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Vitamin D Role in Fecal Incontinence? new
      #371202 - 05/22/14 05:03 PM
HeatherAdministrator

Reged: 12/09/02
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Vitamin D Blog: A Role in Fecal Incontinence?

Published: May 12, 2014
By Kristina Fiore, Staff Writer, MedPage Today


Given its role in muscle function, vitamin D could play a role in fecal incontinence, researchers found.

In a small case-control study, women with fecal incontinence had significantly lower vitamin D levels than controls (29 ng/mL versus 35 ng/mL), according to Candace Parker-Autry, MD, of Wake Forest University in Winston-Salem, N.C., and colleagues.

The odds of vitamin D deficiency were significantly higher in women with fecal incontinence than in controls -- almost three times higher, they reported in the International Urogynecology Journal.

And the women with fecal incontinence who had vitamin D deficiency also reported a greater symptom burden, they found.

Since the study included only 31 cases and 81 controls, the researchers said the study was only hypothesis-generating and that further prospective studies are needed to further explore the relationship between vitamin D deficiency and worse fecal incontinence symptoms.

Ultimately, vitamin D supplementation could "prove to be an important adjunctive therapy to pelvic floor exercises, biofeedback, anal sphincteroplasty, sacral neuromodulation, and pharmacologic therapy for treating fecal incontinence."

Have a tip on a vitamin D study? Email Kristina Fiore at k.fiore@medpagetoday.com.

http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/45733

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Small Study of IBS Patients Suggests Symptom Improvement with Fecal Microbiota Transplant new
      #371254 - 06/27/14 04:15 PM
HeatherAdministrator

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Small Study of IBS Patients Suggests Symptom Improvement with Fecal Microbiota Transplant

Monday, October 14, 2013
8:00 a.m. EDT
Contact:
Jacqueline Gaulin
202-579-1057

In a small study at Montefiore Medical Center in New York City, David M. Pinn, M.D. and colleagues, under the guidance of Lawrence J. Brandt, M.D., MACG followed up on patients treated with fecal microbiota transplantation (FMT) for refractory IBS after interventions of dietary modification, probiotics, antibiotics, and/or anti-depressants had failed.

FMT resolved or improved symptoms in 70 percent of the patients with refractory IBS, including abdominal pain (72 percent), bowel habit (69 percent), dyspepsia (67 percent), bloating (50 percent), and flatus (45 percent). FMT also resulted in improved quality of life (46 percent) as reported by the 13 patients who completed a questionnaire which assessed global well-being and collected other clinical data.

Thirteen patients (54 percent women) completed the study. The average age was 45 years (range: 23-75 years). Patients had IBS for an average of 73 months before FMT (range: 12-180 months). The average time from FMT to data collection was 11 months (range: 6 to 18 months).

Before FMT, global well-being was reported as "good" in zero patients, "acceptable" in four patients (30 percent), and "poor" in nine patients (69 percent). After FMT, global well-being was "good" in three patients (23 percent), "acceptable" in six (46 percent) and "poor" in four (30 percent).

"IBS is a disease that has a tremendous effect on the quality of people's lives and has proven to be very difficult to treat. In our study, we showed that fecal microbiota transplantation can be a safe and effective treatment modality for the symptomatic relief of refractory IBS. Of the participants in the study, 70 percent had symptomatic relief and nearly half reported an improvement in their overall well-being," commented Dr. Pinn.

He added, "Our data was generated before the FDA regulations on FMT were put into effect and any further studies on this important area would have to be performed under an IND and with IRB approval. FMT is an evolving field in medicine, and, as this study demonstrates, it is proving to be an exciting, groundbreaking, new approach in the treatment of IBS."

http://gi.org/media/press-releases-for-acg-annual-scientific-meeting/fmt-ibd-ibs/

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Sacral nerve stimulation does not help IBS new
      #371283 - 07/15/14 02:57 PM
HeatherAdministrator

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Small intestinal motility in IBS patients unaffected by sacral nerve stimulation

Fassov J. BMC Gastroenterol. 2014;doi:10.1186/1471-230X-14-111.

