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Top News in Gastroenterology
Fecal transplantation may not improve IBS symptoms
Reuters Health News ' August 21, 2018
Fecal microbiota transplantation (FMT) increases microbial diversity but does not improve symptoms in patients with irritable bowel syndrome (IBS), according to results from a placebo-controlled study.
The microbiome of the gastrointestinal tract is thought to play a role in IBS, and FMT has yielded benefits in other conditions where altered microbial diversity is important.
Dr. Andreas Munk Petersen from Copenhagen University Hospital Hvidovre, in Denmark, and colleagues assessed the effects of FMT in a double-blind, placebo-controlled trial of 52 adult patients with moderate-to-severe IBS. FMT (or placebo) was administered as 25 capsules every morning for 12 days, preceded by a bowel cleansing corresponding to that performed before colonoscopy.
At 3 months, the placebo group showed a significantly greater improvement in IBS disease severity (as measured by the IBS-severity scoring system, or IBS-SSS) than did the FMT group (mean improvement, 125.71 points vs 52.45 points; P=0.012).
Eight patients in the FMT group (36.4%) experienced at least 50-point improvements in IBS-SSS score compared with 19 patients in the placebo group (79.2%) at 3 months, the researchers report in Gut, online August 4.
On average, patients in the placebo group experienced significantly greater improvement in quality of life (16.50 points), compared with patients in the FMT group (7.22 points).
Patients receiving FMT capsules had increases in microbial biodiversity to that matching the fecal donors, whereas placebo patients remained indistinguishable from their pretreatment state.
Microbial diversity did not correlate with IBS-SSS scores.
"No clinical trials have compared FMT delivery routes in IBS, and further trials are needed to determine if a change in delivery route could have an effect on FMT treatment success in these patients," the researchers note.
"There is no evidence for FMT providing symptomatic benefit in patients with IBS in this trial," they conclude. "Although our study shows a better effect of a bowel cleansing than a bowel cleansing followed by FMT treatment on IBS symptoms, we still believe that FMT can be the way forward."
Dr. Stefano Di Bella of the University Hospital of Trieste, Italy, who recently reviewed the role of FMT in inflammatory bowel disease, told Reuters Health by email, "FMT is not a panacea. Increased fecal microbial diversity is not always a synonym of intestinal 'health.'"
"We do not know the pathogenesis of IBS; therefore, the results are not really surprising," said Dr. Di Bella, who was not involved in the study. "The concept of 'dysbiosis' is too generic to be associated with IBS."
He added, "The results of this study could be a starting point to 're-think' the IBS pathogenesis."
Dr. Petersen did not respond to a request for comments.
"Will Boggs, MD
https://www.mdlinx.com/gastroenterology/top-medical-news/article/2018/08/21/7542281
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Scientists find that hundreds of gut bacteria are electric
13 September 2018
By Maria Cohut
Fact checked by Jasmin Collier
New research uncovers a surprising fact about numerous types of gut bacteria: they can generate electricity.
Hundreds of bacteria found in the gut can generate electricity, a recent study finds.
Electrogenic bacteria are those that are able to produce a certain amount of electricity.
For this reason, ongoing research is looking into ways to use these microorganisms to develop alternative, more sustainable battery-like devices.
So far, electrogenic bacteria have been found in fairly specific natural environments, such as the sediments of various bodies of water.
These environments are typically anaerobic, meaning that they do not contain free oxygen. Now, for the very first time, researchers from the University of California, Berkeley have found that hundred of different bacteria in the human gut are also electrogenic.
These include many types of bacteria, from pathogenic ones that are capable of causing disease, to probiotic bacteria that promote gut health. Yet these gut bacteria produce electricity using a different mechanism than that used by known electrogenic bacteria from other environments.
The researchers " led by Prof. Dan Portnoy " report their important discovery in a study paper that appears in the journal Nature.
A surprising discovery
Prof. Portnoy and team explain that some of the strands of electricity-generating bacteria that they have now identified include Listeria monocytogenes (a common culprit in cases of diarrhea), Clostridium perfringens (which causes gangrene), and Enterococcus faecalis (a pathogen sometimes acquired during hospital stays).
