Durability of the Diagnosis of Irritable Bowel Syndrome Based on Clinical Criteria

Our purpose was to evaluate the durability of the diagnosis of irritable bowel syndrome (IBS) based on clinical criteria. The study population consisted of a cohort of previously published study patients evaluated for IBS between 1989 and 1992, who met the International Congress of Gastroenterology criteria for IBS. Patients were reinterviewed for cardinal features of IBS, Rome I, Rome II, and Manning criteria 10-13 years after the initial diagnosis. During the observational follow-up period, there were 75 patients, 14 males and 61 females, with a mean age of 47.5 +/- 11.3 years (SD; range, 20 to 75 years). Mean time of reinterview after initial diagnosis was 11.8 +/- 0.9 years (range, 10 to 13 years). None of the 75 patients had an abdominal condition which could have been mistaken for IBS. Other abdominal conditions diagnosed during this period included diverticulitis (five), uterine fibromyoma (three), and gallbladder disease (three). Sixty-nine patients (92%) did not consider their symptoms as resolved. Thirty-five (46.7%) had repeat structural evaluation of the colon for similar symptoms without any new diagnoses made. Twenty-six (34.7%) and 32 (42.7%) presently meet the Rome II and Rome I criteria for IBS, respectively. Clinicians are advised to use clinical criteria for a specific and durable diagnosis of IBS.     

The Incidence of Post-infectious Irritable Bowel Syndrome,Anxiety, and Depression in Iranian Patients with Coronavirus Disease 2019 Pandemic: A Cross-Sectional Study

Background:Irritable bowel syndrome refers to a subgroup of disorders of gut–brain interaction associated with stress-related symptoms, but gastrointestinal infection can also be considered the leading risk factor. It is well reported that coronavirus disease 2019 can also result in gastroenteritis. Therefore, this study aimed to evaluate the incidence of post-infectious irritable bowel syndrome and stressful status among coronavirus disease 2019 patients.Methods:This cross-sectional study was conducted on adults with coronavirus disease 2019 referred to the Infectious Disease Clinic in Iran from November 2020 to February 2021. Patients who met all eligibility criteria were included in the study. The data were collected using a demographic questionnaire, Rome IV criteria questionnaire, and Hospital Anxiety and Depression Scale.Results:Totally, the data obtained from 233 eligible patients (136 women, 97 men; mean age 38.41) 11.52 (years) were collected and analyzed, and 53.2% of the cases had a moderate coronavirus disease 2019. The analysis showed that 27 (11.6%) patients suffered from irritable bowel syndrome symptoms based on Rome IV criteria after the recovery from the infection. Also, Hospital Anxiety and Depression Scale-based symptoms of depression and anxiety that occurred with coronavirus disease 2019 were reported in 27.4% and 36.9%, respectively.Conclusion:Our finding illustrated that irritable bowel syndrome symptoms based on Rome IV could occur in post-infected coronavirus disease 2019 patients. Also, Hospital Anxiety and Depression Scale-based symptoms of depression and anxiety were more common in females and coronavirus disease 2019 infected patients with clinical symptoms including cough, shortness of breath, and sore throat.     

A Survey of Irritable Bowel Syndrome in Vietnam Using the Rome Criteria

Prevalence estimates for irritable bowel syndrome from surveys in Western countries are 4.4% to 22%, generally higher in women than men, and only a minority seek health care. There are few studies of bowel patterns in Asian countries. We conducted a survey of a nonpatient population in Ho Chi Minh City, Vietnam, to determine bowel patterns and the prevalence of bowel dysfunction. A forced-choice, self-report questionnaire was distributed to 738 predominantly health care workers, as well as patient relatives, at Cho Ray Hospital in Ho Chi Minh City and returned by 411 (response rate of 55.7%). Results were analyzed for men and women using Student’s t-test for continuous variables and chi-square test for categorical variables. Subjects were 53.6% female, with a mean age of 27.7±6.9 years. Overall perception of health was excellent/very good in 13.6%, good in 54.2%, and fair/poor in 32.1% (males, 17.1%, 51.3%, and 31.5%, vs. females, 10.6%, 56.7%, and 32.7%; P=NS). The mean number of stools reported per week was 6.5 (males, 6.6, vs. females, 6.4; P=NS) and ranged between 3 and 21 stools per week in 95.5%. The frequency of irritable bowel syndrome symptoms (using Rome I criteria) was 7.2% (95% CI=4.8–10.1), with males at 4.8% (95% CI=2.2–8.9) vs. females at 9.2% (95% CI=5.7–13.9) (P=0.08). Of the subjects with irritable bowel syndrome symptoms, 6 of 29 (20.7%) had seen a physician for bowel symptoms. There were no gender differences in reported infrequent stool (12.0%), frequent stool (11.3%), hard stool (17.5%), loose stool (6.5%), straining (14.5%), incomplete emptying (16.2%), bloating (15.0%), urgency (10.0%), or mucus (2.7%). In conclusion, this survey of a nonpatient population in Vietnam showed that irritable bowel syndrome symptoms as defined by Rome criteria were common and that there were no significant differences between sexes in either stool frequency or prevalence of irritable bowel syndrome, unlike previous studies from the United States. The prevalence of irritable bowel syndrome in Vietnam in this study was in the lower range of reported data from Western countries, possibly in part related to the use of the Rome criteria. Only a minority of subjects with irritable bowel syndrome symptoms reported seeking health care for these symptoms.     

