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Pubmed-Bile and fat excretion are biomarkers of clinically significant diarrhoea and constipation in irritable bowel syndrome.

Feb 12, 2019
Related Articles Bile and fat excretion are biomarkers of clinically significant diarrhoea and constipation in irritable bowel syndrome. Aliment Pharmacol Ther. 2019 Feb 10;: Authors: Vijayvargiya P, Camilleri M, Burton D, Busciglio I, Lueke A, Donato LJ Abstract BACKGROUND: Biomarkers in irritable bowel syndrome (IBS) may guide targeted therapy in this multifactorial disease. It has been suggested that 75% accuracy and cost <$500 categorise biomarkers as cost-effective. AIM: To identify differences in faecal bile acids, faecal fat and fasting serum C4 (7a-hydroxy-4-cholesten-3-one) and fibroblast growth factor 19 (FGF19) among patients with IBS-D, IBS-C and healthy controls and to determine accurate, cost-effective biomarkers for clinically relevant diarrhoea and constipation. METHODS: We assessed daily stool frequency and consistency (Bristol Stool Form Scale) from validated bowel diaries, 48 hours total and individual faecal bile acids, 48 hours faecal fat and weight, fasting serum C4 and FGF19, and colonic transit by scintigraphy from healthy volunteers (HV) and patients with IBS-D and IBS-C (Rome III criteria). We utilised multivariate logistic regression to determine biomarkers of clinically significant diarrhoea or constipation based on stool frequency, consistency and weight. RESULTS: Among the 126 HV (44M/82F, 37.5 ± 10.9 years [SD]), 64 IBS-D (5M/59F, 41.9 ± 12.2 years), and 30 IBS-C (0M/30F, 44.6 ± 10 years) patients, there were significant differences between all groups in stool weight, frequency, and consistency; in addition, there were differences in colonic transit at 48 hours, faecal fat, and total and individual faecal bile acids between IBS-D and IBS-C. Reduced total and primary faecal bile acids and increased faecal lithocholic acid were significant predictors of decreased faecal weight, frequency and consistency with AUC > 0.82 (sensitivity >76%, specificity >72%). Total and primary faecal bile acids and faecal fat were significant predictors of increased stool weight, frequency and consistency with AUC > 0.71 (sensitivity >55%, specificity >74%).The faecal parameters had a 11.5 positive likelihood ratio in predicting elevated faecal weight. CONCLUSIONS: Faecal bile acids and faecal fat are cost-effective and accurate biomarkers associated with significant bowel dysfunction among IBS-D and IBS-C patients. PMID: 30740753 [PubMed - as supplied by publisher] View the full article

Pubmed-Metformin prevents colonic barrier dysfunction by inhibiting mast cell activation in maternal separation-induced IBS-like rats.

Feb 12, 2019
Related Articles Metformin prevents colonic barrier dysfunction by inhibiting mast cell activation in maternal separation-induced IBS-like rats. Neurogastroenterol Motil. 2019 Feb 10;:e13556 Authors: Li Y, Yang T, Yao Q, Li S, Fang E, Li Y, Liu C, Li W Abstract BACKGROUND: Intestinal barrier dysfunction is a key etiologic factor of irritable bowel syndrome (IBS). Metformin improves intestinal barrier function, although the underlying mechanism has yet to be fully explained. This study evaluates the protective effect of metformin on colonic barrier integrity and explores the underlying cellular mechanisms. METHODS: IBS-like rats were induced by maternal separation. Metformin was administered daily by gavage at 08:30, and rat pups were then separated from their mother. Visceral hyperalgesia and depression-like behaviors were evaluated by colorectal distension, sucrose preference tests, and forced swimming tests. Intestinal integrity was analyzed using sugar probes and transmission electron microscopy. Inflammatory factors and the levels of corticotropin-releasing factor were assessed by PCR and ELISA. The number of mast cells was evaluated by toluidine blue staining. Protein expression and localization were determined using Western blot and immunochemistry. KEY RESULTS: Metformin pretreatment (a) reduced visceral hypersensitivity to colorectal distension, immobility time and enhanced sucrose consumption; (b) decreased urine lactulose/mannitol ratio and sucralose output; (c) inhibited the dilation of tight junction and prevented claudin-4 translocation; (d) inhibited mast cell activation and downregulated the expression of IL-6, IL-18, tryptase, PAR-2, and ERK activation; (e) inhibited claudin-4 phosphorylation at serine sites and interactions between clau-4 and ZO-1. CONCLUSIONS & INFERENCES: Metformin may block mast cell activation to reduce PAR-2 expression and subsequently inhibit ERK activation and clau-4 phosphorylation at serine sites to normalize the interaction of clau-4 and ZO-1 and clau-4 distribution. Metformin may be clinically beneficial for patients with IBS or IBS-like symptoms. PMID: 30740845 [PubMed - as supplied by publisher] View the full article

