22.85; 35.55) and Firmicutes: Bacteroidetes ratio after GHT were observable. Significant reductions in symptom severity (323 (266–371) vs. 264 (191–331), p = 0.001) and psychological distress 17.0 (12.6–21.8) vs. 12.0 (8.3–18.0), p = 0.001, and increased well-being were found after GHT. Adequate relief after therapy was reported by 32 (84%) patients. Conclusion: Reductions in IBS symptoms and psychological burden were observed after gut-directed hypnotherapy, but only small changes were found in intestinal microbiota composition. The findings suggest that hypnosis may act by central nervous impact and other factors largely independent from microbiota composition modulating the brain-gut axis, possibly alterations in vagus nerve functioning and microbiota metabolism.

Physiotherapy plus conventional treatment versus conventional treatment only in the treatment of functional constipation in children: design of a randomized controlled trial and cost-effectiveness study in primary care

BackgroundOur aim was to design a study to evaluate the effectiveness and cost-effectiveness of adding physiotherapy to conventional treatment for children with functional constipation in primary care. Physiotherapy is focusing on improving the coordination between the pelvic floor and abdominal musculature during bowel movement, while conventional treatment is mainly focusing on symptomatic relief of symptoms, therefore, we expect the effects of physiotherapy will be more sustainable than the effects of conventional treatment. In this paper we describe the final study design and how the design was adapted, to overcome recruitment problems.MethodsWe designed a randomized controlled trial of children aged 4–17 years with functional constipation diagnosed by a general practitioner or pediatrician. Children in the intervention group received physiotherapy plus conventional treatment, and those in the control group received conventional treatment only. Follow-up measurements took place at 4 and 8 months. The primary outcome was treatment success defined according to the Rome-III criteria as the absence of functional constipation, with no laxative use. Secondary outcomes were absence of functional constipation irrespective of laxative use, quality of life, global perceived effect, and costs.Children were recruited from September 2014 to February 2017. Initially, we aimed to include children with recent symptom onset. However, in the first phase of enrollment we were confronted with an unforeseen recruitment problem: many children and their parents refused randomization because physiotherapy was considered too burdensome for the stage of disease. Therefore, we decided to also include children with a longer duration of symptoms. In total 134 children were included.DiscussionThe target number of participants is achieved. Therefore, the results may change thinking about the management of functional constipation in children.Trail registrationNetherlands Trial Register (NTR4797), registered 8 September 2014.

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

Efficacy of Including Interferential Current Therapy in the Rehabilitation Program of Children with Functional Constipation

AbstractAim: To determine the effectiveness of addition of inter-ferential current (IF) stimulatory current to the other conven-tional therapeutic tools related to childhood functional con-stipation (FC).Methods: Children suffering from FC were recognized according to Rome-III criteria of constipation. Two treatment groups, the case group (n=40) underwent IF electrical stimu-lation added to pelvic floor muscle (PFM) exercises and the control group (n=40) received PFM exercises without IF stimulation. A full bowel history with regarding data on defecation frequency/week, form of stool, and the number of fecal soiling episodes/day), a constipation score questionnaire, a visual pain score, a constipation related quality of life questionnaire (QOL) were noted before, after the treatment sessions and 6 months later for all participants.Results: The median of constipation score was decreased in both groups with the cases having lower scores after the treatment (p<0.089 and p<0.0001 respectively). Significantly a better outcome for pain score (p<0.0001) was also observed among the cases after the 6 months follow-up. Fecal soiling episodes/day were reduced after treatment in both groups; this finding was significant in the case group in relation to controls. The constipation-related QOL score has significantly improved all participants.Conclusion: IF stimulatory current was associated with better results in the efficacy of treatment of chronic cases suffering from FC and it should be added to conventional therapy as a part of the rehabilitation program.

Mindfulness Efficacy on the Perception of the Disease and the Quality of Life of Patients with Irritable Bowel Syndrome

Introduction: One of the challenges of patients with irritable bowel syndrome is the quality of life and perception of the disease. In recent decade's mindfulness as one of the most effective treatments in the treatment of many disorders has been introduced. This study aimed to determine the effectiveness of mindfulness therapy on quality of life and perception of disease among patients with irritable bowel syndrome. Materials & Methods: The research method was experimental (pretest-posttest control group and random assignment).The sample of the study consisted of 30 patients with irritable bowel syndrome who among all patients were admitted to hospitals in 2014. After the interview, the Rome-III diagnostic criteria and Quality of life and illness perception questionnaire, using random sampling (n=15 per group) the subjects were selected and randomly divided into two experimental groups and one control. Two months after the completion of 8 sessions (90-minute sessions a week for two months) of treatment, mindfulness and perceived quality of life questionnaire was administered to the patients in both groups. Using multivariate analysis of variance, SPSS vol.20 software was also used to analyze the data. Findings: Mindfulness therapy in improving quality of life (P=0.005) and increasing the understanding of the disease (P=0.002) among patients with irritable bowel syndrome in the experimental group was significantly effective. Discussion & Conclusions: It seems that the implementation of mindfulness therapy can improve the quality of life and perception of disease in patients with irritable bowel syndrome.

