Correlation between the neuroendocrine axis,microbial species,inflammatory response,and gastrointestinal symptoms in irritable bowel syndrome

BACKGROUND This study examines the complex relationships among the neuroendocrine axis,gut microbiome,inflammatory responses,and gastrointestinal symptoms in patients with irritable bowel syndrome(IBS).The findings provide new insights into the pathophysiology of IBS and suggest potential therapeutic targets for improving patient outcomes.AIM To investigate the interactions between the neuroendocrine axis,gut microbiome,inflammation,and gastrointestinal symptoms in patients with IBS.METHODS Patients diagnosed with IBS between January 2022 and January 2023 were selected for the study.Healthy individuals undergoing routine check-ups during the same period served as the control group.Data were collected on neuroendocrine hormone levels,gut microbiome profiles,inflammatory biomarkers,and gastrointestinal symptomatology to analyze their interrelations and their potential roles in IBS pathogenesis.RESULTS IBS patients exhibited significant dysregulation of the neuroendocrine axis,with altered levels of cortisol,serotonin,and neuropeptides compared to healthy controls.The gut microbiome of IBS patients showed reduced diversity and specific alterations in bacterial genera,including Bifidobacterium,Lactobacillus,and Faecalibacterium,which were associated with neuroendocrine disturbances.Additionally,elevated levels of inflammatory markers,such as C-reactive protein,interleukin-6,and tumor necrosis factor-α,were observed and correlated with the severity of gastrointestinal symptoms like abdominal pain,bloating,and altered bowel habits.CONCLUSION The findings suggest that targeting the neuroendocrine axis,gut microbiome,and inflammatory pathways may offer novel therapeutic strategies to alleviate symptoms and improve the quality of life in IBS patients.

Current Insights on Vitamin D Intake, Status and Symptoms of Irritable Bowel Syndrome: A Narrative Review

The association between Vitamin D and IBS has attracted growing interest because of vitamin D’s involvement in immune system function and reduction of inflammation. IBS, a prevalent gastrointestinal condition marked by symptoms such as stomach pain, bloating, and changed bowel habits, implies that sufficient levels of Vitamin D may impact the symptomatology and quality of life associated with IBS. This review aimed to unveil current insights on vitamin D intake, status and symptoms of irritable bowel syndrome. A search was conducted on Embase, Scopus, Medline, and Cochrane Library, as well as a reference list of relevant studies. This paper also examined the current therapeutic practices for using vitamin D in the management of IBS. Although several studies demonstrate a positive association between vitamin D administration and the alleviation of IBS symptoms, the data is not yet definitive. Moreover, the review emphasised the necessity for additional rigorous clinical studies to determine a definitive therapeutic function of vitamin D in IBS based on the literature. The role of vitamin D in the modulation of gut health, particularly in IBS, has garnered significant attention due to its potential impact on both inflammation and the integrity of the gut barrier. Vitamin D, acting as a hormone precursor, is recognised for its crucial involvement in maintaining calcium balance and promoting bone health.

Irritable bowel syndrome symptom severity improves equally with probiotic and placebo

AIM To determine the effects of Lactobacillus acidophilus NCFM on irritable bowel syndrome(IBS) symptoms and quality of life(Qo L).METHODS In this randomized triple-blind trial, adult IBS volunteerswho were recruited according to Rome Ⅲ criteria received 109 or 1010 colony-forming units of NCFM or placebo daily for 12 wk. IBS Symptom Severity Score(IBS-SSS), which constituted the primary outcome, and secondary outcomes, including individual IBS symptoms, IBS-related QoL questionnaire, anxiety and depression, defecation frequency, and stool consistency, were assessed at baseline at the end of the 8-wk runin period, after 4 and 12 wk of intervention, and after a 4-wk washout.RESULTS A total of 340 of 391 randomized volunteers completed the trial. IBS-SSS improved over 12 wk of treatment in all treatment groups, decreasing by a mean ± SD of 44.0 ± 80.2, 50.8 ± 82.4, and 48.3 ± 72.2 in the placebo, active low-dose, and active high-dose groups, respectively. Similarly, secondary outcomes did not differ between treatment groups. However, in a post hoc analysis of volunteers with moderate to severe abdominal pain at baseline(VAS > 35/100), the treatment significantly reduced the sensation of abdominal pain. Pain scores fell by 20.8 ± 22.8, 29.4 ± 17.9, and 31.2 ± 21.9 in the placebo, active low-dose, and active high-dose groups, respectively(P value for placebo vs combined active doses = 0.0460).CONCLUSION NCFM alleviates moderate to severe abdominal pain, consistent with earlier observations of this strain mitigating visceral pain through increased analgesic receptor expression.

