Evaluation of thermal water in patients with functional dyspepsia and irritable bowel syndrome accompanying constipation

AIM: To evaluate the efficacy of water supplementation treatment in patients with functional dyspepsia or irritable bowe syndrome (IBS) accompanying predominant constipation. METHODS: A total of 3872 patients with functional dyspepsia and 3609 patients with irritable bowel syndrome were enrolled in the study by 18 Italina thermal centres. Patients underwent a first cycle of thermal therapy for 21 d. A year later patients were re-evaluated at the same centre and received another cycle of thermal therapy. A questionnare to collect personal data on social and occupational status, family and pathological case history, life style, clinical records, utilisation of welfare and health structure and devices was administered to each patient at basal time and one year after each thermal treatment. Sixty patients with functional dyspepsia and 20 with IBS and 80 healthy controls received an evaluation of gastric output and oro-cecal transit time by breath test analysis. Breath test was performed at basal time and after water supplementaton therapies. Gastrointestinal symptoms were evaluated at the same time points. Breath samples were analyzed with a mass spectometer and a gascromatograph. Results were expressed as T1/2 and T-lag for octanoic acid breath test and as oro-cecal transit time for lactulose breath test. RESULTS: A significant reduction of prevalence of symptoms was observed at the end of the first and second cycles of thermal therapy in dyspeptic and IBS patients. The analysis of variance showed a real and persistant improvement of symptoms in all patients. After water supplementation for 3 wk a reduction of gastric output was observed in 49 (87.5%) of 56 dyspeptic patients. Both T1/2 and T-lag were significantly reduced after the therapy compared to basal values [91±12 (T1/2) and 53±11(T-lag), Tables 1 and 2] with results of octanoic acid breath test similar to healthy subjects. After water supplementation for 3 wk oro-cecal transit time was shorter than that at the beginning of the study. CONCLUSION: Mineral water supplementation treatment for functional dyspepsia or conspipation accompanying IBS can improve gastric acid output and intestinal transit time.     

Irritable bowel syndrome consulters in Zhejiang province： The symptoms pattern, predominant bowel habit subgroups and quality of life

AIM: To investigate the pattern of symptoms, predominant bowel habits and quality of life (QOL) by the Chinese version of the SF-36 in irritable bowel syndrome (IBS) consulters in Zhejiang province. METHODS: From January 2001 to January 2002, 662 Roma Ⅱ criteria-positive IBS patients were enrolled by gastroenterologists in 10 hospitals from Digestive Disease Center of Zhejiang (DDCZ). Patients were classified into constipation predominant IBS (IBS-C), diarrhea predominant IBS (IBS-D) and alternating constipation and diarrhea IBS (IBS-A) according to the predominant bowel habits. All patients were evaluated for the demographic checklists, IBS bowel symptoms, extra-colonic symptoms, and QOL by Chinese version of the SF-36 questionnaire. RESULTS: (1) Besides abdominal pain, the predominant colonic symptoms were in order of altered stool form, abnormalities of stool passage, abdominal distension and passage of mucus in IBS patients. Also, IBS subjects reported generalized body discomfort and psychosocial problems including dyspeptic symptoms, poor appetite, heartburn, headache, back pain, difficulty with urination, fatigue, anxiety and depression. (2) IBS-C and IBS-A are more common among female patients, whereas male patients experienced more cases of IBS-D. In regards to the IBS symptoms, there were significant differences among IBS subgroups. Abdominal pain (frequency ≥2 days per week and duration ≥1 hour per day) was frequent in IBS-A patients (P=0.010 and 0.027, respectively), IBS-D patients more frequently experienced the passage of mucus, dyspeptic symptoms and anxiety (P=0.000, 0.014 and 0.015, respectively). (3) IBS patients experienced significant impairment in QOL, decrements in QOL were most pronounced in vitality, general health, mental health, and bodily pain. Compared with the general population (adjusted for gender and age), IBS patients scored significantly lower on all SF-scales (P<0.001), except for physical function scale (P=0.149). (4) QOL was impaired in all subgroups, particularly in scales of vitality, general health and mental health. Compared with IBS-D, QOL in IBS-C scored significantly lower on physical function, role physical, general health, role emotional, and mental health scales (P=-0.037, 0.040, 0.039, 0.005 and 0.026, respectively). CONCLUSION: Besides colonic symptoms, IBS could cause generalized body discomfort and psychosocial problems. The IBS subgroups based on predominant bowel habits are helpful to identify clinical distinction of the IBS. QOL is significantly impaired in IBS patients. The Chinese version of the SF-36 health survey scales may be a useful measurement of IBS patients.     

