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Related Articles Gas and Bloating-Controlling Emissions: A Case-Based Review for the Primary Care Provider. Mayo Clin Proc. 2016 Aug;91(8):1105-13 Authors: Cotter TG, Gurney M, Loftus CG Abstract The evaluation of the patient with gas and bloating can be complex and the treatment extremely challenging. In this article, a simplified approach to the history and relevant physical examination is presented and applied in a case-oriented manner, suitable for application in the primary care setting. PMID: 27492915 [PubMed - indexed for MEDLINE] View the full article
Pubmed-Open-label versus double-blind placebo treatment in irritable bowel syndrome: study protocol for a randomized controlled trial.
Related Articles Open-label versus double-blind placebo treatment in irritable bowel syndrome: study protocol for a randomized controlled trial. Trials. 2017 May 25;18(1):234 Authors: Ballou S, Kaptchuk TJ, Hirsch W, Nee J, Iturrino J, Hall KT, Kelley JM, Cheng V, Kirsch I, Jacobson E, Conboy L, Lembo A, Davis RB Abstract BACKGROUND: Placebo medications, by definition, are composed of inactive ingredients that have no physiological effect on symptoms. Nonetheless, administration of placebo in randomized controlled trials (RCTs) and in clinical settings has been demonstrated to have significant impact on many physical and psychological complaints. Until recently, conventional wisdom has suggested that patients must believe that placebo pills actually contain (or, at least, might possibly contain) active medication in order to elicit a response to placebo. However, several recent RCTs, including patients with irritable bowel syndrome (IBS), chronic low back pain, and episodic migraine, have demonstrated that individuals receiving open-label placebo (OLP) can still experience symptomatic improvement and benefit from honestly described placebo treatment. METHODS AND DESIGN: This paper describes an innovative multidisciplinary trial design (n = 280) that attempts to replicate and expand upon an earlier IBS OLP study. The current study will compare OLP to double-blind placebo (DBP) administration which is made possible by including a nested, double-blind RCT comparing DBP and peppermint oil. The study also examines possible genetic and psychological predictors of OLP and seeks to better understand participants' experiences with OLP and DBP through a series of extensive interviews with a randomly selected subgroup. DISCUSSION: OLP treatment is a novel strategy for ethically harnessing placebo effects. It has potential to re-frame theories of placebo and to influence how physicians can optimize watch-and-wait strategies for common, subjective symptoms. The current study aims to dramatically expand what we know about OLP by comparing, for the first time, OLP and DBP administration. Adopting a unique, multidisciplinary approach, the study also explores genetic, psychological and experiential dimensions of OLP. The paper ends with an extensive discussion of the "culture" of the trial as well as potential mechanisms of OLP and ethical implications. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02802241 . Registered on 14 June 2016. PMID: 28545508 [PubMed - in process] View the full article
Pubmed-Gastrointestinal tolerance of low FODMAP oral nutrition supplements in healthy human subjects: a randomized controlled trial.
Related Articles Gastrointestinal tolerance of low FODMAP oral nutrition supplements in healthy human subjects: a randomized controlled trial. Nutr J. 2017 May 25;16(1):35 Authors: Erickson J, Korczak R, Wang Q, Slavin J Abstract BACKGROUND: There has been increasing interest in utilizing a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs) for the treatment of irritable bowel syndrome (IBS), a functional gastrointestinal disease. While studies have indicated that this diet can be effective at symptom reduction, it is a restrictive diet and patients may find it challenging to find low FODMAP products to meet their nutrient needs. The primary objective of this study was to assess the gastrointestinal (GI) tolerance of three low FODMAP oral nutrition supplements (ONS) in healthy adults. METHODS: A double-blind randomized controlled crossover study was conducted in 21 healthy adults (19-32 years). Fasted subjects consumed one of four treatments at each visit, with a one week wash out period between visits. Each participant received all treatments. Treatments included three low FODMAP ONS formulas (A, B, and C) as well as a positive control consisting of 5 g fructooligosaccharides (FOS) mixed in lactose-free milk. Breath hydrogen was measured at baseline, 1, 2, 3, and 4 h post treatment consumption. Subjective GI symptom questionnaires were completed at baseline, 0.5, 1, 1.5, 2, 3, 4, 12, 24 and 48 h following treatment consumption. Mean breath hydrogen concentrations and baseline corrected area under the curve for both breath hydrogen and GI symptoms were analyzed and compared between treatments. Significance was determined at P < 0.05. RESULTS: The positive control resulted in higher breath hydrogen response compared to all three of the low FODMAP ONS beverages at 3 and 4 h after consumption. There were no differences in GI symptom response between treatments. CONCLUSIONS: All treatments were well tolerated in healthy participants. The low FODMAP formulas resulted in a lower breath hydrogen response compared to the positive control, and may be better tolerated in individuals with IBS. More research should be conducted to better understand the GI tolerance of low FODMAP ONS in individuals with IBS. TRIAL REGISTRATION: The protocol for this study was registered on ClinicalTrials.gov in January 2016 (Clinical Trials ID: NCT02667184 ). PMID: 28545589 [PubMed - in process] View the full article
Pubmed-Supplementation with a lecithin-based delivery form of Boswellia serrata extract (Casperome®) controls symptoms of mild irritable bowel syndrome.
