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Pubmed-Comparison of non-invasive biomarkers faecal BAFF, calprotectin and FOBT in discriminating IBS from IBD and evaluation of intestinal inflammation.
Related Articles Comparison of non-invasive biomarkers faecal BAFF, calprotectin and FOBT in discriminating IBS from IBD and evaluation of intestinal inflammation. Sci Rep. 2017 06 01;7(1):2669 Authors: Fu Y, Wang L, Xie C, Zou K, Tu L, Yan W, Hou X Abstract Faecal calprotectin and faecal occult blood test (FOBT) were widely used in the diagnosis and assessment of intestinal inflammation in inflammatory bowel disease (IBD). Recently we identified an excellent new biomarker B cell-activating factor (BAFF) for IBD. Here in this study we compared the efficacy of faecal BAFF, calprotectin and FOBT to find the "best non-invasive marker". Results showed that for discriminating IBD from IBS, BAFF ≥227.3 pg/ml yield 84% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 64% negative predictive value (NPV) while calprotectin ≥50 µg/g yield 76% sensitivity, 93% specificity, 97% PPV and 53% NPV. FOBT yield 65% sensitivity, 93% specificity, 97% PPV and 43% NPV. Combining BAFF with calprotectin tests yield 94% sensitivity, 93% specificity, 98% PPV, 81% NPV. Faecal BAFF level showed the stronger correlation with endoscopic inflammatory score as compared to calprotectin not only in UC (correlation coefficient [r] = 0.69, p < 0.0001 vs. r = 0.58, p < 0.0001), but also in CD (r = 0.58, p < 0.0001 vs. r = 0.52, p = 0.0003). Our results indicating that faecal BAFF is a promising non-invasive biomarker in IBD differential diagnosis and monitoring of intestinal inflammation. PMID: 28572616 [PubMed - indexed for MEDLINE] View the full article
Pubmed-Multiple psychological factors predict abdominal pain severity in children with irritable bowel syndrome.
Multiple psychological factors predict abdominal pain severity in children with irritable bowel syndrome. Neurogastroenterol Motil. 2018 Dec 13;:e13509 Authors: Hollier JM, van Tilburg MAL, Liu Y, Czyzewski DI, Self MM, Weidler EM, Heitkemper M, Shulman RJ Abstract BACKGROUND: Anxiety and depression are implicated as contributors to abdominal pain in pediatric irritable bowel syndrome (IBS) but is unclear if this pain is associated with other psychological factors. The study objective was to test if the impact of anxiety or depression on IBS symptom severity is mediated by somatization and/or pain catastrophizing. METHODS: We utilized baseline data from local pediatric IBS clinical studies. Through mediation analysis, we assessed whether somatization or pain catastrophizing mediated (either independently or combined) the separate relationships of anxiety or depression with IBS abdominal pain severity. KEY RESULTS: We analyzed 261 participants. All psychological factors were positively correlated with one another and IBS abdominal pain severity. The association of anxiety with IBS abdominal pain was mediated by both somatization and pain catastrophizing in individual analyses (each mediated standardized coefficient [β] 0.11, CI 0.05-0.18) and in multiple analysis (mediated standardized β 0.18, CI 0.09-0.27). The association of depression with IBS abdominal pain was also mediated by somatization (mediated standardized β 0.08, CI0.02-0.14) and pain catastrophizing (mediated standardized β 0.06, CI 0.01-0.11) in individual analyses and in multiple analysis (mediated standardized β 0.19, CI 0.04-0.19). CONCLUSIONS AND INFERENCES: Somatization and pain catastrophizing mediate the relationships between anxiety/depression and IBS abdominal pain severity. These findings suggest that somatization and pain catastrophizing may be better treatment targets than anxiety and depression. Clinicians should assess these psychological factors in pediatric IBS patients and refer for intervention to improve outcomes. PMID: 30549152 [PubMed - as supplied by publisher] View the full article
Pubmed-Enkephalinase inhibitors, potential therapeutics for the future treatment of diarrhea predominant functional gastrointestinal disorders.