Increasing dietary fiber intake in terms of kiwifruit improves constipation in Chinese patients

AIM To investigate if increased dietary fiber, in terms of kiwifruit, is effective in Chinese constipated patients.METHODS 33 constipated patients and 20 healthy volunteers were recruited for a 4-wk treatment of kiwi fruit twice daily. Response during wk 1-4 was defined as an increase in complete spontaneous bowl, motion (CSBM)≥ 1/wk. Secondary efficacy included response during wk 1-4, individual symptoms and scores of bowel habits and constipation. Responses were compared with the baseline run-in period. Colonic transit time and anorectal manometry were performed before and after treatment.RESULTS Responder rate was 54.5% in the constipated group. The mean CSBM increased after treatment (2.2 ± 2.6 vs 4.4 ± 4.6, P = 0.013). There was also improvement in the scores for bothersomeness of constipation (P = 0.02), and satisfaction of bowel habit (P = 0.001), and decreased in days of laxative used (P =0.003). There was also improvement in transit time (P =0.003) and rectal sensation (P ＜ 0.05). However, there was no change in the bowel symptoms or anorectal physiology in the healthy subjects.CONCLUSION Increasing dietary fiber intake is effective in relieving chronic constipation in Chinese population.     

Increased colon transit time and faecal load in irritable bowel syndrome

BACKGROUND Irritable bowel syndrome(IBS)is a bowel disorder involving abdominal pain or discomfort along with irregularity of stool form and passage frequency.The pathophysiology is poorly understood and seems to be multifactorial.Investigations of possible causes of IBS have included only a few colonic transit studies and no simultaneous determination of the colonic faecal content.AIM To compare colon transit time and faecal load between IBS-patients and healthy control subjects.METHODS The study included 140 patients with IBS,with a mean age of 50.0 years.The control group comprised 44 healthy persons with a mean age of 43.4 years,who were selected at random from the National Civil Register.Both the patient group and the control group underwent a marker study to measure colon transit time(CTT)and to calculate a faecal loading score.The patient group underwent treatment with a combined prokinetic regime,after which their CTT and faecal loading were reassessed.Analyses were performed to compare measurements between the control group and the patient group before and after treatment.RESULTS Compared to healthy controls,IBS-patients exhibited a significantly prolonged mean CTT(45.48 h vs 24.75 h,P=0.0002)and significantly greater mean faecal loading scores in all colonic segments(P<0.001).Among IBS patients,we found no significant differences between the 48 h and 96 h radiographs.Among patients exhibiting increased CTT and faecal loading,approximately half exhibited a palpable mass in the right iliac fossa.After intervention with a prokinetic treatment,the mean CTT among IBS patients was reduced from 45.48 h to 34.50 h(P=0.091),with the post-treatment CTT not significantly differing from the CTT among control subjects(P=0.095).The faecal loading score among IBS patients did not significantly differ before and after treatment(P=0.442).The posttreatment faecal loading score in IBS patients remained significantly higher compared to that in controls(5.3 vs 4.3,P=0.014).After treatment,half of the IBSpatients were relieved of bloating,while the majority no longer experienced abdominal pain and achieved a daily consistent stool.CONCLUSION IBS-patients exhibited prolonged CTT and heavier faecal loading.These assessments may aid in diagnosis.Faecal retention may contribute to IBS symptoms,which can be treated using a prokinetic regime.     

Risk factors of admission for acute colonic diverticulitis in a population-based cohort study: The North Trondelag Health Study,Norway

AIM To assess risk factors of hospital admission for acute colonic diverticulitis.METHODS The study was conducted as part of the second wave of the population-based North Trondelag Health Study(HUNT2), performed in North Trondelag County, Norway, 1995 to 1997. The study consisted of 42570 participants(65.1% from HUNT2) who were followed up from 1998 to 2012. Of these, 22436(52.7%) were females. The cases were defined as those 358 participants admitted with acute colonic diverticulitis during follow-up. The remaining participants were used as controls. Univariable and multivariable Cox regression analyses was used for each sex separately after multiple imputation to calculate HR.RESULTS Multivariable Cox regression analyses showed that increasing age increased the risk of admission for acute colonic diverticulitis: Comparing with ages 50 years, females with age 50-70 years had HR = 3.42, P 0.001 and age 70 years, HR = 6.19, P 0.001. In males the corresponding values were HR = 1.85, P = 0.004 and 2.56, P 0.001. In patients with obesity(body mass index ≥ 30) the HR = 2.06, P 0.001 in females and HR = 2.58, P 0.001 in males. In females, present(HR = 2.11, P 0.001) or previous(HR = 1.65, P = 0.007) cigarette smoking increased the risk of admission. In males, breathlessness(HR = 2.57, P 0.001) and living in rural areas(HR = 1.74, P = 0.007) increased the risk. Level of education, physical activity, constipation and type of bread eaten showed no association with admission for acute colonic diverticulitis.CONCLUSION The risk of hospital admission for acute colonic diverticulitis increased with increasing age, in obese individuals, in ever cigarette smoking females and in males living in rural areas.     

