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Blood Test Helps IBS Patients Get Firm Diagnosis
Rules out inflammatory bowel disease in nearly all cases.
by John Gever
Managing Editor, MedPage Today
This article is a collaboration between MedPage Today® and: Medpage Today
WASHINGTON -- A blood test for antibodies against bacterial toxins allows most patients with diarrhea-predominant irritable bowel syndrome (D-IBS) to avoid invasive endoscopies that would otherwise be needed to check for Crohn's disease or ulcerative colitis, a researcher said here.
The test, which is receiving a commercial launch here at the Digestive Disease Week (DDW) annual meeting, showed positive predictive values "north of 98%" for IBS in a trial involving some 2,700 patients with IBS, inflammatory bowel disease (IBD), or celiac disease as well as healthy controls, said Mark Pimentel, MD, of Cedars-Sinai Medical Center in Los Angeles.
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Results from the trial, in addition to being reported at the meeting, were published last week in PLOS ONE.
Pimentel explained that the test detects antibodies to cytolethal distending toxin B (CdtB) and vinculin, which are released by bacteria that cause food poisoning. Many earlier studies have shown that foodborne bacterial infections can lead to IBS by triggering an autoimmune reaction, he said.
Because IBS symptoms are nonspecific and are also seen in IBD and celiac disease, among others, patients often undergo a long diagnostic odyssey to establish a diagnosis. Pimentel noted as well that IBS is a diagnosis of exclusion, meaning that patients must undergo tests for other conditions that match the symptomatology. In the case of IBD, that typically means repeated colonoscopies.
A blood test that would quickly rule out IBD would be a significant benefit to patients by reducing the cost, inconvenience, and discomfort associated with colonoscopies, Pimentel argued.
For the trial, Pimentel and colleagues enrolled 2,375 patients with D-IBS diagnosed according to Rome III criteria, along with 142 with IBD, 121 with celiac disease (both also diagnosed according to standard methods), and 43 healthy volunteers. Blood samples were tested with an ELISA assay for anti-CdtB and anti-viculin antibodies.
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For distinguishing IBS from IBD, the anti-CdtB assay showed an area under the receiver-operating characteristic curve of 0.81. The anti-viculin test showed an area under the curve of 0.62.
With cutoffs optimized for specificity, the anti-CdtB test had specificity of 91.6% and sensitivity of 43.7%; for anti-viculin, the specificity and sensitivity were 83.8% and 32.6%, respectively.
Combining results from both assays led to a specificity well above 90% and a positive predictive value of 98.6%, Pimentel said. A positive result would allow the clinician to confidently rule out IBD, he suggested.
The assays were not as good for distinguishing IBS from celiac disease, with areas under the curve of 0.61-0.63 for the two antibodies and with optimized specificities in the 80% range. But Pimentel told MedPage Today that this was less problematic because tests for celiac disease are less burdensome for patients.
He also argued that the low sensitivities for IBS with the anti-CdtB/viculin tests were not a significant issue since sensitivity is mainly a concern for screening tests. For a test intended to rule out other diagnoses in clearly symptomatic patients, it's specificity that counts, he said.
The trial was supported by Commonwealth Laboratories, which is formally launching the test as a commercial service called IBSchek at the DDW meeting.
The study was funded by Commonwealth Laboratories. Tests were performed on participants in a clinical trial sponsored by Salix Pharmaceuticals, but that firm retained no commercial interest in the test.
Pimentel disclosed relevant relationships with Commonwealth Laboratories, Salix, Synthetic Biologics, Naia Pharmaceuticals, and Micropharma.
Primary Source
PLOS ONE
Source Reference: Pimentel M, et al "Development and validation of a biomarker for diarrhea-predominant irritable bowel syndrome in human subjects" PLOS ONE 2015; DOI: 10.1371/journal.pone.0126438.
http://www.medpagetoday.com/MeetingCoverage/DDW/51586
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Risk Factors ID'd for Fecal Transplant Failure
Inpatient status, immunosuppression, record of C. diff hospitalizations biggest factors
by Parker Brown
Staff Writer, MedPage Today
HONOLULU -- Three factors were strongly associated with failure of fecal transplant in patients with Clostridium difficile infections (CDI), a researcher said here: being an inpatient while receiving the transplant; being in an immunosuppressed state; or a previous record of hospitalization from CDI-related events.
