Type Irritable Bowel Syndrome Research Articles

Brain function in patients with diarrhea type irritable bowel syndrome after rectal balloon distention

Objective To investigate the correlation between activated brain regions examined by functional magnetic resonance imaging (fMRI) after rectal balloon distention and intestinal symptoms, psychological status, and quality of life in patients with diarrhea type irritable bowel syndrome (IBS-D) at different stages of disease. Methods According to the symptoms status, patients with IBS-D were divided into onset group (seven patients), remission group (five patients) and persistence group (six patients), and six healthy individuals were selected as healthy controls at the same time. After stimulated with rectal balloon distention at first sensation thresholds, continual defecation thresholds or 80% of maximum tolerable thresholds, patients received fMRI examination. Analysis of variance and two-sample t test were used to compare the difference in activated brain areas between two groups. Pearson analysis was performed to analyze the correlations between activated brain areas and scores of irritable bowel syndrome (IBS) intestinal symptom, Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA) and irritable bowel syndrome special quality of life scale (IBS-QOL). Results There was no significant difference in first sensation thresholds, continual defecation thresholds or 80% of maximum tolerable thresholds between patients of different groups. After rectal balloon distention, there were differences in such brain areas: bilateral anterior cingulate cortex (ACC), left inferior parietal lobe, and left middle frontal gyrus. Compared with those of control group, the activation of ACC, inferior parietal lobe and middle frontal gyrus lowered in patients of onset group (both P<0.05). There was positive correlation between the activation of middle frontal gyrus and intestinal symptom scores in persistence group(r=0.823, P=0.048). There were negative correlations between the activation of inferior parietal lobe (r =-0.816, P=0.048), middle frontal gyrus(r=-0.860, P=0.028) of persistence group, activation of middle frontal gyrus (r=-0.892, P=0.042) of remission group and HAMD score. There were positive correlations between the activation of inferior parietal lobe (r =0.818, P=0.047), middle frontal gyrus(r = 0.907, P=0.013) of persistence group, activation of midfrontal gyrus (r = 0.914, P=0.030) of remission group and scores of IBS-QOL. Conclusion The brain regions were activated during the rectal balloon distention both in IBS-D patients and healthy controls, and there were differences in activated brain regions among different stages of IBS-D. Key words: Irritable bowel syndrome; diarrhea; Magnetic resonance imaging; Brain region activities; Rectal balloon distention

Evaluating the efficacy of mixture of Boswellia carterii, Zingiber officinale, and Achillea millefolium on severity of symptoms, anxiety, and depression in irritable bowel syndrome patients.

Background:Irritable bowel syndrome (IBS) is the most prevalent functional gastrointestinal disorders (FGIDs) that affects in different aspects of life and patients experienced depression and anxiety more than others. There are several herbal medicines with positive effects in these patients. The aim of this study is to evaluate the effects of mixture of Boswellia carterii, Zingiber officinale, and Achillea Millefolium on severity of symptoms, anxiety, and depression in IBS patients.Materials and Methods:This clinical trial study was done in sixty IBS patients (with mild-to-moderate symptoms) divided into two case and control groups. Patients were assessed at the beginning, 1 month, and 3 months after by IBS-severity scoring system (IBS-SSS) and Hospital Anxiety and Depression Scale. IBS-SSS is used for quality of life evaluation too.Results:Sixty IBS patients (with mild to moderate symptoms) with a mean age of 38.75 ± 11.74 participated that 55.4% of cases and 72.8% of controls were men. The most prevalent type of IBS was the mixed type of IBS. The mean score of abdominal pain severity and frequency, bloating score, and depression and anxiety score were decreased in patients administered herbal medication, but changes in these variables in controls were not statistically significant. The changes in quality of life score between cases and controls were significant in men (P = 0.01) although it was not significant in women.Conclusion:A mixture of B. Carterii, Z. officinale, and A. millefolium is effective in eliminating IBS symptoms and its related depression and anxiety and using herbal medicine in IBS treatment is suggested.

Frequency of Irritable Bowel Syndrome Among Healthcare Personnel.