Alterations in serotonin,transient receptor potential channels and protease-activated receptors in rats with irritable bowel syndrome attenuated by Shugan decoction

AIM:To determine the molecular mechanisms of Shugan decoction(SGD) in the regulation of colonic motility and visceral hyperalgesia(VHL) in irritable bowel syndrome(IBS).METHODS:The chemical compounds contained in SGD were measured by high-performance liquid chromatography.A rat model of IBS was induced by chronic water avoidance stress(WAS).The number of fecal pellets was counted after WAS and the pain pressure threshold was measured by colorectal distension.Morphological changes in colonic mucosa were detected by hematoxylin-eosin staining.The contents of tumor necrosis factor(TNF)-αin colonic tissue and calcitonin-gene-related peptide(CGRP)in serum were measured by ELISA.The protein expression of serotonin[5-hydroxytryptamide(5-HT)],serotonin transporter(SERT),chromogranin A(Cg A)and CGRP incolon tissue was measured by immunohistochemistry.RESULTS:SGD inhibited colonic motility dysfunction and VHL in rats with IBS.Blockers of transient receptor potential(TRP)vanilloid 1(TRPV1)(Ruthenium Red)and TRP ankyrin-1(TRPA1)(HC-030031)and activator of protease-activated receptor(PAR)4 increased the pain pressure threshold,whereas activators of PAR2and TRPV4 decreased the pain pressure threshold in rats with IBS.The effect of SGD on pain pressure threshold in these rats was abolished by activators of TRPV1(capsaicin),TRPV4(RN1747),TRPA1(Polygodial)and PAR2(AC55541).In addition,CGRP levels in serum and colonic tissue were both increased in these rats.TNF-αlevel in colonic tissue was also significantly upregulated.However,the levels of 5-HT,SERT and Cg A in colonic tissue were decreased.All these pathological changes in rats with IBS were attenuated by SGD.CONCLUSION:SGD alleviated VHL and attenuated colon motility in IBS,partly by regulating TRPV1,TRPV4,TRPA1,PAR2,5-HT,Cg A and SERT,and reducing CGRP and TNF-αlevel.     

Self-reported dietary fructose intolerance in irritable bowel syndrome: Proposed diagnostic criteria

AIM: To study the criteria for self-reported dietary fructose intolerance(DFI) and to evaluate subjective global assessment(SGA) as outcome measure.METHODS: Irritable bowel syndrome(IBS) patients were randomized in an open study design with a 2 wk run-in on a habitual IBS diet, followed by 12 wk with/without additional fructose-reduced diet(FRD). Daily registrations of stool frequency and consistency, and symptoms on a visual analog scale(VAS) were performed during the first 4 wk. SGA was used for weekly registrations during the whole study period. Provocation with high-fructose diet was done at the end of the registration period. Fructose breath tests(FBTs) were performed. A total of 182 subjects performed the study according to the protocol(88 FRD, 94 controls).RESULTS:We propose a new clinically feasible diagnostic standard for self-reported fructose intolerance.The instrument is based on VAS registrations of symptom relief on FRD combined with symptom aggravation upon provocation with fructose-rich diet.Using these criteria 43of 77 patients(56%)in the present cohort of IBS patients had self-reported DFI.To improve the concept for clinical evaluation,we translated the SGA scale instrument to Norwegian and validated it in the context of the IBS diet regimen.The validation procedures showed a sensitivity,specificity andκvalue for SGA detecting the self-reported DFI group by FRD response within the IBS patients of 0.79,0.75 and 0.53,respectively.Addition of the provocation test yielded values of 0.84,0.76 and 0.61,respectively.The corresponding validation results for FBT were 0.57,0.34 and-0.13,respectively.CONCLUSION:FRD improves symptoms in a subgroup of IBS patients.A diet trial followed by a provocation test evaluated by SGA can identify most responders to FRD.     

Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects

AIM: To assess the long-term effects of physical activity on irritable bowel syndrome(IBS) symptoms and on quality of life, fatigue, depression and anxiety.METHODS: Seventy-six patients from a previous randomized controlled interventional study on increased physical activity in IBS were asked to participate in this long-term follow-up study. The included patients attended one visit in which they filled out questionnaires and they underwent a submaximal cycle ergometer test. The primary end point was the change in the IBS Severity Scoring System(IBS-SSS) at baseline, i.e., before the intervention and at follow-up. The secondary endpoints were changes in quality of life, fatigue, depression and anxiety.RESULTS: A total of 39 [32 women, median age 45(28-61) years] patients were included in this followup. Median follow-up time was 5.2(range: 3.8-6.2) years. The IBS symptoms were improved compared with baseline [IBS-SSS: 276(169-360) vs 218(82-328), P = 0.001]. This was also true for the majority of the dimensions of psychological symptoms such as disease specific quality of life, fatigue, depression and anxiety. The reported time of physical activity during the week before the visit had increased from 3.2(0.0-10.0) h at baseline to 5.2(0.0-15.0) h at follow-up, P = 0.019. The most common activities reported were walking, aerobics and cycling. There was no significant difference in the oxygen uptake 31.8(19.7-45.8) m L per min per kg at baseline vs 34.6(19.0-54.6) m L/min per kg at follow-up.CONCLUSION: An intervention to increase physical activity has positive long-term effects on IBS symptoms and psychological symptoms.     

Effect of retrograde colonic electrical stimulation on colonic transit and stress-induced visceral hypersensitivity in rats with irritable bowel syndrome

Objective: To evaluate the effects of retrograde colonic electrical stimulation(RCES) with trains of short pulses and RCES with long pulses on colonic transit in irritable bowel syndrome(IBS) rats and to investigate whether stress-induced visceral hypersensitivity could be alleviated by RCES so as to find a valuable new approach for IBS treatment. Methods:A total of 48 male rats were randomly divided into model group and control group. Visceral hypersensitivity model was induced by a 6-day HIS protocol composed of two stressors, restraint stress for 40 min and forced swimming stress for 20 min. The extent of visceral hypersensitivity was quantified by electromyography and abdominal withdrawal reflx scores(AWRs) of colorectal distension(use a balloon) at different pressures. After the modeling, all rats were equipped with electrodes in descending colon for retrograde electrical stimulation and a PE tube for perfusing phenol red saline solution in the ileocecus. After recovering from surgery, RCES with long pulses, RCES with trains of short pulses, and sham RCES were performed in colonic serosa of rats for 40 min in six groups of 8 each, including three groups of visceral hypersensitivity rats and three groups of health rats. Colonic transit was assessed by calculating the output of phenol red from the anus every 10 min for 90 min. Finally, the extent of visceral hypersensitivity will be quantified again in model group. Results: After the 6-day HIS protocol, the HIS rats displayed an increased sensitivity to colorectal distention, compared to control group at different distention pressures(P0.01). CRES with trains of short pulses and long pulses significantly attenuated the hypersensitive responses to colorectal distention in the HIS rats compared with sham RCES group(P0.01). The effects of RCES on rats colon transmission: In the IBS rats, the colonic emptying were(77.4 ± 3.4)%,(74.8 ± 2.4)% and(64.2 ± 1.6)% in the sham RCES group, long pulses group and trains of short pulses group at 90 min; In healthy rats, The colonic emptying was(65.2 ± 3.5)%,(63.5 ± 4.0)% and(54.0 ± 2.5)% in the sham RCES group, long pulses group and trains of short pulses group at 90 min. Conclusion: RCES with long pulses and RCES with trains of short pulses can significantly alleviate stress-induced visceral hypersensitivity. RCES with trains of short pulses has an inhibitory effect of colonic transit, both in visceral hypersensitivity rats and healthy rats.     

Irritable bowel syndrome and organic diseases: A comparative analysis of esophageal motility

AIM:To assess the esophageal motility in patients with irritable bowel syndrome(IBS)and to compare those with patients with autoimmune disorders.METHODS:15 patients with IBS,22 with systemic lupus erythematosus(SLE)and 19 with systemic sclerosis(SSc)were prospectively selected from a total of 115patients at a single university centre and esophageal motility was analysed using standard manometry(Mui Scientific PIP-4-8SS).All patients underwent esophagogastro-duodenoscopy before entering the study so that only patients with normal endoscopic findings were included in the current study.All patients underwent a complete physical,blood biochemistry and urinary examination.The grade of dysphagia was determined for each patient in accordance to the intensity and frequency of the presented esophageal symptoms.Furthermore,disease activity scores(SLEDAI and modified Rodnan score)were obtained for patients with autoimmune diseases.Outcome parameter:A correlation coefficient was calculated between amplitudes,velocity and duration of the peristaltic waves throughout esophagus and patients’dysphagia for all three groups.RESULTS:There was no statistical difference in the standard blood biochemistry and urinary analysis in all three groups.Patients with IBS showed similar pathologic dysphagia scores compared to patients with SLE and SSc.The mean value of dysphagia score was in IBS group 7.3,in SLE group 6.73 and in SSc group7.56 with a P-value>0.05.However,the manometric patterns were different.IBS patients showed during esophageal manometry peristaltic amplitudes at the proximal part of esophagus greater than 60 mmHg in46%of the patients,which was significant higher in comparison to the SLE(11.8%)and SSc-Group(0%,P=0.003).Furthermore,IBS patients showed lower mean resting pressure of the distal esophagus sphincter(Lower esophageal sphincter,22 mmHg)when compared with SLE(28 mmHg,P=0.037)and SSc(26 mmHg,P=0.052).23.5%of patients with SLE showed amplitudes greater as 160 mmHg in the distal esophagus(IBS and SSc:0%)whereas 2     

