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Gut 2015;64:84-92 doi:10.1136/gutjnl-2013-305965
Neurogastroenterology
Original article
Increased colonic bile acid exposure: a relevant factor for symptoms and treatment in IBS
Antal Bajor1,
Hans Törnblom1,2,
Mats Rudling3,4,
Kjell-Arne Ung5,
Magnus Simrén1,2
+ Author Affiliations
1Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
3Department of Medicine, Metabolism Unit, Center for Endocrinology, Metabolism, and Diabetes, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
4Molecular Nutrition Unit, Department of Biosciences and Nutrition, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
5Department of Internal Medicine, Medicine and R&D Unit, Skaraborgs Hospital, Skövde, Sweden
Correspondence to Professor Magnus Simrén, Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden; magnus.simren@medicine.gu.se
Received 26 August 2013
Revised 18 March 2014
Accepted 21 March 2014
Published Online First 12 April 2014
Abstract
Objective Bile acids may play a role in the pathogenesis of IBS. We investigated the potential effects of bile acids entering the colon and its role in the symptom pattern in IBS.
Design We measured 75Se-labelled homocholic acid-taurine (75SeHCAT) retention, and serum levels of 7α-hydroxy-4-cholesten-3-one (C4) and fibroblast growth factor (FGF) 19 in patients with IBS (n=141) and control subjects (75SeHCAT n=29; C4 and FGF19 n=435). In patients with IBS stool frequency and form, as well as GI symptom severity were registered, and in a proportion of patients colonic transit time and rectal sensitivity were measured (n=66). An 8-week open-label treatment with colestipol was offered to patients with 75SeHCAT <20%, and the effect of treatment was evaluated with IBS severity scoring system and adequate relief of IBS symptoms.
Results Compared with controls, patients with IBS had lower 75SeHCAT values (p=0.005), higher C4c levels (C4 corrected for cholesterol) (p<0.001), but similar FGF19 levels. Abnormal 75SeHCAT retention (<10%) was seen in 18% of patients, whereas 23% had elevated C4c levels. Patients with IBS with 75SeHCAT retention <10% had more frequent stools, accelerated colonic transit time, rectal hyposensitivity, a higher body mass index, higher C4c and lower FGF19 levels. Colestipol treatment improved IBS symptoms (IBS severity scoring system 220±109 vs 277±106; p<0.01), and 15/27 patients fulfilled criteria for treatment response (adequate relief ≥50% of weeks 5–8).
Conclusions Increased colonic bile acid exposure influences bowel habit and colonic transit time in patients with IBS. A high response rate to open label treatment with colestipol supports this, but placebo-controlled studies are warranted.
http://gut.bmj.com/content/64/1/84.abstract
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Gut Microbiome Rebounds After Colonoscopy Bowel Preparation
Lara C. Pullen, PhD
January 02, 2015
Bowel cleaning that uses two separate smaller dosages of polyethylene glycol electrolyte solution appears to introduce fewer alterations to the intestinal microbiota than a bowel cleanse with a single, larger dose of MoviPrep (Salix). The split-dose protocol has also been shown in previous studies to be effective for bowel cleansing before colonoscopy.
Jonna Jalanka, MSc, from the University of Helsinki in Finland, and colleagues published the results of their gut microbiome study online December 19 in Gut.
The investigators randomly assigned 23 healthy participants into two study groups. One group received two separate 1-L doses of MoviPrep, and the other group received a single, 2-L dose of MoviPrep. Fecal samples were collected at baseline, after bowel cleansing, and at 14 and 28 days after treatment.
In general, bowel cleaning resulted in a 31-fold decrease in microbial load. Approximately one quarter (22%) of participants experienced a marked alteration in the community composition of their microbiota after bowel cleansing. The shift in the microbial community was larger in the single-dose protocol than in the double-dose protocol.
Although the gut microbiome recovered to baseline after both protocols, the recovery was more rapid in the double-dose protocol than the single-dose protocol. Patients who received the larger, single dose of polyethylene glycol required as long as 1 month to recover their gut microbiome.
Connecting Bowel Cleansing to Irritable Bowel Syndrome
Bowel cleansing before colonoscopy is considered to be safe for healthy individuals. When the patient consumes polyethylene glycol, water is mobilized into the intestinal tract. Luminal content, including intestinal bacteria, is thus washed out in the stool. The investigators noted that some of the bacterial species that were enriched after bowel cleansing were similar to those associated with irritable bowel syndrome.