Pubmed-Thirty Years of Lactobacillus rhamnosus GG: A Review.

Feb 12, 2019
Thirty Years of Lactobacillus rhamnosus GG: A Review. J Clin Gastroenterol. 2019 Mar;53 Suppl 1:S1-S41 Authors: Capurso L Abstract Lactobacillus rhamnosus GG (LGG) was the first strain belonging to the genus Lactobacillus to be patented in 1989 thanks to its ability to survive and to proliferate at gastric acid pH and in medium containing bile, and to adhere to enterocytes. Furthermore LGG is able to produces both a biofilm that can mechanically protect the mucosa, and different soluble factors beneficial to the gut by enhancing intestinal crypt survival, diminishing apoptosis of the intestinal epithelium, and preserving cytoskeletal integrity. Moreover LGG thanks to its lectin-like protein 1 and 2 inhibits some pathogens such as Salmonella species. Finally LGG is able to promote type 1 immune-responsiveness by reducing the expression of several activation and inflammation markers on monocytes and by increasing the production of interleukin-10, interleukin-12 and tumor necrosis factor-α in macrophages. A large number of research data on Lactobacillus GG is the basis for the use of this probiotic for human health. In this review we have considered predominantly randomized controlled trials, meta-analysis, Cochrane Review, guide lines of Scientific Societies and anyway studies whose results were evaluated by means of relative risk, odds ratio, weighted mean difference 95% confidence interval. The effectiveness of LGG in gastrointestinal infections and diarrhea, antibiotic and Clostridium difficile associated diarrhea, irritable bowel syndrome, inflammatory bowel disease, respiratory tract infections, allergy, cardiovascular diseases, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, cystic fibrosis, cancer, elderly end sport were analyzed. PMID: 30741841 [PubMed - in process] View the full article

Google-Integrative approaches to reduce IBS symptoms - Harvard Health Blog - Harvard Health

Feb 11, 2019
Integrative approaches to reduce IBS symptoms - Harvard Health Blog Harvard HealthIrritable bowel syndrome (IBS), a gastrointestinal condition that involves abdominal pain and altered bowel habits (constipation, diarrhea, or both), affects over ... View the full article

Google-Advances could allow people who can’t stomach wheat or gluten to enjoy bread - The Washington Post

Feb 11, 2019
Advances could allow people who can’t stomach wheat or gluten to enjoy bread The Washington PostAh, bread. Whether they love it or hate it, everyone seems to have an opinion about it. There are whole diets built around avoiding carbs and gluten in bread ... View the full article

Google-Can real-world evidence help improve treatment of functional gastrointestinal disorders? - PoliticsHome.com

Feb 11, 2019
Can real-world evidence help improve treatment of functional gastrointestinal disorders? PoliticsHome.comUsing novel methods based on a combination of social media platforms and validated self-assessment instruments, a study has recently been completed on ... View the full article

Twitter-RT @JohannahRuddy: Seriously so much amazing information here with these world class clinicians talking about treatment options for chronic…

Feb 9, 2019
RT @JohannahRuddy: Seriously so much amazing information here with these world class clinicians talking about treatment options for chronic… (Feed generated with FetchRSS) View the full article

Twitter-RT @JohannahRuddy: @umfoodoc presenting on benefits of low FODMAP diets for patients with #IBS at the @RomeFoundation symposium! Great info…

Feb 9, 2019
RT @JohannahRuddy: @umfoodoc presenting on benefits of low FODMAP diets for patients with #IBS at the @RomeFoundation symposium! Great info… (Feed generated with FetchRSS) View the full article