Unveiling the intricacies of irritable bowel syndrome

Irritable bowel syndrome(IBS)remains a challenging condition both for patients and clinicians,characterized by its chronic nature and the elusive complexity of its underlying mechanisms.The multifaceted relationship between the neuroendocrine axis,gut microbiota,and inflammatory response has emerged as a focal point in recent research,offering new insights into the pathophysiology of IBS.The neuroendocrine axis plays a crucial role in maintaining the delicate balance between the brain and the gut,often referred to as the“gut-brain axis”.This bidirectional communication is essential for regulating gastrointestinal function,stress responses,and overall homeostasis.Dysregulation of this axis,as highlighted by elevated cortisol and serotonin levels in IBS patients,suggests that neuroendocrine imbalances may significantly contribute to the severity of gastrointestinal symptoms.These findings underscore the need for a broader understanding of how stress and emotional factors influence IBS,potentially guiding more effective,personalized treatment approaches.Equally important is the role of the gut microbiota,a diverse and dynamic ecosystem that directly impacts gut health.This dysbiosis disrupts gut function and appears to exacerbate the neuroendocrine and inflammatory responses.These findings align with the growing recognition that gut microbiota is a critical player in IBS,influencing both the disease's onset and progression.

Association of symptoms with gastrointestinal microbiota in irritable bowel syndrome

AIM:To investigate the correlations between selfreported symptoms of irritable bowel syndrome(IBS) and the gastrointestinal(GI) microbiota composition.METHODS:Fecal samples were collected from a total of 44 subjects diagnosed with IBS.Their symptoms were monitored with a validated inflammatory bowel disease questionnaire adjusted for IBS patients.Thirteen quantitative real-time polymerase chain reaction assays were applied to evaluate the GI microbiota composition.Eubacteria and GI bacterial genera(Bifidobacterium,Lactobacillus and Veillonella),groups(Clostridium coccoides/Eubacterium rectale,Desulfovibrio desulfuricans) and distinct bacterial phylotypes [closest 16S rDNA sequence resemblance to species Bifidobacterium catenulatum,Clostridium cocleatum,Collinsella aerofaciens(C.aerofaciens),Coprococcus eutactus(C.eutactus),Ruminococcus torques and Streptococcus bovis ] with a suspected association with IBS were quantified.Correlations between quantities or presence/absence data of selected bacterial groups or phylotypes and various IBSrelated symptoms were investigated.RESULTS:Associations were observed between subjects' self-reported symptoms and the presence or quantities of certain GI bacteria.A Ruminococcus torques(R.torques)-like(94% similarity in 16S rRNA gene sequence) phylotype was associated with severity of bowel symptoms.Furthermore,among IBS subjects with R.torques 94% detected,the amounts of C.cocleatum 88%,C.aerofaciens-like and C.eutactus 97% phylotypes were significantly reduced.Interesting observations were also made concerning the effect of a subject's weight on GI microbiota with regard to C.aerofaciens like phylotype,Bifidobacterium spp.and Lactobacillus spp.CONCLUSION:Bacteria seemingly affecting the symptom scores are unlikely to be the underlying cause or cure of IBS,but they may serve as biomarkers of the condition.

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

AIMTo 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.METHODSBetween 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.RESULTSWe enrolled 91 IBS patients (23 IBS-D, 30 IBS-C and 38 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.CONCLUSIONIBS patients had a more than three times greater risk of TMD compared to HC. The risk of having TMD was 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.

Effect of Bifidobacterium longum 35624 on disease severity and quality of life in patients with irritable bowel syndrome