However, numerous other electricity-producing bacteria in the gut are benign. Some of these are probiotics, the researchers observe, while others, such as the Lactobacilli strains, play a role in fermentation.
"The fact that so many bugs that interact with humans, either as pathogens or in probiotics or in our microbiota or involved in fermentation of human products, are electrogenic " that had been missed before."
Prof. Dan Portnoy
This, he adds, "could tell us a lot about how these bacteria infect us or help us have a healthy gut."
Also, the scientists expect that their unexpected finding may also be helpful in future projects that aim to create microbial fuel cell, an innovative strategy to generate renewable energy.
The researchers explain that bacteria generate electricity as part of their metabolism, in a process that they compare to breathing.
However, whereas organisms such as plants and animals, which live in oxygen-rich environments, use oxygen to aid them in their metabolism, bacteria that reside in anaerobic environments must use other chemical elements.
So, bacteria that reside at the bottom of lakes typically use a mineral, such as iron or manganese, during their complex metabolic process, thereby generating electricity.
Gut bacteria: Electrogenic because it's 'easy?'
However, the electrogenic bacteria found in the gut seem to have a simpler electricity-generating process, and they use an organic compound known as flavin, which is a vitamin B-2 derivative.
"It seems that the cell structure of these bacteria and the vitamin-rich ecological niche that they occupy makes it significantly easier and more cost-effective to transfer electrons out of the cell," explains first study author Sam Light.
"Thus," he says, "we think that the conventionally studied mineral-respiring bacteria are using extracellular electron transfer because it is crucial for survival, whereas these newly identified bacteria are using it because it is 'easy.'"
In collaboration with experts from the Lawrence Berkeley National Laboratory at the University of California, Light and colleagues conducted further tests to see how much electricity these gut bacteria are able to produce.
They found that gut bacteria generate almost as much electricity as other electrogenic bacteria: up to 100,000 electrons per second per cell.
In particular, they were surprised to find that Lactobacillus " a bacterial strand that plays a role in fermentation and is used to make cheese, yogurt, and sauerkraut " has electrogenic properties.
Now, Light and colleagues wonder whether these properties are at all relevant to the taste that Lactobacillus creates in food products obtained through fermentation.
"This is a whole big part of the physiology of bacteria that people didn't realize existed," Light concludes, "and that could be potentially manipulated."
https://www.mdlinx.com/gastroenterology/top-medical-news/article/2018/09/13/7544323/?utm_source=in-house&utm_medium=message&utm_campaign=epick-gastro-sept14
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Exercise boosts well-being by improving gut health
Healthline/Medical News Today ' February 18, 2019
Both bacterial diversity in the gut and regular exercise are important when it comes to health. But how are the two related? A new study uncovers the effect that exercise has on our health by adjusting the balance of the gut microbiome.
Though this may seem strange, human bodies are actually made, according to recent estimates, of about as many bacteria and other microorganisms as regular human cells. In the colon alone"the tract that contains the largest number of bacterial cells"there are approximately 38 trillion bacteria. These bacteria have important effects on the state of our health, and loss of bacterial diversity in the gut is linked to a heightened risk of disease. Now, a new study suggests that the level of a person's physical activity may affect the bacterial diversity in their gut, and thus influence their health.
In a paper that appears in the journal Experimental Physiology, the authors, from Indiana University Bloomington and the University of Alabama at Birmingham, also explain the biological mechanism that makes this possible.
The researchers knew that cardiorespiratory fitness"the efficiency with which the circulatory and respiratory systems deliver oxygen during exercise"was associated with greater bacterial diversity, but it was unclear whether this was due to physical activity or an individual's percentage of body fat. To find out, the team worked with a cohort of 37 participants who had been successfully treated for nonmetastatic breast cancer. The decision to work with this cohort resulted from the fact that cancer treatment typically has a negative impact on metabolic health, including cardiorespiratory fitness.
The participants agreed to perform graded exercises so that the researchers could assess their peak cardiorespiratory fitness, as well as total energy expenditure. The investigators also collected fecal samples from the volunteers and used them to analyze the participants' gut microbiota.