Related Articles Supplementation with a lecithin-based delivery form of Boswellia serrata extract (Casperome®) controls symptoms of mild irritable bowel syndrome. Eur Rev Med Pharmacol Sci. 2017 May;21(9):2249-2254 Authors: Belcaro G, Gizzi G, Pellegrini L, Corsi M, Dugall M, Cacchio M, Feragalli B, Togni S, Riva A, Eggenhoffner R, Giacomelli L Abstract OBJECTIVE: Irritable Bowel Syndrome (IBS) is a chronic, gastrointestinal disorder in which abdominal pain or discomfort is associated with defecation or changes in bowel habits. Its multifactorial pathophysiology leads to a variety of available treatments, mainly aimed at controlling symptoms. The management of IBS patients could be optimized by individualized strategies, including non-pharmaceutical approaches. In this study, we evaluated the efficacy and safety of a novel delivery form of Boswellia serrata extracts (BSE) (Casperome®) in patients with IBS. PATIENTS AND METHODS: 71 otherwise healthy subjects with idiopathic IBS were recruited. Participants were assigned to the following management strategies: hyoscine butylbromide; papaverine hydrochloride + A. belladonna extract; supplementation with Casperome®. Predominant IBS symptoms were evaluated at inclusion and at the end of the observational period (4 weeks). The numbers of subjects who needed rescue medication or medical attention/hospital admission were recorded. Adverse events were also evaluated. RESULTS: In all groups, the IBS symptoms investigated, namely abdominal pain, altered bowel movements, meteorism and cramps improved during the observational period. Of note, the number of subjects who needed medical attention significantly decreased only in Casperome®-supplemented group. In addition, Casperome® supplementation was related to a lower incidence of side effects (mainly stypsis). CONCLUSIONS: This preliminary study suggests that Casperome® supplementation could represent a promising alternative approach to manage symptoms associated with IBS in otherwise healthy subjects. PMID: 28537656 [PubMed - in process] View the full article
Pubmed-The Effect of Peripheral CRF Peptide and Water Avoidance Stress on Colonic and Gastric Transit in Guinea Pigs.
Related Articles The Effect of Peripheral CRF Peptide and Water Avoidance Stress on Colonic and Gastric Transit in Guinea Pigs. Yonsei Med J. 2017 Jul;58(4):872-877 Authors: Hussain Z, Kim HW, Huh CW, Lee YJ, Park H Abstract Functional dyspepsia (FD) and irritable bowel syndrome (IBS) are common gastrointestinal (GI) diseases; however, there is frequent overlap between FD and IBS patients. Emerging evidence links the activation of corticotropin releasing factor (CRF) receptors with stress-related alterations of gastric and colonic motor function. Therefore, we investigated the effect of peripheral CRF peptide and water avoidance stress (WAS) on upper and lower GI transit in guinea pigs. Dosages 1, 3, and 10 μg/kg of CRF were injected intraperitoneally (IP) in fasted guinea pigs 30 minutes prior to the intragastric administration of charcoal mix to measure upper GI transit. Colonic transits in non-fasted guinea pigs were assessed by fecal pellet output assay after above IP CRF doses. Blockade of CRF receptors by Astressin, and its effect on GI transit was also analyzed. Guinea pigs were subjected to WAS to measure gastrocolonic transit in different sets of experiments. Dose 10 μg/kg of CRF significantly inhibited upper GI transit. In contrast, there was dose dependent acceleration of the colonic transit. Remarkably, pretreatment of astressin significantly reverses the effect of CRF peptide on GI transit. WAS significantly increase colonic transit, but failed to accelerate upper GI transit. Peripheral CRF peptide significantly suppressed upper GI transit and accelerated colon transit, while central CRF involved WAS stimulated only colonic transit. Therefore, peripheral CRF could be utilized to establish the animal model of overlap syndrome. PMID: 28541004 [PubMed - in process] View the full article
Pubmed-Functional Gastrointestinal Disorders in Children: A Survey on Clinical Approach in the Mediterranean Area.
