Therapy For Irritable Bowel Syndrome Research Articles

Innovative cognitive behavioral therapies for irritable bowel syndrome: processes, predictors, platforms, and outcomes.

Innovative cognitive behavioral therapies for irritable bowel syndrome: processes, predictors, platforms, and outcomes.

Immune cell signatures and causal association with irritable bowel syndrome: A mendelian randomization study

BACKGROUND The mucosal barrier's immune-brain interactions, pivotal for neural development and function, are increasingly recognized for their potential causal and therapeutic relevance to irritable bowel syndrome (IBS). Prior studies linking immune inflammation with IBS have been inconsistent. To further elucidate this relationship, we conducted a Mendelian randomization (MR) analysis of 731 immune cell markers to dissect the influence of various immune phenotypes on IBS. Our goal was to deepen our understanding of the disrupted brain-gut axis in IBS and to identify novel therapeutic targets. AIM To leverage publicly available data to perform MR analysis on 731 immune cell markers and explore their impact on IBS. We aimed to uncover immunophenotypic associations with IBS that could inform future drug development and therapeutic strategies. METHODS We performed a comprehensive two-sample MR analysis to evaluate the causal relationship between immune cell markers and IBS. By utilizing genetic data from public databases, we examined the causal associations between 731 immune cell markers, encompassing median fluorescence intensity, relative cell abundance, absolute cell count, and morphological parameters, with IBS susceptibility. Sensitivity analyses were conducted to validate our findings and address potential heterogeneity and pleiotropy. RESULTS Bidirectional false discovery rate correction indicated no significant influence of IBS on immunophenotypes. However, our analysis revealed a causal impact of IBS on 30 out of 731 immune phenotypes (P < 0.05). Nine immune phenotypes demonstrated a protective effect against IBS [inverse variance weighting (IVW) < 0.05, odd ratio (OR) < 1], while 21 others were associated with an increased risk of IBS onset (IVW ≥ 0.05, OR ≥ 1). CONCLUSION Our findings underscore a substantial genetic correlation between immune cell phenotypes and IBS, providing valuable insights into the pathophysiology of the condition. These results pave the way for the development of more precise biomarkers and targeted therapies for IBS. Furthermore, this research enriches our comprehension of immune cell roles in IBS pathogenesis, offering a foundation for more effective, personalized treatment approaches. These advancements hold promise for improving IBS patient quality of life and reducing the disease burden on individuals and their families.

Low-FODMAP diet on postprandial distress syndrome type of functional dyspepsia with mixed type of irritable bowel syndrome patient: A case report

Functional dyspepsia is a complex collection of symptoms from the gastroduodenal, while irritable bowel syndrome (IBS) is a disease that chronically weakens gastrointestinal. The occurrences of both of these diseases are common; however, the new approach therapy introducing the low-FODMAP diet (low fructose, oligosaccharides, disaccharides, monosaccharides, and polyols) is rarely discussed. The aim of this case report was to present a case of functional dyspepsia with IBS mixed type treated with a low-FODMAP diet. A female 37 years old reported complaints of heartburn worsening over the last seven months. Based on IBS-symptom severity scale (IBS-SSS) assessment, the patient had 75% scale on belly pain and 50% abdominal distention, which interfered the daily activity significantly. The patient was diagnosed with functional dyspepsia subtype postprandial distress syndrome with IBS mixed type. In addition, the low-FODMAP diet was started immediately, together with pharmacological therapy (oral omeprazole and domperidone), and followed up each week. On the first week of evaluation, the patient was feeling much better as IBS-SSS assessment scores decreased, and the pharmacological therapy was stopped. On the second week of evaluation, the patient had no more complaints with IB-SSS assessment markedly decreased. This case highlights that low-FODMAP diet could be a new approach therapy for IBS that could improve the IBS symptoms.

Management of irritable bowel syndrome: a narrative review.