Partially hydrolyzed guar gum in pediatric functional abdominal pain

AIM:To assess the effects of partially hydrolyzed guar gum(PHGG) diet supplement in pediatric chronic abdominal pain(CAP) and irritable bowel syndrome(IBS).METHODS:A randomized,double-blind pilot study was performed in sixty children(8-16 years) with functional bowel disorders,such as CAP or IBS,diagnosed according to Rome Ⅲ criteria.All patients underwent ultrasound,blood and stool examinations to rule out any organic disease.Patients were allocated to receive PHGG at dosage of 5 g/d(n = 30) or placebo(fruitjuice n = 30) for 4 wk.The evaluation of the efficacy of fiber supplement included IBS symptom severity score(Birmingham IBS Questionnaire),severity of abdominal pain(Wong-Baker Face Pain Rating Score) and bowel habit(Bristol Stool Scale).Symptom scores were completed at 2,4,and 8 wk.The change from baseline in the symptom severity scale at the end of treatment and at 4 wk follow-up after treatment was the primary endpoint.The secondary endpoint was to evaluate compliance to supplementation with the PHGG in the pediatric population.Differences within groups during the treatment period and follow-up were evaluated by the Wilcoxon signed-rank test.RESULTS:The results of the study were assessed considering some variables,such as frequency and intensity of symptoms with modifications of the bowel habit.Both groups were balanced for baseline characteristics and all patients completed the study.Group A(PHGG group) presented a higher level of efficacy compared to group B(control group),(43% vs 5%,P = 0.025) in reducing clinical symptoms with modification of Birmingham IBS score(median 0 ± 1 vs 4 ± 1,P = 0.025),in intensity of CAP assessed with the Wong-Baker Face Pain Rating Score and in normalization of bowel habit evaluated with the Bristol Stool Scale(40% vs 13.3%,P = 0.025).In IBS subgroups,statistical analysis shown a tendency toward normalization of bowel movements,but there was no difference in the prevalence of improvement in two bowel habit subsets.PHGG was therefore better tolerated without any advers     

Predictors of healthcare-seeking behavior among Chinese patients with irritable bowel syndrome

AIM To analyze predictors of healthcare-seeking behavior among Chinese patients with irritable bowel syndrome(IBS) and their satisfaction with medical care.METHODS Participating patients met IBS Rome Ⅲ criteria(excluding those with organic diseases) and were enrolled in an IBS database in a tertiary university hospital. Participants completed IBS questionnaires in face-to-face interviews. The questionnaires covered intestinal and extra-intestinal symptoms, medical consultations, colonoscopy,medications, and self-reported response to medications during the whole disease course and in the past year. Univariate associations and multivariate logistic regression were used to identify predictors for frequent healthcareseeking behavior(≥ 3 times/year), frequent colonoscopies(≥ 2 times/year), long-term medications, and poor satisfaction with medical care.RESULTS In total, 516 patients(293 males, 223 females) were included. Participants' average age was 43.2 ± 11.8 years. Before study enrollment, 55.2% had received medical consultations for IBS symptoms. Ordinary abdominal pain/discomfort(non-defecation) was an independent predictor for healthcare-seeking behavior(OR = 2.07, 95%CI: 1.31-3.27). Frequent colonoscopies were reported by 14.7% of patients(3.1 ± 1.4 times per year). Sensation of incomplete evacuation was an independent predictor for frequent colonoscopies(OR = 2.76, 95%CI: 1.35-5.67). During the whole disease course, 89% of patients took medications for IBS symptoms, and 14.7% reported they were satisfied with medical care. Patients with anxiety were more likely to report dissatisfaction with medical care(OR = 2.08, 95%CI: 1.20-3.59). In the past year, patients with severe(OR = 1.74, 95%CI: 1.06-2.82) and persistent(OR = 1.66, 95%CI: 1.01-2.72) IBS symptoms sought medical care more frequently.CONCLUSION Chinese patients with IBS present high rates of frequent healthcare-seeking behavior, colonoscopies, and medications, and low satisfaction with medical care. Intestinal symptoms are major predictors for healthcare-seeking behavior.     

