Irritable bowel syndrome, chronic pelvic inflammatory disease and endometriosis

Irritable bowel syndrome (IBS) is common. The symptom criteria for the diagnosis of IBS remain non specific. Similarly, pelvic inflammatory disease and endometriosis present with symptoms that may be similar to those of IBS. The site of pain, intermenstrual bleeding and exacerbation of symptoms by food may be able to help differentiate the two groups. However, there is still considerable overlap in the symptomatology of the two conditions and to this end both specialties should work together to investigate and manage these patients.     

肠易激综合征与炎症性肠病

近年发现,炎症性肠病(IBD)患者发病早期或缓解期时常表现为肠易激综合征(IBs)症状,且IBD与IBS的临床表现具有一定的相似性。因而IBS与IBD的相关性受到广泛的重视。此文就IBS与IBD的发病机制及临床相关性予以阐述,以期为临床个体化治疗提供借鉴。     

Irritable bowel syndrome and endometriosis: New insights for old diseases

Irritable bowel syndrome and endometriosis are two diseases affecting a significant part of the female population, either together or individually, with remarkable consequences in the quality of life. Several studies suggest an epidemiological association between them.Their association may not be just an epidemiological phenomenon, but the manifestation of a pathophysiological correlation, which probably generates a mutual promotion phenomenon. In particular, both clinical entities share the presence of a chronic low-grade inflammatory state at the basis of the disease persistence.Recognizing this association is highly significant due to their prevalence and the common clinical manifestation occurring with a chronic abdominal pain. A further multi disciplinary approach is suggested in these patients’ management in order to achieve an adequate diagnostic work up and a targeted therapy.This paper analyses some common pathophysiological mechanisms, such as activation of mast cell line, neuronal inflammation, dysbiosis and impaired intestinal permeability. The aim was to investigate their presence in both IBS and endometriosis, and to show the complexity of their relationship in the generation and maintenance of chronic inflammation.     

Irritable bowel syndrome and chronic constipation: Fact and fiction

Irritable bowel syndrome(IBS) and functional constipation(FC) are the most common functional gastrointestinal disorders. According to the Rome ⅢCriteria these two disorders should be theoretically separated mainly by the presence of abdominal pain or discomfort relieved by defecation(typical of IBS) and they should be mutually exclusive. However,many gastroenterologists have serious doubts as regards a clear separation. Both IBS-C and FC,often associated with many other functional digestive and non digestive disorders,are responsible for a low quality of life. The impact of the media on patients' perception of these topics is sometimes disruptive,often suggesting a distorted view of pathophysiology,diagnosis and therapy. These messages frequently overlap with previous subjective opinions and are further processed on the basis of the different culture and the previous experience of the constipated patients,often producing odd,useless or even dangerous behaviors. The aim of this review was to analyze the most common patients' beliefs about IBS-C and CC,helping physicians to understand where they should focus their attention when communicating with patients,detecting false opinions and misconceptions and correcting them on the basis of scientific evidence.     

Probiotics,irritable bowel syndrome,and inflammatory bowel disease

Opinion statement Probiotics are live, microbial food supplements that benefit the host animal by improving intestinal microbial balance. Their major role in preventing and treating gastrointestinal disease appears to be from their effect on the immune process, protection against abnormal invasive bacteria, and in the production of short-chain fatty acids from starch and non-starch polysaccharides. Probiotic microorganisms are administered in food supplements and yogurts. They are also now sold in the form of capsules and powders. There is great variation in the microorganisms in the various supplements. It is important to understand that all probiotic products are different. Some contain a single organism and others contain multiple organisms. Therapeutic results have been achieved with various probiotics in different diseases. In the treatment of inflammatory bowel diseases (IBD), success has been reported with Escherichia coli Nissle strain in ulcerative colitis, and with a multiple organism product, VSL#3 (VSL Pharmaceuticals, Fort Lauderdale, FL), in Crohn’s disease and pouchitis. Initial reports in irritable bowel syndrome (IBS) have resulted in encouraging results with the use of E. coli Nissle strain, and recently with multiple organism probiotic supplements. However, caution must still apply to the use of probiotics in IBD and IBS because the reports and the number of patients treated are limited.     