BACKGROUND Bifidobacterium longum 35624 has shown efficacy in improving irritable bowel syndrome(IBS)symptoms compared with placebo in double-blind randomized studies.However,few data are available from real-life clinical practice or from studies that used Rome IV criteria to diagnose IBS.AIM To assess the effect of B.longum 35624 on IBS severity and quality of life in a reallife setting.METHODS From November 2018 to January 2020,278 patients with IBS(according to Rome IV criteria)were enrolled in a prospective,open-label,multicenter observational study by private practice gastroenterologists to received one capsule of B.longum 35624(10^(9) colony-forming units)per day for 30 d.Participation in the study was independently proposed to patients during spontaneous consultations.Disease severity(assessed by the IBS severity scoring system)and patient quality of life(assessed by the IBS quality of life questionnaire)were compared between the inclusion visit(baseline)and the visit at the end of 30 d of treatment.The characteristics of patients were described at baseline.Continuous variables comparisons between inclusion and end-of-treatment visits were performed using the t-test and Kruskal-Wallis test.Categorical variables comparisons were performed using theχ^(2) test.RESULTSA total of 233 patients,with a mean age of 51.4 years and composed of 71.2%women,were included in the study.Of these patients,48.1%had moderate IBS and 46.4%had severe IBS.After a 30-d treatment period with one B.longum 35624 capsule per day,a significant decrease in IBS severity was observed compared to baseline(mean±SD,IBS severity scoring system scores:208±104 vs 303±81,P<0.001)and 57%of patients moved to lower severity categories or achieved remission.The quality of life of patients was also improved by the treatment(IBS Quality of Life questionnaire score:68.8±20.9 vs 60.2±20.5;P<0.001)and 63.8%of patients were satisfied with the treatment.CONCLUSION Thirty days of treatment with B.longum 35624 reduces disease severity and improves the quality of life of patients with IBS,particularly those with the most severe forms of IBS.

Serotonin type 3 receptor subunit gene polymorphisms associated with psychosomatic symptoms in irritable bowel syndrome:A multicenter retrospective study

BACKGROUND Single-nucleotide polymorphisms(SNPs)of the serotonin type 3 receptor subunit(HTR3)genes have been associated with psychosomatic symptoms,but it is not clear whether these associations exist in irritable bowel syndrome(IBS).AIM To assess the association of HTR3 polymorphisms with depressive,anxiety,and somatization symptoms in individuals with IBS.METHODS In this retrospective study,623 participants with IBS were recruited from five specialty centers in Germany,Sweden,the United States,the United Kingdom,and Ireland.Depressive,anxiety,and somatization symptoms and sociodemographic characteristics were collected.Four functional SNPs—HTR3A c.-42C>T,HTR3B c.386A>C,HTR3C c.489C>A,and HTR3E c.*76G>A—were genotyped and analyzed using the dominant and recessive models.We also performed separate analyses for sex and IBS subtypes.SNP scores were calculated as the number of minor alleles of the SNPs above.The impact of HTR3C c.489C>A was tested by radioligand-binding and calcium influx assays.RESULTS Depressive and anxiety symptoms significantly worsened with increasing numbers of minor HTR3C c.489C>A alleles in the dominant model(F_(depressive)=7.475,P_(depressive)=0.006;F_(anxiety)=6.535,P_(anxiety)=0.011).A higher SNP score(range 0-6)was linked to a worsened depressive symptoms score(F=7.710,P-linear trend=0.006)in IBS.The potential relevance of the HTR3C SNP was corroborated,showing changes in the expression level of 5-HT3AC variant receptors.CONCLUSION We have provided the first evidence that HTR3C c.489C>A is involved in depressive and anxiety symptoms in individuals with IBS.The SNP score indicated that an increasing number of minor alleles is linked to the worsening of depressive symptoms in IBS.

Age-related symptom and life quality changes in women with irritable bowel syndrome

