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From Current Opinion in Gastroenterology
Post-infectious Irritable Bowel Syndrome
Posted 12/08/2005
Robin Spiller; Eugene Campbell
Abstract
Purpose of Review: Irritable bowel syndrome patients form a heterogeneous group with a variable contribution of central and peripheral components. The peripheral component is prominent in irritable bowel syndrome developing after infection (post-infectious irritable bowel syndrome) and this has proved a profitable area of research.
Recent Findings: Recent studies have overthrown the dogma that irritable bowel syndrome is characterized by no abnormality of structure by demonstrating low-grade lymphocytic infiltration in the gut mucosa, increased permeability and increases in other inflammatory components including enterochromaffin and mast cells. Furthermore, increased inflammatory cytokines in both mucosa and blood have been demonstrated in irritable bowel syndrome. While steroid treatment has proved ineffective, preliminary studies with probiotics exerting an anti-inflammatory effect have shown benefit.
Summary: The study of post-infectious irritable bowel syndrome has revealed the importance of low-grade inflammation in causing irritable bowel syndrome symptoms. It has suggested novel approaches to irritable bowel syndrome including studies of serotonin and histamine metabolism which may be relevant to other subtypes of of the disease.
Robin Spiller and Eugene Campbell, Wolfson Digestive Diseases Centre, University Hospital, Nottingham, UK
Curr Opin Gastroenterol. 2006;22(1):13-17. ©2006 Lippincott Williams & Wilkins
http://www.medscape.com/viewarticle/518355?src=mp
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Clinical & Experimental Immunology
REVIEW
Gut motor function: immunological control in enteric infection and inflammation
W. I. Khan* and S. M. Collins*
Summary
Alteration in gastrointestinal (GI) motility occurs in a variety of clinical settings which include acute enteritis, inflammatory bowel disease, intestinal pseudo-obstruction and irritable bowel syndrome (IBS).
Most disorders affecting the GI tract arise as a result of noxious stimulation from the lumen via either microbes or chemicals. However, it is not clear how injurious processes initiated in the mucosa alter function in the deeper motor apparatus of the gut wall. Activation of immune cells may lead to changes in motor-sensory function in the gut resulting in the development of an efficient defence force which assists in the eviction of the noxious agent from the intestinal lumen.
This review addresses the interface between immune and motor system in the context of host resistance based on the studies in murine model of enteric nematode parasite infection. These studies clearly demonstrate that the infection-induced T helper 2 type immune response is critical in producing the alterations of infection-induced intestinal muscle function in this infection and that this immune-mediated alteration in muscle function is associated with host defence mechanisms.
In addition, by manipulating the host immune response, it is possible to modulate the accompanying muscle function, and this may have clinical relevance. These observations not only provide valuable information on the immunological control of gut motor function and its role in host defence in enteric infection, but also provide a basis for understanding pathophysiology of gastrointestinal motility disorders such as in IBS.
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2249.2005.02979.x
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A Survey on Patient Educational Needs in Irritable Bowel Syndrome and Attitudes Toward Participation in Clinical Research.
Journal of Clinical Gastroenterology. 40(1):37-43, January 2006.
Halpert, Albena D MD *; Thomas, Alicia C +; Hu, Yuming PhD +; Morris, Carolyn B PhD +; Bangdiwala, Shrikant I PhD +; Drossman, Douglas A MD +
Abstract:
Background: The educational needs of patients with irritable bowel syndrome (IBS) are poorly understood and rarely studied.
Aim: To determine the educational needs of IBS patients, regarding content, presentation format, and expectations from healthcare providers.
Methods: Fifteen functional GI clinic patients were asked open-ended questions to generate items for a questionnaire addressing the study aim. A total of 104 IBS patients received this questionnaire by mail (42 had declined to participate in a prior IBS study). To assess the frequency of endorsements and importance (on a scale of 1-3) of the items, an index was calculated (frequency of endorsements x mean rating per item, first priority scored 3, third priority scored 1). A higher index indicated greater endorsement based on frequency and rating of response.
Results: A total of 29 (28%) subjects (22 willing, 7 unwilling to participate previously in questionnaire research) completed the questionnaire (mean age, 42.6 years; SD, 14.2 years; 19 female, 10 male). The overall low response rate is likely related to the population studied; 40.4% of our study subjects have declined participation in prior research. The response rate of those who have previously agreed to participate was 36%. The typical response profile included: interest in learning disease management (index = 1.4) and preference for information presented in person by an M.D. (2.4). Choice of presentation media included magazines (1.9), television (1.5), and Web sites (1.2). Doctors' qualities ranked high related to competency (0.8), allocation of sufficient time (0.7), and listening skills (0.4). Preferred incentives for research participation included a thank you note (0.4), summary of trial results (0.3), and monetary incentives (0.6).
