Enhanced perception of physiological intestinal motility in the irritable bowel syndrome

An increased awareness of intestinal distention or contraction is implicated in the pathogenesis of the irritable bowel syndrome. This study aimed to test this hypothesis in 20 patients with the irritable bowel syndrome and 10 controls by relating the reporting of abdominal sensations to the occurrence of the duodenal phase 3 activity front of the migrating motor complex. During prolonged recordings of interdigestive small bowel motility, subjects were asked to report any episodes of abdominal sensation they experienced. Diurnally, the rate of occurrence of abdominal sensation was significantly greater in patients with the irritable bowel syndrome than in controls (P less than 0.001); such episodes were coincident with a duodenal activity front in 9 patients with the irritable bowel syndrome and in 1 control (P less than .05). Moreover, the rate of occurrence of episodes of sensation was greater (P less than 0.01) during diurnal phase 3 activity than during diurnal phase 2 activity. When episodes were coincident with duodenal phase 3 activity, these activity fronts were of significantly greater amplitude (irritable bowel syndrome: median, 23 mm Hg) than "noncoincident" activity fronts (median, 17 mm Hg; P less than 0.05) in both patients and controls. These data strongly suggest that certain physiological small bowel motor events, if of sufficient contraction amplitude, are able to be perceived by a greater proportion of irritable bowel syndrome patients and with greater frequency than by healthy subjects. The authors conclude that the threshold for perception of intestinal contraction is lower than normal in at least some patients with the irritable bowel syndrome.     

Prevalence of irritable bowel syndrome among undergraduates in Southeast China

BACKGROUND: There is a wide range in reported prevalence of irritable bowel syndrome worldwide. From the data appeared recently in medical literatures in China, it seems that the incidence of irritable bowel syndrome in young adults is not dissimilar to the one in the Western countries. AIMS: To explore the prevalence and epidemiological variations of irritable bowel syndrome in an undergraduate student population in Southeast China on the basis of the Rome II and Rome III criteria. METHODS: All the undergraduate student participants were administered self-report diagnostic measures for irritable bowel syndrome. RESULTS: The sex-adjusted prevalence rate of irritable bowel syndrome was 4.7% (Rome II) and 10.4% (Rome III), respectively. When we combined irritable bowel syndrome mixed and irritable bowel syndrome unsubtyped in the Rome III subgroups into one group considering the counterpart in the Rome II subgroups was alternative irritable bowel syndrome, the agreement between the two ways to subdivide these 54 patients who were identified with irritable bowel syndrome by both the two criteria was 81%, with a kappa value of 0.67. By the Rome III criteria, we found a female predominance which was especially attributed to the subtypes of irritable bowel syndrome with constipation and unsubtyped. CONCLUSIONS: Our study suggests that, in young adults in Southeast China, changing diagnostic criteria for irritable bowel syndrome from Rome II to Rome III may affect women more than men on not only the overall prevalence rate but also the sex-difference present or not, especially in irritable bowel syndrome with constipation and irritable bowel syndrome unsubtyped subgroups.     

Evidence for Autonomic Nervous System Imbalance in Women with Irritable Bowel Syndrome

Autonomic nervous system function was assessedin women with and without irritable bowel syndrome usingfrequency domain measures of heart rate variability.Women were interviewed and placed into the irritable bowel syndrome (N = 25) group based on historyof diagnosis and self-report of current gastrointestinalsymptoms. Women in the control group denied a history ofchronic gastrointestinal symptoms (N = 15). Women werefollowed for one menstrual cycle with a symptom diary,and during mid-luteal phase they wore a Holter 24-hrelectrocardiograph monitor. Women with irritable bowelsyndrome demonstrated significantly lower vagal tone as measured by the highfrequency spectrum relative to control women. Inaddition, women with irritable bowel syndrome had aflattened 24-hr pattern of heart rate variability, withsignificantly lower levels of vagal tone during sleep. Theseresults suggest that systemic sympathovagal balance maybe shifted in a subset of women with irritable bowelsyndrome.     

Gastrointestinal symptoms in the irritable bowel compared with peptic ulcer and inflammatory bowel disease.

Symptoms of 50 patients with the irritable bowel syndrome were compared with those of 49 with endoscopically proven peptic ulcer disease and 49 with radiologically or endoscopically proven inflammatory bowel disease using a questionnaire which was administered after the diagnosis was made. Symptoms of bowel dysfunction including pain related to bowel movements were more likely to occur in the irritable bowel syndrome than peptic ulcer disease. Only abdominal distension, straining at stool and scybala, however, were significantly more likely in the irritable bowel syndrome than inflammatory bowel disease. Four symptoms previously shown to be more common in irritable bowel syndrome than in organic abdominal disease were combined. The more of these symptoms that were present, the more likely were the patients to have the irritable bowel syndrome than peptic ulcer disease. Symptoms of gut dysfunction are highly discriminating between irritable bowel syndrome and peptic ulcer disease but less so between irritable bowel syndrome and inflammatory bowel disease.     