Moreover, patients with irritable bowel syndrome have elevated levels of fecal serine proteases, which are believed to increase intestinal permeability and possibly lead to visceral hypersensitivity.
The single-dose protocol correlated with a larger increase in fecal serine proteases than the double dose. This finding led the researchers to speculate it may reveal a clue to the microbial changes seen with irritable bowel syndrome and other diarrheal diseases.
This work was partly funded by the Finnish Funding Agency for Technology and Innovation and the Academy of Finland, as well as an educational grant from Norgine Pharmaceuticals. One coauthor received grant support for sample collection from Norgine; was an advisory board member of Almirall, Danone and Ironwood; and received lecturing fees from Abbott and Shire. The other authors have disclosed no relevant financial relationships.
Gut. Published online December 19, 2014. Abstract
http://www.medscape.com/viewarticle/837467
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2014 FDA approvals in gastroenterology
January 6, 2015
A large number of new drugs and devices for a wide variety of indications in gastroenterology were approved by the FDA in 2014, ranging from advanced endoscopic imaging devices to multiple new drugs for inflammatory bowel disease, hepatitis C and gastrointestinal cancers.
Below we present a timeline of the most important FDA approvals in 2014 covered by Healio Gastroenterology.
FDA approved capsule endoscopy device for visualization of the colon
The FDA approved a capsule endoscopy device for visualization of the colon, giving PillCam COLON clearance under the direct denovo classification for devices with low to moderate risk that have no predicate in the marketplace, the manufacturer announced on February 3.
According to an announcement by Given Imaging Ltd., the device is designed to detect colon polyps in patients "after an incomplete optical colonoscopy with adequate preparation and a complete evaluation of the colon was not technically possible." Read more
FDA approved Entyvio for ulcerative colitis, Crohn's disease
In May, the FDA approved vedolizumab injections for the treatment of adult patients with moderate to severe ulcerative colitis and Crohn's disease who failed to achieve adequate results from standard therapies, according to a press release.
"Ulcerative colitis and Crohn's disease are debilitating diseases that impact the quality of life of those who have these conditions," Amy G. Egan, MD, MPH, acting deputy director of the Office of Drug Evaluation III in the FDA's Center for Drug Evaluation and Research, said in the release. "Although there is no cure for these conditions … approval provides an important new treatment option for patients who have had an inadequate response to conventional therapy to help control their symptoms." Read more
FDA approved Cyramza for stomach cancer
Richard Pazdur, MD
Richard Pazdur
The FDA approved ramucirumab for treatment of patients with advanced stomach cancer or gastroesophageal junction adenocarcinoma on May 25.
Ramucirumab (Cyramza, Eli Lilly), an angiogenesis inhibitor that blocks the blood supply to tumors, is indicated for patients with unresectable disease, or for those whose disease metastasized after treatment with platinum- or fluoropyrimidine-containing therapy.
"Although the rates of stomach cancer in the United States have decreased over the past 40 years, patients require new treatment options, particularly when they no longer respond to other therapies," Richard Pazdur, MD, director of the Office of Hematology and Oncology Products in the FDA's Center for Drug Evaluation and Research, said in a press release. "Cyramza is new treatment option that has demonstrated an ability to extend patients' lives and slow tumor growth." Read more
FDA approved Movantik for opioid-induced constipation
The FDA approved naloxegol, an oral therapeutic indicated for opioid-induced constipation in adults with chronic noncancer pain, on September 16.
Naloxegol (Movantik, AstraZeneca) is a peripherally acting opioid receptor antagonist, a class of drugs used to mitigate the reduction of gastrointestinal motility commonly associated with opioid use.
"Supportive care products such as Movantik can lessen the constipating side effects of opioids," Julie Beitz, MD, director of the Office of Drug Evaluation III in the FDA's Center for Drug Evaluation and Research, said in the release. Read more
FDA approved Uceris foam for ulcerative colitis
William J. Sandborn, MD
William J. Sandborn
The FDA granted tentative approval for budesonide rectal foam for the induction of remission in patients with mild to moderately active distal ulcerative colitis in September, and granted final approval in October.
The approval follows two phase 3 studies that found "a significantly greater percentage of patients receiving Uceris 2 mg rectal foam achieved remission of distal ulcerative colitis at 6 weeks compared with placebo (41.2% vs. 24%)," according to a press release.