Related Articles Functional Gastrointestinal Disorders in Children: A Survey on Clinical Approach in the Mediterranean Area. J Pediatr Gastroenterol Nutr. 2017 Jun;64(6):e142-e146 Authors: Scarpato E, Quitadamo P, Roman E, Jojkic-Pavkov D, Kolacek S, Papadopoulou A, Roma E, Shamir R, Lev MRB, Lutovac B, Djurisic V, Orel R, Koleilat A, Mneimneh S, Coppola V, Corazziari E, Staiano A Abstract OBJECTIVES: Childhood functional gastrointestinal disorders (FGIDs) are common conditions associated with significant morbidity and high healthcare costs. This multicenter study aimed at assessing the clinical approach to infants (0-6 months) and children/adolescents (4-18 years) with suspected FGIDs by pediatricians from the Mediterranean Area. METHODS: A survey evaluating the diagnostic approach, including the use of Rome II and III criteria, and the therapeutic management of some of the most prevalent FGIDs, such as irritable bowel syndrome (IBS), functional constipation (FC), and functional regurgitation (FR), was distributed to a sample of pediatricians. RESULTS: We collected 278 questionnaires from 9 countries (Croatia, Greece, Israel, Italy, Lebanon, Montenegro, Serbia, Slovenia, and Spain). Rome III criteria are used to diagnose FC by 28.8%. Treatment of FC is based on dietary modifications (97.5%) and osmotic laxatives (93.5%). Rome III criteria are used to diagnose FR by 22.3% of the responders, in contrast to 79.5% who rely on personal experience for diagnosis. Reported treatments mainly consist of reassurance (96.8%) and thickened feedings (77.3%). Nevertheless, 21.2% prescribe proton pump inhibitors or H2-blockers to infants with FR. Rome III criteria are used to diagnose IBS by only 25.9%. Moreover, 86% of the pediatricians base IBS therapy on the predominant symptom. The most prescribed treatments are analgesics (36.6%) for pain control, dietary advice (41.5%) for diarrhea-predominant IBS, and dietary advice (47.8%) for constipation-predominant IBS. CONCLUSIONS: Our data show that the use of Rome III diagnostic criteria is not sufficiently widespread among pediatricians, and that large variability remains in the management of FGIDs within the different Mediterranean countries surveyed. PMID: 28541259 [PubMed - in process] View the full article
Related Articles Irritable Bowel Syndrome. Am J Nurs. 2017 Jun;117(6):48-55 Authors: Weaver KR, Melkus GD, Henderson WA Abstract : Irritable bowel syndrome (IBS) is a common, chronic gastrointestinal (GI) condition characterized by disturbances in bowel habits and abdominal pain in the absence of known organic pathology. IBS reduces quality of life and is costly to treat. It is diagnosed using the symptom-based Rome criteria for functional GI disorders, which was recently updated and released as Rome IV. Both physiologic and psychological variables play a role in the etiology of IBS and perpetuate symptoms. Although research has shed light on IBS pathophysiology, therapeutic interventions remain symptom driven, employing both pharmacologic and nonpharmacologic approaches. Here, the authors review the epidemiology and pathophysiology of IBS, summarize diagnostic and treatment strategies, and discuss implications for nursing practice. PMID: 28541989 [PubMed - in process] View the full article
Pubmed-Development and validation of the Patient-Physician Relationship Scale among patients with irritable bowel syndrome.
