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The Science of IBS - Postinfectious IBS and Small Intestinal Bacterial Overgrowth
      09/30/06 03:23 PM
HeatherAdministrator

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The Science of IBS
From Medscape General Medicine™
MedGenMed Gastroenterology
IBS -- Review and What's New


Postinfectious IBS
The presence of postinfectious (PI)-IBS, referring to the development of IBS symptoms -- particularly abdominal pain and diarrhea -- shortly after an enteric infection, is based on research from prospective studies in which IBS symptoms developed in 7% to 32% of patients after they recovered from bacterial gastroenteritis.[52,55,56] Specific risk factors for the development of PI-IBS have been identified, including younger age, female sex, presence of severe infectious gastroenteritis for a prolonged period, use of antibiotics to treat this infection, and presence of concomitant psychological disorders (eg, anxiety).[39,52,55,57] Difficulty in downregulating intestinal inflammation in the colonic mucosa has been suggested as a potential underlying mechanism in this condition.[52] Also suggested as a potential underlying mechanism is the presence of colonic changes shown in patients with PI-IBS compared with controls, including increased gut permeability, increased mucosal enterochromaffin cell production, and increased concentration of mast cells and T lymphocytes in the gut mucosa.[39,52,55,57] Despite considerable evidence linking IBS with an inflammatory etiology (perhaps triggered by enteric infection), in a controlled trial of patients with PI-IBS, anti-inflammatory treatment with prednisolone was not more effective than placebo in improving patient symptoms.[58] The true role of prior infection as a key factor in PI-IBS remains to be established.[59]

The use of probiotics (products containing live or attenuated bacteria that have a positive effect on the host) in alleviating symptoms in patients with PI-IBS is an area of recent focus.[60,61] The potential utility of probiotics in this setting stems from their antibacterial, antiviral, and immune-modulating properties; their ability to modify intestinal flora; and their potential to enhance intestinal mucus secretion or influence stool consistency or volume and gas handling.[60] The number of studies evaluating the efficacy of probiotic preparations in patients with IBS is limited but growing.[60-68] Because trials vary in study design, dose, and strain (Lactobacillus and Bifidobacteria alone or in combination; mixture of Lactobacillus, Bifidobacteria, and Streptococcus), direct comparison of results is challenging. Overall, some degree of IBS symptom improvement has been demonstrated in symptoms such as abdominal pain,[65,66] bloating,[63,66] gas,[66] and daily symptom scores.[62,65] O'Mahoney and colleagues[60] have recently demonstrated that results with the Bifidobacterium infantis strain are particularly promising. In a separate analysis, these investigators showed that the baseline characteristics of urgency and hard stool increased the odds ratio of response to this strain, whereas straining and alcohol consumption reduced the likelihood of response.[69,70] The ultimate place in therapy of probiotics in IBS remains to be elucidated.

Small Intestinal Bacterial Overgrowth
The presence of a higher than usual population of bacteria in the small intestine (leading to bacterial fermentation of poorly digestible starches and subsequent gas production) has been proposed as a potential etiologic factor in IBS.[71] Pimentel and colleagues have shown that, when measured by the lactose hydrogen breath test (LHBT), small intestinal bacterial overgrowth (SIBO) has been detected in 78% to 84% of patients with IBS.[71,72] However, the accuracy of the LHBT in testing for the presence of SIBO has been questioned.[73] Sensitivity of the LHBT for SIBO has been shown to be as low as 16.7%, and specificity approximately 70%.[74] Additionally, this test may suboptimally assess treatment response.[75] The glucose breath test has been shown to be a more reliable tool,[76] with a 75% sensitivity for SIBO[77] vs 39% with LHBT for the "double-peak" method of SIBO detection.[74] In a recently conducted retrospective study involving review of patient charts for the presence of gastrointestinal-related symptoms (including IBS) in patients who were referred for glucose hydrogen breath tests for SIBO, of 113 patients who met Rome II criteria for IBS, 11% tested positive for SIBO.[78] Thus, results demonstrated that IBS symptoms are often unrelated to the presence of SIBO. Despite the controversy regarding the contribution of SIBO to the underlying pathophysiology of IBS and its symptoms, short-term placebo-controlled clinical studies with select antibiotics, including neomycin and rifaximin, have demonstrated symptom improvement in IBS patients.[61,72,79] Antibiotics may therefore have potential utility in select subgroups of IBS patients in whom SIBO contributes to symptoms. However, the chronic nature of IBS symptoms often leads to the need for long-term treatment. Given the fact that long-term use of antibiotics is generally undesirable, the place of antibiotics in IBS therapy remains to be established.[73]