This study aims to investigate the frequency of irritable bowel syndrome (IBS) among healthcare professionals. A total of 394 healthcare professionals and 207 individuals who were selected as a control group were included in the study. A questionnaire form containing Rome III diagnostic criteria was administered to health workers and the control group. The study groups were evaluated according to age, gender, occupation, profession, presence of chronic disease, drug usage, smoking, awareness of IBS, alarm symptoms, and the type of IBS they have. Irritable bowel syndrome was diagnosed in 44 healthcare workers and 10 control group participants. Of the 44 healthcare professionals with IBS, 6 had alternate, 13 had constipated-dominant, and 25 had diarrhea-dominant IBS. Of the 10 persons in the control group who were diagnosed as having IBS, 5 were diarrhea-dominant and 5 were constipated-dominant type. Irritable bowel syndrome was more frequent in healthcare professionals than in the control group. Healthcare workers are more prone to IBS due to their stressful working environment.

Effectiveness of an Instructional Program concerning Knowledge on clients with Irritable Bowel Syndrome in Liver and Digestive Disease Hospital at Baghdad City

Background: Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder characterized by abdominal pain with diarrhea and/or constipation and defecation with mucus. The etiology of IBS has not been definitively established., The IBS remains a condition that can seriously compromise an individual s’ quality of life. Objective: The present study aims to identify the effectiveness of an Instructional Program concerning Knowledge on clients with Irritable Bowel Syndrome . Methodology: A quasi-experimental design study conducted in Liver and Digestive Disease Hospital at Baghdad City of the period of January ,20th 2015 to October, 1st 2015, the study sample consist of 60 clients have IBS, divided into two groups (30) case and (30) control groups. The study instrument was composed of three parts which as socio- demographic information was included 5 items; (age group, gender, marital status, level of education, occupational), and second parts deals medical history which include (4) items BMI, The duration of developing IBS, type of IBS, diseases, smoking and alcohol drinking, other chronic diseases and factors affecting disease). part three consist of 5 domains concerned to clients knowledge toward the IBS which include (definition, causes and symptoms, diagnosis, and treatment plan which include (dietary change, drug therapy, psychotherapy, herbal therapy, and flow up). The data have been analyzed through the application of: descriptive analysis (frequency, percentages; mean of scores; and the inferential analysis that include: Analysis of variance, and the researcher used the SPSS version 21 to analysis of data. Results: the findings revealed that the 56% of the case group were females at age 33-37 years old, 56% were married at institute &amp; collage graduated, 66.6% of the case group have government employment, 40% of them have IBS of 1-3 years , 50% of the case group have diarrhea prodromal , high percent of them not Smoker, and the results revealed that their effectiveness of instructional program on IBS clients at P≤ 0.05 level. Conclusion: the study concluded that the program applied by the researchers was a clear impact on improving the knowledge of clients relating to the definition and symptoms and how to control the disease through the pretest and posttest of the program. Recommendation: the study recommends to increase health awareness among people through the implementation of courses and lectures in coordination with the Ministries of Health and Education and Higher Education in order to control the causes of disease and reduce symptoms of IBS.

Irritable bowel syndrome (IBS) and stress; a study of international medical school students

IntroductionIrritable bowel syndrome is one of the most commonly diagnosed functional gastrointestinal disorders. Irritable bowel syndrome (IBS) and its association with stress have not been researched in regards to foreign medical students in Cluj-Napoca, Romania.ObjectiveTo establish the prevalence of IBS in foreign medical school students and the relationship with stress.MethodsThis observational case-controlled study was carried out in “Iuliu Hatieganu” University of Medicine and Pharmacy in Cluj-Napoca, Romania. The sample size was 102, and the data was collected using an online self-report questionnaire. The ‘Rome 3 criteria’ was used to diagnose IBS and ‘Stressful Life Events Check-list’ was used to measure levels of stress.ResultsThe prevalence of IBS was 24.5%, with females having higher rates (34%) compared to males (16.4%). The types of IBS were IBS-M (mixed form) 8.8%, IBS-D (diarrhoea dominant) 6.9%, IBS-C (constipation dominant) 5.9% and IBS-U (undefined) 2.9%. Students with IBS reported higher social stress compared to students without IBS.ConclusionsMore efforts should be made to combat stress that medical students experience in order to reduce the number of IBS cases. This may involve an increased role of the medical school to develop initiatives and support, with the aim of helping medical school students better cope with stress and stressful events.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Personality traits and emotional patterns in irritable bowel syndrome.

