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Dig Dis Sci. 2009 Jul;54(7):1532-41. Epub 2009 Apr 1.
A focus group assessment of patient perspectives on irritable bowel syndrome and illness severity.
Drossman DA, Chang L, Schneck S, Blackman C, Norton WF, Norton NJ.
UNC Center for Functional GI and Motility Disorders, Division of Gastroenterology and Hepatology, University of North Carolina, 4150 Bioinformatics Building CB#7080, Chapel Hill, NC 27599-7080, USA.
There is a growing need to understand from the patient's perspective the experience of irritable bowel syndrome (IBS) and the factors contributing to its severity; this has been endorsed by the Food and Drug Administration (FDA). Accordingly, we conducted focus groups to address this issue.
A total of 32 patients with mostly moderate to severe IBS were recruited through advertising and were allocated into three focus groups based on predominant stool pattern. The focus groups were held using standard methodology to obtain a general assessment of the symptoms experienced with IBS, its impact, and of factors associated with self-perceived severity. Patients described IBS not only as symptoms (predominantly abdominal pain) but mainly as it affects daily function, thoughts, feelings and behaviors.
Common responses included uncertainty and unpredictability with loss of freedom, spontaneity and social contacts, as well as feelings of fearfulness, shame, and embarrassment. This could lead to behavioral responses including avoidance of activities and many adaptations in routine in an effort for patients to gain control.
A predominant theme was a sense of stigma experienced because of a lack of understanding by family, friends and physicians of the effects of IBS on the individual, or the legitimacy of the individual's emotions and adaptation behaviors experienced. This was a barrier to normal functioning that could be ameliorated through identifying with others who could understand this situation.
Severity was linked to health-related quality of life (HRQOL) and was influenced by the intensity of abdominal pain and other symptoms, interference with and restrictions relating to eating, work, and social activities, and of the unpredictability of the condition. This study confirms the heterogeneous and multi-component nature of IBS. These qualitative data can be used in developing health status and severity instruments for larger-scale studies.
PMID: 19337833 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/19337833?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
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J Clin Gastroenterol. 2009 Jul;43(6):541-50.
International survey of patients with IBS: symptom features and their severity, health status, treatments, and risk taking to achieve clinical benefit.Drossman DA, Morris CB, Schneck S, Hu YJ, Norton NJ, Norton WF, Weinland SR, Dalton C, Leserman J, Bangdiwala SI.
UNC Center for Functional GI and Motility Disorders, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7080, USA.
BACKGROUND: Although clinicians generally make treatment decisions in irritable bowel syndrome (IBS) related to the type of symptoms, other factors such as the perceived severity and the risks patients are willing to tolerate for effective treatment are also important to consider. These factors are not fully understood.
OBJECTIVE: To describe among patients with IBS their symptoms and severity, quality of life and health status, medications taken, and the risk that they would take to continue medications for optimal relief.
METHODS: Adult patients diagnosed with IBS who accessed the websites of the International Foundation for Functional GI Disorders or the University of North Carolina Center for Functional GI Disorders filled out questionnaires to address the study aims.
RESULTS: The 1966 respondents (83% female, 91% white, 78% US/Canada) reported impaired health status: restricting on average 73 days of activity in a year, having poor health-related quality of life particularly with dietary restrictions, mood disturbance, and interference with daily activity, and 35% reported their symptoms as severe defined primarily as pain, bowel difficulties, bloating, and eating/dietary restrictions). These symptoms were reported in some combination by over 90%, and 35.1% endorsed all 4 items. To receive a treatment that would make them symptom free, patients would give up 25% of their remaining life (average 15 y) and 14% would risk a 1/1000 chance of death. Most of the medications being taken were for pain relief and 18% were taking narcotics. Complementary and alternative treatments were used by 37%.
CONCLUSIONS: Patients accessing IBS informational websites report moderate-to-severe impairments in health status, and would take considerable risk to obtain symptom benefit. There is an unmet need to find effective treatments for patients with IBS and regulatory agencies might consider raising risk-benefit ratios when approving new medications for IBS.