Involvement of parasympathetic pelvic efferent pathway in psychological stress-induced defecation

AIM:To investigate the role of the pelvic nerve pathway in stress-induced acceleration of colorectal transit and defecation in rats.METHODS:Surgical transection of rectal nerves(rectal branches of the pelvic nerve),vagotomy(Vag) or adrenalectomy(Adx) were performed bilaterally in rats.Number of fecal pellet output of these rats was measured during 1-h water avoidance stress(WAS).To evaluate the colonic transit,rats were given phenol red through the catheter indwelled in the proximal colon and subjected to WAS.After WAS session,entire colon and rectum were isolated and distribution of phenol red was measured.Distal colonic and rectal transit was evaluated using glass bead.Rats were inserted the glass bead into the distal colon and evacuation rate of the bead was measured.Neural activation was assessed by immunohistochemical staining of c-Fos and PGP9.5 in colonic whole-mount preparations of longitudinal muscle myenteric plexus(LMMP).RESULTS:In the sham-operated rats(sham op),WAS significantly increased defecation and accelerated colorectal transit with marked elevation of plasma corticosterone level.Compared with sham-operated rats,increase in the excretion of fecal pellets during WAS was significantly reduced by rectal nerve transection(RNT)(sham op:6.9 ± 0.8 vs RNT:4.3 ± 0.6,P < 0.05) or Vag(sham op:6.4 ± 0.8 vs Vag:3.7 ± 1.1,P < 0.05),although corticosterone level remained elevated.Adx-rats significantly increased the defecation despite the lower corticosterone level.Distribution pattern of phenol red showed RNT inhibited distal colonic and rectal transit accelerated by WAS,while Vag inhibited proximal colonic transit.Suppression of distal colonic and rectal transit by RNT was further confirmed by the bead evacuation rate(sham op:80.0% vs RNT:53.8%).WAS significantly increased the number of c-Fos-immunoreactive neural cells in the LMMP of the proximal and distal colon,whereas c-Fos expression was decreased by RNT in the distal colon(sham op:9.0 ± 2.0 vs RNT:4.4 ± 1.0,P < 0.05) and decreased by V     

Irritable bowel syndrome consulters in Zhejiang province: The symptoms pattern, predominant bowel habit subgroups and quality of life

AIM:To investigate the pattern of symptoms,predominantbowel habits and quality of life(QOL)by the Chinese versionof the SF-36 in irritable bowel syndrome(IBS)consulters inZhejiang province.METHODS:From January 2001 to January 2002,662 RomaⅡ criteria-positive IBS patients were enrolled bygastroenterologists in 10 hospitals from Digestive DiseaseCenter of Zhejiang(DDCZ).Patients were classified intoconstipation predominant IBS(IBS-C),diarrhea predominantIBS(IBS-D)and alternating constipation and diarrhea IBS(IBS-A)according to the predominant bowel habits.Allpatients were evaluated for the demographic checklists,IBSbowel symptoms,extra-colonic symptoms,and QOL byChinese version of the SF-36 questionnaire.RESULTS:(1) Besides abdominal pain,the predominantcolonic symptoms were in order of altered stool form,abnormalities of stool passage,abdominal distension andpassage of mucus in IBS patients.Also,IBS subjects reportedgeneralized body discomfort and psychosocial problemsincluding dyspeptic symptoms,poor appetite,heartburn,headache,back pain,difficulty with urination,fatigue,anxietyand depression.(2)IBS-C and IBS-A are more commonamong female patients,whereas male patients experiencedmore cases of IBS-D.In regards to the IBS symptoms,therewere significant differences among IBS subgroups.Abdominal pain(frequency≥2 days per week and duration≥1 hour per day)was frequent in IBS-A patients(P=0.010and 0.027,respectively),IBS-D patients more frequentlyexperienced the passage of mucus,dyspeptic symptomsand anxiety(P=-0.000,0.014 and 0.015,respectively).(3)IBS patients experienced significant impairment in QOL,decrements in QOL were most pronounced in vitality,generalhealth,mental health,and bodily pain.Compared with thegeneral population(adjusted for gender and age),IBS patientsscored significantly lower on all SF-scales(P<0.001),exceptfor physical function scale(P=0.149).(4)QOL was impairedin all subgroups,particularly in scales of vitality,general healthand mental health.Compared with IBS-D,QOL in IBS-C scoredsignificantly lower on physical function,role physical,generalhealth,role emotional,and mental health scales(P=0.037,0.040,0.039,0.005 and 0.026,respectively). CONCLUSION:Besides colonic symptoms,IBS could causegeneralized body discomfort and psychosocial problems.TheIBS subgroups based on predominant bowel habits arehelpful to identify clinical distinction of the IBS.QOL issignificantly impaired in IBS patients.The Chinese version ofthe SF-36 health survey scales may be a useful measurementof IBS patients.     

