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The American Journal of Gastroenterology
Volume 100 Issue 1 Page 124 - January 2005
doi:10.1111/j.1572-0241.2005.40516.x
Is Constipation Associated with Decreased Physical Activity in Normally Active Subjects?
Ashok K. Tuteja, M.D., M.P.H.1, Nicholas J. Talley, M.D., Ph.D.1, Sandra K. Joos, Ph.D., M.P.H.1, James V. Woehl, K.V.C.N.P.1, and David H. Hickam, M.D., M.P.H.1
BACKGROUND: The effectiveness of physical activity in the management of constipation remains controversial. We examined the associations among physical activity, constipation, and quality of life (QoL) in a population of employed adults to determine whether the risk of constipation is related to physical activity.
METHODS: A total of 1,069 employees (age range 2477) of the Veterans Affairs (VA) Black Hills Health Care System were mailed validated questionnaires (response rate 72%), inquiring about bowel habits, QoL (SF 36), and physical activity (modified Baecke questionnaire). Constipation was defined using the Rome I criteria.
RESULTS: One hundred and forty (19.4%, 95% CI 16.222.4) employees reported constipation. The average total physical activity and all subscales of physical activity were not significantly different in subjects with and without constipation (all p 0.2). Subjects with constipation had lower QoL scores than subjects without constipation, and physical activity was positively correlated with physical functioning and health perception.
CONCLUSION: Physical activity appears to be unrelated to the risk of constipation in employed adults, but higher physical activity was associated with improved QoL. Recommendations to increase physical activity may not alter symptoms of constipation but may improve overall well-being.
http://www.blackwell-synergy.com/links/doi/10.1111/j.1572-0241.2005.40516.x/abs/
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Alimentary Pharmacology & Therapeutics
Volume 21 Issue 1 Page 21 - January 2005
doi:10.1111/j.1365-2036.2004.02302.x
The value of a general therapeutic approach in subjects with irritable bowel syndrome
K. W. Monsbakken*, P. O. Vandvik*, & P. G. Farup*,
Summary
Background: The general therapeutic approach is the cornerstone in the management of irritable bowel syndrome, but the effect is poorly documented.
Aim: To evaluate the effect of the general therapeutic approach for irritable bowel syndrome.
Methods: Subjects with irritable bowel syndrome identified in a public screening were included. Scores for abdominal symptom (range 012), musculoskeletal pain and mood disorders were calculated. After exclusion of other disorders, a doctor presented irritable bowel syndrome as a positive diagnosis, gave information, reassurance and lifestyle advice, but no pharmacotherapy. A dietician gave dietary advice. There was a follow-up after 6 months.
Results: Sixty-five persons (females/males: 44/21) with mean age 49 years (range 3176) were included, 31 (48%) were recommended dietary changes. Twenty subjects (31%) had satisfactory relief of symptoms after 6 months. The scores for abdominal symptom was reduced from 3.1 to 2.2 (P = 0.007), the reduction was 2.2 in the diarrhoea-predominant group given advice compared with 0.4 in the other subjects (P = 0.035). Previous consultations for the complaints, visits for psychiatric disorders, and presence of mood disorders were predictors of persistent complaints.
Conclusions: There was a significant relief of symptoms after 6 months, those with psychological co-morbidity responded less well.
http://www.mdlinx.com/GILinx/thearts.cfm?artid=1151236&specid=13&ok=yes
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Neurogastroenterology and Motility
Volume 17 Issue 1 Page 148 - February 2005
doi:10.1111/j.1365-2982.2004.00587.x
Magnetic pill tracking: a novel non-invasive tool for investigation of human digestive motility
e. stathopoulos*, v. schlageter*, b. meyrat, y. de ribaupierre* & p. kucera*
Abstract
A new minimally invasive technique allowing for anatomical mapping and motility studies along the entire human digestive system is presented. The technique is based on continuous tracking of a small magnet progressing through the digestive tract. The coordinates of the magnet are calculated from signals recorded by 16 magnetic field sensors located over the abdomen. The magnet position, orientation and trajectory are displayed in real time. Ten young healthy volunteers were followed during 34 h. The technique was well tolerated and no complication was encountered. The information obtained was 3-D configuration of the digestive tract and dynamics of the magnet displacement (velocity, transit time, length estimation, rhythms). In the same individual, repeated examination gave very reproducible results. The anatomical and physiological information obtained corresponded well to data from current methods and imaging. This simple, minimally invasive technique permits examination of the entire digestive tract and is suitable for both research and clinical studies. In combination with other methods, it may represent a useful tool for studies of GI motility with respect to normal and pathological conditions.