PMID: 19384249 [PubMed - in process]
PMCID: PMC2700202 [Available on 2010/07/01]
http://www.ncbi.nlm.nih.gov/pubmed/19384249?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
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Constipation: a potential cause of pelvic floor damage?
Neurogastroenterology & Motility
Published Online: 17 Sep 2009
c. amselem *, a. puigdollers †, f. azpiroz ‡, c. sala *, s. videla ‡, x. fernández-fraga ‡, p. whorwell § & j.-r. malagelada ‡
*Pelvic Floor Institute, Barcelona, Spain
†Hospital de Mollet, Barcelona, Spain
‡Digestive System Research Unit, University Hospital Vall d'Hebron, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
§Department of Medicine, University Hospital South Manchester, Manchester, UK
Address for Correspondence Fernando Azpiroz MD, Digestive System Research Unit, Hospital General Vall d'Hebron, 08035 – Barcelona, Spain.
Copyright © 2009 Blackwell Publishing Ltd
ABSTRACT
Background Pelvic floor damage is a major clinical problem usually attributed to obstetric injury. We speculated that constipation may also be an aetiological and preventable factor resulting from repeated stress on the perineum over many years, and this study aimed to test this hypothesis.
Methods
A total of 600 women attending a gynaecological clinic were assessed using a structured questionnaire gathering data on pelvic floor damage, constipation and obstetric trauma. Complete data were available on 596 subjects.
Key Results
The prevalence of pelvic floor damage was 10% (61/596). In this group, constipation was identified in 31% (19/61) of women and obstetric trauma in 31% (19/61). In the group without pelvic floor damage, constipation was present in 16% (86/535) and obstetric trauma in 16% (83/535). In univariate analysis, pelvic floor damage was associated with age (OR: 1.05; 95% CI: 1.03–1.08; P < 0.0001), constipation (OR: 2.36; 95% CI: 1.31–4.26; P < 0.0001) and obstetric trauma (OR: 2.46; 95% CI: 1.37–4.45; P < 0.0028). In multivariate analysis, the OR for age was 1.05 (95% CI: 1.03–1.08; P < 0.0001), for constipation 2.35 (95% CI: 1.27–4.34; P < 0.0001) and for obstetric trauma 1.37 (95% CI: 0.72–2.62; P = 0.3398).
Conclusions & Inferences
Constipation appears to be as important as obstetric trauma in the development of pelvic floor damage. Thus, a more proactive approach to recognizing and treating constipation might significantly reduce the prevalence of this distressing problem.
http://www3.interscience.wiley.com/journal/122600426/abstract
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Altered profiles of intestinal microbiota and organic acids may be the origin of symptoms in irritable bowel syndrome
Neurogastroenterology & Motility
Published Online: 10 Nov 2009
© 2010 Blackwell Publishing Ltd
Altered profiles of intestinal microbiota and organic acids may be the origin of symptoms in irritable bowel syndrome
c. tana *, y. umesaki †, a. imaoka †, t. handa *, m. kanazawa * & s. fukudo *
*Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
†Yakult Central Institute for Microbiological Research, Tokyo, Japan
Correspondence to Prof. Shin Fukudo, MD, PhD, Department of Behavioral Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo, Aoba, Sendai 980-8575, Japan.
Copyright © 2009 Blackwell Publishing Ltd
Background
The profile of intestinal organic acids in irritable bowel syndrome (IBS) and its correlation with gastrointestinal (GI) symptoms are not clear. We hypothesized in this study that altered GI microbiota contribute to IBS symptoms through increased levels of organic acids.
Methods
Subjects were 26 IBS patients and 26 age- and sex-matched controls. Fecal samples were collected for microbiota analysis using quantitative real-time polymerase chain reaction and culture methods, and the determination of organic acid levels using high-performance liquid chromatography. Abdominal gas was quantified by image analyses of abdominal X-ray films. Subjects completed a questionnaire for GI symptoms, quality of life (QOL) and negative emotion.