Researchers looked at 345 patients with CDI and found an overall failure rate of 23.7% after a single fecal matter transplant at 3 months of follow-up. Nonsevere cases failed 18% of the time, while severe cases had a 50% failure rate, said co-author Monika Fischer, MD, of Indiana University, in an oral presentation at the annual meeting of the American College of Gastroenterology.
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Receiving an inpatient transplant was the largest predictor of failure (odds ratio 6.92, 95% CI 2.94-16.3; P<0.0001), followed by immunosuppression (OR 3.48, 95% CI 1.66-2.78; P=0.001) and number of CDI-related hospitalizations (OR 1.45, 95% CI 1.18-1.77; P=0.0004).
Hospitalization seemed to be a surrogate for severity of the disease, said Fischer at the presentation.
Based on the results, the authors devised a risk stratification system to identify patients most at risk. Inpatients who'd received a transplant were assigned five points, immunosuppressed patients three points, and patients with hospitalizations from CDI-related were given one point.
When they applied this system to their 345 patients, they found that 117 had a low-risk of fecal matter transplant failure, with zero points, at 12.8%. But 123 patients had a medium-risk, with one-three points, and faced a failure rate of 17.1% and high-risk patients with four points or more had a 43.8% failure rate.
"We hope that physicians will find the proposed risk stratification helpful in planning and discussing fecal matter transplants with their patients, and also with regards to preparedness in treating high risk patients," said Fischer.
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All patients in the study had CDI at least once from 2011 to 2015 and were older than 18. Data were taken from electronic medical records, fecal matter transplant databases, and interviews at two sites -- Brown University and Indiana University. Patients' average age was 62 and 72% were female. About a quarter of the patients were immunosuppressed, and 74% had recurrent CDI. Inpatient transplants were provided to 17%.
Transplant success was defined as complete resolution of CDI symptoms or a negative PCR test for C. diff at 3 months without the need for repeat transplants or other CDI-related therapies.
Nearly 22% percent of those with nonsevere refractory CDI had a failed transplant after 3 months, opposed to 17.2% of recurrent nonsevere patients. Among severe patients, half failed: 35.3% of those with recurrent CDI and 59% with refractory CDI.
Also predictive of failure were:
Presence of pseudomembranes at transplantation (19 patients failed, a rate of 25%; P<0.0001)
Mean albumin (mean level of 3 versus 3.6 for failed versus successful transplants; P<0.0001)
Stool delivery beyond splenic flexure (54 patients failed, a rate of 28.4%; P=0.026)
Patient directed donor type (23 patients failed, a rate of 28.4%; P=0.014)
White blood cell count (13.7 mean for failed transplants versus 10.1 for successful ones; P=0.021)
"Risk of fecal matter transplant failure is predictable based upon pre-fecal matter transplant data," according to Fischer.
The researchers disclosed no relevant relationships with industry.
Primary Source
American College of Gastroenterology
Source Reference: Fischer, M "Predictors of failure After fecal microbiota transplantation (FMT) for the therapy of Clostridium difficile infection (CDI)" ACG 2015; Plenary Session 19.
http://www.medpagetoday.com/MeetingCoverage/ACG/54271?xid=nl_mpt_DHE_2015-10-26&eun=g379602d0r
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Risk factors for IBS in military include stress, infectious gastroenteritis
Riddle MS, et al. Am J Gastroenterol. 2015;doi:10.1038/ajg.2015.386.
January 6, 2016
New research confirms previous findings that stress and infectious gastroenteritis are associated with new-onset irritable bowel syndrome among members of the U.S. military.
"Previous studies have described IBS incidence and risk factors among the U.S. military members using the Department of Defense medical encounter databases, confirming other civilian population-based studies identifying gender and antecedent gastrointestinal infection as risk factors," the researchers wrote. "However, these previous reports, which relied on existing administrative databases containing medical encounter and demographic data, lacked information on many confounders such as life stressors and health behaviors, which are likely important in understanding risk and underlying causal mechanisms for this condition."
Researchers therefore aimed to further explore risk factors for new-onset IBS among 41,175 active duty military members enrolled in the Millenium Cohort Study, a large population-based cohort study of health impacts of military service initiated in 2001. All eligible participants for the current study did not have IBS or inflammatory bowel disease at baseline, completed a baseline survey and at least one follow-up survey by 2009, and remained on active duty at the time of their follow-up survey.
