Severe IBS Research Articles

Factors Underlying the Difference in Response to Fecal Microbiota Transplantation Between IBS Patients with Severe and Moderate Symptoms

BackgroundPrevious studies showed that patients with Severe IBS respond better to fecal microbiota transplantation (FMT) than do those with Moderate IBS.AimsThe present study aimed to determine the effects of the transplant dose, route of administering it and repeating FMT on this difference.MethodsThis study included 186 patients with IBS randomized 1:1:1 into groups with a 90-g transplant administered once to the colon (LI), once to the duodenum (SI), or twice to the distal duodenum twice (repeated SI). The patients provided a fecal sample and were asked to complete three questionnaires at baseline and at 3, 6, and 12 months after FMT. The fecal bacteria composition and Dysbiosis index were analyzed using 16 S rRNA gene PCR DNA amplification/probe hybridization covering regions V3–V9.ResultsThere was no difference in the response rates between severe IBS and moderate IBS for SI and repeated SI at all observation intervals after FMT. In the LI group, the response rate at 3 months after FMT was higher for moderate IBS than for severe IBS. The levels of Dorea spp. were higher and those of Streptococcus salivarius subsp. Thermophilus, Alistipes spp., Bacteroides and Prevotella spp., Parabacteroides johnsoni and Parabacteroides spp. were lower in moderate IBS than in severe IBS.ConclusionsThere was no difference in the response to FMT between severe and moderate IBS when a 90-g transplant was administered to the small intestine. The difference in the bacterial profile between severe and moderate IBS may explain the difference in symptoms between these patients. (www.clinicaltrials.gov: NCT04236843).

Irritable Bowel Syndrome Is Associated With Brain Health by Neuroimaging, Behavioral, Biochemical, and Genetic Analyses

BackgroundIrritable bowel syndrome (IBS) interacts with psychopathology in a complex way; however, little is known about the underlying brain, biochemical, and genetic mechanisms. MethodsTo clarify the phenotypic and genetic associations between IBS and brain health, we performed a comprehensive retrospective cohort study on a large population. Our study included 171,104 participants from the UK Biobank who underwent a thorough assessment of IBS, with the majority also providing neuroimaging, behavioral, biochemical, and genetic information. Multistage linked analyses were conducted, including phenome-wide association analysis, polygenic risk score calculation, and 2-sample Mendelian randomization analysis. ResultsThe phenome-wide association analysis showed that IBS was linked to brain health problems, including anxiety and depression, and poor cognitive performance. Significantly lower brain volumes associated with more severe IBS were found in key areas related to emotional regulation and higher-order cognition, including the medial orbitofrontal cortex/ventromedial prefrontal cortex, anterior insula, anterior and mid-cingulate cortices, dorsolateral prefrontal cortex, and hippocampus. Higher triglycerides, lower high-intensity lipoprotein, and lower platelets were also related (p < 1 × 10−10) to more severe IBS. Finally, Mendelian randomization analyses demonstrated potential causal relationships between IBS and brain health and indicated possible mediating effects of dyslipidemia and inflammation. ConclusionsFor the first time, this study provides a comprehensive understanding of the relationship between IBS and brain health phenotypes, integrating perspectives from neuroimaging, behavioral performance, biochemical factors, and genetics, which is of great significance for clinical applications to potentially address brain health impairments in patients with IBS.

S525 The Low FODMAP Diet Improves Abdominal and Overall Symptoms in Patients With All Subtypes of Irritable Bowel Syndrome

