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Pubmed-Female chronic pelvic pain is highly prevalent in Denmark. A cross-sectional population-based study with randomly selected participants.

12 hours 23 min ago
Related Articles Female chronic pelvic pain is highly prevalent in Denmark. A cross-sectional population-based study with randomly selected participants. Scand J Pain. 2017 Dec 29;5(2):93-101 Authors: Loving S, Thomsen T, Jaszczak P, Nordling J Abstract Background and purpose Female chronic pelvic pain is a significant clinical problem that burdens the health care services and work productivity, and leads to disability and reduced quality of life among the women affected. A recent systematic review reported worldwide prevalence rates for female chronic pelvic pain ranging from 2.1% to 24%. Our aim was to assess the prevalence, characteristics, and factors associated with chronic pelvic pain among women living in Denmark, and to compare these findings with a pain-free reference group. Secondly, we evaluated the impact of pain on daily life in women suffering from chronic pelvic pain. Methods A cross-sectional postal survey of the prevalence of chronic pelvic pain was undertaken in a randomly selected general female population in Denmark (N = 2500). Inclusion criteria were: (a) ≥18 years of age and (b) living in the Capital region or the region of Zealand in Denmark. Statistical analyses included prevalence percentage rates, chi-square tests, Mann-Whitney tests, and unpaired T-tests. Logistic regression analysis was used to identify the significant independent variables and to estimate their simultaneous impact on chronic pelvic pain. The results were expressed as odds ratio and 95% confidence intervals. All tests were two-tailed and significance levels were set at p < 0.05. Results 1179 (48%) women living in representative areas of Denmark responded. The prevalence of chronic pelvic pain was 11% (n = 130) in women ≥18 years with a prevalence of 13.6% (n = 87) in women of reproductive age; 6.2% (n = 73) women experienced at least moderate average pain intensity (numerical rating scale ≥4). Self-reported diagnosis of irritable bowel syndrome (20%), bladder pain syndrome/interstitial cystitis (3%), vulvodynia (9%), endometriosis (8%), and pelvic surgery in the preceding 6 months (5%) were more prevalent in cases compared to pain-free reference subjects (p = 0.00). Chronic pelvic pain interfered with daily life "all the time" in 5% of the women, "sometimes" in 72.3%, and "not at all" in 22.7%. Factors independently associated with chronic pelvic pain were age, country of birth, and former pelvic trauma or pelvic surgery (p < 0.05). No association was found between chronic pelvic pain and selected socio-demographic factors (residential area, educational level, cohabitation status and employment status). Conclusions Female chronic pelvic pain appears highly prevalent (11%) in Denmark (6.2% with moderate to severe pain). Women of reproductive age had a slightly increased prevalence (13.6%). Although the reported prevalence is based on 48% (N = 1179) of the invited sample, dropout analyses found that respondents did not deviate from non-respondents. Therefore, we considered the reported prevalence rate representative for the total sample and generalisable to the general female population in Denmark. This study was cross-sectional, and relied on association-based analyses. Consequently, causality between age groups, country of birth, former pelvic surgeries and pelvic traumas and experiences of chronic pelvic pain remains unknown. Implications In order to improve prevention and treatment of chronic pelvic pain in Denmark, high quality, population-based cohort studies and randomised clinical trials are essential. The demand for trustworthy chronic pelvic pain prevalence estimates might also inspire political attention and hereby facilitate funding for further development of treatment and research. PMID: 29913678 [PubMed - in process] View the full article

Pubmed-Associations between abdominal pain symptom dimensions and depression among adolescents.

12 hours 23 min ago
Related Articles Associations between abdominal pain symptom dimensions and depression among adolescents. Scand J Pain. 2017 Dec 29;5(3):184-190 Authors: Stabell N, Flægstad T, Stubhaug A, Nielsen CS Abstract Background and aims The prevalence of depression is increased among patients with abdominal pain (AP) and Irritable Bowel Syndrome (IBS), but little is known about this association among adolescents in the general population. Furthermore, there is considerable uncertainty about exactly which dimensions of AP and IBS are associated with depression. The aims of this study were therefore: (a) to describe the prevalence of AP, IBS and depression in a representative sample of adolescents, (b) to analyze the association of AP and IBS with depression and lastly, (c) to analyze the relationship between depression and specific AP and IBS symptom dimensions, i.e. pain intensity, frequency, duration, and distribution, the presence of co-morbid non-abdominal pain, and the specific bowel systems distinguishing IBS from AP in general. Materials and methods Self-reported symptoms of AP (monthly or more frequent), IBS (Rome III 2006 criteria), co-morbid chronic pain and depression (The Short Mood and Feeling Questionnaire sum-score ≥11) were recorded among 961 adolescents (mean age 16.1 y and 48.8% girls), participating in a population based study in 2010-2011. Multiple logistic regression carried out to analyze the association of AP and IBS with depression, adjusting for sex, parental level of education (<college or ≥college) and co-morbid chronic pain. Among the AP cases, the association of different AP dimensions and of the specific bowel symptoms in IBS with depression were analyzed in a stepwise multiple logistic regression model. Results Monthly or more frequent AP was reported by 27% of the participants (n = 259) and 8.2% (n = 77) met the Rome III IBS criteria. The prevalence of depression was 11.5% (girls 15.9% and boys 7.3%). The prevalence of depression was higher among both AP and IBS cases compared to in controls (20.5%, 24.7% and 8.1% respectively), but there was no evidence that depression rates differed between the two case groups (IBS: OR = 2.5, 95% CI = 1.6-3.9; AP: OR = 2.4 with 95% CI = 1.3-4.4, after adjusting for sex, parental level of education and co-morbid chronic pain). In the regression analyses within the AP group, the following symptom dimensions were independently associated with depression: severe abdominal pain intensity (OR = 4.0; CI = 1.5-10.7), widespread abdominal pain (OR = 5.5; CI = 2.6-11.8) and presence of co-morbid chronic pain (OR = 3.3; CI = 1.6-6.8). Sex, parental education, and other abdominal pain symptom dimensions, including bowel symptoms that distinguish IBS from AP, were not independently associated with depression. Conclusions and implications The prevalence of depression is considerably increased among adolescents with AP and IBS in the general population, in particular among those reporting severe, widespread abdominal pain, and co-morbid chronic pain. Evaluating these symptom dimensions may be of value for identifying subgroups adolescents with AP and IBS that have greater risk of depression. PMID: 29913707 [PubMed - in process] View the full article

