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Constipation and Laxative Use Found to Increase Colon Cancer Risk new
      #131899 - 12/20/04 01:30 PM
HeatherAdministrator

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12.10.04 -- Constipation and Laxative Use Found to Increase Colon Cancer Risk


By Greg Arnold, DC, CSCS, September 30, 2004, abstracted from "Constipation, laxative use and risk of colorectal cancer: The Miyagi Cohort Study" in the September 2004 issue of the European Journal of Cancer

Constipation is one of the most common gastrointestinal complaints in the United States, resulting in about 2 million doctor visits annually. According to the 1996 National Health Interview Survey, about 3 million people in the United States suffer from constipation, particularly women and adults aged 65 and over.1

Constipation's role as a risk factor for colon cancer has received inconsistent reviews in the literature. While a review found a significantly increased risk between constipation and colon cancer,2 the only prospective cohort study ever conducted did not support an association between constipation and colon cancer.3

Regardless of the risk, patients turn to laxatives to help treat their constipation, with laxative sales exceeding $500 million each year.4 Now a new study5 suggests that constipation coupled with laxative use is a risk for colon cancer.

Researchers studied questionnaires completed by nearly 42,000 Japanese men and women 40-64 years old. The questionnaire asked about education, personal and family history of cancer and other diseases, health habits, including frequency of bowel movements, laxative use, smoking, alcohol consumption, diet and physical activity.

The researcher found a "modest, marginally significant, association" between constipation and colon cancer. They also found an increased risk between laxative use and colon cancer, agreeing with previous studies.6 While constipation is thought to contribute to colon cancer due to the increased the time ammonium acetate in waste has to be absorbed by the body,7 laxatives are thought to contribute to cancer risk because of their ingredients.8

When looking at ways to remedy this situation, we can look to fiber intake among Americans. The National Center for Health Statistics9 states that Americans eat an average of 5 to 14 grams of fiber each, far short of the 20 to 35 grams recommended by the American Dietetic Association.

Supplementation can be very effective in helping Americans increase their daily fiber intake. One such supplement is psyllium husk fiber, with one tablespoon providing 7 grams of fiber. Recent research has found psyllium to exhibit anti-cancer properties, with 3.5 grams of psyllium per day helping to prevent colon cancer.10

Reference:
1 National Library of Medicine's National Digestive Diseases Information Clearinghouse (NDDIC) website http://digestive.niddk.nih.gov/ddiseases/pubs/constipation/index.htm

2 Sonnenberg, A. and A.D. Muller, Constipation and cathartics as risk factors of colorectal cancer: a meta-analysis. Pharmacology, 1993. 47 Suppl 1: p. 224-33

3 Dukas, L., et al., Prospective study of bowel movement, laxative use, and risk of colorectal cancer among women. Am J Epidemiol, 2000. 151(10): p. 958-64

4 Murray, M. Natural Alternatives to OTC and Prescription Drugs, Morrow, NY, 1994, p. 196

5 Watanabe, T., et al., Constipation, laxative use and risk of colorectal cancer: The Miyagi Cohort Study. Eur J Cancer, 2004. 40(14): p. 2109-15

6 Wu, A.H., et al., Alcohol, physical activity and other risk factors for colorectal cancer: a prospective study. Br J Cancer, 1987. 55(6): p. 687-94

7 Zarkovic, M., et al., Tumor promotion by fecapentaene-12 in a rat colon carcinogenesis model. Carcinogenesis, 1993. 14(7): p. 1261-4

8 Borrelli, F., et al., Effect of bisacodyl and cascara on growth of aberrant crypt foci and malignant tumors in the rat colon. Life Sci, 2001. 69(16): p. 1871-7

9 National Center for Health Statistics. Dietary Intake of Macronutrients, Micronutrients, and Other Dietary Constituents: United States, 1988-94. Vital and Health Statistics, Series 11, number 245. July 2002

10 Bonithon-Kopp, C., et al., Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. European Cancer Prevention Organisation Study Group. Lancet, 2000. 356(9238): p. 1300-6

http://www.nowfoods.com/?action=itemdetail&item_id=42677

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Salt intake and smoking play major roles in GERD new
      #131909 - 12/20/04 02:11 PM
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Salt intake and smoking play major roles in GERD

Heartburn experts praised a Norwegian study but add that there is not yet enough evidence to eliminate dietary restrictions on alcohol, coffee and tea consumption.
By Victoria Stagg Elliott, AMNews staff. Dec. 13, 2004.