"These trials definitively demonstrated that Uceris rectal foam is an efficacious and well-tolerated rectal therapy for the induction of remission in patients with mild-to-moderate distal UC," trial researcher William J. Sandborn, MD, chief of the division of gastroenterology, director of the IBD Center at University of California, San Diego, said in the release. Read more
FDA approved Humira for pediatric patients with Crohn's disease
The FDA approved adalimumab for the treatment of moderately to severely active pediatric Crohn's disease in patients for whom other therapies had inadequate results, the manufacturer announced in late September.
"Moderate to severe Crohn's disease is a serious chronic disorder that can impact children and adolescents in significant ways during this important stage of their lives," Jeffrey S. Hyams, MD, head of the division of digestive diseases, hepatology and nutrition, Connecticut Children's Medical Center, said in the release. "The approval of Humira for this patient population offers a new important treatment option for physicians and their patients that can help address this sometimes debilitating disease." Read more
FDA approved Relistor for patients with opioid-induced constipation, chronic noncancer pain
The FDA approved methylnaltrexone bromide subcutaneous injection for the treatment of opioid-induced constipation in patients taking opioids for chronic noncancer pain, the manufacturer announced in late September.
"Patients generally experience a rapid bowel movement following administration of methylnaltrexone, often within 30 minutes," Eugene Viscusi, MD, director of acute pain management, department of anesthesiology at Thomas Jefferson University, Philadelphia, said in a press release. "Unlike laxatives, Relistor offers patients a relatively predictable timed response for a bowel movement. Additionally, most patients describe the sensation like a normal bowel activity. These attributes of treatment with Relistor are tremendous advantages." Read more
http://www.healio.com/gastroenterology/practice-management/news/online/%7Bff49f023-d746-459c-b2ad-e5e333b11378%7D/2014-fda-approvals-in-gastroenterology
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New Criteria Would Double Fibromyalgia Cases
More than 5% of the general population could be diagnosed under new system.
Applying the proposed 2010 modified American College of Rheumatology (ACR) fibromyalgia classification criteria greatly expands the number of persons who qualify for the diagnosis compared with earlier ACR criteria. More than 5% of the general population fulfill the modified 2010 criteria, compared with less than 2% who fulfilled the 1990 and the proposed 2010 criteria, report researchers in Arthritis and Rheumatology.
The findings "do not support previous claims that the modified 2010 criteria do not result in inflated prevalence estimates," they concluded. "We have demonstrated that the prevalence of fibromyalgia varies more than four-fold with the application of different ACR fibromyalgia classification criteria sets, the lowest estimate being with the 2010 criteria and the highest with the modified 2010 criteria. Further, we have shown that there are fundamental differences in the populations identified, in terms of sex ratio and preexisting comorbid rheumatologic conditions."
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The modified 2010 classification criteria rely on self-reported pain and a simplified self-reported version of somatic symptoms, whereas previous ACR classification criteria required moderate or high levels of chronic pain using clinical judgment. A large population survey in Germany found a prevalence of fibromyalgia of 2.1% using the modified 2010 criteria.
Investigators led by Gareth T. Jones, PhD, at the University of Aberdeen in Scotland, compared three sets of fibromyalgia classification criteria -- the ACR 1990 criteria, the ACR 2010 criteria, and the ACR modified 2010 criteria -- in a general population sample of adults in northeast Scotland. Among 1,604 respondents to screening questionnaires that asked about pain, symptoms, and rheumatologic diagnoses, 104 of 269 who reported chronic widespread pain per the ACR 1990 criteria or fibromyalgia according to the ACR modified 2010 criteria accepted an invitation to attend a research clinic for a clinical examination.
Of the 104 clinic attendees, 32 (31%) met at least one set of criteria for fibromyalgia. Eleven met the ACR 1990 criteria, seven met the ACR 2010 criteria and 27 met the ACR modified 2010 criteria. Overlap was modest, with only four subjects (12.5%) meeting all three sets of criteria.
The prevalence of fibromyalgia was 1.7% according to ACR 1990 criteria, 1.2% according to ACR 2010 criteria and 5.4% according to the ACR modified 2010 criteria.
Those meeting the ACR 1990 criteria were mostly female, with a female to male ratio of 13.7 to 1. The female to male ratio was lower when using the ACR 2010 criteria (4.8 to 1) and lower still when using the ACR modified 2010 criteria (2.3 to 1).