Pubmed-Prevalence of functional gastrointestinal disorders among adolescents in Buenos Aires, Argentina.

12 hours 23 min ago
Related Articles Prevalence of functional gastrointestinal disorders among adolescents in Buenos Aires, Argentina. Rev Gastroenterol Mex. 2018 Jun 15;: Authors: Nelissen LG, Koppen IJN, Follett FR, Boggio-Marzet C, Saps M, Garzon K, Benninga MA Abstract INTRODUCTION AND AIMS: The prevalence of functional gastrointestinal disorders (FGIDs) in Argentinean children and adolescents has not yet been studied. Our aim was to determine the prevalence of FGIDs among children and adolescents in Argentina using the Rome III diagnostic criteria. MATERIALS AND METHODS: A total of 483 children, 12-18 years of age, from 3 private schools and 3 public schools, were included in the study. Each child completed the Spanish version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III), which is an age-appropriate and previously validated instrument for diagnosing FGIDs according to the Rome III criteria. Sociodemographic data (age, sex, type of school, family structure and size, family history of gastrointestinal disorders) and data on stressful life events were also obtained. RESULTS: The mean age of the population studied was 15 years (standard deviation 1.74, range 12-18, 52.8% boys). Of the respondents, 229 children (47.4%) attended private school and 254 children (52.6%) attended public school. In total, 82 children (17.0%) were diagnosed with an FGID, according to the Rome III criteria. Abdominal migraine (16.4%) was the most common diagnosis, followed by irritable bowel syndrome (7.0%), functional constipation (6.4%), and aerophagia (5.6%). Girls suffered significantly more from FGIDs than boys (22.4 vs. 12.2%, P=.0032). Children attending private school had significantly more FGIDs than children in public schools (20.5 vs. 13.8%, P=.0499). CONCLUSION: FGIDs are common among Argentinean children and adolescents. PMID: 29914714 [PubMed - as supplied by publisher] View the full article

Pubmed-Characteristics of the bacterial microbiome in association with common intestinal parasites in irritable bowel syndrome.

12 hours 23 min ago
Related Articles Characteristics of the bacterial microbiome in association with common intestinal parasites in irritable bowel syndrome. Clin Transl Gastroenterol. 2018 Jun 19;9(6):161 Authors: Krogsgaard LR, Andersen LO', Johannesen TB, Engsbro AL, Stensvold CR, Nielsen HV, Bytzer P Abstract OBJECTIVE: A low prevalence of intestinal parasites has been identified in individuals with irritable bowel syndrome (IBS), but potential associations with alterations in the bacterial microbiome remain largely unexplored. We aimed to investigate the relationship between parasites and bacteria in individuals with IBS in order to identify potential trans-kingdom microbial characteristics. DESIGN: Stool samples were collected from the Danish background population classified into IBS (n = 119), unspecific gastrointestinal (GI) symptoms (n = 114), and asymptomatic controls (n = 186) based on the Rome III criteria for IBS. Bacterial (16S) and eukaryotic (18S) ribosomal DNA was sequenced, and 18S data were merged with data from conventional parasite laboratory tests. The bacterial microbiome was analyzed according to symptom group and parasite colonization status. RESULTS: Bacterial richness and diversity were similar for IBS and controls but higher in those with unspecific GI symptoms. A higher abundance of Bacteroides and a lower abundance of Faecalibacterium were detected in individuals with IBS and unspecific GI symptoms compared with controls. Principal component analyses indicated differences in bacterial composition related to parasite colonization rather than symptom group. Parasites were detected at the lowest frequency in the IBS group (39%) and in samples dominated by Bacteroides. Higher bacterial richness and diversity were found in parasite-positive samples from controls and those with unspecific GI symptoms but not in individuals with IBS. CONCLUSION: Parasite colonization, rather than bacterial composition, differed between individuals with IBS and healthy controls. Parasite colonization was associated to a rich and diverse bacterial microbiome; however, this association was altered in IBS. PMID: 29915224 [PubMed - in process] View the full article

Pubmed-Wheat Intolerance and Chronic Gastrointestinal Symptoms in an Australian Population-based Study: Association Between Wheat Sensitivity, Celiac Disease and Functional Gastrointestinal Disorders.

