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Top 10 Questions to Ask Your Doc about IBS
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Greater Array of Gut Bugs Points to Metabolic Health
Published: Aug 29, 2013 ' Updated: Aug 30, 2013
By Kristina Fiore, Staff Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner
Individuals with reduced gut microbial gene richness present more pronounced metabolic dysfunction and low-grade inflammation.
Dietary intervention with an energy-restricted, high-protein diet improved low gene richness and clinical phenotypes, but seemed to be less efficient for inflammation variables in individuals with lower gene richness.
People who have less diversity in their intestinal microbiomes tend to be heavier and have more inflammation and metabolic dysfunction than those who have a more robust portfolio of gut bacteria, researchers found.
In an analysis of data from the European consortium MetaHIT, about a quarter of Danish patients had little bacterial richness in their guts, which was associated with greater adiposity, insulin resistance, and dyslipidemia compared with those who had a greater diversity of bugs, Oluf Pedersen, MD, of the University of Copenhagen, and colleagues reported in Nature.
"The present report provides evidence that studies of alterations in our other genome -- the microbial gut metagenome -- may define subsets of adult individuals with different metabolic risk profiles," they wrote. It may help explain some of the heterogeneity seen with adiposity-related phenotypes, they added, providing clues as to why some obese patients can still be metabolically healthy.
The team conducted DNA analysis on intestinal bacteria from 292 Danish patients, 169 of whom were obese and 123 who were not.
They found that 23% of their population had low "bacterial richness," with an average of 380,000 microbial genes, compared with an average of 640,000 genes in those who had more diverse microbiomes.
Patients with lower gene counts had greater adiposity, insulin resistance, and dyslipidemia and a more pronounced inflammatory phenotype than those with high bacterial richness.
And these patients gained significantly more weight over the previous 9 years, the researchers reported.
In terms of microbial communities, anti-inflammatory species such as Faecalibacterium, Bifidobacterium, and Lactobacillus were associated with high diversity, while inflammatory species such as Bacteroides and Ruminococcus were associated with low diversity.
It's not clear why some patients have fewer and less diverse intestinal bacteria, Pedersen and colleagues wrote, but it may have to do with diet, genetic variation, or exposure to antimicrobial agents and other common chemicals such as preservatives and disinfectants.
"We don't know what came first, the chicken or the egg, but one thing is certain: it is a vicious circle that poses a health threat," Pedersen said in a statement.
In a second study published in the same issue of Nature, French researchers found that diet can influence the gut microbiome.
In a study of 38 obese and 11 overweight patients, Stanislav Dusko Ehrlich, PhD, of the Institut National de la Recherche Agronomique in Jouy en Josas, France, and colleagues found that a 6-week, energy-restricted, high-protein diet plus 6 weeks of weight maintenance led to improvements in the number and diversity of microbial species.
That increase in gene richness was associated with decreases in adiposity, cholesterol, and inflammation, they reported.
But they warned that low baseline gene richness was still associated with greater adipose tissue inflammatory cells at 6 weeks and inflammation at 12 weeks, suggesting that initial gene richness may help predict the effectiveness of dietary interventions in heavier patients.
Still, they concluded, their findings "support a recently reported link between long-term dietary habits and the structure of gut microbiota and suggest that a permanent change of microbiota may be achieved by appropriate diet."
In an accompanying editorial, Sungsoon Fang, PhD, and Ronald Evans, PhD, of the Gene Expression Laboratory at the Salk Institute in La Jolla, Calif., said the findings suggest that gut microbial diversity may function as a new biomarker for screening for and treating metabolic disorders.
"Such a concept is promising for clinical research and pharmaceutical drug development, because it opens potential avenues for customizing drugs and reprogramming microbial ecology in individual patients," they wrote.
They cautioned, however, that there is still some debate about using a limited number of enterotypes to classify human gut bacteria, and that the findings also raise the question of whether high microbial gene complexity is "merely a reflection of metabolic health or actually offers protection against disease progression."
The MetaHIT project is supported by the European Union.
Additional support was provided by the Lundbeck Foundation, ANR MicroObes, the Metagenopolis grant, Region Ile de France, Fondacoeur, Novo Nordisk, Agence Nationale de la Recherche, KOT-Ceprodi, Danone Research, and Louis-Bonduelle.
The researchers reported no conflicts of interest.
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Add Your Knowledge ™
Primary source: Nature
Source reference: Le Chatelier E, et al "Richness of human gut microbiom correlates with metabolic markers" Nature 2013; 500: 541-549.
Additional source: Nature
Source reference:Cotillard A, et al "Dietary intervention impact on gut microbial gene richness" Nature 2013; 500: 585-590.