July 4, 2014

Sacral nerve stimulation therapy had no detectable effect on gastric emptying or small intestinal motility in patients with diarrhea-predominant or mixed irritable bowel syndrome, according to recent study data.
See Also

Antidepressants, psychological therapies effectively treated ...
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Linaclotide improved severe abdominal symptoms, QoL in IBS ...

Researchers from Aarhus University Hospital in Denmark performed a controlled crossover study of 20 patients (median age, 31 years; 15 women) with severe diarrhea-predominant or mixed irritable bowel syndrome (IBS) by using sacral nerve stimulation (SNS) to assess its efficacy in IBS-related dysmotility.

During the 2-month study period, participants were randomly grouped to have their neurostimulator turned on or off for the first 4 weeks and then to the opposite setting for the next 4 weeks. Gastrointestinal transit patterns were assessed based on changes in velocity of the magnetic pill measured by the Motility Tracking System-1 (Motilis, Lausanne, Switzerland) at the end of each period. Patients and investigators were masked to the neurotransmitter's setting.

The magnetic pill's median velocity through the small intestine in the initial fasting period was similar compared with periods with and without SNS (On/Off Group: median change 0 m/hour; range, –1.07 to 0.63; Off/On Group: median change 0.27 m/hour; range, –0.59 to 1.12; P=.25). Likewise, similar median velocity was measured in the postprandial period compared with periods with and without SNS (On/Off Group: median change –0.13 m/hour; range, –0.46 to 0.23; Off/On Group: median change 0.015 m/hour; range, –0.48 to 0.59; P=.14). These measurements were true in the diarrhea-predominant and mixed IBS subgroups. There also was no difference in gastric emptying with or without SNS (On/Off Group: median change 3.5 minutes; range, –304 to 79; Off/On Group: median change –33 minutes; range, –128 to 70; P>.09).

"Even though SNS reduces the frequency of defecation, episodes of urgency, and time spent on toilet, this occurs without major changes in small intestinal transit patterns," the researchers concluded. "We speculate that the effects of SNS in IBS may be caused by modulation of afferent nerve fibers causing altered colorectal sensory perception."

http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B007ab05d-0d8a-4c2b-ac6a-fba52e2b0cfb%7D/small-intestinal-motility-in-ibs-patients-unaffected-by-sacral-nerve-stimulation

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Gut microbiome can diagnose colorectal cancer? new
      #371337 - 08/12/14 11:21 AM
HeatherAdministrator

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Gut microbiome represents novel biomarker in colorectal cancer

Schloss PD. Cancer Prev Res. 2014; doi:10.1158/1940-6207.CAPR-14-0129.
August 7, 2014

Analysis of the gut microbiome significantly improved clinical ability to differentiate between patients with precancerous adenomatous polyps and those with invasive colorectal cancer compared with fecal occult blood testing.
See Also

"A person's gut microbiome is the collection of all the bacteria in their gut," Patrick D. Schloss, PhD, associate professor in the Department of Microbiology and Immunology at the University of Michigan, said in a press release.

"The number of bacteria in the gut is huge; it outnumbers the number of cells in our bodies 10 to one, and the diversity of the bacteria present is critical to our health."

Based on prior studies that suggested patients with colorectal cancer exhibited an abnormal gut microbiome structure vs. healthy patients, Schloss and colleagues examined stool samples from 90 individuals: 30 patients with precancerous adenomatous polyps, 30 patients with invasive colorectal cancer and 30 healthy control individuals.

The researchers extracted and analyzed microbial genomic DNA from the stool samples to identify gut microbiome signatures for each patient group. Schloss and colleagues assessed patients for known clinical risk factors for precancerous adenomatous polyps, including age, gender, race/ethnicity, BMI and current medications.