12 hours 23 min ago
Related Articles Wheat Intolerance and Chronic Gastrointestinal Symptoms in an Australian Population-based Study: Association Between Wheat Sensitivity, Celiac Disease and Functional Gastrointestinal Disorders. Am J Gastroenterol. 2018 Jun 19;: Authors: Potter MDE, Walker MM, Jones MP, Koloski NA, Keely S, Talley NJ Abstract OBJECTIVES: Wheat avoidance in the absence of celiac disease (CD) is common but occurrence of concurrent functional gastrointestinal disorders (FGIDs) in this group is uncertain. The aims of this study were to determine the prevalence of self-reported wheat or gluten sensitivity and doctor diagnosed CD in an Australian population, define the associated gastrointestinal (GI) symptoms and FGIDs, and determine the relationship between self-reported wheat sensitivity, demographic and medical factors. METHODS: A total of 3542 people randomly selected from the Australian population returned a mail survey which contained questions on wheat avoidance, GI symptoms, demographic, medical, and lifestyle factors. We defined self-reported wheat sensitivity as people who reported gastrointestinal symptoms on ingestion of wheat based foods, but did not suffer from celiac disease, inflammatory bowel disease or colorectal cancer. Functional dyspepsia (FD) and irritable bowel syndrome (IBS) were diagnosed by Rome III criteria. CD status was self-reported. RESULTS: The prevalence of self-reported wheat sensitivity in this cohort was 14.9% (95% CI 13.7-16.2). The prevalence of CD was 1.2% (95%CI 0.8-1.6). Doctor diagnosed CD was significantly associated with a diagnosis of FD (OR 3.35, 95%CI 1.72-6.52) and IBS (OR 2.28, 95%CI 1.08-4.81). Those with self-reported wheat sensitivity were more likely to report multiple abdominal symptoms (of the 18 assessed) than those without (3.9 symptoms with self-reported wheat sensitivity vs. 1.6 without, p = 0.0001). In a multivariate analysis, self-reported wheat sensitivity was independently associated with IBS (OR 3.55, 95%CI 2.71-4.65) and FD (1.48, 95%CI 1.13-1.94). CONCLUSIONS: Self-reported wheat sensitivity is common, with a prevalence of 14.9% in this cohort. There is a strong association between both celiac disease and self-reported wheat sensitivity, and chronic gastrointestinal symptoms, as well as a diagnosis of FD and IBS. PMID: 29915405 [PubMed - as supplied by publisher] View the full article

Pubmed-Risk of psychiatric disorders in irritable bowel syndrome-A nationwide, population-based, cohort study.

12 hours 23 min ago
Related Articles Risk of psychiatric disorders in irritable bowel syndrome-A nationwide, population-based, cohort study. Int J Clin Pract. 2018 Jun 19;:e13212 Authors: Yeh HW, Chien WC, Chung CH, Hu JM, Tzeng NS Abstract AIMS: This cohort study aimed to investigate the association between irritable bowel syndrome (IBS) and the risk of developing psychiatric disorders. METHODS: Utilizing the National Health Insurance Research Database (NHIRD) of Taiwan, IBS patients were identified and compared with age, sex, and index year-matched controls (1:3). RESULTS: Of the IBS subjects, 3934 in 22 356 (17.60%, or 1533.68 per 100 000 person-years) developed psychiatric disorders when compared with 6127 in 67 068 (9.14%, or 802 per 100 000 person-years) in the non-IBS control group. Fine and Gray's survival analysis revealed that the study subjects were more likely to develop psychiatric disorders. The crude hazard ratio (HR) is 3.767 (95% CI: 3.614-3.925, P < .001), and the adjusted HR is 3.598 (95% CI: 3.452-3.752, P < .001) in the risk of developing psychiatric disorders after being adjusted for age, sex, comorbidities, geographical area of residence, urbanisation level of residence, and monthly insurance premiums. The cohort study revealed that IBS subjects were associated with an increased risk of anxiety, depression, bipolar, and sleep disorders. CONCLUSIONS: This cohort study, using NHIRD, shows evidence support that patients with IBS have a 3.6-fold risk of developing psychiatric disorders. Other large or national datasets should be done to explore to underlying mechanisms. PMID: 29920876 [PubMed - as supplied by publisher] View the full article

Pubmed-The effect of Prim-O-glucosylcimifugin on tryptase-induced intestinal barrier dysfunction in Caco-2 cells.