The review focuses on those personality traits (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness), constructs (alexithymia and distressed - Type D personality) and emotional patterns (negative and positive) that are of particular concern in health psychology, with the aim to highlight their potential role on the pathogenesis, onset, symptom clusters, clinical course, and outcome of irritable bowel syndrome (IBS). Personality traits and emotional patterns play key roles in affecting autonomic, immune, inflammatory, and endocrine functions, thus contributing not only to IBS clinical expression and symptomatic burden, but also to disease physiopathology. In this sense, psychological treatments should address those personality traits and emotional features that are constitutive of, and integral to IBS. The biopsychosocial model of illness applied to IBS acknowledges the interaction between biological, psychological, environmental, and social factors in relation to pain and functional disability. A holistic approach to IBS should take into account the heterogeneous nature of the disorder, and differentiate treatments for different types of IBS, also considering the marked individual differences in prevalent personality traits and emotional patterns. Beyond medications, and lifestyle/dietary interventions, psychological and educational treatments may provide the optimal chance of addressing clinical symptoms, comorbid conditions, and quality of life in IBS patients.

Irritable Bowel Syndrome among Medical and Non-Medical Northern Border University Students, Kingdom of Saudi Arabia: Across Sectional Study

Background: Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder (FGID), characterized by abdominal pain or discomfort and alteration in bowel habits. Aim of the study: To determine the overall prevalence, prevalence of each type and risk factors of IBS among Northern Border University (NBU) students, Arar, Kingdom of Saudi Arabia. Material and methods: We use cross sectional, descriptive study with multistage cluster probability sample. Using Rome III criteria questionnaire of IBS; which is a self-administrated consists of ten questions assessing the current status of an apparently normal person. The questionnaire is administrated to Northern Border University students. Results: A total of 228 University students of them, 94 (41.2%) males and 134 (58.8%) females were included in the study. The overall prevalence of IBS according to Rome III criteria in northern border University was (32.5%). The disease prevalence was 33.6% in females and 30.9% in males. Among the study participants, the most common type of IBS was the mixed one 12.7%, followed by the constipation predominant type 10.5%, then the diarrhea pre-dominant type 5.7% while the least common was unsubtyped cases (3.5%). Statistically significant increase in prevalence of this disease was found among female students (60.8% vs. 39.2% in males) (p-value < 0.05), the students who experienced psychic stress and irritability (79.7%) (p-value < 0.05) and students who were obese (p-value < 0.001). Conclusion: The results of this study concluded the prevalence rate of 32.5% for IBS among the students studying in Northern Border University. Stress and high body mass index were significantly associated with IBS. In addition, this study concluded that IBS was not significantly associated with socio-demographic characteristics and smoking.

Hydrodistension with or without fulguration of hunner lesions for interstitial cystitis: Long-term outcomes and prognostic predictors.

Hydrodistension of the bladder, with optional fulguration of Hunner lesions, is one of the recommended therapies for interstitial cystitis (IC). The aims of this study are to evaluate long-term outcomes of hydrodistension and identify outcome predictors. The study cohort was 191 newly diagnosed IC patients (155 women and 36 men) who underwent hydrodistension with fulguration of Hunner lesions if detected between 2007 and 2013 at our institution. The primary outcome was therapeutic failure, which was defined as repeat hydrodistension, bladder instillation therapy, or narcotic use for pain control. Clinical features, including comorbidities and endoscopic findings, were analyzed along with the outcome. The cohort comprised 126 patients of Hunner type IC and 65 patients of non-Hunner type IC. The mean time to therapeutic failure was 28.5 months in Hunner type IC and 25.2 months in non-Hunner type IC. The therapeutic failure rate was higher in non-Hunner type IC at 17.3 months; however, the long-term outcomes reversed thereafter. The mean time to therapeutic failure was shorter in patients with lumbar spinal stenosis (LSS) or irritable bowel syndrome (IBS). Multivariate analysis identified LSS as a predictor for failure in Hunner type IC and non-Hunner type IC (HR = 18.8, P = 0.001; HR = 3.8, P = 0.028, respectively) and IBS in non-Hunner type IC (HR = 18.0, P = 0.008). Bladder hydrodistension, with fulguration of the Hunner lesions, improved IC symptoms. The outcome was worse in non-Hunner type IC shortly after hydrodistension but eventually comparable across the two types. Concomitant LSS and IBS were predictors for poor outcome. Neurourol. Urodynam. 35:965-969, 2016. © 2015 Wiley Periodicals, Inc.