Key Results
Irritable bowel syndrome patients showed significantly higher counts of Veillonella (P = 0.046) and Lactobacillus (P = 0.031) than controls. They also expressed significantly higher levels of acetic acid (P = 0.049), propionic acid (P = 0.025) and total organic acids (P = 0.014) than controls. The quantity of bowel gas was not significantly different between controls and IBS patients. Finally, IBS patients with high acetic acid or propionic acid levels presented with significantly worse GI symptoms, QOL and negative emotions than those with low acetic acid or propionic acid levels or controls.
Conclusions & Inferences
These results support the hypothesis that both fecal microbiota and organic acids are altered in IBS patients. A combination of Veillonella and Lactobacillus is known to produce acetic and propionic acid. High levels of acetic and propionic acid may associate with abdominal symptoms, impaired QOL and negative emotions in IBS.
Received: 3 June 2009 Accepted for publication: 7 October 2009
http://www3.interscience.wiley.com/journal/122680788/abstract?CRETRY=1&SRETRY=0
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Postgrad Med. 2010 Mar;122(2):102-11.
Importance of early diagnosis in patients with irritable bowel syndrome.
Halpert AD.
Center for Digestive Disorders, Boston University School of Medicine, Boston, MA, 02118, USA.
Patients with irritable bowel syndrome (IBS) account for > $20 billion in direct and indirect costs annually, a large portion of which relates to making the diagnosis. The diagnosis of IBS is challenging because symptoms can vary between patients and overlap with those of other disorders. This review examines the current diagnostic approach in IBS and discusses new tools that may improve diagnostic confidence earlier in the process.
The prevalence of organic disease among patients who meet symptom-based criteria for IBS (eg, Rome III) is generally low; therefore, in the absence of "alarm features," the probability for organic disease is very low. Increased public awareness of IBS symptoms and physician awareness of symptom-based criteria for IBS are needed to facilitate earlier diagnosis.
Accumulating evidence suggests that fecal and/or serum biomarkers may be helpful in differentiating IBS from non-IBS disorders. These tools may help minimize unnecessary testing and diagnostic delays. As biomarkers are further studied and developed, they are likely to become an integral part of the diagnosis of IBS and reduce the potential for incorrect diagnosis and treatment delays.
PMID: 20203461 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/20203461
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Am J Gastroenterol. 2010 Feb 23.
Validation of Symptom-Based Diagnostic Criteria for Irritable Bowel Syndrome: A Critical Review.
Whitehead WE, Drossman DA.
Center for Functional Gastrointestinal and Motility Disorders, and Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
This article reviews the evidence for validity of symptom-based criteria (Manning, Rome I, Rome II, and Rome III) for irritable bowel syndrome (IBS).
Two kinds of validations are reported: (i) studies testing whether symptom criteria discriminate patients with structural disease at colonoscopy from patients without structural disease; and (ii) studies testing whether symptom criteria discriminate patients presumed to have IBS by positive diagnosis from healthy subjects or patients with other functional and structural disorders.
The first study type addresses an important clinical management question but cannot provide meaningful information on the sensitivity or positive predictive value because IBS is defined only by exclusion of structural disease. Specificity is modest (about 0.7) but can be improved to 0.9 by the addition of red flag signs and symptoms.
The second type of study judges validity by whether the symptom criteria consistently perform as predicted by theory.
Here, factor analysis confirms consistent clusters of symptoms corresponding to IBS; symptom-based criteria agree reasonably well (sensitivity, 0.4-0.9) with clinical diagnoses made by experienced clinicians; and patients with a clinical diagnosis of IBS who fulfill Rome II criteria have greater symptom severity and poorer quality of life than patients with a clinical diagnosis of IBS who do not fulfill Rome criteria.
There are no consistent differences in sensitivity or specificity between Manning, Rome I, and Rome II. Both study types support the validity of symptom-based IBS criteria. Tests of Rome III are needed.
Am J Gastroenterol advance online publication, 23 February 2010; doi:10.1038/ajg.2010.56.
