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Familial aggregation of irritable bowel syndrome new
      #29619 - 12/01/03 05:49 PM
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Gut 2003;52:1703-1707
© 2003 by BMJ Publishing Group Ltd & British Society of Gastroenterology

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FUNCTIONAL BOWEL DISEASE

Familial aggregation of irritable bowel syndrome: a prospective study
J S Kalantar1, G R Locke, III2, A R Zinsmeister3, C M Beighley3 and N J Talley4
1 Department of Medicine, University of Sydney, Australia
2 Division of Gastroenterology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
3 Division of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, MN, USA
4 Division of Gastroenterology and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN, USA, and Department of Medicine, University of Sydney, Australia


Correspondence to:
Professor N J Talley
Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; talley.nicholas@mayo.edu


ABSTRACT
Background: Patients with irritable bowel syndrome (IBS) often report family members with similar symptoms, but family studies are lacking. We hypothesised that if there is familial aggregation, there would be an increased frequency of IBS in first degree relatives of IBS patients compared with relatives of controls (the patient's spouse).

Methods: A valid self report bowel disease questionnaire (BDQ) that recorded symptoms, the somatic symptom checklist (a measure of somatisation), and a family information form (FIF) to collect the names and addresses of all first degree relatives were mailed to two groups of patients and their spouses (patients attending an IBS educational programme and residents of Olmsted County, Minnesota, who had been coded as IBS on a database). A BDQ was then mailed to all first degree relatives of subjects identified from the FIF. IBS diagnosis in the relatives was based on the Manning criteria.

Results: The BDQ was sent to a total of 355 eligible relatives; 71% responded (73% relatives of patients, 67% relatives of spouses). Relatives were comparable in mean age, sex distribution, and somatisation score. IBS prevalence was 17% in patients' relatives versus 7% in spouses' relatives (odds ratio adjusted for age and sex 2.7 (95% confidence interval (CI) 1.2, 6.3)). When also adjusted for somatisation score, the odds ratio was reduced to 2.5 (95% CI 0.9, 6.7).

Conclusions: Familial aggregation of IBS occurs, supporting a genetic or intrafamilial environment component, but this may be explained in part by familial aggregation of somatisation.

http://gut.bmjjournals.com/cgi/content/abstract/52/12/1703

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Overlapping upper and lower GI symptoms in IBS patients with constipation or diarrhea new
      #29620 - 12/01/03 05:51 PM
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Volume 98 , Issue 11 , Pages 2454-2459


Overlapping upper and lower gastrointestinal symptoms in irritable bowel syndrome patients with constipation or diarrhea

Nicholas J. Talley b * , Eslie Helen Dennis a , V. Ann Schettler-Duncan a , Brian E. Lacy c , Kevin W. Olden d and Michael D. Crowell c

Received: 1/16/2003. Accepted: 5/20/2003.



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Abstract

Objectives


Distinguishing between irritable bowel syndrome (IBS) and functional dyspepsia can be challenging because of the variations in symptom patterns, which commonly overlap. However, the overlap is poorly quantified, and it is equally uncertain whether symptom patterns differ in subgroups of IBS arbitrarily defined by primary bowel patterns of constipation (IBS-C) and diarrhea (IBS-D). We aimed to determine and to compare the distribution of GI symptoms, both, upper and lower, among IBS-C and IBS-D patients.


Methods


A total of 121 consecutive patients presenting with a diagnosis of IBS were grouped according to primary bowel symptoms as IBS-C (58 women and 18 men, mean age 47 ± 17 yr) or IBS-D (26 women and 19 men, mean age 47 ± 15 yr). The Hopkins Bowel Symptom Questionnaire, which includes a brief Quality of Life assessment, and the Hopkins Symptom Checklist 90-Revised were completed by all patients at intake.