AIM:To explore age-related changes in symptoms and quality of life(QoL) of women with irritable bowel syndrome(IBS).METHODS:Two-hundred and fifty-four female adult outpatients with IBS attending the Department of Gastroenterology at the First Affiliated Hospital of Nanjing Medical University between January,2008 and October,2008 were approached.Patients with a history of abdominal surgery,mental illness or those who had recently taken psychotropic drugs were excluded.A physician obtained demographic and abdominal symptom data.All patients were asked to complete the Zung Self-Rated Anxiety and Depression Scale(SDS/SAS) and the IBS-specific QoL questionnaire.The patients were divided into six groups according to age,in 10-year increments:18-27 years,28-37 years,38-47 years,48-57 years,58-67 years and 68-75 years(maximum 75 years).Age-related differences of abdominal pain or discomfort were analyzed using ranksum tests.Differences in SDS/SAS and IBS-QoL scores between age groups were analyzed using one-way analysis of variance.Pearson's correlations evaluated potential associations between IBS symptoms,psychological factors and QoL in each age group.RESULTS:There were no differences in the distribution of IBS subtypes between age groups(χ2 = 20.516,P = 0.153).Differences in the severity of abdominal pain/discomfort with age were statistically significant(χ2 = 25.638,P < 0.001);patients aged 48-57 years,58-67 years or 68-75 years had milder abdominal pain/discomfort than those in the younger age groups.The severity of anxiety or depressive symptoms did not differ between age groups(SDS,χ2 = 390.845,P = 0.110;SAS,χ 2 = 360.071,P = 0.220).Differences of IBSQoL scores were statistically significant between age groups(χ2 = 1098.458,P = 0.011).The scores of patients in the 48-57-year group were lower than those in the 18-27-year and 28-37-year groups(48-57-year group vs 18-27-year group,74.88 ± 8.76 vs 79.76 ± 8.63,P = 0.021;48-57-year group vs 28-37-year group,74.88 ± 8.76 vs 79.04 ± 8.32,P = 0.014).The scores in the 68-75-year group were lower than those in the 18-27-year,28-37-year and 38-47-year groups(68-75-year group vs 18-27-year group,71.98 ± 9.83 vs 79.76 ± 8.63,P = 0.003;68-75-year group vs 28-37-year group,71.98 ± 9.83 vs 79.04 ± 8.32,P = 0.002;68-75-year group vs 38-47-year group,71.98 ± 9.83 vs 76.44 ± 8.15,P = 0.039).Anxiety and depression were negatively correlated with QoL in all age groups(SDS and QoL:18-27-year group,r =-0.562,P = 0.005;28-37-year group,r =-0.540,P < 0.001;38-47-year group,r =-0.775,P < 0.001;48-57-year group,r =-0.445,P = 0.001;58-67-year group,r =-0.692,P < 0.001;68-75-year group,r =-0.732,P < 0.001.SAS and QoL:18-27-year group,r =-0.600,P = 0.002;28-37-year group,r =-0.511,P < 0.001;38-47-year group,r =-0.675,P < 0.001;48-57-year group,r =-0.558,58-67-year group,P = 0.001;r =-0.588,P < 0.001;68-75-year group,r =-0.811,P < 0.001).A negative correlation between abdominal pain severity and QoL was found in patients aged more than 58 years(58-67-year group,r =-0.366,P = 0.017;68-75-year group,r =-0.448,P = 0.048),but not in younger patients(18-27-year group,r = 0.080,P = 0.716;28-37-year group,r =-0.063,P = 0.679;38-47-year group,r =-0.029,P = 0.812;48-57-year group,r =-0.022,P = 0.876).CONCLUSION:Factors affecting QoL should always be treated in IBS,especially emotional problems in young adults.Even mild abdominal pain should be controlled in elderly patients.

Differences in dietary habits of people with vs without irritable bowel syndrome and their association with symptom and psychological status:A pilot study

BACKGROUND Previous studies have demonstrated that dietary factors are involved in irritable bowel syndrome(IBS),but the role of diet was evaluated mostly based on food frequency questionnaire.Whether food categories,quantity per time,and intake frequency are different between IBS patients and non-IBS individuals has not been clearly clarified.AIM To explore differences in dietary habits of people with vs without IBS and their correlation with symptom and psychological status.METHODS A total of 220 questionnaires were administered in a community population and the Rome IV criteria was applied to diagnose IBS.The dietary questionnaire used in this study was multidimensional from food categories,quantity per time,and intake frequency,in contrast to“yes or no”classification used in previous studies.Questionnaires including IBS symptom severity scale(IBS-SSS),IBS quality of life,visceral sensitivity index,hospital anxiety and depression score(HADS),and gastrointestinal symptom rating scale were used to assess the participants.Rank sum test was used to compare the quantity per time and intake frequency between IBS patients and non-IBS participants.The correlation between psychological factors and diet was evaluated by Spearman correlation analysis.Logistic regression analysis was used to assess the possible dietary risk factors for IBS.RESULTS In total,203 valid questionnaires were collected(response rate 92.3%).Twentyfive participants met the Rome IV criteria for IBS,including 15(60.0%)women and 10(40.0%)men.Compared with the non-IBS group,the quantity per time and intake frequency of soybean and its products,spicy food,and dry-fried nuts were statistically significant in IBS participants(P<0.05).They were positively associated with IBS-SSS and HADS anxiety and depression scores(P<0.05).Besides,seafood,soft drinks,vegetables,and fruits differed only in quantity per time.The intake frequencies of egg,barbecue,and coarse grain were statistically significant in IBS patients(P<0.05).We also found that the frequency of soybean and its products(≥7 times/week,odds ratio=11.613,95%confidence interval:2.145-62.855,P=0.004)was an independent risk factor for IBS.CONCLUSION Both quantity per time and intake frequency,especially soybean,differ between IBS patients and non-IBS participants.Dietary habits might play potential roles in the pathophysiology of IBS.