Fatigue in irritable bowel syndrome: characterization and putative role of leptin

OBJECTIVES: Fatigue has received little attention in the irritable bowel syndrome. Emerging evidence exists that leptin may be involved in the pathogenesis of fatigue in several conditions. We aimed to evaluate the occurrence of fatigue and its characteristics in irritable bowel syndrome and to analyze the relationship between fatigue and leptin. METHODS: We enrolled 51 consecutive irritable bowel syndrome patients and 22 healthy controls without fatigue. None of them were depressed. The Fatigue Impact Scale was used to evaluate fatigue. RESULTS: In all, 62.7% of irritable bowel syndrome patients verbally expressed fatigue and rated more than 4 on the visual analog scale. The total score of fatigue was significantly higher in irritable bowel syndrome than in controls. In irritable bowel syndrome patients, but not in controls, a significant association was found between the total score of fatigue and leptin and this association was more pronounced in 32 irritable bowel syndrome patients who verbally expressed fatigue (r=0.60; P=0.0003). In irritable bowel syndrome, leptin correlated with fatigue independently from age, sex, fat mass and body mass index. CONCLUSIONS: Our study shows that fatigue occurs in 62.7% of irritable bowel syndrome patients when systematically asked for. Fatigue influences all three domains of the Fatigue Impact Scale in irritable bowel syndrome, the most being the physical and the psychosocial domains. Fatigue is associated with circulating leptin levels independently from age, sex, fat mass and body mass index in irritable bowel syndrome. The metabolic sequence involved in the occurrence of fatigue remains to be determined.     

What do patients with irritable bowel syndrome dream about? A comparison with inflammatory bowel disease

BACKGROUND: It is a common experience for people to dream of events about which they are either anxious or concerned. We therefore hypothesised that the dreams of patients with irritable bowel syndrome may reflect their worries about their problem especially as hospital out-patients with this disorder tend to exhibit some anxiety. In addition, dreaming about, for instance bowels, in patients with irritable bowel syndrome in excess of that observed in other gastrointestinal disorders may be of importance. AIM: To establish whether patients with irritable bowel syndrome dream about bowel-related issues more than controls or patients with inflammatory bowel disease. PATIENTS AND METHODS: A total of 57 patients with irritable bowel syndrome and 57 patients with inflammatory bowel disease were compared with 60 healthy controls. All subjects completed a structured questionnaire concerning sleeping habits and dream characteristics as well as an assessment of anxiety and depression. RESULTS: There were no differences in the sleeping habits between any of the groups. However, significantly more patients with irritable bowel syndrome and inflammatory bowel disease dreamt about their bowels (22% inflammatory bowel disease patients, 18% irritable bowel syndrome patients vs 3% of controls, p < 0.05 inflammatory bowel disease and irritable bowel syndrome vs controls) and soiling themselves (16% of inflammatory bowel disease patients, 14% of irritable bowel syndrome patients vs 2% of controls; p < 0.05 inflammatory bowel disease and irritable bowel syndrome vs controls) than controls. CONCLUSION: Chronic gastrointestinal disorders, of both a functional and organic nature, may influence the nature of dreams. In those patients who dream about their symptoms, it would be interesting to know whether this affects the course of their disease, either positively or negatively, in any way.     

Alternative medicine consultations and remedies in patients with the irritable bowel syndrome.

The use of alternative medicine was assessed by questionnaire in 96 patients with irritable bowel syndrome, 143 patients with organic upper gastrointestinal disorders and 222 patients with Crohn's disease of comparable age and sex. Significantly more patients with the irritable bowel syndrome (16%) had consulted practitioners of alternative medicine about their condition than had patients in either of the other groups. Similarly, significantly more irritable bowel syndrome patients said they would consult an alternative medicine practitioner (41%) if conventional treatment failed. Current usage of alternative medicine remedies was significantly greater in the irritable bowel syndrome patients (11%) than in patients with Crohn's disease (4%) and tended to be greater than in patients with organic upper gastrointestinal disorders (6%). This study has shown that the use of alternative medicine is common in patients with irritable bowel syndrome and this does not appear to be explicable in terms of the nature, chronicity or refractoriness to treatment of symptoms.     

Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples

Women with symptoms indicative of irritable bowel syndrome who had not consulted a physician were compared with female patients at a gastroenterology clinic to investigate whether self-selection for treatment accounts for psychologic abnormalities in clinic patients' with irritable bowel syndrome. Two sets of diagnostic criteria were compared: restrictive criteria based on the work of Manning and conventional criteria (abdominal pain plus altered bowel habits). Lactose malabsorbers were included as a control group because they have medically explained bowel symptoms similar to those that define irritable bowel syndrome. Thus they control for the causative effects of chronic bowel symptoms on psychologic distress. Women who met restrictive criteria for irritable bowel syndrome but had not consulted a physician had no more symptoms of psychologic distress on the Hopkins Symptom Checklist than asymptomatic controls. However, medical clinic patients with both irritable bowel syndrome and lactose malabsorption had significantly more psychologic symptoms than asymptomatic controls or nonconsulters with the same diagnoses. Individuals who met only the conventional criteria for irritable bowel syndrome reported more psychologic distress than controls, whether or not they consulted a physician. These results suggest that (a) symptoms of psychologic distress are unrelated to irritable bowel syndrome but influence which patients consult a doctor and (b) conventional diagnostic criteria identify more psychologically distressed individuals than do restrictive criteria.     

Evidence for exacerbation of irritable bowel syndrome during menses

Many women report that bowel symptoms are associated with menstruation, but neither the prevalence of these complaints nor their physiological basis is known. This study aimed to estimate prevalence, to determine whether patients with irritable bowel syndrome are more likely to make such complaints, and to determine whether bowel complaints during menstruation are attributable to psychological traits such as increased somatization. To estimate prevalence, 369 clients of Planned Parenthood of Maryland were asked whether gas, diarrhea, or constipation occurred during menstruation. These subjects were compared with women referred to a gastroenterology clinic and found to have irritable bowel syndrome or functional bowel disorder (abdominal pain plus altered bowel habits but not satisfying restrictive criteria for irritable bowel syndrome). Thirty-four percent of 233 Planned Parenthood clients who denied symptoms of irritable bowel syndrome or functional bowel disorder reported that menstruation was associated with one or more bowel symptoms. Gastroenterology clinic patients with irritable bowel syndrome were significantly more likely to experience exacerbations of each of these bowel symptoms, but especially increased bowel gas. Self-reports of bowel symptoms during menstruation were not associated with psychological traits or with menses-related changes in affect.     

Irritable bowel syndrome in young and elderly patients with stable asthma

BACKGROUND: It has been speculated that asthma and irritable bowel syndrome may share common pathophysiological processes. AIM: To estimate the prevalence of irritable bowel syndrome in young and elderly patients with stable asthma. PATIENTS AND METHODS: Sixty-five young (age < 60 years) and 66 elderly (age > or = 60 years) stable asthmatics, and 119 age-matched healthy volunteers were enrolled. In all participants, presence of irritable bowel syndrome, quality of life and psychological status were evaluated. RESULTS: The prevalence of irritable bowel syndrome in asthmatic group was higher than that in the control group (27.5% versus 16.8%; odds ratio, 1.8 [1.0-3.4]; p=0.04). The prevalence of irritable bowel syndrome was significantly higher in young asthmatics than in age-matched healthy controls (36.9% versus 20.3%; odds ratio, 2.2 [1.0-5.1]; p=0.04) and than in elderly asthmatics (36.9% versus 18.2%; odds ratio, 0.3 [0.1-0.8]; p=0.01). Logistic regression analysis identified the younger age (odds ratio, 2.1 [1.1-3.8]; p=0.01), and the presence of asthma (odds ratio, 1.9 [1.0-3.5]; p=0.03) as independent risk factors for irritable bowel syndrome in all participants after adjusting for gender. We also found impaired quality of life to be associated with the presence of irritable bowel syndrome and asthma in all participants after adjusting for age and gender. CONCLUSION: The prevalence of irritable bowel syndrome appears to be significantly higher in young asthmatics, but not in elderly asthmatics, compared to age-matched healthy counterparts. Potential pathogenic mechanisms of higher irritable bowel syndrome prevalence in young asthmatics need to be explained by further studies.     

Domperidone treatment in the irritable bowel syndrome

Domperidone treatment did not differ significantly from placebo treatment in irritable bowel syndrome patients concurrently put on high fibre diet. No side effects attributable to the drug were encountered. This study further reinforces the necessity to have patients concurrently on a high fibre diet when testing for drug efficiency in the irritable bowel syndrome. Double-blind drug versus placebo studies should be undertaken in the irritable bowel syndrome patients who fail to respond to a high fibre diet. Dopamine receptor sites are unlikely to be primarily involved in the irritable bowel syndrome.     