Related Articles Development and validation of the Patient-Physician Relationship Scale among patients with irritable bowel syndrome. Neurogastroenterol Motil. 2017 May 22;: Authors: Kurlander JE, Chey WD, Morris CB, Hu YJB, Padival RK, Bangdiwala SI, Norton NJ, Norton WF, Drossman DA Abstract BACKGROUND: An effective patient-physician relationship (PPR) is essential to the care of patients with irritable bowel syndrome (IBS). We sought to develop and validate an IBS-specific instrument to measure expectations of the PPR. METHODS: We conducted structured focus groups about PPRs with 12 patients with IBS. Qualitative analysis was used to generate a questionnaire (the Patient-Physician Relationship Scale [PPRS]), which was modified with input from content experts and usability testing. For validation, we administered it online to US adults with IBS. Participants also completed the Functional Bowel Disorder Severity Index, the Rome III Adult Functional gastrointestinal (GI) Disorder Criteria Questionnaire, and modified versions of the Communication Assessment Tool (CAT-15) and Patient-Doctor Relationship Questionnaire (PDRQ-9). We performed principal components factor analysis for the PPRS. KEY RESULTS: The PPRS contained 32 questions with responses on a 7-item Likert scale. Themes included interpersonal features, clinical care expectations, and aspects of communication. One thousand and fifty-four eligible individuals completed the survey (88% completion rate). Most participants were middle aged (mean 48 years, SD 16.3), white (90%), and female (86%). Factor analysis showed only one relevant factor, relating to quality of PPR. The final scale ranged from possible-96 to +96 (mean 62.0, SD 37.6). It correlated moderately with the CAT-15 (r=.40, P<.001) and PDRQ-9 (r=.30, P<.001), establishing concurrent validity. CONCLUSIONS & INFERENCES: We describe the development and validation of the first questionnaire for use in measuring patient expectations of the PPR, which can be used for future outcomes studies and training physicians. PMID: 28544094 [PubMed - as supplied by publisher] View the full article
OregonLive.com Chipotle employee fired over irritable bowel syndrome, $400k lawsuit claims OregonLive.com According to Melani's lawsuit, he had diarrhea or felt sick to his stomach in February and April 2016. Although he thought his symptoms were caused by irritable bowel syndrome and not contagious, he followed company directives and didn't work, the suit ... View the full article
IBgard reduces IBS symptoms within 24 hours Healio CHICAGO —IBgard showed significant efficacy in a combined group of patients with irritable bowel syndrome with both diarrhea and constipation, and patients with diarrhea-predominant IBS, at 24 hours and at 4 weeks, according to data from two posters ... View the full article
NDTV IBS (Irritable Bowel Syndrome): What to Eat and What to Avoid NDTV Irritable Bowel Syndrome or IBS is a gastrointestinal disorder (functional disorder), the causes of which are unknown, but it is believed that it could be due to intestinal infection, bile acid malabsorption or sensitivity to a particular food item ... View the full article
News-Medical.net FODMAPs and Irritable Bowel Syndrome (IBS) News-Medical.net Irritable bowel syndrome (IBS) is a somewhat common diagnosis, prevalent in 8-20 percent of the population in the US. It is a chronic disorder which has symptoms of abdominal distension and pain, diarrhea, bloating and flatulence, in one or the other ... View the full article
FierceBiotech Takeda and NEA back $39M series A for GI biotech OrphoMed FierceBiotech OrphoMed gained a $39 million early funding boost from a Japanese big pharma and a host of VCs as it looks to push on with work on its leading med for forms of irritable bowel syndrome that it hopes can have a better safety profile than those meds on ... News OrphoMed Raises $39M in Series A Financi...Genetic Engineering & Biotechnology News OrphoMed Secures $39 Million Series A Financing RoundPR Newswire (press release) all 4 news articles » View the full article
Google-Probiotics could help improve gut symptoms and psychological issues in IBS, study shows - News-Medical.net
Probiotics could help improve gut symptoms and psychological issues in IBS, study shows News-Medical.net In a study published in the medical journal Gastroenterology (May 2), researchers of the Farncombe Family Digestive Health Research Institute found that twice as many adults with irritable bowel syndrome (IBS) reported improvements from co-existing ... and more » View the full article
Related Articles Diagnosis and management of chronic constipation in adults. Nat Rev Gastroenterol Hepatol. 2016 May;13(5):295-305 Authors: Rao SS, Rattanakovit K, Patcharatrakul T Abstract Constipation is a heterogeneous, polysymptomatic, multifactorial disease. Acute or transient constipation can be due to changes in diet, travel or stress, and secondary constipation can result from drug treatment, neurological or metabolic conditions or, rarely, colon cancer. A diagnosis of primary chronic constipation is made after exclusion of secondary causes of constipation and encompasses several overlapping subtypes. Slow-transit constipation is characterized by prolonged colonic transit in the absence of pelvic floor dysfunction. This subtype of constipation can be identified using either the radio-opaque marker test or wireless motility capsule test, and is best treated with laxatives such as polyethylene glycol or newer agents such as linaclotide or lubiprostone. If unsuccessful, subspecialist referral should be considered. Dyssynergic defecation results from impaired coordination of rectoanal and pelvic floor muscles, and causes difficulty with defecation. The condition can be identified using anorectal manometry and balloon expulsion tests and is best managed with biofeedback therapy. Opioid-induced constipation is an emerging entity, and several drugs including naloxegol, methylnaltrexone and lubiprostone are approved for its treatment. In this Review, we provide an overview of the burden and pathophysiology of chronic constipation, as well as a detailed discussion of the available diagnostic tools and treatment options. PMID: 27033126 [PubMed - indexed for MEDLINE] View the full article
