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Am J Gastroenterol. 2008 Aug 5.
Genetics of Irritable Bowel Syndrome.Saito YA, Talley NJ.
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, and Jacksonville, Florida, USA.
Irritable bowel syndrome (IBS) is one of the most common diagnoses made by gastroenterologists and primary care providers alike, and yet the underlying mechanism remains poorly understood. Family and twin studies suggest that IBS may have a genetic basis. Several candidate gene association studies have been performed, but thus far, they have failed to clearly identify an "IBS gene." Epidemiological studies are needed to facilitate phenotype definition and identify relevant environment risk factors that will need to factor in gene and environment interactions in all future genetic studies. As genetic research in IBS is relatively nascent, much opportunity, as well as many challenges, exists in identifying the genes responsible for IBS.
PMID: 18684190 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/18684190?ordinalpos=29&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Researchers at Mayo Clinic studying irritable bowel syndrome say their study of people with this disorder suggests genetic factors may play a role.
Irritable bowel syndrome is a common problem affecting about one in 10 adults. However, many people don't talk about irritable bowel syndrome, which causes abdominal cramping, constipation and diarrhea. The study, which is published in the December issue of Gut, an international journal in gastroenterology, shows that the risk of having irritable bowel syndrome is nearly double in the families of people with the disorder.
"The next challenge is determining nature versus nurture," said G. Richard Locke, M.D., a Mayo Clinic gastroenterologist and one of the authors of the study. "Is this due to a gene or genes or is it due to a shared environmental factor? Our group is active in investigating these issues."
In developing the study, researchers noted that people with irritable bowel syndrome often report family members with similar symptoms. The researchers hypothesized that if there is a familial connection, there would be an increased frequency of irritable bowel syndrome in direct relatives of irritable bowel syndrome patients compared to relatives of people without irritable bowel syndrome.
Others who conducted the study include Jamshid Kalantar, M.D., Alan Zinsmeister, Ph.D., Christopher Beighley, and Nicholas Talley, M.D., Ph.D. Dr. Kalantar was a research fellow at Mayo Clinic during the study, but is now with the Department of Medicine, University of Sydney, Australia. Mr. Beighley now works in West Virginia. The others are with Mayo Clinic in Rochester.
In the study, patients with irritable bowel syndrome seen at Mayo Clinic and their spouses filled out a bowel disease questionnaire and provided the names and addresses of their direct relatives. Researchers then sent a bowel disease questionnaire to 355 relatives of the patients and their spouses, and 71 percent responded. Irritable bowel syndrome occurred in 17 percent of the patients' relatives compared with 7 percent in spouses' relatives.
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Adapted from materials provided by Mayo Clinic.
MLA Mayo Clinic (2003, December 11). Irritable Bowel Syndrome's Possible Genetic Link Studied. ScienceDaily.
http://www.sciencedaily.com/releases/2003/12/031211080446.htm
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Int J Nurs Stud. 2008 Sep 29.
An examination of subgroup classification in irritable bowel syndrome patients over time: A prospective study.
Penny KI, Smith GD, Ramsay D, Steinke DT, Kinnear M, Penman ID.
Napier University, Edinburgh, UK.
BACKGROUND: Irritable bowel syndrome (IBS) is a complex functional gastrointestinal disorder which to date remains poorly understood. Therapies for irritable bowel syndrome (IBS) patients are usually aimed at relieving the predominant symptom; however, little evidence exists as to whether or not the predominant symptom changes with time. Nurses are becoming increasingly involved in the assessment and management of IBS patients. OBJECTIVES: To categorise IBS patients into one of three sub-types, namely diarrhoea-predominant, constipation-predominant and a third group who alternate between the two, and to investigate changes in patient sub-type classification over time. DESIGN: Observational cohort study. SETTING: The general population of the United Kingdom (UK). METHODS: A cohort of 494 IBS patients, with a confirmed Rome II classification diagnosis, was recruited in the UK. Patients' IBS symptoms were recorded throughout a 26-week period. Proportions of individuals in each IBS subgroup were calculated and probabilities of moving from one subgroup to another between consecutive weeks were estimated. RESULTS: The percentage of patients given an overall subgroup classification of diarrhoea-predominant IBD (D-IBS) is 40.9%; 58.1% and 1% were classified as belonging to the alternator (A-IBS) and constipation-predominant (C-IBS) subgroups, respectively. PATIENTS: classified as an alternator or as diarrhoea-predominant have a high probability (0.67 and 0.71, respectively) of remaining in the same subgroup; however this probability is lower for constipation-predominant patients (0.35). CONCLUSION: Although many patients remain in the same IBS subgroup classification over time, there are individuals whose subgroup classification varies. As such, patients' IBS subgroup classification should be reviewed regularly and treatment adjusted accordingly in order to optimise patient care.