肠易激综合征的胆囊收缩功能

本文对１５例肠易激综合征（ＩＢＳ）和１０例健康对照的胆囊收缩功能进行了研究。应用超声显像测定了以下参数：（１）空腹胆囊容积（ＦＧＶ），（２）服脂餐后胆囊达最大收缩时残余容积（ＲＧＶ），（３）胆囊最大排空率（ＭＧＥＲ），（４）达最大收缩的经历时间。结果显示，ＩＢＳ患者的ＦＧＶ、达最大收缩时ＲＧＶ及经历时间均显著大于对照组（均为Ｐ＜０．０１），而其ＭＧＥＲ则显著小于对照组（Ｐ＜０．０１）．提示ＩＢＳ患者的胆囊收缩功能显著异常。     

Bronchial Hyperresponsiveness in Irritable Bowel Syndrome

Extraintestinal symptoms are often found in patients with irritable bowel syndrome (IBS). Recent studies suggest that IBS is associated with bronchial hyperresponsiveness. But it is still arguable that the bronchial hyperresponsiveness is associated with IBS patients. The purpose of this study is to investigate the possible relationship between IBS and bronchial hyperresponsiveness. Forty-two patients with IBS and 42 control subjects were included in this study. All patients underwent pulmonary function, methacholine challenge, and skin prick tests. There was no statistical difference between the two groups with respect to percentage of all pulmonary function test parameters, including FEV₁%, FCV%, FVC/FEV₁, and FEF_{25 − 75}%. Only two persons in the alternating-type IBS patient group and one person in the control group tested positive in the methacholine provocation test. But all PC₂₀ values were above 16 mg/ml. These results do not demonstrate a relationship between bronchial hyperresponsiveness and IBS. However, a relationship might exist in a subpopulation of IBS patients.     

Evolution of Visceral Sensitivity in Patients with Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) has been associated with visceral hypersensitivity. Here we examined the evolution of rectal sensitivity and of gastrointestinal symptomatology in IBS patients over time, to verify if the clinical and biological parameters showed parallel behavior. Patients complaining of IBS, identified by Rome 1 criteria, were included in this study. The severity of the gastrointestinal (Gastrointestinal) symptoms was assessed by a gastrointestinal index. The pain threshold to rectal distension was measured by a barostat programmed for phasic ascending distensions. Both measures were obtained before and after treatment. Thirty-nine patients were followed while on a 10-week group psychotherapy (psy) program. Twelve patients were controlled after pharmacological treatment with amitriptyline (Ami) 10 mg hours for two weeks and then 25 mg hours for the following 4 weeks. Clinical improvement with symptom reduction was achieved in both patients groups. With psy, the Gastrointestinal index declined from an initial value of 78.4 ± 4.8 to 65.5 ± 4.5 at the end of treatment (P < 0.05). With Ami, the gastrointestinal index decreased from 91.6 ± 5.6 to 61.8 ± 9.1 (p < 0.01). The pain threshold to rectal distension increased from 27.7 ± 1.0 to 33.7 ± 1.9 mmHg (P < 0.01) after drug treatment, but remained unchanged (30.6 ± 1.0 vs 30.6 ± 1.1 mm Hg) with psy. Evolution of the gastrointestinal index and rectal sensitivity were directly correlated (r = –0.71; P < 0.01) in Ami patients, but not in those treated with Psy (r = –0.001). In conclusion, visceral hypersensitivity appeared as a stable biological defect over a 10- to 12-week period during clinically-effective treatment with psychotherapy. Rectal pain threshold, however, seemed to be pharmacologically manipulatable in patients treated with Ami.     