PMID: 20179688 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20179688
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No Increased Risk of Colon Cancer, IBD Among Patients With IBS
ANN ARBOR, Mich. March 9, 2010 -- Patients with irritable bowel syndrome (IBS) are at no greater risk of polyps, colon cancer, or inflammatory bowel diseases than healthy people, according to new research published in the American Journal of Gastroenterology.
"Patients and doctors get nervous about the symptoms of irritable bowel syndrome (IBS)," says William D. Chey, MD, University of Michigan Medical School, Ann Arbor, Michigan. "This study should reassure doctors and patients that typical IBS symptoms are not indicators of a more serious disease."
Dr. Chey was lead author on the IBS study, the largest prospective evaluation of colonoscopy findings in patients with irritable bowel syndrome. The case-control study compared the prevalence of colonic lesions in 466 patients with suspected IBS and 451 controls.
The IBS group had a significantly lower prevalence of adenomas (7.7% vs 26.1%, P < .0001) and diverticulosis (8.8% vs 21.3%, P < .0001) compared with the control group. The most common lesions among this group were hemorrhoids (18.2%), polyps (14.6%), and diverticulosis (8.8%).
Patients with IBS often undergo colonoscopies because physicians are particularly concerned about missing colorectal cancer or inflammatory bowel diseases like ulcerative colitis or Crohn's disease, Dr. Chey explains. Roughly one-quarter of all colonoscopies performed in the United States are for IBS-related symptoms.
This research shows that it is unnecessary to order colonoscopies for patients with IBS, unless they show alarming symptoms like unexplained weight loss or anaemia, bleeding from the GI tract, or have a family history of colon cancer, inflammatory bowel disease, or celiac disease, says Dr. Chey.
"Lay people and doctors overuse colonoscopies, which are very expensive procedures, in patients with typical IBS symptoms and no alarm features. Of course, patients over the age of 50 years or who have alarm features should undergo colonoscopy to screen for polyps and colon cancer." Dr. Chey says.
Dr. Chey's research also showed that 2.5% of IBS patients older than >=45 years had an unusual disease called microscopic colitis, compared with 1.5% among the control group. Microscopic colitis can masquerade as IBS in patients with diarrhoea and is important to diagnose because it is treated differently than IBS, he says.
SOURCE: University of Michigan Health System and American Journal of Gastroenterology
http://www.docguide.com/news/content.nsf/news/852576140048867C852576E20000C862
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Irritable bowel syndrome (IBS) does seem to run in families, a new study by Mayo Clinic researchers shows.
People with IBS were three times as likely as people without the condition to have a relative who also had the disorder, Dr. Yuri A. Saito of the clinic's Miles and Shirley Fiterman Center for Digestive Disease in Rochester, Minnesota, and her colleagues found.
IBS may affect up to 30 percent of the general population. Symptoms can include abdominal pain, diarrhea, bloating and constipation. It's not clear what causes the condition, although severe gastrointestinal infections may increase IBS risk.
While past studies have suggested that family members of people with IBS are at increased risk of the disease themselves, these investigations have relied on patients' own reports of their relative's symptoms. And since these symptoms aren't matters for dinner table conversation in most families, Saito noted in an interview, many patients may be unaware that a relative is also suffering from the syndrome.
In the current study, Saito and her team directly surveyed 477 people with IBS and 1,492 of their first-degree relatives (meaning a parent, sibling or child), as well as 297 healthy control patients and 936 of their relatives, about their bowel symptoms.
Half of the IBS patients' family members had symptoms themselves, compared to 27 percent of the control patients' families. This translated into a 2.75 times greater risk of IBS for patients' family members.
Saito said she hopes the findings will kick-start a hunt for genes that might be involved in IBS; right now, she noted, none have been discovered. Environmental factors shared within families could also be a factor too, the researcher pointed out; for example, people who have been abused are at increased risk.
While the findings have no treatment implications for people struggling with IBS right now, the researcher added, it may be "reassuring" for them to know that their symptoms have some biological cause.
"I think a lot of people ask themselves, 'why me,' and a lot of times we don't have a good answer to that," she said. "We don't know exactly what it is yet, but we're working on it."