Enkephalinase inhibitors, potential therapeutics for the future treatment of diarrhea predominant functional gastrointestinal disorders. Neurogastroenterol Motil. 2018 Dec 14;:e13526 Authors: Szymaszkiewicz A, Storr M, Fichna J, Zielinska M Abstract The endogenous opioid system (EOS) is considered being a crucial element involved in the pathophysiology of irritable bowel syndrome (IBS) as it regulates gastrointestinal (GI) homeostasis through modulation of motility and water and ion secretion/absorption. Along with opioid receptors (ORs), the following components of EOS can be distinguished: 1. endogenous opioid peptides (EOPs), namely enkephalins, endorphins, endomorphins and dynorphins, and 2. peptidases, which regulate the metabolism (synthesis and degradation) of EOPs. Enkephalins, which are δ-opioid receptors agonists, induce significant effects in the GI tract as they act as potent pro-absorptive neurotransmitters. The action of enkephalins and other EOPs is limited, since EOPs are easily and rapidly inactivated by a natural metalloendopeptidase (enkephalinase/neprilysin) and aminopeptidase N. Studies show that the activity of EOPs can be enhanced by inhibition of these enzymes. In this review, we discuss the antidiarrheal and antinociceptive potential of enkephalinase inhibitors. Furthermore, our review is to answer the question whether enkephalinase inhibitors may be helpful in the future treatment of diarrhea predominant functional GI disorders. PMID: 30549162 [PubMed - as supplied by publisher] View the full article
Plecanatide for Treatment of Chronic Constipation and Irritable Bowel Syndrome. Am J Med. 2018 Dec 11;: Authors: Love BL Abstract Chronic idiopathic constipation and irritable bowel syndrome with constipation are commonly encountered in ambulatory patients, but limited options exist for patients with persistent or severe symptoms following treatment with non-prescription products. Plecanatide (Trulance, Synergy Pharmaceuticals) is a 16-amino acid peptide analogue of uroguanylin that stimulates guanylate cyclase-C receptors to increase chloride and bicarbonate secretion into the intestine and prevents the absorption of sodium ions, thereby increasing the secretion of water into the lumen. The influx of additional fluid accelerates intestinal transit, softens the stool and facilitates easier defecation. Plecanatide is the second guanylate cyclase-C receptor agonist to be approved by the US Food and Drug Administration for chronic idiopathic constipation and irritable bowel syndrome, but plecanatide is unique since its effects are limited to the proximal small bowel. PMID: 30550753 [PubMed - as supplied by publisher] View the full article
Twitter-RT @GMFHx: There is still uncertainty regarding the mechanisms of action of probiotics on gut motility and constipation. This Review from @…
RT @GMFHx: There is still uncertainty regarding the mechanisms of action of probiotics on gut motility and constipation. This Review from @… (RSS generated with FetchRss) View the full article
Related Articles Management Options for Irritable Bowel Syndrome. Mayo Clin Proc. 2018 Dec;93(12):1858-1872 Authors: Camilleri M Abstract Irritable bowel syndrome (IBS) is associated with diverse pathophysiologic mechanisms. These mechanisms include increased abnormal colonic motility or transit, intestinal or colorectal sensation, increased colonic bile acid concentration, and superficial colonic mucosal inflammation, as well as epithelial barrier dysfunction, neurohormonal up-regulation, and activation of secretory processes in the epithelial layer. Novel approaches to treatment include lifestyle modification, changes in diet, probiotics, and pharmacotherapy directed to the motility, sensation, and intraluminal milieu of patients with IBS. Despite recent advances, there is a need for development of new treatments to relieve pain in IBS without deleterious central or other adverse effects. PMID: 30522596 [PubMed - in process] View the full article
Pubmed-Key mechanisms of cognitive behavioural therapy in irritable bowel syndrome: The importance of gastrointestinal related cognitions, behaviours and general anxiety.