As our understanding of the pathophysiology of irritable bowel syndrome (IBS) has advanced, so too has the therapeutic landscape, offering a myriad of approaches to alleviate symptoms and enhance the well-being of patients. This review paper is dedicated to a comprehensive exploration of the diverse therapeutic modalities available for managing IBS. By delving into the complexities of IBS therapeutics, our aim is to contribute to the enhancement of patient care and the overall quality of life for patients grappling with this complex condition. This review utilized information from PubMed/MEDLINE using the key search term "irritable bowel syndrome" as well as the 2020 American College of Gastroenterology (ACG) and 2022 American Gastroenterological Association (AGA) society guidelines on IBS. The search was restricted to articles in the English language only and included peer-reviewed observational studies and randomized controlled trials (RCTs) in adult patients from April 22, 2020 to October 16, 2023. This review will start with an overview of the current guidelines for pharmacologic therapies for IBS as recommended by the ACG and the AGA, with an emphasis on clinical trials published after the most recent guidelines. It will then delve into the literature on dietary modifications, probiotics, fecal microbiota transplant, behavioral therapy, and complementary and alternative medicine approaches to IBS. It is evident that the management of IBS has transcended a one-size-fits-all approach. As the field of IBS management continues to evolve, it is imperative for physicians to stay informed and receptive to the array of therapeutic options available, ultimately providing patients with the most effective and personalized care.

AYURVEDIC & CONTEMPORARY PERSPECTIVE OF IRRITABLE BOWEL SYNDROME – CONCEPTUAL STUDY

Irritable bowel syndrome (IBS), often known as irritable colon, is a prevalent reason for visits to general practitioners or gastroenterologists. People with IBS experience a lot of distress. This functional, idiopathic gastrointestinal condition is characterized by abdominal pain and unusual bowel habits, such as constipation, diarrhea, and alternating diarrhea and constipation. IBS continues to be a significant health issue for people around the world who are working age. IBS is the functional GIT condition that accounts for most outpatient visits to gastroenterology clinics. IBS therapies or precise diagnostic signs still need to be improved. The fundamental cause of IBS is still unknown, and it is still very challenging to cure. The sickness is frustrating for the patient and the clinician because of the patient's poor quality of life. There is a solid theoretical basis for Ayurveda regarding the causes of IBS. IBS is known as grahani in Ayurveda, which refers to the ability of the small intestine or duodenum to remain intact. The condition is referred to as graham if the function of these organs is affected or if the gut loses control and becomes less effective at absorbing nutrients. It can be effectively managed through diet, manner of life, and stress management.

Gut–Brain Axis, Microbiota and Probiotics—Current Knowledge on Their Role in Irritable Bowel Syndrome: A Review

Irritable bowel syndrome (IBS) is a common digestive disorder with a significant impact on both individuals and society in terms of quality of life and healthcare costs. A growing body of research has identified various communication pathways between the microbiota and the brain in relation to motility disorders, with the gut–brain axis being key to the pathogenesis of IBS. Multiple factors contribute to the pathogenetic pathways in IBS, including immune mechanisms, psychosocial factors, increased oxidative stress and pro-inflammatory cytokine release, as well as genetic and hormonal factors. Increased permeability of the normal intestinal barrier allows bacterial products to access the lamina propria, providing a mechanism for perpetuating chronic inflammation and characteristic symptoms. The microbiota influences inflammatory processes in IBS by altering the balance between pro-inflammatory factors and host defence. Probiotics modulate the pathophysiological mechanisms involved in IBS by influencing the composition of the microbiota and improving intestinal motility disorders, visceral hypersensitivity, immune function of the intestinal epithelium, metabolic processes in the intestinal lumen, dysfunction of the microbiota-GBA, and are recognised as effective and safe in IBS therapy. Our study aimed to provide a comprehensive overview of the relationship between the gut–brain axis, microbiota, and IBS, based on current information.

Advances in Therapy for Irritable Bowel Syndrome with Diarrhea: Role of Rifaximin in Combination with Metronidazole

