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All Boards >> Irritable Bowel Syndrome Research Library

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HeatherAdministrator

Reged: 12/09/02
Posts: 7658
Loc: Seattle, WA
General IBS / Bowel Dysfunction
      #13954 - 07/14/03 01:56 PM

All general research regarding IBS and bowel dysfunction / dysmotility that does not fit into one of the specific library category topics should be posted here.



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HeatherAdministrator

Reged: 12/09/02
Posts: 7658
Loc: Seattle, WA
Inflammatory bowel disease and irritable bowel syndrome: separate or unified? new
      #13963 - 07/14/03 02:32 PM

Current Opinion in Gastroenterology 2003; 19(4):336-342

Inflammatory bowel disease and irritable bowel syndrome: separate or unified?

Sylvie Bradesi, PhD *; James A. McRoberts, Ph.D *; Peter A. Anton, MD *; Emeran A. Mayer, MD *†‡

Both irritable bowel syndrome and inflammatory bowel diseases share symptoms of altered bowel habits associated with abdominal pain or discomfort. Irritable bowel syndrome has been referred to as a functional bowel disorder, which is diagnosed by a characteristic cluster of symptoms in the absence of detectable structural abnormalities. Inflammatory bowel disease is a heterogeneous group of disorders characterized by various forms of chronic mucosal and/or transmural inflammation of the intestine. In this review, the authors discuss recent evidence suggesting several potential mechanisms that might play a pathophysiologic role in both syndromes. Possible shared pathophysiologic mechanisms include altered mucosal permeability, an altered interaction of luminal flora with the mucosal immune system, persistent mucosal immune activation, alterations in gut motility, and a role of severe, sustained life stressors in symptom modulation. It is proposed that similarities and differences between the two syndromes can best be addressed within the framework of interactions between the central nervous system and the gut immune system. Based on recent reports of low-grade mucosal inflammation in subpopulations of patients meeting current diagnostic criteria for irritable bowel syndrome, therapeutic approaches shown to be effective in inflammatory bowel disease, such as probiotics, antibiotics, and antiinflammatory agents, have been suggested as possible therapies for certain patients with irritable bowel syndrome.

Abbreviations
HPA hypothalamic-pituitary-adrenal

IBD inflammatory bowel diseases

IBS irritable bowel syndrome

IELs intraepithelial lymphocytes

iNOS inducible nitric oxide synthase

MAPK mitogen-activated protein kinase

PI-IBS postinfectious irritable bowel syndrome

Th1 T helper 1

TNF-α tumor necrosis factor- α

CNS: Center of Neurovisceral Sciences & Women's Health, Division of Digestive Diseases and Brain Research Institute, Departments of Medicine*, Physiology†, and Psychiatry & Biobehavioral Sciences‡, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, USA.

Correspondence to: Emeran A. Mayer, MD, CNS: Center of Neurovisceral Sciences and Women's Health, VAGLAHS, Bldg.115/CURE, Room 223, 11301 Wilshire Boulevard, Los Angeles, CA 90073, USA; e-mail: emayer@ucla.edu

Current Opinion in Gastroenterology 2003; 19(4):336-342
Copyright © 2003 Lippincott Williams & Wilkins
All rights reserved

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HeatherAdministrator

Reged: 12/09/02
Posts: 7658
Loc: Seattle, WA
Irritable bowel syndrome in primary care: The patients’ and doctors’ views new
      #13968 - 07/14/03 02:43 PM

The Canadian Journal of Gastroenterology May 2003, Volume 17, Number 5 : 363-368

Irritable bowel syndrome in primary care: The patients’ and doctors’ views on symptoms, etiology and management

CJ Bijkerk, NJ de Wit, WAB Stalman, JA Knottnerus, AW Hoes, JWM Muris

BACKGROUND: To facilitate the development of clinical guidelines and to direct future irritable bowel syndrome (IBS) research, insight into the perceptions of patients and general practitioners (GPs) regarding IBS is required.

OBJECTIVES: To compare patients’ and GPs’ views on the symptomatology, etiology and treatment of IBS.

METHODS: One hundred forty-two IBS patients and 100 GPs were requested to complete a structured questionnaire.

RESULTS: The response rates of the patients and GPs were 80% and 47%, respectively. Abdominal pain and bloating were considered to be the most bothersome symptoms in IBS, by both patients and GPs. Although all patients were diagnosed by their GP as having IBS, and 62% met the Manning criteria, only 18% fulfilled the Rome II criteria for IBS. Patients consider food intolerance and GPs regard lack of fibre as the main etiologic dietary factor. Many IBS patients expect a diagnostic work-up, but GPs generally restrict this to elderly patients. GPs start IBS management with dietary advice (94%), counselling (77%) and drug therapy (55%). Patients expect reassurance (47%) and drug treatment (37%), but dietary interventions are less appreciated (9%).

CONCLUSIONS: Patients and GPs have different perceptions of the efficacy of diagnostic and dietary interventions in IBS. GPs should explore the patients expectations and incorporate these in their approach to IBS patients.

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HeatherAdministrator

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Update on Treatment of Functional Gastrointestinal Disorders new
      #13970 - 07/14/03 02:55 PM

Digestive Disease Week 2003
IBS/Other Functional GI Disorders CME
May 18 - 21, 2003, Orlando; Florida

The Brain, the Gut, the Food, and the Bacteria? Update on Treatment of Functional Gastrointestinal Disorders

Yehuda Ringel, MD Douglas A. Drossman, MD

Introduction
Despite being the most prevalent gastrointestinal (GI) disorders seen in gastroenterology practice, functional gastrointestinal disorders (FGIDs) continue to be difficult conditions to understand and manage, for both clinicians and patients. The latter relates to the complex, multifactorial nature of these disorders, the limited understanding of the pathophysiologic mechanisms that underlie them, and the lack of effective comprehensive treatments. Given these circumstances, it has not been surprising to note the ongoing increase in interest in FGIDs, as reflected by the number of high-quality abstracts submitted and presented at this year's Digestive Disease Week (DDW) meeting, as well as by the number of attendees at sessions focusing on these disorders.

Presentations during this year's meeting proceedings covered the wide spectrum of intensive research that is ongoing in the field, and provided interesting new data about various aspects of these disorders. The latter included discussion of new data on the epidemiology, clinical characteristics, possible pathophysiologic mechanisms, diagnosis, and management of FGIDs.

This overview focuses on those key presentations that provided updates and new information about the effect and efficacy of available and commonly used treatment options for functional GI and motility disorders.

The Brain
Antidepressants have been commonly used for the treatment of irritable bowel syndrome (IBS) and other FGIDs, and recently published American Gastroenterological Association guidelines recommended their use for the pain associated with FGIDs, particularly when first-line therapies fail.[1] However, despite this recommendation and their long-standing availability and use in clinical settings, the evidence for efficacy of antidepressants in the treatment of FGIDs has been relatively weak. This has been, in part, due to the quality of the trials and the small sample sizes.