Results


IBS-C patients reported significantly more overall GI symptoms when compared to patients with IBS-D (6.67 vs 4.62, respectively, p < 0.001). Abdominal pain patterns differed in patients with IBS-C versus IBS-D (lower abdominal pain: 40.8% vs 24.4% p = 0.05 and upper abdominal pain: 36.8% vs 24.4%, respectively). Bloating was substantially more common in IBS-C patients (75%) than in IBS-D (40.9%). There were no significant differences in personality subscales by IBS subgroup; however, somatization was positively associated with multiple symptom reports and was negatively correlated with quality of life.


Conclusions


Upper GI symptoms consistent with functional dyspepsia were more frequent in IBS-C. Although there was considerable overlap of upper and lower GI symptoms in patients with IBS-C and IBS-D, the former had more frequent lower abdominal pain and bloating.





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Affiliations:
a Mayo Foundation, Mayo Medical School, Rochester, Minnesota, USA. b Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. c Mayo Foundation and Medical School, Scottsdale, Arizona, USA. d Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA.


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Copyright
© 2003 Am. Coll. of Gastroenterology

http://www.medicinedirect.com/journal/journal/article?acronym=AMGAST&format=abstract&uid=PIIS0002927003007056

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Colonic Propulsive Impairment in Intractable Slow-Transit Constipation new
      #32155 - 12/16/03 12:03 PM
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Colonic Propulsive Impairment in Intractable Slow-Transit Constipation

Gabrio Bassotti, MD, PhD; Fabio Chistolini, MD; Francis Sietchiping Nzepa, MD; Antonio Morelli, MD


Arch Surg. 2003;138:1302-1304.
Vol. 138 No. 12, December 2003

Hypothesis:

Intractable constipation, especially of the slow-transit subtype, may represent several pathophysiologic entities with a common final symptomatic appearance. An overall impairment of colonic propulsive activity may represent a major disease mechanism.

Design: Case series.

Setting: Tertiary university hospital.

Subjects: Twenty-nine severely constipated patients with clinical and homogeneous features of slow-transit constipation that were unresponsive to conventional medical measures and 16 age-matched healthy volunteers.

Interventions: Twenty-four–hour manometric recordings obtained in patients and controls to assess high- and low-amplitude colonic propulsive activity.

Results: Compared with controls, patients showed heavily reduced high-amplitude propagated activity (average, <1 event per subject per day). No differences were found in low-amplitude propagated activity.

Conclusions: Patients with severe constipation that is refractory to medical treatment may display an important reduction of colonic forceful propulsive activity. This may justify a surgical approach, which may offer the best results in such patients. It is, however, important to obtain thorough physiologic documentation before such a drastic approach is considered. The residual low-amplitude propulsive activity might represent a partially compensatory mechanism in these patients. Studies in more homogeneous groups of such patients are needed.


From the Gastroenterolgy and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia Medical School, Perugia, Italy.

http://archsurg.ama-assn.org/cgi/content/abstract/138/12/1302



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Abnormal Colonic Propagated Activity in Patients with Constipation new
      #32160 - 12/16/03 12:07 PM
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Abnormal Colonic Propagated Activity in Patients with Slow Transit Constipation and Constipation-Predominant Irritable Bowel Syndrome

Gabrio Bassotti, Fabio Chistolini, Gabriele Marinozzi, Antonio Morelli

Gastroenterology and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy


Digestion 2003;68:178-183 (DOI: 10.1159/000075554)