Irritable Bowel Syndrome in a Bangladeshi Urban Community: Prevalence and Health Care Seeking Pattern

Background/Aims:

Although irritable bowel syndrome (IBS) is a common gastrointestinal disorder, its prevalence is unknown, especially in the urban population of Bangladesh. This community-based study aimed to find out the prevalence of IBS and healthcare-seeking patterns using the Rome-II definition.

Materials and Methods:

A population-based cross-sectional survey of 1503 persons aged 15 years and above was carried out in an urban community of Bangladesh. The subjects were interviewed using a valid questionnaire based on Rome-II criteria in a home setting. Statistical analysis was performed with Statistical Package for Social Science (SPSS) Programmers and the level of significance was set at P ≤ 0.05.

Results:

A response rate of 97.2% yielded 1503 questionnaires for analysis. The prevalence of IBS was found to be 7.7% (n = 116) with a male to female ratio of 1:1.36 (49 vs. 67). “Diarrhoea-predominant IBS” (50%, n = 58) was the predominant IBS subgroup. Symptoms of abdominal pain associated with a change in stool frequency (100%) and consistency (88.8%) were quite common. All IBS symptoms were more prevalent among women (P < 0.000). In the past one year, 65.5% (n = 76) IBS subjects had consulted a physician with a slightly higher rate of women consulters (68.6 vs. 61.2%). The main predictor for healthcare-seeking was the presence of multiple dyspeptic symptoms.

Conclusions:

The prevalence of IBS in the urban community was found to be similar to that in rural communities. A higher rate of consultation was found among urban IBS subjects than in the rural subjects, with sex not seen to be a discriminator to seek consultation.     

美常安联合得舒特治疗腹泻型肠易激综合征的疗效观察

目的 探讨美肠安治疗腹泻型肠易激综合征的疗效.方法 将60例患者随机分为2组,A组30例,口服得舒特50 mg,每天3次.B组30例,口服美常安500 mg,每天3次,得舒特50 mg,每天3次,疗程4周.观察大便性状评分,腹部综合症状等级评分和疗效评价.结果 治疗4周后,两组Bristol评分均较治疗前明显提高,腹部症状评分较治疗前都有明显下降,B组改善更明显.两组之间的治疗效果比较有明显差异,B组疗效更好.结论 美肠安治疗腹泻型肠易激综合征安全有效.     

Prevalence of irritable bowel syndrome in Hong Kong

BACKGROUND AND AIMS: As part of a public education program, the Hong Kong Society of Gastrointestinal Motility studied the prevalence of irritable bowel syndrome (IBS) in the community, which was based on the recently published Rome II criteria. The distribution of diarrhea or constipation-predominant IBS subtypes, the prevalence of bowel symptoms and the predictors of health-care seeking were also studied. METHODS: Among 1797 randomly selected respondents, 1000 successful telephone interviews (56%) were conducted from August 2000 to December 2000, using a validated questionnaire in Chinese that looked into demographic data and various bowel symptoms during the past year. RESULTS: The 12-month prevalence of IBS as defined by the Rome II criteria in Hong Kong was 6.6%. The female to male ratio was 1.3:1, but this ratio was the same in the control group. The distribution of IBS patients into diarrhea predominant, constipation predominant, and non-specific subtypes was 27, 17 and 56%, respectively. The predominant symptom in the IBS group was pain (54.5%), followed by urgency (15%), abdominal distension (15%) and diarrhea (11%). Forty-seven percent of IBS patients sought medical attention and only 21% of them knew that they had IBS. Moderate to severe pain severity (odds ratio 3.7, 95% CI 1.02-13) and mucus in stool (odds ratio 3.57, 95% CI 1.18-10.7) were associated with health-care seeking in univariate analysis. The prevalence of bowel symptoms such as urgency, straining, feeling of incomplete defecation, mucus in stool and abdominal distension ranged from 11 to 41%. CONCLUSION: The prevalence of IBS in Hong Kong was 6.6%, and the female to male ratio was similar to the control group. The majority was of non-specific IBS subtype. Gross underdiagnosis (21%) by Western practitioners was noted.     

Role of Anger in Antral Motor Activity in Irritable Bowel Syndrome

There is considerable evidence indicating that patients with irritable bowel syndrome respond to emotional and environmental stimulation with increased colon motor activity. It has been suggested also that increased colon motor activity is not confined to the colon and may be representative of a broader disorder affecting the rest of the gastrointestinal tract in this population. The results of our current study suggest that anger may have a significant, although differential effect on antral motor activity in IBS patients compared to normal controls. We found that while antral motor activity did not differ significantly in our groups during rest, anger decreased antral motor activity in IBS patients and increased antral motor activity in normal controls. The difference was not attributable to a difference in anger levels since the groups did not differ in their response to the standardized anger stressor. Rather, the difference in the antral motor response appears to be qualitative and a possible marker for irritable bowel syndrome. Our data further suggest that increased colon motor activity in IBS patients during emotional stress is not a result of a rise in motor activity throughout the gastrointestinal tract, but a phenomenon that may be unique to the colon in this patient population.     