Related Articles The Hippo pathway in intestinal regeneration and disease. Nat Rev Gastroenterol Hepatol. 2016 Jun;13(6):324-37 Authors: Hong AW, Meng Z, Guan KL Abstract The Hippo pathway is a signalling cascade conserved from Drosophila melanogaster to mammals. The mammalian core kinase components comprise MST1 and MST2, SAV1, LATS1 and LATS2 and MOB1A and MOB1B. The transcriptional co-activators YAP1 and TAZ are the downstream effectors of the Hippo pathway and regulate target gene expression. Hippo signalling has crucial roles in the control of organ size, tissue homeostasis and regeneration, and dysregulation of the Hippo pathway can lead to uncontrolled cell growth and malignant transformation. Mammalian intestine consists of a stem cell compartment as well as differentiated cells, and its ability to regenerate rapidly after injury makes it an excellent model system to study tissue homeostasis, regeneration and tumorigenesis. Several studies have established the important role of the Hippo pathway in these processes. In addition, crosstalk between Hippo and other signalling pathways provides tight, yet versatile, regulation of tissue homeostasis. In this Review, we summarize studies on the role of the Hippo pathway in the intestine on these physiological processes and the underlying mechanisms responsible, and discuss future research directions and potential therapeutic strategies targeting Hippo signalling in intestinal disease. PMID: 27147489 [PubMed - indexed for MEDLINE] View the full article
Related Articles IBS and IBD - separate entities or on a spectrum? Nat Rev Gastroenterol Hepatol. 2016 Sep 26;13(10):613-21 Authors: Spiller R, Major G Abstract The acute phase of IBD with inflamed gut and often ulcerated mucosa is clearly different from the apparently normal mucosa characteristic of IBS. However, more detailed assessment has detected immune activation, increased gut permeability, increased mucosal serotonin availability, abnormalities of enteric nerve structure and function, and dysbiosis in gut microbiota in IBS - all features seen in IBD. Furthermore, as treatments for inflammation in IBD have become more effective it is now apparent that ∼1 in 3 patients with IBD in remission from inflammation still have persistent abnormalities of sensation, motility and gut microbiota, which might cause IBS-like symptoms. This Perspective explores the overlap between IBS and IBD and their treatments, proposing future directions for research in this stimulating area. PMID: 27667579 [PubMed - indexed for MEDLINE] View the full article
Related Articles Opioids in Gastroenterology: Treating Adverse Effects and Creating Therapeutic Benefits. Clin Gastroenterol Hepatol. 2017 May 18;: Authors: Camilleri M, Lembo A, Katzka DA Abstract The use of opioid medications on both an acute and chronic basis is ubiquitous in the U.S. As opioid receptors densely populate the gastrointestinal tract, symptoms and side effects can be expected in these patients. In the esophagus, dysmotility may result manifesting with dysphagia and a syndrome indistinguishable from primary achalasia. In the stomach, a marked delay in gastric emptying may ensue with postprandial nausea and early satiety. Postoperatively, particularly with abdominal surgery, opioid induced ileus may ensue. In the colon, opioid induced constipation (OIC) is common. A unique syndrome termed narcotic bowel syndrome is characterized by chronic abdominal pain often accompanied by nausea and vomiting in the absence of other identifiable causes. With the recognition of the important role of opioids on gastrointestinal function, novel drugs have been developed which utilize this physiology. These medications include peripheral acting opioid agonists to treat OIC and combination agonist and antagonists used for diarrhea predominant irritable bowel syndrome. This review summarizes the most recent data in these areas. PMID: 28529168 [PubMed - as supplied by publisher] View the full article
Independent Online IBS - embarrassing, painful and constant Independent Online IT'S one of the things many take for granted - normal daily bowel movements - but for Masego (not her real name), an irritable bowel syndrome (IBS) sufferer, passing stools has become an obsession. This week, she “was lucky”, she said, almost ... IBS: How Your Doctor Could Be Misdiagnosing YouHuffPost UK IBS symptoms related to childhood trauma?Bel Marra Health all 3 news articles » View the full article
HuffPost UK IBS: How Your Doctor Could Be Misdiagnosing You HuffPost UK A staggering 20-25% of the UK population reveal they have suffered symptoms of Irritable Bowel Syndrome (IBS) at some point in their lives. Whilst many have turned to IBS-prescribed medication in order to relieve themselves from this conditions, these ... IBS symptoms related to childhood trauma?Bel Marra Health IBS - embarrassing, painful and constantIndependent Online all 3 news articles » View the full article