Randomized,double-blinded,placebo-controlled trial evaluating simethicone pretreatment with bowel preparation during colonoscopy

BACKGROUND The presence of small air bubbles and foam are an impediment to a successful colonoscopy. They impair an endoscopist's view and diminish the diagnostic accuracy of the study. This has been particularly noted to be of concern with the switch to lower volume polyethylene glycol(PEG) and bisacodyl combination preparation.AIM To evaluate the effect of oral simethicone addition to bowel preparation on intraluminal bubbles reduction during colonoscopy.METHODS Described is a prospective, randomized, multi-center, double-blinded, placebocontrolled study to evaluate the use of premixed simethicone formulation with split-regimen, low-volume PEG-bisacodyl combination bowel preparation for 168 outpatients undergoing screening, surveillance, and diagnostic colonoscopies.Primary outcome includes evaluation of bubbles during colonoscopy graded using the Intraluminal Bubbles Scale. Secondary outcomes include evaluation ofthe Boston Bowel Preparation Scale(BBPS), total number of polyps, polyp size differentiation, polyp laterality, adenoma detection, mass detection, cecal insertion time, withdrawal time, and patient-reported adverse events.RESULTS Higher Intraluminal Bubbles grades III and IV(less than 75% of the mucosa cleared of bubbles/foam requiring intervention with simethicone infused wash)were detected in the placebo group [Simethicone n = 4/84 vs Placebo n = 20/84(P= 0.007)]. BBPS total score was 7.42 [standard deviation(SD) = ± 1.51] in the simethicone group and 7.28(SD = ± 1.44) in the placebo group(P = 0.542) from a total of 9. Significantly higher number of adenomas were detected in the simethicone group(P = 0.001).CONCLUSION The addition of simethicone to bowel preparation is well advised for its antifoaming properties. The results of this study suggest that addition of oral simethicone can improve bowel wall visibility.     

Nutrient drink test: A promising new tool for irritable bowel syndrome diagnosis

BACKGROUND Irritable bowel syndrome(IBS) is a highly prevalent condition. It is diagnosed on the basis of chronic symptoms after the clinical and/or investigative exclusion of organic diseases that can cause similar symptoms. There is no reproducible noninvasive test for the diagnosis of IBS, and this raises diagnostic uncertainty among physicians and hinders acceptance of the diagnosis by patients.Functional gastrointestinal(GI) syndromes often present with overlapping upper and lower GI tract symptoms, now believed to be generated by visceral hypersensitivity. This study examines the possibility that, in IBS, a nutrient drink test(NDT) provokes GI symptoms that allow a positive differentiation of these patients from healthy subjects.AIM To evaluate the NDT for the diagnosis of IBS.METHODS This prospective case-control study compared the effect of two different nutrient drinks on GI symptoms in 10 IBS patients(patients) and 10 healthy controls(controls). The 500 kcal high nutrient drink and the low nutrient 250 kcal drink were given in randomized order on separate days. Symptoms were assessed just before and at several time points after drink ingestion. Global dyspepsia and abdominal scores were derived from individual symptom data recorded by two questionnaires designed by our group, the upper and the general GI symptomquestionnaires, respectively. Psycho-social morbidity and quality of life were also formally assessed. The scores of patients and controls were compared using single factor analysis of variance test.RESULTS At baseline, IBS patients compared to controls had significantly higher levels of GI symptoms such as gastro-esophageal reflux(P = 0.05), abdominal pain(P =0.001), dyspepsia(P = 0.001), diarrhea(P = 0.001), and constipation(P = 0.001) as well as higher psycho-social morbidity and lower quality of life. The very low incidence of GI symptoms reported by control subjects did not differ significantly for the two test drinks. Compared with the low nutrient drink, IBS patients with the high nutrient drink had significantly more dyspeptic symptoms at 30(P =0.014), 45(P = 0.002), 60(P = 0.001), and 120 min(P = 0.011). Dyspeptic symptoms triggered by the high nutrient drink during the first 120 min gave the best differentiation between healthy controls and patients(area under receiver operating curve of 0.915 at 45 min for the dyspepsia score). Continued symptom monitoring for 24 h did not enhance separation of patients from controls.CONCLUSION A high NDT merits further evaluation as a diagnostic tool for IBS.     

Endoscopic submucosal dissection of a large colonic lipoma:Report of two cases

A colonic lipoma is a very rare benign tumor that is usually asymptomatic and is found incidentally by colonoscopy.Patients with a large colonic lipoma may present with symptoms such as abdominal pain,bleeding,and colonic obstruction or intussusceptions.We report two patients with large colonic lipomas and symptoms.Standard endoscopic submucosal dissection(ESD) was performed to remove the lipomas instead of conventional surgical bowel resection.No complications were observed during or after the procedure.The tumors were resected en bloc,and the patients were discharged 2 d after ESD with a regular diet.The results indicate that ESD can be applied as safe and effective treatment for a large colonic lipoma.     