A total of 55% who met the ACR 1990 criteria reported prior rheumatologic diagnoses, compared with 28% who met the ACR 2010 criteria and 45% who met the ACR modified 210 criteria. All who fulfilled both the ACR 2010 and the ACR modified 2010 criteria met the ACR modified 2010 criteria on the basis of a high score on the Widespread Pain Index rather than the Symptom Severity Scale.
The specificity of the ACR 2010 criteria was "near perfect," with 92 of 93 participants correctly identified from these criteria as not having fibromyalgia, the authors note. The sensitivity, however, was barely more than 50%. "The modified 2010 criteria, while exhibiting improved sensitivity (more participants positive for fibromyalgia according to the 1990 criteria were correctly identified), suffered from a decrease in specificity (fewer participants negative for fibromyalgia according to the 1990 criteria were correctly identified)," they wrote.
Before confirming the new criteria, the authors urge the ACR to consider that the new set of criteria identifies a different patient group compared with the ACR 1990 criteria, with the modified 2010 criteria influenced more by somatic symptoms rather than pain, and that "operationalization of any new criteria must be clear and unambiguous, as well as immediately implementable." They state that, "This is not currently the case."
A limitation is the modest (36%) response rate to the initial survey and the reliance on very small samples to determine prevalence. Another limitation was the use of a single clinician for the examination and case history.
The study was supported by the University of Aberdeen Development Trust from charitable donations for research in the study of fibromyalgia.
Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner
http://www.medpagetoday.com/Rheumatology/Fibromyalgia/49913?xid=nl_mpt_DHE_2015-02-07&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=ST&eun=g379602d0r&userid=379602&email=heather%40helpforibs.com&mu_id=5372841&utm_term=Daily
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Reuters Health Information
Case Report: Fecal Transplants May up Risk of Obesity Onset
By Will Boggs MD
February 17, 2015
NEW YORK (Reuters Health) - Fecal microbiota transplantation can be effective for recurrent Clostridium difficile infection, but new-onset obesity could follow transplant of stool from an overweight donor, say the authors of a case report.
"Fecal transplant has helped a lot of people who have run out of other options," Dr. Colleen R. Kelly, from Warren Alpert School of Medicine of Brown University, Providence, Rhode Island, told Reuters Health by email. "However, there is a lot we don't know in terms of side effects/risks and long-term safety."
Dr. Kelly and Dr. Neha Alang, from Newport Hospital, Rhode Island, report the case of a 32-year-old woman with recurrent C. difficile infection who received a fecal microbiota transplant from her 16-year-old daughter.
She had no further recurrence of her C. difficile infection after the transplant, according to the February 1 Open Forum Infectious Diseases online report.
Prior to her illness, she had always been of normal weight. In the 16 months after her fecal microbiota transplant, the patient reported an unintentional weight gain of 34 pounds. By 36 months post-transplant, she had gained another seven pounds despite efforts to diet and exercise.
"This patient's weight gain was dramatic and disturbing," Dr. Kelly said. "She told me she felt like a 'switch flipped' in her body after the fecal transplant, and she has been unable to get back to a healthy weight despite great efforts."
In the meantime, her daughter's weight increased from about 140 pounds (BMI=26.4) to 170 pounds.
Animal models support the notion that fecal microbiota transplantation can trigger or contribute to obesity. Unfortunately, the researchers note, they did not have microbiome sequencing to compare the patient and the donor.
Dr. Kelly also said that other factors could have contributed to her weight gain: "She was ill for a while; perhaps weight gain related to increased intake, which she kept up after getting better. . . . Perhaps genetics . . . her daughter was heavy before she was. Patient remembers going on oral contraceptives shortly after; another possible factor."
"(We) need much more research and probably a national registry to follow these patients for a period of time after fecal transplant," Dr. Kelly said. "There is a lot of excitement around fecal transplantation right now for other things; we must remember it's experimental and unproven therapy."
In the meantime, the authors recommend selecting non-overweight donors for fecal microbiota transplantation.
Dr. Ana A. Weil and Dr. Elizabeth L. Hohmann, from Massachusetts General Hospital and Harvard Medical School, Boston, wrote an editorial related to this report. They told Reuters Health in a jointly authored email, "Groups using family members or intimate partners as donors have proposed and used less rigorous lab testing and phenotyping of donors for numerous practical reasons."
"We don't yet know the entire spectrum of risks and benefits, for the short and the long term," they added. "For that reason, we should use caution in choosing donors, and more importantly in choosing patients who are deemed in need of fecal microbiota transplant (FMT). Yet, (we) would emphasize that for some patients FMT can be life-changing and even life-saving, such as patients with recurrent severe C. difficile infection."