PMID: 18829027 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/18829027?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
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Contributions of Pain Sensitivity and Colonic Motility to IBS Symptom Severity and Predominant Bowel Habits
Authors: Kanazawa, Motoyori; Palsson, Olafur S.1; Thiwan, Syed I.M.1; Turner, Marsha J.1; van Tilburg, Miranda A.L.1; Gangarosa, Lisa M.1; Chitkara, Denesh K.1; Fukudo, Shin2; Drossman, Douglas A.1; Whitehead, William E.1
Source: The American Journal of Gastroenterology, Volume 103, Number 10, October 2008 , pp. 2550-2561(12)
Publisher: Blackwell Publishing
Abstract:
OBJECTIVES: Irritable bowel syndrome (IBS) patients show pain hypersensitivity and hypercontractility in response to colonic or rectal distention. Aims were to determine whether predominant bowel habits and IBS symptom severity are related to pain sensitivity, colon motility, or smooth muscle tone.
METHODS: One hundred twenty-nine patients classified as IBS with diarrhea (IBS-D, N = 44), IBS with constipation (IBS-C, N = 29), mixed IBS (IBS-M, N = 45), and unspecified IBS (IBS-U, N = 11) based on stool consistency, and 30 healthy controls (HC) were studied. A manometric catheter containing a 600-mL capacity plastic bag was positioned in the descending colon. Pain threshold was assessed using a barostat. Motility was assessed for 10 min with the bag minimally inflated (individual operating pressure [IOP]), 10 min at 20 mmHg above the IOP, and for 15-min recovery following bag inflation. Motility was also recorded for 30 min following an 810-kcal meal.
RESULTS: Compared with HC, IBS patients had lower pain thresholds (medians 30 vs 40 mmHg, P < 0.01), but IBS subtypes were not different. IBS symptom severity was correlated with pain thresholds. During distention, the motility index (MI) was significantly higher in IBS compared with HC. Average barostat bag volume at baseline was higher (muscle tone lower) in HC compared with IBS-D and IBS-M but not compared with IBS-C. The baseline MI and bag volume differed between IBS-D and IBS-C and correlated with symptoms of abdominal distention and dissatisfaction with bowel movements. Pain thresholds and MI during distention were uncorrelated.
CONCLUSIONS: Pain sensitivity and colon motility are independent factors contributing to IBS symptoms. Treatment may need to address both, and to be specific to predominant bowel habit.
(Am J Gastroenterol 2008;103:2550-2561)
Document Type: Research article
DOI: 10.1111/j.1572-0241.2008.02066.x
Affiliations: 1: Center for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 2: Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
http://www.ingentaconnect.com/content/bsc/ajg/2008/00000103/00000010/art00020;jsessionid=gj248stmp9het.alice
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Med J Malaysia. 2008 Jun;63(2):140-2.
A physiologic events' cascade: irritable bowel syndrome may even terminate with chronic gastritis.
Helvaci MR, Kaya H, Algin MC, Yalcin A.
Medical Faculty of the Mustafa Kemal University, Antakya, Turkey.
When specifically asked, about one third of people report recurrent upper abdominal discomfort, and irritable bowel syndrome (IBS) and chronic gastritis (CG) maybe the most frequently diagnosed ones among all.