SOURCE: The American Journal of Gastroenterology, April 2010.
http://www.reuters.com/article/idUSTRE62T5EK20100330
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Shift Workers At More Risk For Irritable Bowel Syndrome
Article Date: 19 Mar 2010 - 2:00 PDT
Nurses participating in shift work, especially those working rotating shifts, face a significantly increased risk of developing Irritable Bowel Syndrome (IBS) and abdominal pain compared to those working a standard day-time schedule, according to research published in the American Journal of Gastroenterology.
"We know that people participating in shift work often complain of gastrointestinal symptoms such as abdominal pain, constipation and diarrhea," says Sandra Hoogerwerf, M.D., assistant professor of internal medicine at the University of Michigan Medical School. "These are the same symptoms of IBS."
IBS is the most common functional bowel disorder and is difficult to identify because it is diagnosed by clinical symptoms rather than tests, says Hoogerwerf, lead author of the study. IBS symptoms include recurrent episodes of abdominal pain or cramping in connection with altered bowel habits.
Hoogerwerf and her collegues evaluated nurses classified into three groups-214 working permanent day shifts, 110 working permanent night shifts and 75 working rotating shifts between day and night-based on self-reported abdominal symptoms and sleep quality. More than 85% were women.
"Our findings suggest that nurses participating in shift work, particularly those who participate in rotating shift work, have a higher prevalence of IBS and abdominal pain. This association is independent of sleep quality," the authors write.
"We know the colon has its own biological clock and that's what increases the likelihood of having a bowel movement in the first six hours of the day," Hoogerwerf says.
"Shift work can cause chronic disruption of that biological rhythm, resulting in that clock to constantly be thrown off and needing to adjust, creating symptoms of diarrhea, boating, constipation and abdominal pain and discomfort."
The researchers say their study suggests that sleep disturbances do not completely explain the existence of IBS or abdominal pain associated with shift work.
"The question now for further research is if IBS and abdominal pain is an underlying manifestation of a circadian rhythm disorder," Hoogerwerf says.
Meanwhile, the researchers suggest "practicing gastroenterologists should be aware of this association and educate patients with IBS on the possible impact of their work schedule on their symptoms."
The Michigan Bowel Control Program offers a multidisciplinary approach with quick diagnostic testing, endoscopic procedures provided by gastroenterology physicians and colorectal surgeons, specialized pelvic floor nerve and muscle testing, surgeons with operative experience in colorectal and urogynecological interventions, pelvic floor muscle strengthening and biofeedback program provided by physical therapists and rapid reports to the patient's primary care or referring physician. http://www.med.umich.edu/bowelcontrol/index.shtml
Additional authors: Along with Hoogerwerf, Borko Nojkov, M.D., Beaumont Services Company; Joel H. Rubenstein, M.D., M.Sc., assistant professor of internal medicine at the U-M Medical School; and William D. Chey, M.D., professor of internal medicine at the U-M Medical School.
Reference: Am J Gastroenterol advance online publication 16 February 2010; doi: 10.1038/ajg.2010.48
Source
University of Michigan Health System
http://www.medicalnewstoday.com/articles/182819.php?nfid=79339
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Rome Foundation Introduces Clinical Tool For Diagnosis Of Functional Gastrointestinal Disorders
Article Date: 07 Apr 2010 - 1:00 PDT
New clinical algorithms will give physicians a practical, efficient and cost-effective aid to diagnose the frequent gastrointestinal symptoms that patients commonly bring to their primary care doctors and gastroenterologists--symptoms of functional GI disorders that are often difficult to diagnose.
Developed by the Rome Foundation and published in the April issue of The American Journal of Gastroenterology, the new tool, Diagnostic Algorithms for Common Gastrointestinal Symptoms, provides an evidence-based approach to the diagnosis of functional gastrointestinal disorders, including irritable bowel syndrome (IBS) and functional dyspepsia, by providing diagnostic pathways for common symptoms such as abdominal pain, nausea and vomiting, diarrhea and constipation. These diagnostic algorithms are based on the consensus of international experts, use standard methods and yes-no decision trees, and all end in specific diagnoses, providing clinicians with the best diagnostic strategies currently available.