The researchers generated logit models using both clinical and microbiome data as independent variables to contrast dissimilarities across patient groups. As a basis for comparison, researchers also evaluated the likelihood of adenoma detection using guaiac fecal occult blood test in these three patient groups.

According to study results, gut microbiome data, when combined with known risk factors for colorectal cancer, demonstrated a 4.5-fold improved ability to predict precancerous adenomatous polyps. In addition, combining risk factor and gut microbiome data enabled 5.4-fold improved prediction of invasive colorectal cancer.

"We found that the composition of the gut microbiome allowed us to identify who in our study had precancerous adenomatous polyps and who had invasive colorectal cancer," Schloss said. "If our results are confirmed in larger groups of people, adding gut microbiome analysis to other fecal tests may provide an improved, noninvasive way to screen for colorectal cancer."

The researchers also determined that gut microbiome signatures were superior to fecal occult blood testing in differentiating patients with precancerous adenomatous polyps (area under the curve= 0.617) from those with invasive colorectal cancer (area under the curve=0.952).

"The feasibility, lack of invasive procedures, ability complement existing screening methods and the strength of signal seen in this study support the further investigation and application of microbial biomarkers from stool as a method for colorectal cancer screening," Schloss and colleagues wrote.

http://www.healio.com/gastroenterology/oncology/news/online/%7B3f3e7299-5267-438c-95ec-db97c680831f%7D/gut-microbiome-represents-novel-biomarker-in-colorectal-cancer

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All IBS subtypes have similar symptom severity new
      #371447 - 09/05/14 03:50 PM
HeatherAdministrator

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Symptoms, QOL did not differ between IBS subtypes

Rey de Castro NG. J Gastroenterol Hepatol. 2014;doi:10.1111/jgh.12704.
August 26, 2014

The three subtypes of irritable bowel syndrome did not significantly differ in terms of symptom severity and quality of life, according to recent study data.


"Traditionally, it has always been thought that patients with the diarrhea form of IBS tend to be more anxious," Peter J. Whorwell, MD, PhD, professor of medicine and gastroenterology, Wythenshawe Hospital, United Kingdom, told Healio.com/Gastroenterology. "In addition, it has also been considered that the symptom profiles in the three subtypes are different. However, our study does not support these ideas and, in this large group of patients, there was very little to choose between them."

Peter J. Whorwell

Whorwell and colleagues grouped 1,000 patients (79.6% female) with at least a 2-year history of pharmacologically resistant IBS by diarrhea (IBS-D; n=256), constipation (IBS-C; n=296) or mixed (IBS-M; n=448) bowel habit subtype. All were administered validated questionnaires to score symptom severity, somatization, quality of life (QOL) and anxiety or depression levels.

Researchers found no differences between groups for all tested factors (all P>.05), including symptom severity (P=.24), abdominal pain intensity (P=.31), anxiety (P=.16), depression (P=.08), QOL (P=.64), and noncolonic symptoms and somatization (P=.53). They did observe that symptom severity was slightly correlated with anxiety (P<.001), depression (P<.001) and QOL (P<.001), and moderately correlated to somatization (P<.001).

"Consequently, a patient should not necessarily be denied treatment, say for anxiety, just because they are constipated and that group is generally not thought to be as anxious as the diarrhea group," said Whorwell. "The strength of this study is that it was done on a very large group of patients, therefore, the results are likely to be reliable.

"A possible drawback is that our patients tend to be quite severe as we are a referral center. However, when the more severe patients were excluded, the results still stayed much the same."

Disclosure: Whorwell reports receiving research grants or honoraria from Danone, Almirall, Salix, Shire, Abbott and Norgine. The researchers report no other relevant financial disclosures.


http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B15196ae9-899f-401f-86c0-52f6c6aa9612%7D/symptoms-qol-did-not-differ-between-ibs-subtypes

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Domestic violence may trigger irritable bowel syndrome new
      #371474 - 09/17/14 02:15 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7799
Loc: Seattle, WA

Intimate partner violence may trigger irritable bowel syndrome, insomnia

Published on September 16, 2014 at 8:36 AM · No Comments

Physical symptoms like irritable bowel syndrome and insomnia also associated with higher risks of intimate partner violence.