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

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

Two gastrointestinal conditions with similar symptoms and endoscopic appearance: irritable bowel syndrome and microscopic colitis.

Irritable bowel syndrome (IBS) is a gastrointestinal condition characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any organic cause. This trial investigated the presence of microscopic colitis (MC) and associated factors related to MC in patients diagnosed with IBS. The study group (group I) consisted of 91 consecutive patients diagnosed with IBS based on the Rome III Criteria for whom colonoscopic examination was requested. The control group (group II) had 41 patients diagnosed with IBS considered as eligible for colonoscopic investigation due to specific conditions, and for whom colonoscopic examination was recommended for screening purposes due to a familial history of colon cancer. Clinical data, endoscopic findings, and the effects of the therapy were evaluated. In the diarrhea-predominant IBS group, nine patients (9.89%) were diagnosed with microscopic colitis, seven with lymphocytic colitis (7.69%), and two with collagenous colitis (CC) (2.19%). None of the patients in group II were found to have MC (P = 0.007). There were no diagnoses of MC in the constipation-predominant and mixed type IBS groups. Clinicians should keep MC in mind for patients presenting with diarrhea-predominant IBS symptoms.

La dieta con bajo contenido en hidratos de carbono de cadena corta y polioles fermentables mejora los síntomas en pacientes con trastornos funcionales gastrointestinales en España

Background and aimsSuccessful treatment of patients with irritable bowel syndrome (IBS) often remains elusive. Recent studies in Australia, the United Kingdom and New Zealand have suggested the efficacy of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) in the management of these patients. The aims of this study were to determine whether a diet low in FODMAPs improves symptoms in patients with functional gastrointestinal disorders (FGID) in Spain and to analyze the predictors of a good response. Patients and methodsA prospective study was carried out in consecutive patients with FGID type IBS and functioanl abdominal bloating. At inclusion all patients underwent an assessment through a baseline demographic questionnaire of symptoms of anxiety and depression and quality of life. A hydrogen breath test with lactose and fructose was performed and a low FODMAPs diet was indicated for 2 months by expert dietitians. These tests were taken as a reference. A positive response was defined as an improvement of at least 5 points out of a possible 10 in the symptom questionnaire. ResultsWe included 30 patients (24 women, 39 [12] years). The response to the low FODMAPs diet was positive in controlling overall symptoms and specific symptoms such as functioanl abdominal bloating, abdominal pain, diarrhea, flatulence, nausea and fatigue in more than 70% of patients (P<.05). By contrast, constipation was controlled in only 48% of patients (P>.05). Adherence to the diet was good in 87% of patients and was a predictor of positive response in the univariate analysis. ConclusionsA diet low in FODMAPs is associated with symptom improvement in patients with IBS and functioanl abdominal bloating. Adherence to the diet was a determining factor.

Effectiveness Of Probiotics In Irritable Bowel Syndrome: A Systematic Review With Meta-Analysis.