Following all the assessments and analyses, the researchers established that participants with higher cardiorespiratory fitness also had more diverse bacterial populations in the gut, compared with peers who had low cardiorespiratory fitness. Moreover, the team confirmed that cardiorespiratory fitness was linked with about a quarter of the variance in bacterial species diversity and that this effect was independent of that produced by an individual's body fat percentage. The data thus indicate that exercising with an intensity that is adequately high and can boost cardiorespiratory effectiveness will improve overall health by supporting a better-balanced gut.
Still, the researchers warn that their findings are only correlative, and further research should aim to test the potential causational relationships. Furthermore, the cohort was very restricted"a small group of women treated for breast cancer"so the team advises caution in applying the findings to other populations. However, going forward, the investigators aim to address these shortcomings and find out how best to apply their findings to improve the health of at-risk individuals.
"Our group is actively pursuing an interventional study to determine how variation in exercise intensity can influence gut microbiota diversity under controlled-feeding conditions," says the study's lead author, Stephen Carter, Ph.D.
"[The aim is] to uncover how exercise may affect functional outcomes of gut microbiota, as well as studying how exercise prescription may be optimized to enhance health outcomes among clinical populations."
"Lead author Stephen Carter, PhD
https://www.mdlinx.com/gastroenterology/top-medical-news/article/2019/02/18/7557655/?utm_source=in-house&utm_medium=message&utm_campaign=epick-gastro-feb19
https://www.medicalnewstoday.com/articles/324465.php
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According to a recent study, as many as one in five adult women suffers from uncontrolled bowel movements. This is also a problem in men, but tends to be more common in women.
Here are the five most common conditions that can lead to faecal incontinence:
1. Diarrhoea
Diarrhoea can be caused by many conditions such as a viral or bacterial stomach infection, food poisoning, too much alcohol or a drastic change in diet. An involuntary bowel movement can, however, be more debilitating when it’s caused by a chronic disease such as irritable bowel syndrome.
2. Nerve damage
Any damage or injury to the nerves that make you feel the sensation of stool in the rectum or that control the anal sphincter could cause incontrollable bowel movements. Nerve damage can be caused by many factors such as childbirth or constant straining (if you suffer from chronic constipation).
Other chronic diseases such as diabetes or multiple sclerosis can also cause damage to the nerve points near the rectum if left unmanaged.
Physical injury to the spinal cord as the result of an accident can also cause nerve damage.
3. Radiation treatment
Radiation around the area of the scrotum and rectum is often applied as treatment for prostate cancer. While radiation is designed to zap the cancerous cells, the surrounding healthy cells may also be affected, causing injury that can lead to faecal incontinence.
Doctors do their best to eliminate exposure that may cause these side-effects, but the risk is always present.
4. Stroke
After an event such as a stroke, cognitive function can become impaired. There are many reasons why this may happen. The area of the brain that controls bowel movements may become impaired as a result of a stroke, or a patient might not be fully conscious and may have a bowel movement without being aware of it.
5. Alzheimer's
According to the Alzheimer's Association, many people experience either urinary or faecal incontinence in the later stages of the disease. This can be caused by various factors. A person can become unable to realise that they need to go to the loo, they may forget where the bathroom is located, or physical impairment or a loss of motor skill might make it difficult for them to get to the bathroom or remove clothing in time.
How to manage faecal incontinence
Faecal incontinence has a far-reaching impact on the quality of a patient's life. Here are a few tips on how a caretaker can help:
Be supportive and never make the patient feel more embarrassed than they may already be.
Make the toilet as user-friendly as possible and avoid any obstructions.
Respect the patient's need for privacy.
Be aware of nonverbal signs such as facial expressions or restlessness that may indicate the need to go to the bathroom when the person has lost the ability to talk.
If the faecal incontinence is caused by IBS, learn how to manage the condition by discussing possible medication with the patient's medical professional.