Related Articles Key mechanisms of cognitive behavioural therapy in irritable bowel syndrome: The importance of gastrointestinal related cognitions, behaviours and general anxiety. J Psychosom Res. 2018 Nov 22;: Authors: Windgassen S, Moss-Morris R, Goldsmith K, Chalder T Abstract BACKGROUND: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterised by abdominal pain and altered bowel movements. Cognitive behavioural therapy (CBT) has been shown to be effective in reducing symptom severity in IBS and enhancing quality of life/functioning. The present study sought to identify how CBT achieves change in these outcomes. METHOD: Secondary analysis was conducted on 149 patients with irritable bowel syndrome who had been randomised to cognitive behavioural therapy plus an antispasmodic medication or antispasmodic alone. Single and sequential mediation was modelled using structural equation modelling. Gastrointestinal (GI) related avoidance behaviour, safety behaviour, cognitions and general anxiety were included as mediators. RESULTS: GI safety behaviours, cognitions and general anxiety mediated treatment effect on the outcomes of symptom severity and work and social adjustment. Avoidance behaviour was not a significant mediator for either outcome. Sequential mediation models indicated that unhelpful GI related cognitions reduced before anxiety did, and this sequential path (R➔GI related cognitions➔anxiety➔outcome) was significant for both symptom severity (b = -0.22, CI [-0.40 to -0.90], p = .005) and work and social adjustment (b = -0.26, CI [-0.44 to -0.11], p = .003) where 'R' is randomisation. Reduction in GI safety behaviours also preceded reduction in anxiety. This sequence (R ➔GI safety behaviours➔anxiety➔outcome) was significant for both symptom severity (b = -0.11, CI [-0.24 to -0.01], p = .049) and work and social adjustment (b = -0.12, CI [-0.23 to -0.03], p = .03). CONCLUSION: Results suggest that it is important for psychological treatments to target IBS specific factors for change. PMID: 30522750 [PubMed - as supplied by publisher] View the full article
Pubmed-Pioglitazone improves visceral sensation and colonic permeability in a rat model of irritable bowel syndrome.
Related Articles Pioglitazone improves visceral sensation and colonic permeability in a rat model of irritable bowel syndrome. J Pharmacol Sci. 2018 Nov 24;: Authors: Nozu T, Miyagishi S, Nozu R, Takakusaki K, Okumura T Abstract Visceral hypersensitivity and impaired gut barrier with minor inflammation are considered to play an important role in the pathophysiology of irritable bowel syndrome (IBS). Since pioglitazone is known to have anti-inflammatory property, we hypothesized that pioglitazone is beneficial for treating IBS. In this study, the effect was tested in rat IBS models such as lipopolysaccharide or repeated water avoidance stress-induced visceral allodynia and increased colonic permeability. Pioglitazone blocked these visceral changes, and GW9662, a peroxisome proliferator-activated receptor gamma (PPAR-γ) antagonist fully reversed the effect by pioglitazone. These results suggest that PPAR-γ activation by pioglitazone may be useful for IBS treatment. PMID: 30522964 [PubMed - as supplied by publisher] View the full article
Related Articles Separating "good" from "bad" faecal dysbiosis - evidence from two cross-sectional studies. BMC Obes. 2018;5:30 Authors: Farup PG, Aasbrenn M, Valeur J Abstract Background: Faecal dysbiosis associated with the use of metformin has been conceived as a favourable ("good") dysbiosis and that with intake of non-nutritive sweeteners (NNS) as unfavourable ("bad"). The study aimed to construct an alternative dysbiosis index (ADI) for the separation of the dysbioses into "good" and "bad", and to validate the ADI. Methods: Subjects with morbid obesity were included. Use of NNS and drugs were noted, IBS was classified according to the Rome III criteria and the severity measured with the Irritable bowel severity scoring system (IBSSS). Faecal dysbiosis was tested with GA-Map ™ Dysbiosis test (Genetic Analysis AS, Oslo, Norway). The result was given as Dysbiosis Index (DI) scores 1-5, score > 2 indicates dysbiosis. An ADI was constructed and validated in subjects with IBS at another hospital. Results: Seventy-six women and 14 men aged 44.7 years (SD 8.6) with BMI 41.8 kg/m2 (SD 3.6) were included. Dysbiosis was associated with the use of NNS and metformin, but not with IBS or IBSSS. An ADI based on differences in 7 bacteria was positively and negatively associated with the "good" metformin dysbiosis and the "bad" NNS dysbiosis respectively. The ADI was also negatively associated with IBSSS (a "bad" dysbiosis). The negative associations between ADI and IBS and IBSS were confirmed in the validation group. Conclusions: The new ADI, but not the DI, allowed separation of the "good" and "bad" faecal dysbiosis. Rather than merely reporting dysbiosis and degrees of dysbiosis, future diagnostic tests should distinguish between types of dysbiosis. PMID: 30524735 [PubMed] View the full article
Pubmed-Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link?