Background: The pathophysiological basis of constipation is still unclear, and the role of colonic dysfunction is debated, especially in irritable bowel syndrome. Objective data are quite scarce, especially concerning colonic propulsive activity. Aims: To evaluate high- and low-amplitude colonic propulsive activity in constipated patients (slow-transit type and irritable bowel syndrome) in comparison with normal controls. Patients and Methods: Forty-five constipated patients (35 with slow-transit constipation and 10 with constipation-predominant irritable bowel syndrome) were recruited, and their data compared to those of 18 healthy subjects. Twenty-four-hour colonic manometric recordings were obtained in the three groups of subjects, and data concerning high- and low-amplitude colonic propulsive activity were then compared. Results: High-amplitude propagated contractions were significantly (p < 0.05) decreased in patients with slow-transit constipation and constipation-predominant irritable bowel syndrome with respect to controls (1.5 ± 0.4, 3.7 ± 2, and 6 ± 1 events/subject/day, respectively). In slow-transit constipation, a significant decrease of contractions' amplitude was also observed. Concerning low-amplitude propagated contractions, patients with slow-transit constipation had significantly less events with respect to patients with constipation-predominant irritable bowel syndrome (46 ± 7 vs. 87.4 ± 19, p = 0.015); no differences were found between patients with slow-transit constipation and controls and between patients with constipation-predominant irritable bowel syndrome and controls. All three groups displayed a significant increase of low-amplitude propagated contractions after meals (6.3 ± 2 vs. 18.2 ± 5 for controls, p < 0.005; 6.4 ± 1.4 vs. 16.3 ± 2.4 for slow-transit constipation, p < 0.005; 10.5 ± 3.2 vs. 32.6 ± 7 for constipation-predominant irritable bowel syndrome, p = 0.001). Conclusions: Low-amplitude propagated contractions may represent an important physiologic motor event in constipated patients, reducing the severity of constipation in patients with irritable bowel syndrome and preserving a residual colonic propulsive activity in patients with slow-transit constipation.

Copyright © 2003 S. Karger AG, Basel

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ProduktNr=223838&Ausgabe=229844&ArtikelNr=75554

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Faecal incontinence - Many treatment options now exist new
      #32168 - 12/16/03 12:17 PM
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BMJ 2003;327:1299-1300 (6 December), doi:10.1136/bmj.327.7427.1299


Faecal incontinence - Many treatment options now exist for this embarrassing condition

Faecal incontinence, not a glamorous area of medicine, has changed markedly in its recognition and management over the past 10 years. Patients and doctors can talk about it now as the taboo is disappearing. Pathophysiology is better understood, helped by advances in imaging. Treatments are improving as they move away from invasive sphincter surgery as an early step to the use of simple pharmacological treatments, behavioural techniques, injectable biomaterials, and, when necessary, minimally invasive surgery.

Faecal incontinence affects both sexes and all age groups. Approximately 2% of the adult population have it on a frequent basis.1 The commonest cause of faecal leakage is probably degeneration of the delicate smooth muscle of the internal anal sphincter—the muscle that maintains sphincter closure.2 The commonest cause in young women is obstetric anal sphincter damage. Most sphincter damage is occult; approximately a third of first vaginal deliveries result in endosonographically identifiable structural sphincter damage; about a third of these are associated with new bowel symptoms of faecal incontinence or urgency.3 Forceps delivery is the greatest risk factor; others are a large baby, occipito-posterior position, and a prolonged second stage of labour. The same risk factors apply to the 1% of vaginal deliveries complicated by a recognised third degree tear.4

Structural damage to the sphincter can also result from surgery. This may be an unavoidable consequence of necessary treatment such as in the care of an anal fistula. Or it may result from anal dilatation, an outmoded form of treatment for chronic fissure or constipation.

In elderly people, especially those in care, faecal impaction is a common cause of leakage. Many factors contribute to this process, including constipating medications and poor mobility.5 Children with faecal impaction leak stool. Others have impaired continence after correction of congenital anorectal abnormalities.

A complete history, examination for sphincter damage or faecal impaction, and correction of predisposing factors, can lead to successful treatment in many patients. If further investigation is required anal endosonography has become the standard means of imaging the anal sphincter, and is now available in most specialist centres.6 It enables identification of structural damage and degenerative disorders of the sphincter muscles. When sepsis involves the sphincter complex, such as in complex perianal fistulas or Crohn's disease, magnetic resonance imaging provides accurate information.