http://www.blackwell-synergy.com/links/doi/10.1111/j.1365-2982.2004.00587.x/abs/
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Neurogastroenterology and Motility
Volume 17 Issue 1 Page 29 - February 2005
doi:10.1111/j.1365-2982.2004.00581.x
G. R. Locke III, A. R. Zinsmeister, S. L. Fett, L. J. Melton III & N. J. Talley
Overlap of GI symptom complexes in a US community
Background: Although the Rome criteria define a number of individual functional gastrointestinal disorders, people may have symptoms of multiple disorders at the same time. In addition, therapies may be effective in subsets of people with specific disorders, yet at the same time help people with multiple disorders.
Aim: To estimate the prevalence of combinations of gastrointestional (GI) symptom complexes.
Methods: A valid self report questionnaire which records GI symptoms was mailed to an age- and gender-stratified random sample of Olmsted County, MN residents aged 3064 years. Standard definitions were used to identify people with gastro-oesophageal reflux, dyspepsia, irritable bowel syndrome (IBS), constipation and diarrhoea. The prevalence of people meeting multiple symptom complexes was estimated. Specifically, combinations of dyspepsia, IBS and constipation were compared to dyspepsia, IBS and diarrhoea.
Results: A total of 657 (69%) of 943 eligible subjects responded; 643 provided data for each of the necessary symptom questions. Each two-way combination of symptom group was present in between 4 and 9% of the population; each three-way combination was present in 14% of the population. The overlap between dyspepsia, IBS and constipation was similar to dyspepsia, IBS and diarrhoea, except body mass index was higher in the diarrhoea overlap group (P = 0.03).
Conclusion: Symptom complex overlap is common in the community; for each condition, the majority of sufferers reported an additional symptom complex. This overlap of symptoms challenges the current paradigm that functional GI disorders represent multiple discreet entities.
http://www.blackwell-synergy.com/links/doi/10.1111/j.1365-2982.2004.00581.x/abs/
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Eur J Gastroenterol Hepatol. 2005 Jan;17(1):5-9. Related Articles, Links
Intestinal infection and irritable bowel syndrome.
Parry S, Forgacs I.
Department of Gastroenterology, King's College Hospital, London, UK.
The observation that the symptoms of irritable bowel syndrome (IBS) in some patients might follow an episode of acute gastroenteritis came from epidemiological studies. Both retrospective and prospective studies suggest that between 4% and 26% of patients develop IBS for the first time after gastroenteritis. The diagnosis of post-infectious IBS is typically made from the history. In addition, as with the diagnosis of IBS more generally, it is important to exclude other clinical causes for persistent bowel dysfunction. There is little, if any, evidence to support the widely-held view that patients with post-infectious IBS carry a better prognosis than IBS patients more generally. The management of patients with post-infectious IBS is the standard approach that might be applied to all patients with IBS. Post-infectious IBS patients may differ from IBS patients in general in having a low-level of intestinal inflammation. Work in animal models, and detection of low-grade inflammation in intestinal biopsies combined with markers of intestinal inflammation such as faecal calprotectin all indicate a strong possibility that persisting inflammation after the acute infection may be important in the pathogenesis of post-infectious IBS.
PMID: 15647632 [PubMed - in process]
http://www.docguide.com/news/content.nsf/PaperFrameSet?OpenForm&refid=2&id=48DDE4A73E09A969852568880078C249&c=&newsid=8525697700573E1885256F8A0044E7D7&u=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15647632&ref=/news/content.nsf/SearchResults?openform&Query=ibs&so=date&id=48DDE4A73E09A969852568880078C249
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Journal of Paediatrics and Child Health
Volume 41 Issue 1-2 Page 1 - January 2005
doi:10.1111/j.1440-1754.2005.00527.x
Review article
Chronic constipation in children: Organic disorders are a major cause
BR Southwell 1,3, SK King 2,4,5 and JM Hutson 2,4,5
Abstract: Diagnostic tools for paediatric chronic constipation have been limited, leading to over 90% of patients with treatment-resistant constipation being diagnosed with chronic idiopathic constipation, with no discernible organic cause. Work in our institution suggests that a number of children with intractable symptoms actually have slow colonic transit leading to slow transit constipation.
