Irritable Bowel Research Articles

Combined oral contraceptives are associated with increased risk of developing gastroparesis in pre-menopausal women.

Females are disproportionately affected by gastroparesis. Sex hormones play a significant role. The aim of this study was to investigate the effects of combined oral contraceptives (COC) on the development of gastroparesis and its related symptoms, medication use, and diagnostic testing in pre-menopausal women. A population-based cohort study was conducted utilizing the TriNetX platform. The study group included pre-menopausal women. The effect of developing gastroparesis at least 30 days after initiating COC was assessed by comparing it to pre-menopausal women not on contraceptive therapy. A 1:1 propensity score matching was performed to adjust for age, race, ethnicity, body mass index, and diabetes mellitus. Exclusion criteria included upper gut and bariatric surgery, functional dyspepsia, cyclic vomiting syndrome, gastro-esophageal reflux disease, irritable bowel syndrome, cannabis dependence and opiate use. Odds ratios with 95 % confidence intervals were calculated. P-value <0.05 was considered statistically significant. After propensity matching, 1,370,274 patients were included in the study for each cohort. A total of 1,050 pre-menopausal women developed gastroparesis at least 30 days after being prescribed COC compared to 815 pre-menopausal women not prescribed COC (OR 1.29 [1.176-1.412] p-value<0.0001). These associations persisted in sensitivity analysis over 5 years (OR 1.31 [1.097-1.575] p-value=0.0029). COC were associated with increased gastrointestinal symptoms including early satiety (OR 2.31 [2.08-2.577] p-value<0.0001) and prokinetic medications including metoclopramide (OR 1.30 [1.285-1.316] p-value<0.0001). Gastrointestinal diagnostic tests including esophagogastroduodenoscopy (OR 1.611 [1.561-1.663] p-value<0.0001) and gastric emptying scintigraphy (OR 1.89 [1.717-2.085] p-value<0.0001) were more likely to be performed in pre-menopausal women who were prescribed COC. COC is associated with an increased risk of developing gastroparesis, which persists over time. Furthermore, COC is associated with developing gastrointestinal symptoms, increased prokinetic usage, and diagnostic testing.

A Review on miRNAs in Enteric Bacteria-mediated Host Pathophysiology: Mechanisms and Implications.

Recently, many studies focused on the billions of native bacteria found inside and all over the human body, commonly known as the microbiota, and its interactions with the eukaryotic host. One of the niches for such microbiota is the gastrointestinal tract (GIT), which harbors hundreds to thousands of bacterial species commonly known as enteric bacteria. Changes in the enteric bacterial populations were linked to various pathologies such as irritable bowel syndrome and obesity. The gut microbiome could affect the health status of individuals. MicroRNAs (miRNAs) are one of the extensively studied small-sized noncoding RNAs (ncRNAs) over the past decade to explore their multiple roles in health and disease. It was proven that miRNAs circulate in almost all body fluids and tissues, showing signature patterns of dysregulation associated with pathologies. Both cellular and circulating miRNAs participate in the posttranscriptional regulation of genes and are considered the potential key regulators of genes and participate in cellular communication. This manuscript explores the unique interplay between miRNAs and enteric bacteria in the gastrointestinal tract, emphasizing their dual role in shaping host-microbiota dynamics. It delves into the molecular mechanisms by which miRNAs influence bacterial colonization and host immune responses, linking these findings to gut-related diseases. The review highlights innovative therapeutic and diagnostic opportunities, offering insights for targeted treatments of dysbiosis-associated pathologies.

Regulation of Feeding and Defecation in Drosophila by Trpγ, Piezo, and DH44R2.