Continue reading -
http://www.medscape.com/viewarticle/839835
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FDA approves Eclipse System for fecal incontinence in women
Richter HE, et al. Obstet Gynecol. 2015;doi:10.1097/AOG.0000000000000639.
February 13, 2015
The FDA approved marketing of the Eclipse System, a nonsurgical vaginal bowel-control system for the treatment of fecal incontinence in women, according to an agency press release.
"Current treatment options for fecal incontinence include drugs, dietary changes, exercise and surgery," William Maisel, MD, MPH, deputy director of science and chief scientist in the FDA's Center for Devices and Radiological Health, said in the release. "The Eclipse System provides an additional treatment option for women who suffer from this condition."
William Maisel
According to the release, the Eclipse System (Pelvalon) includes a balloon that is placed in the vagina and inflated to exert pressure through the vaginal wall onto the rectal area, which reduces the number of fecal incontinence episodes. It is intended to treat women aged 18 to 75 years who have at least four fecal incontinence episodes in 2 weeks. Initial fitting and inflation is performed by a clinician after which patients can inflate and deflate the device as needed at home, the release said.
The approval follows positive clinical trial data reported from the LIFE study, which demonstrated that women achieved significant improvement in fecal incontinence by objective and subjective measures.
"The Eclipse insert provides an effective low-risk treatment modality that can be used on its own or combined with other strategies to help control this devastating condition in many women," study investigator Holly E. Richter, PhD, MD, director of the division of urogynecology and pelvic reconstructive surgery at the University of Alabama, told Healio Gastroenterology.
LIFE Study
Aiming to determine the safety and efficacy of this device in women with fecal incontinence, Richter and colleagues performed a prospective, open-label trial from August 2012 to April 2014, which involved 110 women from six centers who had a history of fecal incontinence for at least 6 months and at least four fecal incontinence episodes in 2 weeks. Symptoms were measured by questionnaire and treatment diary. The intention-to-treat analysis included the 55.5% of patients who were successfully fit with the device (mean age, 60.8 ± 9.4 years), and the per-protocol analysis included patients who completed at least 7 days in the treatment diary. All patients were assessed for reduction of incontinence episodes at 1 month and invited into an extended-wear period of an additional 2 months.
Holly E. Richter
"The LIFE study results indicate that Eclipse will offer an important new therapeutic option for women with accidental bowel leakage," Richter said in a press release. "This approach to therapy typically provides immediate effectiveness and allows the patient to be a proactive partner with the provider in the management of a condition that often keeps them being active in family and societal events."
Treatment was successful in 78.7% (95% CI, 66-88) of the intention-to-treat population and in 85.7% (95% CI, 74-94) of the per-protocol population after 1 month, and 69.6% (95% CI, 56.7-80.6) of the per-protocol population had at least 75% reduction in incontinence episodes, whereas 41.1% (95% CI, 28-55) had complete continence. Regarding bowel control, 57.1% of patients reported it was "very much better" and 28.6% reported it was "much better." Of the 44 patients who completed the additional 2-month extended wear period, 86.4% (95% CI, 73-95) had treatment success. There were no serious adverse events, and the most common device-related adverse event was pelvic cramping or discomfort (22.7%), mostly occurring during fitting (64%).
A second longer-term outcome study (the LIBERATE study) will soon be underway, Richter said. – by Adam Leitenberger
Disclosure: Richter and other researchers report they have been consultants for Pelvalon. Richter also reports relationships with Kimberly Clark and UpToDate.
http://www.healio.com/gastroenterology/motility/news/online/%7B83571d6b-9e0c-47ff-9162-47b87f7e7012%7D/fda-approves-eclipse-system-for-fecal-incontinence-in-women
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Prediabetes Patients Have Fewer Gut Bugs
A change for the worse apparent in the intestinal microbiome.
by Parker Brown
Staff Writer, MedPage Today
This article is a collaboration between MedPage Today® and:
Medpage Today
SAN DIEGO -- Gut bacteria changed for the worse over time in black men who were pre-diabetic, researchers reported here.
Changes in the composition, diversity, and abundance of microbiota were already apparent for those with impaired glucose tolerance and prediabetes, said Elena Barengolts, MD, at the University of Illinois College of Medicine, who presented the study at a press conference at the Endocrine Society's annual meeting prior to its formal presentation.