Jun 19, 2018
Related Articles The effect of Prim-O-glucosylcimifugin on tryptase-induced intestinal barrier dysfunction in Caco-2 cells. Biol Pharm Bull. 2018 Jun 16;: Authors: Xu L, Cai J, Tian A, Qian K, Qin R, Qi S, Tan X, Qiu Y, Gong M, Han B, Hu X Abstract The intestinal barrier dysfunction is a critical pathological change in irritable bowel syndrome (IBS). The objective of this study was to evaluate the effect of Prim-O-glucosylcimifugin (POG) on intestinal barrier dysfunction and reveal possible molecular mechanisms. Caco-2 cell monolayers induced by tryptase(TRYP) were used to establish an intestinal barrier dysfunction model. Caco-2 cell monolayers from both functional and dysfunctional samples were treated with POG (30, 60 and 120 µg/mL) for 2, 8, 24, 36, 48 and 72h. The Caco-2 cell monolayers were assessed by measurement of trans-epithelial electrical resistance (TEER) and percentage of fluorescein permeation (PFP). The expression of PAR-2 and MLCK mRNA was analyzed by RT-PCR and the level of ZO-1 protein expression was determined by western blot. In addition, the impact of POG on the distribution of the tight juction protein of Occludin was performed by immunofluorescence. Our results showed that POG elevated the TEER and decreased the PFP of the functional Caco-2 cell monolayers, as well as the dysfunctional Caco-2 cell monolayers. Furthermore, POG inhibited the expression of PAR-2 mRNA and MLCK mRNA and increased the level of ZO-1 protein expression in dysfunctional Caco-2 cells. The distribution of the Occludin proteins was ameliorated simultaneously. This study demonstrates that POG can enhances the intestinal barrier function of Caco-2 cell monolayers by inhibiting the expression of PAR-2 and MLCK and up-regulating the expression of ZO-1 protein, and ameliorated the distribution of Occludin protein. PMID: 29910215 [PubMed - as supplied by publisher] View the full article

Pubmed-Newly developed serine protease inhibitors decrease visceral hypersensitivity in a post-inflammatory rat model for irritable bowel syndrome.

Jun 19, 2018
Related Articles Newly developed serine protease inhibitors decrease visceral hypersensitivity in a post-inflammatory rat model for irritable bowel syndrome. Br J Pharmacol. 2018 Jun 17;: Authors: Ceuleers H, Hanning N, Heirbaut J, Van Remoortel S, De Bruyn M, Joossens J, van der Veken P, Lambeir AM, Francque SM, De Man JG, Timmermans JP, Augustyns K, De Meester I, De Winter BY Abstract BACKGROUND AND PURPOSE: Serine proteases are suggested as important players in visceral pain. We investigated their effect by using newly developed serine protease inhibitors with a well-characterized inhibitory profile in a post-inflammatory IBS rat model. EXPERIMENTAL APPROACH: Colitis rats received intrarectal TNBS and controls 0.9% NaCl. Colonoscopies were performed on day 3, to confirm colitis, and later on until mucosal healing. Visceral hypersensitivity was quantified by visceromotor responses (VMR) to colorectal distension, 30 min after intraperitoneal injection of the serine protease inhibitors nafamostat, UAMC-00050 or UAMC-01162. Serine proteases, protease-activated receptors (PARs) and transient receptor potential channels (TRPs) were quantified via qPCR and immunohistochemistry. Proteolytic activity was characterized using fluorogenic substrates. KEY RESULTS: VMR was significantly elevated in post-colitis rats. Nafamostat normalized VMRs at the lowest dose tested. UAMC-00050 and UAMC-01162 significantly decreased VMR dose-dependently. mRNA expression of tryptase-αβ-1, PAR4 and tryptase immunoreactivity were significantly increased in the colon of post-colitis animals. Accordingly, trypsin-like activity was significantly increased in the colon but not in the feces. PAR2 and TRPA1 immunoreactivity colocalized with CGRP-positive nerve fibers in control and post-colitis animals. CONCLUSIONS AND IMPLICATIONS: The increase in serine protease expression and activity together with the increased expression of downstream molecules at the colonic and DRG level and in CGRP positive sensory nerve fibers point to a role for serine proteases in post-inflammatory visceral hypersensitivity. The results of this study call for further investigation of serine protease inhibitors as an interesting treatment strategy for IBS related visceral pain. PMID: 29911328 [PubMed - as supplied by publisher] View the full article

Pubmed-Comparison of Lactase Variant MCM6 -13910 C>T Testing and Self-report of Dairy Sensitivity in Patients With Irritable Bowel Syndrome.