Factors contributing to continence include the integrity of the sphincter muscles, the force of bowel contraction, consistency of stools, and cognitive factors. Each of these can act as a suitable target for treatment. Most commonly a combination of treatments is useful. For example, for patients with urge faecal incontinence, learning to overcome a sense of panic, sustain contraction of the sphincter, and titrate loperamide can lead to marked improvement in the symptom sometimes even when there is structural damage to the sphincter.7

Drugs that diminish the force of bowel contractions and enhance absorption of luminal colonic water can transform bowel control and the ability to function socially. Loperamide is effective in patients with symptoms of either urgency or leakage. The wide therapeutic to toxic ratio makes this a very safe drug in adults and one that should be titrated to achieve control of symptoms. If one capsule is too constipating patients can use smaller doses of the syrup formulation.

Topical application to the perianal skin is an alternative pharmacological approach. Topical phenylephrine, which increases the tone of the sphincter smooth muscle, is under development.8

Behavioural techniques have transformed the management of this condition.9 Even in patients with structural damage it is often possible to improve continence substantially, which implies that there is often an element of reversibility and that a complex combination of factors contributes to continence.7 9

A recent randomised study examined which component of behavioural treatment was most important.7 Treatment with bowel focused counselling, including advice on resisting urgency and titrating loperamide, was as effective as providing the patient with real time feedback—biofeedback—about sphincter function. The pharmacological treatment, advice, and nature of the interaction between therapist and patient seemed to be more important than the technical aspects of treatment.

In institutionalised elderly patients a combination of treatments is most likely to be fruitful, including attention to medications, regular toileting, and sometimes use of gentle laxatives.5 When non-invasive treatments have failed minimally invasive treatments can be considered. Injection of silicone biomaterial can improve leakage caused by a weak internal anal sphincter.10 Surgery should be reserved for patients with major incontinence that has failed to respond to conservative treatment and is necessary in only very few patients. However, no operation is capable of restoring the sphincter to its original finely tuned state.

An overlap repair of the sphincter is still the first line surgical treatment for major disruption of the sphincter due to obstetric causes, especially if there is loss of the perineal body. However, although the short term results are good, the long term results are less satisfactory.11

More invasive procedures include the artificial bowel sphincter or repositioning the gracilis muscle as a neo-sphincter around the anal canal.12 Both operations have a substantial learning curve, a success rate of about 50% in good hands, and are associated with considerable morbidity. Another treatment undergoing evaluation is radiofrequency ablation at the anorectal junction, a process that may induce fibrosis and prevent neurally mediated sphincter relaxations.

An alternative to sphincter surgery entails modulating the neural control of the lower bowel and sphincter. Chronic low amplitude stimulation of sacral nerves, via percutaneously inserted fine wire electrodes, is substantially less invasive than sphincter surgery and has proved successful.13

The socially disabling symptom of faecal incontinence is usually amenable to simple and inexpensive treatments. General practitioners need to be familiar with the condition, initiate treatment, or obtain help from continence advisers. Surgeons need to exhaust conservative treatments before proceeding to surgery and be realistic about the outcome of surgery. Healthcare providers need to establish multiskilled regional centres offering a range of diagnostic and treatment expertise.

Michael A Kamm, professor of gastroenterology

St Mark's Hospital, Watford Road, Harrow HA1 3UJ
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Competing interests: MK has acted as an adviser to Curon, Johnson and Johnson, Medtronic, and Uroplasty, and has received financial support from SLA Pharma.