Gallstones,cholecystectomy and irritable bowel syndrome (IBS): MICOL population-based study

BackgroundSubjects with irritable bowel syndrome may undergo an excess of cholecystectomy. It is not known, however, whether the cholecystectomy rate parallels an increased risk of gallstones.AimAim was to assess the prevalence and the incidence of gallstones and cholecystectomy in subjects with irritable bowel syndrome symptoms.Subjects and methodsIn this population-based study, 29,139 subjects (63.2% of 46,139 randomly selected subjects, age 30–69 years) underwent a physical examination, an interview on gastrointestinal symptoms and an upper abdominal ultrasonography. An identical survey was carried out 7.8 ± 1.0 (M ± S.D.) years later on 8460 gallstone-free subjects at the first survey.Prevalence and incidence of gallstones and cholecystectomy were assessed in subjects with (1) irritable bowel syndrome; (2) abdominal pain and normal bowel; (3) altered bowel and no abdominal pain and (4) asymptomatic controls; univariate and multivariate regression logistic models were used for statistical analysis.ResultsPrevalence odds of gallstones and cholecystectomy were significantly higher in irritable bowel syndrome and abdominal pain and normal bowel than in controls. Irritable bowel syndrome and abdominal pain and normal bowel subjects were more aware of gallstones than controls (p < 0.001), and the prevalence of gallstones in irritable bowel syndrome subjects unaware of their gallbladder status was not significantly different from the controls. The incidence of gallstone disease in irritable bowel syndrome, abdominal pain and normal bowel, and altered bowel and no abdominal pain subjects did not differ from the controls. The incidence of cholecystectomy was higher in irritable bowel syndrome and abdominal pain and normal bowel groups than in controls and altered bowel and no abdominal pain group.ConclusionsIrritable bowel syndrome subjects have an increased risk of cholecystectomy that is not due to an increased risk of gallstones, but rather to abdominal pain, awareness of having gallstones, and inappropriate surgical indications.     

肠吉泰联合经皮穴位电刺激法治疗腹泻型肠易激综合征的随机、双盲、安慰剂对照研究

[目的]观察肠吉泰联合经皮穴位电刺激法治疗腹泻型肠易激综合征(IBS-D)的临床疗效和复发率。[方法]遵循随机、双盲、安慰剂平行对照的设计原则,将242例IBS-D患者分为肠吉泰、肠吉泰联合经皮穴位电刺激、安慰剂3组。按照病情分级特征再次将各组患者分为轻、中、重度进行分层观察研究,以肠道总体症状尺度表评判治疗结果。治疗结束后按1∶1∶1比例将所有治愈和显效的受试者随机分为穴位经皮电刺激组、模拟刺激对照组和空白对照组,电话随访记录受试者复发时间。[结果]肠吉泰和肠吉泰联合经皮穴位电刺激组对肠道总体症状的改善显著优于安慰剂组(P0.05,0.01),肠吉泰联合经皮穴位电刺激组较肠吉泰组疗效更显著(P0.05)。治疗结束后经皮穴位电刺激组的复发率显著低于模拟刺激组和空白对照组(P0.05)。[结论]经皮穴位电刺激联合肠吉泰比单用肠吉泰治疗有显著的优越性,而且经穴刺激可以有效预防IBS-D的再度复发。     

Irritable bowel syndrome, chronic pelvic inflammatory disease and endometriosis: a comparison of symptomatology

BACKGROUND AND OBJECTIVES: Both irritable bowel syndrome and some gynaecological diseases can give rise to lower abdominal pain, which may result in diagnostic confusion. Disorders such as endometriosis and chronic pelvic inflammatory disease can be diagnosed definitively only by laparoscopy, which is seldom undertaken in the gastroenterological setting. It was the aim of this study to compare the symptomatology of irritable bowel syndrome with that of laparoscopically confirmed chronic pelvic inflammatory disease and endometriosis. PATIENTS AND METHODS: A symptom questionnaire was administered to 50 women with irritable bowel syndrome and 51 gynaecological patients (30 patients with endometriosis, 21 patients with chronic pelvic inflammatory disease). As the symptoms of the two gynaecological conditions were so similar, the groups were combined for the purposes of comparison with irritable bowel syndrome. RESULTS: Patients with irritable bowel syndrome suffered significantly more upper abdominal pain, colicky pain and exacerbation of pain by food or stress. They also experienced more disturbance of bowel habit, distension and nausea. In contrast, the only gynaecological features that were more common in the gynaecological patients were intermenstrual bleeding, premenstrual exacerbation of pain and forniceal tenderness. CONCLUSION: The presence of gastrointestinal symptomatology, especially bowel dysfunction, in a woman with lower abdominal pain is suggestive of irritable bowel syndrome. However, the history may not be so helpful in detecting gynaecological disease.     