Jun 19, 2018
Comparison of Lactase Variant MCM6 -13910 C>T Testing and Self-report of Dairy Sensitivity in Patients With Irritable Bowel Syndrome. J Clin Gastroenterol. 2018 Jun 16;: Authors: Almazar AE, Chang JY, Larson JJ, Atkinson EJ, Locke GR, Talley NJ, Saito YA Abstract GOALS: To evaluate agreement of MCM6-13910 with self-report of dairy sensitivity (DS) and lactose hydrogen methane breath test (LHMBT) results in subjects with irritable bowel syndrome (IBS). BACKGROUND: IBS is a functional gastrointestinal disorder with symptoms including abdominal pain, variable bowel habits, and bloating. Adult patients with lactose malabsorption may present with similar symptoms. Patients with lactose malabsorption have a lactase nonpersistent (LNP) phenotype. Recent studies found 2 single nucleotide polymorphisms associated with LNP: G/A-22018 and C/T-13910. STUDY: Genotyping the MCM6-13910 variant of LNP in 538 IBS patients and 317 controls (without IBS). Subjects completed questionnaires pertaining to gastrointestinal problems and dietary consumption, with charts abstracted. RESULTS: Self-reported DS was higher in IBS (45%) than controls (9.8%, odds ratio=6.46, P<0.001). The C/C-13910 genotype was similar in IBS cases and controls, 81 (15.1%) and 47 (14.8%). Among subjects reporting DS, 49 (18.0%) had the C/C genotype. Overall agreement between genotype and self-reported DS was 0.06 in IBS and 0.07 in controls. There were 20 subjects with LHMBT results; 3 had positive results, 17 were negative. LNP genotypes were found in all 3 of positive LHMBT results; 16 had negative LHMBT among the 17 who were lactase persistent. Agreement between C/C-13910 genotype and LHMBT was excellent with κ-statistic of 0.83 (0.50-1.00). CONCLUSIONS: In IBS patients, self-report of lactose intolerance are highly prevalent but are a poor indicator of underlying C/C-13910 genotype. LHMBT had excellent agreement with C/C-13910 genotype. PMID: 29912753 [PubMed - as supplied by publisher] View the full article

Pubmed-Bile acids and FXR in functional gastrointestinal disorders.

Jun 18, 2018
Related Articles Bile acids and FXR in functional gastrointestinal disorders. Dig Liver Dis. 2018 May 30;: Authors: Mosińska P, Szczepaniak A, Fichna J Abstract Functional gastrointestinal disorders (FGIDs), such as irritable bowel syndrome (IBS) and chronic constipation (CC), are commonly diagnosed conditions in clinical practice which create a substantial global burden. Since the farnesoid X receptor (FXR) and bile acids (BAs) are responsible for maintaining homeostasis in the GI tract, any disturbances in the expression of FXR or the composition of BAs may contribute to the development of the GI symptoms. Alterations in the mechanism of action of FXR directly affect the BAs pool and account for increased intestinal permeability and changes in abundance and diversity of gut microbiota leading to intestinal dysmotility. Current review focuses on the correlation between the FXR, BAs and the composition of gut microbiota and its influence on the occurrence of GI symptoms in FGIDs. PMID: 29908754 [PubMed - as supplied by publisher] View the full article

Pubmed-Association Between Ultra-Processed Food Consumption and Functional Gastrointestinal Disorders: Results From the French NutriNet-Santé Cohort.

Jun 16, 2018
Related Articles Association Between Ultra-Processed Food Consumption and Functional Gastrointestinal Disorders: Results From the French NutriNet-Santé Cohort. Am J Gastroenterol. 2018 Jun 15;: Authors: Schnabel L, Buscail C, Sabate JM, Bouchoucha M, Kesse-Guyot E, Allès B, Touvier M, Monteiro CA, Hercberg S, Benamouzig R, Julia C Abstract OBJECTIVES: Ultra-processed foods (UPF) consumption has increased over the last decades and is raising concerns about potential adverse health effects. Our objective was to assess the association between UPF consumption and four functional gastrointestinal disorders (FGIDs): irritable bowel syndrome (IBS), functional constipation (FC), functional diarrhea (FDh), and functional dyspepsia (FDy), in a large sample of French adults. METHODS: We analyzed dietary data of 33,343 participants from the web-based NutriNet-Santé cohort, who completed at least three 24 h food records, prior to a Rome III self-administered questionnaire. Proportion (in weight) of UPF in the diet (UPFp) was computed for each subject. The association between UPFp quartiles and FGIDs was estimated by multivariable logistic regression. RESULTS: Participants included in the analysis were mainly women (76.4%), and the mean age was 50.4 (SD = 14.0) years. UPF accounted for 16.0% of food consumed in weight, corresponding to 33.0% of total energy intake. UPF consumption was associated with younger age, living alone, lower incomes, higher BMI, and lower physical activity level (all p < 0.0001). A total of 3516 participants reported IBS (10.5%), 1785 FC (5.4%), 1303 FDy (3.9%), and 396 FDh (1.1%). After adjusting for confounding factors, an increase in UPFp was associated with a higher risk of IBS (aOR Q4 vs. Q1 [95% CI]: 1.25 [1.12-1.39], p-trend < 0.0001). CONCLUSIONS: This study suggests an association between UPF and IBS. Further longitudinal studies are needed to confirm those results and understand the relative impact of the nutritional composition and specific characteristics of UPF in this relationship. PMID: 29904158 [PubMed - as supplied by publisher] View the full article

Pubmed-Chronic Diffuse Pain and Functional Gastrointestinal Disorders After Traumatic Stress: Pathophysiology Through a Polyvagal Perspective.