AIM: To investigate the efficacy of probiotics in irritable bowel syndrome (IBS) patients. METHODS: PubMed, Cochrane library, Scopus, Google Scholar, and Clinicaltrial.gov databases were searched for literature published between September 2007 and December 2013. The applied Mesh terms were “probiotics,” “irritable bowel syndrome,” and “irritable bowel syndrome treatment.” The collected data contained24 clinical trials, of which 15 were eligible for meta-analysis and nine were reviewed systematically. All studies were randomized placebo-controlled trials in patients with IBS that investigated the efficacy of probiotics in IBS improvement. The Jadad score was used to assess the methodological quality of trials. The quality scale ranges from 0 to 5 points, with a score ≤ 2 indicating a low quality report, and a score of ≥ 3 indicating a high quality report. Relative risk (RR), standardized effect size, and 95%CI were calculated using the DerSimonian-Laird method. The Cochran Q test was used to test heterogeneity with P < 0.05. Funnel plots were constructed and Egger’s and BeggMazumdar tests were performed to assess publication bias. RESULTS: A total of 1793 patients were included in the meta-analysis. The RR of responders to therapies based on abdominal pain score in IBS patients for two included trials comparing probiotics to placebo was 1.96 (95%CI: 1.14-3.36; P = 0.01). RR of responders to therapies based on a global symptom score in IBS patients for two included trials comparing probiotics with placebo was 2.43 (95%CI: 1.13-5.21; P = 0.02). For adequate improvement of general symptoms in IBS patients, the RR of seven included trials (six studies) comparing probiotics with placebo was 2.14 (95%CI: 1.08-4.26; P = 0.03). Distension, bloating, and flatulence were evaluated using an IBS severity scoring system in three trials (two studies) to compare the effect of probiotic therapy in IBS patients with placebo, the standardized effect size of mean differences for probiotics therapy was -2.57 (95%CI: -13.05--7.92). CONCLUSION: Probiotics reduce pain and symptom severity scores. The results demonstrate the beneficial effects of probiotics in IBS patients in comparison with META-ANALYSIS Submit a Manuscript: http://www.wjgnet.com/esps/ Help Desk: http://www.wjgnet.com/esps/helpdesk.aspx DOI: 10.3748/wjg.v21.i10.3072 World J Gastroenterol 2015 March 14; 21(10): 3072-3084 ISSN 1007-9327 (print) ISSN 2219-2840 (online) © 2015 Baishideng Publishing Group Inc. All rights reserved. 3072 March 14, 2015|Volume 21|Issue 10| WJG|www.wjgnet.com inhibitors, tricyclic antidepressants, and 5-hydroxytryptamine type-3 antagonists such as ramosetron and alosetron, and lubiprostone and linaclotide. However, due to lack of favorable efficacy and associated adverse events with pharmacologic treatments, some IBS patients look for alternative treatments such as herbal medications and Chinese acupuncture. Probiotics are live microorganisms which have been demonstrated to exhibit potential effects on human health. Probiotics may influence the IBS symptoms including abdominal pain, bloating, distension, flatulence, altered bowel movements, and gut microbiota. The nature of probiotics explains their beneficial role in intestinal function as they can protect against pathogenic bacteria via their antimicrobial properties. Probiotics also amplify the intestinal tight junctions and stabilize the permeability. Moreover, probiotics stimulate goblet cells to produce mucus to enhance the intestinal barrier function, normalize bowel movements, and reduce visceral hypersensitivity in pediatric and adult patients. Several probiotic strains showed beneficial outcomes in IBS patients. The present study was performed to update the previous meta-analysis with consideration of further clinical trials. A systematic review has been also conducted to assess the efficacy of probiotics in IBS patients in clinical trials that were not eligible for inclusion in the meta-analysis. MATERIALS AND METHODS Data sources PubMed, Cochrane library, Scopus, Google Scholar, and Clinicaltrial.gov databases were searched for articles published between September 2007 and December 2013. The applied Mesh terms were “probiotics,” “irritable bowel syndrome,” and “irritable bowel syndrome treatment.” Study selection Three reviewers inspected the topic and abstracts of all articles to eliminate identical studies, review articles, systematic reviews, and meta-analysis investigations. All relevant characteristics of included trials, such as IBS type, probiotic strain, dose of probiotics, trial and follow-up duration, and patient characteristics and outcomes, were collected and summarized. All randomized controlled trials that considered IBS symptom improvement as outcome of interest were included. The reference lists of searched articles were reviewed to identify any additional eligible articles. Assessment of trial quality The Jadad score, which indicates the quality of studies based on their description of randomization, blinding, and dropouts (withdrawals), was used to assess the methodological quality of trials. The quality Didari T et al . Effectiveness of probiotics in IBS 3073 March 14, 2015|Volume 21|Issue 10| WJG|www.wjgnet.com placebo.