Normal gastrointestinal (GI) motility, including defecation, is crucial for nutrient absorption, energy balance, and overall health in species ranging from insects to humans. Disruptions in GI motility can lead to conditions like constipation or severe diseases. Mechanosensors, including TRP channels and Piezo, are known to play key roles in regulating gut physiology in Drosophila melanogaster, but their precise involvement in defecation is not fully understood. Additionally, neuropeptides like DH44 have been implicated in gut regulation. This study explores the roles of Trpγ, Diuretic hormone 44 Receptor 2 (DH44R2), and Piezo in controlling feeding amount, gut motility, and defecation using genetic mutants and RNAi techniques. Mutants for these genes exhibited increased excreta production and size, whereas Dh44 and Dh44R1 mutants had a reduced number of excreta, but with increased size. Co-expression and rescue experiments further confirmed the critical roles of these genes in the same gut cells. The findings reveal that local gut-specific mechanisms are the primary drivers of defecation. The results highlight the collaboration between Trpγ, Piezo, and DH44R2 in regulating gut motility and defecation. By uncovering how these mechanosensory proteins and cells work together, this research may offer insights into human GI disorders like Irritable Bowel Syndrome (IBS) and Hirschsprung's disease, shedding light on the complex regulatory network underlying defecation.

Irritable bowel syndrome manifestation in pediatric Fabry disease patients

Irritable bowel syndrome manifestation in pediatric Fabry disease patients

Alterations in the Tongue Coating Microbiome in Patients With Diarrhea-Predominant Irritable Bowel Syndrome: A Cross-Sectional Study.

The gut microbiota plays a critical role in the occurrence and development of IBS-D, however, IBS-D-associated tongue coating microbiome dysbiosis has not yet been clearly defined. To address this, we analyzed the structure and composition of the tongue coating microbiome in 23 IBS-D patients and 12 healthy controls using 16S rRNA high-throughput sequencing analysis. The 16S rRNA sequencing results revealed that the overall observed OTUs of tongue coating microbiome in IBS-D patients exhibited a significant decrease compared with the healthy controls. Alpha diversity analysis showed that the diversity and community richness were significantly reduced in IBS-D patients, and PCoA revealed a distinct clustering of tongue coating microbiome between the IBS-D patients and healthy controls. Microbial comparisons at the genus level showed that the abundance of Veillonella, Prevotella in IBS-D patients was higher than those in healthy controls, while Streptococcus, Haemophilus, Granulicatella, and Rothia were significantly reduced compared with the healthy volunteers. Functional analysis results showed significant differences in 88 functional metabolic pathways between the IBS-D patients and the healthy controls, including fatty acid biosynthesis. These findings identified the structure, composition, functionality of tongue coating microbiome in IBS-D patients, and hold promise the potential for therapeutic targets during IBS-D management.

Prevalence of eating disorder risk in irritable bowel syndrome, coeliac and inflammatory bowel diseases using SCOFF

IntroductionEating disorders (EDs) and disordered eating behaviours are common in the general population. Those with gastrointestinal (GI) disorders may be particularly at risk, as they may need dietary therapies. There...

Efficacy of Amitriptyline in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis.

Amitriptyline is prescribed off-label for irritable bowel syndrome (IBS). We conducted a meta-analysis to assess its efficacy. A systematic literature review was conducted until November 10, 2023, using MEDLINE, Embase, Cochrane Library, and Web of Science to study the efficacy of amitriptyline in patients with IBS. We included all randomized controlled trials that compared amitriptyline to placebo. Revised Cochrane risk-of-bias tool was used to assess the quality of studies. Meta-analyses were performed using a bivariate random-effects model. Statistical analyses were performed using R Software 4.2.3 and heterogeneity was assessed with I2 statistics. Seven trials were included with 796 patients (61% female). Amitriptyline was associated with better treatment response (OR, 5.30; 95% CI, 2.47 to 11.39; P < 0.001), reduced Irritable Bowel Syndrome Symptom Severity Scores (MD, -50.72; 95% CI, -94.23 to -7.20; P = 0.020) and improved diarrhea (OR, 10.55; 95% CI, 2.90 to 38.41; P < 0.001). No significant difference between the 2 groups regarding the adverse effects was observed. Three trials showed an overall low risk of bias, 2 trials showed an overall high risk of bias due to randomization and missing data, and 2 trials had some concerns regarding missing data. Amitriptyline was found to be well-tolerated and effective in treating IBS compared to placebo. These findings support the use of amitriptyline for the management of IBS, particularly among patients with the IBS diarrhea subtype. Future research should focus on the dose-dependent effects of amitriptyline in IBS to better guide clinicians in personalized titration regimens.