This paper reviews recent data suggesting that a significant number of the children with chronic treatment-resistant constipation may have organic causes (slow colonic transit and outlet obstruction) and suggests new approaches to the management of children with chronic treatment-resistant constipation.
http://www.blackwell-synergy.com/links/doi/10.1111/j.1440-1754.2005.00527.x/abs/
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From Ask the Experts about General Gastroenterology
From Medscape Gastroenterology
Surgical Treatment of Chronic Functional Constipation?
Question
What is the appropriate work-up for chronic functional constipation, and how successful is partial colectomy in patients whose very-slow-transit constipation is "resistant" to routine treatment?
Response from Yehuda Ringel, MD
Assistant Professor of Medicine, University of North Carolina at Chapel Hill; Staff Physician, Department of Medicine, University of North Carolina Hospital, Chapel Hill
Surgical treatment of chronic functional constipation should be considered only in the most severe cases of slow-colonic-transit constipation for those patients who do not respond to aggressive medical therapy. Prior to surgery, patients should be carefully evaluated for existence of other gastrointestinal conditions and symptoms, particularly abdominal pain and irritable bowel syndrome. It is crucial to inform the patient that the surgical procedure is aimed to ease the constipation but is not likely to alleviate other gastrointestinal symptoms. A detailed work-up should include: (1) exclusion of known causes of constipation, such as medications (eg, opiates and anticholinergics); low-fiber diet; mechanical obstruction (eg, colon cancer or stricture); metabolic disorders (eg, hypothyroidism, hypercalcemia); psychological disorders (severe depression); and others; (2) confirming the diagnosis of severe functional colonic inertia (slow transit)-type constipation by studying colonic transit time (eg, radiopaque marker studies); and (3) exclusion of other possible treatable conditions, such as disturbed defecation, as assessed by anorectal manometry (eg, for Hirschsprung's disease and other pelvic floor dysfunctions) and defecation studies (eg, for rectocele and rectal prolapse); and chronic intestinal pseudo-obstruction, as assessed by radiologic or manometric studies.
The recommended surgical procedure is subtotal colectomy with ileorectal anastomosis. Partial colectomy has not been found to be helpful and should therefore not be considered. A comprehensive review of 13 reported studies of 362 patients who underwent colectomy and who were followed for 1.2-8.9 years reported a success rate of 88%.[1] A recent prospective long-term (mean follow-up of 56 months) study of 52 patients who were carefully evaluated and underwent surgery for slow-transit constipation showed that over 90% of patients were satisfied with the results of surgery, and reported a good or improved quality of life.[2] Postoperative complications may include small-bowel obstruction, prolonged ileus, abdominal pain, and diarrhea.
More recently, antegrade continent enema has been suggested as an alternative approach in patients who are unable or unwilling to undergo colectomy. Conduits can be created from the appendix, cecum, or ileum. A recent retrospective study of 32 patients who underwent this procedure, with a median of 36 months' (range, 13-140 months) follow-up, reported satisfactory long-term results in approximately half of the patients -- although revision procedures were often required.[3] However, the procedure is reversible and does not preclude subsequent surgical intervention.
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References
Pikarsky AJ, Singh JJ, Weiss EG, Nogueras JJ, Wexner SD. Long-term follow-up of patients undergoing colectomy for colonic inertia. Dis Colon Rectum. 2001;44:179-183. Abstract
Nyam DC, Pemberton JH, Ilstrup DM, Rath DM. Long-term results of surgery for chronic constipation. Dis Colon Rectum. 1997;40:273-279. Abstract
Lee NP, Hodson P, Hill J, Pearson RC, MacLennan I. Long-term results of the antegrade continent enema procedure for constipation in adults. Colorectal Dis. 2004;6:362-368. Abstract
Disclosure: Yehuda Ringel, MD, has disclosed that he has received grants for clinical research from GlaxoSmithKline, AstraZeneca, and Novartis. He has received grants for educational activities from Solvay. Dr. Ringel has also reported that he is on the speaker's bureau for Novartis and has served as an advisor or consultant for GlaxoSmithKline.