Consecutive patients with upper abdominal discomfort applying to the Internal Medicine Polyclinic were included into the study. IBS was diagnosed according to Rome II criteria and CG was diagnosed histologically. All cases with IBS were compared with the age and sex-matched randomly selected cases without IBS.
One hundred and fifty-six patients with IBS and 179 patients without IBS were studied. CG was detected in 72.4% (113 cases) of cases with IBS, and only 36.3% (65 cases) in patients without IBS (p < 0.001).
IBS probably is a cascade of many physiological events, being initiated by infection, inflammation, psychological disturbances-like many stresses and eventually leading to dysfunctions of gut and other systems of the body via a low-grade inflammatory process.
CG may be one of the terminating points of the physiological events' cascade, IBS. This may explain the high prevalence of IBS in society.
Keeping in mind this association will be helpful during prevention, treatment, and follow up of these common pathologies in Primary Health Centers and Internal Medicine and Gastroenterology Polyclinics for physicians.
PMID: 18942301 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/18942301?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
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Irritable Bowel Syndrome Can Have Genetic Causes
ScienceDaily (Dec. 13, 2008) — Irritations of the bowel can have genetic causes, according to new research from the Institute of Human Genetics at Heidelberg University Hospital. The causes of what is known as irritable bowel syndrome (IBS), one of the most common disorders of the gastrointestinal tract, are considered unclear – making diagnosis and treatment extremely difficult.
The results from Heidelberg improve the outlook for an effective medication against a disease that is frequently played down as a functional disorder.
In Germany, approximately five million people are affected by IBS, women about twice as often as men. But only around 20 percent of these people even consult a physician. Many patients suffer from constipation, others from severe diarrhea, or a combination of both. The illness affects the general condition and quality of life of these patients and often lasts for months or even years.
Modified receptors lead to overstimulation of the bowel
Serotonin plays an important role in the complex processes in the digestive tract– just as it affects sleep, mood, and blood pressure. Various types of receptors are located in the intestine, to which serotonin attaches ac-cording to the lock and key principle and thus transmits cellular signals.
"We have determined that patients who suffer from irritable bowel syndrome with diarrhea show a higher frequency of certain mutations ", ex-plains Dr. Beate Niesler, who investigates the genetic causes of complex diseases with her team in the Department of Human Molecular Genetics (Director: Prof. Gudrun Rappold) at the Heidelberg Institute of Human Genetics. These mutations appear to cause changes in the composition or number of receptors on the cell surface. "The signal transduction in the digestive tract may be disturbed and this may lead to over-stimulation of the intestine. Resulting disturbances in fluid balance could explain the occurrence of diarrhea", says Johannes Kapeller, a PhD student in the team.
Medication blocks serotonin receptors
The serotonin receptor blocker Alosetron is only approved in the US where it is effectively used in the treatment of women suffering from diarrhea-predominant IBS, but can only be prescribed with strict limitations due to its side effects. Alosetron inhibits the serotonin receptors in the intestinal tract and thus slows the movement of the bowels.
"Currently, patients with irritable bowel syndrome are treated on a trial and error basis", explains Dr. Beate Niesler. The Heidelberg data could contribute to development and prescription of specific medications for certain genetic mutations in patients.
Correlation with depression and pain
Research of the serotonin system shows interesting correlations – serotonin receptors are located on neural transduction pathways involved in pain perception and influence them – which could explain why patients with irritable bowel syndrome often complain of severe pain although no pathological changes such as infections or tumors are present. It has also been noted that persons with modified receptors suffer more frequently from depression.
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Journal reference:
Kapeller et al. First evidence for an association of a functional variant in the microRNA-510 target site of the serotonin receptor-type 3E gene with diarrhea predominant irritable bowel syndrome. Human Molecular Genetics, 2008; 17 (19): 2967 DOI: 10.1093/hmg/ddn195
Adapted from materials provided by University Hospital Heidelberg.
http://www.sciencedaily.com/releases/2008/12/081210121920.htm
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Highlights of ACG's New Recommendations on IBS Therapies
In general, treatments for IBS are directed towards the patient's predominant symptoms. There are a wide variety of available therapies, many of which improve individual IBS symptoms. Only a small number of therapies has been shown to be of benefit for global symptoms of IBS.