Additional source: Nature
Source reference:Fang S, Evans RM "Wealth management in the gut" Nature 2013; 500: 538-539.
http://www.medpagetoday.com/Endocrinology/Obesity/41265?xid=nl_mpt_DHE_2013-08-30&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g379602d0r&userid=379602&email=heather@helpforibs.com&mu_id=5372841
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Gut microbes closely linked to proper immune function, other health issues
09/17/2013
A new understanding of the essential role of gut microbes in the immune system may hold the key to dealing with some of the more significant health problems facing people in the world today, Oregon State University researchers say in a new analysis.
Problems ranging from autoimmune disease to clinical depression and simple obesity may in fact be linked to immune dysfunction that begins with a "failure to communicate" in the human gut, the scientists say. Health care of the future may include personalized diagnosis of an individual's "microbiome" to determine what prebiotics or probiotics are needed to provide balance. Appropriate sanitation such as clean water and sewers are good. But some erroneous lessons in health care may need to be unlearned –– leaving behind the fear of dirt, the love of antimicrobial cleansers, and the outdated notion that an antibiotic is always a good idea.
We live in a world of "germs" and many of them are good for us. "Asked about their immune system, most people might think of white blood cells, lymph glands or vaccines," said Dr. Natalia Shulzhenko, author of a new report in Clinical Reviews in Allergy and Immunology, and assistant professor and physician in the OSU Department of Biomedical Sciences. "They would be surprised that's not where most of the action is.
Our intestines contain more immune cells than the entire rest of our body.
http://www.mdlinx.com/gastroenterology/newsl-article.cfm/4832591/ZZ956160859472514387259/?news_id=522&newsdt=091713&subspec_id=155&utm_source=Newsletter&utm_medium=DailyNL&utm_content=General-Article&utm_campaign=Article-Section
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Research Suggests Efficacy of Diagnostic Blood Test for Irritable Bowel Syndrome (IBS)
Anti- vinculin antibodies are elevated in IBS compared to non-IBS, according to the results of the study, "Anti-Vinculin Antibodies: Multicenter Validation of a Diagnostic Test for Irritable Bowel Syndrome," which assessed anti-vinculin antibodies as a predictor of IBS as compared to healthy subjects and IBD.
Vinculin is a cell migration and adherence protein found predominantly on nerves and epithelium. A series of studies leading up to this result suggests that acute gastroenteritis causes antibodies to be formed to vinculin and is associated with IBS development.
"This is the first test that discriminated IBS from IBD," said Dr. Pimentel, Director of the Gastrointestinal Motility Program and Laboratory at Cedars-Sinai Medical Center in Los Angeles, who coauthored the multicenter study with researchers from Beth Israel Deaconess Medical GAS in Boston.
In total 165 IBS, 30 IBD and 26 healthy control subjects were evaluated. Demographics were similar between groups. Overall, IBS had a significantly greater optical density for antibodies to vinculin compared to IBD and healthy subjects. The test had a high specificity for IBS.
"Anti-vinculin antibodies are elevated in IBS compared to non-IBS," said Dr. Pimentel. "This is the first diagnostic test for IBS based on serum and a pathophysiologic mechanism of IBS through acute gastroenteritis precipitating molecular mimicry and autoimmunity. This is a major breakthrough as the first test to potentially distinguish IBS from IBD and reduce the need for unnecessary testing in these conditions. Moreover, this test is based on a potential pathophysiologic mechanism of IBS development."
"The authors have identified a potentially novel clinical biomarker for IBS, possibly of the post-infectious type," said Douglas A. Drossman MD, President of the Rome Foundation and the Center for Education and Practice of Biopsychosocial Care, LLC. "However, we need to be careful not to over interpret the significance of the findings with regard to diagnostic or therapeutic specificity. IBS is a collection of symptoms with heterogeneous determinants. Perhaps with further confirmation, anti-vinculin antibodies may in the future identify one of possibly several meaningful physiological subsets that are more amenable to targeted treatments."
http://www.newswise.com/articles/psychological-factors-like-anxiety-depression-may-be-central-drivers-of-ibs-rather-than-inflammation?ret=/articles/list&category=medicine&page=1&search[status]=3&search[sort]=date+desc&search[section]=10&search[has_multimedia]=
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Doctors Say Reid's Request For Bowel Research Money Is No Joke
by
January 16, 2014 1:29 PM
In his new memoir, former Secretary of Defense Robert Gates heaped scorn on many members of Congress for pushing their parochial interests with him.
But he saved a special dig for Senate Majority Leader Harry Reid.