Irritable bowel syndrome (IBS) with diarrhea predominance is a subtype of IBS characterized by recurrent abdominal pain or discomfort along with frequent loose or watery stools. A significant number of individuals are impacted and are physically, socially, and emotionally impacted. Managing diarrhea-predominant IBS (IBS-D) involves a multidimensional approach due to unpredictable nature of the condition involving lifestyle modifications, dietary changes, stress management techniques, and medications. Altered gut microbiota and small intestinal bacterial overgrowth (SIBO) often precede IBS leading to dysbiosis. Systemic antibiotics and other treatment options have been reported with varied outcomes, yielding inconsistent results. Rifaximin, with its broad anti-bacterial action, along with eubiotic activity, limited systemic exposure, gut-specific action, and limited potential for drug interactions along with metronidazole is proposed as a novel treatment option for IBS-D. Rifaximin and metronidazole fixed-dose combination will not only address infectious diarrhea associated with IBS but also SIBO and postinfectious IBS with excellent efficacy and tolerability. For patients with IBS-D, rifaximin along with metronidazole can be a new treatment avenue as increasing evidence supports the hypothesis that bacterial overgrowth may be involved in the pathogenesis of IBS and parasitic infections can be a triggering factor for the exacerbation of IBS. PubMed and Google Scholar were searched through May 2023. Randomized controlled trials and reviews published in English were selected that evaluated rifaximin and/or metronidazole in patients with IBS.

Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment in primary care (ATLANTIS): a randomised, double-blind, placebo-controlled, phase 3 trial

Most patients with irritable bowel syndrome (IBS) are managed in primary care. When first-line therapies for IBS are ineffective, the UK National Institute for Health and Care Excellence guideline suggests considering low- dose tricyclic antidepressants as second-line treatment, but their effectiveness in primary care is unknown, and they are infrequently prescribed in this setting. This randomised, double-blind, placebo-controlled trial (Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment [ATLANTIS]) was conducted at 55 general practices in England. Eligible participants were aged 18 years or older, with Rome IV IBS of any subtype, and ongoing symptoms (IBS Severity Scoring System [IBS-SSS] score ≥75 points) despite dietary changes and first-line therapies, a normal full blood count and C-reactive protein, negative coeliac serology, and no evidence of suicidal ideation. Participants were randomly assigned (1:1) to low-dose oral amitriptyline (10 mg once daily) or placebo for 6 months, with dose titration over 3 weeks (up to 30 mg once daily), according to symptoms and tolerability. Participants, their general practitioners, investigators, and the analysis team were all masked to allocation throughout the trial. The primary outcome was the IBS-SSS score at 6 months. Effectiveness analyses were according to intention-to-treat; safety analyses were on all participants who took at least one dose of the trial medication. This trial is registered with the ISRCTN Registry (ISRCTN48075063) and is closed to new participants. Between Oct 18, 2019, and April 11, 2022, 463 participants (mean age 48·5 years [SD 16·1], 315 [68%] female to 148 [32%] male) were randomly allocated to receive low-dose amitriptyline (232) or placebo (231). Intention-to-treat analysis of the primary outcome showed a significant difference in favour of low-dose amitriptyline in IBS-SSS score between groups at 6 months (-27·0, 95% CI -46·9 to -7·10; p=0·0079). 46 (20%) participants discontinued low-dose amitriptyline (30 [13%] due to adverse events), and 59 (26%) discontinued placebo (20 [9%] due to adverse events) before 6 months. There were five serious adverse reactions (two in the amitriptyline group and three in the placebo group), and five serious adverse events unrelated to trial medication. To our knowledge, this is the largest trial of a tricyclic antidepressant in IBS ever conducted. Titrated low-dose amitriptyline was superior to placebo as a second-line treatment for IBS in primary care across multiple outcomes, and was safe and well tolerated. General practitioners should offer low-dose amitriptyline to patients with IBS whose symptoms do not improve with first-line therapies, with appropriate support to guide patient-led dose titration, such as the self-titration document developed for this trial. National Institute for Health and Care Research Health Technology Assessment Programme (grant reference 16/162/01).

Efficacy of probiotics, prebiotics and synbiotics in irritable bowel syndrome: a systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials.