Twitter-RT @bayskitchenuk: Tips to Increase Prebiotic-rich Foods on a low FODMAP Diet - https://t.co/ydu42vns9C via @KateScarlata_RD #guthealth #lo…

Feb 9, 2019
RT @bayskitchenuk: Tips to Increase Prebiotic-rich Foods on a low FODMAP Diet - https://goo.gl/4st9yU via @KateScarlata_RD #guthealth #lo… (Feed generated with FetchRSS) View the full article

Pubmed-Opportunities for reducing emergency diagnoses of colon cancer in women and men: A data-linkage study on pre-diagnostic symptomatic presentations and benign diagnoses.

Feb 9, 2019
Related Articles Opportunities for reducing emergency diagnoses of colon cancer in women and men: A data-linkage study on pre-diagnostic symptomatic presentations and benign diagnoses. Eur J Cancer Care (Engl). 2019 Feb 08;:e13000 Authors: Renzi C, Lyratzopoulos G, Hamilton W, Rachet B Abstract OBJECTIVES: To identify opportunities for reducing emergency colon cancer diagnoses, we evaluated symptoms and benign diagnoses recorded before emergency presentations (EP). METHODS: Cohort of 5,745 colon cancers diagnosed in England 2005-2010, with individually linked cancer registry and primary care data for the 5-year pre-diagnostic period. RESULTS: Colon cancer was diagnosed following EP in 34% of women and 30% of men. Among emergency presenters, 20% of women and 15% of men (p = 0.002) had alarm symptoms (anaemia/rectal bleeding/change in bowel habit) 2-12 months pre-diagnosis. Women with abdominal symptoms (change in bowel habit/constipation/diarrhoea) received a benign diagnosis (irritable bowel syndrome (IBS)/diverticular disease) more frequently than men in the year before EP: 12% vs. 6% among women and men (p = 0.002). EP was more likely in women (OR = 1.20; 95% CI 1.1-1.4), independently of socio-demographic factors and symptoms. Benign diagnoses in the pre-diagnostic year (OR = 2.01; 95% CI 1.2-3.3) and anaemia 2-5 years pre-diagnosis (OR = 1.91; 95% CI 1.2-3.0) increased the risk of EP in women but not men. The risk was particularly high for women aged 40-59 with a recent benign diagnosis vs. none (OR = 4.41; 95% CI 1.3-14.9). CONCLUSIONS: Women have an increased risk of EP, in part due to less specific symptoms and their more frequent attribution to benign diagnoses. For women aged 40-59 years with new-onset IBS/diverticular disease innovative diagnostic strategies are needed, which might include use of quantitative faecal haemoglobin testing (FIT) or other colorectal cancer investigations. One-fifth of women had alarm symptoms before EP, offering opportunities for earlier diagnosis. PMID: 30734381 [PubMed - as supplied by publisher] View the full article

Twitter-The February Issue of The American Journal of Gastroenterology https://t.co/ooSzFFhbqB

Feb 8, 2019
The February Issue of The American Journal of Gastroenterology https://www.newswise.com/articles/the-february-issue-of-the-american-journal-of-gastroenterology#.XF4stS9Ar7k.twitter (Feed generated with FetchRSS) View the full article

Pubmed-Evaluation of subclinical gut inflammation using fecal calprotectin levels and colonic mucosal biopsy in psoriasis and psoriatic arthritis patients.

Feb 8, 2019
Related Articles Evaluation of subclinical gut inflammation using fecal calprotectin levels and colonic mucosal biopsy in psoriasis and psoriatic arthritis patients. Br J Dermatol. 2019 Feb 06;: Authors: Sharma A, Adarsh MB, Dogra S, Vaiphei K, Vaishnavi C, Sinha S Abstract Relationship between the joint disease and the gut inflammation has been established in axial spondyloarthritis(SpA). However this is not well established in Psoriatic arthritis(PsA). Our aim was to compare gut inflammation in psoriasis (PsO), PsA and irritable bowel syndrome(IBS) using fecal calprotectin assay which is a non-invasive tool. This was a single centre prospective case control study. This article is protected by copyright. All rights reserved. PMID: 30729502 [PubMed - as supplied by publisher] View the full article

Pubmed-Sex-related differences in resting-state brain activity and connectivity in the orbital frontal cortex and insula in patients with functional constipation.