IBS was identified using medical encounter data, infectious gastroenteritis was identified using medical encounter data or self-report, and other covariates were identified using the surveys.
The researchers identified 314 new-onset cases of IBS (estimated incidence, 141.39 per 100,000 person-years), and risk factors included:
antecedent infectious gastroenteritis (adjusted HR = 2.05; 95% CI, 1.53-2.75);
female gender (aHR = 1.96; 95% CI, 1.53-2.52);
army service (aHR = 0.67; 0.51-0.87);
moderate alcohol consumptions (aHR = 0.68; 95% CI, 0.54-0.86);
being overweight (aHR = 0.77; 95% CI, 0.61-0.99);
obesity (aHR = 0.67; 95% CI, 0.46-0.97);
one life stressor (aHR = 1.82; 95% CI, 1.37-2.41);
two life stressors (aHR = 2.86; 95% CI, 2.01-4.06);
three or more life stressors (aHR = 6.69; 95% CI, 4.59-9.77);
anxiety syndrome (aHR = 1.74; 95% CI, 1.17-2.58);
one deployment (aHR = 0.61; 95% CI, 0.47-0.8); and
two or more deployments (aHR = 0.52; 95% CI, 0.39-0.7).
When the analysis was restricted to individuals with highly probably IBS, the association with antecedent infectious gastroenteritis was stronger (aHR = 2.2; 95% CI, 1.1-4.43), especially when based only on medical encounter records (aHR = 2.84; 95% CI, 1.33-6.09).
"Consistent interactions among highly probable IBS and [medical encounter only or all source infectious gastroenteritis] were found for both depression and anxiety," the researchers wrote.
"In summary, these findings represent additional data that contribute to an accumulating body of evidence linking acute gastrointestinal infections and chronic gastrointestinal sequelae. In addition to important findings from mechanistic studies also being reported, our findings add to the belief that this observed phenomenon is not exaggerated." – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7Bc4c785bf-f913-4e3d-9335-b82e0a1d35b0%7D/risk-factors-for-ibs-in-military-include-stress-infectious-gastroenteritis
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Takeda, Enterome to collaborate on microbiome-based drugs for IBD, IBS, other GI disorders
January 6, 2016
Takeda Pharmaceuticals and Enterome Bioscience SA today announced they will collaborate on research and development of new potential therapies aimed at microbiome targets believed to be involved in GI disorders like inflammatory bowel disease and irritable bowel syndrome, according to a press release.
"This strategic collaboration with Takeda is a significant achievement for Enterome and represents an important step towards realizing the full potential of our expertise and unique capabilities in unlocking the microbiome to generate new therapeutic solutions to serious diseases," Pierre Belichard, CEO of Enterome, said in the press release. "We are delighted to begin this new collaboration, which will combine our continuing leadership in the microbiome space and Takeda's global therapeutic drug discovery and development capabilities. It is also an important step for Enterome towards achieving its ambition to become a leading global biopharmaceutical company in the microbiome space."
The collaboration agreement entails Enterome will support discovery of potential novel small molecules or biologics derived from gut microbiota using its proprietary metagenomics platform, and the GI targets to which these agents will be directed will be selected by both companies. Takeda will have exclusive, global license options on selected agents and will lead their regulatory and clinical development and commercialization efforts.
Moreover, Takeda will provide Enterome with 3-year research and development funding up front. For each molecule discovered, Enterome will be able to receive additional payments in the form of option exercise, development, regulatory and commercial milestone payments, and for any products Takeda commercializes, Enterome will be able to receive potential tiered royalties on net sales.
"At Takeda, innovation is at the core of our efforts to bring new therapies to patients in the future," Gareth Hicks, PhD, head of gastroenterology drug discovery for Takeda, said in the press release. "In partnering with scientists at Enterome, who perform cutting-edge research into microbiome-derived agents, Takeda is able to explore this exciting science and bring innovative therapies forward."
Disclosures: Belichard reports he is an employee of Enterome, and Hicks reports he is an employee of Takeda.
http://www.healio.com/gastroenterology/therapeutics-diagnostics/news/online/%7B3e55bab3-4cbd-45f3-94f4-cb0e78c55645%7D/takeda-enterome-to-collaborate-on-microbiome-based-drugs-for-ibd-ibs-other-gi-disorders
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Microbiota and arthritis: correlations or cause?