One in five men in the U.S. reports violence towards their spouse or significant other, says a new nationally-representative study by the University of Michigan.

The analysis also found that male aggression toward a partner is associated with warning signs that could come up during routine health care visits, including irritable bowel syndrome (IBS) and insomnia, in addition to better known risks like substance abuse and a history of either experiencing or witnessing violence as a child.

The findings appear in the Journal of the American Board of Family Medicine and are based on the most recent data available from the National Comorbidity Survey-Replication from 2001-2003. The survey assesses intimate partner violence and characteristics among male perpetrators.

"When people think of men who abuse their partners, they often think of violent people who they have never come across, or people they have only heard about in the news," says lead author Vijay Singh, M.D., MPH, MS, a clinical lecturer in the Departments of Emergency Medicine and Family Medicine at the University of Michigan Medical School.

"However, our study showed one out of every five men in the U.S. reported physical violence toward an intimate partner. It's likely that we've all met these men in our daily environment. This is an issue that cuts across all communities, regardless of race, income, or any other demographics."

Domestic violence has become a growing health concern. In the U.S. each year, roughly 320,000 outpatient health visits and 1,200 deaths among women are due to intimate partner violence, and $8.3 billion is spent in related medical and mental health services alone. The new U-M findings show that the prevalence of partner violence in the country is even greater than that of diabetes.

The subject has also recently been in the headlines, with the case of NFL running back Ray Rice. The Baltimore Ravens released Rice this week after a video of him hitting his wife in a casino elevator surfaced in the news.

The U-M study found that more than half of the men who reported violence toward a partner had at least one routine health visit over the last year and nearly one third noted at least one emergency room visit over the last year.

"Most of our efforts to prevent intimate partner violence have focused on screening and improving outcomes for women who are victims, because their health and well-being is our priority. Very little work, however, has been done on how to identify male perpetrators," says Singh, who is also a member of the University of Michigan Injury Center and Institute for Healthcare Policy and Innovation.

"Our research shows that male perpetrators of intimate partner violence seek routine medical services, and they have physical symptoms that are common reasons patients seek medical care. This suggests that we may be missing an important opportunity in the primary care setting to identify their aggressive behavior and potentially intervene."

Singh says further work needs to be done on developing identification and intervention programs focused to on male aggression toward a partner.

The nationally-representative sample included 530 men with an average age of 42. Roughly 78 percent were non-Hispanic white, 56 percent were educated beyond high school and 84 percent were employed.

Intimate partner violence was defined as pushing, grabbing, shoving, throwing something, slapping or hitting, kicking, biting, beating up, choking, burning or scalding, or threatening a partner with a knife or gun.

http://www.news-medical.net/news/20140916/Intimate-partner-violence-may-trigger-irritable-bowel-syndrome-insomnia.aspx


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Sleep Measures Can Help Predict Next-Day Symptoms in IBS Female Patients new
      #371475 - 09/17/14 02:27 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7799
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Sleep Measures Can Help Predict Next-Day Symptoms in IBS Female Patients

Posted by: Leonor Mateus Ferreira in News 1 day ago

IBS and sleep disordersThe exacerbation of irritable bowel syndrome (IBS) symptoms in women are predictable through sleep disturbances, determined through an objective measurement of sleep, according to a recent exploratory study conducted at the University of Washington, in Seattle. Not only self-reported IBS symptoms, mood disturbance, and fatigue, but also objectively measured sleep using actigraphy are able to foretell next-day effects.

"This small exploratory study supports previous findings that self-reported sleep disturbance predicted exacerbation of next-day symptoms in women with IBS and extends this relationship using an objective sleep measure," the study concluded, which was led by Diana Taibi Buchanan, Ph.D. "The study adds further evidence that sleep quality predicts subsequent IBS symptoms, but not the converse. The findings from this small study support the importance of additional longitudinal research to further understand the relationships between sleep and IBS."