Irritable bowel syndrome and chronic constipation: Emerging drugs, devices, and surgical treatments

Irritable bowel syndrome (IBS) and chronic constipation (CC) are two of the most common functional disorders of the gut. CC and IBS are estimated to affect up to 20% and 27% of the North American population respectively. Although not life-threatening, CC and IBS can profoundly and negatively affect quality of life and are associated with a significant economic burden related to direct and indirect annual health-care costs. Possible etiologies for IBS and CC include alterations in visceral sensation and gastrointestinal motility. IBS may be caused by disturbances in brain-gut interactions affecting gastrointestinal motility and visceral sensitivity. Research efforts in CC have begun to identify abnormalities in myenteric neurons, alterations in neurotransmitters and their receptors, and incoordination of the muscles of the pelvic floor or anorectum. Both disorders may be influenced by genetic predisposition, environmental factors, and stress. In this article, the safety and efficacy of traditional and emerging therapies for CC and IBS are examined. In addition, their pathophysiology and symptoms are briefly reviewed.     

Irritable bowel syndrome: a primer on management

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain, bloating, and either constipation or diarrhea. Managing this chronic condition requires a coordinated effort between patient and physician. The diagnosis of IBS should be made as early as possible in the evaluation of a patient, so that treatment can be initiated as soon as possible. Treatment usually requires a multifactorial approach, including patient education, reassurance, lifestyle changes, and pharmacotherapy. In this article, medications commonly used to treat the individual symptoms of IBS are reviewed, based on evidence from the literature. In addition, new agents that affect the serotonin system and treat the global symptoms of IBS are described.     

Irritable bowel syndrome: a management strategy.

In the development of a management strategy for irritable bowel syndrome (IBS) patients we must consider the great number of people with the condition, most of whom do not consult doctors for it. Furthermore, we must be aware of the hidden agenda of those that do. The cause of IBS is unknown, and consequently cure of this chronic recurrent condition is not likely. Moreover, the disorder is very costly, drawing precious resources from the care of more serious diseases. In this chapter I propose a management strategy based on a firm diagnosis of IBS using a minimum of tests, consideration of the patient's agenda, the use of dietary advice, the strategic use of drugs only in resistant cases, a graded therapeutic response and continuing care. There is no specific treatment. The doctor-patient interaction is most important to allay patients' fears and concerns, assist them with psychosocial difficulties, and provide the caring support known to maximize the 'placebo' effect of any treatment.     

Irritable bowel syndrome and surgery: a multivariable analysis

BACKGROUND & AIMS: Patients with irritable bowel syndrome (IBS) have high surgical rates. We investigated the demographic and medical factors independently associated with surgical histories of health examinees. METHODS: We applied multiple stepwise logistic regression analysis to self-completed questionnaire data from 89,008 examinees, assessing 6 surgeries as outcomes. We assessed questionnaire/physician record agreement of physician-diagnosed IBS and surgical history on 201 randomly selected examinees with > or =3 years of records. RESULTS: Questionnaire/record agreement for IBS and surgery was 83.6% (kappa = 0.68) and 95.5%-100.0% (kappa = 0.82-1), respectively. IBS was reported by 4587 examinees (5.2%) (1382 men [3.0%] and 3205 women [7.5%]). Subjects with and without IBS, respectively, reported the following surgical procedures: cholecystectomy, 569 (12.4%) versus 3428 (4.1%), P < 0.0001; appendectomy, 967 (21.1%) versus 9906 (11.7%), P < 0.0001; hysterectomy, 1063 (33.2%) versus 6751 (17.0%), P < 0.0001; back surgery, 201 (4.4%) versus 2436 (2.9%), P < 0.0001; coronary artery surgery, 127 (2.8%) versus 2033 (2.4%), P > 0.05; peptic ulcer surgery, 22 (0.5%) versus 277 (0.3%), P > 0.05. Among independent surgery associations, IBS was associated with cholecystectomy (adjusted odds ratio [OR], 2.09; 95% confidence interval [CI], 1.89-2.31; P < 0.0001), appendectomy (OR, 1.45; 95% CI, 1.33-1.56; P < 0.0001), hysterectomy (OR, 1.70; 95% CI, 1.55-1.87; P < 0.0001), and back surgery (OR, 1.22; 95% CI, 1.05-1.43; P = 0.0084). CONCLUSIONS: Health examinees with physician-diagnosed IBS report rates of cholecystectomy 3-fold higher, appendectomy and hysterectomy 2-fold higher, and back surgery 50% higher than examinees without IBS; IBS is independently associated with these surgical procedures.     

