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British Medical Journal
Overly Anxious and Driven People Prone to Irritable Bowel Syndrome
Overly anxious and driven people are susceptible to irritable bowel syndrome, usually known as IBS, indicates research published ahead of print in the journal Gut.
[The cognitive behavioural model of irritable bowel syndrome: a prospective investigation of patients with gastroenteritis Gut 2007; doi: 10.1136/gut.2006.108811]
Newswise — Overly anxious and driven people are susceptible to irritable bowel syndrome, usually known as IBS, indicates research published ahead of print in the journal Gut.
The researchers studied 620 people who had confirmed gastroenteritis caused by a bacterial infection. None had had IBS before, or indeed any serious bowel disorder.
Each participant completed a detailed questionnaire when their infection was confirmed. This included questions about mood, perceived stress levels, perfectionism and illness beliefs and behaviours.
They were then monitored three and six months later to see whether they had developed the typical symptoms of IBS, which include diarrhoea and/or constipation, abdominal pain and bloating.
In all, 49 people had IBS at both time points. Women were more than twice as likely to have IBS as the men.
Those with IBS were significantly more likely to have reported high levels of stress and anxiety and psychosomatic symptoms than those who did not develop the condition
They were also significantly more likely to be "driven," carrying on regardless until they were forced to rest - a pattern of behaviour which only worsens and prolongs the condition, say the authors.
Although not likely to be depressed, those with IBS were more likely to take a pessimistic view of illness.
IBS affects between 10 and 15% of adults in industrialised countries, but its exact cause is unknown. "Gastroenteritis may trigger the symptoms, but cognitions, behaviour and emotions may help to prolong and maintain them over time," conclude the authors, who suggest that cognitive behavioural therapy may be an effective treatment.
Click here to view the paper in full: http://press.psprings.co.uk/gut/february/gt108811.pdf
http://www.newswise.com/articles/view/527575/
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Digestive and Liver Disease
Volume 39, Issue 3 , March 2007, Pages 201-215
New insights into the pathogenesis and pathophysiology of irritable bowel syndrome
L. Öhmana and M. Simrén, a,
aDepartment of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
Received 11 September 2006; accepted 25 October 2006. Available online 30 January 2007.
Abstract
The pathogenesis and pathophysiology of irritable bowel syndrome is complex and still incompletely known. Potential pathogenetic factors include genes, infectious events, psychological symptoms and other loosely defined environmental factors. Both alterations at the central and peripheral level are thought to contribute to the symptoms of irritable bowel syndrome, including psychosocial factors, abnormal gastrointestinal motility and secretion, and visceral hypersensitivity. Today irritable bowel syndrome is viewed upon as a disorder of dysregulation of the so-called brain–gut axis, involving abnormal function in the enteric, autonomic and/or central nervous systems, with peripheral abnormalities probably dominating in some patients and disturbed central processing of signals from the periphery in others. Lines of evidence also suggest that inflammation within the gastrointestinal tract may be of great importance in at least subgroups of irritable bowel syndrome patients. To conclude, a complex picture of the pathogenesis and pathophysiology of irritable bowel syndrome is emerging, with interactions between several different alterations resulting in the divergent symptom pattern in these patients.