Introduction. Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects the quality of life of numerous people worldwide.Gap statement. The therapeutic role of gut microbiota modulation in IBS remains controversial.Aim. We aimed to assess the efficacy of probiotics, prebiotics or synbiotics in patients with IBS.Methodology. We searched MEDLINE and EMBASE up to 1 August 2023, to identify the randomized, double-blind, placebo-controlled trials investigating the effectiveness of probiotics, prebiotics or synbiotics among patients with IBS. Pooled analyses of the effects of probiotics in relieving IBS symptoms were calculated using a random-effects model. Further subgroup analyses were performed by different genera, doses and duration of treatment.Results. Our final analysis included 52 trials involving 6289 IBS patients. Probiotics significantly increased the overall response rate (RR:1.64; P<0.00001), subjective relief rate (RR:1.50; P=0.0002) and abdominal pain relief rate (RR:1.69; P<0.00001). As for specific genera, mixed probiotics (RR:1.41; P=0.0001), Bifidobacterium (RR:1.76; P<0.00001), Lactobacillus (RR:1.97; P=0.0004) and Saccharomyces (RR:1.31; P=0.0004) markedly relieved IBS symptoms. Mixed probiotics (RR:1.31; P=0.005), Lactobacillus (RR:2.22; P=0.04) and Bifidobacterium (RR:1.62; P<0.0001) elevated patients' subjective relief rate. Besides, probiotics effectively relieved the abdominal pain in IBS patients (RR:1.69; P<0.00001). Probiotics appeared to show a remarkable beneficial role at a dose of 109 c.f.u./day or above (RR:1.662; P<0.0001) and started to work at 4 weeks (RR 1.72; P<0.00001). Efficacy of prebiotics and synbiotics in IBS remained uncertain, due to the deficiency of available RCTs.Conclusions. Probiotics have a therapeutic role in IBS. However, the effect of different probiotics varies. The minimal effective dose of probiotics may be 109 c.f.u./day. With appropriate probiotic formula, the therapeutic effect can occur at 4 weeks. These data provide a basis for further research on the optimal probiotic therapy in IBS.

The role of the gut microbiota and the use of new therapies in Irritable Bowel Syndrome

Introduction: Irritable bowel syndrome is a functional disorder of the gastrointestinal tract with a multifactorial nature of the disease. IBS affects 11% of the population, with the gut microbiota playing an important role in the pathophysiology. Purpose: The aim of this article is to present the course of irritable bowel syndrome, the role of the gut microbiota in pathophysiology, and new therapeutic approaches, including probiotics, based on the current state of knowledge. Conclusions: IBS is a syndrome whose exact pathophysiology is not fully understood. The state of the gut microbiota has a huge impact on the course of the disease, but also on the functioning of the whole body. New therapies currently in use, i.e. probiotics, are showing promising results, but more research is needed to find the golden mean to treat the disease. Methods: Data for the article were retrieved using PubMed setting the time descriptors to 2013-2023. Irritable bowel syndrome is one of the more common functional disorders of the gastrointestinal tract. It manifests as recurrent abdominal pain, discomfort and bloating accompanied by bowel movements without a direct underlying cause. From multicentre clinical studies, it is known that disorders of various mechanisms within the brain-gut axis, altered gastrointestinal motility and visceral hypersensitivity are the underlying causes. In addition, many scholars are of the opinion that disturbances in the gut microbiota play a key role in the pathogenesis of IBS.

Clinical Response to Personalized Dietary Therapy for Irritable Bowel Syndrome (IBS)

Clinical Response to Personalized Dietary Therapy for Irritable Bowel Syndrome (IBS)

Возможности патогенетической терапии у больных с функциональной патологией органов пищеварения

INTRODUCTION: Functional diseases of the gastrointestinal tract presents a real problem to public health. The basis of effective therapy for irritable bowel syndrome (IBS) and functional dyspepsia (FD) is a combined use of symptom-reducing drugs. AIM: To assess the dynamics of the intensity of abdominal pain and changes in the motility of stomach and intestine after treatment of patients with IBS, and with IBS in combination with FD, with STW 5 preparation. MATERIALS AND METHODS: 28 patients with IBS, including patients with a combination of IBS and FD, were taking STW 5 orally, 20 drops 3 times daily before meals for 14 days, to relieve clinical symptoms. Before and after treatment, patients completed a survey using VAS and ‘7 × 7’ questionnaires and underwent peripheral electrogastroenterocolography (EGECG). RESULTS: The level of abdominal pain before treatment in patients with predominating constipation corresponded to a moderate degree of intensity, in patients with diarrhea to a mild degree of intensity. During treatment, 32.1% of patients noted relief of abdominal pain in the second week of treatment; bloating was less common and/or did not occur in 71.4% of patients; 42.9% of study participants noted normalization of stool frequency and/or stool shape. Improvement of clinical condition in terms of FD symptoms was observed in 76.9% of patients with IBS and FD. The use of STW 5 was associated with a 51.3% reduction of pain intensity (p &lt; 0.001) after a week of treatment. Mean changes in the colon coefficient rhythmicity (Crhythm) according to the results of EGECG after treatment in patients with constipation reliably differed from the level of change in Crhythm in patients with diarrhea (p = 0.047). CONCLUSION: The results of the study confirm the effectiveness of STW 5 in the treatment of patients with IBS, and with IBS in combination with FD.