Current Opinion in Rheumatology:
March 2016 - Volume 28 - Issue 2 - p 161–167
doi: 10.1097/BOR.0000000000000261
IMMUNOPATHOGENESIS AND TREATMENT OF AUTOIMMUNE DISEASES: Edited by Iain McInnes
Microbiota and arthritis: correlations or cause?
Bravo-Blas, Alberto; Wessel, Hannah; Milling, Simon
Abstract
Purpose of review: The microorganisms that colonise our bodies, the commensal 'microbiota', respond to changes in our behaviour and environment, and can also profoundly affect our health. We can now investigate these organisms with unprecedented depth and precision, revealing that they may contribute to the pathogenesis of diseases including arthritis. Here we discuss the changes occurring in the microbiota in people with arthritis, and how manipulation of the microbiota may provide an additional pathway for therapy.
Recent findings: We highlight two important aspects of the recent literature. First we describe changes in the microbiota identified in people with arthritis; these correlations give insights into the microbial changes that may contribute to symptoms of arthritis. We then discuss attempts to ameliorate arthritis by manipulating the microbiota. This is a rapidly developing area of research. There are tantalising hints that interventions targeting the microbiota may become therapeutically viable for some types of inflammatory arthritis.
Summary: Our commensal microbial communities respond to changes in our health, and are altered in people with arthritis. Understanding the complex relationships between the microbiota and the body may enable us to deliberately manipulate these organisms and provide additional therapeutic options for people with arthritis.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
http://journals.lww.com/co-rheumatology/Citation/2016/03000/Microbiota_and_arthritis___correlations_or_cause_.12.aspx?ct=t%28Gutbliss_Rx_February_17th2_16_2016%29&mc_cid=cf7a530c27&mc_eid=9823b4836b&utm_source=Newsletter&utm_medium=Click&utm_campaign=1391
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Autism symptoms improve after fecal transplant, small study finds
Ohio State University News
Children with autism may benefit from fecal transplants a new study has found.
Behavioral symptoms of autism and gastrointestinal distress often go hand–in–hand, and both improved when a small group of children with the disorder underwent fecal transplant and subsequent treatment.
In the study of 18 children with autism and moderate to severe gastrointestinal problems, parents and doctors said they saw positive changes that lasted at least eight weeks after the treatment. Children without autism were included for comparison of bacterial and viral gut composition prior to the study.
The study, which appeared in the journal Microbiome, was conducted while Gregory and her adviser and co–author, Matthew Sullivan, were at the University of Arizona. Other lead researchers on the project are from Arizona State University and Northern Arizona University.
A growing body of research is drawing connections between the bacteria and viruses that inhabit the gut and problems in the brain, and it is possible the two are tied together in an important way in autism, she said.
Previous research has established that children with autism typically have fewer types of some important bacteria in their guts and less bacterial diversity overall – a difference that held true in this study. That could be because many of them are prescribed a lot of antibiotics in the first three years of life, the research team wrote in the study.
Parents of the children not only reported a decrease in gut woes including diarrhea and stomach pain in the eight weeks following the end of treatment: They also said they saw significant changes for the better when it came to behavioral autism symptoms in their sons and daughters, who ranged from 7 to 16 years old.
The researchers collected this information from parents through established, standardized questionnaires to assess social skills, irritability, hyperactivity, communication and other measures. One of those tools showed the average developmental age increased by 1.4 years after treatment.
The average score on a scale for ranking gastrointestinal symptoms dropped 82 percent from the beginning to the end of treatment. And when the researchers asked parents to give feedback on 17 autism–related symptoms, they saw overall improvement that was sustained two months after the final treatment.
Doctor–reported symptoms (from the Childhood Autism Rating Scale) decreased by 22 percent at the end of treatment and 24 percent eight weeks after treatment ended compared with ratings at the start of the study.
Researchers also were able to document a rebalancing of the gut following treatment. At the end of the study, the bacterial diversity in the children with autism was indistinguishable from their healthy peers. The study also included a unique viral analysis by Ohio State scientists, made possible because of previous work in the world's oceans.
Gregory, who is particularly interested in the interplay between viruses and bacteria, used genetic testing to examine the viral diversity in the guts of the treated children. It rebounded quickly, and became more similar to the donor's microbiome.