Related Articles Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link? Eur J Gastroenterol Hepatol. 2018 Dec 12;: Authors: Mari A, Hosadurg D, Martin L, Zarate-Lopez N, Passananti V, Emmanuel A Abstract OBJECTIVES: The low-FODMAP diet has emerged as an option for the treatment of irritable bowel syndrome (IBS). This diet is very restrictive, and compliance is usually low. Preliminary findings suggest an association between eating disorders (EDs) and the risk of developing IBS. The aim of this study was to assess the correlation between compliance with a low-FODMAP diet and the risk of ED behaviours among patients with IBS. PATIENTS AND METHODS: A single-centre prospective study was carried out among 233 IBS patients (79.8% females) at University College London Hospital, who commenced a low FODMAPs group programme for IBS (Rome III or IV). Self-reported diet adherence at the end of the 6-week programme was measured. At baseline, and at the 6-week follow-up visit, participants completed the validated IBS-Symptom Severity Score, the SCOFF ED screening questionnaire and the Hospital Anxiety and Depression Scale. RESULTS: Adherence with a low-FODMAP diet was found in 95 (41%) patients. Overall, 54 (23%) patients were classified to be at risk for ED behaviour. Adherence was 57% in the ED group (31/54) versus 35% in the non-ED group (64/179); P<0.05. Adherence with a low-FODMAP diet was highest (51%) in the IBS with diarrhoea subtype and lowest (10%) in IBS with constipation. There was no significant correlation between IBS-Symptom Severity Score and either adherence (P=0.39) or ED behaviour (P=0.28). CONCLUSION: In this IBS cohort, greater adherence to a low-FODMAP diet is associated with ED behaviour. The implications of our study are important in clinical practice for a clinician to have a high index of suspicion of EDs in IBS patients when a high level of low-FODMAP diet achieved. PMID: 30543574 [PubMed - as supplied by publisher] View the full article
Pubmed-Pressure management as an occupational stress risk factor in irritable bowel syndrome: A cross-sectional study.
Related Articles Pressure management as an occupational stress risk factor in irritable bowel syndrome: A cross-sectional study. Medicine (Baltimore). 2018 Dec;97(49):e13562 Authors: Popa SL, Leucuta DC, Dumitrascu DL Abstract Irritable Bowel Syndrome (IBS) is the most prevalent functional gastrointestinal disorder. Psychosocial stress is one of the pathogenic factors involved in the pathogenesis of IBS. The Pressure Management Indicator (PMI) is a validated questionnaire to analyze all aspects of occupational stress-a model involving sources of pressure, the mechanisms of coping, the personality, and the resulting effects of the interaction between these 3 elements. The purpose of this study was to analyze the association between socio-professional stress effects in IBS, and the relationship of IL-6 levels and salivary cortisol with occupational stress.We conducted a prospective cross-sectional study on 76 patients (39 patients with IBS, diagnosed according to the Rome III criteria and 37 healthy controls) who were investigated using a validated self-administered questionnaire: PMI. The biologic markers of chronic stress were analyzed using salivary cortisol and the immune response with serum interleukin 6 (IL-6).The IBS patients corresponded to the following subtypes: diarrhea-predominant: 22, constipation-predominant: 14 and mixed: 3. All the socio-professional pressure effects variables and scales were statistically significant, in an inversely proportional relation with IBS. Lower scores (poor effects) were found in IBS subjects. The adjusted odds ratios of having IBS versus healthy subjects for the socio-professional pressure effects scales were: 0.81 (95% confidence interval (CI) 0.72-0.88), for satisfaction, 0.85 (95% CI 0.78-0.91) for organization, 0.85 (95% CI 0.79-0.91) for mental wellbeing and 0.8 (95% CI 0.71-0.87) for physical wellbeing (P <.001). Also, the serum IL-6 levels were significantly higher in IBS than in controls (p < 0.001). There was no statistical difference between the salivary levels of cortisol between IBS patients and controls (P = .898).The level of occupational stress was higher in IBS patients compared to healthy subjects (socio-professional stress effects were lower in IBS patients) and correlated with IL-6 levels. Salivary cortisol was not associated with occupational pressure management. PMID: 30544474 [PubMed - in process] View the full article
Related Articles Pediatric Integrative Medicine in Academia: Stanford Children's Experience. Children (Basel). 2018 Dec 12;5(12): Authors: Ramesh G, Gerstbacher D, Arruda J, Golianu B, Mark J, Yeh AM Abstract Pediatric integrative medicine is an emerging field which, to date, has not been described in detail in academic medical centers in the United States. Early research of pediatric integrative medicine modalities shows promise for the treatment of common pediatric conditions such as irritable bowel syndrome, acute and chronic pain, headache, and allergy, among others. In light of the growing prevalence of pediatric illnesses and patient complexity, it is crucial to emphasize the patient's overall well-being. As academic centers around the world start to develop pediatric integrative medicine programs, the aim of this manuscript is to briefly highlight evidence of effective integrative treatments in pediatric subspecialties, to describe the establishment of our integrative medicine program, to summarize its early efforts, and to discuss potential barriers and keys to success. PMID: 30545081 [PubMed] View the full article
Pubmed-A review of the gluten-free diet in non-celiac patients: beliefs, truths, advantages and disadvantages.