Fructose Malabsorption in Patients With Irritable Bowel Syndrome-like Symptoms: What Is the Role in the Pathogenesis and Clinical Implication?

Article: Unclear abdominal discomfort: pivotal role of carbohydrate malabsorption Goebel-Stengel M, Stengel A, Schmidtmann M, van der Voort I, Kobelt P, Mönnikes H.

Importance of rectal urgency in childhood irritable bowel syndrome.

TO THE EDITOR: We read with interest the article titled “The incidence of irritable bowel syndrome in children using the Rome III criteria and the effect of trimebutine treatment” by Karabulut et al1 that is a rare and a valuable study from our country. As the author stated, functional dyspepsia and urgency are very common symptoms in irritable bowel syndrome (IBS) patients. Although the association with the functional dyspepsia is known there is limited study regarding the frequency of rectal urgency in literature and we consider this knowledge to be of importance. In adult studies it was reported that rectal urgency is common especially in diarrheal type of IBS, although it is not included in the Rome III criteria. Cheng et al2 in their study indicated 83% association between rectal urgency and IBS in only 6 cases. Karabulut et al1 reported frequency of rectal urgency as 66.7% in children. That shows rectal urgency is an important symptom in childhood IBS and shed light on new studies about its utility as a diagnostic criteria. It was also shown that colonic motility is related with opioid receptors in colon by pathophysiologic studies. Another important point from the study is the successful result with the trimebutine maleate that is effective on opioid receptors. Current treatments are not effective enough against IBS symptoms and new treatment modalities are necessary. Trimebutin maleate, one of the treatment options, shows encephalin like effect and binds to intestine smooth muscle μ and δ receptors. It is stimulatory in case of hypomotility states and inhibitory in case of hypermotility states.3 Although the success rate is approximately 50% in adults, it is important to note that it was more than 90% in children population in terms of pain and abdominal discomfort. It suggests that opioid receptors have an important role in the pathogenesis of childhood IBS. In a recent study, it was shown that urgency symptoms improved markedly with Eluxadoline that exerts its effects by opioid receptors.4 However, recovery of the IBS symptoms was evaluated according to the last week’s pain and abdominal discomfort. Therefore, it is yet a question weather the drug has a long-term effect or not. Last but not least, IBS and related syndromes (chronic pain syndrome, fibromyalgia and chronic pelvic pain syndrome) can affect the quality of life and cause decline in school performance in children. Even though the primary aim of this study is not to evaluate quality of life, successful treatment of pain and abdominal discomfort symptoms with trimebutine maleate will support the healthy psychosocial development and quality of life in children.

Therapeutic effects of biobran, modified arabinoxylan rice bran, in improving symptoms of diarrhea predominant or mixed type irritable bowel syndrome: a pilot, randomized controlled study.

Background. Recently, it was revealed that low grade mucosal inflammation and/or immune imbalance of the lower digestive tract is one of the mechanisms involved in symptom generation in patients with irritable bowel syndrome (IBS). Biobran, arabinoxylan compound derived from rice bran, has been reported to have several biological actions such as anti-inflammatory and immune modulatory effects. So we investigated the therapeutic effects of Biobran in patients with IBS. Method. Forty patients with diarrhea predominant or mixed type IBS were randomly assigned to either a Biobran group for treatment with Biobran or a placebo group. Therapeutic efficacy and IBS symptoms were assessed subjectively by the patients after 4 weeks of administration. Results. The global assessment was effective in 63.2% of the Biobran group and in 30% of the placebo group (P < 0.05, Biobran group versus placebo group). Biobran group showed a significant decrease in the score of diarrhea and constipation and in CRP value. However, no significant changes were observed in the placebo group. Conclusion. The administration of Biobran improved IBS symptoms. It is likely that anti-inflammatory and/or immune modulatory effects of Biobran might be useful in IBS patients.