Отдаленные результаты лечения пациентов с синдромом раздраженного кишечника

Aim of investigation. To estimate duration of remission of irritable bowel syndrome after treatment by multistrain probiotic drug, motility regulator or antispasmodic medication. Material and methods. Original study included overall 87 patients with irritable bowel syndrome (IBS) or IBS in combination with functional dyspepsia (FD) in whom the diagnosis was confirmed according to compliance of symptoms to the Rome-III criteria and absence of organic diseases according to laboratory and instrumental investigation. In 42 patients diarrheapredominant variant of IBS was diagnosed (IBS-D), in 45 patients - constipation-predominant (IBS-C). All patients enrolled in original study underwent monotherapy by probiotic agent, motility regulator trimebutine or spasmolytic drug. The probiotic agent (Bifidobacterium bifidum, B. longum, B. infantis, Lactobacillus rhamnosus) was prescribed to 15 patients with IBS-D and 15 patients with IBS-C, motility regulator (trimebutine) - respectively to 12 and 15 patients, antispasmodic was used in 15 patients with IBS-D and 15 - with IBS-C. All patients at the end of 28thday of treatment achieved clinical remission of the disease (decrease of the total score of «7×7» Questionnaire for 50% and more). At the 30, 45 and 60 days after treatment secession in patients had telephone interview with health-related questions. Patients’ responses of those who received no maintenance therapy were statistically analyzed. Results. In 30 days secession of pharmaceutical therapy 73.3% of patients with IBS-D who received probiotic therapy during relapse maintained clinical remission, 75% of patients often motility regulator treatment and 60% of those who received antispasmodic medications. Of patients with IBS-C in 30 days after treatment termination remission was maintained in 60% of those after probiotic treatment, in 80% of the motility regulator treatment and in 60% antispasmodic therapy. In 45 days 47% of IBS-D patients treated by probiotics had sense of well-being, 58% of those who received motility regulators and 47% of patients who received antispasmodics previously. Of IBS-C patients in 1.5 months 33.3% of those, who received probiotic were symptomless, 46,3% of patients after trimebutine therapy and 33,3% of patients who achieved remission after antispasmodic therapy. In 60 days of IBS-D 20% in the group of patients remained in remission after probiotic treatment, 20% after trimebutine therapy and 33% after antispasmodic. Of IBS-C patients 20, 33 and 20% of patients respectively maintained clinical remission. No statistically significant differences between groups of patients with IBS-D and IBS-C were revealed (р>0.05). Conclusion. According to the obtained data, pharmacologically induced remission in the most of IBS cases is short-term. Remission duration depend neither on clinical variant of disease, nor on the group of drugs applied for remission induction.

Psychiatric Co-morbidity in Patients With Irritable Bowel Syndrome at a Tertiary Care Center in Northern India.

Background/AimsIrritable bowel syndrome (IBS) is a chronic psycho-physiological disorder. It is considered to be the most common functional gastrointestinal disorder, and about 50–90% of IBS patients have associated psychiatric co-morbidity. We aimed to study psychiatric co-morbidities in patients with IBS visiting a tertiary care center.MethodsThis was a cross-sectional case-control study conducted over a duration of one and a half years from January 2014 to July 2015. Patients were selected from the out-patient department of gastroenterology. About 160 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. The healthy attendants of cases were selected as controls. A total of 200 controls were selected. Rome-III criteria were used to diagnose IBS. For diagnosing psychiatric disorders, we used the Mini International Neuropsychiatric Interview Schedule Plus.ResultsMean age of our cases and controls was 39.7 ± 11.4 and 37.7 ± 9.6 years, respectively. Females outnumbered males in our cases as well as their controls by a ratio of 2:1 approximately. Psychiatric disorders were seen in 84.4% of IBS patients as compared to 41.5% in controls. Major psychiatric disorders seen in our patients were generalized anxiety disorders (30.0%) and depression (28.0%).ConclusionsThe majority of patients with IBS who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.

Approach to a Child with Irritable Bowel Syndrome: A Review

Irritable bowel syndrome (IBS) is one of the most common and best studied disorders among the group of functional gastrointestinal disorders. It is a functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit. Visceral hypersensitivity and increased GIT motility are the main patho-physiological mechanism for developing IBS. IBS present with diarrhoea or constipation or both. Investigations are least needed for diagnosis of IBS rather done to exclude differential diagnosis. Diagnosis of IBS is done on the basis of Rome-III criteria. Proper counseling, dietary management, antispasmotic and antidepressant are the mainstay of treatment. Journal of National Institute of Neurosciences Bangladesh, 2016;2(1): 34-39