Marelize Wilke
Dr Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.
https://www.health24.com/Medical/Incontinence/Faecal-incontinence/5-conditions-that-can-cause-uncontrolled-bowel-movements-20190228?mid=3298&eid=7534&lid=75058&utm_source=Newsletter&utm_medium=Click&utm_campaign=3298
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Harmful bacteria increased in IBS, protective bacteria decreased
Pittayanon R, et al. Gastroenterology. 2019;10.1053/j.gastro.2019.03.049.
April 2, 2019
Although diversity of the gut microbiota in patients with irritable bowel syndrome was similar to controls, a systematic review published in Gastroenterology identified specific bacteria that were either present or protective in IBS.
Paul Moayyedi, PhD, MPH, AGAF, of the division of gastroenterology at McMaster University in Canada, and colleagues wrote that research over the last 10 years has positioned an altered gut microbiota as a possible cause of IBS.
“The previous observational studies have demonstrated that the change of intestinal microbiota as a result of acute gastroenteritis is associated with an increased risk of subsequent development of IBS,” they wrote. “However, the data on specific bacterial groups in IBS is conflicting and still inconclusive.”
Researchers searched databases for case-control studies that compared the fecal or colon microbiomes of adult or pediatric patients with IBS with microbiomes of healthy individuals. They were looking for specific differences in gut microbes between the groups of patients.
In their analysis of 24 studies, investigators identified several harmful bacteria that were increased in patients with IBS, including family Enterobacteriaceae, family Lactobacillaceae, and genus Bacteroides. The presence of these different kinds of bacteria could be due to a number of factors, including previous infection and inflammation.
Moayyedi and colleagues wrote that their most consistent findings were groups of protective bacteria like Clostridiales I, Facalibacterium and genus Bifiobacterium were decreased in patients with IBS compared with controls.
The built-in limitations of the studies included in the review led to a lack of consistency in the results. Moayyedi and colleagues wrote that future studies should describe variables such as antibiotic use and diet and use standardized practice for sample storage and DNA extraction.
“This review highlights the heterogeneity of the microbiota in IBS patients; however, proposes some evidence that certain bacteria may be helpful in IBS treatment,” they concluded.
Article in Press
Gut Microbiota in Patients With Irritable Bowel Syndrome"a Systematic Review
Rapat Pittayanon1,2
, Jennifer T. Lau1
, Yuhong Yuan1
, Grigorios I. Leontiadis1
, Frances Tse1
, Michael Surette1
, Paul Moayyedi1,∗,'Correspondence information about the author Paul MoayyediEmail the author Paul Moayyedi
PlumX Metrics
DOI: https://doi.org/10.1053/j.gastro.2019.03.049
showArticle Info
Abstract
Background & Aims
Irritable bowel syndrome (IBS) is common but difficult to treat. Altering the gut microbiota has been proposed as a strategy for treatment of IBS, but the association between the gut microbiome and IBS symptoms has not been well established. We performed a systematic review to explore evidence for this association.
Methods
We searched databases, including MEDLINE, EMBASE, Cochrane CDSR, and CENTRAL, through April 2, 2018 for case"control studies comparing the fecal or colon microbiomes of adult or pediatric patients with IBS with microbiomes of healthy individuals (controls). The primary outcome was differences in specific gut microbes between patients with IBS and controls.
Results
The search identified 2631 citations; 24 studies from 22 articles were included. Most studies evaluated adults presenting with various IBS subtypes. Family Enterobacteriaceae (phylum Proteobacteria), family Lactobacillaceae, and genus Bacteroides were increased in patients with IBS compared with controls, whereas uncultured Clostridiales I, genus Faecalibacterium (including Faecalibacterium prausnitzii), and genus Bifidobacterium were decreased in patients with IBS. The diversity of the microbiota was either decreased or not different in IBS patients compared with controls. More than 40% of included studies did not state whether cases and controls were comparable (did not describe sex and/or age characteristics).