- Trials suggest soluble fiber, certain antispasmodics, and peppermint oil are effective in IBS patients although the quality of the evidence is poor.
- Evidence suggests that some probiotics may be effective in reducing overall IBS symptoms but more data are needed.
- Anti-diarrheals reduce the frequency of stools but do not affect the overall symptoms of IBS.
- 5HT 3 antagonists are efficacious in IBS patients with diarrhea and the quality of evidence is good. Patients need to be carefully selected, however, because potentially serious side effects include constipation and colon ischemia. Current use of alosetron is regulated by a prescribing program set forth by the FDA.
- 5HT 4 agonists are modestly effective in IBS patients with constipation and the quality of evidence is good although the possible risk of cardiovascular events associated with these agents may limit their utility. Currently, there are no 5-HT 4 receptor agonists available for use in North
America.
- Tricyclic anti-depressants and selective serotonin reuptake inhibitors have been shown to be effective in IBS patients of all subtypes. The trials generally are of good quality but the limited number of patients included in trials implies that further evidence could change the confidence in the estimate of effect and therefore the quality of evidence was graded as moderate.
- Non-absorbable antibiotics are effective, particularly in
diarrhea-predominant IBS.
- The selective C-2 chloride channel activator, lubiprostone, is efficacious in constipation-predominant IBS with a moderate quality of evidence.
- Psychological therapies also may provide benefit to IBS patients although the quality of evidence is poor.
http://www.acg.gi.org/media/releases/ajg_ibs_supp_0109.pdf
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Clin Gastroenterol Hepatol. 2008 Dec 13.
Prevalence of Functional Gastrointestinal Disorders in Patients With Fibromyalgia and the Role of Psychologic Distress.
Almansa C, Rey E, Sánchez RG, Sánchez AA, Rubio MD.
Digestive Diseases Department, Hospital Clínico San Carlos, Madrid, Spain.
BACKGROUND & AIMS: Fibromyalgia is a rheumatologic disorder associated with somatic and psychologic conditions. Although fibromyalgia is associated with irritable bowel syndrome, its relationship with other functional gastrointestinal disorders (FGID) is unclear. We evaluated the prevalence of FGID in patients with fibromyalgia and the role of psychologic factors in this relationship.
METHODS: From a Spanish population, 100 patients with fibromyalgia and 100 matched controls completed the Rome II Integrative Questionnaire to assess the prevalence of FGID and the SCL-90R to evaluate psychologic distress. Patients completed the Fibromyalgia Impact Questionnaire to evaluate the overall impact of fibromyalgia and controls filled out the Chronic Widespread Pain Questionnaire to detect potential cases of fibromyalgia.
RESULTS: Ninety-three percent of the total study population was female, with a mean age of 50 years. We identified 6 cases of widespread pain among controls. The average Fibromyalgia Impact Questionnaire score for patients was 67.28 +/- 14.25. All gastrointestinal symptoms except for vomiting were more frequent in patients. Ninety-eight percent of patients with fibromyalgia had at least one FGID, compared with only 39% of controls. Fibromyalgia was correlated most highly with irritable bowel syndrome. Patients presented with significantly higher scores of psychologic distress than controls, especially those with fecal incontinence.
CONCLUSIONS: There is a prevalence of FGID in patients with fibromyalgia and a wider distribution of such symptoms along the gastrointestinal tract compared with controls. We propose that an increased degree of psychologic distress in these patients predisposes them to FGID, especially significant for anorectal syndromes.
PMID: 19138763 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/19138763?ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
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BMC Gastroenterol. 2009 Feb 4;9(1):10.
