Irritable bowel syndrome

The diagnosis of irritable bowel syndrome requires the exclusion of any associated organic disease: a positive diagnosis would avoid expensive and potentially dangerous diagnostic procedures. A scoring system has been proposed for positive diagnosis where more than 44 points excluded organic digestive disease. The aim of this study was to determine the usefulness of this scoring system in a different setting. Patients (1257) consecutively referred to our medical division were admitted to the study and 270 of these, complaining of abdominal symptoms, were scored on the Kruis system method. The positive predictive value (53.8% for men and 81.5% for women) and the sensitivity (46.7% and 59.5%) did not appear to be adequate. The negative predictive value (91.6% and 87.3%) and the specificity (93.5 and 95.4%) gave higher results, but two cases of neoplasia and nine cases of other organic digestive diseases were not identified or suggested. We believe that this scoring system may be useful only as a first step in a diagnostic flow chart.     

Irritable bowel syndrome

Conceptually, the irritable bowel syndrome (IBS) has been considered a brain-gut functional disorder, but this paradigm is under serious challenge. There is increasing evidence that organic disease of the gastrointestinal tract can be identified in subsets of patients who fulfil the Rome criteria for IBS. Evidence for subtle inflammatory bowel disease, serotonin dysregulation, bacterial overgrowth and central dysregulation continue to accumulate. The underlying causes of IBS remain to be adequately identified, but postinfectious IBS is a clear-cut entity. Furthermore, a genetic contribution to IBS also seems likely. Diagnosis continues to be based on the symptom profile and the absence of alarm features. A heightened awareness of coeliac disease masquerading as IBS is becoming accepted. Management remains largely based on symptomatic rather than on disease-modifying therapy, but this is likely to change in the near future. Here, recent advances in the pathophysiology and management of IBS are considered.     

Irritable bowel syndrome,the microbiota and the gut-brain axis

Irritable bowel syndrome is a common functional gastrointestinal disorder and it is now evident that irritable bowel syndrome is a multi-factorial complex of changes in microbiota and immunology. The bidirectional neurohumoral integrated communication between the microbiota and the autonomous nervous system is called the gut-brain-axis, which integrates brain and GI functions, such as gut motility, appetite and weight. The gut-brain-axis has a central function in the perpetuation of irritable bowel syndrome and the microbiota plays a critical role. The purpose of this article is to review recent research concerning the epidemiology of irritable bowel syndrome, influence of microbiota, probiota, gut-brain-axis, and possible treatment modalities on irritable bowel syndrome.     

Irritable bowel syndrome in women having diagnostic laparoscopy or hysterectomy

We identified irritable bowel syndrome (IBS) in 47.7% of 86 women having diagnostic laparoscopy for chronic pelvic pain, 39.5% of 172 women having elective hysterectomy, and 32.0% of 172 controls age-matched for the hysterectomy group (P=NS). Constipation and pain subtype IBS were more common in hysterectomy patients than controls (P < 0.05). In laparoscopy patients, dyspareunia was more common in those with IBS than in those without it (P < 0.05). In the hysterectomy group, more IBS patients had chronic pelvic pain (P < 0.005), and abnormal menses (P < 0.01). Chronic pelvic pain was more frequently the only prehysterectomy diagnosis in IBS patients (P < 0.05), and IBS was present more often when pain was a reason for hysterectomy (P < 0.01). One year after laparoscopy, IBS patients gave lower overall status ratings (P < 0.01) and lower pain improvement ratings (P < 0.05) than non-IBS patients. In women who had a hysterectomy for pain, there was less pain improvement one year later in those with the pain subtype of IBS than in non- IBS patients (P < 0.05). IBS is associated with gynecologic symptoms and affects the symptomatic outcome of diagnostic laparoscopy and hysterectomy.     

Post-infectious irritable bowel syndrome in patients with Shigella infection

BACKGROUND AND AIMS: Bacterial gastroenteritis has been known as a risk factor of irritable bowel syndrome (IBS). Several risk factors of post-infectious IBS (PI-IBS) have been documented. The aims of this study were to verify the role of bacterial gastroenteritis in the development of IBS and the risk factors for the development of PI-IBS. The clinical course of PI-IBS was also investigated. METHODS: We recruited 143 patients with shigellosis during its outbreak and 113 controls. Both groups were followed up for 12 months. Bowel symptoms were evaluated by use of questionnaires at 3, 6 and 12 months after the initial recruitment. RESULTS: Complete data were obtained from 101 patients (70.6%) and 102 healthy controls (90.3%). At 12 months, 15 patients and six controls had IBS (adjusted OR; 2.9, 95% CI; 1.1-7.9). Of the 15 patients, five had IBS symptoms consistently for 12 months, three did not have IBS symptoms initially and seven had fluctuating bowel symptoms. The duration of diarrhea was an independent risk factor of PI-IBS. CONCLUSIONS: Bacterial gastroenteritis is a risk factor of IBS and the duration of diarrhea as the index of severity of initial illness is an independent risk factor of PI-IBS. The clinical course of PI-IBS is variable over the 1 year of follow-up.     