References:

Perry S, Shaw C, McGrother C, Matthews RJ, Assassa RP, Dallosso H, et al. Prevalence of faecal incontinence in adults aged 40 years or more living in the community. Gut 2002;50: 480-4.[Abstract/Free Full Text]
Vaizey CJ, Kamm MA, Bartram CI. Primary degeneration of the internal anal sphincter as a cause of passive faecal incontinence. Lancet 1997;349: 612-5.[CrossRef][ISI][Medline]
Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal-sphincter disruption during vaginal delivery. N Engl J Med 1993;329: 1905-11.[Abstract/Free Full Text]
Sultan AH, Kamm MA, Hudson CN, Bartram CI. Third degree obstetric anal sphincter tears: risk factors and outcome of primary repair. BMJ 1994;308: 887-91.[Abstract/Free Full Text]
Potter J, Norton C, Cottenden A, eds. Bowel care in older people. Research and practice. London: Royal College of Physicians of London, 2002.
Law PJ, Kamm MA, Bartram CI. Anal endosonography in the investigation of faecal incontinence. Br J Surg 1991;78: 312-4.[ISI][Medline]
Norton C, Chelvanayagam S, Wilson-Barnett J, Redfern S, Kamm MA. Randomized controlled trial of biofeedback for fecal incontinence. Gastroenterology (in press).
Cheetham, Kamm MA, Phillips RKS. Topical phenylephrine increases anal canal resting pressure in patients with faecal incontinence. Gut 2001;48: 356-9.[Abstract/Free Full Text]
Norton C, Kamm MA. Anal sphincter biofeedback and pelvic floor exercises for faecal incontinence in adults - a systematic review. Aliment Pharmacol Ther 2001;15: 1147-54.[CrossRef][ISI][Medline]
Kenefick NJ, Vaizey CJ, Malouf AJ, Norton CS, Marshall M, Kamm MA. Injectable silicone biomaterial for faecal incontinence due to internal anal sphincter dysfunction. Gut 2002;51: 225-8.[Abstract/Free Full Text]
Malouf AJ, Norton CS, Engel AF, Nicholls RJ, Kamm MA. Long term results of overlapping anterior anal sphincter repair for obstetric trauma. Lancet 2000;355: 260-5.[CrossRef][ISI][Medline]
Madoff RD, Rosen HR, Baeten CG, LaFontaine LJ, Cavina E, Devesa M, et al. Safety and efficacy of dynamic muscle plasty for anal incontinence: lessons from a prospective multicenter trial. Gastroenterology 1999;116: 549-56.[ISI][Medline]
Kenefick NJ, Vaizey CJ, Cohen RCG, Nicholls RJ, Kamm MA. Medium-term results of permanent sacral nerve stimulation for faecal incontinence. Br J Surg 2002;89: 896-901.[CrossRef][ISI][Medline]


Prevalence of faecal incontinence
Peter J Elton
bmj.com, 8 Dec 2003

http://bmj.bmjjournals.com/cgi/content/full/327/7427/1299

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Intestinal gas distribution determines abdominal symptoms new
      #32181 - 12/16/03 12:27 PM
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Gut 2003;52:1708-1713

Intestinal gas distribution determines abdominal symptoms

H Harder1,*, J Serra1, F Azpiroz1, M C Passos1,**, S Aguadé2 and J-R Malagelada1

1 Digestive System Research Unit, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain

2 Department of Nuclear Medicine, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain


Correspondence to:
Dr F Azpiroz
Digestive System Research Unit, Hospital General Vall d'Hebron, 08035-Barcelona, Spain;



ABSTRACT
Background: Patients with functional gut disorders manifest poor tolerance to intestinal gas loads but the mechanism of this dysfunction is unknown.

Aim: Our aims were firstly, to explore the relative importance of the amount of intestinal gas versus its distribution on symptom production, and secondly, to correlate gut motility and perception of gas loads.

Subjects: Fourteen healthy subjects with no gastrointestinal symptoms.

Methods: In each subject a gas mixture was infused (12 ml/min) either into the jejunum or rectum for one hour during blocked rectal gas outflow, and subsequently gas clearance was measured over one hour of free rectal evacuation. We measured abdominal perception, distension, and gut tone by duodenal and rectal barostats.