A qualitative exploration into the lived experiences of females with a gastrointestinal condition.

Research typically addresses the experiences of those with gastrointestinal (GI) conditions using quantitative methods, even though qualitative exploration of lived experiences could provide valuable knowledge for health and policy stakeholders. The study explored the lived experiences of eight females with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) using semi-structured interviews. Reflexive thematic analysis (RTA) identified five themes: negative emotional experiences, coping with daily life, a barrier in daily life, lived experiences of remission and lack of awareness: better informing others of GI conditions. Themes suggested complex experiences of those living with IBS or IBD, with embarrassment, negatively affected romantic relationships, and a general lack of awareness of these conditions, ameliorated by forging the experience of positive aspects including strong social networks, remission as a period of relief, and finding adaptive coping strategies.

A novel, IBS-specific IgG ELISA-based elimination diet in irritable bowel syndrome: A randomized, sham-controlled trial.

Personalized dietary therapies for irritable bowel syndrome (IBS) are needed and an IgG-antibody-based elimination diet presents a potential solution. However, existing studies have serious methodological limitations. This study aimed to assess the efficacy of an elimination diet utilizing a novel IBS-specific IgG assay. We conducted a randomized, double-blind, sham-controlled trial enrolling subjects with IBS from 8 centers. Subjects positive for ≥1 food on an 18-food IgG assay and an average daily abdominal pain intensity (API) score between 3-7.5 on an 11-point scale during a 2-week run-in period were randomized to either an experimental antibody-guided diet or sham diet for 8 weeks. The primary outcome was a ≥30% decrease in API for ≥2 of the last 4 weeks of the treatment period. Among 238 randomized IBS subjects, 223 were included in the modified intention-to-treat analysis. A significantly greater proportion of subjects in the experimental diet group met the primary outcome than those in the sham diet group (59.6% vs. 42.1%, P=0.02). Subgroup analysis revealed that a higher proportion of IBS-C and IBS-M subjects in the experimental diet group met the primary endpoint vs. the sham group (67.1% vs. 35.8% and 66% vs. 29.5%, respectively). Subjects on an IgG-guided elimination diet were more likely to achieve the primary endpoint than those on a sham elimination diet. Subgroup analysis suggests a more robust benefit for subjects with IBS-C and IBS-M. This highlights the potential effectiveness of a personalized elimination diet based on a novel IBS-specific IgG assay. A larger study is warranted to validate these observations.

Improving Irritable Bowel Syndrome (IBS) Symptoms and Quality of Life with Quebracho and Chestnut Tannin-Based Supplementation: A Single-Centre, Randomised, Double-Blind, Placebo-Controlled Clinical Trial

Background/Objectives: Irritable Bowel Syndrome (IBS) is a disorder of the gut-brain axis for which the gastroenterologist is most often consulted. Gastrointestinal symptoms and decreased quality of life lead to a considerable burden of disease. The exact causes of IBS are not well understood, and no standard therapy has been established. The primary outcome of the study focused on the improvements of the IBS symptoms assessed through the validated questionnaire IBS-Severity Scoring System (IBS-SSS). Similarly, secondary outcomes geared towards the improvement of the quality of life (IBS-Quality of Life (IBS-QoL) and the Gastrointestinal Quality of Life Index (GIQLI)) and specific IBS symptoms (bloating, abdominal distension, feeling of heaviness, abdominal pain, and flatulence), were assessed through self-administered questionnaires. Intestinal habits (consistency and frequency of depositions) through subject stratification into diarrhoea (IBS-D), constipation (IBS-C), mixed type (IBS-M), as well as the treatment tolerability were also evaluated. Methods: A randomised, placebo-controlled, double-blind, clinical trial was conducted on 156 enrolled IBS patients (79 female and 77 male), aged 18–70 years, randomised (1:1 allocation ratio) to receive either two capsules per day of the food supplement (containing 480 mg of a complex of tannin extracts) or a placebo for 56 days. Linear random intercept mixed models (LMM) were used to analyse all experimental variables Results: Supplementation resulted in a significant improvement (p &lt; 0.05) in the primary outcome IBSS score, with respect to the placebo group, changing the IBS condition going from mild (242.3 ± 89.8) to moderate (148.1 ± 60.6). Similarly, all indicators concerning quality of life, and specific intestinal symptoms resulted in a significant improvement (p &lt; 0.05). Furthermore, the tannin-based treatment showed the ability to modulate the response to different symptomatology such as diarrhoea and constipation, without side effects being reported. Conclusions: The use of a supplement based on chestnut and quebracho tannins presents great application potential in the management of IBS-related disorders, with the peculiarity of resolving opposite symptoms, such as diarrhoea and constipation, indiscriminately.