A prospective assessment of bowel habit in irritable bowel syndrome in women: defining an alternator

BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is subtyped as IBS with diarrhea (IBS-D) or IBS with constipation (IBS-C) based on Rome II guidelines. The remaining group is considered as having mixed IBS (IBS-M). There is no standard definition of an alternator (IBS-A), in which bowel habit changes over time. Our aim was to use Rome II criteria to prospectively assess change in bowel habit for more than 1 year to understand IBS-A. METHODS: Female patients (n=317) with IBS entering a National Institutes of Health treatment trial were studied at baseline with questionnaires and 2-week daily diary cards of pain and stool frequency and consistency. Studies were repeated at the end of treatment (3 months) and at four 3-month intervals for one more year. Algorithms to classify subjects into IBS-D, IBS-C, and IBS-M groups used diary card information and modified Rome II definitions. Changes in bowel habit at 3-month intervals were then assessed using these surrogate diary card measures. RESULTS: At baseline, 36% had IBS-D, 31% IBS-M, and 34% IBS-C. Except for stool frequency, there were no differences between groups. While the proportion of subjects in each subgroup remained the same over the year, most individuals (more than 75%) changed to either of the other 2 subtypes at least once. IBS-M was the least stable (50% changed out by 12 weeks). Patients were more likely to transition between IBS-M and IBS-C than between IBS-D and IBS-M. Notably, only 29% switched between the IBS-D and IBS-C subtypes over the year. CONCLUSIONS: While the proportion of subjects in each of the IBS subtypes stays the same, individuals commonly transition between subtypes, particularly between IBS-M and IBS-C. We recommend that IBS-A be defined as at least one change between IBS-D and IBS-C by Rome II criteria over a 1-year period.     

Irritable bowel syndrome: focus on otilonium bromide

Irritable bowel syndrome is a prevalent and chronic disorder, characterized by recurrent abdominal pain/discomfort, bloating and altered bowel habits. This condition affects an estimated 10–15% of the population worldwide and impacts heavily on a patient's daily life and ability to work, as well as healthcare resource utilization. Drug therapy aimed at correcting the primary symptoms of diarrhea/constipation/bloating may have little effect on abdominal pain, which results from visceral hypersensitivity. Smooth muscle relaxants or antispasmodics decrease the tone and contractility of intestinal smooth muscle, effectively managing abdominal pain. Otilonium bromide has been widely used worldwide and has been found to be safe and well tolerated, and superior to placebo for the reduction of symptoms and the prevention of symptom relapse in patients with irritable bowel syndrome.     

Irritable bowel syndrome: Epidemiology,diagnosis and treatment: An update for health‐care practitioners

Irritable bowel syndrome (IBS), a chronic gastrointestinal disorder, affects from 3–20% of the US population, depending on sociocultural and comorbid factors. IBS is characterized by a symptom complex of abdominal pain and abnormal bowel habits that present as diarrhea or constipation, and general physical weakness in the absence of abnormal morphological, histological or inflammatory markers. The main diagnostic Rome III criteria as established by international professional organizations are based on exclusion criteria and the occurrence and rate of symptoms. Because the pathophysiology and causes of IBS are poorly understood, treatment approaches are mainly focused on symptom management to maintain everyday functioning and improve quality of life for persons with IBS. The mainstay of intervention is pharmacological treatment with antispasmodics and antidiarrheals for diarrhea, prokinetics and high‐fiber diets for constipation, and supportive therapy with low‐dose antidepressants to normalize gastrointestinal motility. Other interventions include lifestyle and dietary changes, psychotherapy, herbal therapies and acupuncture. The purpose of this review is to critically assess benefits and risks of current treatment approaches as well as promising complementary and alternative therapies.     

