High risk of temporomandibular disorder in irritable bowel syndrome: Is there a correlation with greater illness severity?

AIM To investigate the prevalence and the risk of temporomandibular disorders(TMDs)in patients with irritable bowel syndrome(IBS)(including each subtype:constipation,diarrhoea,and mixed)compared to the general population.METHODS Between January 2014 and December 2015 we enrolled consecutively adult patients diagnosed with IBS at the outpatient clinic of the University of Salerno and healthy controls(HC)without IBS.At enrollment,we analyzed all patients for the presence of TMDs according to the Research Diagnostic Criteria for TMD.RESULTS We enrolled 91 IBS patients(23 IBS-D,30 IBS-C and38 IBS-M)and 57 HC in the study.We found a higher risk of having TMD(OR=3.41,95%CI:1.66-7.01)compared to the HC.The risk of having TMD was independent of IBS-subtype.Multiple regression analysis showed that facial pain was positively related to abdominal pain and higher level of depression.CONCLUSION IBS patients had a more than three times greater risk of TMD compared to HC.The risk of having TMDwas similar in different IBS subtypes.IBS patients that also fulfilled criteria for TMD seem to share along with chronic facial and abdominal pain a significant co-occurrence with psychiatric disorders and female preponderance.Key words:Temporomandibular disorders;Irritable bowel syndrome;Chronic pain;Facial pain;Abdominal pain;Irritable bowel syndrome severity score symptoms;Irritable bowel syndrome predominant diarrhea;Irritable bowel syndrome predominant constipation;Irritable bowel syndrome mixed?The Author(s)2017.Published by Baishideng Publishing Group Inc.All rights reserved.

Can fecal microbiota transplantation cure irritable bowel syndrome?

AIM To verify the utility of treatment with fecal microbiota transplantation(FMT) in patients with irritable bowel syndrome(IBS).METHODS We searched EMBASE, Cochrane Library and Pub Med in March, 2017. The reviewed literature was based on two systematic searches in each of the databases. The Me SH terms used were IBS and fecal microbiota transplantation and the abbreviations IBS and FMT. Reference lists from the articles were reviewed to identify additional pertinent articles. RESULTS A total of six conference abstracts, one case report, one letter to the editor, and one clinical review were included. In the final analysis, treatment of 48 patients was evaluated. Treatment revealed an improvement in 58% of cases. The varying structure of the nine included studies must be taken into consideration.CONCLUSION Data on FMT and IBS are too limited to draw sufficientconclusions. Standardized double blinded randomized clinical trials need to be carried out to evaluate the effect of FMT on IBS.

Epidemiological and clinical perspectives on irritable bowel syndrome in India, Bangladesh and Malaysia: A review

Irritable bowel syndrome(IBS) is a chronic gastrointestinal disorder, common in clinic and in the community. It has a significant impact on both society and patients' quality of life. The epidemiology, clinical presentation, and management of IBS may vary in different geographical regions due to differences in diet, gastrointestinal infection, socio-cultural and psychosocial factors, religious and illness beliefs, symptom perception and reporting. Although previous reviews and consensus reports on IBS in Asia have been published, Asia is quite diverse socio-demographically. In this context, India, Bangladesh and Malaysia share some similarities, including:(1) large proportion of the population living in rural areas;(2) rapid development and associated lifestyle changes in urban areas; and(3) dietary, cultural and religious practices. The present review explores the clinical and epidemiological data on IBS from these three major nations in South and South-East Asia. In-depth review of the literature revealed important differences between IBS in the East, as revealed by studies from these three countries, and the West; these include a predominantly rural profile, differences in bowel habit and symptom profile, raising concern with regards to diagnostic criteria and subtyping of IBS, higher dietary fiber consumption, frequent lactose malabsorption, parasitosis, and possible overlap between post-infectious IBS and tropical sprue. Moreover, the current perception on difference in prevalence of the disorder in these countries, as compared to the West, might be related to variation in survey methods.