During DDW 2003, Drossman and colleagues[2,3] presented the results of a 7-year, 2-site, randomized, double-blind, placebo-controlled, treatment trial in patients with moderate-to-severe functional bowel disorders (FBDs; ie, chronic functional abdominal pain, IBS, painful constipation, and unspecified FBD). The investigators from the University of North Carolina and the University of Toronto randomized 431 patients into 2 treatment arms: medication (antidepressants vs placebo)[2] and psychological (cognitive behavioral therapy vs education).[3]

Medication Approach
In the medication arm,[2] 216 patients were randomized to receive either desipramine* up to 150 mg/day, and averaging 100 mg/day (dosage adjustment was based on side effects), or placebo. Responders were determined by an averaged satisfaction with treatment score of > 3.5 on a 0-5 scale range. The results on the intention-to-treat analysis (includes all patients who started the medication treatment) showed no statistically significant difference between the active and placebo groups (response rate of 60% vs 47%, respectively; P = .128). However, in the per protocol analysis of study completers (excluding 25% [30% desipramine, 17% placebo] drop outs and 12 subjects with nondetectable desipramine blood levels), there was a significant effect (response rate of 73% vs 49%, respectively; P = .006) and a number needed to treat of 4.3. It is interesting to note that desipramine was found to be more effective in nondepressed patients, as well as in those with moderate disease severity, predominant diarrhea, and a history of abuse.

Psychological Approach
The other arm of this study was presented in poster form. In this psychological treatment arm,[3] 215 patients were randomized to receive either cognitive behavioral treatment (CBT) or education for 12 weeks. Responder rates were determined, similar to the medication arm, by an averaged satisfaction with treatment score of > 3.5 on a 0-5 scale range. In the intention-to-treat analysis, CBT was found to be more effective than education (P = .0001), with a response rate of 70% vs 37% (P < .0001) and a number needed to treat of 3.1. These results held also in per protocol analysis after 21% (18% on CBT, 29% on education) dropped out. CBT was found to be effective for patients with moderate or severe FBD and for individuals with or without abuse history, but was not different from EDU in efficacy for patients with severe depression.

Commentary. The study authors concluded that CBT is statistically and clinically effective for treatment of FBD (including IBS) and that desipramine, although not significant in the intention-to-treat analysis, appears effective for patients who stay on treatment and who can tolerate the side effects (if present). However, certain clinically meaningful subgroups (eg, patients with depression, patients who appear less responsive) may be amenable to combination treatments using both modalities.

The Gut
Very few medications have been specifically approved for treatment of FGIDs. Therefore, it is not surprising that the US Food and Drug Administration-approved serotonin active agent, tegaserod, has gained noticeable interest during this year's meeting. Tegaserod, a 5-HT4 partial agonist, has been shown to be more effective than placebo in alleviating IBS global and associated symptoms in women with IBS with constipation. Because of its promotility/prokinetic effects on various parts of the GI tract, clinicians have been prompted to use this medication for various non-IBS-related GI motility disorders as well. Several studies were presented during DDW 2003 that offered new information about the use of tegaserod in these settings.

Dyspepsia and Gastroparesis
Tougas and colleagues[4] investigated the effect of different doses of tegaserod* in 163 patients with dyspeptic symptoms who also had delayed gastric emptying. Subjects were randomized to receive tegaserod at 6 mg twice daily (n = 38), 6 mg thrice daily (n = 24), 12 mg twice daily (n = 38), or placebo (n = 63), and gastric emptying was quantitated by scintigraphy before and after treatment. The investigators reported statistically significant improvement in gastric emptying with the 18 mg and 24 mg per day dosages of tegaserod.

Commentary. Several limitations of this study make it difficult to assess the clinical significance and relevance of these findings, such as that the currently approved dose of 12 mg daily did not show a significant effect; the patient population did not meet criteria for dyspepsia or other defined disorders; and information was not available about the symptom response or patients' quality of life (QOL) with this treatment. This is particularly important since it is well known that the correlation between dyspeptic symptoms and gastroparesis is poor. Therefore, at this time, the role of tegaserod in the treatment of dyspepsia and gastroparesis is not yet defined and additional investigation is warranted.

Chronic Constipation
Johansen and colleagues[5] reported the results of a double-blind, placebo-controlled multicenter study that examined the efficacy of tegaserod* 2 mg twice daily (n = 450), 6 mg twice daily (n = 451), or placebo (n = 447) in patients with chronic constipation. They found that tegaserod, 2 mg twice daily and 6 mg twice daily, given for 12 weeks, was superior to placebo in increasing spontaneous bowel movements per week (response was defined as an increase of > 1 spontaneous bowel movements/week compared with baseline), either after 4 weeks (response rate, 41.4%, 43.2%, and 24.9%, respectively; P < .0001 vs placebo) and 12 weeks (40.3%, 44.8%, and 26.9%, respectively; P < .0001 vs placebo). This response was also associated with improvement in other functional GI symptoms.

Commentary. The study authors concluded that tegaserod (2 mg twice daily and 6 mg twice daily) is effective in the treatment of chronic constipation and its related symptoms. However, it should be noted that patients with IBS whose predominant symptom was constipation were not excluded from this study. Patients with IBS with constipation are already known to benefit from tegaserod; therefore, not identifying this subgroup in the study population may have made it difficult to assess the efficacy of this agent in this setting. It would have been helpful to divide the patients in this study into 2 treatment groups -- those with chronic constipation with IBS and those with chronic constipation without IBS -- and to have looked at the treatment response rate in each subgroup. Thus, although these data are encouraging, additional investigation is warranted to assess the efficacy of tegaserod in treating chronic functional constipation.

The Food
Nutritional factors have been suspected to contribute to the symptoms and clinical presentation of FGIDs. Exacerbation of symptoms such as diarrhea, dyspepsia, and nausea are commonly reported postprandially. Many patients attribute some of their symptoms to certain types of food, and therefore avoid those food items. However, recommendations for elimination of specific food items in FGIDs is usually done in variable ways. That is, there are no available guidelines' evidence for the efficacy of this approach to managing these disorders.

Atkinson and colleagues[6] presented an interesting approach to this issue by assessing the efficacy of an exclusion diet based on testing for the presence of IgG food antibodies in unselected (all subtypes) patients with IBS. Patients (n = 150) were tested for the presence of IgG antibodies in a variety of food items and were then blindly randomized to receive either a diet excluding all foods to which they were found to be sensitive (IgG antibody titers >/= 3:1) or a sham diet excluding the same number of foods, but not those to which they were sensitive.