Introduction: There is substantial evidence that a diet low in fermenTable oligo-, di-, monosaccharides, and polyols (FODMAPs) improves symptoms in patients with Irritable Bowel Syndrome and diarrhea (IBS-D). Though the low-FODMAP diet is increasingly used in patients with IBS and constipation (IBS-C) or mixed bowel habits (IBS-M), there is little data to support this practice. We aim to compare the real-world effectiveness of a low-FODMAP diet in patients with IBS-D, IBS-C, and IBS-M. Methods: Utilizing a commercially available meal procurement service which prepares and delivers meals certified low in FODMAP content (Modify Health, Atlanta, GA), patients with suspected IBS met with a registered dietitian and completed the IBS symptom severity scale (IBS-SSS) questionnaire before starting the low-FODMAP diet and after the restriction phase of the diet plan. A decrease in IBS-SSS score of >100 was defined as a responder. Results: 403 IBS patients filled out baseline and post-elimination IBS-SSS surveys. 26% of patients were referred by a GI specialist; the rest were self-referrals. 193 (48%) patients had severe IBS (IBS-SSS > 300) prior to the intervention. IBS-D patients had a 71% improvement in pain, 56% improvement in bloating, and 55% improvement in bowel movement satisfaction. 77% of IBS-D patients had improvement in total IBS-SSS >100. IBS-C patients had a 69% improvement in pain, 49% improvement in bloating, and 42% improvement in bowel movement satisfaction. 67% of IBS-C patients had improvements in IBS-SSS >100. IBS-M patients had 85% improvement in pain, 55% improvement in bloating, and 53% improvement in bowel movement satisfaction. 72% of IBS-M patients had improvement in total IBS-SSS >100. Those who used the commercial meals for "all" of the restriction phase had a mean IBS-SSS improvement of 174, and mean quality of life (QOL) improvement of 40%, while those who used the commercial meals for "some" of the elimination phase had mean IBS-SSS improvement of 153, and mean QOL improvement of 33% (p=0.059 and 0.03, respectively). (Table) Conclusion: This data supports the effectiveness of a low-FODMAP diet for all IBS subtypes, including IBS-C and IBS-M. Patients who obtained prepared low-FODMAP meals during the entire restriction phase experienced greater benefits than those who only obtained meals for a portion of the restriction phase. Table 1. - Improvement in IBS-SSS Categories by IBS-Subtype IBS Subtype Total Number of Patients IBS-SSS (Mean % Improvement) Pain (Mean % Improvement) Bloating (Mean % Improvement) BM Satisfaction (Mean % Improvement) % Improvement in IBS-SSS >100 IBS-D 87 59 (p< 0.001) 72 56 56 77 IBS-C 73 50 (p< 0.001) 70 49 42 67 IBS-M 91 56 (p< 0.001) 73 55 53 73

Episodic Memories Among Irritable Bowel Syndrome (IBS) Patients: An Important Aspect of the IBS Symptom Experience.

Objective:Some IBS patients possess detailed memories of the events surrounding their bowel symptom onset (“episodic memories”). In this exploratory study we sought to: (1) examine memory relationship with gastrointestinal (GI) symptom severity, extraintestinal symptoms, and mood; (2) qualitatively explore memory valence and content in IBS patients with or without episodic memories.MethodsReferral IBS patients n = 29; age 47.0± 2.2 years, 79.3% female) enrolled in this cross-sectional, mixed methods research study. Participants completed validated specific memory instruments [Autobiographical Memory Test (AMT), Sentence Completion for Events from the Past Test (SCEPT)] and relevant questionnaires [IBS symptoms 10-cm visual analog scale); SF-36 Health-related quality of life (HRQOL); Perley-Guze and PHQ-15/12: somatization; Beck Depression/Anxiety Inventories). Qualitative analysis examined the content and valence of general memories.Results14/29 (48.3%) of IBS subjects endorsed episodic memories of IBS symptom onset, often GI infections/enteritis (35.7%). Recall of the exact year (69%) and month (60%) of symptom onset were common. Episodic memories were associated with greater IBS symptom severity/bother, higher anxiety/depression, and poorer HRQOL. Though AMT and SCEPT memory specificity were not different based on episodic memories, overgeneralization to negatively-valenced cues in the AMT was associated with more severe IBS in those without episodic memory. Qualitative analysis revealed no observable differences in topic focus of IBS patients with and without episodic memories.ConclusionsIBS patients often endorse episodic memories associated with symptom onset, and this recall seems to associate with more severe symptoms. Overgeneralization responses to negative stimuli may lead to worse bowel symptoms in those without episodic memories. IBS memory specificity may associate with qualitative differences in processing psychosocial experiences and might be important to IBS pathophysiology.