"With two ongoing wars and all our budget and other issues, I didn't know whether to laugh or cry," Gates writes, describing how the Nevada Democrat urged him to have the Defense Department invest in research into irritable bowel syndrome.
It's an anecdote that drew snickers — and media attention, including here at NPR.
But was Reid's appeal to Gates really as absurd as portrayed?
Not according to doctors who treat Gulf War veterans, and researchers like those affiliated with the National Academy of Sciences' Institute of Medicine. They identify irritable bowel syndrome (IBS), which is marked by chronic cramping, bloating and diarrhea, as one of a range of illnesses that plague returning military women and men.
"If you look at the veterans coming home, and what proportion of them are becoming disabled by chronic conditions, you will see that this is not something to ignore but something to treat," says Dr. Douglas Drossman, an internationally recognized expert in gastrointestinal disorders.
"There is a bill in Congress that would provide for research on this, and I think that's why Sen. Reid came up with that request," Drossman says.
Reid's office declined to comment. But it's worth noting that the $1 trillion omnibus spending bill currently being considered by Congress includes close to a billion dollars in medical research funding for the Defense Department.
A Classified Disability
Drossman served on an Institute of Medicine committee that in 2010 determined that, in addition to post-traumatic stress syndrome, "a large number of veterans" of the 1991 Persian Gulf War were reporting long-term, multisymptom health issues. They included IBS, substance abuse, anxiety, and depression.
Evidence included in the report, "," showed a relationship between military deployment and gastrointestinal infections, and, subsequently, post-infectious IBS.
That 2010 study involved veterans of the 1991 war; ongoing studies of more recent returning veterans suggest that IBS and other multisymptom health issues continue to plague that population.
The Department of Veterans Affairs has determined that IBS is a disorder that can be classified as a disability if related to military service, even though the exact cause of the syndrome is difficult to pinpoint, says Dr. , a University of Michigan medical school professor and expert in gastroenterology, including IBS.
"The link between being a veteran and having a higher risk of IBS is unclear," says Schoenfeld, "partly because the underlying cause is unclear."
"We don't know why all of a sudden those muscles in the colon don't work properly," he says.
Stress may exacerbate symptoms by inducing chemical and hormonal changes; female veterans suffering from PTSD are much more likely to have IBS than female veterans who don't have PTSD, says Schoenfeld, who heads the gastroenterology division at a VA hospital in Ann Arbor.
Treatment ranges from anti-diarrheal medication to anti-depression agents used to mitigate pain and the brain's reaction to it, he says.
Source Of Suffering Unclear
Congress in 2010 asked the Institute of Medicine and the National Academy of Sciences to undertake a comprehensive review of best treatments for chronic multisymptom illnesses, or CMI, faced by Gulf War veterans.
, the Institute of Medicine committee confirmed that there's no consensus on the cause of CMI, including irritable bowel syndrome, and a "growing belief that no specific causal factor or agent will be identified." (Stress and crowded war theater conditions that may exacerbate the spreading of infections have been suggested as triggers for IBS.)
But researchers found that preliminary data suggest that CMI is occurring in veterans of the wars in Iraq and Afghanistan, as well as the thousands reporting post-1991 war symptoms.
Diet, lifestyle, medication, psychotherapy and hypnosis, as well as relaxation and stress management techniques, are treatments recommended to varying degrees.
"Irritable bowel syndrome is a disorder that really compromises the daily lives of veterans," Schoenfeld says.
But he says he understands Gates' position, given the issues on his desk and other, more traumatic injuries suffered by veterans.
"It's tough to put a value on what disorders need more research," Schoenfeld says. "But IBS should not be dismissed as a minor ailment that doesn't have any impact on peoples' lives."
http://www.npr.org/blogs/itsallpolitics/2014/01/16/263087761/doctors-say-reid-request-for-bowel-research-money-no-joke
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Non-GI issues exert most powerful influence on IBS patient 'wellness'
Lackner JM. Am J Gastroenterol. 2014;109:224-233.
March 31, 2014
Non-biomedical factors exerted a stronger effect on the self-reported health of patients with irritable bowel syndrome than disease symptoms themselves, according to new data.
Researchers at the University of Buffalo School of Medicine and Biomedical Sciences administered a test battery to 234 Rome III-positive irritable bowel syndrome (IBS) patients (average symptom duration, 16.2 years; mean age, 41 years; 78.2% women). In addition to gathering self-reported health (SRH) data, researchers used psychometrically validated measures to gauge well-being in three domains: somatic, psychological and social.