They found that the true diet was significantly more effective than the sham diet in reducing symptom severity scores (average reduction, 34; 95% confidence interval [CI]: 17.3, 68.6; P = .049) in the intention-to-treat analysis (considering all patients who were offered the treatment). When accounting for the patients' adherence to the number of foods to which they were sensitive, the reduction in symptom scores was even higher (average reduction, 89; 95% CI: 41, 137; P < .001). The adherence to the diet affected the response observed in patients on the true diet, but not patients on the sham diet (P = .038). These findings further supported the potential clinical benefit of food-elimination diets based on IgG food antibodies in patients with IBS.

The Bacteria
Several studies have suggested a potential beneficial effect of certain probiotics in reducing some of the symptoms of IBS.[7]

Probiotics vs Antibiotics
In a small (n = 44) study, Faber[8] examined the effect of probiotics* alone (n = 20) and in combination with antibiotics (n = 24) on GI symptoms and QOL in an uncontrolled trial of unselected (all subtypes) patients with IBS. Antibiotic treatment included ciprofloxacin* 500 mg twice daily per week, and probiotic treatment included Lactobacillus acidophilus NCFM (10 billion/g) and Bifidobacteria infantis (10 billion/g) daily for 4 weeks. Both groups showed significant improvement following treatment: In the probiotic/antibiotic group, a decrease in symptom frequency index scores from 35 to 18 (P < .001) and an increase in IBS-QOL scores from 67.6 to 87.8 (P < .001) were seen; in the probiotic-only group, a decrease in symptom frequency index scores from 39 to 17 (P < .001) and an increase in IBS-QOL scores from 69.3 to 86.4 (P < .001) were seen. The predominant IBS type did not alter the response to therapy.

Commentary. As a small uncontrolled study, these results may reflect, at least in part, a placebo response. Nevertheless, the findings emphasize the need for additional clinical studies to evaluate the role of probiotics and antibiotics in IBS patients.

Mechanisms of Probiotics
Although the efficacy and role of probiotics in the treatment of IBS remain uncertain and require confirmation, several studies presented during this year's meeting examined possible mechanisms for their effects on GI motor, sensory, and immune function.

Lamine and colleagues[9] investigated the effect of treatment with Lactobacillus farciminis bacteria on the nociceptive response to colorectal distension in basal conditions and after TNBS (2,4,6-trinitrobenzene sulfonic acid)-induced colonic inflammation in rats. They found that L farciminis treatment significantly reduced (P < .05) abdominal nociceptive response for all distending pressures in both the noninflamed-treated group compared with the noninflamed controls and in the TNBS-induced inflamed hypersensitivity treated group compared with the nontreated group. These researchers attributed this antinociceptive effect to the known ability of L farciminis to produce nitric oxide (NO). Indeed, hemoglobin (an NO scavenger) infusion resulted in reversing this organism's antinociceptive effect. These investigators concluded that a 3-week treatment with L farciminis can reduce visceral pain induced by colorectal distension in basal and inflammatory conditions, and that this effect depends on the NO released by these bacterial strains into the colonic lumen.

In another study, the same group of investigators reported a protective effect of the NO producing-L farciminis against TNBS-induced colitis in rats.[10] Rats that were treated with this organism for 3 weeks prior to induction of colitis showed significantly lower inflammation, as expressed by reduction in macroscopic damage score, MPO (myeloperoxidase) activity, and inducible NO synthase activities. As with the previous study, hemoglobin reversed the beneficial effect of L farciminis on the inflammation activity in the colitic rats.

Commentary. These studies suggest a role for NO-producing bacteria in protecting against inflammatory and hypersensitivity conditions. However, these findings in animal models deserve additional investigation in humans in order to confirm beneficial effects.

Another possible mechanism mediating the effects of probiotic bacteria on GI function has been proposed by Verdu and colleagues.[11] They investigated the effects of probiotics on intestinal muscle dysfunction in a mouse model of postinfective Trichinella spiralis IBS. Study mice groups were treated with Lactobacillus paracasei, Lactobacillus johnsonii, Bifidobacterium longum, or B lactis. Additional mice received heat-inactivated L paracasei or bacteria-free L paracasei spent culture medium (SCM). At 21 days post infection, L paracasei, but not L johnsonii, showed significant attenuation of hypercontractility to carbachol stimulation, compared with the control group (P = .01). The 2 bifidobacteria strains tended to decrease the hypercontractility; however, this trend did not reach statistical significance (P = .09). The attenuation of muscle hypercontractility was paralleled by a 2-fold decrease in the secretion of interleukin-4 (P < .0001), mRNA for transforming growth factor-beta (P = .0001), and cyclooxygenase-2 (P = .001) in longitudinal myenteric plexus preparation and by modulation of genes involved in innate defenses such as RANTES and cryptdin, as evaluated by gene array analysis.

Commentary. It is interesting that the normalization of the postinfection contractility was independent of L paracasei presence in the mucosa-associated flora -- thus indicating that the improvement in intestinal muscle dysfunction by L paracasei and free-L paracasei SCM is likely due to attenuation of cytokine and inflammatory mediator production in the muscularis externa and modulation of innate defense genes in the small intestine. In addition, this effect is strain-dependent.

The importance of the strain-specific effect has also been suggested by findings from other studies.[12] The clinical implication for this strain-specific effect has been shown in an interesting abstract presented by Drisko and colleagues.[13] These investigators examined 5 commercially, commonly available probiotic products. They used polymerase chain reaction (PCR) gel electrophoresis and amplicon excision with DNA sequencing to determine the bacterial strain content of these 5 products and compared their findings against what was reported in the respective product labeling information.

These investigators found that with a single exception, all bacterial species that were tested were detected in the probiotic samples by PCR analysis and confirmed by DNA sequencing. Bifidobacterium bifidum was not detected in 2 of the 5 samples reporting its presence. In contrast, Lactobacillus spp. were detected in 2 of the 5 product samples for which the species was not listed as an "ingredient."

Commentary. Although cultures of commercially available probiotics closely resemble their labeling information overall, there are some differences. Because emerging data suggest that the beneficial effect of probiotics is strain-dependent, a better regulation of dietary supplements may be necessary to ensure proper preparation and marketing standards.

Concluding Remarks
The above discussion is intended to bring to the fore the current state of knowledge regarding the multifactorial nature of FGIDs. Within this context, new insight may be gained with respect to the clinical and therapeutic implications for patients with these disorders, with a view toward the effect and effectiveness of available and commonly used treatment options.

* The United States Food and Drug Administration has not approved this medication for this use.