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"Changes in the gut microbiota occur in the early stage of diabetes development," said Barengolts. "The gut bacteria signature -- the composition and abundance -- could be a useful tool in assessing a persons risk for developing obesity and diabetes."
Changes in intestinal bacteria were measured at 12 months and compared at baseline. The 116 participants were African-American veterans who were all in a vitamin D intervention funded by the Department of Veterans Affairs. They ranged from age 45 to 75, with an average age of 60.
They were put into one of four groups: those with a stable glucose tolerance, those with stable impaired fasting glucose or stable impaired glucose tolerance, those with worsened glucose tolerance, and those with improved glucose tolerance.
There were significant differences in bacterial composition between the first and second groups (P=0.03) at the phylum level. Bacteroidetes was higher and Firmicutes was lower with worse glycemic control in the second group. The Bacteroidetes/Firmicutes ratio was 1.9 versus 0.9 in group 1 and 2 (P=0.01) and 1.9 versus 1.1 in group 1 and 3 (P=0.04).
Proteobacteria decreased over the period in groups 2 and 4 compared to group 1 (P=0.04 for both).
At the family and genus levels, in group 2 versus group 1 there was less Prevotella, and a higher Bacteroides/Prevotella ratio in the second group at 5.6 to 2.7 (P=0.05). There was also less Enterobacteriacea (P=0.03), and more Ruminococcae (P=0.01) and Veillonelacea (P=0.02).
"We speculate that lower abundance of Prevotella may be associated with worsening glycemia, and conversely higher abundance of Akkermansia might be associated with improving glycemia, thus corroborating suggestions from previous studies," the researchers said.
Previous research has shown a relationship between diabetes and gut bacteria. And, said Barengolts, there are two studies underway, one in Italy and one in China, looking at bacteria transplant as a treatment for diabetes.
"While changes in microbiota have been described in obesity and diabetes, little is known about microbiota composition in various dysglycemic states," said the researchers. "[But] there is emerging evidence that intestinal microbiota is a contributor to the metabolic/glycemic phenotype."
Diet, especially the consumption of probiotics and prebiotics, may lead to healthier bacteria profiles, Barengolts said.
She also noted that it isn't clear from the study which direction if any the causal arrows run. "There is interaction," she said. "But what is the egg and what is the chicken? We are not able to determine."
The study was fairly small, and the results may not be generalizable. But Barengolts said that previous studies have shown similar results for those with diabetes, and that findings are consistent across different populations. "Our genome and our metabolism is predominately similar," she said.
The study was funded by the Department of Veterans Affairs.
Researchers disclosed no relevant relationships with industry.
Primary Source
Endocrine Society
Source Reference: Ciubotaru I, et al "Significant Differences in Fecal Microbiota Are Associated with Various Stages of Glucose Tolerance in African-American Male Veterans" ENDO 2015; abstract FRI-597.
http://www.medpagetoday.com/MeetingCoverage/ENDO/50373?xid=nl_mpt_DHE_2015-03-09&utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=ST&eun=g379602d0r&userid=379602&email=heather@helpforibs.com&mu_id=5372841
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Children who were classified as "selective eaters" had a higher risk of social anxiety or depression, according to the results of a small population-based study of North Carolina preschoolers.
Nancy Zucker, PhD, of Duke University, and colleagues found that children with severe selective eating (SE) were more than twice as likely to be diagnosed with social anxiety (OR 2.70, 95% CI 1.3-5.5, P=0.009) or depression (OR 2.01, CI 1.2-3.8, P=0.001) and experience high levels of depression, social anxiety and generalized anxiety symptoms compared to children without SE.
However, while children with moderate SE experienced high levels of symptoms, moderate SE was not associated with increased likelihood of psychiatric diagnoses, they wrote in Pediatrics.
Even after controlling for baseline psychiatric symptoms, these associations predicted changes in anxiety symptoms. Children with both severe and moderate SE had an almost twofold risk of generalized anxiety disorder (1.7, 95% CI 1.2-2.6, P=0.01) or symptoms of general anxiety (1.7, CI 1.2-2.5, P=0.006).
Though not involved with the study, S. Skylar Griggs, MS, RD, LDN, clinical nutrition specialist for the preventative cardiology division at Children's Hospital in Boston said that she was aware of the prevalence of selective eating in pediatrics, but not that the severity of psychopathological symptoms worsening as the selective eating became more severe.