The scientists recruited women with IBS between the ages of 18 and 45 and asked them to fulfill sleep and IBS symptom diaries for one menstrual cycle, and wore Actiwatch-64 actigraphs for 7 days at home. The data was then analyzed using generalized estimating equation (GEE) models.

The study revealed sleep quality significance in the prediction of next-day abdominal pain, anxiety, and fatigue. However, it did not suggest any link with gastrointestinal (GI) symptoms or depressed mood. On the other hand, actigraphic sleep efficiency (SEF) significantly predicted worsening next-day anxiety and fatigue, but not abdominal pain, GI symptoms, or depressed mood.

This new research joins mounting evidence that sleep disturbances and disorders have an impact on disease progression. In related news, the underlying cause of fatigue experienced by multiple sclerosis (MS) patients may be undiagnosed sleep disorders, according to a study conducted at the Department of Neurology of the University of California.

http://ibdnewstoday.com/2014/09/16/sleep-measures-can-help-predict-next-day-symptoms-in-ibs-female-patients/

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Researchers develop, validate eight GI symptom scales new
      #371522 - 10/07/14 02:17 PM
HeatherAdministrator

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Using the NIH Patient-Reported Outcomes Measurement Information System framework, researchers have developed and validated eight gastrointestinal symptom scales for use in clinical care and research across the full spectrum of GI disorders.

To create a standardized and comprehensive set of patient-reported outcomes in gastroenterology, Brennan Spiegel, MD, MSHS, department of gastroenterology and health services, Cedars-Sinai Medical Center, Los Angeles, Dinesh Khanna, MD, MSc, division of rheumatology, University of Michigan, and colleagues developed the NIH PROMIS GI symptom scales in three phases during 4 years.

In phase one they developed candidate items by performing a systematic literature review and conducting 12 disease-specific focus groups involving 102 GI patients. Phase two involved a qualitative item review. It resulted in 102 final items based on PROMIS standards and additional patient cognitive interviews (n=28) that investigators found to be simple, understandable and relevant to patients. In phase three the researchers performed quantitative psychometric analyses of the resulting symptom scales in a US general population control sample (n=1,177) and 865 patients with irritable bowel syndrome, inflammatory bowel disease, systemic sclerosis and other common GI disorders.

Researchers found that each scale had high internal reliability and construct validity compared with legacy instruments. Based on confirmatory factor analyses and item response theory modeling, scales were created for:

gastroesophageal reflux (13 items)
disrupted swallowing (seven items)
diarrhea (five items)
bowel incontinence/soilage (four items)
nausea and vomiting (four items)
constipation (nine items)
belly pain (six items)
gas/bloat/flatulence (12 items)

"In conclusion, we developed the NIH PROMIS GI symptom scales — a publicly available set of valid and reliable [patient-reported outcomes] for use in people with GI symptoms," the researchers concluded. "The eight scales can be used together or individually for clinical practice and clinical research in a disease-agnostic manner. The scales are broadly applicable across populations, GI symptoms, GI diseases, and demographics."

http://www.healio.com/gastroenterology/therapeutics-diagnostics/news/online/%7Be8714237-42dd-4ec4-b3b7-db4ed5e231d6%7D/researchers-develop-validate-eight-gi-symptom-scales

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Volatile organic compounds accurate biomarkers for IBS in children new
      #371570 - 10/27/14 01:59 PM
HeatherAdministrator

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Volatile organic compounds accurate biomarkers for IBS in children
October 24, 2014


PHILADELPHIA — Volatile organic compounds were accurate in diagnosing irritable bowel syndrome among pediatric patients, according to data presented at the ACG Annual Scientific Meeting.