References
Drossman DA, Camilleri M, Mayer EA, Whitehead WE. AGA technical review on irritable bowel syndrome. Gastroenterology. 2002;123:2108-2131.
Drossman DA, Diamant N, Toner B, et al. A multi-center randomized trial of despiramine (DES) vs placebo (PLA) in moderate to severe functional bowel disorder (FBD). Gastroenterology. 2003;124:A-30. [Abstract #199]
Drossman DA, Toner B, Whitehead W, et al. A mutli-center randomized trial of cognitive-behavioral treatment (CBT) vs education (EDU) in moderate to severe functiona; bowel disorder. Gastroenterology. 2003;124:A-530. [Poster #T1422]
Tougas G, Chen Y, Luo D, et al. Tegaserod improves gastric emptying in patients with gastroparesis and dyspeptic symptoms. Gastroenterology. 2003;124:A-54. [Abstract #432]
Johansen JF, Tougas G, Chey WD, et al. Tegaserod provides rapid and sustained relief of constipation, abdominal bloating/distension, and abdominal discomfort/pain in patients with chronic constipation. Gastroenterology. 2003;124:A-47. [Abstract #371]
Atkinson W, Gurney R, Sheldon TA, Whorwell PJ. Do food elimination diets improve irritable bowel syndrome? A double blind trial based on IgG antibodies to food. Gastroenterology. 2003;124:A-29. [Abstract #198]
Kim HJ, Camilleri M, McKinzie S, et al.A randomized controlled trial of a probiotic, VSL#3, on gut transit and symptoms in diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2003;17:895-904.
Faber S. Comparison of probiotics with antibiotics alone in treatment of diarrhea-predominant IBS (D-IBS), alternating (A-IBS), and constipation (C-IBS) patients. Gastroenterology. 2003;124:A-687. [Poster #W1523]
Lamine F, Cauquil E, Eutamene H, et al. Lactobacillus farciminis reduces sensitivity to rectal distension in rats: Involvement of nitric oxide. Gastroenterology. 2003;124:A-476. [Poster #T1060]
Lamine F, Cauquil E, Nepveu F, et al. Nitric oxide released by Lactobacillus farciminis protects rat colon against TNBS-induced inflammation. Gastroenterology, 2003;124:A-113. [Abstract #828]
Verdu EF, Bercik P, Blennerhassett P, et al. Strain-dependent effects of probiotics on intestinal muscle dysfunction in an animal model of post-infective irritable bowel syndrome. Gastroenterology. 2003;124:A-29. [Abstract # 197]
Ringel Y, Drossman DA. Inflammation, infection, and irritable bowel syndrome. Medscape Conference Coverage based on selected sessions at Digestive Disease Week, 2002. Medscape Gastroenterology 2002. Available at:
http://www.medscape.com/viewarticle/434527 Accessed June 3, 2003.
Drisko JA, Bischoff B, Giles C, et al. Evaluation of 5 probiotic products for bacteria by PCR. Gastroenterology. 2003;124:A-687. [Poster #W1522]

Copyright © 2003 Medscape.

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HeatherAdministrator

Reged: 12/09/02
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Loc: Seattle, WA
The Irritable Bowel Syndrome-Fibromyalgia Connection new
      #13979 - 07/14/03 03:19 PM

The Irritable Bowel Syndrome-Fibromyalgia Connection

Is there a connection between these two functional disorders?


As many as one-third of irritable bowel syndrome (IBS) patients have described extra intestinal symptoms such as rashes, tension headaches, and muscle aches and pains. Research has shown that as many as 60% of IBS patients also suffer from fibromyalgia syndrome (FMS). Conversely, as many as 70% of FMS patients have reported experiencing symptoms of IBS.(1) Could there be a common cause for the two conditions?

Fibromyalgia. FMS is a disorder of the musculoskeletal system that is associated with symptoms of general muscle aches, stiffness, overall fatigue, and poor sleeping habits (see Fibromyalgia Basics for a complete list of fibromyalgia symptoms). Symptoms can vary in both severity and duration; the pain may be dull or knife-like, linger persistently, or be intermittent. Like IBS, FMS is a functional disorder, therefore tests to find the origins of the pain often come back negative (see Table below for the diagnostic criteria for FMS). Approximately 3.4% of women, and 5% of men suffer from FMS.

The IBS-FMS connection. Given the co-existence of IBS and FM in so many people, it is reasonable to consider a connection between them. Even though IBS affects the gastrointestinal tract and FMS the musculoskeletal system, there are striking similarities. Neither condition can be explained by organic disease; they are considered functional disorders. At least in Western society, both occur frequently in women and the onset may be during a stressful event in life. Cognitive behavior therapy and certain types of prescription drugs are effective in both IBS and FMS.

Research has been suggested that people with IBS or FMS respond to pain differently than other persons. However, IBS patients have an altered response to visceral (intestinal) pain, while persons with FMS have an altered response to somatic (skin and muscle) pain. Not surprisingly, further studies have shown that people with both IBS and FMS have an altered response to both types of pain. Additionally, persons with severe cases of IBS were more likely to have FMS than those with less acute symptoms.(2)

Although researchers have suggested a common mechanism for both disorders, its origins are still unknown. Relatively speaking, the medical community has only just recognized both IBS and FMS as legitimate disorders and not psychosomatic problems. Therefore, research on either condition is still in its infancy, and studies connecting the two are rare. However, there is hope for sufferers from both conditions, as researchers are taking new interest in discovering why IBS and FMS seem to be connected.

Diagnosing fibromyalgia

In 1990, criteria for the diagnosis of fibromyalgia were established by the American College of Rheumatology (ACR).(3) These are:
A history of widespread pain, which is identified by pain being present:
In the left side of the body.
In the right side of the body.
Above the waist.
Below the waist.
Shoulder and buttock pain are taken into account as pain in the side of the body. Additionally, axial skeletal pain must also be established, which is defined by pain in one of the following:
Cervical spine.
Anterior chest.
Thoracic spine.
Low back (lower segment).
Pain must also be present in 11 of 18 pre-defined sites on the body when palpated (touched with the fingers) by a physician. The more technical ACR definitions of the sites are in parentheses.
1-2:The base of the skull, right and left sides (occiput: bilateral, at the suboccipital muscle insertions).
3-4: The lower neck, right and left sides (low cervical: bilateral, at the anterior aspects of the intertransverse spaces at C5-C7).
5-6: The midpoint between the neck and shoulder, right and left sides (trapezius: bilateral, at the midpoint of the upper border).
7-8: Muscles over the shoulder blades, right and left sides (supraspinatus: bilateral, at origins, above the scapula spine near the medial border).
9-10: The upper edge of the breastbone, right and left sides (second rib: bilateral, at he second costochondral junctions, just lateral to the junctions on upper surfaces).
11-12: Two centimeters towards the wrist from either elbow (lateral epicondyle: bilateral, 2 cm distal to the epicondyles).
13-14: The outer buttock muscles, right and left sides (gluteal: bilateral, in upper outer quadrants of buttocks in anterior fold of muscle).
15-16: Upper buttock muscle where the buttocks meet the back, right and left sides (greater trochanter: bilateral, posterior to the trochanteric prominence).
17-18: Just inside and above either kneecap (knee: bilateral, at the medial fat pad proximal to the joint line).