Conclusions: This qualitative study will provide pilot data for a national survey on the educational needs of IBS patients, for use in developing effective patient-centered, educational programs.
(C) 2006 Lippincott Williams & Wilkins, Inc.
http://www.jcge.com/pt/re/jclngastro/abstract.00004836-200601000-00008.htm;jsessionid=DBzN4wivqQBSipQaK8Unsn7x6V4d4LnaSosc1HnyVvUe3c2a69Eq!600736187!-949856144!9001!-1
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Neurogastroenterology and Motility
Online Early
doi:10.1111/j.1365-2982.2005.00731.x
Volume 0 Issue 0
Possible role of nitric oxide in visceral hypersensitivity in patients with irritable bowel syndrome
s. d. kuiken, t. k. klooker, g. n. tytgat, a. lei & g. e. boeckxstaens
Abstract Background: Visceral hypersensitivity is a consistent finding in a considerable proportion of patients with irritable bowel syndrome (IBS), and may provide a physiological basis for the development of IBS symptoms. In this study, we aimed to confirm the hypothesis that nitric oxide (NO) is involved in maintaining visceral hypersensitivity in IBS.
Ten healthy volunteers (HV) and 12 IBS patients with documented hypersensitivity to rectal distension underwent a rectal barostat study. The effect of placebo and the specific NO synthase inhibitor NG-monomethyl-l-arginine (l-NMMA) on resting volume, rectal sensitivity to distension and rectal compliance was evaluated in a double-blind, randomized, cross-over fashion.
NG-monomethyl-l-arginine did not alter resting volumes in HV or IBS patients. In HV, l-NMMA did not alter rectal sensory thresholds compared to placebo (45 ± 3 and 46 ± 3 mmHg, respectively).
In contrast, l-NMMA significantly increased the threshold for discomfort/pain in IBS patients (placebo: 18 ± 2, l-NMMA: 21 ± 3 mmHg, P < 0.05). Rectal compliance was not affected by l-NMMA.
Although NO does not seem to play a major role in normal rectal sensation or tone, we provide evidence that NO may be involved in the pathophysiology of visceral hypersensitivity in IBS.
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2982.2005.00731.x
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Digestive Woes May Keep the Overweight From Exercising
TUESDAY, Dec. 27 (HealthDay News) -- While exercise is often recommended for overweight people as part of a weight-loss program, digestive problems that affect them may hamper their ability to exercise.
That finding by U.S. researchers appears in a study in the current issue of the journal Clinical Gastroenterology and Hepatology.
The study of 983 overweight or obese men and women in Minnesota concluded that links between gastrointestinal (GI) problems and diet and exercise may affect treatment for both obesity and gastrointestinal problems, such as irritable bowel syndrome.
"Our main finding is that the amount of exercise people in weight loss programs do is related to gastrointestinal symptoms," study lead author Rona Levy, a psychologist and professor of social work at the University of Washington.
"In statistical terms, this means exercise is protective against gastrointestinal symptoms. This isn't surprising, but it has not been demonstrated before with this population. Science has now validated what people have been guessing," she said.
"But we don't know if this is a 'did the chicken or the egg come first?' kind of thing. We are not sure which is the key, exercise or gastrointestinal symptoms. It is plausible that if a physician put a patient on an exercise program to lose weight, the GI problems experienced might hamper the patient's ability to exercise," Levy said.
The GI problems experienced by the people in the study included abdominal pain, irritable bowel syndrome, diarrhea, and bloating. The more people weighed, the more likely they were to report problems. People who started to reduce their fat intake and increase their fiber intake by eating more fruits and vegetables reported lower levels of GI symptoms, the study found.
"This study is another argument for exercise. Even though anyone engaging in a weight-loss program should know that gastrointestinal symptoms may impede their ability to exercise, those symptoms may also be alleviated by exercise," Levy said.
SOURCE: University of Washington, news release, Dec. 8, 2005
Copyright © 2005 ScoutNews LLC. All rights reserved.
http://generic.e-healthsource.com/index.php?p=news1&id=529651
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From Alimentary Pharmacology & Therapeutics
Stability of Irritable Bowel Syndrome Using a Rome II-Based Classification
Posted 01/03/2006
R.E. Williams; C.L. Black; H.-Y. Kim; E.B. Andrews; A.W. Mangel; J.J. Buda; S.F. Cook
Background: As there is no biological marker for irritable bowel syndrome, a diagnosis is made using symptom-based criteria.