Jun 16, 2018
Related Articles Chronic Diffuse Pain and Functional Gastrointestinal Disorders After Traumatic Stress: Pathophysiology Through a Polyvagal Perspective. Front Med (Lausanne). 2018;5:145 Authors: Kolacz J, Porges SW Abstract Chronic diffuse pain disorders, such as fibromyalgia, and functional gastrointestinal disorders (FGIDs), such as irritable bowel syndrome, place substantial burden on those affected and on the medical system. Despite their sizable impact, their pathophysiology is poorly understood. In contrast to an approach that focuses on the correlation between heart rate variability (HRV) and a specific organ or symptom, we propose that a bio-evolutionary threat-related autonomic response-as outlined in the Polyvagal Theory-may serve as a plausible explanation of how HRV, particularly respiratory sinus arrhythmia (RSA), would index the pathophysiology of these disorders. Evidence comes from: (1) the well-documented atypical autonomic regulation of the heart common to fibromyalgia and irritable bowel syndrome reflected in dampened RSA, (2) the neural architecture that integrates the heart, pain pathways, and the gastrointestinal tract, (3) the common physical co-morbidities shared by chronic diffuse pain and FGIDs, many of which are functionally regulated by the autonomic nervous system, (4) the elevated risk of chronic diffuse pain and FGIDs following traumatic stress or abuse, (5) and the elevated risk of chronic diffuse pain and FGIDs in individuals with anxiety and panic disorders. This novel conceptualization points to a pathogenesis rooted in changes to brain-body autonomic feedback loops in response to evolutionarily-salient threat cues, providing an integrated biopsychosocial model of chronic diffuse pain and FGIDs and suggesting new, non-pharmacological treatment strategies. PMID: 29904631 [PubMed] View the full article

Pubmed-Electroacupuncture treatments for gut motility disorders.

Jun 16, 2018
Electroacupuncture treatments for gut motility disorders. Neurogastroenterol Motil. 2018 Jul;30(7):e13393 Authors: Chen JDZ, Ni M, Yin J Abstract Functional gastrointestinal (GI) diseases are common and there are patients who are refractory to medical therapies as not all treatments work in all patients. Consequently, a large number of patients with functional GI diseases use complementary and alternative medicine, such as acupuncture or electroacupuncture (EA). In this issue, Zheng et al. reported interesting results of a multi-center placebo-controlled clinical study on the use of EA for treating refractory functional dyspepsia; another study reported a multi-center clinical trial on EA for chronic functional constipation; Liang et al. studied mechanisms of EA involving enteric nervous system and neurotransmitters in treating constipation in rats. While controversial reports are available in the literature, EA with appropriate methodologies as shown in these recent studies is believed to be effective in treating certain functional GI diseases. In this mini-review, a number of clinical studies, including those included in this issue on the use of EA for treating gastro-esophageal reflux, functional dyspepsia, irritable bowel syndrome, and constipation are reviewed. Some critically important issues, such as the choice of stimulation parameters for EA, the administration frequency of the therapy, and the appropriate choice of placebo for clinical research are also discussed. Mechanisms of action involved in the therapeutic effects of EA for gut dysmotility and future research directions are also presented. PMID: 29906324 [PubMed - in process] View the full article

Pubmed-Eph/ephrin signalling serves a bidirectional role in lipopolysaccharide‑induced intestinal injury.

Jun 15, 2018
Related Articles Eph/ephrin signalling serves a bidirectional role in lipopolysaccharide‑induced intestinal injury. Mol Med Rep. 2018 Jun 14;: Authors: Xiong Y, Li KX, Wei H, Jiao L, Yu SY, Zeng L Abstract A growing body of evidence has demonstrated that Eph/ephrin signalling may serve a central role in intestinal diseases. However, whether erythropoietin‑producing hepatocellular (Eph)/ephrin signalling is associated with the development of post‑infectious irritable bowel syndrome (PI‑IBS) is still unknown. In the present study, the role of Eph/Ephrin signalling in lipopolysaccharide (LPS)‑induced intestinal injury was evaluated in vivo and in vitro. LPS treatment significantly increased the levels of proinflammatory mediators [monocyte chemoattractant protein‑1, tumour necrosis factor α, interleukin (IL)‑1β, IL‑6, intercellular adhesion molecule 1 and vascular cell adhesion molecule‑1], activated the EphA2‑Ephrin A1, protein kinase B (Akt)‑nuclear factor (NF)‑κB, Src‑NF‑κB and Wnt/β‑catenin signalling pathways, and inhibited EphB1‑Ephrin B3 signalling in colon tissues, and primary cultured enteric neuronal and glial cells. Notably, EphA2 monoclonal antibody (mAb) treatment or Ephrin B3 overexpression could partially alleviate the LPS‑induced upregulation of proinflammatory mediators, and Akt‑NF‑κB, Src‑NF‑κB and Wnt/β‑catenin signalling pathways. In addition, EphA2 mAb treatment could partially inhibit LPS‑induced inactivation of EphB‑Ephrin B3 signalling, while Ephrin B3 overexpression could abrogate LPS‑induced activation of EphA2‑Ephrin A1 signalling. EphB1/Ephrin B3 signalling may antagonise the EphA2/Ephrin A1‑dependent pathway following LPS treatment. The results associated with the EphA2 signaling pathway, indicated that Eph/ephrin signalling may serve a bidirectional role in LPS‑induced intestinal injury. Eph/ephrin signalling may be a novel therapeutic target for LPS‑induced intestinal injury and potentially PI‑IBS. PMID: 29901151 [PubMed - as supplied by publisher] View the full article