1. Veale D, Kavanagh G, Fielding JF, Fitzgerald O. Primary fibromyalgia and the irritable bowel syndrome. Br J Rheumatol. 1991;30:220-222.
2. Lubrano E, Iovino P, Tremolaterra F, et al. Fibromyalgia in patients with irritable bowel syndrome. An association with the severity of the intestinal disorder. Int J Colorectal Dis. 2001;16:211-215.
3. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990;33:160-172.

Copyright © 2003 About, Inc

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HeatherAdministrator

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New and Important Insights Into IBS new
      #13981 - 07/14/03 03:24 PM

New and Important Insights Into IBS: From Epidemiology to Treatment

Nicholas J. Talley, MD, PhD

Introduction
Disorders of gastrointestinal dysfunction, including irritable bowel syndrome (IBS), continue to attract increasing attention as our understanding of them accelerates. At this year's meeting of the American College of Gastroenterology, a number of important new findings in IBS emerged regarding epidemiology, impact, diagnosis, prognosis, potential mechanisms, and treatment. This summary discusses this new knowledge and places it in appropriate clinical context.

Epidemiology
It is well known that IBS is highly prevalent in the general population, but national US data are limited and previous studies have often focused on self-reported diagnosis of IBS data rather than applying standard diagnostic criteria (eg, Rome).[1]

Hungin and colleagues[2] applied random-digit-dialing technology to conduct telephone interviews in more than 5000 subjects 18 years and older in the United States. Using a structured questionnaire to obtain information on IBS, they identified the overall prevalence of this disorder to be 14%, with a female-male ratio of approximately 2:1. More women than men had typical IBS symptoms, but overall only about one fourth had been formally diagnosed as having IBS; 34% had symptoms for more than 10 years, and 48% had symptoms for more than 5 years. Approximately 60% of subjects used over-the-counter medications, and 20% used nothing to treat their IBS. These investigators reported that abdominal pain was the major reason patients visited healthcare professionals. They also observed that there was a higher rate of cholecystectomy and hysterectomy among those with IBS in the population. These findings are consistent with other high-quality US epidemiologic studies.[3] Similar results have also been observed in Europe[4] and Australia.[5]

In another epidemiologic study of 1069 employees of the Veterans' Affairs Health Care System in Utah, Tuteja and colleagues[6] evaluated potential risk factors for IBS. They recruited a total of 723 subjects, obtaining a response rate of 72%, and observed that 9% had IBS, as expected. Adjusting for age and sex, IBS was not associated with smoking, aspirin use, alcohol consumption, or education level. However, unmarried patients and those taking acetaminophen were at a significantly higher risk for IBS. Being unmarried may be of relevance because there is a lack of social support and therefore a potential increased vulnerability to stress. On the other hand, acetaminophen use may reflect the need for this medication for abdominal pain or extraintestinal pain, although there is no evidence that acetaminophen effectively relieves pain in this condition.

Impairment of quality of life is considered by many to be an important prerequisite if a condition not associated with mortality is to be labeled a disease.[1,7] Hungin and associates[8] reported that despite substantial nonconsulting, IBS had a significant impact on patients' day-to-day life: 25% were working fewer hours and 20% had changed their work schedule because of the disease. Although IBS has a confirmed predominance among women, it is still not known whether there are sex-specific differences that predict health-related quality of life in IBS.[1] Sach and associates[9] evaluated this issue. They found that IBS in both women and men had a similar overall gastrointestinal symptom severity score. They also noted that IBS patients in this study had more impaired mental and physical quality of life and worse vital exhaustion scores than controls. It appeared that in women physical factors may predominately predict impaired quality of life, whereas in men cognitive factors appear to be stronger predictors of impaired quality of life.

Thus, sex differences do matter in IBS, as exemplified by the not-yet-explained superior efficacy of the new peripherally acting serotonin-modulating drugs in IBS, which appear to be more efficacious in women (although admittedly there are fewer data in men).[1,7] Additional work is required to interpret the sex-specific impact of IBS and explore the mechanisms underlying the sex-specific differences in this disease.

Diagnosis
Symptomatic Differentiation
There is increasing interest in evaluating the utility of symptoms for distinguishing IBS from other functional and organic diseases.[1] One of the major issues that often faces clinicians is the challenge of differentiating IBS with constipation from functional constipation due to slow colonic transit or pelvic floor dysfunction.

Crowell and colleagues[10] evaluated patients seen in a tertiary referral center who fulfilled the Rome I criteria for either IBS or functional constipation. They applied a standardized bowel symptom questionnaire to determine which symptoms might differentiate IBS from functional constipation. They observed significant symptom overlap for the 2 conditions. However, they were able, applying discriminate analysis, to correctly classify the majority of patients (73%), although the model appeared to lack clinical utility and requires prospective testing. At this stage, differentiating IBS from other functional bowel diseases based on symptoms is arbitrary; more work is needed to determine if meaningful groupings can be identified with more careful attention to specific symptoms and pathophysiologic abnormalities in constipated patients.

IBD and IBS: Common Link?
A key issue that continues to be controversial is whether IBS and inflammatory bowel disease (IBD) have a common link. A small increased risk of IBD among individuals with IBS has been identified in 1 prospective cohort study.[11] Furthermore, it is well recognized that typical IBS-like symptoms may occur in IBD in remission.[1] Therefore, it may be difficult to distinguish these diseases unless colonoscopy and biopsy are performed.

KothandaRaman and colleagues[12] evaluated the pain experienced by patients with IBS compared with that experienced by patients who had Crohn's disease. They studied 12 patients with IBS and 22 with Crohn's disease, all of whom completed the McGill Pain Questionnaire, the Pain Disability Index, the Pain Catastrophizing scale, the Multi-Dimensional Pain Inventory, and a quality-of-life measure (the 36-Item Short-Form Health Survey [SF-36]). Pain descriptors were similar in both groups, although the patients with Crohn's disease had a more helpless attitude and a lower overall quality of life. Therefore, it appears that the pain experience is similar in IBS and Crohn's disease and that using pain descriptors to differentiate IBS from IBD is unlikely to be effective.

Zaman and associates[13] evaluated symptoms in patients with Crohn's disease (n = 30) and left-sided ulcerative colitis (n = 25) or IBS (n = 21). In patients with IBS compared with active IBD, the symptoms were remarkably similar, suggesting that it can be difficult to differentiate IBD based on gastrointestinal symptoms alone. The precise utility of the Rome II criteria in IBD remains poorly defined, but these criteria are likely to be insufficient on their own. Alternatively, alarm symptoms, such as rectal bleeding or weight loss, in combination with typical IBS symptoms may be considerably more helpful in differentiating active IBD from IBS, as may be the use of inflammatory markers, such as a sensitive assay for C-reactive protein or calprotectins.[1]

Sugar Intolerance
Another condition that can be confused with IBS is sugar intolerance; however, the role of fructose and sorbitol in the etiology of symptoms typical of IBS remains controversial. A high prevalence of sugar malabsorption has been observed in patients with IBS, although the benefits of restricting intake of the problematic sugars has been highly variable.[14,15]

Gagliardi and colleagues[16] noted that the mean fructose intake in the United States is at least 37 g/d. They studied 15 healthy adult patients who consumed both 25 g and 50 g of fructose on separate days. Breath hydrogen testing was then conducted. The study authors observed that 50% of patients had hydrogen peak levels above 20 ppm with the 25-g dose of fructose, whereas 75% taking the 50-g dose had an abnormal hydrogen peak. This finding suggests that in the normal population a large number of individuals have fructose malabsorption. Furthermore, symptom scores were greater after both doses of fructose, although the higher dose did not increase the scores.