"This finding highlights the importance of clinicians looking at selective eating as perhaps not an acute problem that will go away on its own as the child gets older but a condition that should be intervened on and monitored for progress over time," she told MedPage Today via e-mail. "As a clinician, I will be more apt to screen for selective eating behaviors in those patients with a diagnosis of anxiety and depression."
As might be expected, children with severe and moderate SE were three to five times more likely to to have conflicts regarding food (moderate SE: 3.3, 95% CI 1.6-6.8, P=0.001; severe SE: 5.1, CI 2.5-10.2, P<0.001), the authors wrote. Both groups were also associated with heightened aversion to food, as well as reduced growth. Parents of children where SE was more severe described their children as being more likely to have an oral-motor problem, such as problems with swallowing.
These issues did not remain confined to their home life, as children with severe SE were twice as likely to have behavior problems outside the home (2.1, 95% CI 1.0-4.5, P=0.05).
Co-author William Copeland, PhD, also of Duke University, told MedPage Today that while "picky eating" is a relatively common parental concern, it also means that clinicians need to gather more information about the child's emotional functioning and it is something to keep an eye out for during subsequent visits.
He added that if a child has SE, he would be the most comfortable making a referral to a behavior modification specialist for the child and the parent in order to determine the best course of treatment.
"When you're working with children this young, it's not about applying some treatment to the child – it's about learning parent response to the child and what they can do that might be helpful in resolving this situation," said Copeland. "It's more sort of a dynamic intervention and that may require more time than the pediatrician has."
Griggs said that a family-based approach was essential to reducing selective eating and that clinicians should continue to provide support and structured guidance to reduce family conflicts around food.
"It's not too late for these patients and families to get the support they need from a team of professionals," she said. "As clinicians we should continue to have the knowledge of resources available for management of SE when reported by parent at the time of a clinical visit."
Zucker and colleagues examined a cohort of 917 children aged 24 to 71 months and their designated caregivers. Exclusion criteria included mental retardation (IQ<70), autism or other pervasive developmental disorders. In-home assessments were from January 2007 to December 2010, where caregivers completed Preschool Aged Psychiatric Assessment (PAPA) was completed.
Selective eating was measured on a 3-level scale, where 0 was no restricted intake, 1 was "the child only ate within the range of his/her preferred foods" (moderate), and 2 was "eating with others was difficult because of the extreme limited range" (severe).
The study consisted of three phases: a primary care questionnaire, an in-home interview and a laboratory-based case control. A cohort of 180 children was used for the case-control study. Children with anxiety disorders were over-sampled and the remainder were healthy controls from the original cohort.
Limitations to the study include the fact that children's eating was measured by parental report and that by excluding children with pervasive developmental disorders, SE cannot be measured against this clinical background.
The authors concluded that the term "picky eating" is now obsolete and that SE implies an impairment better characterized as avoidant/restrictive food intake disorder (ARFID). This eating disorder is a new addition to the DSM-V.
Copeland suggested that they want to continue following up with this cohort to see how long these problems can extend and if they affect other areas of functioning as well. He also mentioned expanding the research to include children in middle childhood and adolescence.
"This is kind of a general risk factor, but what are the more specific predictors of having problems down the road," said Copeland. "We want to find out whether these continue to be markers for kids with emotional problems."
This study was supported by grants from the National Institute of Mental Health and funded by the National Institutes of Health (NIH).
Primary Source
Pediatrics
Source Reference: Zucker N, et al "Psychological and psychosocial impairment in preschoolers with selective eating" Pediatrics 2015; DOI: 10.1542/peds.2014-2386.
http://www.medpagetoday.com/Pediatrics/EatingDisorders/52894?xid=nl_mpt_DHE_2015-08-04&eun=g379602d0r
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Higher reported cat dander sensitization rate may explain asthma prevalence in IBS patients
September 7, 2015
Reports of sensitization to cat dander were found to be higher among patients with IBS, which may explain the high prevalence of asthma in this population, according to data presented at the AGA's 2015 James W. Freston Conference in Chicago.
Aiming to explore the relationship between aeroallergens and IBS, researchers from Singapore recruited 87 consecutive patients (48 female) referred to an allergy clinic. They completed questionnaires, skin prick tests and venipuncture to test allergic symptoms, food and aeroallergen sensitization and potential occult parasitic infections.