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

The usual bits of advice -- that gastroesophageal reflux disease patients give up on alcohol, coffee and tea -- may not actually be words of wisdom, according to a study published in this month's Gut.

Scandinavian researchers analyzed data from two extensive public health surveys of thousands of people in Norway. They found that smoking, long considered a culprit in causing GERD, increased the risk of the disease by 70%. The use of table salt, which has never been implicated in this condition, also increased the risk by 70%.

Alcohol, coffee and tea intake did not appear to make a difference. Dietary fiber and regular exercise seemed to be protective.

"The present study indicates an important role for exogenous exposures in the form of lifestyle-related factors in the etiology of GERD," wrote the authors.

Heartburn experts widely praised the study for taking a closer look at the eating, drinking and other activities that may play a role in the disease's development and for suggesting a research path that might lead to prevention strategies.

"This study brings up the under-appreciated point that lifestyle-related factors may bring on the very common symptoms of heartburn," said A. Mark Fendrick, MD, a member of the medical advisory board of the National Heartburn Alliance and professor of internal medicine and health management and policy at the University of Michigan Medical School. "And maybe we can try to prevent the disease process from starting."

Primary care physicians appreciated the paper because it adds weight to the argument that their patients, particularly if they have reflux, should quit smoking, reduce their salt intake, eat fiber and exercise.

"The conclusions for this article really kind of go along with what we need to be promoting in primary care anyway," said Joel Heidelbaugh, MD, clinical assistant professor in the Dept. of Family Medicine at the University of Michigan and a co-author of his institution's GERD management guidelines.

Continuing questions

Experts said, however, that while these were intriguing data, it would be premature to advise GERD patients, many of whom may have cut out or reduced coffee, tea and alcohol intake, to now return to their old ways.

"This is going to raise new questions" said Dr. Heidelbaugh. "But one study is not going to change everybody's mind."

Smoking and use of table salt increase GERD risks 70%.
Meanwhile, critics suggested that some of the conclusions may not be that generalizable to the United States, and that, although the belief that alcohol, tea and coffee play a role in GERD is not backed by much science, it is supported by experience.

"I would love to see this survey duplicated here or across several nations," said Edward Zurad, MD, a family physician from Tunkhannock, Pa. "In our American population, both from a pragmatic and anecdotal standpoint, we believe that there is a causal connection."

Some experts also questioned the conclusions.

They said this population-based case control study supported the idea that there was an association between these lifestyle factors and GERD, but not whether one caused the other. This study also relied on patient self-reporting of symptoms rather than a physician-confirmed diagnosis.

"These are important associations, but they don't necessarily tell us about risk because there may be other confounders that they didn't consider," said Charlene Prather, MD, a gastroenterologist and associate professor of medicine at Saint Louis University School of Medicine.

Experts also suggested that salt or fiber intake could be indicators of other players in the condition such as the amount of fat in a diet.

"Dietary fiber may just be a surrogate marker for a lower-fat diet, and we do know that higher fat increases your risk for reflux disease," said Dr. Prather. "Also, perhaps people who salt their food are people who eat higher-fat food?"

This study adds to the growing body of literature about lifestyle factors that may lead to the development of the disease, but physicians working with GERD patients concede there is still little evidence that changing these factors can make a difference once symptoms occur.

Also, by the time patients approach physicians with questions about reflux, they have usually tried lifestyle changes and over-the-counter remedies and are looking for something more advanced.

"Most of our patients when they come to us really want to go to sophisticated pharmacologic approach in addition to a review of lifestyle changes," said Dr. Zurad.


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


ADDITIONAL INFORMATION:
When life leads to reflux
Objective: Determine which lifestyle habits are associated with the development of gastroesophageal reflux disease.

Participants: More than 3,000 people with GERD symptoms and more than 40,000 without who participated in two large public health surveys in Nord-Trondelag, Norway.

Methods: Using a case control design, the data were analyzed to develop odds ratios linking GERD with smoking and exercise as well as with the consumption of alcohol, coffee, tea, table salt and fiber.