Related Articles A review of the gluten-free diet in non-celiac patients: beliefs, truths, advantages and disadvantages. Minerva Gastroenterol Dietol. 2018 Dec 14;: Authors: Palmieri B, Vadala' M, Laurino C Abstract A gluten-free diet is the safest treatment for the treatment of patient with celiac disease (CD) and other gluten-related disorders. However, in the last years, gluten-free diet is one of the most popular diet followed by the general population and by patients affected from others clinical conditions, such as non-celiac gluten sensitivity (NCGS), irritable bowel syndrome (IBS), autism, neurological, psychiatric and rheumatologic diseases and for improving sports practice. This review highlights some questions about the appropriateness of follow this trend answering to some questions such as how safe are the current gluten-free products, what are the benefits and side effects of gluten-free diet and what are clinical conditions that might benefit from gluten avoidance. PMID: 30545212 [PubMed - as supplied by publisher] View the full article
Pubmed-[Irritable bowel syndrome: comorbid psychiatric disorders and psychological treatment options].
Related Articles [Irritable bowel syndrome: comorbid psychiatric disorders and psychological treatment options]. Orv Hetil. 2018 Dec;159(50):2115-2121 Authors: Gajdos P, Rigó A Abstract Irritable bowel syndrome is a chronic functional gastrointestinal disorder with a prevalence of 7-21%. It has a negative impact on health-related quality of life and work productivity and it is associated with increased psychological distress and mental comorbidity, like major depression disorder and generalised anxiety disorder. Due to biopsychosocial factors and the brain-gut axis playing a key role in the aetiology of the disease, the use of psychological treatments has great importance in the therapy of irritable bowel syndrome. These interventions focus on central mechanisms, like visceral sensitivity, pain amplification, hypervigilance and gastrointestinal symptom-specific anxiety. They significantly reduce damaging illness-related cognitions, the use of maladaptive coping strategies, catastrophic appraisals of bodily sensations and chronic muscle tension. The utilization of these treatments is associated with clinically significant symptom improvement and positive mental health outcomes. This review study focuses on the psychiatric comorbidity of irritable bowel syndrome and the use of evidence-based psychological therapies in the treatment of the disease. Using ScienceDirect and PubMed databases, almost 60 studies have been selected. A high number of studies investigate the efficacy of cognitive behaviour therapy and hypnotherapy with meta-analyses included. There is also growing evidence on the beneficial impacts of mindfulness-based stress reduction. Future research will need to concentrate on studying the utility of mind-body therapies such as relaxation techniques in the treatment of irritable bowel syndrome with meta-analyses on the effects of mindfulness-based interventions. Orv Hetil. 2018; 159(50): 2115-21121. PMID: 30545263 [PubMed - in process] View the full article
The Right Chemistry: Probiotics and your gut Montreal GazetteTwo recent studies indicate that adjustment of the composition of the microbiome is a complex matter. View the full article
Why garlic can make IBS and diarrhoea worse Telegraph.co.ukSuffering with IBS? You might want to consider giving up garlic. Here are a few alternatives that can have a positive impact on your gut. View the full article
Twitter-Are you still trying to understand exactly what are #probiotics and how they can aid #guthealth? Find the answers to your #GI questions in our new #blog post: https://t.co/wpkf3mNScy https://t.co/pVtszUwnQD
Are you still trying to understand exactly what are #probiotics and how they can aid #guthealth? Find the answers to your #GI questions in our new #blog post: http://ow.ly/Hoga30mXwYo (RSS generated with FetchRss) View the full article