Overall, 26.4% of patients had asthma, 74.7% had allergic rhinitis, 42.5% had atopic eczema and 41.4% met Rome III criteria for IBS (5 patients had constipation-predominant IBS, 11 had diarrhea-predominant IBS, 15 had mixed IBS and 5 had unsubtyped IBS).
The researchers observed a significant association between IBS and cat dander sensitization based on positive skin prick tests to cat dander and specific IgE cat protein Fel d 1 (P < .05). Patients with asthma, pet owners and patients with positive skin prick tests to dog allergens were significantly more likely to have IBS, while patients with allergic rhinitis, eczema and food allergy were not.
Multivariate analyses showed asthma was independently associated with IBS (OR = 7.2; 95% CI, 1.7-29.9) and cat sensitization based on positive skin prick tests was independently associated with IBS (OR = 8.4; 95% CI, 1.7-41.3).
"IBS subjects reported a high cat dander sensitization rate, suggesting a plausible explanation of high asthma prevalence in IBS subjects," the researchers wrote. "It is important to explore the underlying pathophysiologic mechanisms and potential therapeutic options." – by Adam Leitenberger
Reference:
Siah KTH, et al. Presented at: James W. Freston Conference; August 29-30, 2015; Chicago.
http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B242228a9-6e3b-48d9-b8ca-a68c5fc57207%7D/higher-reported-cat-dander-sensitization-rate-may-explain-asthma-prevalence-in-ibs-patients
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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!
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Differences in IBS patients' microbiota more significant in feces vs. mucosa
Rangel I, et al. Aliment Pharmacol Ther. 2015;doi:10.1111/apt.13399.
September 25, 2015
Microbial composition and diversity in unprepared sigmoid colon mucosa differed insignificantly between patients with irritable bowel syndrome and healthy controls compared to the differences in the fecal microbiota between both groups, according to recent study data.
"The main objective of this study was to compare the fecal- and mucosal-associated microbiota in healthy individuals and IBS patients, respectively, as models of physiologically normal and immunologically disturbed intestinal systems," the researchers wrote. "In addition, our aim was to determine to which extent alterations in the fecal-associated microbiota in IBS, compared to healthy controls, would mirror variations in the mucosal-associated microbiota."
Mucosal biopsies from the unprepared sigmoid colon were collected from 35 IBS patients and 10 healthy controls, and fecal samples were collected the day before colonoscopy from 33 IBS patients and 16 healthy controls, resulting in 33 and eight paired samples for IBS patients and healthy controls, respectively.
Microbiota composition was analyzed using a phylogenetic microarray and redundancy discriminant analysis was used to determine differences in microbiota profile signatures.
The investigators found clear differences in microbial composition between mucosal and fecal samples of both IBS patients and healthy controls (P = .002), and while these differences were more distinct among IBS patients, there was no association found between microbiota differences and IBS clinical characteristics.
In healthy controls, there was a higher relative abundance of Bacteroidetes in mucosal samples, and a higher relative abundance of Firmicutes (Clostridium cluster XIVa) in the fecal samples (P < .05).
"Remarkably, the number of significantly different microbial groups separating the fecal- and mucosal-associated microbiota in IBS consisted of 107 genus-like bacterial groups," the researchers wrote. There was higher relative abundance of Bacteroidetes in the mucosa, and higher relative abundance of Actinobacteria, Bacilli, Clostridium clusters IV, IX and XIVa, and Proteobacteria in the feces of IBS patients (cut-off false discovery rate < .05).
The mucosal microbiota was more similar between IBS patients and healthy controls compared to the fecal microbiota of both groups, with the exception of Clostridiales I, which had sixfold higher relative abundance in the mucosa of healthy controls compared to IBS patients (1.9% vs. 0.3%; P < .005).
In IBS patients, bacterial diversity was significantly higher in fecal microbiota compared with mucosal microbiota (P < .005).
The researchers concluded that differences in the mucosal microbiota between IBS patients and healthy controls are minimal (one bacterial group) compared to differences in their fecal microbiota (53 bacterial groups), and that the microbial differences in IBS patients are more prominent in the feces compared to the mucosa. They also attributed the main differences in fecal microbiota between IBS patients and healthy controls to the diarrhea-predominant IBS subgroup, representing nearly half of the IBS cohort. – by Adam Leitenberger
http://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B6d52a107-ddf6-49ea-a9f0-009840291603%7D/differences-in-ibs-patients-microbiota-more-significant-in-feces-vs-mucosa
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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!
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