Pubmed-Systematic review with meta-analysis: online psychological interventions for mental and physical health outcomes in gastrointestinal disorders including irritable bowel syndrome and inflammatory bowel disease.

Jun 15, 2018
Related Articles Systematic review with meta-analysis: online psychological interventions for mental and physical health outcomes in gastrointestinal disorders including irritable bowel syndrome and inflammatory bowel disease. Aliment Pharmacol Ther. 2018 Jun 14;: Authors: Hanlon I, Hewitt C, Bell K, Phillips A, Mikocka-Walus A Abstract BACKGROUND: Online psychotherapy has been successfully used as supportive treatment in many chronic illnesses. However, there is a lack of evidence on its role in the management of gastrointestinal (GI) diseases. AIMS: To examine whether online psychological interventions improve mental and physical outcomes in gastrointestinal diseases. METHODS: We searched CINAHL Plus, MEDLINE, EMBASE, Health Management Information Consortium, PsycINFO, British Nursing Index, Cochrane Library, a specialised register of the IBD/FBD Cochrane Group, MEDLINE (PubMed) WHO International Clinical Trial Registry, ClinicalTrials.gov, and reference lists of all papers included in the review. The Cochrane Risk of Bias Tool was used to assess internal validity. Where possible, data were pooled using random-effects meta-analysis. RESULTS: We identified 11 publications (encompassing nine studies) meeting inclusion criteria. One study had a high risk of selection bias (allocation concealment), all studies had a high risk of performance and detection bias. Eight studies were included in the meta-analyses (6 on irritable bowel syndrome [IBS] and two on inflammatory bowel disease [IBD]). Online cognitive behavioural therapy (CBT) was shown to significantly improve gastrointestinal symptom-specific anxiety (MD: -8.51, 95% CI -12.99 to -4.04, P = 0.0002) and lessen symptom-induced disability (MD: -2.78, 95% CI -5.43 to -0.12, P = 0.04) in IBS post intervention. There was no significant effect of online CBT on any other outcomes in IBS. No significant effect of online psychotherapy was demonstrated in IBD. CONCLUSION: There is insufficient evidence to demonstrate the effectiveness of online CBT to manage mental and physical outcomes in gastrointestinal diseases. PMID: 29901820 [PubMed - as supplied by publisher] View the full article

Pubmed-Analysis of Fecal Primary Bile Acids Detects Increased Stool Weight and Colonic Transit in Patients with Chronic Functional Diarrhea.

Jun 15, 2018
Related Articles Analysis of Fecal Primary Bile Acids Detects Increased Stool Weight and Colonic Transit in Patients with Chronic Functional Diarrhea. Clin Gastroenterol Hepatol. 2018 Jun 11;: Authors: Vijayvargiya P, Camilleri M, Chedid V, Carlson P, Busciglio I, Burton D, Donato L Abstract BACKGROUND & AIMS: Patients with bile acid diarrhea (BAD) are identified based on increased levels of BAs in fecal samples collected over a 48-hr period while on a 100-gram fat diet (48-hr BA), retention of 75Se-labeled homocholic acid taurine, or serum levels of C4 or FGF19. BAD increases fecal weight and colonic transit. We investigated whether results of tests for BAD associate with increased fecal weight and more rapid colonic transit over a 24- or 48-hr period in patients with irritable bowel syndrome with diarrhea (IBS-D). We also estimated the prevalence of increased 48-hr fecal BAs in patients with chronic diarrhea. METHODS: We performed a retrospective study of 64 patients with IBS-D, 30 patients with IBS-constipation, 30 healthy volunteers (controls). We collected data on fecal weights (measured over a 48-hr period), colonic transit over a 24-hr period (measured by scintigraphy), and percentages of different BAs in stool samples. Colonic transit was measured as the geometric center (weighted average) of colonic counts on a scale of 1 (100% in ascending colon) to 5 (100% in stool). We performed area under the curve (AUC) analyses to assess the association between result of serum and stool tests and high fecal weight (>400g/48 hrs) or rapid colonic transit (>3.34, corresponding to isotope geometric center in sigmoid colon). We estimated the prevalence of increased 48-hr fecal BAs among 938 patients with chronic diarrhea. RESULTS: Total fecal 48-hr BA alone, or in combination with percentage of primary fecal BAs, identified patients with increased fecal weight with an AUROC of 0.86. Percentage of primary fecal BA alone identified patients with increased fecal weight with an AUROC of 0.73. Total fecal 48-hr BA alone identified patients with increased colonic transit with an AUROC of 0.65 and percentage of primary fecal BA alone identified patients with increased colonic transit with an AUROC of 0.69; combined data on these features identified patients with increased colonic transit with an AUROC of 0.70. Serum level of C4 identified patients with increased colonic transit with an AUROC of 0.60. Primary BAs >10% identified patients with increased fecal weight (sensitivity 49% and specificity 91%) and rapid colonic transit (sensitivity 48% and specificity 87%). Among the patients with chronic diarrhea, 45.6% had fecal primary BAs >10% and 27% had increased total fecal BAs (>2337 μmol/48 hrs). CONCLUSION: In a retrospective analysis of patients with IBS-D, we found percentage of primary BAs in fecal samples to provide an alternative to total fecal BAs in identification of patients with BAD or chronic diarrhea. PMID: 29902647 [PubMed - as supplied by publisher] View the full article