Keywords: Brain–gut axis; Gastrointestinal motility; Inflammation; Irritable bowel syndrome; Serotonin; Visceral hypersensitivity
Abbreviations: ANS, autonomic nervous system; CNS, central nervous system; EC, enterochromaffin; ENS, enteric nervous system; fMRI, functional magnetic resonance imaging; GI, gastrointestinal; HPA, hypothalamic-pituitary-adrenal; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; Ig, immunoglobulin; IL, interleukin; NMDA, N-methyl-d-aspartic acid; PET, positron emission tomography; SERT, serotonin reuptake transporter; TNF, tumour necrosis factor; Treg, regulatory T cells; TNBS, trinitrobenzenesulfonic acid
Corresponding author at: Section of Gastroenterology & Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, S-41345 Gothenburg, Sweden. Tel.: +46 31 342 10 00; fax: +46 31 82 21 52.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7582-4MY0V07-2&_user=10&_coverDate=03%2F31%2F2007&_rdoc=2&_fmt=summary&_orig=browse&_srch=doc-info(%23toc%2312914%232007%23999609996%23643896%23FLA%23display%23Volume)&_cdi=12914&_sort=d&_docanchor=&view=c&_ct=97&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=298bc3220d6ab80646176c1921fbf292
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Audit of Constipation in a Gastroenterology Referral Center
Authors: Iantorno, Guido; Cinquetti, Monica; Mazzocchi, Alessandro; Morelli, Antonio; Bassotti, Gabrio1
Source: Digestive Diseases and Sciences, Volume 52, Number 2, February 2007, pp. 317-320(4)
Publisher: Springer
Abstract:
This study was designed to assess the various subtypes of functional constipation in a referral gastrointestinal center of a Latino-American country. All patients referred for evaluation of constipation during a 10-year period were audited, and those with functional constipation according to Rome I criteria classified by physiologic tests of colonic transit, as well as tests of anorectal and pelvic floor function. More than 70% of patients with functional constipation had evidence of pelvic floor dysfunction, whereas those with slow transit and constipation-predominant irritable bowel syndrome subtypes were less frequently represented. Even in a setting different from those most frequently reported in the literature, pelvic floor dysfunction represents the most common cause of functional constipation. Simple, physiologic testing is needed and useful for the diagnosis. This fact has therapeutic implications, especially because many such patients may benefit from biofeedback.
Keywords: Constipation; Pelvic floor dysfunction; Slow transit constipation
Document Type: Research article
http://www.ingentaconnect.com/content/klu/ddas/2007/00000052/00000002/00009486;jsessionid=6pb4kt10ii907.victoria
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Continuity and change?: Exploring reactions to a guided self-management intervention in a randomised controlled trial for IBS with reference to prior experience of managing a long term condition
Anne Rogers , Victoria Lee and Anne Kennedy
National Primary Care Research and Development Centre, 5th floor Williamson Building, The University of Manchester, Oxford Road, Manchester, 13 9PL, UK
Trials 2007, 8:6 doi:10.1186/1745-6215-8-6
The electronic version of this article is the complete one and can be found online at: http://www.trialsjournal.com/content/8/1/6
Received 28 June 2006
Accepted 22 February 2007
Published 22 February 2007
© 2007 Rogers et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
--------------------------------------------------------------------------------
ABSTRACT
Self-care interventions are promoted as effective strategies for improving the quality of life and health outcomes for individuals with long-term health conditions. Outcome measures used in evaluations using Randomised Controlled Trials (RCTs) are not designed to consider patients' prior management strategies and experience of illness. Yet the experience of illness literature suggests that adjusting to living with chronic illness, together with broader contextual influences, are likely to be relevant to understanding responses to self-management initiatives.
Using group and individual interview data we attempt to illuminate the transposition of IBS from a condition unsatisfactorily managed by medicine to one successfully managed within the life worlds of individuals. If routine embedding of complex interventions depends on the accomplishment of integration and workability in patients' everyday lives then the design and evaluation of such interventions should view participation as part of a process of continuity as well as change.
Responses to formal self-management can be extended beyond psychological and other quantitatively measured outcomes. A useful addendum to trial outcomes for self-management education is an understanding of change as being inextricably linked to people's previous attempts to, and experience of, managing long-term conditions. We suggest that the benefits of understanding the prior experience of managing illness and contact with health services include the acceptability and workability of complex interventions in patients' everyday lives.
For full article:
http://www.trialsjournal.com/content/8/1/6
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Symptomatic overlap between irritable bowel syndrome and microscopic colitis.
Limsui D, Pardi DS, Camilleri M, Loftus Jr EV, Kammer PP, Tremaine WJ, Sandborn WJ.
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota.
Background: Microscopic colitis is diagnosed on the basis of histologic criteria, and irritable bowel syndrome (IBS) is diagnosed by symptom-based criteria. There has been little investigation into the symptomatic overlap between these conditions.