Predictive value of alarm symptoms in Rome IV irritable bowel syndrome:A multicenter cross-sectional study

BACKGROUND Irritable bowel syndrome(IBS)is a common functional bowel disease that shares features with many organic diseases and cannot be accurately diagnosed by symptom-based criteria.Alarm symptoms have long been applied in the clinical diagnosis of IBS.However,no study has explored the predictive value of alarm symptoms in suspected IBS patients based on the latest Rome IV criteria.AIM To investigate the predictive value of alarm symptoms in suspected IBS patients based on the Rome IV criteria.METHODS In this multicenter cross-sectional study,we collected data from 730 suspected IBS patients evaluated at 3 tertiary care centers from August 2018 to August 2019.Patients with IBS-like symptoms who completed colonoscopy during the study period were initially identified by investigators through medical records.Eligible patients completed questionnaires,underwent laboratory tests,and were assigned to the IBS or organic disease group according to colonoscopy findings and pathology results(if a biopsy was taken).Independent risk factors for organic disease were explored by logistic regression analysis,and the positive predictive value(PPV)and missed diagnosis rate were calculated.RESULTS The incidence of alarm symptoms in suspected IBS patients was 75.34%.Anemia[odds ratio(OR)=2.825,95%confidence interval(CI):1.273-6.267,P=0.011],fecal occult blood[OR=1.940(95%CI:1.041-3.613),P=0.037],unintended weight loss(P=0.009),female sex[OR=0.560(95%CI:0.330-0.949),P=0.031]and marital status(P=0.030)were independently correlated with organic disease.The prevalence of organic disease was 10.41%in suspected IBS patients.The PPV of alarm symptoms for organic disease was highest for anemia(22.92%),fecal occult blood(19.35%)and unintended weight loss(16.48%),and it was 100%when these three factors were combined.The PPV and missed diagnosis rate for diagnosing IBS were 91.67%and 74.77%when all alarm symptoms were combined with Rome IV and 92.09%and 34.10%when only fecal occult blood,unintended weight loss and anemia were combined with Rome IV,respectively.CONCLUSION Anemia,fecal occult blood and unintended weight loss have high predictive value for organic disease in suspected IBS patients and can help identify patients requiring further examination but are not recommended as exclusion criteria for IBS.

Ehealth:Low FODMAP diet vs Lactobacillus rhamnosus GG in irritable bowel syndrome

AIM: To investigate the effects of a low fermentable, oligosaccharides, disaccharides, monosaccharides and polyols diet (LFD) and the probiotic Lactobacillus rhamnosus GG (LGG) in irritable bowel syndrome (IBS).

Irritable bowel syndrome: Relations with functional, mental, and somatoform disorders

This review describes the conceptual and clinical relations between irritable bowel syndrome (IBS), other functional, somatoform, and mental disorders, and points to appropriate future conceptualizations. IBS is considered to be a functional somatic syndrome (FSS) with a considerable symptom overlap with other FSSs like chronic fatigue syndrome or fibromyalgia syndrome. IBS patients show an increased prevalence of psychiatric symptoms and disorders, especially depression and anxiety. IBS is largely congruent with the concepts of somatoform and somatic symptom disorders. Roughly 50% of IBS patients complain of gastrointestinal symptoms only and have no psychiatric comorbidity. IBS concepts, treatment approaches, as well as health care structures should acknowledge its variability and multidimensionality by: (1) awareness of additional extraintestinal and psychobehavioral symptoms in patients with IBS; (2) general and collaborative care rather than specialist and separated care; and (3) implementation of &#x0201c;interface disorders&#x0201d; to abandon the dualistic classification of purely organic or purely mental disorders.

Endocrine cells in the oxyntic mucosa of the stomach in patients with irritable bowel syndrome