Development of an educational intervention for patients with Irritable Bowel Syndrome (IBS) - a pilot study.
Ringstrom G, Storsrud S, Lundqvist S, Westman B, Simren M.
ABSTRACT: BACKGROUND: Many IBS patients experience that they receive limited information and that the health care system does not take their complaints seriously. We aimed to develop a structured patient education, an 'IBS school', and investigate if the efficacy could be evaluated in terms of improved knowledge, symptom severity and health related quality of life (HRQOL).
METHODS: The IBS school consisted of six weekly two hour sessions in a group setting. Five different health care professionals were responsible for one session each. Questionnaires covering patients' experience of the education, perceived knowledge about IBS, gastrointestinal symptoms, and HRQOL, were used for evaluation at baseline and at three, six, and twelve months after education.
RESULTS: Twelve IBS patients were included. The patients were overall satisfied with the IBS school. In line with this, the gastrointestinal symptoms, HRQOL, and perceived knowledge about IBS improved significantly after the education.
CONCLUSIONS: An IBS school seems to be a proper method to meet the patients' need of information about IBS and also to improve the patients' gastrointestinal symptoms, HRQOL, and knowledge about IBS. Further controlled studies are now needed in larger numbers of patients to confirm these preliminary results in order to implement this intervention in clinical practice.
PMID: 19192312 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/19192312?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
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Published: Tuesday, May 12, 2009
Edmonds woman key to suggesting new relief law
By Jerry Cornfield
Herald Writer
OLYMPIA -- An idea in an e-mail from an Edmonds woman became a new law Monday and should bring peace of mind to thousands of people with incurable bowel disorders.
And those not suffering such ailments may benefit, too.
Gov. Chris Gregoire signed legislation requiring retailers make employee bathrooms available to customers with Crohn's disease and other gastrointestinal disorders that can make need of a restroom an unexpected emergency.
"Individuals with qualifying medical conditions will be able to live a more comfortable life," Gregoire said upon acting.
Edmonds' Lois Fink stood at Gregoire's side and said afterward that the moment had "a dreamlike quality."
"There were so many emotions going through me," said Fink, a Crohn's sufferer who since having an ileostomy in 1986 has been able to enjoy a more normal life.
Rep. Marko Liias, D-Mukilteo, introduced the bill after receiving an e-mail from Fink last year in which she laid out the problem and possible solutions.
Today, many retailers do allow the public to use their private bathrooms on a case-by-case basis. The law, which takes effect July 25, requires they do so when the request comes from a person with documentation signed by a doctor listing their medical condition.
It is intended to serve people with inflammatory bowel disorders, such as Crohn's disease and ulcerative colitis. Other conditions covered in the law are irritable bowel syndrome, those requiring use of an ostomy device and "any other permanent or temporary medical condition that requires immediate access to a restroom facility" such as pregnancy.
Liias has said as many as 30,000 people in Washington suffer from a bowel disorder. Among them is Mike McCready of Pearl Jam, another Crohn's sufferer, who attended the signing and praised Fink.
"I wanted to jump on her bandwagon and be part of it. This law is something I've always wanted to see happen," he said. "I really feel it's a moral and civil rights issue."
Fink and McCready each told of experiencing feelings of humiliation when they've gone into a shop and pleaded to use the restroom.
"It's a humane bill that will educate as well," Fink said.
People who don't suffer a gastrointestinal disorder will be helped by this law.
Under a last-minute change by the Senate, businesses, under certain circumstances, must allow any customer to use the facilities. The key circumstance is there must be at least three employees on hand at the time. This requirement does not apply for those with a qualifying medical condition.
In all instances, a company can deny access to their bathrooms if doing so poses a health or safety risk to the customer.
Also, banks, financial institutions and firms dealing with sensitive material can turn down the requests if it means customers would have to enter secure areas to reach the restroom
The final version of the legislation passed the House 93-0 and the Senate on a 33-12 margin.
Jerry Cornfield: 360-352-8623,
http://heraldnet.com/article/20090512/NEWS01/705129886
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