"Functional gastrointestinal disorders are among the most commonly seen chronic disorders in clinical practice, affecting all regions of the digestive tract and comprising about 40 percent of gastroenterologists' diagnoses," explained Douglas A. Drossman, MD, FACG who is president of the Rome Foundation and Co-Director, UNC Center for Functional GI and Motility Disorders, at the University of North Carolina at Chapel Hill.
"Patient's don't go to their doctors complaining of IBS, or Sphincter of Oddi dysfunction," said Drossman. "They present with symptoms of abdominal pain, nausea, vomiting and constipation among others."
Accordingly, the Rome Foundation's objective for the new algorithms is a symptom-based diagnostic assessment of 15 of the most common GI symptoms that patients bring to primary care physicians as well as gastroenterologists.
"Efficient diagnoses can be challenging especially since the symptoms for these disorders often mimic one another, and arise from several areas of the GI tract," said guest editor John E. Kellow, MD, Associate Professor of Medicine, University of Sydney and Director, Gastrointestinal Investigation Unit, Royal North Shore Hospital, Sydney, Australia.
"Not only do many of these conditions lack reliable clinical signs, but also they do not exhibit structural change or biochemical abnormalities," said Kellow. "As a result, many clinicians avoid making a formal diagnosis of a specific functional GI disorder, either categorizing the disorder as 'functional', or diagnosing a wide range of disorders and symptoms as 'irritable bowel.'"
"The diagnosis of functional GI disorders should not be considered merely one of exclusion," said Kellow. "Diagnosis involves a guided algorithmic approach in order to move from symptoms to diagnosis, be it disease or symptom."
The Rome Foundation has for years recognized the limitations of the diagnostic criteria for functional GI disorders they developed known widely as "the Rome Criteria" - a standardized classification system for the functional GI disorders, which, until now, did not include a clinical application component. The new diagnostic tool is the result of a two-year collaborative process that incorporates symptom-based criteria and other diagnostic information into clinical algorithms that can be easily understood and applied in the clinical setting.
"These new algorithms offer the chance to advance the diagnostic capabilities of gastroenterologists and other healthcare practitioners by providing a clear and evidence-based roadmap to make a specific diagnosis when it comes to complex functional GI disorders," said Philip O. Katz, MD, FACG, President, American College of Gastroenterology. "Ultimately these tools will have the potential to improve the patient's experience and provide opportunities to reduce excessive testing and office visits in a quest for a definitive diagnosis and relief from their symptoms."
To Access Full-Text of Rome Foundation Algorithms
A special section of the April 2010 issue of The American Journal of Gastroenterology is devoted to the content and process of diagnostic decision making for GI symptoms. The Rome Foundation special section of the journal is organized into six separate chapters that cover the primary GI regions (esophagus, gastroduodenal, biliary, bowel, anorectal and functional abdominal pain.) Journalists can access full text of the Rome Foundation Diagnostic Algorithms for Common Gastrointestinal Symptoms by emailing press@nature.com and referencing DOI numbers which are available from the Journal Web site.
About the Rome Foundation
The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of functional gastrointestinal disorders (FGIDs). The mission of the Rome Foundation is to improve the lives of people with functional GI disorders.
About The American Journal of Gastroenterology
The American Journal of Gastroenterology is published on behalf of the American College of Gastroenterology by Nature Publishing Group. As the leading clinical journal covering gastroenterology and hepatology, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastroenterological disorders seen most often in patients.
Published with practicing clinicians in mind, AJG devotes itself to publishing timely medical research in gastroenterology and hepatology. The Co-Editors-in-Chief are William D. Chey, MD, AGAF, FACG, FACP of the University of Michigan and Paul Moayyedi, BSc, MB ChB, PhD, MPH, FRCP, FRCPC, FACG of McMaster University.
Source
American College of Gastroenterology
http://www.medicalnewstoday.com/articles/184606.php?nfid=79339
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