Results: People who smoked for more than 20 years or always used extra table salt were 70% more likely to have reflux symptoms. No association was found between reflux and coffee, tea or alcohol. Eating bread high in dietary fiber and regular exercise appeared to be protective.

Conclusions: Smoking and excess salt intake are risk factors for GERD. A diet high in fiber and regular exercise may be protective. Alcohol, coffee and tea, which have long been viewed as aggravators of this condition, may not play a role.

Source: Gut, December


http://www.ama-assn.org/amednews/2004/12/13/hlsb1213.htm

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New Risk for Asthma, Allergy Found in the Gut new
      #136194 - 01/07/05 04:53 PM
HeatherAdministrator

Reged: 12/09/02
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New Risk for Asthma, Allergy Found in the Gut

Changes in gut bacteria and fungi may increase chances of problems


THURSDAY, Dec. 23 (HealthDayNews) -- Do you have the guts to resist allergies and asthma?

A University of Michigan study says changes in the bacteria and fungi (microflora) in the gastrointestinal tract may intensify immune system response to common allergens inhaled into the lungs. This can result in an increased risk of developing chronic asthma or allergies.

"Our research indicates that microflora lining the walls of the gastrointestinal tract are a major underlying factor responsible for the immune system's ability to ignore inhaled allergens. Change the microflora in the gut and you upset the immune system's balance between tolerance and sensitization," study author Gary Huffnagle, an associate professor of internal medicine and of microbiology and immunology, said in a prepared statement.

He and a colleague tested this theory in a mouse they developed that mimics how some humans develop allergies after taking antibiotics, which can upset the balance of gut microflora.

The study appears in the January issue of Infection and Immunity .

"If lungs are repeatedly exposed to an allergen, regulatory T-cells (immune cells that can moderate immune system response) learn to recognize the allergen as not dangerous and something that can be safely ignored," Huffnagle said.

"Most researchers think that tolerance develops in the lungs, but we believe it actually occurs in the gut. When immune cells in the GI tract come in contact with swallowed allergens, that interaction triggers the development of regulatory T-cells, which then migrate to the lungs," he said.

More information

The Cleveland Clinic Foundation has more about allergies .

SOURCE: -- Robert Preidt, University of Michigan Health System, news release, Dec. 23, 2004

http://www.healthscout.com/template.asp?ap=1&page=newsdetail&id=523011

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Suicide in IBS patients emphasizes need for improvements in treatment new
      #136210 - 01/07/05 05:47 PM
HeatherAdministrator

Reged: 12/09/02
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Background & Aims: Irritable bowel syndrome (IBS) traditionally is considered as more of a nuisance than having especially serious consequences. However, this is not the picture witnessed in tertiary care where we have encountered some tragic cases, prompting an assessment of suicidal ideation in such patients.

Methods: One hundred follow-up, tertiary care IBS (tIBS) patients were compared with 100 secondary IBS (sIBS), 100 primary IBS (pIBS) care patients, and 100 patients with active inflammatory bowel disease (IBD). Patients were asked if they had either seriously contemplated or attempted suicide specifically because of their bowel problem as opposed to other issues. The hospital anxiety depression score was recorded, as were other clinical details on all patients.

Results: A total of 38% of tIBS patients had contemplated suicide because of their symptoms compared with 16% and 4% in the sIBS and pIBS groups (tIBS vs. sIBS vs. pIBS, P = .002, P < .001). The figure for IBD was 15% (tIBS v. IBD, P < .001). Five tIBS and 1 IBD patient had attempted suicide for gastrointestinal reasons. Mean depression scores did not exceed threshold (10) in the sIBS group contemplating suicide (9.7), but were increased in the equivalent tIBS group (11.7). Hopelessness because of symptom severity, interference with life, and inadequacy of treatment were highlighted as crucial issues for all IBS patients.

Conclusions: IBS has the potential for a fatal outcome from suicide with depression not accounting for all the variance in suicidal ideation. Our observations emphasize the level of hopelessness felt by these patients and the need for improvement in the services provided to them.