Choi and associates[17] specifically assessed fructose intolerance in the setting of IBS. They studied 209 patients with unexplained bloating, altered bowel habit, and pain who were given either a 25-g or 50-g fructose challenge. It was observed that in patients receiving the higher fructose load, symptom scores were higher for diarrhea but not for other gastrointestinal symptoms. Overall, one third of patients with suspected IBS in this tertiary referral center appeared to have fructose intolerance. However, avoidance of fructose and symptom relief were not evaluated. Clinicians may wisely wish to consider prescribing a low-fructose diet as part of their initial management of IBS with diarrhea, but the benefits even among patients with coexistent fructose intolerance are as yet not established.

Prognosis
Durability of Diagnosis
Traditionally, IBS is considered to be a "safe" diagnosis.[1] Adeniji and colleagues[18] studied a well-characterized cohort of patients to confirm the safety (durability) of a diagnosis of IBS. They reviewed a cohort of patients who were diagnosed with IBS between 1989 and 1992 and who fulfilled the Rome I criteria for the diagnosis. The study population was reinterviewed for IBS symptoms 10-13 years after the initial diagnosis. In 75 patients, the mean time to the second interview was 11.8 years, and none had the diagnosis refuted. There were other gastrointestinal diagnoses noted in small numbers among patients in this cohort, including 5 cases of diverticulitis and 3 of gallbladder disease. Many patients (46%) had undergone a second, but arguably unnecessary, structural evaluation that ultimately produced negative results (no change in diagnosis). Of particular interest was the finding that only 43% of patients continued to meet the Rome I criteria for IBS, implying that some symptoms in IBS will often fluctuate. This finding suggests that the current symptom criteria for IBS may require reconsideration to include subthreshold cases.

Postenteritis IBS
Currently, another area of major interest in IBS is the prognosis of postenteritis IBS.[19] It is now well recognized that up to 1 in 5 cases of IBS will occur after infection, and a low-grade inflammatory process has been documented in some of these cases, although histologically the colonic mucosa is normal.[1,19]

In a study by Spears and colleagues,[20] patients with acute infectious enteritis were administered standardized questionnaires 3 months after infection as part of a repeat evaluation. Although a small study, the investigators observed that 2 patients with IBS 3 months after infection also had depression. In contrast, the remaining 9 patients who did not develop postenteritis IBS were negative for depression on the patient health questionnaire. These results are consistent with the literature, which suggests that psychological factors may identify a vulnerability to the development of postinfectious IBS.[1] The latter may in turn reflect disturbed central down-regulation of visceral afferent signals from the gut that may be genetically determined.

Pathophysiology
Altered Serotonin Signaling?
The pathogenesis of IBS remains obscure, and in particular, an explanation for alternating diarrhea and constipation has been elusive. In arguably one of the most important papers presented during this year's meeting, Moses and colleagues[21] studied potential deregulation of the gut's serotonin transporter in IBS.

It is known that serotonin (5-hydroxytryptamine or 5HT) is released from enteroendocrine (or enterochromaffin) cells in response to either chemical or mechanical stimulation of the gut mucosa. Serotonin in turn initiates peristalsis, and then the serotonin released is taken up in health by a highly selective serotonin transporter (SERT). One potential mechanism that could explain altered bowel function in IBS is an abnormality in the serotonin transporter itself. The study authors evaluated this hypothesis in patients with IBS with constipation and IBS with diarrhea compared with patients with ulcerative colitis and healthy controls. They were able to convincing show on blinded review that SERT immunoreactivity was less intense in patients with IBS with constipation and patients with ulcerative colitis.

If these findings are indeed correct, they represent a landmark observation. The findings suggest that patients with constipation and IBS may have a reduced capacity to reuptake serotonin, leading to excess free serotonin and then desensitization of these receptors, thus reducing motor function. In contrast, in the setting of diarrhea, serotonin uptake was normal. If the underlying abnormality in serotonin transporter function alternated, then this would in turn explain alternating constipation and diarrhea.

These data strongly suggest that IBS is a "real" gut disease and a potential diagnostic disease marker. They also suggest that it is valid to subdivide IBS into constipation and diarrhea symptom subgroups. This study also provides additional rationale for the use of serotonin-modulating agents in IBS and provides a new target for drug modulation. Confirmation of these very exciting initial findings in larger patient samples is awaited with great interest.

Therapy
Tegaserod
Tegaserod is a partial serotonin type 4 agonist (at least in the guinea pig ileum) and is a prokinetic agent that also promotes fluid secretion.[7] Recent randomized, controlled trials have shown that this drug is effective in IBS with constipation, with significant global improvement and improvement in constipation symptoms and abdominal pain.[22] One issue to be resolved is whether the benefits of tegaserod are purely due to its prokinetic action relieving constipation. Animal data suggest that tegaserod has some visceral analgesic actions, although the relevance of this to humans is not yet established.[7]

Dunger-Baldauf and colleagues[23] aimed to evaluate the relevance of the improvement in constipation by performing a meta-analysis of the available tegaserod phase 3 clinical trials. They compared the time course of daily abdominal pain and discomfort and daily bowel movements and failed to show any temporal relationship between these symptoms. The study authors concluded that any benefit to abdominal pain was independent of the drug's prokinetic action. However, a proof-of-concept study comparing standard osmotic laxatives with tegaserod is warranted to validate this finding.

An important issue for clinicians is the safety of tegaserod. Ruegg and colleagues[24] evaluated the combination of antidepressant drugs with tegaserod in the phase 3 tegaserod clinical trials. They showed that tegaserod in combination with antidepressants appeared to be well tolerated and that there were no increased adverse events in this setting. This finding is reassuring because combination therapy is likely to be used by clinicians for IBS in difficult cases.