The role of gastrointestinal specific anxiety and alexithymia as predictors of the severity of irritable bowel syndrome in women

Aim. To analyze the role of gastrointestinal specific anxiety and alexithymia in predicting the severity of the disease in 194 women with moderate to severe IBS with refractory course (average duration of the disease 38.4 months).&#x0D; Methods of investigation. Gastrointestinal Symptom Rating Scale-IBS (GSRS-IBS), Irritable Bowel Syndrome Severity Scoring System (IBS-SSS), Visceral Sensitivity Index (VSI), TAS-20, HADS, and SF-12.&#x0D; Results. It was shown that in women, the severity of irritable bowel syndrome and the risks of refractory course are closely related to high alexithymia and uncontrolled gastrointestinal specific anxiety, which are also related to each other. Patients with severe IBS significantly differ from patients with moderate symptomocoplex manifestations (pain, bloating, diarrheal manifestations), satisfaction with the quality of life, pronounced symptoms of depression, visceral sensitivity and alexithymia, which contributes to the formation of a number of therapeutic barriers. Regression analysis showed that the severity of IBS was equally predicted by presence of alexithymia and gastrointestinal specific anxiety in the patient.&#x0D; Conclusions. Alexithymia, especially the difficulty of expressing negative emotions (for example, irritation, anger), describing feelings, desires to other people, was a stronger factor in women predicting the severity of IBS compared to gastrointestinal specific anxiety. The presented symptomatic picture of alexithymic manifestations in patients with IBS shows that violations of emotional awareness affect the pathogenesis, the spectrum of reinsurance and avoidance behavior.

Irritable Bowel Syndrome, Immune Fitness, and Insomnia: Results from an Online Survey Among People Reporting Sleep Complaints

ObjectivesIrritable bowel syndrome (IBS) and insomnia symptoms are often found to occur together. The aim of this study was to investigate the relationship between sleep and IBS complaints, and their impact on reported health and daytime functioning.MethodsAn online advertisement invited people with difficulty initiating and/or maintaining sleep to participate in an online survey. Sleep characteristics were assessed and the Birmingham IBS Symptoms Questionnaire was completed, including subscales on IBS-related constipation, pain, and diarrhoea. Perceived immune functioning and general health were self-rated and the lapses subscale of the Manchester Driver Behaviour Questionnaire was completed as a proxy of daytime functioning.ResultsSignificant associations were found between sleep symptoms and IBS-related constipation, pain, and diarrhoea reports. Most sleep variables were negatively affected in subjects reporting IBS complaints, as reflected in patients reporting poorer sleep quality and less satisfaction with their sleep pattern. The associations with sleep difficulties were most pronounced for IBS-related pain. Being a woman, of younger age, and having an insomnia diagnosis were factors that were associated with having significantly more severe IBS symptoms. The association with IBS was significant for the severity of difficulty falling asleep, but not for the severity of difficulty maintaining sleep.ConclusionThere is a clear relationship between sleep, perceived health, and IBS complaints. The association with IBS complaints was significant for difficulty falling asleep, but not for difficulty maintaining sleep, which may have implications for the combined treatment of sleep difficulties and IBS-related pain.

Alosetron use in clinical practice: significant improvement in irritable bowel syndrome symptoms evaluated using the US Food and Drug Administration composite endpoint.

Background:Alosetron is approved to treat women with severe IBS and diarrhea (IBS-D) who have failed standard therapy. In our study, we aimed to evaluate alosetron efficacy using new US Food and Drug Administration (FDA) endpoints and utilization in clinical practice.Methods:This prospective, open-label, multicenter, observational 12-week study evaluated women with severe IBS-D enrolled in the alosetron prescribing program. The coprimary FDA endpoints were changes from baseline in stool consistency and abdominal pain severity. Responders achieved a 30% decrease compared with baseline in weekly average of the worst abdominal pain in the past 24 h, and a 50% or greater reduction from baseline in the number of days/week with at least one stool of type 6 (mushy) or type 7 (watery) consistency. Secondary endpoints included changes from baseline in stool frequency, fecal urgency and fecal incontinence.Results:Enrolled patients (n = 192) were primarily White (90.6%), with a mean age of 44.5 years. Patient and physician rating of IBS severity was between moderate and severe (85.9% concordance, Spearman coefficient 0.429, p < 0.0001). Alosetron 0.5 mg twice daily (82.8%) was the most common dosing regimen. A total of 152 alosetron-treated patients completed the study. Of 105 fully evaluable patients, 45% met the FDA composite endpoint responder criteria for ⩾50% of the study period. Improvements in all individual symptoms were statistically significant compared with baseline. There were no serious adverse events, cases of colonic ischemia, or complications of constipation.Conclusion:In a clinical practice setting study, alosetron demonstrated treatment success using a rigorous FDA composite endpoint and also improved multiple other IBS symptoms, including fecal urgency and incontinence in women with severe IBS-D [ClinicalTrials.gov identifier: NCT01257477].