Results: Similar magnitude of gas retention (720 ml) produced significantly more abdominal symptoms with jejunal compared with rectal infusion (perception score 4.4 (0.4) v 1.5 (0.5), respectively; p<0.01) whereas abdominal distension was similar (15 (2) mm and 14 (1) mm girth increment, respectively). Jejunal gas loads were associated with proximal contraction (by 57 (5)%) and colonic loads with distal relaxation (by 99 (20)%).

Conclusion: The volume of gas within the gut determines abdominal distension whereas symptom perception depends on intraluminal gas distribution and possibly also on the gut motor response to gas loads.

© 2003 by BMJ Publishing Group Ltd & British Society of Gastroenterology

http://gut.bmjjournals.com/cgi/content/abstract/52/12/1708

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Irritable Bowel Syndrome's Possible Genetic Link new
      #35694 - 01/07/04 11:40 AM
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Wed Dec 10 14:48:40 2003 Pacific Time

Irritable Bowel Syndrome's Possible Genetic Link Studied by Mayo Clinic Researchers

ROCHESTER, Minn., Dec. 10 (AScribe Newswire) -- Researchers at Mayo Clinic studying irritable bowel syndrome say their study of people with this disorder suggests genetic factors may play a role.

Irritable bowel syndrome is a common problem affecting about one in 10 adults. However, many people don't talk about irritable bowel syndrome, which causes abdominal cramping, constipation and diarrhea. The study, which is published in the December issue of Gut, an international journal in gastroenterology, shows that the risk of having irritable bowel syndrome is nearly double in the families of people with the disorder.

"The next challenge is determining nature versus nurture," said G. Richard Locke, M.D., a Mayo Clinic gastroenterologist and one of the authors of the study. "Is this due to a gene or genes or is it due to a shared environmental factor? Our group is active in investigating these issues."

In developing the study, researchers noted that people with irritable bowel syndrome often report family members with similar symptoms. The researchers hypothesized that if there is a familial connection, there would be an increased frequency of irritable bowel syndrome in direct relatives of irritable bowel syndrome patients compared to relatives of people without irritable bowel syndrome.

Others who conducted the study include Jamshid Kalantar, M.D., Alan Zinsmeister, Ph.D., Christopher Beighley, and Nicholas Talley, M.D., Ph.D. Dr. Kalantar was a research fellow at Mayo Clinic during the study, but is now with the Department of Medicine, University of Sydney, Australia. Mr. Beighley now works in West Virginia. The others are with Mayo Clinic in Rochester.

In the study, patients with irritable bowel syndrome seen at Mayo Clinic and their spouses filled out a bowel disease questionnaire and provided the names and addresses of their direct relatives. Researchers then sent a bowel disease questionnaire to 355 relatives of the patients and their spouses, and 71 percent responded. Irritable bowel syndrome occurred in 17 percent of the patients' relatives compared with 7 percent in spouses' relatives.

http://www.ascribe.org/cgi-bin/spew4th.pl?ascribeid=20031210.142614&time=14%2048%20PST&year=2003&public=1

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Electric activity of the colon in irritable bowel syndrome new
      #35700 - 01/07/04 11:52 AM
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Journal of Gastroenterology and Hepatology

The Official Publication of the Asian Pacific Association for the Study of the Liver and the Asian Pacific Association of Gastroenterology

Edited by:
R.K. Tandon


Print ISSN: 0815-9319
Online ISSN: 1440-1746
Issues per Volume: Monthly
Current Volume: 19
ISI Journal Citation Reports® Ranking: 2002: 25/47 (Gastroenterology & Hepatology)
Impact Factor: 1.521



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Table of Contents > Issue > Abstract

Volume 19: Issue 2

Electric activity of the colon in irritable bowel syndrome: The 'tachyarrhythmic' electric pattern

AHMED SHAFIK
OLFAT EL-SIBAI
ALI A SHAFIK
ISMAIL AHMED




Abstract

Background and Aim:
The etiology of irritable bowel syndrome is unknown. It presents with crampy abdominal pain associated with alternating constipation and diarrhea but with no anatomic abnormality on diagnostic testing. Because the condition is related to motility disturbance, the hypothesis that a disorder of the colonic electromyographic activity is responsible for the colonic motile disorders in irritable bowel syndrome, was investigated.