Google-UPDATE: Synergy Pharma shares slide 55% as it files for Chapter 11, clearing way for sale too Bausch - MarketWatch
UPDATE: Synergy Pharma shares slide 55% as it files for Chapter 11, clearing way for sale too Bausch MarketWatchSynergy Pharmaceuticals Inc. shares SGYP, -4.05% slid 55% in premarket trade Wednesday, after the company filed a voluntary petition for Chapter 11, ... View the full article
Consensus document on exclusion diets in irritable bowel syndrome (IBS). Nutr Hosp. 2018 Dec 03;35(6):1450-1466 Authors: Casellas F, Burgos R, Marcos A, Santos J, Ciriza-de-Los-Ríos C, García-Manzanares Á, Polanco I, Puy-Portillo M, Villarino A, Lema-Marqués B, Vázquez-Alférez MªDC Abstract This paper summarizes the contents of a consensus document on exclusion diets in irritable bowel disease that was developed by a task force from SEPD, FEAD, SENPE, FESNAD, SEÑ, SEEN, SEGHNP, SEDCA and ADENYD. The complete document is available at the FEAD and in SENPE websites. Irritable bowel syndrome is a highly prevalent functional digestive disorder where, in addition to drugs, therapy includes diet and acquisition of healthy habits as basic elements for its control. In order to facilitate dietary counseling for these patients in daily practice, the present consensus document on the role of exclusion diets was developed. To this end, consensus opinions were collected from various experts in the national scientific societies aiming at establishing recommendations applicable to the health care of patients with irritable bowel syndrome. PMID: 30525861 [PubMed - in process] View the full article
Pubmed-Bifidobacterium infantis M-63 improves mental health in victims with irritable bowel syndrome developed after a major flood disaster.
Bifidobacterium infantis M-63 improves mental health in victims with irritable bowel syndrome developed after a major flood disaster. Benef Microbes. 2018 Dec 10;:1-10 Authors: Ma ZF, Yusof N, Hamid N, Lawenko RM, Mohammad WMZW, Liong MT, Sugahara H, Odamaki T, Xiao J, Lee YY Abstract Individuals in a community who developed irritable bowel syndrome (IBS) after major floods have significant mental health impairment. We aimed to determine if Bifidobacterium infantis M-63 was effective in improving symptoms, psychology and quality of life measures in flood-affected individuals with IBS and if the improvement was mediated by gut microbiota changes. Design was non-randomised, open-label, controlled before-and-after. Of 53 participants, 20 with IBS were given B. infantis M-63 (1×109 cfu/sachet/day) for three months and 33 were controls. IBS symptom severity scale, hospital anxiety and depression scale, SF-36 Questionnaire, hydrogen breath testing for small intestinal bacterial overgrowth and stools for 16S rRNA metagenomic analysis were performed before and after intervention. 11 of 20 who were given probiotics (M-63) and 20 of 33 controls completed study as per-protocol. Mental well-being was improved with M-63 vs controls for full analysis (P=0.03) and per-protocol (P=0.01) populations. Within-group differences were observed for anxiety and bodily pain (both P=0.04) in the M-63 per-protocol population. Lower ratio of Firmicutes/Bacteroidetes was observed with M-63 vs controls (P=0.01) and the lower ratio was correlated with higher post-intervention mental score (P=0.04). B. infantis M-63 is probably effective in improving mental health of victims who developed IBS after floods and this is maybe due to restoration of microbial balance and the gut-brain axis. However, our conclusion must be interpreted within the context of limited sample size. The study was retrospectively registered on 12 October 2017 and the Trial Registration Number (TRN) was NCT03318614. PMID: 30525951 [PubMed - as supplied by publisher] View the full article