Medscape Gastroenterology. 2005; 7 (1): ©2005 Medscape
http://www.medscape.com/viewarticle/497702?src=mp
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Journal of Gastroenterology and Hepatology
Volume 20 Issue 3 Page 381 - March 2005
doi:10.1111/j.1440-1746.2005.03574.x
GASTROENTEROLOGY
Post-infectious irritable bowel syndrome in patients with Shigella infection
SANGWON JI*, HYOJIN PARK*, DOKYONG LEE*, YOUNG KOO SONG*, JAE PHIL CHOI* AND SANG-IN LEE*
Abstract
Background and Aims: Bacterial gastroenteritis has been known as a risk factor of irritable bowel syndrome (IBS). Several risk factors of post-infectious IBS (PI-IBS) have been documented. The aims of this study were to verify the role of bacterial gastroenteritis in the development of IBS and the risk factors for the development of PI-IBS. The clinical course of PI-IBS was also investigated.
Methods: We recruited 143 patients with shigellosis during its outbreak and 113 controls. Both groups were followed up for 12 months. Bowel symptoms were evaluated by use of questionnaires at 3, 6 and 12 months after the initial recruitment.
Results: Complete data were obtained from 101 patients (70.6%) and 102 healthy controls (90.3%). At 12 months, 15 patients and six controls had IBS (adjusted OR; 2.9, 95% CI; 1.17.9). Of the 15 patients, five had IBS symptoms consistently for 12 months, three did not have IBS symptoms initially and seven had fluctuating bowel symptoms. The duration of diarrhea was an independent risk factor of PI-IBS.
Conclusions: Bacterial gastroenteritis is a risk factor of IBS and the duration of diarrhea as the index of severity of initial illness is an independent risk factor of PI-IBS. The clinical course of PI-IBS is variable over the 1 year of follow-up.
Accepted for publication 30 April 2004.
Affiliations
*Yonsei Institute of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
Correspondence
Dr Hyojin Park, Department of Internal Medicine, Yongdong Severance Hospital, Yonsei University College of Medicine, Yongdong PO Box 1217, Seoul 135-270, Korea. Email: HJPARK21@yumc.yonsei.ac.kr
To cite this article
JI, SANGWON, PARK, HYOJIN, LEE, DOKYONG, SONG, YOUNG KOO, CHOI, JAE PHIL & LEE, SANG-IN (2005)
Post-infectious irritable bowel syndrome in patients with Shigella infection.
Journal of Gastroenterology and Hepatology 20 (3), 381-386.
doi: 10.1111/
j.1440-1746.2005.03574.x
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http://www.blackwell-synergy.com/links/doi/10.1111/j.1440-1746.2005.03574.x/abs/
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The American Journal of Gastroenterology
Volume 100 Issue 2 Page 373 - February 2005
doi:10.1111/j.1572-0241.2005.40312.x
Analysis of the Fecal Microbiota of Irritable Bowel Syndrome Patients and Healthy Controls with Real-Time PCR
Erja Malinen, Ph.D.1, Teemu Rinttilä, M.Sc.1, Kajsa Kajander, M.Sc.1, Jaana Mättö, Ph.D.1, Anna Kassinen, M.Sc.1, Lotta Krogius, M.Sc.1, Maria Saarela, Ph.D.1, Riitta Korpela, Ph.D.1, and Airi Palva, Ph.D.1
OBJECTIVE: The gut microbiota may contribute to the onset and maintenance of irritable bowel syndrome (IBS). In this study, the microbiotas of patients suffering from IBS were compared with a control group devoid of gastrointestinal (GI) symptoms.
METHODS : Fecal microbiota of patients (n = 27) fulfilling the Rome II criteria for IBS was compared with age- and gender-matched control subjects (n = 22). Fecal samples were obtained at 3 months intervals. Total bacterial DNA was analyzed by 20 quantitative real-time PCR assays covering approximately 300 bacterial species.