Relationship Between Asthma and Irritable Bowel Syndrome: Role of Food Allergy

The increasing prevalence of both asthma and irritable bowel syndrome (IBS) are major health problems. One hundred twenty-five patients with asthma and 95 healthy subjects were included in this study. The rate of IBS was 29.6% and 12.7% (p < 0.005), and the incidence of food allergy was 7.2% and 2.1% (p > 0.05) respectively for asthma and control group. There was no significant association between asthma related parameters, IBS, and food allergy. There is not a single clear reason as to what causes IBS, so further studies are needed to clarify the potential pathogenic mechanisms underlying the association between IBS and asthma.     

Irritable Bowel Syndrome on Inflammatory Bowel Disease in Deep Remission: No Relation with Remission Deepening and Inflammation

Background: The aim of the study was to establish the frequency of irritable bowel syndrome (IBS) in patients with inflammatory bowel disease (IBD) in clinical, endoscopic, and histologic remission and in relation to both the depth of remission and inflammation markers. Methods: Patients with ulcerative colitis (UC) and with Crohn’s disease (CD) in clinical remission for at least 6 months were enrolled in the study. All of the patients underwent colonoscopy, and biopsy specimens were taken to evaluate endoscopic and histopathologic remission. Patients were evaluated according to Rome III criteria for IBS. Fecal calprotectin level and blood samples for C-reactive protein (CRP), sedimentation rate, and fibrinogen levels were studied.Results: IBS frequency was 20.9% in UC cases and 28.9% in CD cases in clinical remission. Rates with and without endoscopic remission in UC (20.5% vs. 22.2%, P = .727) and CD (25% vs. 33.3%, P = .837, respectively) were not different. Similarly, rates with and without histopathologic remission in UC (15.7% vs. 26.6%, P = .723), and CD (21.4% vs. 33.3%, P = .999) were not statistically different. Also, it was not related to inflammation markers.Conclusion: IBS frequency among IBD patients with remission was in a substantial rate; these rates kept up with the process of deep remission and even complete mucosal healing and were irrelevant to inflammation.     

Prevalence of irritable bowel syndrome in young adult Malaysians: a survey among medical students

BACKGROUND AND AIMS: Irritable bowel syndrome (IBS) is a common functional bowel disease in the West. Information on the prevalence of IBS in the Asian population is relatively scanty. The aims of the present study were to determine the prevalence of IBS and to assess the symptom subgroups based on the predominant bowel habit in a young adult population of Asian origin. METHODS: Basic demographic data and symptoms of IBS using the Rome I criteria were sought using a questionnaire administered to all apparently healthy students in a medical school. Other questions asked related to alcohol intake, smoking, chili consumption, dietary fiber intake, and to psychological and psychosomatic symptoms of anxiety, depression, insomnia, headache, and backache. The health-care seeking behavior of the subjects was also analyzed. RESULTS: Of the 610 questionnaires administered, 533 complete responses were received (response rate of 87.4%). The responders comprised 229 men (43.0%) and 304 (57.0%) women with a mean age of 22 +/- 1.8 years. The ethnic distribution was Malays 278 (52.2%), Chinese 179 (33.6%), Indians 46 (8.6%), and others 30 (5.6%). Eighty-four (15.8%) reported symptoms consistent with the diagnosis of IBS, predominantly women. Sixty-five (77.4%) and six (7.1%) were of the constipation-predominant and diarrhea-predominant IBS subgroups, respectively. Thirteen (15.5%) subjects fell into the non-specific IBS subgroup. The self-reported psychological and psychosomatic symptoms of anxiety (P = 0.02), depression (P = 0.002), insomnia (P = 0.006), headache (P = 0.04), and backache (P = 0.006) were encountered more frequently in the subjects with IBS. Only 13.1% of the IBS group had consulted their health-care practitioner, and 20.2% reported self-medication. CONCLUSIONS: Symptoms supportive of the diagnosis of IBS were common among young Malaysians, with a prevalence rate of 15.8%. There were significantly more women with IBS than men. Within the IBS population, the majority (77.4%) was of the constipation-predominant IBS subgroup. A significantly higher prevalence of psychological and psychosomatic symptoms was found in individuals with IBS. Only a minority sought medical advice for their symptoms.     