http://www.medscape.com/viewarticle/532089_3

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* New Recommendations for Treating Children With Chronic Abdominal Pain
HeatherAdministrator
03/28/05 01:59 PM
* Irritable bowel syndrome in developing countries
HeatherAdministrator
03/28/05 01:29 PM
* Stress and the gastrointestinal tract
HeatherAdministrator
03/28/05 01:27 PM
* Alternating Bowel Habit Subtype in Patients with Irritable Bowel Syndrome
HeatherAdministrator
03/28/05 12:28 PM
* Fecal Microbiota of Irritable Bowel Syndrome Patients
HeatherAdministrator
03/04/05 12:11 PM
* Post-infectious IBS in patients with Shigella infection
HeatherAdministrator
03/04/05 12:03 PM
* Surgical Treatment of Chronic Functional Constipation?
HeatherAdministrator
03/04/05 11:24 AM
* Chronic constipation in children
HeatherAdministrator
02/19/05 05:53 PM
* Intestinal infection and irritable bowel syndrome.
HeatherAdministrator
02/19/05 05:36 PM
* Overlap of GI symptom complexes in a US community
HeatherAdministrator
02/06/05 02:35 PM
* Magnetic pill tracking: a novel non-invasive tool for investigation of human digestive motility
HeatherAdministrator
02/06/05 02:27 PM
* The value of a general therapeutic approach in subjects with irritable bowel syndrome
HeatherAdministrator
02/06/05 02:22 PM
* Is Constipation Associated with Decreased Physical Activity in Normally Active Subjects?
HeatherAdministrator
02/06/05 02:18 PM
* High interdigestive and postprandial motilin levels in patients with the irritable bowel syndrome
HeatherAdministrator
02/06/05 02:12 PM
* 10% to 20% of older adults have IBS
HeatherAdministrator
01/23/05 05:05 PM
* Diagnostic Criteria for Irritable Bowel Syndrome - Family Practice Doctors Unaware of Guidelines
HeatherAdministrator
01/07/05 06:20 PM
* Stress Increases Visceral Sensitivity in IBS Patients
HeatherAdministrator
01/07/05 06:13 PM
* Treatment of irritable bowel syndrome with colonic pacing
HeatherAdministrator
01/07/05 05:53 PM
* Irritable bowel syndrome: colonoscopy painful and difficult?
HeatherAdministrator
01/07/05 05:50 PM
* Suicide in IBS patients emphasizes need for improvements in treatment
HeatherAdministrator
01/07/05 05:47 PM
* New Risk for Asthma, Allergy Found in the Gut
HeatherAdministrator
01/07/05 04:53 PM
* Salt intake and smoking play major roles in GERD
HeatherAdministrator
12/20/04 02:11 PM
* Constipation and Laxative Use Found to Increase Colon Cancer Risk
HeatherAdministrator
12/20/04 01:30 PM
* Link Between Irritable Bowel Syndrome (IBS), Alcoholism and Mental Illness
HeatherAdministrator
12/20/04 01:24 PM
* Complementary and alternative medicine in gastroenterology
HeatherAdministrator
12/20/04 01:16 PM
* Advances in the Treatment of Chronic Constipation
HeatherAdministrator
11/28/04 02:55 PM
* Symptom patterns in functional dyspepsia and irritable bowel syndrome
HeatherAdministrator
11/28/04 02:34 PM
* Obese Women Face Higher Risk of Colorectal Cancer
HeatherAdministrator
11/08/04 04:48 PM
* Obesity is Associated With Increased Risk of Gastrointestinal Symptoms
HeatherAdministrator
10/24/04 07:42 PM
* Stress Therapy Can Help Irritable Bowel
HeatherAdministrator
10/24/04 07:38 PM
* Relationship Between Colon Ischemia, Irritable Bowel Syndrome
HeatherAdministrator
10/11/04 04:15 PM
* Clinical Update on the Treatment of Constipation in Adults
HeatherAdministrator
10/11/04 03:34 PM
* Racial Differences in the Impact of Irritable Bowel Syndrome on Health-Related Quality of Life