The place of antispasmodic drugs in modern therapy of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common functional disease of the gastrointestinal tract, affecting a large number of adults worldwide, and leads to a significant decrease in the quality of life. IBS places a heavy burden on patients, most of whom are able-bodied population, as well as doctors and the healthcare system. The pathogenesis of this disease is multifactorial and includes the brain-intestine axis, disorders of the immune function of the mucous membrane, visceral hypersensitivity, changes in the motility of the gastrointestinal tract, changes in the microbial composition of the intestine. Based on the fact that changes in intestinal motility and visceral hypersensitivity are among the key factors in the pathogenesis of the disease, he use of antispasmodic drugs as part of complex therapy is justified. Mebeverin is a myotropic antispasmodic drug recommended for use in patients with IBS according to Rome IV Criteria, as well as clinical recommendations of the Russian Gastroenterological Association and the Association of Coloproctologists of Russia. According to available data, mebeverin has proven to be an effective and safe antispasmodic used to treat patients with IBS. The article presents a clinical case demonstrating the experience of effective use of the drug Mebespalin®. A patient with a diagnosis of IBS with a predominance of constipation is recommended to take an antispasmodic, as well as lifestyle modification – the addition of fiber-rich foods, sufficient drinking regime and increased physical activity. A week after the start of treatment, the patient noted an improvement in her condition – abdominal pain did not bother, the stool normalized.

Vitamin D improves irritable bowel syndrome symptoms: A meta-analysis

Background & aimsApproximately 5%–10% of the population in most geographical regions suffer from irritable bowel syndrome (IBS), which creates a significant burden on individual patients, their families, and society. Recent advances in IBS therapies have indicated that vitamin D supplementation is potential to relieve its symptoms, but evidence of this is lacking. This meta-analysis aimed to estimate the effect of vitamin D on gastrointestinal (GI) symptoms in IBS patients. MethodsThe PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched from their inception to March 2022. Statistical analyses were performed with Stata 12.0 and Review Manager 5.4, and statistical significance was defined as P < 0.05. The pooled results are presented as weighted mean differences (WMD) and 95% confidence intervals (CI). ResultsThe meta-analysis including 6 randomized controlled trials (RCT) with 572 patients found a significant difference in IBS symptom severity score (WMD, −34.88; 95% CI, −62.48 to −7.27; P = 0.013; random-effects model) but no significant difference in IBS quality of life score (WMD, 3.33; 95% CI, −5.12 to −11.77; P = 0.440; random-effects model). ConclusionsOverall, IBS patients may benefit from vitamin D supplementation to reduce the GI symptoms.

Use of a synbiotic for the correction of gut microbiota and treatment of patients with irritable bowel syndrome