Tegaserod is a prokinetic, and hence diarrhea would be expected with its use. However, this appears not to be a major issue according to data reported by Earnest and associates.[25] The study authors found that when diarrhea was reported, it occurred early in treatment and that the majority of patients (71%) had only 1 episode. The safety of tegaserod, even in IBS with diarrhea, has been described elsewhere recently.[26] Therefore, although 1 in 10 patients will experience diarrhea, this appears to be a mild and transient issue that typically requires no additional therapy. There are 5-hydroxytryptamine type 4 or 5HT4 receptors on the atria in the heart, but other data support the safety of tegaserod in terms of an absence of electrocardiographic effects.[27]

Probiotics
Probiotics are gaining increasing attention as potential therapies for IBS.[28] Uncontrolled studies have been encouraging, as evidenced by presentations during this year's scientific sessions. Positive results were reported by Bazzocchi and coworkers[29] in an open, uncontrolled trial. Similarly, in a retrospective study, Faber[30] reported significant improvement in symptoms and quality of life from baseline with probiotic therapy. However, Kim and colleagues[31] conducted a randomized, double-blind, placebo-controlled trial and found more sobering and likely more accurate results. They found no overall symptomatic improvement associated with the probiotic they administered (although bloating did improve), and they also found no change in colonic transit.

Only high-quality randomized controlled trials will address the issue of whether probiotics have a place in the treatment of IBS. Furthermore, any benefit will need a mechanistic explanation, which at present is lacking.

Conclusion
This year's annual meeting of the American College of Gastroenterology has provided a forum for the presentation of new and important insights into IBS. Some truly exciting developments have emerged that will hopefully translate into improved patient outcomes as we begin to unravel this increasingly better understood disease entity.

References
Talley NJ, Spiller R. Irritable bowel syndrome: a little understood organic bowel disease? Lancet. 2002;360:555-564.
Hungin APS, Tack J, Mearin F, Whorwell PJ, Dennis E, Barghoui V. Irritable bowel syndrome (IBS): prevalence and impact in the USA - the truth in IBS (T-IBS) survey. Am J Gastroenterol. 2002;97:242. [Poster #460]
Saito YA, Schoenfeld P, Locke GR III. The epidemiology of irritable bowel syndrome in North America: a systematic review. Am J Gastroenterol. 2002;97:1910-1915.
Badia X, Mearin F, Balboa A, et al. Burden of illness in irritable bowel syndrome comparing Rome I and Rome II criteria. Pharmacoeconomics. 2002;20:749-758.
Koloski NA, Talley NJ, Boyce PM. Epidemiology and health care seeking in the functional GI disorders: a population-based study. Am J Gastroenterol. 2002;97:2290-2299.
Tuteja AK, Joos SK, Talley NJ, Hickam DH. Functional bowel disorders: a population based study of prevalence and risk factors. Am J Gastroenterol. 2002;97:241. [Poster #454]
Talley NJ. Serotonergic neuroenteric modulators. Lancet. 2001;358:2061-2068.
Hungin APS, Tack J, Mearin F, Whorwell PJ, Dennis E, Barghoui V. The truth in IBS (T-IBS) survey - healthcare utilization and medication use among IBS patients in the USA. Am J Gastroenterol. 2002;97:243. [Poster #461]
Sach JA, Chang L, Naliboff B, Emeran A. Are there gender specific predictors of health related quality of life (HRQOL) impairment in patients with irritable bowel syndrome? Am J Gastroenterol. 2002;97:122. [Abstract #41]
Crowell MD, Schattler-Duncan A, Dennis EH. Symptomatic differentiation of irritable bowel syndrome with constipation vs. functional constipation. Am J Gastroenterol. 2002;97:308. [Poster #721]
Garcia Rodriguez LA, Ruigomez A, Wallander MA, Johansson S, Olbe L. Detection of colorectal tumor and inflammatory bowel disease during follow-up of patients with initial diagnosis of irritable bowel syndrome. Scand J Gastroenterol. 2000;35:306-311.
KothandaRaman M, Turnbull GK, Valis TM. The pain experience by patients with irritable bowel syndrome. Am J Gastroenterol. 2002;97:308. [Poster #723]
Zaman MS, Robson KM, Lembo AJ. Overlap of irritable bowel syndrome (IBS) symptoms in patients with inflammatory bowel disease (IBD). Am J Gastroenterol. 2002;97:241. [Poster #455]
Fernandez-Banares F, Esteve-Pardo M, de Leon R, et al. Sugar malabsorption in functional bowel disease: clinical implications. Am J Gastroenterol. 1993;88:2044-2050.
Ledochowski M, Widner B, Bair H, Probst T, Fuchs D. Fructose- and sorbitol-reduced diet improves mood and gastrointestinal disturbances in fructose malabsorbers. Scand J Gastroenterol. 2000;35:1048-1052.
Gagliardi M, Beyer P, Pehlivanov N, McCallum R. Should we be testing for fructose tolerance in patients with GI complaints? Am J Gastroenterol. 2002;97:308. [Poster #724]
Choi YK, Jacdson M, Summers R, Rao S. Fructose intolerance and irritable bowel syndrome (IBS). Am J Gastroenterol. 2002;97:309. [Poster #725]
Adeniji OA, Barnett B, DiPalma JA. Durability of the irritable bowel syndrome. Am J Gastroenterol. 2002;97:121. [Abstract # 40]
Neal KR, Barker L, Spiller RC. Prognosis in post-infective irritable bowel syndrome: a six year follow up study. Gut. 2002;51:410-413.
Spears AD, Tuteja A, Frederick S, et al. Evaluation of the natural history and role of psychological factors in post-enteritis irritable bowel syndrome. Am J Gastroenterol. 2002;97:308. [Poster # 722]
Moses PL, Bannon C, Linden DR, Crowell MD, Sharkey KA, Mawe GM. Evidence for altered serotonin signalling in IBD and constipation predominant IBS. Am J Gastroenterol. 2002;97:240. [Poster #452]
Muller-Lissner SA, Fumagalli I, Bardhan KD, et al. Tegaserod, a 5-HT4 receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther. 2001;15:1655-1666.
Dunger-Baldauf C, Rueegg PC, Lefkowitz M. Is relief from abdominal discomfort/pain in tegaserod treated IBS-C, patients due to an increased frequency of bowel movements. Am J Gastroenterol. 2002;97:177. [Poster #199]
Ruegg P, Lefkowitz M, Drossman D, Shi V. Tegaserod alone or in combination with antidepressant drugs is well tolerated in patients with IBS-C. Am J Gastroenterol. 2002;97:176. [Poster #195]
Earnest D, Rueegg PC, Dunger Baldauf C, Lefkowitz M. Diarrhea in patients treated with tegaserod for irritable bowel syndrome with constipation (IBS-C) is infrequent and usually self-limited. Am J Gastroenterol. 2002;97:177. [Poster #197]
Fidelholtz J, Smith W, Rawls J, et al. Safety and tolerability of tegaserod in patients with irritable bowel syndrome and diarrhea symptoms. Am J Gastroenterol. 2002;97:1176-1781.
Morganroth J, Ruegg PC, Dunger-Baldauf C, Appel-Dingemanse S, Bliesath H, Lefkowitz M. Tegaserod, a 5-hydroxytryptamine type 4 receptor partial agonist, is devoid of electrocardiographic effects. Am J Gastroenterol. 2002;97:2321-2327.
Hunter JO, Madden JA, Hunter JO. A review of the role of the gut microflora in irritable bowel syndrome and the effects of probiotics. Br J Nutr. 2002;88:67-72.
Bazzocchi G, Almerigi PF, Gionchetti P, Campieri M. Changes in symptoms, distension-stimulated colonic motility and in fecal microbiological features after oral bacteriotherapy in patients with diarrhea-predominant IBS (D-IBS) or with functional diarrhea (FD). Am J Gastroenterol. 2002;97:176. [Poster # 196]
Faber SM. Irritable bowel syndrome and reinoculation with probiotics. Am J Gastroenterol. 2002;97:211. [Poster #336]
Kim HJ, Camilleri M, McKinzie S, Burton D, Thomforde G, Zinsmeister AR. Effect of a probiotic, VSL#3 in diarrhea-predominant irritable bowel syndrome: a randomised, double blind, placebo controlled trial. Am J Gastroenterol. 2002;97:177. [Poster #200]