Copyright © 2004 by American Gastroenterological Association

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Irritable bowel syndrome: colonoscopy painful and difficult? new
      #136212 - 01/07/05 05:50 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
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Med Klin (Munich). 2004 Dec 15;99(12):713-8.

Irritable bowel syndrome: colonoscopy painful and difficult?

Nattermann C, Fimmers R, Bayer B.

Hochtaunus-Kliniken gGmbH, Medizinische Klinik, Usingen. chnattermann@hotmail.com

BACKGROUND AND PURPOSE: Hyperalgesia induced by pelvic colon distension has been demonstrated in patients with irritable bowel syndrome (IBS). In this study the authors analyzed whether colonoscopy of patients with IBS is more painful and technically more demanding as compared to non-IBS patients.

PATIENTS AND METHODS: In a prospective study 639 patients (132 with IBS, 507 without IBS) who underwent colonoscopy were evaluated for sex, age, body mass index, administration of sedatives and analgesics, time for cecal intubation, intensity of pain during examination (intensity graduated 1-5), diagnosis and degree of diverticulosis, spasticity, loop formation, elongation and distortion, respectively. A statistical comparison of both patient groups was performed.

RESULTS: Patients of the IBS group were significantly younger compared with patients in the control group (p < 0.001). In an age-matched comparison of both groups low pain (intensity 1) was noted in 29 (22%) of IBS patients and 82 patients (31%) in the control group. Severe pain (intensity 4 and 5) occurred in 17 (12.9%) and six (4.5%), respectively, of IBS patients and in 21 (8%) and five patients (2%), respectively, of the control group. The differences were statistically not significant (p = 0.1). Administration of analgesics occurred significantly more frequently in the IBS group (p = 0.01), however, only nine IBS patients (6.8%) and four patients without IBS (1.5%) received analgesics. All other parameters analyzed did not show significant differences between the groups.

CONCLUSION: Regarding perception of procedure-related pain and technical problems in colonoscopy, patients with IBS do not show significant differences compared to patients without IBS.

PMID: 15599681 [PubMed - in process]

http://www.docguide.com/news/content.nsf/PaperFrameSet?OpenForm&refid=2&id=48DDE4A73E09A969852568880078C249&c=&newsid=8525697700573E1885256F6E0074EA17&u=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15599681&ref=/news/content.nsf/SearchResults?openform&Query=ibs&so=date&id=48DDE4A73E09A969852568880078C249

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Treatment of irritable bowel syndrome with colonic pacing new
      #136214 - 01/07/05 05:53 PM
HeatherAdministrator

Reged: 12/09/02
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Hepatogastroenterology. 2004 Nov-Dec;51(60):1708-12.

Treatment of irritable bowel syndrome with colonic pacing: evaluation of pacing parameters required for correction of the "tachyarrhythmia" of the IBS.


Shafik A, Shafik AA, Ahmed I, el-Sibai O.

Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Cairo, Egypt. shafik@ahmed-shafik.org

BACKGROUND/AIMS: A recent study of the electromyographic (EMG) activity of irritable bowel syndrome (IBS) has shown that the frequency, amplitude and conduction velocity of the slow waves (SWs) of the sigmoid colon (SC) were significantly higher in IBS patients than in the healthy volunteers. The SW rhythm was irregular. A "tachyarrhythmic pattern" was characteristic of the IBS. The SC pressure in the IBS was also significantly higher than that of the healthy controls. We suggested that the cause of IBS is related to an aberrant focus in one or more of the colonic pacemakers which possibly triggers abnormal impulses to the colon. We hypothesized that stimulation of the pacemaker which delivers electric waves to the SC, may correct the abnormal electric waves and eliminate the IBS symptoms. In this communication we tried to define the adequate pacing parameters necessary for normalization of the tachyarrhythmic pattern of the electric waves in IBS.

METHODOLOGY: Nineteen subjects with IBS were divided into a study group (age 48.6+/-9.8 years; 7 women, 4 men) and a control group (age 47.6+/-9.2 years; 5 women, 3 men). The study also included 8 healthy volunteers (47.9+/-9.7 years; 5 women). Three 28-gauge cardiac pacing electrodes were used: one for pacing applied to the pacemaker at the colosigmoid junction (CSJ) and 2 for recording applied to the SC mucosa. In the study group, the CSJ electrode was stimulated using an electrical stimulator which delivered a constant current. The optimal pacing parameters had been determined after repeated trials with different variables. In the control group, recording was done without pacemaker activation. The SC pressure was measured by a 10-F saline-perfused tube.