Long-Term Success of GUT-Directed Group Hypnosis for Patients With Refractory Irritable Bowel Syndrome: A Randomized Controlled Trial

Gut-directed hypnotherapy (GHT) in individual sessions is highly effective in the treatment of irritable bowel syndrome (IBS). This study aimed to assess the long-term effect of GHT in group sessions for refractory IBS. A total of 164 patients with IBS (Rome-III-criteria) were screened, and 100 refractory to usual treatment were randomized 1:1 either to supportive talks with medical treatment (SMT) or to SMT with GHT (10 weekly sessions within 12 weeks). The primary end point was a clinically important improvement on several dimensions of daily life (assessed by IBS impact scale) after treatment and 12-month follow-up. The secondary end point was improvement in general quality of life (QOL; Medical Outcome Study Short-Form-36), psychological status (Hospital Anxiety Depression Scale) and reduction of single IBS symptoms. Analysis was by intention to treat. A total of 90 patients received allocated intervention. After treatment, 28 (60.8%) out of 46 GHT patients and 18 (40.9%) out of 44 SMTs improved (absolute difference 20.0%; 95% confidence interval (CI): 0-40.2%; P=0.046); over 15 months, 54.3% of GHT patients and 25.0% of controls improved (absolute difference 29.4%; 95% CI 10.1-48.6%; P=0.004). GHT with SMT improved physical and psychological well being significantly more than SMT alone (P<0.001). Gender, age, disease duration and IBS type did not have an influence on the long-term success of GHT. GHT improves IBS-related QOL, is superior to SMT alone, and shows a long-term effect even in refractory IBS.

Correlation between diarrhea type irritable bowel syndrome overlapped with functional dyspepsia andpsychology and gastrointestinal hormones

Objective To investigate the psychological status of diarrhea type irritable bowel syndrome （D-IBS） patients overlapped with functional dyspepsia （FD） and its relationship with the changes of brain-gut peptides and cytokines levels. Methods A total of 190 D-IBS-FD overlapped patients and 30 healthy controls were selected and all of them completed the questionnaire. The adult psychological testing system was applied for the Symptom Checklist （SCL-90） assessment. Plasma levels of 5-hydroxytryptamine （5-HT）, somatostatin （SS）, vasoactive intestinal peptide （VIP）, endothelin （ET）, interleukin （IL）-10 and IL-12 were measured in 59 randomly selected patients.Single factor analysis of variance and LSD test were performed for statistical analysis. Results In D- IBS-FD overlapped patients, the plasma 5-HT levels of the D-IBS patients and the FD patients were （1906.83±676. 88） μg/L and （1745. 53±653. 23） μg/L respectively, both of them were significant higher than those of control group [（1289.44±918.45） μg/L, LSD test, both P〈0. 051. However the levels of VIP and IL-10 were significant lower than those of control group （LSD test, both P〈0.01）. In D-IBS patients, the plasma level of SS was significantly lower than that of control group （LSD test, P=0. 025） ; the level of ET was significantly higher than that of control group and FD patients （LSD test, both P〈0. 05）. In D-IBS-FD overlapped patients, the scores of anxiety, depression and opponent were higher than those of control group （F=5. 114, 4. 555 and 10. 285, all P〈0.05）. The plasma VIP and SS levels of patients with anxiety or depression were lower than those of control group （LSD test, both P〈0.05）. The plasma VIP level was lower than that of patients without psychological disorders （LSD test, P=0. 005）. The plasma ET level of patients with disease course over five years was significantly higher than that of patients with disease course less than one year or between one and five years （LSD test, both P〈0.05）, and the IL-10 level was significantly lower than that of patients with disease course less than one year （LSD test, P=0. 004）. Conclusions There were sub-healthy psychology state in D-IBS-FD overlapped patients. The overlapping symptoms may be correlated with disease course, psychological disorder, the increased plasma 5-HT level and the decreased IL-10 level. There was close correlation between the lower gastrointestinal symptoms and the decreased levels of VIP, SS and the increased level of ET. Key words: Irritable bowel syndrome; Dyspepsia; Anxiety; Serotonin; InterIeukin 10; Vasoactive intestinal peptide; Somatostatin; Endotoxins

Editorial: Non-Celiac Wheat Sensitivity: Separating the Wheat from the Chat!