Most strongly correlated with SRH were somatization, depression, fatigue, stress, anxiety and medical comorbidities (P<.05). IBS symptom severity was weakly associated with SRH (P<.05). A final regression analysis linked 41.3% of the SRH score variance (P<.001) with significant predictors including fatigue, medical comorbidities, somatization and negative social interactions.
"We were actually surprised there was not a stronger relationship between IBS symptoms and self-reported health," Jeffrey M. Lackner, PsyD, director of the University of Buffalo Behavioral Medicine Clinic, said in a press release. "Oftentimes, patients' perceptions are at odds with medical reality. It's a much more complex, cognitive process that factors in a number of medical and social factors that are not necessarily on a physician's radar screen."
http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7Ba802ac1d-7cd4-4c89-b5b1-1d4dce8f6afb%7D/non-gi-issues-exert-most-powerful-influence-on-ibs-patient-wellness
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Patients with painful constipation, IBS tended to be younger than those without pain
Rey E. Am J Gastroenterol. 2014;doi:10.1038/ajg.2014.18.
March 28, 2014
Patients with chronic constipation, with or without irritable bowel syndrome, tended to present without pain, but those who experienced pain were generally younger, more constipated, and more symptomatic than those without pain in a recent study.
Researchers in Spain conducted a telephone survey of 1,500 random individuals (51% women; aged 18 years and older) in June 2011. Only one person in each home was interviewed, using the validated Spanish-language version of the Rome III questionnaire. General quality of life data were captured on the short form-12 (SF-12), and participants answered the quality of life in constipation-20 (CVE-20) questionnaire.
Chronic constipation (CC) prevalence was 19.2% (95% CI, 17.2-21.2%), while in subgroup analysis, 209 respondents were classified with nonpainful CC (prevalence, 13.9%; 95% CI, 12.2-15.7%), 30 with painful CC (prevalence, 2%; 95% CI, 1.3-2.7%) and 49 patients with CC with irritable bowel syndrome (IBS; prevalence, 3.3%; 95% CI, 2.4-4.2).
CC was more prevalent in women than men (27.6% vs. 10.6%), and researchers said patients "with painful CC and CC in patients with IBS were younger, reported more constipation, and had more symptoms" than patients with nonpainful CC. In multivariate analysis, physical activity and age were significantly associated with CC.
Those with nonpainful CC reported greater success with laxatives than the other subgroups. Patients with CC were more impaired on the physical (P<.001) and mental (P<.001) scales of the SF-12 questionnaire. There were no significant differences in CVE-20 between groups.
"CC appears to be a spectrum: most patients do not have abdominal pain/discomfort but others (with otherwise quite similar characteristics) are patients with IBS or fall outside any established diagnosis," the researchers wrote.
http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B354e8e6d-6c2c-423f-8dd4-98c55b0ffd68%7D/patients-with-painful-constipation-ibs-tended-to-be-younger-than-those-without-pain?addnw=1
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IBS aggregated in families, along with spouses
Waehrens R. Gut. 2014;doi:10.1136/gutjnl-2013-305705.
April 11, 2014
A genetic component for increased risk for irritable bowel syndrome was observed among first- second- and third-degree relatives along with an increased non-genetic risk factor among spouses, according to a nationwide family study in Sweden.
In the largest register-based family study of irritable bowel syndrome (IBS), researchers linked the Swedish Multigeneration Register to the Hospital Discharge Register (1987-2010) and the Swedish Outpatient Care Register (2001-2010) to analyze 51,962 individuals with IBS.
IBS odds ratios for relatives of individuals who had an IBS diagnosis were calculated and compared with relatives of unaffected individuals. Investigators also calculated ORs for IBS cases recorded in primary health care in four Swedish counties (2001-2007).
ORs for IBS were (all 95% CI):
1.75 in siblings (1.63-1.89)
1.82 in offspring (1.67-1.97)
1.9 in parents (1.76-2.05)
1.1 in maternal half-siblings (0.88-1.39)
1.78 in paternal half-siblings (1.48-2.15)
1.27 in nieces/nephews (1.18-1.38)
1.11 in cousins (1.04-1.18)
1.51 in spouses of probands diagnosed with IBS (1.24-1.84)
In primary health care, the OR for probands diagnosed with IBS was 1.82 in siblings (1.52-2.18, and 1.82 in offspring (1.49-2.21).
Researchers posed a number of possible explanations for the increased odds of IBS among spouses, including shared family environmental exposures and shared positive and negative life events.