"Those donor viruses seemed to help," she said.
In this study, the researchers used a method called microbiota transfer therapy, which started with the children receiving a two–week course of antibiotics to wipe out much of their existing gut flora. Then, doctors gave them an initial high–dose fecal transplant in liquid form. In the seven to eight weeks that followed, the children drank smoothies blended with a lower–dose powder.
James Adams, one of the study's lead authors and an Arizona State University professor who specializes in autism, called the results compelling, but cautioned that larger, more rigorous studies confirming benefits must be done.
https://www.mdlinx.com/gastroenterology/top-medical-news/article/2017/01/26/3?utm_source=in-house&utm_medium=message&utm_campaign=mh-psych-jan17
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FMT improves symptoms, QOL in IBS patients
May 8, 2017
CHICAGO — Fecal microbiota transplantation improved symptoms and quality of life in patients with irritable bowel syndrome, according to the results of a double blind randomized controlled trial presented at Digestive Disease Week.
"It seems that FMT has a beneficial effect on symptom scores and on quality of life in IBS patients. However, this effect is also observed in the placebo group, although to a lesser extent, but this indicates that placebo controlled studies are definitely necessary in IBS patients," Savanne Holster, PhD, of the Nutrition-Gut-Brain Interactions Research Center at Örebro University in Sweden, said during her presentation.
Holster and colleagues randomly assigned 16 patients with IBS to receive FMT via colonoscopy using either donor material or their own fecal material as placebo. The researchers assessed symptom scores and quality of life before and after the procedure.
IBS Symptom Severity Scores in patients who received donor FMT dropped significantly at 4 and 8 weeks after treatment compared with baseline (P < .01 for both), while there were no significant changes observed in the placebo group. There were also no significant differences observed in IBS-SSS between the treatment and placebo groups.
Gastrointestinal Symptom Rating Scale scores dropped significantly for both the treatment and placebo groups 2 and 4 weeks after FMT compared with baseline (P < .01 for FMT and P < .05 for placebo at both time points). There were again no significant differences observed between the treatment and placebo groups.
Further, IBS Quality of Life total scores increased significantly in the treatment group but not in the placebo group at 8 weeks (P < .01), as did three of eight SF-36 subscores. The general health subscore in particular increased significantly in the treatment group compared with placebo at 8 weeks (P < .01).
"We think that maybe the bowel cleansing or the processing of the [autologous] fecal material might have contributed to the placebo effect," Holster said. – by Adam Leitenberger
Reference:
Holster S, et al. Abstract #430. Presented at: Digestive Disease Week; May 6-9, 2017; Chicago.
Disclosures: Holster reports no relevant financial disclosures.
http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7Bd40fc27c-30ae-45ee-9963-15ab694f9399%7D/fmt-improves-symptoms-qol-in-ibs-patients
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August 25, 2017
Top News in Gastroenterology #6 of 6
Bacteria can trigger stomach cancer
Charité - Universitätsmedizin Berlin News
Helicobacter pylori infection stimulates stem cells in stomach glands.
Working with colleagues from the Max Planck Institute for Infection Biology and the Stanford School of Medicine, researchers from Charité – Universitätsmedizin Berlin have shown how Helicobacter pylori infection could cause stomach cancer. For the first time, this study was able to show a direct link between H. pylori and an increase in stem cell regeneration within stomach glands. By increasing the number of cells with stem cell potential, the presence of the bacterium also increases the risk of pathological changes.
The study was published in the journal Nature.
H. pylori infection is common, and is considered the most significant risk factor for the development of stomach cancer. While infection is known to trigger an increase in cell division in affected tissues, the underlying mechanism had previously remained unknown. It has now been unraveled by a team of researchers led by Dr. Michael Sigal (Charité's Medical Department, Division of Hepatology and Gastroenterology, and BIH Charité Clinician Scientist) and Prof. Dr. Thomas F. Meyer (Director of the Max Planck Institute for Infection Biology, Berlin). Gastric glands have a high regenerative capacity and renew themselves every 7 to 14 days. How a bacterial infection might produce long–term changes under such conditions has puzzled the researchers.