RESULTS: Extensive individual variation was observed in the GI microbiota among both the IBS- and control groups. Sorting of the IBS patients according to the symptom subtypes (diarrhea, constipation, and alternating predominant type) revealed that lower amounts of Lactobacillus spp. were present in the samples of diarrhea predominant IBS patients wheras constipation predominant IBS patients carried increased amounts of Veillonella spp. Average results from three fecal samples suggested differences in the Clostridium coccoides subgroup and Bifidobacterium catenulatum group between IBS patients (n = 21) and controls (n = 15). Of the intestinal pathogens earlier associated with IBS, no indications of Helicobacter spp. or Clostridium difficile were found whereas one case of Campylobacter jejuni was identified by sequencing.
CONCLUSIONS: With these real-time PCR assays, quantitative alterations in the GI microbiota of IBS patients were found. Increasing microbial DNA sequence information will further allow designing of new real-time PCR assays for a more extensive analysis of intestinal microbes in IBS.
Received February 20, 2004; accepted October 31, 2004.
Affiliations
1Department of Basic Veterinary Sciences, Faculty of Veterinary Medicine, Section of Microbiology, P.O. Box 66, FIN-00014 University of Helsinki, Finland; Valio Ltd, R&D, P.O. Box 30, FIN-00039 Helsinki, Finland; VTT Biotechnology, P.O. Box 1500, FIN-02044 VTT, Finland; and Institute of Biomedicine, Pharmacology, P.O. Box 63, FIN-00014 University of Helsinki, Finland
Correspondence
To cite this article
Malinen, Erja, Rinttilä, Teemu, Kajander, Kajsa, Mättö, Jaana, Kassinen, Anna, Krogius, Lotta, Saarela, Maria, Korpela, Riitta & Palva, Airi (2005)
Analysis of the Fecal Microbiota of Irritable Bowel Syndrome Patients and Healthy Controls with Real-Time PCR.
The American Journal of Gastroenterology 100 (2), 373-382.
doi: 10.1111/
j.1572-0241.2005.40312.x
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http://www.blackwell-synergy.com/links/doi/10.1111/j.1440-1746.2005.03574.x/abs/
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The American Journal of Gastroenterology
Volume 100 Issue 4 Page 896 - April 2005
doi:10.1111/j.1572-0241.2005.41211.x
Characterization of the Alternating Bowel Habit Subtype in Patients with Irritable Bowel Syndrome
Kirsten Tillisch, M.D.1, Jennifer S. Labus, Ph.D.1, Bruce D. Naliboff, Ph.D.1, Roger Bolus, Ph.D.1, Michael Shetzline, M.D.1, Emeran A. Mayer, M.D.1, and Lin Chang, M.D.1
BACKGROUND: Due to a wide range of symptom patterns, patients with irritable bowel syndrome (IBS) are often subgrouped by bowel habit. However, the IBS subgroup with alternating bowel habits (IBS-A) has been poorly characterized.
OBJECTIVES: (i) To determine a set of bowel habit symptom criteria, which most specifically identifies IBS patients with an alternating bowel habit, (ii) to describe IBS-A bowel symptom patterns, and (iii) to compare clinical characteristics among IBS-A, constipation-predominant (IBS-C), and diarrhea-predominant IBS (IBS-D).
METHODS: One thousand one hundred and two Rome I positive IBS patients were analyzed. Three sets of potential criteria for IBS-A were developed and compared by multirater Kappa test. Gastrointestinal, psychological, extraintestinal symptoms, and health-related quality of life were compared in IBS-A, IBS-C, and IBS-D using 2 test and analysis of variance (ANOVA).
RESULTS: Stool consistency was determined to be the most specific criteria for alternating bowel habits. IBS-A patients reported rapid fluctuations in bowel habits with short symptom flares and remissions. There was a greater prevalence of psychological and extraintestinal symptoms in the IBS-A subgroup compared to IBS-C and IBS-D. No differences were seen between bowel habit subtypes in health-related quality of life.
CONCLUSIONS: IBS-A patients have rapidly fluctuating symptoms and increased psychological comorbidity, which should be taken into account for clinical practice and clinical trials.
http://www.blackwell-synergy.com/links/doi/10.1111/j.1572-0241.2005.41211.x/abs/
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