Our aim was to assess the prevalence of symptoms of irritable bowel syndrome in a population-based cohort of patients with microscopic colitis.Methods: The Rochester Epidemiology Project (REP), a medical records linkage system providing all health care data for the defined population of Olmsted County, Minnesota, was used to identify all county residents with a diagnosis of microscopic colitis between 1985 and 2001. The medical records of these individuals were reviewed to ascertain symptoms consistent with Rome, Rome II, and Manning criteria for irritable bowel syndrome.
Results: One hundred thirty-one cases of microscopic colitis were identified. Median age at diagnosis was 68 years (range, 24-95); 71% were women. Sixty-nine (53%) and 73 (56%) met Rome and Rome II criteria for irritable bowel syndrome, respectively. Fifty-four (41%) had three or more Manning criteria. Forty-three (33%) had previously been diagnosed with irritable bowel syndrome.
Conclusions: In this population-based cohort of histologically confirmed microscopic colitis, approximately one-half met symptom-based criteria for the diagnosis of irritable bowel syndrome. The clinical symptom-based criteria for irritable bowel syndrome are not specific enough to rule out the diagnosis of microscopic colitis.
Therefore, patients with suspected diarrhea-predominant irritable bowel syndrome should undergo biopsies of the colon to investigate for possible microscopic colitis if symptoms are not well controlled by antidiarrheal therapy.(Inflamm Bowel Dis 2006).
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17206699&query_hl=1&itool=pubmed_DocSum
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While IBS is a common disorder – affecting 10 to 15 percent of the U.S. population – it's also one of the most misunderstood among patients and physicians alike, says William D. Chey, M.D., a gastroenterologist at the University of Michigan Health System.
"There are a wide spectrum of symptoms that IBS patients can experience, which can make it challenging to diagnose," says Chey, director of the Gastrointestinal Physiology Laboratory in the U-M Division of Gastroenterology.
"While we know diet does play a role in symptoms for many patients with IBS, those trigger foods often vary from person to person."
To help people with IBS gain a better understanding of the condition and how it's diagnosed, as well as what foods may trigger symptoms, and the over-the-counter and prescription treatments available, Chey offers these seven tips to help separate IBS fact from fiction.
7 common myths – and facts – about IBS
MYTH: IBS is psychosomatic
FACT: For many years, physicians believed IBS was a psychological condition – it only existed in the patient's head. While some patients with IBS experience depression or anxiety, it is likely that psychological distress or stress worsen IBS, but may not be the primary cause of it.
MYTH: IBS only affects young women
FACT: Although IBS does tend to occur more frequently in women, Chey says, "it's important that people know that there are many men diagnosed with IBS, and it also affects the elderly. In fact, there's some early evidence to suggest that IBS affects 8 to 10 percent of older individuals."
MYTH: IBS is not an important condition
FACT: "Many physicians believe that IBS is not an important condition because it does not affect a person's lifespan," says Chey. While that may be the case, IBS can significantly impact a person's quality of life and ability to function on a day-to-day basis, and should be taken seriously by doctors and patients alike.
MYTH: IBS is related to lactose intolerance
FACT: About a quarter of patients with IBS are also lactose intolerant. However, Chey notes that about a quarter of the general population who don't have IBS are lactose intolerant as well. So, he says, while lactose intolerance may play a role in some patients, it is not the cause of symptoms in the vast majority of patients with IBS.
MYTH: IBS means a lifetime of bland food
FACT: "A lot of patients with IBS end up on these very bland diets, and I think most of the time it is not justified," says Chey. Instead, Chey has his patients keep a diary to record all of the food that they eat, and any symptoms they may experience.
"At the end of a two week period, it's possible to get a fairly good idea about whether there are specific trigger foods associated with the onset of symptoms. Those foods then can be easily eliminated from a patient's diet." Certain foods, however, such as fatty foods, milk products, chocolate, alcohol, caffeine and carbonated drinks are more likely to aggravate symptoms in some IBS patients.