Sleep Disturbance Influences Gastrointestinal Symptoms in Women with Irritable Bowel Syndrome

This analysis evaluated the association between sleep disturbance and gastrointestinal symptoms in women with and without irritable bowel syndrome (IBS), and examined the role of psychological distress in this relationship. Women with IBS (N = 82) reported considerably higher levels of sleep disturbance compared to controls (N = 35), using both retrospective seven-day recall and daily diary recall for two menstrual cycles (P < 0.05 on 8 of 10 measures). We used daily diary data to estimate the association between sleep disturbance and gastrointestinal symptoms, both across women (ie, whether women with high average sleep disturbance have higher average gastrointestinal symptoms) and within woman (ie, whether poorer than average sleep on one night is associated with higher than average gastrointestinal symptoms the following day). The regression coefficients for the across-women effect are large and highly significant in both groups (IBS, ± se = 0.46 ± 0.08, P < 0.001; controls, 0.57 ± 0.13, P < 0.001). The regression coefficients for the within-woman effect are considerably smaller and statistically significant only in the IBS group (IBS, 0.06 ± 0.02, P = 0.006; control, 0.01 ± 0.03, P = 0.691). These regression coefficients showed little change when daily psychological distress or stress was controlled for, the one exception being the coefficient for the across-women effect in the IBS group, which decreased substantially but still remained highly significant. Because it is possible that gastrointestinal symptoms could, in fact, cause poor sleep, we also fitted the temporally reversed model to evaluate the association between gastrointestinal symptoms on one day and sleep disturbance that night. The within-woman regression coefficients were nonsignificant in both the IBS and control groups. In conclusion, these results are consistent with the hypothesis that poor sleep leads to higher gastrointestinal symptoms on the following day among women with IBS.     

Relationship Between Systemic Immune-Inflammation Index and Irritable Bowel Syndrome

BackgroundIrritable bowel syndrome is accepted as a functional disorder; however, there is growing evidence in favor of the inflammatory process contributing to its pathogenesis. We aimed to evaluate the role of the systemic immune-inflammation index as a marker of inflammation in patients with irritable bowel syndrome.MethodsThe study was conducted in the outpatient clinic of the Gastroenterology Department with patients having constipation-predominant irritable bowel syndrome diagnosis according to Rome IV criteria between March 1, 2019 and December 31, 2020. The systemic immune-inflammation index was calculated and compared with age- and sex-matched healthy controls.ResultsThe study was performed with 214 participants, 107 patients and 107 control groups. Platelet and neutrophil counts (P < .001, for both) were higher, and lymphocyte count (P = .003) was lower in the irritable bowel syndrome group. The systemic immune-­inflammation index was higher in irritable bowel syndrome patients (P < .001). Multivariate logistic regression analyses showed the role of the systemic immune-inflammation index as an independent predictor of the presence of IBS (odds ratio: 1.100, P < .001).ConclusionSystemic immune-inflammation index may be a cheap, universal, and reliable indicator of the inflammatory process in irritable bowel syndrome patients.     

Functional Gastrointestinal Disorders in Canada: First Population-Based Survey Using Rome II Criteria with Suggestions for Improving the Questionnaire

The Rome II criteria and questionnaires developed to identify functional gastrointestinal disorders have not been evaluated. Our objectives were to determine the prevalence of functional gastrointestinal disorders in Canada, compare our results with data from other published studies, assess concordance of Rome I and Rome II criteria for irritable bowel syndrome, and suggest improvements in the Rome II questionnaire. An independent research firm was employed to conduct a random digit dial national survey, inviting household members 18 years of age to participate in a study examining personal health issues. Subjects recruited by telephone, who agreed to participate, were mailed a questionnaire, and the data were retrieved by a follow-up phone call. The Rome II questionnaire and algorithms were used and where possible Rome I algorithms were also applied. At least one functional gastrointestinal disorder occurred in 61.7% of 1149 respondents (65.6% female versus 57.6% male; P < 0.05). The most prevalent were the functional bowel disorders at 41.6% followed by esophageal disorders at 28.9%. Irritable bowel syndrome prevalence by Rome II and I criteria were 12.1% and 13.5%, respectively (kappa = 0.76). Because the Rome II criteria have added exclusion items that are not present in the Rome I criteria, the prevalence of esophageal, gastroduodenal, and anorectal disorders is lower than the figures from a US market survey. In conclusion, functional gastrointestinal disorders are highly prevalent in Canada, with a significantly higher rate in women. There is substantial agreement between Rome I and Rome II criteria for irritable bowel syndrome. Rome criteria and questionnaire remain works in progress.