AIM: To study the different endocrine cell types in the oxyntic mucosa of patients with irritable bowel syndrome(IBS).METHODS: Seventy-six patients with IBS were included in the study(62 females and 14 males; mean age 32 years, range 18-55 years), of which 40 also fulfilled the Rome Ⅲ criteria for functional dyspepsia(FDP). Of the entire IBS cohort, 26 had diarrhea as the predominant symptom(IBS-D), 21 had a mixture of diarrhea and constipation(IBS-M), and 29 had constipation as the predominant symptom(IBS-C). Fortythree age and sex-matched healthy volunteers withoutany gastrointestinal complaints served as controls. The patients were asked to complete the Birmingham IBS symptom questionnaire. Both the patients and controls underwent a standard gastroscopy, during which three biopsy samples were taken from the corpus. Sections from these biopsy samples were immunostained using the avidin-biotin complex(ABC) method, for ghrelin, serotonin, somatostatin and histamine. The densities of these cell types and immunoreactivity intensities were quantified using computerized image analysis with Olympus cellSens imaging software(version 1.7).RESULTS: The densities of the ghrelin cells in the control, IBS-total, IBS-D, IBS-M and IBS-C groups were 389(320, 771), 359(130, 966), 966(529, 1154), 358(120, 966) and 126(0, 262) cells/mm2, respectively. There was a significant difference between the tested groups(P < 0.0001). Dunn's multiple comparison test showed that the ghrelin cell density was significantly higher in IBS-D and lower in IBS-C than in the controls(P = 0.03 and 0.0008, respectively). The ghrelin cell density in patients with both IBS and FDP was 489(130, 966), and in those with IBS only 490(130, 956). There was no statistical significant difference between these 2 groups of patients(P = 0.9). The immunoreactivity intensity did not differ between any of the groups(P = 0.6). The diarrhea score of the Birmingham IBS symptom questionnaire was significantly positively correlated with ghrelin cell density(r = 0.65; P < 0.0001) and significantly inversely correlated with that of constipation(r = 90.69; P < 0.0001). The densities of the serotonin cells were 63(51, 82), 51(25, 115), 120(69, 128), 74(46, 123) and 40(0, 46) cells/mm2 in the control, IBS-total, IBS-D, IBS-M and IBS-C groups, respectively. A statistically significant difference was found between the tested groups(P < 0.0001). Posttest revealed that serotonin cell density was significantly higher in IBS-D and lower in IBS-C than in controls(P = 0.02 and 0.004, respectively), but did not differ in the IBS-total and IBS-M groups from that in controls(P = 0.5 and 0.4, respectively). The serotonin cell densityin patients with both IBS and FDP was 62(25, 115)and in those with IBS only 65(25, 123). There was no statistically significant difference between these2 groups of patients(P = 1). The immunoreactivity intensity of serotonin did not differ significantly between any of the groups(P = 0.0.9). The serotonin cell density was significantly positively correlated with the diarrhea score of the Birmingham IBS symptom questionnaire(r = 0.56; P < 0.0001) and significantly inversely correlated with that of constipation(r = 0.51;P < 0.0001). The densities of the somatostatin cells were 97(72, 126), 72(0, 206), 29(0, 80), 46(0, 103)and 206(194, 314) cells/mm2 in the control, IBS-total,IBS-D, IBS-M and IBS-C groups, respectively(Figures7 and 8). There was a statistically significant difference between the controls and the IBS subgroups(P <0.0001). The density of somatostatin cells was significantly lower in the IBS-D and IBS-M groups but higher in IBS-C patients than in the controls(P < 0.01, P =0.02, and P = 0.0008, respectively). The somatostatin cell density in patients with both IBS and FDP was 86(0-194), and in those with IBS only 110(0-206). There was no statistically significant difference between these 2 groups of patients(P = 0.6). There was no significant difference in somatostatin immunoreactivity intensity between the controls. The diarrhea score of the Birmingham IBS symptom questionnaire was inversely correlated with somatostatin cell density(r =0.38; P = 0.0007) and was positively correlated with that of constipation(r = 0.64; P < 0.0001).CONCLUSION: The finding of abnormal endocrine cells in the oxyntic mucosa shows that the endocrine cell disturbances in IBS are not restricted to the intestine. Furthermore, it appears that ghrelin, serotonin and somatostatin in the oxyntic mucosa of the stomach may play an important role in the changing stool habits in IBS through their effects on intestinal motility.

Efficacy and safety profile of LCR35 complete freeze-dried culture in irritable bowel syndrome:A randomized,double-blind study