Conclusions
In a systematic review, we identified specific bacteria associated with microbiomes of patients with IBS vs controls. Studies are needed to determine whether these microbes are a product or cause of IBS.
https://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7b97a47f60-9752-4540-b597-7286e8659d2e%7d/protective-bacteria-found-in-patients-with-ibs
https://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7b97a47f60-9752-4540-b597-7286e8659d2e%7d/protective-bacteria-found-in-patients-with-ibs
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Microbiome science may help doctors deliver more effective, personalized treatment to children with irritable bowel syndrome
A new, improved diagnostic classification technique enables stratification of pediatric patients with irritable bowel syndrome with greater precision so they can receive optimal treatment, reports The Journal of Molecular Diagnostics
Philadelphia, April 17, 2019 - To improve the treatment of children with irritable bowel syndrome (IBS), investigators have developed a sophisticated way to analyze the microbial and metabolic contents of the gut. A report in The Journal of Molecular Diagnostics, published by Elsevier, describes how a new battery of tests enables researchers to distinguish patients with IBS from healthy children and identifies correlations between certain microbes and metabolites with abdominal pain. With this information, doctors envision tailoring nutritional and targeted therapies that address a child's specific gastrointestinal problems.
"This research highlights the importance of the microbiome-gut-brain axis and our understanding of chronic abdominal pain. Development of new disease classifiers based on microbiome data enables precision diagnostics to be developed for IBS and similar disorders. Although other studies have found differences in the gut microbiomes of patients with IBS, this study is the first to combine deep microbiome analysis with development of new diagnostic strategies," explained James Versalovic, MD, PhD, of the Department of Pathology & Immunology at Baylor College of Medicine and the Department of Pathology at Texas Children's Hospital, Houston, TX, USA. The term microbiome refers to the genetic material of all the microbes--bacteria, fungi, protozoa, and viruses--that live on and inside the human body.
Samples for this study were obtained from 23 preadolescent children with IBS (age 7 to 12 years) and 22 healthy controls. Participants were asked to maintain daily pain and stool diaries for two weeks and to provide stool (fecal) samples.
Investigators found that there are differences in bacterial composition, bacterial genes, and fecal metabolites in children with IBS compared to healthy controls. In addition to identifying correlations of these factors with abdominal pain, they generated a highly accurate classifier using metagenomic and metabolic markers that distinguishes children with IBS from healthy controls with 80 percent or greater accuracy. This classifier assesses specific metabolites, types of bacteria, functional pathways, and other factors. "This disease classifier represents a significant advance in the diagnosis of IBS and could be clinically impactful," commented Dr. Versalovic.
This microbiome-based classifier can potentially help identify subpopulations of children with IBS that are more likely to benefit from microbiome-related therapies including diet modification, while guiding others to alternative appropriate treatment plans. The investigators also provide insights into how specific microbiome-related findings may be related to abdominal pain, thus opening up potential novel treatment approaches.
A chronic disease that is evaluated clinically can be stratified in the future based on differences in the composition and function of the intestinal microbiome. Dr. Versalovic envisions that these findings will begin to usher in an era of metagenomics-based, data-driven precision diagnostics for IBS and other functional gastrointestinal disorders. "Microbiome-based diagnosis and disease stratification of patients with IBS means that we create hope for tailored nutrition and targeted therapies in the future, leading to better outcomes for patients with chronic disease," noted Dr. Versalovic.
IBS is a disruptive gastrointestinal condition characterized by bloating, changes in bowel habits, and pain that affects up to 20 percent of the world's population (children and adults). Increasing evidence indicates that the onset and symptoms of IBS are related to the gut microbiome. Deficiencies or excesses of specific gut microbes or metabolites may contribute to the disease process of IBS.
https://www.eurekalert.org/pub_releases/2019-04/e-msm041519.php
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Oh, Poop! Study Links Pets to Higher IBS Risk for Owners
Possible reasons: microbiome-disrupting poop exposure; common thread of anxiety/depression
by Randy Dotinga, Contributing Writer, MedPage Today
May 19, 2019
This article is a collaboration between MedPage Today® and: Medpage Today
SAN DIEGO -- Four-legged furballs may boost the risk for irritable bowel syndrome (IBS), and exposure to canine and feline feces could be a crucial factor, researchers reported here.
In a meta-analysis of five studies, participants who were exposed to a variety of kinds of pets faced an odds ratio 1.26 (95% CI 1.018-1.569) of IBS, according to Laith Al Momani, MD, Ankit Patel, both of East Tennessee State University (ETSU) in Johnson City, and colleagues.