Feb 8, 2019
Related Articles Sex-related differences in resting-state brain activity and connectivity in the orbital frontal cortex and insula in patients with functional constipation. Neurogastroenterol Motil. 2019 Feb 06;:e13566 Authors: Jin Q, Duan S, Li G, Sun L, Hu Y, Hu C, Zhao J, von Deneen KM, Qian L, Wang H, Ji G, Wu K, Fan D, Cui G, Nie Y, Zhang Y Abstract Functional magnetic resonance imaging (fMRI) has been used to investigate sex-related differences in brain abnormalities in patients with irritable bowel syndrome (IBS). Like IBS, women with functional constipation (FC) are 2.1 times as many as men. No study has been performed yet to examine sex-related differences in brain activity and connectivity in patients with FC. Here, we employed resting-state fMRI with amplitude of low-frequency fluctuation (ALFF) to investigate brain functional differences in 51 patients with FC (34 females) and 52 healthy controls (34 females). Results showed abdominal pain and abdominal distension correlated with trait (TAI) and state (SAI) anxiety ratings in the female FC group, and abdominal distension correlated with sensation of incomplete evacuation in the male FC group. Two-way ANOVA revealed sex effects on ALFF in precentral gyrus, thalamus, insula (INS), and orbital frontal cortex (OFC, PFWE < 0.05). Post hoc test showed that the female FC group had lower ALFF than males in these brain regions (P < 0.01), and ALFF in INS and OFC was correlated with abdominal pain and difficulty of defecation, respectively. Seed voxel correlation analysis showed that the female FC group had weaker connectivity than males between INS and lateral OFC (lOFC). INS-lOFC connectivity was negatively correlated with the anxiety score in the female FC group and was negatively correlated with abdominal distension in the male FC group. These findings provide the first insight into sex-related differences in patients with FC and highlight that INS and OFC play an important role in modulating the intrinsic functional connectivity of the resting brain network showing that this role is influenced by sex. PMID: 30729624 [PubMed - as supplied by publisher] View the full article

Pubmed-Joint Hypermobility Among Female Patients Presenting with Chronic Myofascial Pelvic Pain.

Feb 8, 2019
Related Articles Joint Hypermobility Among Female Patients Presenting with Chronic Myofascial Pelvic Pain. PM R. 2019 Feb 06;: Authors: Hastings J, Forster JE, Witzeman K Abstract BACKGROUND: Female chronic pelvic pain is estimated to affect up to 24% of adult women, many of whom have a component of myofascial pelvic pain. Although an association of joint hypermobility and pelvic pain has been hypothesized, limited data are available that estimate the prevalence of joint hypermobility in this population. OBJECTIVE: To estimate the prevalence of generalized hypermobility spectrum disorder (G-HSD) among female patients with chronic myofascial pelvic pain and examine the association between G-HSD and other frequent pelvic pain-associated complaints. STUDY DESIGN: Retrospective case control. SETTING: Tertiary referral center within a university-affiliated public health system. PATIENTS: Adult women who were diagnosed with myofascial pelvic pain during a 1-year period. Ultimately, 318 patients were included in the study cohort. METHODS: Data was abstracted via chart review of patients meeting inclusion criteria and diagnosed with myofascial pelvic pain during the study period. OUTCOMES: The primary outcome of this study was to assess the prevalence of G-HSD among patients with persistent myofascial pelvic pain in our clinic population. The secondary outcome was to assess for associations in this population between G-HSD and dyspareunia, provoked vestibulodynia, stress urinary incontinence, irritable bowel syndrome, hip pain, low back pain, and fibromyalgia. RESULTS: Twenty-four percent (N=77; 95% CI: 19.6, 29.4) of myofascial pelvic pain patients also met criteria for G-HSD. After adjusting for confounders, the odds in favor of having G-HSD was 3.55 higher (95% CI: 1.50, 8.40) (p=.004) in females with dyspareunia; 7.46 higher (95% CI: 2.41, 23.1) (p=<.001) with low back pain; 3.76 higher (95% CI: 1.35, 10.5) (p=0.02) with SUI; 4.72 higher (95% CI: 2.00, 11.2) (p=<.001) with IBS; and 3.12 higher (95% CI: 1.36, 7.13) (p=.007) with hip pain. There was no significant association identified between PVD or fibromyalgia and G-HSD. CONCLUSIONS: The estimated prevalence of G-HSD is higher in chronic myofascial pelvic pain patients than in the general population with statistically significant associations with several co-morbid conditions. Characterizing these associations is the first step in developing effective, evidence-based screening recommendations. LEVEL OF EVIDENCE: III This article is protected by copyright. All rights reserved. PMID: 30729750 [PubMed - as supplied by publisher] View the full article