Irritable bowel syndrome, gastro-oesophageal reflux, and bronchial hyper-responsiveness in the general population

Background—Associations have been shown betweenirritable bowel syndrome (IBS) and gastro-oesophageal reflux, betweengastro-oesophageal reflux and asthma, and more recently between IBS andbronchial hyper-responsiveness (BHR).
Aims—To explore the inter-relations between these conditions.
Subjects—A randomly selected community sample of4432adults.
Methods—A validated postal symptom questionnaireinvestigating the associations between IBS, gastro-oesophageal refluxsymptoms, and symptomatic BHR.
Results—3169 questionnaires (71.7%response) returned by 1451 men and 1718 women were analysed. One yearprevalences, in men and women respectively, of IBS were 10.5% and22.9%, of dyspepsia 26.3% and 25.25%, of gastro-oesophageal refluxsymptoms 29.4% and 28.2%, of BHR 13.2% and 14.6%, and of chronicbronchitis 8.3% and 4.9%. Logistic regression showed independentassociations between IBS and BHR, gastro-oesophageal reflux symptoms,and dyspepsia. There was no significant independent association betweenIBS and chronic bronchitis. In men and women the odds ratio with 95%confidence interval (CI) for IBS and gastro-oesophageal reflux symptomswas 2.6 (2.1-3.1; p<0.001) and for IBS and BHR 2.1 (1.7-2.7;p<0.001). These associations held on stratifying for sex andconsultation behaviour. IBS, gastro-oesophageal reflux symptoms, andbronchial hyper-responsiveness occurred more frequently together thanexpected, 2.5% (95% CI 2.41-2.57) of the sample having all threeconditions compared with an expected prevalence of 0.7% (95% CI0.66-0.71). The conditions were independently associated with each other.
Conclusions—These observations may indicate thepresence of an underlying disorder producing symptoms ingastrointestinal and respiratory systems.

     

Irritable bowel syndrome in the 21st century: perspectives from Asia or South-east Asia

Asian irritable bowel syndrome (IBS) studies not only confirm the truth of this functional disorder but also describe the current disease situation of this continent, with its variable socioeconomic backgrounds. Most Asian community IBS prevalence is within 5-10%, regardless of gender or ethnic character. As well as meeting the main Rome II criteria, Asian IBS subjects also have many minor symptoms. Thus this recommendation remains useful to diagnose Asian IBS. Also, female patients commonly express constipation-predominant (C-) symptoms. Extra-colonic symptoms are common in Asia, for example dyspepsia, insomnia and irritable urinary bladder. Asian IBS subjects do experience psychological disturbances including anxiety, depression, agoraphobia and neuroticism. Accordingly, their quality of life is poor and there is absenteeism leading to excessive physician visits. Abnormal gut motor and sensory functions have been indicated among the Asian IBS subjects. Now, there is evidence of altered colonic neuroimmune function leading to gut hypersensitivity and dysmotility. An Asia-Pacific trial also confirmed tegaserod efficacy on female C-IBS subjects. More than 90% of nurses have very limited IBS knowledge, and are unable even to explain it clearly. In conclusion, Western recommended criteria clearly diagnose Asian IBS and many factors are mutual leading to IBS. Current IBS treatments remain useful but additional reeducation for medical professionals appears to be needed.     

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: Role of food in pathogenesis and management

Patients with the irritable bowel syndrome (IBS) commonly report the precipitation of symptoms on food ingestion. Though the role of dietary constituents in IBS has not been extensively studied, food could contribute to symptom onset or even the causation of IBS through a number of mechanisms. First, the physiological response of the intestine to food ingestion could precipitate symptoms in predisposed individuals; second, there is some evidence that allergy or intolerance to a particular food can produce IBS‐like symptoms, third, certain foods may alter the composition of the luminal milieu, either directly or indirectly through effects on bacterial metabolism, and thus induce symptoms and, finally, IBS may develop following exposure to food‐borne pathogens. Anticipatory, psychological factors generated by previous negative experiences with food ingestion or other factors may also contribute though their contribution has been scarcely quantified. Not surprisingly, there is considerable interest in the potential roles of diet and food supplements in the therapy of IBS; for the most part, the evidence base for such recommendations remains slim though certain probiotics show considerable promise.     