Aim: To evaluate the stability of self-reported symptoms consistent with Rome II-based irritable bowel syndrome classification.
Methods: Irritable bowel syndrome subjects identified in a 2001 population-based study by modified Rome II criteria were re-contacted 2 years later. Data were collected via a web-based questionnaire.
Results: Of the 697 subjects, 30% remained in the same irritable bowel syndrome subtype in both surveys, 18.4% changed irritable bowel syndrome subtype and 52% no longer met the irritable bowel syndrome criteria at follow-up. Subjects continuing to meet the irritable bowel syndrome criteria were more likely to have been initially classified in the alternating irritable bowel syndrome subtype and had more psychological impairment and lower irritable bowel syndrome-related quality of life than subjects not fulfilling the irritable bowel syndrome criteria at follow-up.
Lack of pain caused more subjects to fall out of the irritable bowel syndrome criteria than the absence of non-painful bowel symptoms. However, the majority of subjects that did not fulfill the pain component of the irritable bowel syndrome criteria continued to report abdominal pain of at least moderate severity.
Conclusion: In a US population-based follow-up study using modified Rome II criteria, we found irritable bowel syndrome is episodic in nature and current classification is limited in capturing fluctuation of disease over time.
http://www.medscape.com/viewarticle/519949?src=mp
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Online Early
doi:10.1111/j.1365-2982.2005.00746.x
Volume 0 Issue 0
Distension technique influences the relationship between colonic and rectal hypersensitivity in irritable bowel syndrome
c. ng 1 , a. malcolm , r. hansen & j. e. kellow
Abstract In irritable bowel syndrome (IBS), it remains unclear whether rectal hypersensitivity is a 'marker' of colonic hypersensitivity. Our aim was to examine the relation between colonic and rectal sensitivity in IBS patients, comprising phasic and ramp distension techniques.
Twenty IBS patients and 12 healthy subjects (N) underwent stepwise ramp and random phasic barostat distensions in the colon and rectum in random order. The sensory threshold pressure (ramp distension) and the visual analogue scale score (VAS, phasic distension), for pain and non-pain, were recorded.
Colonic thresholds were lower, and VAS scores were generally higher, for pain and non-pain sensitivities in IBS compared to N. Rectal thresholds were lower, and VAS scores were higher, for pain but not for non-pain, in IBS compared to N.
In IBS, for phasic distension, there was good correlation between the colon and rectum for non-pain (e.g. at 16 mmHg, r = 0.59, P = 0.006) and pain (r = 0.60, P = 0.006) sensitivities. In contrast, there was no significant correlation between the colon and rectum for ramp distension.
In conclusion, colonic and rectal sensitivity in IBS are correlated in response to phasic but not ramp barostat distensions. The rectum serves as a legitimate 'window' for evaluating colonic hypersensitivity in IBS, provided that phasic distensions are employed.
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2982.2005.00746.x
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Value in Health
Volume 9 Page 39 - January 2006
doi:10.1111/j.1524-4733.2006.00079.x
Volume 9 Issue 1
Discrepancies between Patient-Reported Outcomes and Clinician-Reported Outcomes in Chronic Venous Disease, Irritable Bowel Syndrome, and Peripheral Arterial Occlusive Disease
Olivier Chassany, MD, PhD1, Philippe Le-Jeunne, MD2, Martin Duracinsky, MD, MSc3, Marie-Sophie Schwalm, MSc2, Marc Mathieu, MD4
ABSTRACT
Objective: To explore the degree of agreement between patient- and clinician-reported outcomes (PROs and CROs, respectively) in three chronic diseases.
Methods: Respectively, 120, 131, and 61 French general practitioners (GPs) included 291, 307, and 90 patients with chronic venous disease (CVD), irritable bowel syndrome (IBS), and peripheral arterial occlusive disease (PAOD), in a cross-sectional survey. Patients completed a specific Health-Related Quality of Life (QoL) questionnaire (Chronic Venous Insufficiency Questionnaire [CIVIQ], Functional Digestive Disorders Quality of Life [FDDQL], and Claudication Scale [CLAU-S], respectively) and scored their pain (visual analog scale, pain-free walking distance). GPs were concomitantly asked to estimate patients' pain and QoL.