Introduction. Irritable bowel syndrome (IBS) is a chronic functional bowel disorder that presents with abdominal pain associated with defecation, a change in stool frequency and a change in the appearance of the stool. The high socio-medical significance of this disorder is determined by high global prevalence, impact on quality of life and significant costs for patients, health care and society. Currently, the intestinal wall status, and the qualitative and quantitative changes in gut microbiota are considered as one of the factors provoking the disorder. Given the role of microbiota in the development of irritable bowel syndrome, it is advisable to use probiotics as a therapy for IBS. Aim. To evaluate the effect of synbiotic Maxilac® on the gut microbiota and clinical signs of IBS. Materials and methods. A total of 15 (9 women and 6 men, mean age 42,6 ± 3,7 years) patients with diarrhea-predominant IBS (IBS-D) were enrolled in the study. They received Maxilac® at a dose of 1 capsule in the evening with meals for 21 days. Before and after treatment, all patients underwent bacteriological testing of faeces and assessment of clinical signs: stool frequency during the week, abdominal pain measurements using a VAS scale (mm), bloating severity measurements using a VAS scale (mm). Results and discussion. The study showed positive changes in the intestinal microbiota: a significant growth of bifidobacteria and lactobacilli (CFU), typical E.coli and enterococci. The number of hemolytic E. coli, Staphylococcus aureus and Candida fungi (CFU) was significantly reduced. In the Maxilac® group, the defecation frequency decreased from 31 to 16 times a week (p &lt; 0.05); abdominal pain from 55 to 35 VAS scores (p &lt; 0.05); bloating from 60 to 40 VAS scores (p &lt; 0.05). Conclusions. The synbiotic Maxilac® is one of the drugs that can be efficiently and safely used as part of combination therapy for IBS.

Computer Engineering Research: Innovative Treatment Methods and Genetic Analysis of Digestive Tract Diseases based on Neuroscience and VR Technology

Background: According to the data from the Autonomous University of Barcelona, Spain, at present, 20% of people in the world may suffer from irritable bowel syndrome. Research methods: The research group has carried out computational engineering modeling for music therapy of irritable bowel syndrome, which uses virtual reality technology that can interfere with human biological neural network, and has also carried out the process design of biological neural network working mechanism, using computer engineering to complete necessary stimulation, and using neural network algorithm model to complete in-depth learning, After the algorithm modeling is successful, it can complete the prediction of the improvement of patients by music chords of different emotional colors, and provide clinicians with new ideas for treatment and health economic intelligent products. The first author looks forward to the cooperation between Chifeng University and Barcelona Autonomous University in the research of irritable bowel syndrome, expounds the advantages of both sides, and expresses a strong willingness to communicate. At the same time, the advantages of the Sakharov Institute in Belarus are discussed. Results: The research team carried out research in combination with biological neural network experiment and social experiment, and completed the market demand survey. Conclusion: The chord trend in this model can complete the intervention for patients. Patients have better subjective feelings, and the algorithm model is highly popularized. Virtual reality technology can be used as an important medium to complete this work, which is suitable for promotion.

Efficacy and safety of probiotics in the treatment of irritable bowel syndrome: A systematic review and meta-analysis of randomised clinical trials using ROME IV criteria

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder which affects a great number of patients globally. Clinical trials and meta-analyses have evaluated different therapies for IBS. Some of them have shown that probiotics play a significant role in the management of IBS-patients. Nevertheless, results are controversial, and the efficacy of the administration of probiotics remains to be confirmed, especially in regard to which type of probiotic-strains are beneficial. The aim of the present meta-analysis is to assess the efficacy and safety of the administration of probiotics to IBS-patients with a diagnosis based on Rome IV criteria, which is performed for the first time. Electronic databases (Pubmed, Scopus and Cochrane) were searched until 26.01.2023 for randomized controlled trials (RCTs) studying the administration of probiotics in adult IBS-patients, who were categorized according to the Rome IV criteria. The risk of bias was assessed using the Cochrane Risk of Bias tool (ROB) 2.0. Weighted and standardized mean difference with the 95% confidence intervals were used for the synthesis of the results. Primary outcomes were the decrease of IBS-Symptom Severity Score (IBS-SSS) and decrease of abdominal pain. The secondary outcomes were the improvement in quality of life (QoL) and the decrease of bloating. Lastly, the adverse effects of probiotics were evaluated. The protocol of the study has been registered at protocols.io (DOI dx.doi.org/10.17504/protocols.io.14egn218yg5d/v1). Six double-blind (N=970) placebo-control RCTs fulfilled the inclusion criteria and overall, nine different strains of probiotics were examined. No significant reduction in IBS-SSS (WMD-43.2, 95% CI-87.5 to 1.0, I2=82.9%) was demonstrated, whereas a significant decrease regarding abdominal pain (SMD-0.94, 95% CI-1.53 to-0.35, I2=92,2) was shown. Furthermore, no correlation between improvement of QoL and the use of probiotics (SMD-0.64, 95% CI-1.27 to 0.00, I2= 93,9%) was shown. However, probiotics were associated with a significant reduction in bloating (SMD-0.28, 95% CI-0.47 to-0.09, I2= 36,0%). A qualitative synthesis was conducted about adverse events and showed that the use of probiotics' is safe without severe adverse events. The administration of probiotics to IBS-patients demonstrated a positive effect on pain and bloating, but due to significant heterogeneity and confounding factors, that were not examined in the included studies, a definitive statement cannot be made. Moreover, probiotics did not lead to an improvement in other parameters. There is a need for larger RCTs in IBS-patients diagnosed according to Rome IV (not III) criteria and especially it is essential to be conducted RCTs which examine the administration of specific strains and have similar methodological characteristics.