Saccharomyces cerevisiae CNCM I-3856 in irritable bowel syndrome: An individual subject meta-analysis

AIM To confirm previous conclusions on Saccharomyces cerevisiae(S. cerevisiae) CNCM I-3856 for irritable bowel syndrome(IBS) management.METHODS An individual patient data meta-analysis was performed on two randomized clinical trials studying the effect of S. cerevisiae CNCM I-3856 supplementation on gastrointestinal(GI) symptoms in IBS subjects. A total of 579 IBS subjects were included. Outcomes were the daily Likert scale scores of abdominal pain/discomfort and bloating [area under the curve(AUC) and weekly means], responder status, and bowel movements(stool frequency and consistency). Statistical analyses were conducted in Intent to Treat(ITT) population, IBS-C subjects and IBS-C subjects with an abdominal pain/discomfort score higher than or equal to 2 at baseline("IBS-C ≥ 2 subpopulation").RESULTS S. cerevisiae CNCM I-3856 significantly improved abdominal pain/discomfort and bloating during the second month of supplementation [AUC(W5-W8)]with improvement up to the minimal clinically relevant threshold of 10%: a 12.3% reduction of abdominal pain/discomfort in the ITT population compared to the Placebo group(P = 0.0134) has been observed. In the IBS-C ≥ 2 subpopulation, there were a 13.1% reduction of abdominal pain/discomfort and a 14.9% reduction of bloating compared to the Placebo group(P = 0.0194 and P = 0.0145, respectively). GI symptoms significantly decreased during supplementation but no statistical differences were reported between groups at the end of the supplementation period. Responder status was defined as a subject who experienced a decrease of 1 arbitrary unit(a.u.) or 50% of the abdominal discomfort score from baseline for at least 2 wk out of the last 4 wk of the study. A significant difference between groups was reported in the ITT population, when considering the first definition: subjects in the Active group had 1.510 higher odds to be a responder(reduction of 1 a.u. of abdominal pain/discomfort) compared with subjects in the Placebo group(P = 0.0240). At the end of supplementation period, stool consistency in the Active group of the ITT population was significantly improved and classified as "normal" compared to Placebo(respectively 3.13 ± 1.197 a.u. vs 2.58 ± 1.020 a.u., P = 0.0003). Similar results were seen in the IBS-C ≥ 2 subpopulation(Active group: 3.14 ± 1.219 a.u. vs Placebo group: 2.59 ± 1.017 a.u., P = 0.0009).CONCLUSION This meta-analysis supports previous data linking S. cerevisiae I-3856 and improvement of GI symptoms, in IBS overall population and in the IBS-C and IBS-C ≥ 2 subpopulations.

Irritable bowel syndrome evaluation using computed tomography colonography

AIM To evaluate the morphology of the colon in patients with irritable bowel syndrome(IBS) by using computed tomography colonography(CTC).METHODS Twelve patients with diarrhea type IBS(IBS-D), 13 patients with constipation type IBS(IBS-C), 12 patients with functional constipation(FC) and 14 control patients underwent colonoscopy following CTC. The lengths of the rectosigmoid colon, transverse colon and the total colon were measured. The diameters of the rectum, sigmoid colon, descending colon, transverse colon, and ascending colon were measured.RESULTS The mean length of the total colon was 156.5 cm in group C, 158.9 cm in group IBS-D, 172.0 cm in group IBS-C, and 188.8 cm in group FC. The total colon in group FC was significantly longer than that in group C(P < 0.05). The mean length of the rectosigmoid colon was 56.2 cm, 55.9 cm, 63.6cm, and 77.4 cm(NS). The mean length of the transverse colon was 49.9 cm, 43.1 cm, 57.0 cm, and 55.0 cm. The transverse colonin group IBS-D was significantly shorter than that in group IBS-C(P < 0.01) and that in group FC(P = 0.02). The mean diameter of the sigmoid colon was 4.0 cm, 3.3 cm, 4.2 cm, and 4.3 cm(NS). The mean diameter of the descending colon was 3.6 cm, 3.1 cm, 3.8 cm, and 4.3 cm. The descending colon diameter in group IBS-D was significantly less than that in group IBS-C(P = 0.03) and that in group FC(P < 0.001). The descending colon diameter in group FC was significantly greater than that in group C(P = 0.04). The mean diameter of the transverse colon was 4.4 cm, 3.3 cm, 4.2 cm, and 5.0 cm(NS).CONCLUSION CT colonography might contribute the clarification of subtypes of IBS.