Su1373 Ibgard®, a Novel Small Intestine Targeted Delivery System of Peppermint Oil, Results in Significant Improvement in Severe and Unbearable IBS Symptom Intensity. Results From a US Based, 4-Week, Randomized, Placebo-Controlled, Multi-Center Ibsrest™ Trial

Su1373 Ibgard®, a Novel Small Intestine Targeted Delivery System of Peppermint Oil, Results in Significant Improvement in Severe and Unbearable IBS Symptom Intensity. Results From a US Based, 4-Week, Randomized, Placebo-Controlled, Multi-Center Ibsrest™ Trial

Su1371 Non-Traumatic Stressful Events At the Time of Abdominal Pain Onset Is a Marker of Current Psychological but Not GI Health in More Severe IBS Patients

BACKGROUND. IBS is a chronic, potentially disabling GI disorder that affects up to 50 million Americans. Despite its prevalence, IBS symptoms of a significant proportion of individuals go unrecognized or untreated. Efforts to improve case detection by encouraging MDs to adopt Rome diagnostic criteria have been suboptimal. An alternative approach is to improve symptom reporting through the use of self-administered checklists or screeners that increase individuals' awareness and knowledge of the diagnostic symptoms of IBS. When shared with the treating gastroenterologist (GE), information derived from symptom checklists have potential to improve diagnostic accuracy, conserve time and resources, strengthen patient engagement, and help patients obtain improved quality of life and relief for the disorder for which they seek care. These goals have been hampered by the lack of a brief, easy to administer, simple to score/interpret, and validated measure.AIM. To examine the diagnostic accuracy of a brief (4 True-False questions) screening tool of IBS symptoms based on Rome III criteria. METHOD. 384 IBS patients (80% F; M age = 41 yrs.) completed the IBS screener (4-IBS) that was embedded in a test battery administered at pretreatment assessment of an NIH trial for IBS. Assessment included the IBS Symptom Severity Scale, IBS QOL, Brief Symptom Inventory (distress), SF-12, Visceral Sensitivity Inventory (VSI, fear of visceral sensation). Administration time was < 1 minute. GI symptoms were assessed by a board certified GE who confirmed Rome diagnosis (‘gold standard') in all cases. GEs were blind to patient responses to the 4-IBS when Rome diagnosis was made. RESULTS. Agreement between GE diagnosis and 4-IBS screener diagnosis was good to excellent. The 4-IBS symptom screener correctly diagnosed IBS in 71% of IBS-C patients and 75% of IBSD patients. Agreement was strongest (90%) for IBS-M patients. Patients for whom there was greatest agreement between self-report and GE diagnosis were characterized by stronger fears of GI symptoms (VSI, p<.05).CONCLUSION. Data corroborated the diagnostic validity of a brief, self-report IBS screener for identifying patients likely to meet Rome criteria for IBS. While a clinical evaluation is necessary to confirm IBS and rule out other potential conditions whose GI symptoms mimic those of IBS, the 4-IBS screener may prove useful for identifying IBS patients in busy clinical settings. A self-screener may be particularly useful for early identification of patients who drive health care use. For patients with stronger fears of GI symptoms (high VSI), their hypervigilance to core IBS symptoms and features (e.g., pain onset associated with change in stool consistency) may promote accurate diagnosis of IBS relative to less fearful patients with lower attentional focus to visceral sensations. Acknowledgements: NIH grant DK77738

Sa1334 Testing the Relationship Between Psychological Factors and Post Prandial Symptoms in Moderate to Severe IBS Patients: Are We Approaching the Boundaries of the Biopsychosocial Model?

Sa1334 Testing the Relationship Between Psychological Factors and Post Prandial Symptoms in Moderate to Severe IBS Patients: Are We Approaching the Boundaries of the Biopsychosocial Model?

Sa1326 Psychosocial Predictors of Self Ratings of Health in Moderate to Severe IBS Patients: What's Involved in Feeling Healthy Besides the Severity of GI Symptoms?

Sa1326 Psychosocial Predictors of Self Ratings of Health in Moderate to Severe IBS Patients: What's Involved in Feeling Healthy Besides the Severity of GI Symptoms?