HeatherAdministrator
10/11/04 03:25 PM
* What Differentiates Chronic Constipation From IBS With Constipation?
HeatherAdministrator
09/26/04 03:25 PM
* Treatment options in irritable bowel syndrome
HeatherAdministrator
09/26/04 02:57 PM
* Diagnostic approach to suspected irritable bowel syndrome
HeatherAdministrator
09/12/04 03:38 PM
* Dyssynergic Defecation: Demographics, Symptoms, Stool Patterns, and Quality of Life
HeatherAdministrator
09/12/04 03:35 PM
* Small Intestinal Bacterial Overgrowth - A Framework for Understanding IBS
HeatherAdministrator
08/30/04 01:46 PM
* New views - and some respect - for IBS
HeatherAdministrator
08/30/04 01:25 PM
* Categorization of dysmotility in patients with chronic constipation
HeatherAdministrator
08/08/04 02:54 PM
* Prevalence of IBS according to different diagnostic criteria
HeatherAdministrator
08/08/04 02:50 PM
* Irritable Bowel Can Follow Dysentery
HeatherAdministrator
08/08/04 02:37 PM
* Irritable Bowel Syndrome Remains a Difficult Condition to Manage
HeatherAdministrator
07/24/04 02:09 PM
* Intolerance to visceral distension in functional dyspepsia or irritable bowel syndrome
HeatherAdministrator
07/24/04 02:17 PM
* Bacillary dysentery as a causative factor of irritable bowel syndrome and its pathogenesis
HeatherAdministrator
07/24/04 01:42 PM
* Irritable Bowel Syndrome Linked to High Rates of Various Surgeries
HeatherAdministrator
07/11/04 02:15 PM
* Drug-Free Ways to Treat IBS
HeatherAdministrator
07/11/04 01:47 PM
* Irritable Bowel Syndrome - An Evidence-Based Approach to Diagnosis
HeatherAdministrator
06/27/04 01:14 PM
* Biases Affect Treatment of IBS
HeatherAdministrator
06/04/04 06:45 PM
* Moms with Bowel Symptoms Take Baby to Doctor More
HeatherAdministrator
05/25/04 11:53 AM
* Natural History of Irritable Bowel Syndrome
HeatherAdministrator
05/10/04 02:36 PM
* Intestinal Gas May Contribute to IBS Symptoms
HeatherAdministrator
05/10/04 02:29 PM
* Are Your Bowels Irritable? IBS Awareness Month is Here
HeatherAdministrator
04/09/04 07:11 PM
* Heartburn May Not Reflect Gastroesophageal Reflux Disease Severity
HeatherAdministrator
03/30/04 02:43 PM
* A link between irritable bowel syndrome and fibromyalgia
HeatherAdministrator
03/30/04 01:46 PM
* Diverticular Disease: Electrophysiologic Study and a New Concept of Pathogenesis
HeatherAdministrator
03/09/04 11:48 AM
* New Syndrome Connects Gallbladder Dysfunction And Chronic Diarrhea
HeatherAdministrator
03/09/04 11:45 AM
* Researchers Pioneer Accessible, Cost-Effective Treatments for IBS
HeatherAdministrator
03/08/04 06:48 PM
* Splitting IBS: from original Rome to Rome II criteria
HeatherAdministrator
02/10/04 02:35 PM
* Utilization patterns and net direct medical cost to Medicaid of IBS
HeatherAdministrator
02/10/04 02:34 PM
* Family practitioners' attitudes and knowledge about IBS
HeatherAdministrator
02/10/04 02:32 PM
* The Effect of Somatization on Gastrointestinal and Extraintestinal Symptoms of IBS
HeatherAdministrator
01/26/04 03:26 PM
* Surgery and IBS
HeatherAdministrator
01/26/04 03:21 PM
* IBS Subgroups by Bowel Habit Predominance
HeatherAdministrator
01/26/04 03:13 PM
* Visceral perception thresholds in irritable bowel syndrome
HeatherAdministrator
01/07/04 11:56 AM
* Electric activity of the colon in irritable bowel syndrome
HeatherAdministrator
01/07/04 11:52 AM
* Irritable Bowel Syndrome's Possible Genetic Link
HeatherAdministrator
01/07/04 11:40 AM