Pubmed-Continuing Medical Education Questions: February 2019.

Feb 8, 2019
Related Articles Continuing Medical Education Questions: February 2019. Am J Gastroenterol. 2019 Feb;114(2):200 Authors: Lustbader I Abstract To receive CME/MOC credit for this activity, please go to: http://acgjournalcme.gi.org/Article Title: Influence of Dietary Restriction on Irritable Bowel Syndrome. PMID: 30730323 [PubMed - in process] View the full article

Pubmed-Conditioned Pain Modulation (CPM) is Reduced in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of CPM and the Role of Psychological Factors.

Feb 8, 2019
Related Articles Conditioned Pain Modulation (CPM) is Reduced in Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis of CPM and the Role of Psychological Factors. J Clin Gastroenterol. 2019 Feb 05;: Authors: Marcuzzi A, Chakiath RJ, Siddall PJ, Kellow JE, Hush JM, Jones MP, Costa DSJ, Wrigley PJ Abstract This systematic review summarises evidence assessing endogenous pain inhibition in people with irritable bowel syndrome (IBS) compared with healthy controls using conditioned pain modulation (CPM) and offset analgesia (OA). Evidence regarding the role of psychological variables is also examined. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Four electronic databases were searched to retrieve studies assessing CPM or OA in adults diagnosed with IBS according to the ROME II/III criteria. Standardized mean differences were calculated for each study and a random effects model was used for meta-analysis. Eleven studies were included, 5 of which reported results on the relationship between CPM and psychological variables. None of the studies assessed OA. The risk of bias assessment found a lack of assessor blinding in all studies. The pooled effect estimate was 0.90 (95% CI, 0.40-1.40) indicating a significantly lower CPM effect in people with IBS compared with controls. This effect was reduced to 0.51 when 1 outlier was excluded from the analysis. In addition, reduced CPM responses were significantly correlated with higher anxiety (r=0.17 to 0.64), stress (r=0.63), and pain catastrophizing (r=0.38) in people with IBS; however, the evidence available was limited and the strength of these associations variable. Depression was not found to be associated with CPM in these IBS cohorts. The results of this review suggest that people with IBS, as a group, demonstrate reduced pain inhibition measured by CPM. The preliminary evidence about the association between psychological factors and CPM warrants further investigations. PMID: 30730473 [PubMed - as supplied by publisher] View the full article

Pubmed-Effects of CPEB1 in the anterior cingulate cortex on visceral pain in mice.

Feb 8, 2019
Related Articles Effects of CPEB1 in the anterior cingulate cortex on visceral pain in mice. Brain Res. 2019 Feb 04;: Authors: Wang XS, Yue J, Hu LN, Tian Z, Yang LK, Lu L, Zhao MG, Liu SB Abstract Patients with irritable bowel syndrome suffer from chronic visceral pain, and in some of them, this is accompanied by anxiety comorbidity. Cytoplasmic polyadenylation element binding protein 1 (CPEB1) mediates the cytoplasmic polyadenylation of mRNAs and facilitates their translation. Our previous studies have shown that CPEB1 knockdown in the amygdala exerts anxiolytic but not analgesic effects in a mouse model of inflammatory pain. However, the roles of CPEB1 in the anterior cingulate cortex (ACC) in visceral pain modulation remain unclear. In this study, a visceral pain mouse model was established by injecting zymosan into the colon of mice. Zymosan injection significantly induced visceral pain- and anxiety-like behaviors in mice and increased the levels of GluA1, phosphorylated GluA1 at S845 and S831, and CPEB1 in the ACC. CPEB1 knockdown in the ACC by AAV-CPEB1-shRNA reduced zymosan-induced pain- and anxiety-like behaviors in mice. This observation was closely correlated with reduced AMPA receptor, synaptophysin, and PSD95 levels. These data suggest that CPEB1 in the ACC is a potential therapeutic target for visceral pain and anxiety comorbidity. PMID: 30731077 [PubMed - as supplied by publisher] View the full article

Pubmed-[Sensitivity and Specificity of the Reizdarm-Fragebogen].