"Assortative mating could also contribute to the association among spouses," the investigators wrote. "Thus, individuals with IBS may be more likely to marry individuals with similar health problems. Moreover, spouses of individuals with IBS may also be more likely to seek medical attention."
http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B3397fd41-c360-46a0-8064-1e400120f681%7D/ibs-aggregated-in-families-along-with-spouses
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Good Vibration(s) for Constipation?
Meeting Coverage
DDW Roundup: Constipation, Celiac Disease, Gastroparesis
Published: May 11, 2014
By Charles Bankhead, Staff Writer, MedPage Today
The study of the vibrating capsule involved 28 patients with chronic idiopathic constipation or constipation-subtype irritable bowel syndrome. The patients had a median age of 47 (range 19 to 65), and women accounted for all but three of the patients.
The capsule houses a tiny receiver and vibrating mechanism and is activated by an external transmitter. When activated, the device generates three pulses per minute in the colon, approximating normal peristalsis.
All patients discontinued use of laxatives for 2 weeks prior to enrollment. They swallowed two capsules per week for 2 weeks and kept daily records of bowel movements. The capsule was activated remotely 6 hours after intake.
All but two patients completed the study, said Yishai Ron, MD, of Tel-Aviv Sourasky Medical Center in Israel. The average number of spontaneous bowel movements increased from about two per week at baseline to almost four at the end of the study (P<0.0001). Three patients required rescue medication more than once during the run-in and study periods.
Two patients reported adverse events: one patient complained of abdominal pain, diarrhea, and flatulence and the other reported feeling muscle twitches in the abdominal wall.
"This was a safety trial mandated by the Israeli government," Ron told MedPage Today. "We showed that the device is safe. The clinical results are very favorable, but the study involved few patients and did not have a control group. The efficacy of the device must be evaluated in a randomized trial involving a larger number of patients."
http://www.medpagetoday.com/MeetingCoverage/DDW/45711?xid=nl_mpt_DHE_2014-05-12&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&eun=g379602d0r&userid=379602&email=heather@helpforibs.com&mu_id=5372841
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Colonic bile acid exposure influenced IBS symptoms, therapy
Bajor A. Gut. 2014;doi:10.1136/gutjnl-2013-305965.
ay 15, 2014
Patients with irritable bowel syndrome, primarily those who were nonconstipated, had elevated levels of colonic bile acid that was indicative of abnormal 75Se-labeled homocholic acid-taurine retention and high 7 alpha-hydroxy-4-cholesten-3-one serum levels in a recent study.
Swedish researchers enrolled 141 patients (mean age, 35.3 years; 72.3% women) with irritable bowel syndrome (IBS), who were subclassified as IBS-diarrhea predominant (IBS-D; n=65), IBS-constipation predominant (IBS-C; n=26) and alternating IBS (IBS-A; n=50). They measured patients for 75Se-labeled homocholic acid-taurine (75SeHCAT) retention, serum levels of 7 alpha-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor (FGF19).
The IBS cohort had lower 75SeHCAT retention values (28 ± 19% vs. 39 ± 18%; P=.005) at 7 days than 29 healthy controls without GI symptoms, and IBS patients displayed greater levels of C4c than controls (n=435) when adjusted for cholesterol (P<.001). FGF19 was considered similar.
Eighteen percent of IBS patients demonstrated abnormal 75SeHCAT retention (<10%), and 30 of 133 evaluable patients had high C4c values. Those with abnormal 75SeHCAT retention had more frequent stools (2.9 vs. 2.1 stools/daily; P=.01), greater BMI (26 vs. 23.1 kg/m2; P=.002), accelerated colonic transmit time (0.9 vs. 1.9 days; P=.007), rectal hyposensitivity (48.7 vs. 38.9 mm Hg; P=.008) and C4c values (11.5 vs. 3.7 mg/mol; P=.02), and lower FGF19 levels (99.2 vs. 149.7 pg/mL; P=.002) than IBS patients with 75SeHCAT retention greater than 10%.
IBS patients (n=27) treated with colestipol for up to 8 weeks showed improved IBS Severity Severity Scoring System grades (P<.01), including 15 patients who met treatment response criteria of at least 50% adequate relief of weeks 5 through 8.
"Our findings … strengthen the involvement of increased bile acid exposure in the colon as a partial mechanism for symptom generation in patients with especially nonconstipated IBS, that is, IBS-D and IBS-A," the researchers concluded. "The positive symptomatic response to open label treatment with bile acid binders in patients with IBS with low 75SeHCAT values supports a role of bile acids in IBS symptomatology, but placebo-controlled studies are warranted."
http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B46b70fe3-d645-48bf-b29b-899c7f150fab%7D/colonic-bile-acid-exposure-influenced-ibs-symptoms-therapy
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