AIM:To assess the effects and safety of Lactobacillus casei rhamnosus LCR35 complete freeze-dried culture(LCR35) in patients suffering from irritable bowel syndrome(IBS).METHODS:A randomized,double-blind pilot study was performed in 50 patients complaining of IBS symptoms complying with RomeⅢcriteria.Patients were allocated to receive either LCR35(n = 25) at a minimum daily dose of 6 × 108 colony forming units or placebo(n = 25) for 4 wk.At inclusion,after treatment and 2 wk later,patients completed the IBS severity scale.Change from baseline in the IBS severity score at the end of treatment was the primary efficacy criterion.Changes were compared between groups in the whole population and in IBS subtypes(IBS with predominance of constipation,IBS with predominance of diarrhoea,mixed IBS,unsubtyped IBS).The presence of lactobacillus casei rhamnosus in stools was investigated at inclusion and at the end of treatment.The gastrointestinal quality of life questionnaire and the hospital anxiety and depression(HAD) scale were also completed.RESULTS:Both groups were balanced for baseline characteristics.In 85% of patients,stool analyses showed that lactobacillus casei rhamnosus able to survive in the digestive tract.In the whole population,improvements in the IBS severity score did not differ significantly between treatments with a 25% decrease after 4-wk treatment,and a 15% decrease from baseline 2 wk later in both groups.In IBS subgroups,statistical analysis could not be performed due to small sample size,but a clinical response in favour of LCR35 was observed in IBS patients with predominance of diarrhoea:no change in the symptom severity score was seen with the placebo after 4 wk treatment,whereas a clinically relevant decrease occurred with LCR35(-37% vs-3%).Furthermore,in spite of an increase in symptom intensity,the IBS severity score was maintained below the baseline value 2 wk later with LCR35(-19% from baseline),whilst a slight 5% increase from baseline was observed with placebo.In the IBS subgroup with predominance of diarrhoea only,a clinically relevant decrease in abdominal pain severity score(-36%)was observed with LCR35,whereas no change occurred with placebo.In mixed IBS patients,the 20% and 30% decreases in the IBS severity score observed after treatment with LCR35 and placebo,respectively,were maintained 2 wk later in both groups.A clinical response slightly in favour of placebo was observed at the end of the treatment period in IBS patients with predominance of constipation(-41% vs-20%) and unsubtyped IBS patients(-47% vs-17%),with the same value maintained 2 wk later.In both groups,no clinically relevant changes were observed either for the gastrointestinal quality of life index or HAD score.Thus,these results suggest that sub-grouping of IBS patients may be important for optimizing treatment responses by the physician.CONCLUSION:This pilot study suggests that LCR35 could have some efficacy in IBS patients complaining of diarrhoea.These preliminary results need to be conf irmed in larger studies.

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.

Treatment of Irritable Bowel Syndrome with a Combination of Curcumin, Green Tea and Selenomethionine Has a Positive Effect on Satisfaction with Bowel Habits

Background: Irritable bowel syndrome (IBS) is a common disorder impairing patient’s quality of life. Currently, there is no effective treatment for this syndrome. Coltect is a dietary supplement containing curcumin, green tea and selenomethionine. Aim: To investigate the effects of Coltect on IBS symptoms. Methods: A randomized, prospective, placebo-controlled, double blinded, crossover study. The study population included patients diagnosed with IBS by Rome criteria. Subjects were randomized to receive either Coltect or placebo for 4 weeks, and then received the opposite treatment for 4 weeks following a washout period of 2 weeks. The placebo was a pill, identical in color and size to the Coltect pill, with no active ingredients. Patients completed IBS health-related quality of life, severity score and IBS symptom questionnaires before and after each treatment period. Results: The study included 22 patients, ages 22 – 77 years. Coltect had a positive effect on patients’ satisfaction with their bowel habits (as measured on a scale from 0—Very satisfied to 100—Very unsatisfied). Average score was 70.4 ± 33.1 before and 61.8 ± 29.3 after Coltect treatment (p = 0.037). Other parameters, including abdominal pain, bloating, and effects of IBS on daily activity, symptoms, IBS-related quality of life and general health quality of life were unchanged. Conclusion: Coltect seems to have a positive effect on satisfaction with bowel habits.

A Simultaneous Multidisciplinary Evaluation of Irritable Bowel Syndrome in Egyptian Patients: Dietary, Psychiatric, Microbiologic and Autonomic Aspects

Background and Aim: Irritable bowel syndrome (IBS) is a common medical disorder that may be severe enough to impair the quality of life. This study aimed to assess the role of each of dietary, psychiatric, autonomic, and microbiology background and their interactions in Egyptian patients with IBS. Patients and Methods: Forty adult patients diagnosed with IBS, equally divided into 2 groups the diarrhea predominant and the constipation predominant, were recruited from the Endoscopy Unit. Dietary assessment was done by monthly food frequency questionnaire. Psychiatric assessment was done by both the Eysenck Personality Questionnaire (EPQ) and Hopkins Symptom Checklist (HSCL-90). Microbiologic evaluation was done by faecal cultures and neurophysiologic autonomic evaluation was done via the sympathetic skin response and the parasympathetic R-R interval variation. Another 20 healthy subjects were included as control group. Results: All IBS patients were young, with significant female predominance (P = 0.007), particularly in IBS-C group (20/20;100%, P = 0.003). Psychologically, abnormal scores of neuroticism, extraversion and criminality, and depression, obsessive compulsion, somatization, sensitivity and anxiety in both IBS groups with particularly extraversion, criminality and depression were significantly higher in constipation subtype. Microbiologically, Bacteroids were significantly related to IBS, while Klebsiella was significantly deficient without significant difference between its groups. On the contrary, neither diet nor autonomic activity showed any significant relation. Conclusions: IBS is a disorder induced by many factors and affected by several interacting agents, thus revealing controversial results when studied simultaneously.