Feb 8, 2019
Related Articles [Sensitivity and Specificity of the Reizdarm-Fragebogen]. Psychother Psychosom Med Psychol. 2019 Feb 07;: Authors: Schäfer SK, Weidner KJ, Becker N, Lass-Hennemann J, Stokes C, Lammert F, Köllner V Abstract BACKGROUND: The Reizdarm-Fragebogen (RDF) is the first German questionnaire to assess subjectively perceived symptom severity of irritable bowel syndrome (IBS). Thus far, this was only possible in the context of a medical examination by a practitioner. The goal of the current study was to assess differences in RDF scores among IBS patients and other clinical and non-clinical populations. Further, the study aimed to define a cut-off score for the presence of IBS and thereby, to evaluate the RDF as screening instrument in IBS diagnosis. MATERIALS AND METHODS: The study sample consisted of 372 individuals (62.6% male, mean age=41±17 years). 17.5% (of the sample) were IBS patients, 9.9% received treatment for chronic inflammatory bowel disease, 12.1% of the participants were recruited from a psychosomatic clinic, and 50.5% belonged to a control group. All participants filled out the 13 item RDF. RESULTS: The IBS patients' RDF scores differed significantly from those of other clinical and non-clinical subsamples [t(98.82)=13.61, p<0.001]. Except for the subscale "bloating" this difference was consistently found for all RDF subscales ("diarrhea", "constipation", and "pain and feeling of tension"). With respect to the identification of a cut-off for IBS diagnosis, a score of 32 showed both good sensitivity (90.80%) and specificity (75.56%). DISCUSSION AND CONCLUSION: The RDF is an efficient instrument for the assessment of subjectively perceived symptom severity in IBS. Based on the current findings and its good psychometric properties it can be used as a screening instrument for IBS in both clinical practice and research. PMID: 30731510 [PubMed - as supplied by publisher] View the full article

Pubmed-[The Role of Psychotherapy in the Treatment of Irritable Bowel Syndrome].

Feb 8, 2019
Related Articles [The Role of Psychotherapy in the Treatment of Irritable Bowel Syndrome]. Psychother Psychosom Med Psychol. 2019 Feb 07;: Authors: Weibert E, Stengel A Abstract Irritable bowel syndrome is a common functional gastrointestinal disorder that greatly impacts on quality of life due to gastrointestinal complaints such as pain or altered stool habits. Based on the biopsychosocial model the severity of the disease is affected by the combination of physiological processes, social aspects and psychological factors. While treatment approaches mainly focused on the reduction of gut complaints by dietary means or medication, psychotherapy is becoming an alternative or additional approach with very good evidence, especially in light of associated psychiatric comorbidities (e. g. depression, anxiety disorder). Often psychiatric symptoms/comorbidities increase the probability of a complicated course of the disease with a reciprocal interaction of gut complaints and psychiatric symptoms. Behavioral therapy, psychodynamic psychotherapy, hypnotherapy, mindfulness interventions and other psychotherapeutic methods are used to increase coping as well as disease control and to restructure dysregulated cognitive processes. The current review focuses on psychosocial aspects of the irritable bowel syndrome and discusses the benefit of psychotherapeutic interventions. PMID: 30731513 [PubMed - as supplied by publisher] View the full article

Google-IBS Symptoms May Be Alleviated by Antidepressants, Psychological Therapies - Consultant360

Feb 8, 2019
IBS Symptoms May Be Alleviated by Antidepressants, Psychological Therapies Consultant360Antidepressants and psychological therapies can reduce irritable bowel syndrome (IBS) symptoms, according to a new study. “For patients with persistent IBS ... View the full article

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