"The odds ratio isn't huge. But with the prevalence of IBS, this can affect a lot of people," said Patel, an ETSU medical student, at the annual Digestive Disease Week.
Also, it was not clear if certain kinds of pets posed a higher risk, the authors noted.
There's been little research into pet exposure and IBS, and none of the five studies in the meta-analysis solely examined pets as a risk factor. Instead, the studies from 2000 to 2016 looked at multiple risk factors, including pet ownership. In total, the studies examined 2,883 people.
Among the five studies, a 2016 Singapore report turned up the largest link between IBS and pet ownership. Among 297 participants, almost 21% of whom fulfilled the Rome III IBS criteria, who had ever owned a pet were more likely to have the condition (OR 2.5, 95% CI, 1.3-5.0, P=0.008). Most of the pet owners reported owning cats, dogs, and hamsters, while the others had birds, tortoises, and fish, among others.
An Australian survey of 767 participants who were linked to "exposure to a herbivore pet" in childhood -- a category that includes rabbits, guinea pigs, and hamsters -- also had a higher risk of IBS (OR1.65, 95% CI 1.10-2.48, P=0.02).
What might be going on? Here's the scoop, so to speak: Al Momani told MedPage Today that it was possible that pet ownership boosts the risk of IBS through exposure to pet feces, which may disrupt the gut microbiome in a similar way to fecal transplants.
Pet dander may also play a role, Patel said, although he acknowledged that this theory conflicts with the idea that early exposure to allergens is helpful.
He also noted that patients with IBS have higher levels of anxiety and depression, which may spur them to seek comfort via pet ownership.
Patel stressed that the findings aren't conclusive and that "This study was done to start a conversation," he said.
That's good news for Al Momani's feline companion:"The cat is safe -- for now," he said.
Al Momani, Patel, and co-authors disclosed no relevant relationships with industry.
last updated 05.20.2019
Primary Source
Digestive Disease Week
Source Reference: Al Momani L, et al "Exposure to pets is associated with irritable bowel syndrome: A systematic review and meta-analysis" DDW 2019; Abstract Sa1687.
https://www.medpagetoday.com/meetingcoverage/ddw/79919?xid=nl_mpt_DHE_2019-05-20&eun=g379602d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily%20Headlines%20Random%202019-05-20&utm_term=NL_Daily_DHE_Random
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New, noninvasive test for bowel diseases
MedicalXpress Breaking News-and-Events ' June 27, 2019
Gut diseases such as inflammatory bowel disease (IBD) are increasingly prevalent worldwide, especially in industrialized countries. In 2015 alone, 250,000 people in the United Kingdom were diagnosed with IBD, and 3 million in the United States. Symptoms can include pain and swelling of the stomach, bloody diarrhea, weight loss, and extreme tiredness.
A new study in Experimental Physiology proposes a novel, non-invasive test for assessing gut function that may help screen and monitor treatment of gut diseases using only a small sample (1 mL) of blood and stool. How well your gut functions is determined by the gut-blood barrier, a complex multi-layer system. This can be compared to a fine-tuned filter that precisely controls the passage of nutrients and prevents bacteria passing from inside the bowel into the bloodstream.
In those with IBD, and other intestinal diseases, the gut-blood barrier is impaired. Here the intestinal wall is more like a ripped sieve, allowing more bacterial products to pass from the gut into the blood. This is commonly referred to as a leaky gut.
This test measures the concentration of gut bacterial products (produced by bacteria during metabolism) in the patient's blood and stool. The authors believe that with further research this assessment of gut leakage will be very important in the diagnosis and treatment of IBD and other intestinal diseases.
The usual strategy for diagnosing and monitoring IBD is based on a colonoscopy, which is invasive, often requires anesthesia, and assesses structural lesions, rather than gut malfunction. Gut disorders can happen before there are visible structural changes, so diagnosing based on functional tests evaluating gut leakage could allow clinicians to detect the disease earlier. While there is no cure for IBD, it is controllable. Early diagnosis would enable patients to control symptoms before they became severe, improving their quality of life.