Neo4j-Based Analysis of Traditional Chinese Medicine Clinical Patterns Used to Treat Irritable Bowel Syndrome

Neo4j-Based Analysis of Traditional Chinese Medicine Clinical Patterns Used to Treat Irritable Bowel Syndrome

Research Progress on Diagnosis and Treatment of Diarrhea Predominant Irritable Bowel Syndrome in Traditional Chinese Medicine

Research Progress on Diagnosis and Treatment of Diarrhea Predominant Irritable Bowel Syndrome in Traditional Chinese Medicine

Low-FODMAP Diet for Irritable Bowel Syndrome: Insights from Microbiome

Low-FODMAP Diet for Irritable Bowel Syndrome: Insights from Microbiome

Determining the incidence, risk factors and biological drivers of irritable bowel syndrome (IBS) as part of the constellation of postacute sequelae of SARS-CoV-2 infection (PASC) outcomes in the Arizona CoVHORT-GI: a longitudinal cohort study

IntroductionPostacute sequelae of SARS-CoV-2 infection (PASC) are extensive. Also known as long COVID, primary outcomes reported are neurologic, cardiac and respiratory in nature. However, several studies have also reported an...

Patients with Irritable Bowel Syndrome Exhibit Aberrant Expression of Endogenous Retroviruses and SETDB1

Irritable bowel syndrome (IBS) is a common disease, whose etiopathogenesis is poorly understood. Human endogenous retroviruses (HERVs) originate from ancient infections of germinal cells and represent 8% of our DNA. Most HERVs have become defective due to the accumulated mutations; some can, however, still be activated, and their altered expressions have been associated with a number of chronic inflammatory and immune-mediated disorders, including gastrointestinal diseases. Retroviral transcription is modulated by TRIM28 and SETDB1, which also participate in the regulation of epigenetic mechanisms and in shaping the immune system. Expressions of HERVs and TRIM28/SETDB1 have not been investigated in patients affected by IBS. Using a PCR real-time Taqman amplification assay, we explored the RNA levels of HERV-H-pol, HERV-K-pol, and HERV-W-pol; syncytin 1 (SYN1), SYN2, and HERV-W-env; and TRIM28 and SETDB1 in the peripheral blood of 37 IBS patients and healthy controls (HCs) of similar age. The transcript levels were higher in IBS patients than in HCs for all HERVs except for HERV-W-pol, with significant p-values for HERV-H-pol, HERV-K-pol, and SYN1 and borderline p-values for SYN2 and HERV-W-env. The RNA levels of SETDB1 were significantly enhanced in IBS patients, while those of TRIM28 were in the normal range. Patients with severe disease had significant upregulation of SETDB1 compared to those with mild or moderate symptoms. These findings suggest that overexpression of HERVs and SETDB1 may contribute to the development of IBS and open the way to innovative therapeutic strategies.