Methods:
The electromyographic activity of the sigmoid colon was recorded transcutaneously in 18 patients with irritable bowel syndrome (49.6 ± 10.2 years, 12 women) and 14 healthy volunteers (47.2 ± 9.9 years; eight women) by applying three electrodes to the abdominal skin below the umbilicus. The sigmoid colon pressure was measured by means of a saline-perfused tube connected to a pneumohydraulic capillary infusion system.

Results:
Slow waves with a regular rhythm were recorded in the healthy volunteers exhibiting the same frequency, amplitude and conduction velocity from all three electrodes. Action potentials (AP) were not registered. The basal sigmoid colon pressure was interrupted by bouts of elevation. In irritable bowel syndrome, the electromyographic rhythm was irregular and the slow wave variables were higher than those of the normal volunteers and were not the same from the three electrodes; occasional AP were also recorded. The sigmoid colon basal pressure was significantly higher, and was interrupted by pressure bouts significantly higher, than those of the volunteers.

Conclusions:
Irritable bowel syndrome exhibited a 'tachyarrhythmic' pattern of electromyographic activity with higher slow wave variables than normal and occasional AP. The resulting elevated basal colonic pressure and tone may explain some of the irritable bowel syndrome symptoms. Because diagnostic testing of the irritable bowel syndrome shows no anatomic abnormalities, it is suggested that the cause of irritable bowel syndrome is related to an abnormal focus in one or more of the colonic pacemakers emitting these abnormal waves. However, further studies are required to verify these findings.



Article Type: Original Article
Page range: 205 - 210

http://www.blackwellpublishing.com/abstract.asp?ref=0815-9319&vid=19&iid=2&aid=14&s=&site=1



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Visceral perception thresholds in irritable bowel syndrome new
      #35704 - 01/07/04 11:56 AM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Journal of Gastroenterology and Hepatology

The Official Publication of the Asian Pacific Association for the Study of the Liver and the Asian Pacific Association of Gastroenterology

Edited by:
R.K. Tandon


Print ISSN: 0815-9319
Online ISSN: 1440-1746
Issues per Volume: Monthly
Current Volume: 19
ISI Journal Citation Reports® Ranking: 2002: 25/47 (Gastroenterology & Hepatology)
Impact Factor: 1.521



--------------------------------------------------------------------------------

Table of Contents > Issue > Abstract

Volume 19: Issue 2
Visceral perception thresholds after rectal thermal and pressure stimuli in irritable bowel syndrome patients

YANQING LI
YANMEI WANG
XIULI ZUO
YUTING GUO
HAIYAN ZHANG
XUEFENG LU
JUNMAN LI
PAUL V DESMOND




Abstract

Background and Aim:
Visceral hypersensitivity has been shown to be present in irritable bowel syndrome (IBS). The current study sought to compare the characteristics of visceral perception thresholds after rectal thermal and pressure stimuli between IBS patients and healthy subjects.

Methods:
A total of 46 patients with IBS were diagnosed using Rome II criteria. Thirteen healthy individuals participated in the study. Rectal visceral perception thresholds were examined in patients with IBS and in normal controls after thermal and pressure stimuli. Subjects were asked to report the sensation type, location, and spread.

Results:
Compared with healthy subjects, IBS patients demonstrated significantly initially lower perception thresholds and defecation thresholds to rectal thermal and pressure stimuli, particularly in patients with diarrhea-predominant IBS. Ice stimuli on the abdominal wall had varied effects on symptoms in patients with IBS and did not affect perception thresholds.

Conclusions:
Visceral perception thresholds were decreased significantly after rectal thermal and pressure stimuli in patients with IBS. Visceral hypersensitivity may be one of the important pathogenic mechanisms in IBS.