This new research provides a non-invasive, simple test that could not only be useful for diagnosing IBD, but also other gut disorders, such as celiac disease and food allergies. It's also helpful for detecting diseases that result in a leaky gut, such as heart failure, high blood pressure, and liver ailments.
Marcin Ufnal, senior author on the study said, "This may be a very important tool for diagnosis and treatment of gut and other diseases, using the leaky gut as a marker for disease, as well as a potential target for treatment."
https://www.mdlinx.com/gastroenterology/top-medical-news/article/2019/06/27/7570997?uic=ZZF16D371AFB75451A8446A549F6A3EB45&utm_source=Sailthru&utm_medium=email&utm_campaign=Gastro%20Morning%20June28&utm_term=Daily%20Update%20Gastro%20with%20Sailthru%20Activity
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Patients with IBS-D, IBS-C find their lives impacted in different ways
Ballou S, et al. Clin Gastroenterol Hepatol. 2019;doi:10.1016/j.cgh.2019.08.016.
August 15, 2019
Although patients with diarrhea- and constipation-predominant irritable bowel syndrome tend to find their condition equally bothersome, they find their lives impacted in different ways, according to survey results.
Sarah Ballou, PhD, of the division of gastroenterology at Beth Israel Deaconess Medical Center, and colleagues wrote that the impact of IBS on patients' work lives is well-documented, but only a few small studies have looked at its impact on social interaction and daily living.
"Many studies have documented decreased quality of life, elevated rates of psychological comorbidities and high economic costs associated with IBS," they wrote. "No study to date has compared impairment of specific daily activities in IBS subtypes using a large, nationwide sample of individuals in the community with IBS-C and IBS-D."
Researchers used data collected from The Life with IBS survey to compare the effects of the different subtypes of IBS on different areas of life. Individuals who responded to the survey all met Rome II criteria for either IBS-C (n = 1,667) or IBS-D (n = 1,587).
Patients in both groups who were either working or in school reported similar impact on their productivity (average 8 days per month) and absenteeism, with patients with IBS-C missing an average of 1.7 days per month compared with 1.3 days among patients with IBS-D.
Investigators found that patients with IBS-C were more likely to report that they had more difficulty concentrating, felt self-conscious and avoided sex because of their condition. Patients with IBS-D were more likely to report that they avoid making plans, traveling, leaving home and going to places without bathrooms.
Ballou and colleagues wrote that the results show that patients with IBS-D are more likely to avoid specific activities because of increased bowel activity or frequency, while physiological and psychological factors likely lead to avoidance of physical intimacy among patients with IBS-C.
The survey also included a hypothetical question that asked patients what they would exchange for 1 month of symptom relief. More than half reported that they would give up caffeine or alcohol, nearly a quarter said they would give up their cell phone, about 20% would give up the internet for a month and 40% reported that they would give up sex.
"This study highlights important differences between IBS-C and IBS-D, which could impact the development and refinement of mind-body therapies for IBS, with tailored treatment goals for each IBS subtype," Ballou and colleagues wrote. "For example, treatment tailored specifically for IBS-D may be more behaviorally focused, while treatment for IBS-C may be more cognitively focused in addition to targeting the bowel dysfunction and pain" - by Alex Young
https://www.healio.com/gastroenterology/irritable-bowel-syndrome/news/online/%7B2911229c-7889-422e-8164-0aa2a1d7721e%7D/patients-with-ibs-d-ibs-c-find-their-lives-impacted-in-different-ways?utm_source=selligent&utm_medium=email&utm_campaign=gastroenterology%20news&m_bt=428850516595
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Constipation in Older Adults Improved With Biofeedback
Small retrospective study extends efficacy observed in younger patients
by Charles Bankhead, Senior Editor, MedPage Today
October 31, 2019
This article is a collaboration between MedPage Today® and: Medpage Today
SAN ANTONIO -- Biofeedback training resulted in significant improvement in dyssynergic defecation associated with constipation in older patients, a small retrospective analysis showed.