P-130. A Case-Control Study of Post-Infectious Sequelae Following a Shiga Toxin-Producing Escherichia coli (STEC) Outbreak at a U.S. Marine Corps Recruit Depot

Abstract Background In November 2017, an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 and O26 occurred among male recruits at a United States Marine Corps Recruit Depot, San Diego, CA. We sought to evaluate the 6-year risk of hypertension (HTN), chronic kidney disease (CKD), and irritable bowel syndrome (IBS) following STEC infection by conducting a retrospective, case-control study utilizing medical record data.Table 1.Proportion of STEC cases and matched asymptomatic controls with post-infectious sequelae following November 2017 outbreak Methods Data from the outbreak investigation were used to identify cases and asymptomatic controls. Asymptomatic controls were recruits who were in the exposure area during the outbreak but remained asymptomatic and were negative for STEC by stool PCR. Cases were matched 1:4 with asymptomatic controls based on the duration of follow-up available in the Military Health System Data Repository (MDR). Controls could be matched to &amp;gt; 1 case. Post-infectious outcomes were assessed using ICD-10 diagnostic codes in the MDR. Results 239 cases were identified of whom 192 (80%) developed bloody diarrhea, 30 (13%) were hospitalized, and 17 (7%) developed hemolytic uremic syndrome (HUS). The stx-2 gene was detected in 39% of PCR positive cases. The median age of recruits was 19 years, and the median duration of MDR follow-up for cases and controls was 3.7 years (IQR: 2.9-5.4). There was no significant difference in the proportion of cases and controls with post-infectious sequelae (Table 1). Resolution of renal dysfunction was noted within 3 months after discharge for all HUS cases, and only 1 case remained hypertensive following discharge. There was no significant difference in the proportion of bloody diarrhea and HUS cases that developed IBS compared to controls. A limitation of the analyses was the short duration of MDR follow-up available for 6/30 hospitalized cases due to military separation after hospital discharge. Conclusion STEC infection in this cohort of young military recruits was associated with a good prognosis, even among cases of STEC-associated HUS, with resolution of renal dysfunction and no increase in incidence of IBS or HTN compared with asymptomatic controls. The findings suggest that STEC infection in young adults who recover from acute illness is not associated with a higher likelihood of post-infectious sequelae. Disclosures Ryan C. Maves, MD, AiCuris: Grant/Research Support|Biotest: Grant/Research Support|GeoVax: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Honoraria|Sound Pharmaceuticals: Grant/Research Support

Beyond the “Master” Role in Allergy: Insights into Intestinal Mast Cell Plasticity and Gastrointestinal Diseases

Mast cells (MCs) are essential components of the immune system that enter the circulation as immature bone marrow progenitors and differentiate in peripheral organs under the influence of microenvironment factors. As tissue-resident secretory immune cells, MCs rapidly detect the presence of bacteria and parasites because they harbor many surface receptors, which enable their activation via a multitude of stimuli. MC activation has been traditionally linked to IgE-mediated allergic reactions, but MCs play a pivotal role in different physiological and pathological processes. In gut, MCs are essential for the maintenance of gastrointestinal (GI) barrier function, and their interactions with neurons, immune cells, and epithelial cells have been related to various GI disorders. This review recapitulates intestinal MC roles in diseases with a main focus on inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Emerging therapies targeting MCs and their mediators in clinical practices will also be discussed.

Euodiae Fructus: a review of botany, application, processing, phytochemistry, quality control, pharmacology, and toxicology