Transit through the proximal colon influences stool weight in the irritable bowel syndrome.

The inherent variability of symptoms and motor abnormalities in patients with the irritable bowel syndrome has hampered the demonstration of motor abnormalities that could underlie symptoms. The aim in the current study was to evaluate whether altered regional capacitance or transit of solid residue through the unprepared human gut were factors in the diarrhea of patients with the irritable bowel syndrome. In 10 such patients and in 5 healthy controls, gastric and small bowel transits were evaluated scintigraphically by means of a mixed meal containing 99mTc-labeled resin pellets. Regional colonic transit was quantitated by 111In-labeled pellets delivered to the ileocecal region by a pH-sensitive, methacrylate-coated capsule. Symptomatic patients did not have significantly altered gastric or small bowel transits, but colonic transit was accelerated in 7 of 10 persons with the irritable bowel syndrome (P less than 0.02), in the proximal colon of five patients and in the left colon of two patients. The 24-hour stool weight was positively correlated with the rate at which solid residue emptied from the ascending and transverse colons (r = 0.78; P less than 0.01). There was also an inverse relationship between emptying rates and maximal volumes accommodated by the proximal colon (r = -0.58; P less than 0.05), although the maximum volume of the proximal colon was not significantly different in patients and healthy subjects. Thus, accelerated transit through the proximal colon is a factor in the pathophysiology of the irritable bowel syndrome and influences the stool weight of such patients. The capacitance of the proximal colon presumably influences its storage capacity and, hence, the rate at which it empties.     

幽门螺杆菌感染与肠易激综合征关系研究

目的研究幽门螺杆菌(H.pylori)感染与肠易激综合征(IBS)之间的关系。方法随机选取肠易激综合征患者40例为实验组,另选取40例正常健康者为对照组,应用13C尿素呼气试验及快速尿素酶法分别测定二者的H.pylori感染率。并根据检测结果将26例H.pylori阳性的IBS患者随机分为观察组(13例)和对照组(13例),观察组加用根除H.pylori药物治疗2周,观察其疗效。结果 IBS患者中的H.pylori感染率(65.00%)明显高于对照组(42.50%),二者相比差异有统计学意义(P<0.05)。H.pylori阳性的IBS患者,观察组治疗有效率(92.31%)明显高于对照组(38.46%),差异有统计学意义(P<0.05)。结论 H.pylori感染与肠易激综合征之间有一定关系,根除H.pylori可能在IBS的治疗中起一定作用。     

Abnormal colonic propagated activity in patients with slow transit constipation and constipation-predominant irritable bowel syndrome

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

A comparative reappraisal of the Rome II and Rome III diagnostic criteria: are we getting closer to the 'true' prevalence of irritable bowel syndrome?

OBJECTIVES: Revisions of the diagnostic criteria for irritable bowel syndrome have led to varying prevalence estimates. The Rome III criteria require a lower symptom frequency than Rome II (at least 10% of the time for Rome III, compared with at least 25% of the time for Rome II). In an epidemiological survey of a representative sample of Israeli adults using Rome II, we reported the prevalence for irritable bowel syndrome as 2.9%. The official Rome II integrative questionnaire, used for that study, enables a close approximation of Rome III rates, facilitating a retrospective comparison of these criteria. METHODS: A representative sample of 1000 adults was interviewed with a validated Hebrew version of the official Rome II integrative questionnaire. The data were re-evaluated retrospectively to compare the Rome II results with a close approximation of the new Rome III criteria. RESULTS: The prevalence rates for irritable bowel syndrome were 2.9 and 11.4%, respectively, for Rome II and Rome III. The corresponding consultation rates were 57.1 and 41.7%, indicating that the more strict Rome II criteria may select out a group of patients with more severe disease or greater psychosocial problems. Women made up 71.4% of irritable bowel syndrome by Rome II and 62.5% by Rome III. CONCLUSIONS: In the present retrospective study, the prevalence rate for irritable bowel syndrome in our population is significantly higher by Rome III compared with Rome II. Rome III may more closely reflect the socioeconomic burden of irritable bowel syndrome compared with the overly strict Rome II. Prospective comparative studies should be conducted to confirm these results.