The mean score on a global scale of bowel movement satisfaction almost doubled, and the feeling of incomplete evacuation after a bowel movement decreased by 95%. Assessment by high-resolution anal manometry showed resolution of dyssynergic defecation in 79% of the patients.
The results suggested that the efficacy of biofeedback for dyssynergic defecation observed in younger patients applies to their elders as well, Samantha Spilman, MD, of the University of California San Diego, reported here at the American College of Gastroenterology (ACG) meeting.
"Biofeedback for dyssynergic defecation led to meaningful improvement in both patient-reported outcomes and objective manometric parameters in older adults," said Spilman. "Patients with type 2 [inadequate propulsive force] dyssynergic defecation showed the most gains in defecation index."
"Biofeedback improved dyssynergic defecation in older adults as defined by ACG criteria, as well as the narrower Rome IV definition," she added. "Given the profound burden of constipation with dyssynergic defecation in older adults, we propose biofeedback therapy to continue to be given strong consideration as first-line therapy for this population."
Dyssynergic defecation, a manifestation of pelvic floor dysfunction, occurs in as many as half of all patients with chronic constipation. Biofeedback therapy has proven to be highly effective in correcting dyssynergic dysfunction, said Spilman. However, few studies evaluated use of biofeedback for older patients with chronic constipation associated with dyssynergic defecation. The therapy is covered by Medicare.
Spilman and colleagues retrospectively reviewed records of patients 65 or older who enrolled for biofeedback therapy for dyssynergic defecation during 2015 to 2018 and identified those who attended at least two therapy sessions. At each session, patient-reported outcomes (PROs) were assessed, and anorectal manometry was performed.
The biofeedback program combined patient education and physical therapy to help patients retrain pelvic floor muscles and improve the strength and coordination of anorectal musculature. Training sessions included activities such as breathing exercises and instruction in postural techniques.
Investigators identified 58 patients who met the inclusion criteria. They had attended a median of three biofeedback sessions. The patients had a median age of 74, body mass index of 28.5, and constipation duration of 9.5 years. A third of the patient had a history of childhood constipation, and 22% had a diagnosis of irritable bowel syndrome. The cohort had an even distribution of men and women.
PRO data showed significant improvement in Global Stool Satisfaction from an average of 2.8 (on a scale of 1-10) to 5.0 (P<0.0001). Number of stooling medications, stool frequency, and Bristol Stool Score did not change significantly. Prior to biofeedback therapy, 95% of the patients reported a feeling of incomplete evacuation at the end of a bowel movement; afterward, the proportion reporting that feeling decreased to 24% (P=0.026). The proportion of patients who used manual maneuvers to remove stool decreased from 31% to 19% (P=0.31).
Manometry data showed that patients benefited from biofeedback therapy regardless of whether the dyssynergia primarily involved defects in propulsion or paradoxical contraction of sphincter muscles during defecation (P=0.0006), Spilman reported. Patients with both defects (type 2) derived the most benefit versus other subtypes of dyssynergic defecation. The mean defecation index (intrarectal pressure divided by residual intra-anal pressure during simulated defecation) also improved significantly with biofeedback therapy.
Overall, 81% of the patients no longer had dyssynergia after biofeedback therapy.
Spilman acknowledged several limitations of the study: small sample size, no baseline assessment of cognitive function (which could affect learning capacity), and no balloon expulsion testing at the end of biofeedback therapy.
"The major point of this study is that older adults have a large burden of dyssynergia, and we're trying to decrease medication use," she said. "Here we present a therapy approach that is nonpharmacologic and can help patients resolve their constipation and dyssynergia."
In response to a question, Spilman acknowledged that one-fourth of patients discontinued biofeedback before completing the recommended three to four sessions. Investigators had no information about the reasons for discontinuation.
Primary Source
American College of Gastroenterology
Source Reference: Spilman SL, et al "Efficacy of biofeedback therapy for dyssynergic constipation among elderly patients" ACG 2019; Abstract 45.
https://www.medpagetoday.com/meetingcoverage/acg/83056?xid=nl_mpt_SRGastroenterology_2019-11-03&eun=g379602d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=GastroUpdate_110119&utm_term=NL_Spec_Gastroenterology_Update_Active
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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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