MYTH: IBS cannot be accurately diagnosed
FACT: Contrary to what some physicians believe, Chey says most patients do not need a lot of medical tests to be diagnosed with IBS. "Identifying the presence of persistent or recurrent abdominal pain in association with altered bowel habits, and excluding warning signs (e.g. new symptoms occurring after age 50, GI bleeding, unexplained weight loss, nocturnal diarrhea, severe or progressively worse symptoms or a family history of colon cancer, inflammatory bowel disease, colon cancer or celiac disease), is enough to accurately diagnose IBS in most patients."
MYTH: There are no good treatment options for IBS
FACT: Not true, says Chey. With effective counseling, dietary and lifestyle intervention, and use of over-the-counter or prescription medications, IBS can be effectively managed. "Treating infrequent or mild symptoms with over-the-counter medication is effective for most patients," he says. "If symptoms are persistent, however, it's important to see your physician because the excessive use of over-the-counter medications can actually lead to more gastrointestinal symptoms." If symptoms doe not improve with changes in diet and lifestyle, or over-the-counter medications, prescription medications are available for people with IBS.
http://www.med.umich.edu/opm/newspage/2007/hmibs.htm
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Breath Methane Levels Correlate With Constipation in IBS
NEW YORK (Reuters Health) Apr 27 - The degree of breath methane production in patients with irritable bowel syndrome (IBS) correlates with the severity of constipation, Los Angeles-based researchers report in the April issue of the American Journal of Gastroenterology.
"About three years ago, we discovered that methane on lactulose breath testing seemed to be highly associated with constipation-predominant IBS. We later found that the gas methane is actually the cause of this slowing of the intestine," senior investigator Dr. Mark Pimentel told Reuters Health.
In the current study, Dr. Pimentel of Cedars-Sinai Medical Center in Los Angeles and colleagues studied another population of 87 IBS subjects with constipation. Over 7 days these patients kept stool diaries and rated diarrhea and constipation.
The researchers then used lactulose breath testing over 3 hours to establish methane and hydrogen profiles. In all, 20 of the patients (23.8%) produced methane. The researchers suggest that greater methane levels detected on breath tests may represent a more widespread proliferation of methanogenic organisms.
On a 100 mm visual analogue scale, the subjects who produced methane had a mean constipation severity score of 66.1, compared to 36.2 for those who did not produce methane. The converse was true for diarrhea.
In addition, the quantity of methane seen on breath tests was directly proportional to the degree of constipation reported by patients, and greater methane production correlated with a lower stool frequency and Bristol Stool Score.
Dr. Pimentel noted that in another study, he and his colleagues found that neomycin improved constipation in IBS. "This," he said, "occurred predominantly in a manner that was dictated by the elimination of methane production by the antibiotic."
"The association between methane and constipation," Dr. Pimentel concluded, "is really one of the first descriptions of a gas produced by gut bacteria, causing effects on the human they live in."
Am J Gastroenterol 2007;102:837-841.
http://www.medscape.com/viewarticle/555807
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Inflamm Bowel Dis. 2007 Feb;13(2):175-81.
Symptomatic overlap between irritable bowel syndrome and microscopic colitis.
Limsui D, Pardi DS, Camilleri M, Loftus EV Jr, Kammer PP, Tremaine WJ, Sandborn WJ.
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
BACKGROUND: Microscopic colitis is diagnosed on the basis of histologic criteria, and irritable bowel syndrome (IBS) is diagnosed by symptom-based criteria. There has been little investigation into the symptomatic overlap between these conditions. Our aim was to assess the prevalence of symptoms of irritable bowel syndrome in a population-based cohort of patients with microscopic colitis. METHODS: The Rochester Epidemiology Project (REP), a medical records linkage system providing all health care data for the defined population of Olmsted County, Minnesota, was used to identify all county residents with a diagnosis of microscopic colitis between 1985 and 2001. The medical records of these individuals were reviewed to ascertain symptoms consistent with Rome, Rome II, and Manning criteria for irritable bowel syndrome. RESULTS: One hundred thirty-one cases of microscopic colitis were identified. Median age at diagnosis was 68 years (range, 24-95); 71% were women. Sixty-nine (53%) and 73 (56%) met Rome and Rome II criteria for irritable bowel syndrome, respectively. Fifty-four (41%) had three or more Manning criteria. Forty-three (33%) had previously been diagnosed with irritable bowel syndrome. CONCLUSIONS: In this population-based cohort of histologically confirmed microscopic colitis, approximately one-half met symptom-based criteria for the diagnosis of irritable bowel syndrome. The clinical symptom-based criteria for irritable bowel syndrome are not specific enough to rule out the diagnosis of microscopic colitis. Therefore, patients with suspected diarrhea-predominant irritable bowel syndrome should undergo biopsies of the colon to investigate for possible microscopic colitis if symptoms are not well controlled by antidiarrheal therapy.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17206699&query_hl=9&itool=pubmed_DocSum
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Aliment Pharmacol Ther. 2007 Jun 1;25(11):1343-50.