Results: Although correlated (CVD and IBS: Kw = 0.27 and Kw = 0.31, respectively; PAOD: r = 0.64, P < 0.01), pain intensity estimated by GPs was lower than as estimated by patients with CVD and IBS (e.g., 39.0 ± 24.9 vs. 30.4 ± 21.0 for IBS), and pain-free walking distance was greater as estimated by GPs than by patients with PAOD. Pain estimated by patients only partially reflected their QoL (r between 0.30 and 0.78; P between 0.02 and <0.01). Global QoL scores estimated by patients and GPs were moderately correlated (Kw between 0.17 and 0.28). GPs underestimated QoL impairment in CVD (global score: 72 ± 19 vs. 61 ± 20) and in most dimensions of the IBS questionnaire (in six of eight dimensions), and overestimated QoL impairment in PAOD (54 ± 21 vs. 66 ± 23).
Conclusions: Although correlated, PROs and CROs differed. In addition, their relationship was not consistent across diseases. PROs are therefore essential to take account of all the aspects of diseases.
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1524-4733.2006.00079.x
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IBS Patients Show Greater Brain Response to Subliminal Gut Stimuli
NEW YORK (Reuters Health) Feb 13 - A new study demonstrates that patients with irritable bowel syndrome (IBS) show greater sensitivity in their visceral sensory neural circuitry in response to subliminal stimuli than healthy controls.
Tests for visceral hypersensitivity in IBS have relied on perceived stimulus, Dr. Reza Shaker and colleagues from the Medical College of Wisconsin and Milwaukee write in the January issue of Gastroenterology. Given that subliminal stimuli have recently been shown to register in the cerebral cortex, they add, it is now possible to evaluate gut neurocircuitry without the effect of cognitive processes.
To test the hypothesis that IBS patients would show a greater response to subliminal stimuli of visceral neurocircuitry, the researchers evaluated fMRI activity in 10 IBS patients and 10 controls during rectal distension with a computerized, barostat-controlled device.
Study participants were evaluated at 10, 15 and 20 mm Hg. Threshold for perception was 21 mm Hg in IBS patients and 25 in controls. All IBS patients showed cerebral cortical activity several times greater in volume in response to the same level of pressure as age- and sex-matched controls.
The findings could be used to distinguish between neural and neurocognitive effects of IBS drugs, and also to stratify patients based on neural or neurocognitive abnormalities, the researchers write.
"The findings of this study also objectively show the existence of long-suspected neural hypersensitivity in IBS patients and as such help better dissect and define different pathophysiologic components that may exist in this patient group," they add.
Questions remain about whether changes in IBS patients' visceral perception and autonomic response may be caused by emotional and cognitive factors that alter central pain modulation, Drs. Bruce D. Naliboff and Emeran A. Mayer of the David Geffen School of Medicine at the University of California, Los Angeles, write in an accompanying editorial. Another question is whether visceral hypersensitivity is specific to IBS or appears in other types of functional disorders as well.
New, more sophisticated imaging and analysis techniques along with more specific study designs should help to answer these questions, the editorialists conclude.
Gastroenterology 2006;130:26-33,267-269.
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Reuters Health Information 2006. © 2006 Reuters Ltd.
http://www.medscape.com/viewarticle/523558
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Alimentary Pharmacology & Therapeutics
Lifestyle Factors and Symptoms of Gastro-oesophageal reflux - A Population-Based Study
M. Nocon; J. Labenz; S.N. Willich
Background: Although the symptoms of gastro-oesophageal reflux disease are common in the general adult population, the aetiology of gastro-oesophageal reflux disease is still largely unknown. Lifestyle factors such as diet, body mass index, and smoking have been frequently suggested as possible risk factors.
Aim: In the present study, we investigated the relationship between various lifestyle factors and gastro-oesophageal reflux disease symptoms.
Methods: A total of 7124 subjects were interviewed as part of the German National Health Interview and Examination Survey, a representative sample of the general adult population. We examined a variety of possible risk factors, including age, gender, body mass index, smoking, alcohol consumption, sports and different foods. To investigate the association between lifestyle and symptoms, we used a multiple logistic regression model, including various gastro-oesophageal reflux disease patient characteristics.
Results: We found an association among those with reflux symptoms who were overweight and obese (odds ratio: 1.8, 95% confidence interval: 1.5-2.2; odds ratio: 2.6, 95% confidence interval: 2.2-3.2), respectively. Further risk factors included smoking and the frequent consumption of spirits, sweets, or white bread. Physical activity and the consumption of fruits seemed to have some protective effect.
Conclusions: Lifestyle factors - in particular overweight, obesity and smoking - were associated with increased reflux symptoms.
http://www.medscape.com/viewarticle/519948?src=mp
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