Diet in irritable bowel syndrome: What to recommend, not what to forbid to patients.

A substantial proportion of patients with irritable bowel syndrome(IBS) associate their symptoms with the ingestion of specific foods. Therefore, in recent years, scientific research has increasingly focused on the role of diet in IBS and dietary management is now considered an important tool in IBS treatment. This article reviews the main dietary approaches in IBS emphasizing evidence from experimental and observational studies and summarizing the main diet and lifestyle recommendations provided by dietary guidelines and scientific literature. Despite the limited evidence for a beneficial role, general advice on healthy eating and lifestyle is recommended as the first-line approach in the dietary management of IBS. Standard recommendations include adhering to a regular meal pattern, reducing intake of insoluble fibers, alcohol, caffeine, spicy foods, and fat, as well as performing regular physical activity and ensuring a good hydration. Second-line dietary approach should be considered where IBS symptoms persist and recommendations include following a low FODMAP diet, to be delivered only by a healthcare professional with expertise in dietary management. The efficacy of this diet is supported by a growing body of evidence. In contrast, the role of lactose or gluten dietary restriction in the treatment of IBS remains subject to ongoing research with a lack of high-quality evidence. Likewise, further clinical trials are needed to conclude the efficacy of probiotics on IBS symptoms.

Metabolic syndrome and risk of subsequent colorectal cancer

The metabolic syndrome and visceral obesity have anincreasing prevalence and incidence in the generalpopulation. The actual prevalence of the metabolicsyndrome is 24% in US population and between24.6% and 30.9% in Europe. As demonstrated by many clinical trials (NAHANES , INTERHART) the metabolic syndrome is associated with an increased risk of both diabetes and cardiovascular disease. In addition to cardiovascular disease, individual components of the metabolic syndrome have been linked to the development of cancer, particularly to colorectal cancer. Colorectal cancer is an important public health problem; in the year 2000 there was an estimated total of 944 717 incident cases of colorectal cancer diagnosed world-wide. This association is sustained by many epidemiological studies. Recent reports suggest that individuals with metabolic syndrome have a higher risk of colon or rectal cancer. Moreover, the clusters of metabolic syndrome components increase the risk of associated cancer. The physiopathological mechanism that links metabolic syndrome and colorectal cancer is mostly related to abdominal obesity and insulin resistance. Population and experimental studies demonstrated that hyperinsulinemia, elevated C-peptide, elevated body mass index, high levels of insulin growth factor-1, low levels of insulin growth factor binding protein-3, high leptin levels and low adiponectin levels are all involved in carcinogenesis. Understanding the pathological mechanism that links metabolic syndrome and its components to carcinogenesis has a major clinical signifi cance and may have profound health benefi ts on a number of diseases including cancer, which represents a major cause of mortality and morbidity in our societies.

Spontaneous and antiviral-induced cutaneous lesions in chronic hepatitis B virus infection

AIM:To describe spontaneous,or interferon(IFN)-or immunization-induced skin lesions in hepatitis B virus(HBV)infection.METHODS:A comprehensive literature search of all the papers presenting case reports of dermatological lesions in patients with chronic HBV infection was carried out.We included only patients with histologically proven skin lesions that appeared in the normal course of hepatitis B infection,or after immunization for hepatitis B or antiviral treatment.RESULTS:We found 44 papers on this topic,reporting 151 cases.About 2%of patients with hepatitis B infection,mainly men,presented with skin lesions.Among patients with chronic hepatitis B,vasculitis and essential mixed cryoglobulinemia seemed to be the most frequent skin lesion(53.3%),followed by papular changes,rashes and Gianotti-Crosti syndrome,skin carcinoma and Henoch-Sch?nlein purpura were rare.IFN treatment seemed to be effective against HBV-associated and immunoglobulin-complex-mediated disease(vasculitis).Two cutaneous lesions(lichen planus andgranuloma annulare)were described after hepatitis B vaccination.Systemic lupus and lupus-like lesions were the most frequently encountered lesions after antiviral treatment.Immunosuppressive and steroid therapy ameliorates lichen planus lesions in 50%of cases.CONCLUSION:Vasculitis was the most frequent spontaneous skin lesion found in chronic hepatitis B.Lichen planus was most frequent after immunization and lupus/lupus-like lesions after IFN.

Disorders of the brain-gut interaction and eating disorders

BACKGROUND Eating disorders(ED)involve both the nervous system and the gastrointestinal tract.A similar double involvement is also found in disorders of the brain-gut interaction(DGBI)and symptoms are sometimes similar.AIM To find out where there is an association and a cause-effect relationship,we looked for the comorbidity of DGBI and ED.METHODS A systematic review was undertaken.A literature search was performed.Inclusion criteria for the articles retained for analysis were:Observational cohort population-based or hospital-based and case-control studies,examining the relationship between DGBI and ED.Exclusion criteria were:Studies written in other languages than English,abstracts,conference presentations,letters to the Editor and editorials.Selected papers by two independent investigators were critically evaluated and included in this review.RESULTS We found 29 articles analyzing the relation between DGBI and ED comprising 13 articles on gastroparesis,5 articles on functional dyspepsia,7 articles about functional constipation and 4 articles on irritable bowel syndrome.CONCLUSION There is no evidence for a cause-effect relationship between DGBI and ED.Their common symptomatology requires correct identification and a tailored therapy of each disorder.