Sa1330 Prevalence, Severity, and Predictors of Self-Reported Fatigue in Patients With Moderate to Severe IBS

Sa1330 Prevalence, Severity, and Predictors of Self-Reported Fatigue in Patients With Moderate to Severe IBS

Tu2019 Straining Rectal Pressure in Constipation: Could Excessively High Pressure Be Important Too?

mmHg; p=0.4) and nominal increases in compliance with HPD (0.6 ±0.7 ml/mmHg; p= 0.17). Between groups, these differences in barostat acclimation were significant for HPD (p=0.03) but not LPD (p =0.28). Rectal compliance did not correlate with subjective discomfort ratings of LPD or HPD in either group; however, lower mean rectal compliance with HPDs trended toward predicting more severe IBS symptoms (p=0.07) and higher symptomatic days (p=0.08). CONCLUSIONS: IBS patients have decreased dynamic rectal compliance with both low pressure and high pressure rectal distensions. While healthy individuals acclimate to a series of distensions by increasing rectal compliance, IBS patients experience minimal increases, or even losses in rectal compliance with subsequent distensions. These observations appear to relate to IBS symptom severity and frequency, and advance our understanding of the relevance of rectal compliance to IBS pathophysiology.

Psychotropics Benefit Moderate to Severe IBS

Psychotropics Benefit Moderate to Severe IBS

Severe IBS May Be Tied To Psychosocial Issues

Severe IBS May Be Tied To Psychosocial Issues

Drug Utilization Characteristics among Patients with Non-D IBS

Purpose: In this study we described the patterns of drug use and characteristics of patients with non-diarrhea predominant irritable bowel syndrome (non-D IBS) based on the drug categories at baseline. Methods: ILOS is a 6-month, prospective, observational study of patients with a physician diagnosis of non-D IBS, conducted in 46 sites in the US. Physician and patient reported over-the-counter and prescription drug use for GI-related disorders were assessed at baseline. Patients were categorized as receiving no drug, monotherapy (mono) or polytherapy (poly). Patient reported quality of life (QOL) assessed by SF-36 and the validated IBSQOL, health care resource utilization, and work productivity using the Work Productivity and Activity Impairment Questionnaire: Digestive Health were collected at baseline. Severity of IBS symptoms were assessed by the frequency, intensity and distress/bothersomeness of the symptoms, using a 5-point Likert scale. Differences in patient characteristics between the drug categories were assessed using Kruskal-Wallis or Chi-Square or Fisher's Exact test as appropriate. Results: Of the 380 patients identified with non-D IBS, 67.1% were on poly, 20.7% were on mono and 12.1% did not report any GI-related medication use. Of those on mono, the top 5 drug categories were tegaserod (29.1%), pain medications (20.3%), acid reducers (12.7%), anti-depressants (11.4%) and fiber (10.1%). A significant trend towards more QOL impairment with increasing drug use was observed in each of the following SF-36 domains (p < 0.01): physical functioning, role physical, role emotional, and vitality. Based on IBSQOL scores, patients on polytherapy had poorer QOL compared to those receiving monotherapy or no drugs (p = 0.003). Patients on polytherapy had higher severity scores on the cardinal IBS symptoms of abdominal pain, bloating and constipation, sought more medical care and had greater daily activity impairment than those receiving monotherapy or no drugs, though these results were statistically non-significant. Conclusions: Most patients with non-D IBS use multiple GI-related drugs to relieve their symptoms. Based on the drug categories at baseline, patients on poly appear to have more severe IBS and had poorer QOL than those receiving mono or no drugs.

A HOLISTIC GROUP PSYCHOTHERAPEUTIC INTERVENTION FOR THE TREATMENT OF IRRITABLE BOWEL SYNDROME AND ITS COMORBID DEPRESSION AND ANXIETY

The aim of this study was to ascertain the effects of a holistic short-term group intervention in the treatment of Irritable Bowel Syndrome (/BS) with comorbid depression and anxiety. The sample consisted of 24 South African women who had been diagnosed with severe IBS. Furthermore, each participant had to have associated moderate to severe depression and anxiety. The group design was a pre-test, post-test control group design where the experimental group (n = 12) received group intervention and the members of the control group (n = 12) received no intervention until after completion of the research. All the participants completed the Functional Bowel Disorder Severity Index and the Depression and Anxiety subscales of the Personality Assessment Inventory before commencement of group therapy for Group 1 and one month after completion of this intervention. The effect of the intervention was determined by utilising comparative statistics. The findings indicate that holistic short-term group therapy results in significant improvement in terms of depreSSion and anxiety scores, but that IBS symptom severity remains unchanged. It is recommended that further research be conducted to ascertain whether holistic group therapy of a longer duration has a greater impact on the IBS symptom severity.