"At the base of the glands, however, there are long–lived stem cells, which continuously generate new cells," explains Dr. Sigal. He adds: "In addition to identifying these cells, we also wanted to discover the processes which control their regeneration." Stem cell characterization revealed that there are two different types of stem cells in the stomach, both of which are positive for the protein AXIN2. "We found that the cells directly below the glands produce a specific molecule known as 'R–spondin'. This molecule has a major effect on stem cells. It drives cell division in one type of stem cell, thereby increasing the speed of gastric gland regeneration," says the researcher. Infection with H. pylori results in an increased production of R–spondin and increased stem cell activity. It is likely that a sustained high rate of stem cell proliferation promotes cancer formation.
As part of their study, the researchers used an animal model to characterize the stem cells of the stomach. Using highly–sensitive new techniques, they were able to produce high–resolution images of molecules within the stomach tissue. In addition to visualizing the molecules responsible for controlling stem cells, the researchers were also able to show their proximity to the stem cell populations. The researchers also used a model of H. pylori infection which recreates the precursor stages of cancer in humans, and conducted experiments using 'organoids' – cell cultures derived from stem cells harvested directly from the stomach tissue of both animals and humans.
While it has long been recognized that certain viruses can cause cancer by introducing genes into the host cell, bacteria are also being studied as potential causative agents – although the underlying mechanisms are rather less clear. Working with colleagues, the research teams led by Dr. Sigal and Prof. Meyer have now been able to break down the established dogma, which holds that bacterial infections only affect cells at the surface. "Helicobacter pylori causes a life–long infection, and increases the number of long–lived cells with stem cell potential within the glands of the stomach. The rate of stem cell division is increased, which eventually leads to pathological changes in the epithelium," explained Dr. Sigal.
https://www.mdlinx.com/gastroenterology/top-medical-news/article/2017/08/25/7379185utm_source=in-house&utm_medium=message&utm_campaign=article2-gastro-aug25&sec=special_features&feat_order_num=2&time_id=118252017&alert_job_num=41298
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IBS Awareness Month: 10 recent advances in research, diagnostics
April 13, 2018
April is IBS Awareness Month. First designated by the International Foundation for Functional Gastrointestinal Disorders in 1997, this initiative aims to raise awareness of the 10% to 15% of Americans who experience the symptoms of irritable bowel syndrome, an "often misunderstood and stigmatized condition," according to the IFFGD.
To contribute to this effort, the editors of Healio Gastroenterology and Liver Disease have compiled a roundup of 10 recent news articles highlighting the latest research and regulatory developments in IBS.
See Also
8 news updates to mark IBS Awareness Month
IBS linked to genetic variant found only in women
Italian hepatitis A outbreak among MSM linked to two…
1. IBS linked to genetic variant found only in women
In a genome-wide association study, investigators linked IBS to certain DNA variants found only in women, which researchers said could explain why the condition is less common in men.
2. Vitamin D supplements may ease IBS symptoms
Vitamin D could be effective in treating the painful symptoms associated with IBS, according to a study published in The European Journal of Clinical Nutrition.
3. New blood test distinguishes between IBD, IBS
Analyte Health announced that it now offers a new test to help health care providers determine if a patient has inflammatory bowel disease (IBD) or IBS. The IsolateIBS-IBD test uses RNA expression analysis to determine the correct diagnosis with 90% accuracy, according to a press release.
4. FDA approves Trulance for IBS-C
In January, Synergy Pharmaceuticals announced the FDA approved Trulance for the treatment of constipation-predominant IBS (IBS-C) in adults. This is the second indication for Trulance (plecanatide), which the FDA first approved for chronic idiopathic constipation (CIC) in January 2017.
5. Low FODMAP diet shows short-term efficacy, safety for IBS
Patients with IBS who adhered to a low fermentable, oligo-, di-, mono-saccharides and polyol diet, known as the low FODMAPs diet, experienced improvement in gastrointestinal symptoms and quality of life, according to a new meta-analysis published in Nutrition.
6. Tenapanor shows favorable tolerability in IBS-C safety study
Tenapanor showed positive results in a safety extension study, which the manufacturer Ardelyx said will support a new drug application along with two successful phase 3 trials for IBS-C.
7. Self-administered cognitive behavior therapy improves IBS symptoms
Self-administered cognitive behavior therapy was significantly more effective than an education intervention, and comparable to more resource-intensive clinic-based cognitive behavior therapy for improving symptoms of IBS, according to the results of a randomized controlled trial presented at the World Congress of Gastroenterology at ACG 2017.