Effectiveness of an amino acid beverage formulation in diarrheapredominant irritable bowel syndrome:A pragmatic real-world study

BACKGROUND Amino-acid based medical foods have shown promise in alleviating symptoms of drug induced gastrointestinal side effects;particularly,diarrhea-predominant symptoms.Irritable bowel syndrome(IBS)is a gastrointestinal disorder that affects up to 9% of people globally,with diarrhea predominant IBS(IBS-D)being the most prevalent subtype.Further trials are needed to explore potential added benefits when integrated into standard care for IBS-D.AIM To assess the effectiveness of an amino acid-based medical food as an adjunct to standard of care for adults with IBS-D.METHODS This is a pragmatic,real world,open label,single arm study comparing a 2-week baseline assessment to a 2-week intervention period.One hundred adults,aged 18 to 65 years,with IBS-D,according to Rome IV criteria,were enrolled after completing a 2-week baseline assessment period and received a 2-week supply of an amino acid based medical food which was consumed at home twice daily on top of their standard of care.The primary outcome was an assessment of tolerability after 2-weeks of consumption,while secondary outcomes included changes in stool consistency(Bristol Stool Form Scale),severity of abdominal pain&discomfort,symptoms of urgency,Global Improvement Survey(GIS),and the IBS severity scoring system(IBS-SSS).RESULTS The test product was well-tolerated as each participant successfully completed the full 14-day trial,and there were no instances of dropouts or discontinuation of the study product reported.Forty percent of participants achieved a 50% or more reduction in the number of days with type 6-7 bowel movements(IBS-D stool consistency responders).Fifty-three percent of participants achieved a clinically meaningful reduction of 30% in mean weekly pain scores,and 55%experienced the same for mean weekly discomfort scores(IBS-D pain and discomfort responders).Participants experienced a mean-109.4(95% confidence interval:-130.1,-88.8)point reduction on the IBS-SSS and 52% experienced a minimally clinically important difference of>95 points.An IBS-SSS category shift from severe to moderate or mild occurred in 69% of participants.For functional symptoms,76% of participants reported symptom relief on the GIS.CONCLUSION The amino acid-based medical food was well-tolerated,when added to the standard of care,and demonstrated improvements in both overall IBS symptom severity and IBS-D symptoms within just 2 wk.

Low-FODMAP vs regular rye bread in irritable bowel syndrome:Randomized SmartPill~ study

AIM To compare the effects of regular vs low-FODMAP rye bread on irritable bowel syndrome(IBS) symptoms and to study gastrointestinal conditions with Smart Pill?.METHODS Our aim was to evaluate if rye bread low in FODMAPs would cause reduced hydrogen excretion,lower intraluminal pressure,higher colonic p H,different transit times,and fewer IBS symptoms than regular rye bread.The study was a randomized,double-blind,controlled cross-over meal study.Female IBS patients(n = 7) ate study breads at three consecutive meals during one day.The diet was similar for both study periods except for the FODMAP content of the bread consumed during the study day.Intraluminal p H,transit time,and pressure were measured by Smart Pill,an indigestible motility capsule.RESULTS Hydrogen excretion(a marker of colonic fermentation) expressed as area under the curve(AUC)(0-630 min) was [median(range)] 6300(1785-10800) ppm?min for low-FODMAP rye bread and 10 635(4215-13080) ppm?min for regular bread(P = 0.028).Mean scores of gastrointestinal symptoms showed no statistically significant differences but suggested less flatulence after low-FODMAP bread consumption(P = 0.063).Intraluminal pressure correlated significantly with total symptom score after regular rye bread(ρ = 0.786,P = 0.036) and nearly significantly after lowFODMAP bread consumption(ρ = 0.75,P = 0.052).We found no differences in p H,pressure,or transit times between the breads.Gastric residence of Smart Pill was slower than expected.Smart Pill left the stomach in less than 5 h only during one measurement(out of 14 measurements in total) and therefore did not follow on par with the rye bread bolus.CONCLUSION Low-FODMAP rye bread reduced colonic fermentation vs regular rye bread.No difference was found in median values of intraluminal conditions of the gastrointestinal tract.