Use of a device that applies external kneading-like force on the abdomen for treatment of constipation

AIM: To evaluate the efficacy of a recently developed device that applies kneading-like motion on the abdomen in improving constipation in elderly long-term care patients. METHODS: Thirty constipated elderly patients were randomly selected from two nursing homes. They were instructed to use the device once daily for 20 min. Rate of bowel movements, volume and consistency of stool and the use of laxantia were all recorded during a 3-wk baseline period and for 12-wk treatment period. Colonic transit time (CTT) was measured in 13 patients by radiopaque markers during the baseline and at the end of treatment. RESULTS: Bowel movement rate (BM/week) increased from 1.4±0.4 BM/wk during baseline to 3.9±0.8 BM/wk during treatment (P<5.0×10-7). Stool amount that was "low" in 30 patients during baseline increased in 21 patients at the end of the study period (x2 = 19.048-P= 1.3×10-5). Stool consistency,that was "hard" in 25 patients and "soft" in 5 patients during baseline, ameliorated in 23 patients at the end of the study (only 2 patients referred "hard" stool) (x2 = 21.043-P= 4.0×10-6). The mean baseline CTT measured was 92.3±32.3 h at baseline and decreased to 49.4±31.3 h during the study period (P = 0.000208). No side effects were observed during the study period. CONCLUSION: External mechanical vibration of the abdomen reduced CTT and helped to relieve severe constipation in elderly constipated patients.     

Protozoan parasites in irritable bowel syndrome:A case-control study

AIM To investigate the putative role of protozoan parasites in the development of irritable bowel syndrome(IBS).METHODS The study included 109 IBS consecutive adult patients fulfilling the Rome Ⅲ criteria and 100 healthy control subjects. All study subjects filled a structured questionnaire, which covered demographic information and clinical data. Fresh stool samples were collected from patients and control subjects and processed within less than 2 h of collection. Iodine wet mounts and Trichrome stained smears prepared from fresh stool and sediment concentrate were microscopically examined for parasites. Blastocystis DNA was detected by polymerase chain reaction, and Cryptosporidium antigens were detected by ELISA.RESULTS A total of 109 IBS patients(31 males, 78 females) with a mean age ± SD of 27.25 ± 11.58 years(range: 16-60 years) were enrolled in the study. The main IBS subtype based on the symptoms of these patients was constipation-predominant(88.7% of patients). A hundred healthy subjects(30 males, 70 females) with a mean ± SD age of 25.0 ± 9.13 years(range 18-66 years) were recruited as controls. In the IBS patients, Blastocystis DNA was detected in 25.7%, Cryptosporidium oocysts were observed in 9.2%, and Giardia cysts were observed in 11%. In the control subjects, Blastocystis, Cryptosporidium and Giardia were detected in 9%, 0%, and 1%, respectively. The difference in the presence of Blastocystis(P = 0.0034), Cryptosporidium(P = 0.0003), and Giardia(P = 0.0029) between IBS patients and controls was statistically significant by all methods used in this study.CONCLUSION Prevalence of Blastocystis, Cryptosporidium and Giardia is higher in IBS patients than in controls. These parasites are likely to have a role in the pathogenesis of IBS.     

计算机视觉食管曲张静脉压力检测技术的初步研究

Objective To evaluate the clinical reliability and feasibility of computerized endoscopic balloon manometry in vitro and in vivo, in measurement of pressure of esophageal varices. Methods Computerized endoscopic balloon manometry was used to measure the pressure of variceal model with different diameter (3 mm, 6 mm and 8 mm) and intraluminal pressures (ranging from 8 to 36 mm Hg), and the findings were compared with actual pressures. The technique was also applied in 23 patients with liver cirrhosis and esophageal varices, and its correlation with hepatic venous pressure gradient and other factors related with varices bleeding. Results The study in vitro showed that the measured intraluminal pressure was correlated significantly with the actual value ( r ≥ 0. 993, P ＜ 0. 001 ) without obvious measurement bias(95% CI = -0.13 cm H2O to 0. 33 cm H2O). The measurement in 23 patients were success with little variation coefficient (r≥0. 998) between repeated procedures. Regression analysis showed a good correlation between variceal pressure and hepatic venous pressure gradient (r=0. 858, P ＜ 0. 001 ). A higher variceal pressure was strongly associated with presence of previous bleeding episodes, vascular diameter and presence of red color signs, but did not correlate with the parameter of Child-Pugh classification ( t = 0. 31, P =0. 76). Conclusion Computerized endoscopic balloon manometry is reliable and feasible to examine esophageal variceal pressure, and is very likely to be a valuable clinical index for variceal bleeding.