8. Long-term cannabis use increases risk for IBS
Cannabis use increased the risk for IBS in the general population, according to a poster presented at the World Congress of Gastroenterology at ACG 2017. Additionally, the effects may be worse among men, Caucasians and Hispanics.
9. How to make 'the conversation about poop' easier for IBS patients
In this exclusive video, Jack Braha, DO, a practitioner at Brooklyn Gastroenterology and Endoscopy, discusses how physicians can make "the conversation about poop" easier for patients with IBS. Watch now
10. IBS-D tied to food poisoning, treated without relapse for 6 months
IBS with diarrhea (IBS-D) found further definition this year with pinpointing causes and improved treatments, according to one expert at the World Congress of Gastroenterology at ACG 2017.
https://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B53f8e713-507c-40e1-a364-7a16ce511b23%7D/ibs-awareness-month-10-recent-advances-in-research-diagnostics
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Heather is the Administrator of the IBS Message Boards. She is 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!
Edited by Heather (04/19/18 11:58 AM)
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JULY 25, 2018
Gastroenterology & Endoscopy News
Fecal Microbiota Transplant Relieves IBS With Predominant Bloating
Washington—Fecal microbiota transplant is an effective treatment for symptoms of irritable bowel syndrome with predominant abdominal bloating, according to results of a double-blind trial.
Nearly half of the patients treated with FMT reached the primary end point of adequate symptom relief 12 weeks after treatment versus 29% of those treated with placebo. In addition, FMT patients had statistically significant reductions from baseline in discomfort, number of stools, urgency, flatulence and abdominal pain, reported Tom Holvoet, MD, PhD, a researcher in the Department of Gastroenterology at the University Hospital in Ghent, Belgium. These benefits were not seen in controls, according to Dr. Holvoet, who presented the data at the 2018 Digestive Disease Week (abstract 617).
For enrollment in this study, patients were required to have IBS with predominant abdominal bloating, as defined in the ROME III criteria. Patients with constipation were excluded. Sixty-four eligible patients were randomly assigned in a 2:1 ratio to receive FMT with fresh donor stool or a control of the patient's own stool. The active treatment stool provided from two donors had been associated with benefit against IBS in a previous pilot study. This stool also was characterized as having "high microbial richness." The investigators collected stool samples at baseline, at intervals during the study, and at the end of 12 weeks to examine changes in gut microbiota, according to Dr. Holvoet.
At the end of 12 weeks, 49% of patients in the experimental group reported adequate relief of both general IBS symptoms and abdominal bloating. This rate of response was nearly 70% higher than the 29% rate of adequate relief in the control group (P=0.004). Among specific symptoms, the 26% reduction from baseline in abdominal pain (P=0.001) and the 19% reduction in general discomfort (P=0.001) were highly statistically significant, Dr. Holvoet noted.
The investigators are conducting ongoing analyses, noting that linking IBS symptoms with specific bacterial species could provide new opportunities for more targeted FMT as well as treatment with probiotics.
Although advances in understanding the importance of gut microflora in human diseases has led many to speculate that dysbiosis may be a factor in IBS and other functional bowel disorders, this is one of the first well-controlled randomized trials with FMT, Dr. Holvoet said. Several recently published reviews, such as one by investigators at Beth Israel Deaconess Medical Center, in Boston (Ann Transl Med 2017;5[24]:506), have found a growing body of evidence of benefit from FMT in uncontrolled studies as well as experimental evidence supporting the concept.
"FMT is allowing us to understand the microbial contribution of several chronic diseases," said Jessica R. Allegretti, MD, the director of clinical trials at the Crohn's and Colitis Center at Brigham and Women's Hospital, in Boston. An investigator who has participated in several studies with FMT and who recently wrote a review of the role of FMT in inflammatory bowel diseases (Inflamm Bowel Dis 2017;23[10]:1710-1717), Dr. Allegretti called these data "very encouraging, given that bloating is one of the most difficult symptoms to treat" in patients with IBS.
—Ted Bosworth
https://www.gastroendonews.com/In-the-News/Article/07-18/Fecal-Microbiota-Transplant-Relieves-IBS-With-Predominant-Bloating/50110
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Heather is the Administrator of the IBS Message Boards. She is 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!
Edited by Heather (07/25/18 12:50 PM)
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