肠易激综合征的治疗进展

肠易激综合征（irritable bowel syndrome,IBS）作为消化系统疾病中较为常见的功能性胃肠病,由于发病机制未 明,临床上缺乏行之有效的治疗手段,其临床诊治一直以来是研究的热点和难点。而近年来,相关药物的研发及诊疗 策略的更新,使得IBS的诊疗得到了进一步发展。文章就目前IBS的治疗进展做一论述,以期为IBS的临床诊治提供 指导,使更多的IBS患者从中获益。     

肠易激综合征与饮食因素

肠易激综合征（irritable bowel syndrome,IBS）症状与饮食关系密切,饮食疗法是IBS的重要的治疗手段之一。饮 食疗法主要包括传统的饮食建议,低可发酵的低聚糖、二糖、单糖和多元醇（fermentable oligosaccharides, disaccharides,monosaccharides and polyols,FODMAPs）饮食,无麸质饮食(gluten-free diet,GFD）以及益生菌。文章重点 阐述了饮食因素与IBS发病的关系以及饮食管理在IBS治疗中的作用。     

Guidelines on the irritable bowel syndrome: mechanisms and practical management

Background

IBS affects 5–11% of the population of most countries. Prevalence peaks in the third and fourth decades, with a female predominance.

Aim

To provide a guide for the assessment and management of adult patients with irritable bowel syndrome.

Methods

Members of the Clinical Services Committee of The British Society of Gastroenterology were allocated particular areas to produce review documents. Literature searching included systematic searches using electronic databases such as Pubmed, EMBASE, MEDLINE, Web of Science, and Cochrane databases and extensive personal reference databases.

Results

Patients can usefully be classified by predominant bowel habit. Few investigations are needed except when diarrhoea is a prominent feature. Alarm features may warrant further investigation. Adverse psychological features and somatisation are often present. Ascertaining the patients'' concerns and explaining symptoms in simple terms improves outcome. IBS is a heterogeneous condition with a range of treatments, each of which benefits a small proportion of patients. Treatment of associated anxiety and depression often improves bowel and other symptoms. Randomised placebo controlled trials show benefit as follows: cognitive behavioural therapy and psychodynamic interpersonal therapy improve coping; hypnotherapy benefits global symptoms in otherwise refractory patients; antispasmodics and tricyclic antidepressants improve pain; ispaghula improves pain and bowel habit; 5‐HT₃ antagonists improve global symptoms, diarrhoea, and pain but may rarely cause unexplained colitis; 5‐HT₄ agonists improve global symptoms, constipation, and bloating; selective serotonin reuptake inhibitors improve global symptoms.

Conclusions

Better ways of identifying which patients will respond to specific treatments are urgently needed.     

Relationship of abdominal bloating to distention in irritable bowel syndrome and effect of bowel habit

BACKGROUND & AIMS: The relationship between the sensation of bloating, often ranked as the most bothersome symptom by patients with irritable bowel syndrome (IBS), and actual distention manifest as an increase in abdominal girth is controversial. Investigation of this problem has been hampered by the lack of a reliable ambulatory technique to measure abdominal girth. The aim of this study was to use the technique of abdominal inductance plethysmography to compare diurnal variation in girth in IBS patients and healthy volunteers, relating these changes to the sensation of bloating. METHODS: Abdominal girth was recorded for 24 hours in 20 IBS-constipation (age, 18-73 y), 20 IBS-diarrhea (age, 25-62 y) and 10 IBS-alternating (age, 21-59 y) female patients meeting Rome II criteria and 20 healthy female controls (age, 18-67 y). All subjects pursued normal daily activities, recording their symptoms of bloating and pain together with bowel habit. RESULTS: All patients with IBS, irrespective of bowel habit, reported significantly greater bloating than controls (P < .0001). Forty-eight percent of patients also showed distention beyond the 90% control range, with this being most prominent in IBS-constipation. Bloating correlated strongly only with distention in IBS-constipation (r > or = 0.48; P < or = .02). Neither bloating nor distention in IBS was related to body mass index, age, parity, or psychologic status. CONCLUSIONS: Abdominal distention is a clearly definable phenomenon in IBS that can reach 12 cm. However, it only occurs in half of patients reporting bloating, and the 2 only correlate in IBS-constipation. Bloating and distention may differ pathophysiologically and this appears to be reflected in the bowel habit subtype.     

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.     

肠易激综合征与肠黏膜异常

肠易激综合征（irritable bowel syndrome，IBS）是以腹痛或腹部不适，伴有大便性状改变和排便习惯改变为特征的功能性肠道疾病，是消化科常见的疾病之一。目前，IBS的发病机制尚不明确。肠道黏膜是机体接触外环境最大的部位，拥有丰富的神经、免疫、内分泌等感觉细胞，IBS患者肠道黏膜的变化对研究IBS的发病机制具有独特的意义。本文对近年IBS与肠黏膜异常的研究进展做一综述。