Current evidence for dietary therapies in irritable bowel syndrome.

Diet appears to trigger symptoms in the majority of individuals with irritable bowel syndrome (IBS) and is associated with a reduced quality of life. There has been a recent focus on the role of dietary therapies to manage individuals with IBS. The aim of this review is to discuss the utility of traditional dietary advice (TDA), low-FODMAP diet (LFD) and gluten-free diet (GFD) in IBS. Several recent randomized controlled trials (RCTs) have been published demonstrating the efficacy of the LFD and GFD in IBS, with the evidence base for TDA being predominantly based on clinical experience, with emerging RCTs evaluating TDA. Only one RCT has been published to date comparing TDA, LFD and GFD head to head, with no difference noted between diets in terms of efficacy. However, TDA has been noted to be more patient-friendly and is commonly implemented as a first-line dietary therapy. Dietary therapies have been demonstrated to improve symptoms in patients with IBS. In view of insufficient evidence to recommend one diet over another currently, specialist dietetic input in conjunction with patient preference is required to determine implementation of dietary therapies. Novel methods of dietetic delivery are required in view of the lack of dietetic provision to deliver these therapies.

In Silico, In Vitro, and Ex Vivo Biological Activity of Some Novel Mebeverine Precursors

In silico analysis aimed at predicting the pharmacodynamic profile of the compounds was performed. Based on these predictions, ex vivo bioelectrical activity (BEA) and immunohistochemical effects of the compounds were established. A thorough biological evaluation of the compounds was conducted assessing their in vitro antimicrobial and cytotoxic activity. All the newly synthesized compounds exerted drug-like properties, whereby 3-methyl-1-phenylbutan-2-amine 3 showed a significant change in BEA due to Ca2+ channel regulation, Ca2+ influx modulation, and a subsequent change in smooth muscle cell response. The immunohistochemical studies showed a good correlation with the obtained data on the BEA, defining amine 3 as a leader structure. No cytotoxicity to human malignant leukemic cell lines (LAMA-84, K-562) was observed for all tested compounds. Based on the experimental results, we outlined 3-methyl-1-phenylbutan-2-amine 3 as a potential effective choice for orally active long-term therapy of IBS.

Nonceliac gluten sensitivity.

To describe recent advances on nonceliac gluten sensitivity (NCGS), a recently described disorder characterized by variable symptoms and frequent irritable bowel syndrome (IBS)-like manifestations. The recent description of disease-triggering wheat components other than gluten, such as fructans and amylase-trypsin inhibitors (ATIs), definitely suggests that nonceliac wheat sensitivity (NCWS) is a better 'umbrella' terminology than NCGS. Self-reported NCWS is very common worldwide, particularly in patients seen at the gastroenterology clinic, but many of these diagnoses are not confirmed by standard clinical criteria. A biomarker of NCWS is still lacking, however, subtle histological features at the small intestinal biopsy may facilitate diagnosis. Treatment of NCWS is based on the gluten-free diet (GFD). The GFD has proven to be an effective treatment of a significant proportion of NCWS-related IBS patients. Dietary therapies for IBS, including the GFD, should be offered by dietitians who first assess dietary triggers and then tailor the intervention according to patient choice. Pioneer studies are under way to test the therapeutic efficacy of supplemental gluten-digesting enzyme preparations in patients with NCWS. Recent studies highlight interesting pathophysiological and clinical features of NCWS. Many questions remain, however, unanswered, such as the epidemiology, a biomarker(s), and the natural history of this clinical entity.