RESULTS: In the healthy volunteers, the basal SWs were regular and followed or superimposed by action potentials (APs). Pacing produced a significant increase in the SW variables and SC pressure; the latency was 20.3+/-3.6 s. The study and the control group exhibited a basal tachyarrhythmic pattern and a significantly higher SC pressure than the healthy volunteers. Pacing of the study group effected lowering of the SW variables and SC pressure which did not show a significant difference against those of the healthy volunteers at rest. The optimal pacing parameters comprised an amplitude of 6 mA, a pulse width of 150 ms and a 25% higher frequency than that of the already recorded basal colonic waves. The control group showed no change in the tachyarrhythmic pattern.

CONCLUSIONS: CS pacing parameters were identified and succeeded in normalizing the tachyarrhythmic pattern of the IBS. We suggest that this method be used for the treatment of patients with IBS when other measures have failed to cure the condition.

PMID: 15532810 [PubMed - in process]

http://www.docguide.com/news/content.nsf/PaperFrameSet?OpenForm&refid=2&id=48DDE4A73E09A969852568880078C249&c=&newsid=8525697700573E1885256F4900362EDF&u=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=15532810&ref=/news/content.nsf/SearchResults?openform&Query=ibs&so=date&id=48DDE4A73E09A969852568880078C249

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Stress Increases Visceral Sensitivity in IBS Patients new
      #136221 - 01/07/05 06:13 PM
HeatherAdministrator

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Stress Increases Visceral Sensitivity in IBS Patients

NEW YORK (Reuters Health) Dec 30 - Acute stress appears to alter gut-specific efferent autonomic innervation in patients with irritable bowel syndrome (IBS) and in healthy controls. However, UK researchers report that only IBS patients show heightened visceral sensation.

"Stress is an important causative factor in IBS," Dr. Anton V. Emmanuel, of St. Mark's Hospital, Harrow and colleagues note in the December issue of Gastroenterology. However, "it remains unknown whether stress-related changes in gut function are mediated by altered autonomic efferent gut-specific innervation."

The researchers examined the effect of acute physical and psychological stress on autonomic innervation and visceral sensitivity in 24 patients with constipation-predominant IBS and 12 healthy controls.

Baseline perception of stress was higher among patients with IBS. During physical stress, rectal mucosal blood flow, a measure of gut-specific innervation, decreased by 29.6% in IBS patients and 28.7% in controls. During psychological stress, the corresponding decreases were 24.4% and 23.5%.

During physical stress, patients with IBS experienced decreased rectal perception thresholds compared to controls (23.2% versus 0.6%) as well as decreased and rectal pain thresholds (27.0% versus 1.3%).

During psychological stress, patients with IBS had reduced thresholds for rectal perception (19.4% versus 8%) and rectal pain (28.4% versus 3.4%). They also had increased anal perception thresholds during physical and psychological stress.

"Visceral sensitivity but not somatic sensitivity is heightened in patients with IBS in response to stress," Dr. Emmanuel and colleagues conclude." This, they add suggests "involvement of a different regulator mechanism, either central or peripheral."

Gastroenterology 2004;127:1695-1703.


http://www.medscape.com/viewarticle/496750?src=mp

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Diagnostic Criteria for Irritable Bowel Syndrome - Family Practice Doctors Unaware of Guidelines new
      #136222 - 01/07/05 06:20 PM
HeatherAdministrator

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

Diagnostic Criteria for Irritable Bowel Syndrome: Utility and Applicability in Clinical Practice

R. Lea, V. Hopkins, J. Hastleton, L.A. Houghton, P.J. Whorwell

Medical Academic Department, South Manchester University Hospitals, Manchester, UK


Digestion 2004;70:210-213 (DOI: 10.1159/000082891)

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

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Abstract

Background/Aims: Symptom-based criteria have been introduced to aid the diagnosis of irritable bowel syndrome (IBS). Although they have been widely adopted and have proved useful for research purposes by ensuring homogeneity of study populations, there is little information about their utility in routine clinical practice. It was the aim of this study to assess the applicability of the Manning, Rome I and Rome II criteria in the clinical setting and to ascertain how often hospital specialists and general practitioners (GPs) use them.