Article Type: Original Article
Page range: 187 - 191

http://www.blackwellpublishing.com/abstract.asp?ref=0815-9319&vid=19&iid=2&aid=11&s=&site=1



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IBS Subgroups by Bowel Habit Predominance new
      #41032 - 01/26/04 03:13 PM
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IBS Subgroups by Bowel Habit Predominance

Lin Chang, MD

Although there are symptom-based Rome II diagnostic criteria for IBS and for the subgroups of IBS with diarrhea and IBS with constipation, the subgroup criteria are not evidence-based and were developed using expert opinion.

A study was performed to develop a symptom-based algorithm to classify patients with IBS into 3 subgroups: IBS with constipation, IBS with diarrhea, and IBS with alternating symptoms.[15] Similar to the methodology used in the previously mentioned IBS study assessing burden of illness,[8] clinical characteristics and gastrointestinal symptoms were gathered in an IBS patient population comprising members of the Intestinal Disease Foundation (n = 1340). Expert opinion was used to define symptom criteria for each subgroup. A hierarchical classification algorithm was developed based on the frequency of patients experiencing a combination of relevant gastrointestinal symptoms (diarrhea, constipation, and other Rome symptom criteria for IBS and functional constipation). The classification of patients with IBS by this algorithm was then compared with that determined by the Rome II criteria for subgroup classification. Of the 657 (49%) members who responded to the survey, 430 (65%) had IBS. The symptom-based algorithm classified 40% with IBS with diarrhea, 33% with IBS with constipation, and 12% with IBS alternating symptoms. Using the Rome II criteria, 31% had IBS with diarrhea, 10% had IBS with constipation, 41% had IBS with alternating symptoms, and 18% were unclassified.

The study authors concluded that the symptom-based algorithm was "more reflective" of the estimated prevalence of IBS subgroups in the general population. A few relevant points should be considered when interpreting these results: (1) the symptoms used in the algorithm consist of more constipation symptoms than diarrhea symptoms, and therefore may bias the classification towards IBS with constipation; (2) there are only symptom-based Rome II criteria for IBS with diarrhea and IBS with constipation, but not IBS with alternating symptoms; therefore, patients who do not meet criteria for IBS with diarrhea or IBS with constipation are in an intermediate group with no absolute criteria -- this may explain the significant number of unclassified IBS patients; and (3) the symptoms used to determine subgroups in the algorithm were based on expert opinion and were not evidence-based.

A study by Locke and colleagues[16] specifically addressed the symptom profile in a community population that self-reported having alternating constipation and diarrhea. Four thousand twenty-nine randomly selected households were sent gastrointestinal symptom questionnaires and 2718 respondents were eligible for the analysis; 9.2%, 2.5%, and 7.6% of respondents reported their usual bowel pattern as constipation, diarrhea, or alternating diarrhea and constipation, respectively. The respondents were not required to meet diagnostic criteria for IBS (ie, presence of chronic or recurrent abdominal pain or discomfort associated with altered bowel habits). In general, self-report of bowel pattern approximated symptom criteria. Eighty-three percent of individuals with self-reported constipation met constipation symptom criteria; 67% of individuals self-reporting diarrhea met criteria for diarrhea. Among those individuals with alternating bowel habits (mean age 54 years, 63% women), 59% met symptom criteria for constipation, 35% met criteria for diarrhea, 20% met criteria for both, and 25% did not meet criteria for either. Predictive symptoms of alternators were incomplete evacuation and the presence of mucus.

Clearly, additional studies need to be performed to more accurately classify patients with IBS into bowel habit subgroups and characterize symptoms in patients with IBS with alternating symptoms (which is lacking in the literature). But first, it should be determined whether subclassifying IBS into these subgroups is even clinically relevant for patient care and research studies, given the fluctuation of IBS symptoms over time.

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http://www.medscape.com/viewarticle/463421

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