Historically, it has been reported that patients with undetected celiac disease (CD) may present with irritable bowel syndrome (IBS) type symptoms. This has led to the recommendation by the American College of Gastroenterology Task force that patients presenting with diarrhea predominant IBS type symptoms should be serologically tested for CD. Concurrently speculative media data suggest that the US general public have increased their uptake of a gluten-free diet (GFD) far in excess of the known prevalence of CD. This may suggest that individuals with gastrointestinal symptoms are deriving benefit from a GFD even if they do not have CD. This has led to the scientific community considering the evidence for an emerging concept of non-celiac wheat sensitivity. There is a significant disparity in our views about what this phenomenon may be. There is also confusion about the nomenclature for this entity and indeed whether patients are suffering due to symptoms related to gluten or perhaps other components of wheat, for example fructans. In this month's edition of the American Journal of Gastroenterology, we see evidence to support the clinical concept of wheat sensitivity or intolerance. Irrespective of the nomenclature Carroccio provides a clinically applicable approach that may be adopted internationally by clinicians. This offers a new option in our armamentarium when seeing patients with IBS type symptoms.

Targeted screening for Coeliac Disease among irritable bowel syndrome patients: analysis of cost-effectiveness and value of information

A high prevalence of Coeliac Disease (CD) is found among patients with a clinical diagnosis of irritable bowel syndrome (IBS) compared to the general population. Symptoms of CD are quite similar to IBS, but its treatment is different. The aim of this study was to evaluate the cost-effectiveness of screening for CD in patients with diarrhoea/mixed type IBS (IBS-D/mix) in terms of cost per quality adjusted life year (QALY) in the Netherlands. A decision model was constructed to evaluate the costs and health benefits of serological testing followed by confirmatory endoscopy with biopsy. Probabilistic sensitivity analysis (PSA) was performed to examine the effect of parameter uncertainty. Finally, the budget impact of implementing the screening process was also computed for implementation over a 10-year time horizon. Screening resulted in an increase of about 0.07 quality life years (QALYs) per patient over a lifetime horizon. The incremental cost effectiveness ratio was about 6,200 euro/QALY compared to no screening. The PSA showed that the uncertainty in cost effectiveness results is not considerable. The value of information analysis confirmed the robustness of the results. Screening all current patients with diarrhea/mixed type IBS would require a total budget of about 25 million Euros over a 10 year time period. Screening patients with IBS-D or IBS-mix for CD is almost certainly cost-effective. The screening program would improve the quality of life of those patients with IBS symptoms who actually have CD at a relatively low cost.

Role of Capsule Study in Evaluation of Irritable Bowel Syndrome

Purpose: Introduction: Irritable bowel syndrome (IBS) is a common disorder that accounts for one-third of the referrals to a gastroenterologist. Most patients diagnosed with IBS have had limited or no evaluation for pathology of the small bowel or for presence of abnormal transit time. Capsule endoscopy is a non-invasive method of imaging the small bowel and measuring transit time. The purpose of this study is to measure the prevalence of small bowel mucosal pathology in diarrhea dominant or mixed bowel pattern IBS patient and to measure differences in transit time. Methods: Prospective study participants at Naval Medical Center Portsmouth qualified for Rome III criteria of diarrhea and mixed type IBS and had no alarm symptoms. Each patient underwent capsule study and images were evaluated by a gastroenterologist. Gastric transit time and small bowel transit time were determined by landmark identification using the GIVENTM capsule system. Post-hoc analysis was performed for transit time differences and two-tailed paired t-test was performed. P-values were determined using two tails. Results: 20 of the patients enrolled were alternating types and 30 were diarrhea dominant types. Two diarrhea types were excluded from study final transit time results, one due to obscured camera view and the other secondary to the capsule being inserted below the pylorus by endoscopy. No small bowel pathology was found in all patients. The mean gastric transit time for the alternating type was 46.9 minutes (SD 42.21) and for the diarrhea dominant type was 46.75 minutes (SD 50.94), P =0.9914. The mean for small bowel transit time was 261.9 minutes (SD 89.33) for alternating type and 178.21 minutes (SD 70.87) for diarrhea dominant type, P=0.0007. Conclusion: No small bowel pathology was found in all IBS patients and supports ACG position statement concerning evaluation of IBS patients. However, capsule endoscopy was able to document statistically significant small bowel transit time differences between IBS patients who had diarrhea predominate symptoms and alternating predominate symptoms. The use of capsule technology may help direct medical management in complex IBS patients.