Methods: Hundred secondary-care IBS patients were assessed for their conformity to these criteria. Forty-eight hospital specialists and 68 GPs were asked about their knowledge and utilization of these criteria.

Results: Seventy-three percent of IBS patients met Rome II diagnostic criteria with 82 and 94% meeting Rome I and Manning, respectively.

Approximately 80% of GPs had no knowledge of any of the specific criteria, and only 4% had ever used them. The majority of specialists had knowledge of the criteria, with 70% having used them.

Conclusion: The Rome II criteria are remarkably insensitive and if rigidly applied in the clinical situation would lead to much diagnostic uncertainty. The current lack of interest in them, especially amongst GPs, is unlikely to change unless they can be considerably improved.

Copyright © 2004 S. Karger AG, Basel


http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ProduktNr=223838&Ausgabe=230654&ArtikelNr=82891

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10% to 20% of older adults have IBS new
      #141619 - 01/23/05 05:05 PM
HeatherAdministrator

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

Irritable bowel syndrome

10% to 20% of older adults have symptoms
consistent with diagnosis

Although irritable bowel syndrome (IBS) is a common disorder, IBS is
traditionally considered to be a condition that primarily affects young
and middle-aged adults. However, increasing evidence suggests that
prevalence of IBS in older adults may be similar to that in younger
adults; therefore, the diagnosis should be considered when a geriatric
patient presents with unexplained abdominal symptoms. Because
incidences of other conditions with similar symptoms are higher in the
geriatric population, use of certain diagnostic tests (eg, colonoscopy) is
warranted in this patient population. In addition, because older adults
are more likely than younger adults to suffer from comorbid conditions,
polypharmacy is common in this patient population, and this should be
considered when diagnosing and treating these patients.

Ehrenpreis ED. Irritable bowel syndrome in older adults. Geriatrics 2005; 60(Jan):25-28.

http://www.mdlinx.com/GILinx/thearts.cfm?artid=1141420&specid=13&ok=yes

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High interdigestive and postprandial motilin levels in patients with the irritable bowel syndrome
      #147267 - 02/06/05 02:12 PM
HeatherAdministrator

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

Neurogastroenterology and Motility
Volume 17 Issue 1 Page 51 - February 2005
doi:10.1111/j.1365-2982.2004.00582.x


High interdigestive and postprandial motilin levels in patients with the irritable bowel syndrome

M. Simrén, E. S. Björnsson & H. Abrahamsson

Abstract

Motilin shows cyclic variation with the different phases of the migrating motor complex (MMC). (Motilin is a 22 amino acid peptide secreted by endocrinocytes in the mucosa of the proximal small intestine. Based on amino acid sequence, motilin is unrelated to other hormones. Motilin participates in controlling the pattern of smooth muscle contractions in the upper gastrointestinal tract.)

Altered motilin levels have been found in irritable bowel syndrome (IBS) patients, but in these studies motilin levels were analysed without the knowledge of the phases of MMC. We included 13 healthy controls (HC) and 24 patients with IBS [12 diarrhoea-predominant (IBS-D) and 12 constipation-predominant (IBS-C)].

We performed interdigestive and postprandial antroduodenojejunal manometry and blood samples for analysis of motilin were drawn. Group differences in plasma levels of motilin were analysed during mid-phase II, just before the start of phase III (pre-III), during phase I, immediately before the meal and 30 and 60 min after the 500 kcal mixed meal. Higher motilin levels were observed in IBS vs HC in both the interdigestive and postprandial periods (P < 0.05). No significant differences between IBS-C and IBS-D were observed. The cyclic variation of motilin during MMC and the meal response was similar in IBS and controls. IBS patients, irrespective of the predominant bowel habit, demonstrate higher motilin levels than HCs in all phases of the MMC and also after a meal. These findings may bear some pathophysiological importance in IBS and relate to the gastrointestinal dysmotility often seen in these patients.


http://www.blackwell-synergy.com/links/doi/10.1111/j.1365-2982.2004.00582.x/abs/

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