"IBS in children is a very common problem that we encounter in pediatrics," Sophia A. Patel, MD, gastroenterology fellow at Cleveland Clinic Children's, said during her presentation. "Prevalence is recorded up to 16%. It can present as a diagnostic for pediatric gastroenterologists because it is not associated with any abnormal radiologic or endoscopic abnormalities, and there is no reliable objective biomarker or test for its diagnosis. … Volatile organic compounds (VOCs) have been shown to be very valuable biomarkers in certain disease states."

Sophia A. Patel

Patel and colleagues recruited 77 patients from the Pediatric Gastroenterology Clinic of Cleveland Clinic and evaluated their exhaled breaths for VOCs using a selective ion flow tube to determine new biomarkers and patterns for IBS. Twenty-two patients had IBS and 55 served as healthy controls.

Results indicated that the patients with IBS had increased levels of the following VOCs compared with the controls: benzene (2.9 ppb vs. 1.9 ppb; P=.02), dimethyl sulfide (3.2 ppb vs. 1.3 ppb; P=.01), 1-octene (10.3 ppb vs. 5.9 ppb; P=.026) and 3-methyhexane (33.3 ppb vs. 16.4 ppb; P=.015).

"In children with IBS, there is a significant difference in VOCs in the breath samples of these children compared to healthy controls," Patel said. "This may be a promising and objective way to diagnose IBS in children."

For more information:

Patel SA. Abstract 12. Presented at: ACG Annual Scientific Meeting, Oct. 20-22, 2014; Philadelphia.

http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7Ba9e8f7a7-b28b-46be-baac-aa7936578102%7D/volatile-organic-compounds-accurate-biomarkers-for-ibs-in-children?sc_trk=internalsearch

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Ineffective Pain Meds in IBS Patients Related to Immune System Changes
      #371698 - 12/09/14 11:34 AM
HeatherAdministrator

Reged: 12/09/02
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Gastroenterology and Endoscopy News

ISSUE: SEPTEMBER 2014 ' VOLUME: 65:9

Ineffective Pain Meds in IBS Patients Related to Immune System Changes

by GEN Staff

Defects in the immune system in people with irritable bowel syndrome (IBS) is the major reason why sufferers have ongoing issues with pain, and one reason why some painkillers do not provide satisfactory relief to these patients, according to a recent study by researchers in Australia.

IBS is a functional gastrointestinal (GI) disorder leading to bowel changes, pain and discomfort. Studies estimate that IBS affects 3% to 20% of the adult population; however, only 5% to 7% of adults have been diagnosed, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

IBS is often classified into four subtypes based on a person's usual stool consistency: IBS with constipation (IBS-C), IBS with diarrhea (IBS-D), mixed IBS (IBS-M) and unsubtyped IBS (IBS-U). Although there are various forms, all involve unexplained gut pain, which often has the greatest impact on quality of life.

Scientists in the Nerve-Gut Research Laboratory at the University of Adelaide demonstrated the mechanisms involved in that pain, and the differences between the immune pain response in healthy people and in those with IBS. The gut contains monocytes and macrophages. In healthy people, these immune cells normally secrete opioid chemicals that block pain, but this opioid production is defective in patients with IBS.

"It is no wonder that people with IBS are experiencing ongoing periods of unexplained pain. And if the immune system is defective, it may also mean that painkilling medications taken to relieve their symptoms are not being adequately converted [by the body] to pain relief," said Patrick Hughes, PhD, NHMRC Peter Doherty Fellow in the University of Adelaide's School of Medicine.

The researchers obtained blood samples from more than 100 people, half with IBS and half without the condition. They analyzed the amount of endorphins and immune mediators that play a role in controlling pain, and found that these chemicals were deficient in subjects with IBS. The results were published online in Brain, Behavior, and Immunity (2014 July [Epub ahead of print]).

Although the exact cause of pain in IBS remains unknown, "we have now confirmed, and detailed, information about the important role of the immune system in this pain response," said Dr. Hughes, who added that he hopes the work will lead to more targeted treatment for IBS.


http://www.gastroendonews.com/ViewArticle.aspx?d=In+the+News&d_id=187&i=September+2014&i_id=1101&a_id=28186



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