Copyright © 2002 Medscape.

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HeatherAdministrator

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Features of eating disorders in patients with IBS new
      #14080 - 07/15/03 11:12 AM

J Psychosom Res. 1998 Aug;45(2):171-8.

Features of eating disorders in patients with irritable bowel syndrome.

Tang TN, Toner BB, Stuckless N, Dion KL, Kaplan AS, Ali A.

Women's Mental Health Research Programme, Clarke Institute of Psychiatry, Toronto, Ontario, Canada.

The relationship between characteristics of irritable bowel syndrome (IBS) and eating disorders (ED) was investigated in a clinical sample of 43 female and 17 male IBS patients who completed the Eating Disorder Inventory (EDI). A diagnosis of IBS was generally unrelated to the Body Dissatisfaction, Perfectionism, and Ineffectiveness subscales of the EDI, but symptom severity was correlated with Perfectionism and Ineffectiveness. Severe bouts of vomiting were significantly associated with desires for lower body weight and reported binge-purge behaviors and cognitions measured by the Bulimia subscale of the EDI. Results suggest the need for a more comprehensive understanding of both types of illness as well as a possible framework for future empirical work.

PMID: 9753389 [PubMed - indexed for MEDLINE]

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Heather is the Administrator of the IBS Message Boards. She’s the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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HeatherAdministrator

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Functional GI disorders and eating disorders - Relevance of the association new
      #14081 - 07/15/03 11:14 AM

Scand J Gastroenterol. 1998 Jun;33(6):577-82.

Functional gastrointestinal disorders and eating disorders. Relevance of the association in clinical management.

Porcelli P, Leandro G, De Carne M.

Dept. of Gastroenterology, Scientific Institute of Gastroenterology Saverio de Bellis, Castellana Grotte (Bari), Italy.

BACKGROUND: As functional gastrointestinal disorders (FGID) are common in eating disorder patients, we aimed to assess past eating disorders in patients referred for current FGID. METHODS: One hundred and twenty-seven consecutive FGID outpatients and 163 patients with gallstone disease (GD) were enrolled. All patients were interviewed to detect GI symptoms (by means of the GI Symptom Rating Scale), lifetime eating disorders (on the basis of DSM-IV criteria), and current psychologic distress (on the Hospital Anxiety and Depression Scale). RESULTS: Past eating disorders were significantly more prevalent in FGID (15.7%) than in GD patients (3.1%) (chi-square = 14.6, P < 0.001). FGID patients with past eating disorders were significantly younger, more educated, more psychologically distressed, more dyspeptic, and more were women than FGID patients without past eating disorders. CONCLUSIONS: This study confirms the previously found association between functional GI symptoms and eating disorders and shows that functional GI symptoms may still persist even after the recovery from eating disorders, particularly in psychologically distressed patients.

PMID: 9669626 [PubMed - indexed for MEDLINE]

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HeatherAdministrator

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Dieting severity and GI symptoms in college women. new
      #14090 - 07/15/03 01:13 PM

J Am Coll Health. 1996 Sep;45(2):67-71.

Dieting severity and gastrointestinal symptoms in college women.

Krahn D, Kurth C, Nairn K, Redmond L, Drewnowski A, Gomberg E.

Department of Psychiatry, University of Wisconsin-Madison Medical School, USA.

Young women report symptoms associated with irritable bowel syndrome (IBS), such as pain, bloating, and changes in bowel movements, more often than young men. Young women with eating disorders also report these gastrointestinal symptoms frequently. We hypothesized that if dieting behaviors were associated with these symptoms, the prevalence and frequency of the symptoms would be positively related to dieting severity in young women. We interviewed 301 1st-year college women representing the continuum of dieting severity. We found that severity of dieting was positively related to frequency of abdominal pain, bloating, diarrhea, and constipation, and that the women who reported 3 or more symptoms regularly scored higher on a scale for dieting severity. Although this study did not examine the relationship between dieting severity and clinical IBS, the findings suggested that dieting is associated with gastrointestinal symptoms in young women.

PMID: 8908880 [PubMed - indexed for MEDLINE]

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Heather is the Administrator of the IBS Message Boards. She’s the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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Postinfectious irritable bowel syndrome. new
      #14123 - 07/15/03 06:19 PM

Gastroenterology. 2003 May;124(6):1662-71.

Postinfectious irritable bowel syndrome.

Spiller RC.

Division of Gastroenterology, University Hospital, Nottingham, United Kingdom. robin.spiller@noittingham.ac.uk

A small but significant subgroup of patients with irritable bowel syndrome (IBS) report a sudden onset of their IBS symptoms after a bout of gastroenteritis. Population-based surveys show that although a history of neurotic and psychologic disorders, pain-related diseases, and gastroenteritis are all risk factors for developing IBS, gastroenteritis is the most potent. More toxigenic organisms increase the risk 11-fold, as does an initial illness lasting more than 3 weeks. Hypochondriasis and adverse life events double the risk for postinfective (PI)-IBS and may account for the increased proportion of women who develop this syndrome. PI-IBS is associated with modest increases in mucosal T lymphocytes and serotonin-containing enteroendocrine cells. Animal models and some preliminary human data suggest this leads to excessive serotonin release from the mucosa. Both the histologic changes and symptoms in humans may last for many years with only 40% recovering over a 6-year follow-up. Celiac disease, microscopic colitis, lactose intolerance, early stage Crohn's disease, and bile salt malabsorption should be excluded, as should colon cancer in those over the age of 45 years or in those with a positive family history. Treatment with Loperamide, low-fiber diets, and bile salt- binding therapy may help some patients. Serotonin antagonists are logical treatments but have yet to be evaluated.

Publication Types:
Review
Review, Tutorial

PMID: 12761724 [PubMed - indexed for MEDLINE]
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