* Intestinal gas distribution determines abdominal symptoms
HeatherAdministrator
12/16/03 12:27 PM
* Faecal incontinence - Many treatment options now exist
HeatherAdministrator
12/16/03 12:17 PM
* Abnormal Colonic Propagated Activity in Patients with Constipation
HeatherAdministrator
12/16/03 12:07 PM
* Colonic Propulsive Impairment in Intractable Slow-Transit Constipation
HeatherAdministrator
12/16/03 12:03 PM
* Overlapping upper and lower GI symptoms in IBS patients with constipation or diarrhea
HeatherAdministrator
12/01/03 05:51 PM
* Familial aggregation of irritable bowel syndrome
HeatherAdministrator
12/01/03 05:49 PM
* Outlook affects bowel disorder patients
HeatherAdministrator
11/18/03 03:30 PM
* Doctors unmoved by bowel misery
HeatherAdministrator
11/18/03 03:28 PM
* Travelers' Diarrhoea Can Trigger Irritable Bowel
HeatherAdministrator
11/04/03 03:21 PM
* Mind-Body Technique Eases Kids' Gut Pain
HeatherAdministrator
10/30/03 11:17 AM
* Molecular Alterations In Patients With Irritable Bowel Syndrome
HeatherAdministrator
10/20/03 03:46 PM
* Three in Four People With IBS Also Have Functional Dyspepsia
HeatherAdministrator
10/15/03 03:28 PM
* Infectious Gastroenteritis Linked to Irritable Bowel Syndrome
HeatherAdministrator
09/30/03 02:27 PM
* Association Between Pain Episodes & High Amplitude Pressure Waves in IBS
HeatherAdministrator
09/16/03 03:54 PM
* Constipation and its management
HeatherAdministrator
09/16/03 03:41 PM
* Contributions of suggestion, desire, and expectation to placebo effects in IBS patients
HeatherAdministrator
09/16/03 03:28 PM
* Do published guidelines for evaluation of IBS reflect practice?
HeatherAdministrator
08/30/03 02:40 PM
* Cognitive-behavioral therapy versus education and desipramine versus placebo for IBS
HeatherAdministrator
08/12/03 12:54 PM
* Distinctive features of postinfective irritable bowel syndrome
HeatherAdministrator
07/28/03 03:18 PM
* UCLA/CURE Neuroenteric Disease Program Newsletter
HeatherAdministrator
07/23/03 10:38 AM
* Bacterial Overgrowth in IBS
HeatherAdministrator
07/18/03 12:15 PM
* Diagnosis of irritable bowel syndrome.
HeatherAdministrator
07/18/03 11:54 AM
* Eradication of small intestinal bacterial overgrowth reduces symptoms of IBS
HeatherAdministrator
07/18/03 11:44 AM
* Antibiotics increase functional abdominal symptoms.
HeatherAdministrator
07/18/03 11:41 AM
* Treatment of the irritable bowel syndrome.
HeatherAdministrator
07/15/03 11:02 PM
* Extraintestinal symptoms in IBS and IBD
HeatherAdministrator
07/15/03 06:21 PM
* Postinfectious irritable bowel syndrome.
HeatherAdministrator
07/15/03 06:19 PM
* Dieting severity and GI symptoms in college women.
HeatherAdministrator
07/15/03 01:13 PM
* Functional GI disorders and eating disorders - Relevance of the association
HeatherAdministrator
07/15/03 11:14 AM
* Features of eating disorders in patients with IBS
HeatherAdministrator
07/15/03 11:12 AM
* New and Important Insights Into IBS
HeatherAdministrator
07/14/03 03:24 PM
* The Irritable Bowel Syndrome-Fibromyalgia Connection
HeatherAdministrator
07/14/03 03:19 PM
* Update on Treatment of Functional Gastrointestinal Disorders
HeatherAdministrator
07/14/03 02:55 PM
* Irritable bowel syndrome in primary care: The patients’ and doctors’ views
HeatherAdministrator
07/14/03 02:43 PM
* Inflammatory bowel disease and irritable bowel syndrome: separate or unified?
HeatherAdministrator
07/14/03 02:32 PM

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