Medical News Today-What does it mean if you have a high C-reactive protein?

Jun 14, 2018
Doctors can use a C-reactive protein (CRP) test to check the levels of this protein. Many conditions can elevate CRP levels, including rheumatic arthritis and irritable bowel syndrome. Symptoms of high CRP levels include chills and pain. Treatment depends on the underlying cause. Learn more about the CRP test here. View the full article

Pubmed-Pharmacokinetic drug evaluation of rifaximin for treatment of diarrhea-predominant irritable bowel syndrome.

Jun 14, 2018
Pharmacokinetic drug evaluation of rifaximin for treatment of diarrhea-predominant irritable bowel syndrome. Expert Opin Drug Metab Toxicol. 2018 Jun 13;: Authors: Bruzzese E, Pesce M, Sarnelli G, Guarino A Abstract INTRODUCTION: Rifaximin is a poorly absorbable antibiotic with a broad-spectrum activity against both Gram-negative and -positive bacteria. It is active in the small intestine due to its high bile solubility, whereas in the aqueous environment of the colon, it shows limited efficacy against highly susceptible bacteria. These unique pharmacokinetic properties limit its systemic effects and can correct gut microflora imbalances. Thus, rifaximin has become a major therapeutic agent in several gastrointestinal diseases in which an imbalance in gut microflora may play a role, including diarrhea predominant irritable bowel syndrome (IBS-D). AREA COVERED: This is an up-to-date review focusing on the efficacy of rifaximin in the treatment of IBS-D in both adult and pediatric populations. We will review the pharmacokinetic properties of rifaximin, including its absorption in health and disease, mechanisms of action, and interactions with other drugs. EXPERT OPINION: Given its safety profile and its negligible absorption, rifaximin is a suitable treatment forIBS-D, in both adults and children. The possibility of modulating gut microbiota composition without side effects has made this drug an appealing therapeutic agent in highly prevalent gastrointestinal diseases. However, to date, monitoring for the development of resistant bacterial strains during long-term rifaximin use is still lacking. PMID: 29897844 [PubMed - as supplied by publisher] View the full article

Pubmed-Is irritable bowel syndrome also present in dogs?

Jun 14, 2018
Is irritable bowel syndrome also present in dogs? Tierarztl Prax Ausg K Kleintiere Heimtiere. 2018 Jun;46(3):176-180 Authors: Cerquetella M, Rossi G, Spaterna A, Tesei B, Jergens AE, Suchodolski JS, Bassotti G Abstract Irritable bowel syndrome (IBS) in humans is described as the recurrent presence of gastrointestinal signs, without gross histopathologic evidence of inflammation and of other morphologic lesions; however, it is a syndrome not unanimously defined in veterinary medicine. There is some evidence that dysmotility could be related to stressors in some dogs that present with clinical signs (e.g. chronic idiopathic large-bowel diarrhea) that share overlapping aspects with human IBS. The authors hypothesize that an IBS-like condition, similar to that described in humans, might also be present in dogs. Nevertheless, the diagnostic path for canine IBS needs to be further elucidated and its pathogenesis better defined for a more rational therapeutic approach. PMID: 29898479 [PubMed - in process] View the full article

Pubmed-An acute care approach to functional abdominal pain.

Jun 13, 2018
Related Articles An acute care approach to functional abdominal pain. JAAPA. 2017 Oct;30(10):17-21 Authors: Krajicek E, Hansel S Abstract Functional abdominal pain disorders are commonly seen in the acute care setting and can be a source of frustration for patients and providers given their inherent chronic nature. However, an understanding of both the general approach to these disorders and the approach to specific common subtypes can help alleviate this frustration and lead to both short-term and long-term therapeutic success. This article describes the pathophysiology of these disorders and outlines a diagnostic and therapeutic approach to commonly seen functional abdominal pain disorders in adults. PMID: 28891837 [PubMed - indexed for MEDLINE] View the full article

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