Influence of genetics on irritable bowel syndrome, gastro-oesophageal reflux and dyspepsia: a twin study.
Lembo A, Zaman M, Jones M, Talley NJ.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
Background
A genetic contribution has been proposed for irritable bowel syndrome (IBS) and gastro-oesophageal reflux disease (GERD), but is controversial. No twin data exist for dyspepsia.
Aim
To determine the relative contribution of genetic factors in GERD, dyspepsia (upper abdominal pain) and IBS. Methods A total of 986 twin pairs (from initial mail-out response 51%). Both members completed validated symptom and psychological questionnaires; 481 monozygotic pairs [mean (s.d.) age 53 +/- 5.8 years] and 505 dizygotic pairs (mean age 54 +/- 5.6 years).
Results
Prevalence of IBS, dyspepsia and GERD was 12%, 10% and 20%, respectively. Polychoric correlation for monozygotic twins for IBS (0.47) and GERD (0.44) were both substantially larger than those for dizygotic twins (0.17 and -0.37, respectively). Polychoric correlation was slightly lower in monozygotic than dizygotic twins for dyspepsia. Genetic modelling confirmed the independent additive genetic effects in GERD and IBS but not dyspepsia. Estimates of genetic variance were 22% for IBS, 13% for GERD and 0% for dyspepsia, but adjusting for anxiety and depression removed the statistical significance for IBS and GERD.
Conclusions
There is a genetic contribution to GERD and IBS but not dyspepsia; this may be mediated by the hereditability of anxiety and depression.
PMID: 17509102 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17509102&query_hl=2&itool=pubmed_docsum
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Aliment Pharmacol Ther. 2007 Jun 1;25(11):1329-41.
Irritable bowel syndrome: patients' attitudes, concerns and level of knowledge.
Lacy BE, Weiser K, Noddin L, Robertson DJ, Crowell MD, Parratt-Engstrom C, Grau MV.
Section of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Background
Irritable bowel syndrome (IBS) is a common, chronic disorder that reduces patients' quality-of-life. Although highly prevalent, little is known about patients' understanding of this disorder. Aim To evaluate the knowledge, fears and concerns of IBS patients.
Methods
Seven hundred thirty-six IBS patients (Rome II criteria) were eligible for inclusion in this prospective study. Each patient received a validated questionnaire to evaluate knowledge, attitudes and fears regarding IBS.
Results
A total of 261 of 664 potential respondents completed the questionnaire (39.3%). 83% of respondents were women, with a mean age of 53.7 years, and mean duration of symptoms of 14.2 years. Patients frequently believed that IBS develops because of anxiety (80.5%), dietary factors (75.1%) and depression (63.2%). Few respondents (28.7%) recognized that abdominal pain is the cardinal symptom of IBS, and 40.6% stated that colonoscopy can diagnose IBS. One in seven patients stated that IBS turns into cancer, and 29.9% noted that IBS increases the risk of inflammatory bowel disease.
Conclusions
Many IBS patients have significant misconceptions regarding the nature of their disease and its prognosis. An overwhelming majority of IBS patients believe that anxiety, dietary factors and depression cause IBS. These findings are discordant with physicians' views and practices and highlight the need for patient-oriented educational programs.
PMID: 17509101 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17509101&query_hl=2&itool=pubmed_docsum
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