Euodiae Fructus (EF) is the dried and nearly ripe fruit of Euodia rutaecarpa, first recorded in Shen Nong’s Herbal Classic. EF is a versatile Traditional Chinese Medicine (TCM) known for the effects of dispelling colds and alleviating pain, suppressing adverse qi to relieve vomiting, and boosting yang to mitigate diarrhea. However, it should be noted that EF possesses mild toxicity. In TCM prescriptions, EF is employed to treat various ailments, including abdominal pain, diarrhea, chronic non-atrophic gastritis, irritable bowel syndrome, and primary dysmenorrhea. This review collected the literature published before September 2024 on EF. An exhaustive analysis of EF literature was conducted utilizing multiple sources, namely classic TCM books and various scientific databases like Web of Science, PubMed, Elsevier, ACS, ResearchGate, Google Scholar, and Chinese National Knowledge Infrastructure. So far, more than 300 metabolites have been extracted and identified from EF, exhibiting various pharmacological effects, such as cardiovascular protection, gastrointestinal protection, neuroprotection, anti-inflammation, analgesia, anti-tumor, glucose and lipid metabolism regulation, etc. It also exhibits diverse toxicological properties and poses specific toxic risks to the liver, heart, and kidney. Nonetheless, research is scarce regarding the toxicology of EF, especially on its cardiotoxicity and nephrotoxicity. Further in-depth research is necessary to explore the mechanisms underlying EF’s pharmacological and toxicological mechanisms and to develop strategies for quality control and toxicity mitigation. The toxicity of EF can be reduced by processing, but this aspect is rarely discussed, and the quality control needs to be further standardized. Evodiamine, rutaecarpine, and limonin are the effective metabolites of EF and are also one of the causes of EF toxicity. The pharmacological effects of evodiamine and rutaecarpine have been intensely studied, but there are few studies on limonin and other metabolites of EF. Therefore, this paper focuses on the botanical characteristics, traditional applications, processing methods, phytochemistry, quality control, pharmacology, and toxicology of EF. We hope this paper provides a theoretical basis for the future high-value and high-connotation development of EF.

Human-derived microRNA 21 regulates indole and L-tryptophan biosynthesis transcripts in the gut commensal Bacteroides thetaiotaomicron.

The mammalian gut represents one of the largest and most dynamic host-microbe interfaces. Host-derived microRNAs (miRNAs), released from the gut epithelium into the lumen, have emerged as important contributors to host-microbe crosstalk. Levels of several miRNAs are altered in the stool of patients with irritable bowel syndrome or inflammatory bowel disease. Understanding how miRNAs interact with and shape gut microbiota function is crucial as it may enable the development of new targeted treatments for intestinal diseases. This study provides evidence that the miRNA miR-21 can rapidly associate with diverse microbial cells form the gut and increase levels of transcripts involved in tryptophan synthesis in a ubiquitous gut microbe. Tryptophan catabolites regulate key functions, such as gut immune response or permeability. Therefore, this mechanism represents an unexpected host-microbe interaction and suggests that host-derived miR-21 may help regulate gut function via the gut microbiota.

Self-administered active versus sham acupressure for diarrhea predominant irritable bowel syndrome: a nurse-led randomized clinical trial

BackgroundDiarrhea-predominant irritable bowel syndrome (IBS-D) significantly impacts patients’ quality of life, with existing treatments offering limited relief. Self-administered acupressure presents a potential non-invasive, cost-effective treatment option that could alleviate symptoms and enhance health outcomes in these patients.AimThis randomized controlled trial aimed to evaluate the effect of active acupressure compared to sham acupressure on primary and secondary outcomes among IBS-D patients.MethodThe study included 63 patients with IBS-D, recruited from Alexandria Main University Hospital, Egypt. Participants were randomized into either an active acupressure group or a sham acupressure group. Both groups underwent two days of training, followed by four weeks of intervention. The active group applied pressure to specific therapeutic acupoints, while the sham group used non-therapeutic points. Outcomes were assessed at baseline, week 2, and week 4.ResultsThe active acupressure group showed a significant reduction in symptom severity, improved stool consistency, and frequency, and greater adequate symptom relief by week 4 compared to the sham group. Psychological outcomes, including anxiety and depression, also improved significantly in the active group. Additionally, the active group reported reduced use of rescue medications.ConclusionActive acupressure is an effective nursing intervention for alleviating symptoms of IBS-D, particularly when applied consistently over time. It improves both physical and psychological outcomes, offering a valuable non-pharmacological treatment option.ImplicationsNurses can integrate self-administered acupressure into IBS-D care plans, teaching patients this technique to manage symptoms independently, thus enhancing their quality of life (QOL) and reducing reliance on conventional medications. This intervention aligns with holistic nursing care and offers a cost-effective, patient-friendly solution for managing IBS-D.Trial registrationThis study was prospectively registered as a randomized controlled trial in https://clinicaltrials.gov/ Registration Date: January 7, 2023, Registration Number: NCT05702255.