Irritable bowel syndrome: a co-twin control analysis

OBJECTIVES: Among individuals who satisfy diagnostic criteria for both major depressive disorder (MDD) and irritable bowel syndrome (IBS), little is known about the role of familial tendency and environmental influences in disease susceptibility. Therefore, we aimed to examine if there is a genetic component to the co-occurrence of MDD and IBS in participants from the population-based Swedish Twin Registry. METHODS: We implemented a nested case-control analysis and a co-twin control analysis. IBS cases were ascertained using an adapted version of the Rome II criteria and MDD cases were assessed using a shortened version of the Computerized International Diagnostic Interview. The case-control analysis included individuals with complete covariate information (N = 29,616), and adjusted for twin pair, 3-yr age band, and sex. The co-twin control analysis considered 288 twin pairs discordant for IBS. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using generalized estimating equations for the case-control analysis and conditional logistic regression for the co-twin control analysis. RESULTS: In all analyses, comorbid disorders of chronic widespread pain, chronic fatigue-like illness, and MDD were more common in IBS cases than controls. In the case-control analysis, individuals with IBS had an increased odds of MDD (OR 2.7, 95% CI 2.3-3.2). In the co-twin analysis, the association was similar (OR 2.2, 95% CI 1.5-3.3) when both MZ and DZ twins were used, and larger among only MZ twins (OR 3.2, 95% CI 1.7-6.1). CONCLUSIONS: From this analysis, we found no evidence that genetic and family environmental factors explain the association between MDD and IBS. Rather, one of these disorders appears to be part of the disease-causing sequence of events, or biologic disease pathway, for the other disorder. However, it was not possible to evaluate the timing of onset between MDD and IBS in this study.     

Irritable bowel syndrome: evaluation and treatment

Irritable bowel syndrome is a common gastrointestinal disorder characterized by abdominal pain, bloating, and disturbed defecation in the absence of other medical conditions with similar presentations. Because physical findings and currently available diagnostic tests lack sufficient specificity for clinical use, the diagnosis of IBS is based on characteristic symptoms as outlined in several symptom-based criteria for IBS. When used in combination with a detailed history, physical examination, and limited diagnostic testing, these criteria are a valid method of diagnosing IBS. Once a confident diagnosis of IBS has been made, treatment of IBS should be based on the predominant symptom while taking into account the severity of symptoms and the degree of functional impairment both physically and psychologically. Most patients with IBS have mild symptoms and education, reassurance, dietary and lifestyle changes, and a therapeutic physician-patient relationship form the backbone of treatment. A smaller number of patients have moderate symptoms, which are typically intermittent, but may at times interrupt their normal activities. In addition to dietary and lifestyle modifications, pharmacologic intervention based on the predominant symptom (diarrhea, constipation, or pain) may be used to relieve symptoms. Finally, a small subset of patients has severe or intractable symptoms. These patients, often seen in tertiary referral centers, often have constant pain symptoms and psychosocial impairments. A multidisciplinary approach including pharmacologic treatments, psychologic treatments, and possibly a mental health or pain center involvement may be beneficial.     

Irritable bowel syndrome: Diagnosis and pathogenesis

Irritable bowel syndrome (IBS) is a common gastro-intestinal (GI) disorder that considerably reduces the quality of life. It further represents an economic burden on society due to the high consumption of healthcare resources and the non-productivity of IBS patients. The diagnosis of IBS is based on symptom assessment and the Rome Ⅲ criteria. A combination of the Rome Ⅲ criteria, a physical examination, blood tests, gastros-copy and colonoscopy with biopsies is believed to be necessary for diagnosis. Duodenal chromogranin A cell density is a promising biomarker for the diagnosis of IBS. The pathogenesis of IBS seems to be multifactorial, with the following factors playing a central role in the pathogenesis of IBS:heritability and genetics, dietary/intestinal microbiota, low-grade inflammation, and disturbances in the neuroendocrine system (NES) of the gut. One hypothesis proposes that the cause of IBS is an altered NES, which would cause abnormal GI motility, secretions and sensation. All of these abnormalities are characteristic of IBS. Alterations in the NES could be the result of one or more of the following:genetic factors, dietary intake, intestinal flora, or lowgrade inflammation. Post-infectious IBS (PI-IBS) and inflammatory bowel disease-associated IBS (IBD-IBS) represent a considerable subset of IBS cases. Patients with PI-and IBD-IBS exhibit low-grade mucosal inflammation, as well as abnormalities in the NES of the gut.